Dr. Yael Bar-Zeev is on a mission: to eliminate tobacco and smoking from Israel. As a public health physician, behavioral scientist, epidemiologist, and tobacco treatment specialist, Yael is well-equipped to tackle smoking.
She is a faculty member at the Braun School of Public Health and Community Medicine, helped found and currently chairs the Israeli Medical Association for Smoking Cessation and Prevention, and is a regular participant in Knesset meetings, Ministry of Health Committees, and the media.
Smoking in the Age of a Global Pandemic
As the Coronavirus introduced new buzzwords such as ‘social distancing’ and ‘flattening the curve,’ Dr. Bar-Zeev’s mind was somewhere else entirely: how would the pandemic, and the looming shutdown, affect Israelis’ smoking habits?
She identified two contradictory forces: On one hand, stress levels were skyrocketing, possibly leading to increased smoking rates. On the other hand, widespread unemployment and financial woes, coupled with a heightened awareness of pulmonary vulnerability, might lead to a reduction in smoking. An additional concern was exposure to secondhand smoke, which might become more prevalent during a shutdown or quarantine.
"Smoking kills 8,000 Israelis each year and is damaging our ability to deal with the Coronavirus pandemic. The Ministry of Health and health-care providers must not neglect the fight against smoking, which continues to be the leading risk factor for mortality and morbidity in Israel."
An Exploratory Survey
Dr. Bar-Zeev and Prof. Yehuda Neumark designed a survey targeting smokers and ex-smokers. It was disseminated through social media, reaching 660 participants, and revealed interesting data:
First, 45% of respondents reported an increase in their motivation to quit. Yet only 7% of respondents actually stopped smoking and another 16% were unsuccessful in their attempts. Taken together, these 24% are an improvement; during ordinary times, this number hovers around 20%. Of those who attempted to quit, nearly 16% used some form of behavioral and/or medical support.
On the flip side, 44% of respondents reported upping their intake by an average of 3 cigarettes per day. While they may have been motivated to quit, they felt incapable of doing so.
In terms of secondhand smoke, over 80% of respondents noted no change in their home smoking rules. This may be good news, as nearly 88% already restricted smoking in their homes, including nearly 70% who limited smoking to the balcony or outdoors. At the same time, 6.6% (equaling roughly 80,000 smokers) reported that their home smoking rules worsened during the shutdown, exposing their loved ones to more secondhand smoke.
A Missed Opportunity?
Dr. Bar-Zeev’s data, along with similar surveys conducted worldwide, indicate that the pandemic might be an ideal time to reach out to smokers and actively offer guidance and support for quitting or reducing one’s cigarette intake.
"The pandemic has presented a golden opportunity to leverage smokers’ heightened motivation to quit and provide them with free, effective support, all while taking specific, immediate steps that could aid also in the management of the Coronavirus pandemic."
Yet despite the immense potential, reality was sobering. During the period of severe restrictions in Israel, group counseling workshops already in progress transitioned to one-on-one telephone consultations, and all scheduled cessation workshops were cancelled. The two health-care providers that routinely provide quit-line phone services require that patients must first obtain a referral from their primary care physician – posing an additional logistical hurdle. Only now, over six months into the Coronavirus pandemic, these providers have begun offering scant online group workshops.
In January, the Israeli Ministry of Health opened a national quit-line – with little fanfare and even less advertising. As a result, when the pandemic struck, very few Israelis, including medical practitioners, were aware of the quit-line’s existence.
In addition, it took the Ministry of Health until June to create two Coronavirus-themed anti-smoking ads, which are published on alternate months. These ads were the first to feature the national quit-line number.
Don't Double Your Risk
The two Ministry of Health Coronavirus-themed anti-smoking advertisements. The first ad (right) came out in June 2020.
Translating Findings to Policy Recommendations
Dr. Ben-Zeev has plenty of ideas how to leverage the Coronavirus crisis to help combat smoking. These range from requiring the health-care providers to actively reach out to smokers to training cessation counselors to help smokers reduce or maintain their intake, to prevent increases. In addition, she was a signatory on a policy paper issued by a variety of medical, health, and anti-smoking organizations, submitted to the Ministry of Health this May.
Among their recommendations:
Gather accurate smoking data and history of all Coronavirus patients.
Run public awareness campaigns on ways to quit and reducing exposure to secondhand smoke, including adding a specific insert and the national quit-line number on all tobacco products packaging.
Create a national, proactive plan to support people who wish to quit, including staffing the phone lines, planning workshops in accordance to the Ministry’s Coronavirus guidelines, and foster interorganizational cooperation.
Limit smoking in public and include anti-smoking policies within the Ministry’s guidelines; specifically, banning outdoor smoking in public places such as restaurants and coffee-shops, so people do not have to choose between reducing their exposure to the Coronavirus and exposure to secondhand smoke.
Continue expanding the ban on advertising tobacco products to include the print media.
Continue implementing the WHO Framework Convention on Tobacco Control, which Israel has ratified.