Passive smoking: Israel’s ticking time bomb

Removing the risks of passive smoking from dance bars and clubs would be a significant milestone.

Once again my girlfriend returned depressed after an attempt to enjoy one of Tel Aviv’s excellent music venues with friends. This time she was out only 30 minutes. I leaned to kiss her hello but hesitated. Her beautiful, dark hair and warm skin smelled of tobacco smoke.
Tears in her eyes, she said she had had enough. She had even called the police but was told her complaint would be passed on to another agency which would deal with it “in due course.” She railed at me about the anti-public-smoking laws that had been passed in March 2001 and were deemed to be “among the toughest in the world,” according to a report in the British Medical Journal. The laws have been stiffened over the years, but to little effect other than a reported reduction in smoking in restaurants.
My girlfriend does not smoke and never has, which makes her all the more attractive to me, not least because, unlike her smoking friends, I know her skin will not deteriorate in the years to come. She told me sardonically that the venue she had visited had no-smoking signs right in front of those lighting up. It simply seems impossible to have an evening out or attend any form of dance without having other people’s smoke inflicted upon you.
It is, sadly, very clear nowadays that Israelis blatantly ignore, deny and trample on the anti-smoking legislation, and the authorities simply ignore it – to the future cost of their citizens’ health. The issues were reviewed in The Jerusalem Post (March 2) in an interview with Prof. Gregory Connolly of the Harvard School of Public Health. In it a study by public health expert Dr. Leah Rosen of Tel Aviv University was cited. Rosen’s study showed that owners of Tel Aviv pubs consistently fail to enforce laws, and inform one another that municipal inspectors are on the prowl for violators I remember similar attitudes being prevalent in Britain until, in the 1990s, the government realized the real costs of treating smokers and non-smoking adults and children.
In the 1990s, the estimated cost to American society of smoking was $52 billion in health expenses or time lost from work – about $221 per person each year, according to federal officials. The current cost of passive smoking in the UK to children’s health alone was estimated at £23.3 million per year.
The British government in 2002 estimated that the net benefits (after calculating loss of revenue and other costs as well as benefits) of just making all workplaces smoke free would be between £2.3 and £2.7 billion per year. This is equivalent to treating 1.3-1.5 million hospital waiting list patients. In Scotland, the net benefit of making all public places smoke free was calculated at around £124 million per year.
Other, similar, figures worldwide convinced politicians that preventing passive smoking would be of significant benefit to society.
Health promotion then kicked in successfully, reinforced by bans on tobacco advertising, an increase in tax on cigarettes, presentation of the nonsmoking message on popular television, and various social marketing strategies. In addition, free stop-smoking clinics were provided along with subsidized nicotine treatments such as anti-craving drugs, nicotine patches, gum and inhalers. Not only the health of smokers was considered, but also the risks of passive smoking.
A miracle ensued. Britain, Ireland and many European countries now have dance bars, raves and rock concerts which anyone can enjoy and come away with cleansmelling clothes and clear lungs. The streets no longer have cigarette butts strewn across them, and the air generally smells and feels cleaner. Britons actually seem to be taking pride in their environment.
The tobacco companies hated it but bowed to the inevitable and took their poison trade to developing places like Asia, Africa and the Far East.
A KEY part of the change was the willingness by politicians to take health-related research seriously and use strategies such as social marketing to really tackle the issue. This occurred once politicians began to realize the huge negative impact of smoking on public health and the economy.
A highly influential report based on leading international research was produced by Britain’s Royal College of Physicians in 2005. Entitled “Going Smoke Free,” it presents the medical case for smoke-free areas at home, work and in public places. Its main conclusion is that for the safety of all, it is better to legislate for completely smoke-free public places and work places and to advise people to make their homes smoke free.
The risks of passive smoking that it highlights include all the risks faced by smokers, plus things like sudden infant death syndrome and increased risk of asthma. The risk of bronchitis and pneumonia in infants during the first two to three years is 57 percent greater for children whose parents smoke. Ear disease is another issue, as is meningitis, and second-hand smoke may damage a child’s ability to smell.
Other data indicate there is also the chance that passive smoking may have a negative effect on a child’s ability to read or use reasoning skills. A key message is “do not smoke around children.”
Skin problems such as premature aging and wrinkling, have been shown to develop much more quickly in smokers, and those who are regularly around smokers are also at risk. Other research found that passive smoking kills 12,000 people in the UK each year.
IN ISRAEL, there have been a number of studies about smoking and passive smoking.
According to a May study by the Health Ministry, 22.8 percent of the adult population smokes. The study found 31.3% of men smoke, while for women the figure is 14.8%. A study of eighth-grade students found that 5% smoke occasionally. Jewish children whose parents smoke were 2.8 times more likely to smoke themselves. Arab children whose parents smoke were 5.8 times more likely to do so. According to a 2009 report in the European Journal of Public Health, 8,664 deaths in Israel were attributable to smoking in 2003. The number attributed to passive smoking is unclear.
Smoking is also associated with low IQ, according to a study of 20,000 IDF soldiers by Dr. Mark Weiser from the Sheba Medical Center in Tel Hashomer. Published in the journal Addiction in March, Weiser’s research found a direct correlation between the number of cigarettes used and low IQ.
And what exactly is in tobacco smoke? According to data available freely on the Internet, tobacco smoke contains more than 4,000 chemical compounds, including at least 40 cancer-causing agents.
Tobacco smoke also contains carbon monoxide, a poisonous gas which inhibits the transportation of oxygen to the body’s vital organs via the blood. The smoke emitted from the tip of a cigarette has about double the concentration of nicotine and tar as smoke directly inhaled. It also contains about three times the amount of the carcinogen benzo(a)pyrene, five times the level of carbon monoxide and about 50 times the ammonia. Add to these the other chemicals like arsenic, formaldehyde, vinyl chloride, and hydrogen cyanide, and it becomes a pretty toxic gas cocktail.
THE GREATEST challenge to tackling smoking is in attitudes.
Smokers often have a “live now, pay later” approach. I have heard a smoker say things like: “So what? I could be run over by a bus tomorrow, so I might as well enjoy my cigarette today.”
This lasts until they or a relative’s health becomes severely impaired. I remember being put off smoking for life when my grandmother, then 61, had to have the iliac arteries in her legs replaced due to secondary damage from smoking.
She was never able to walk without discomfort again.
The other common argument presented by smokers is “it’s my right to smoke if I want.”
They conveniently forget the effect of their smoke on others and the reality of smoking being a purely selfish act.
The calculation of the personal cost of smoking and the benefits of stopping helped many give up.
A key approach to tackling smoking and passive smoking in Israel will be social marketing. This involves systematically applying the principles of marketing alongside other concepts and techniques to achieve changes in behavior.
Commercial marketing is different in that its aims are primarily financial, measured in terms of profits or shareholder value. Social marketing aims specifically to achieve improvement in the lives of people. It works by focusing on specific groups in context and delivering messages to help create lasting change.
This would have to be backed up with support to quit, and easy access to nicotine replacement methods.
For my girlfriend, even removing the risks of passive smoking from dance bars and clubs in Tel Aviv would be a significant milestone. For her, her sisters and friends, music is their interest and priority, but smoking is not something they can simply ignore. “If people want to smoke, then tell them not to exhale,” she says. This option is not so far from being achievable, with new technology like nicotine gums, patches and inhalators. A smoke-free Israel is not impossible.
The writer is a therapist and former UK National Health Service manager. He has an MSc in clinical and public health aspects of addiction and a special interest in social marketing in health. He spends much of his time in Tel Aviv when he is not working in London.