Tobacco.org

Issues in estimating smoking attributable mortality in Israel  

Results: Around 50.3% of the increase from the un-lagged SAM estimate of 3859 deaths to the final SAM estimate of 8664 deaths in 2003 is attributable to the introduction of lag times. More robust estimates of risk accounted for a further 29.6% of the increase. While 21.2% is attributable to the inclusion of additional disease categories, only 1.5% was attributable to the widening of existing diseases categories.

Conclusion: This difference in estimates is attributable to expansion of the list of diseases included, updating the estimates of RR for smoking-attributable death, and the use of smoking prevalence from previous years to more accurately reflect the effect of tobacco use on disease occurrence. There is a need to establish an 'authority' to implement a multi-faceted intervention strategy to decrease the considerable burden from smoking in Israel.

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• Research: Smoking kills 10,000 Israelis annually 

About 10,000 Israelis die each year from smoking, 8,664 actual smokers and the rest from other people's cigarette smoke, according to Dr. Gary Ginsberg and colleagues who just published an article in the European Journal of Public Health.

Around 23 percent of the population over 18 smokes, and about half of all smokers eventually die of tobacco-related diseases.

The former head of the Health Ministry's Center for Disease Control, Prof. Manfred Green, who is now head of the University of Haifa's School for Public Health, had previously set the estimate considerably lower.

The previous official estimate of deaths among active smokers was 3,859 per year; the new calculation puts the real figure at more than twice that. . . .

The US Centers for Disease Control supplies a widely used online user-friendly computational program called SAMMEC (Smoking Attributable Mortality, Morbidity and Economic Costs) to produce estimates of tobacco-related mortality.

However, the SAMMEC tool, write Ginsberg and colleagues, "loses accuracy because it lacks flexibility in deciding which diseases enter into the calculations, has estimates of relative risk attributable to smoking based on old studies and does not allow for the latency period that occurs between initial exposure and mortality."

The difference between the old estimates and the new one is attributable to expansion of the list of diseases included, updating the estimates of relative risk for smoking-attributable death and the use of smoking prevalence from previous years to more accurately reflect the effect of tobacco use on disease occurrence, the researchers write.

They add that "there is a need to establish an "authority‚ to implement a multi-faceted intervention strategy to decrease the considerable burden from smoking in Israel."

Amos Hausner, a prominent tobacco-control lawyer who heads the Israel Council for the Prevention of Smoking, commented that much publicity is given by the media to less than two dozen deaths from swine flu. But smoking has a much more devastating toll among people of all ages.

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• MK considers bill to bar smoking in vehicles with kids 

After Johns Hopkins University researchers have proven that the amount of harmful nicotine in air-conditioned cars with smokers is much higher than in pubs and restaurants that allow smoking, an MK is considering initiating a bill to bar smoking in vehicles with children as passengers.

Only a few countries and several US states have barred smoking in cars occupied by children. Photo: Tovah Lazaroff

Israel Beiteinu MK Robert Ilatov, whose colleague MK Yuri Shtern proposed such legislation three weeks before his death from brain cancer in 2007, told The Jerusalem Post on Monday after learning of the Baltimore study that such a bill would be a fitting memorial to Shtern. He asked to read the study, which was published on Tuesday in the journal Tobacco Control.

Health Ministry associate director-general Dr. Boaz Lev said he personally was very much opposed to smoking in cars containing minors, but that he had not discussed the proposal with Deputy Health Minister Ya'acov Litzman (United Torah Judaism), who decides policy.

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• Litzman dithers over graphic cigarette warnings 

Although the US has now joined 30 countries in requiring all cigarette packets to display gruesome images of the results of diseases caused by smoking, Deputy Health Minister Ya'acov Litzman (United Torah Judaism) has "not yet decided his position," an aide said.

Use of the graphic displays is being strongly urged by the World Health Organization's Framework Convention on Tobacco Control, which Israel has ratified. Putting such images on packets has been proven in scientific research to lower smoking rates significantly, with many smokers getting the message and their children, spouses and friends demanding that they kick the habit.

Images appearing around the world include a mouthful of yellowed, rotten teeth; blackened lungs; gangrenous feet; a dead fetus lying near cigarette butts; a hole in the throat, in addition to bold texts such as "WARNING: Smoking can kill you," and "Tobacco smoke can harm your children."

Countries featuring the warnings include Canada, the UK, Singapore, China, Brazil, Austria, Germany, Finland, the Czech Republic, New Zealand, Australia, Panama, Thailand, Romania, France, Hungary, Jordan and Iran.

"His schedule is packed," Litzman's personal aide Ya'acov Izak told The Jerusalem Post

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• Health Ministry Bans Electronic Cigarettes  

The Health Ministry has banned electronic cigarettes, both the import and use of those previously brought into the country. The product is marketed as an aid to help smokers stop smoking.

The move comes in the wake of a health warning by the U.S. Food and Drug Administration (FDA) about the product. The FDA did not ban their sale or use, however.

The Israeli Health Ministry decision, which came out Tuesday, covers both the import and sale of the product, including those that are marketed as nicotine-free.

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FDA finds carcinogens in e-cigarettes 

E-cigarettes do not contain any health warnings in Israel or anywhere abroad comparable to those on FDA-approved nicotine replacement products or conventional cigarettes. They are also available in different flavors, such as chocolate and mint, which may appeal to young people.

Asked to comment on the FDA statement, the Health Ministry in Jerusalem said it and the Justice Ministry are examining the evidence, but that there is no law prohibiting the sale of e-cigarettes or their use in public places.

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Heath Scan: Quitting cigarettes doesn't always cause weight gain 

Not all people who quit smoking gain a lot of weight. according to Dr. Rahel Dahan, a family medicine expert of Clalit Health Services and the Technion-Israel Institute of Technology's Rappaport Medical Faculty in Haifa.

Writing in the Journal of Israeli Family Practice, Dahan said the average weight gain for those who kick the habit is only four or five kilos if they don't adopt a more nutritious diet or exercise. Many quitters don't gain any weight at all. In any case, she continues, the danger of gaining a few kilos is "minuscule" compared to the risks of continuing to smoke. Not only will the danger of lung cancer and heart disease decline, but the person will also breathe better, have fewer wrinkles, and minimize the risk of yellow teeth and bad breath.

Dahan, who is experienced at helping patients stop smoking, and is also an authorized hypnotist, advises those who have given up tobacco to take a bottle of cold water (preferably with a little lemon juice) and sugarless gum with them to keep themselves under control when they watch TV, drive or do other things that used to be accompanied by a cigarette.

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Litzman mulls tougher methods to cut smoking rate  

As the smoking rate in Israel remains steady, Deputy Health Minister Ya'acov Litzman is considering new measures to significantly bring it down, he said Sunday, at his first World No-Smoking Day press conference.

His proposals include charging tobacco companies so that an independent body can disseminate anti-smoking advertisements and education; restricting or eliminating cigarette vending machines, increasing the cigarette tax by an additional NIS 2 per packet; prohibiting tobacco companies from sponsoring youth and sports events, and demanding regular reports from municipalities on how they are enforcing no-smoking laws.

Litzman - a confirmed tobacco opponent, unlike his predecessor, Yitzhak Ben-Yizri, who has smoked for more than 65 years - was not involved in the preparation of the eighth annual report, but as the person in control of the ministry, he was required by law to present it to the Knesset.

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• Smoke-free advocate: Minister can restrict tobacco products  

Israeli anti-tobacco activists are divided over whether the government should initiate a law to regulate the manufacture and marketing of tobacco products. Such a law is about to be signed by US President Barack Obama - 45 years after the US Surgeon General officially declared that smoking was dangerous to health. . . .

Amos Hausner, Israel's leading smoke-free advocate, told The Jerusalem Post on Sunday that the US legislation was "very controversial" and that he had "mixed feelings about it."

"The danger to health is inherent to tobacco products. But if there is regulation by the authorities, smokers could think they're not so bad," he explained.

He added, though, that if Israel wanted to implement a similar policy, " we don't need the US law, because since 1993, Israel has had pharmaceutical regulations that give the health minister the power to issue regulations regarding consumer products that endanger health - and cigarettes are included. The health minister can demand changes by the manufacturer and even prohibit sale." . . .

The ministry executive briefly discussed the US law during its weekly Sunday morning meeting. It has not yet released its official policy. But the ministry fears that the Treasury would not give it funding for a unit to supervise and regulate tobacco products, even if a law to this effect were passed.

Dr. Lea Rosen, a former Health Ministry public health official who now does research on tobacco cessation at Tel Aviv University's School of Public Health, told the Post that in general, she would favor such a law here.

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• Saving tomorrow's patients 

What is the most effective way to discourage smoking? Chantix tablets? A support group? Nicotine patches? Or, how about sharply raising the price of cigarettes by jacking up the tax?

A new study compared the efficacy of the various methods in Israel for the first time, looking at medical efficacy and cost efficiency. The results are presented here in a ranked list. . . .

The team compiled two lists: One lists methods that save the state money. The other lists methods that may not achieve that end, but the methods in both lists have proved effective in helping people stop smoking.

The first contains methods that were found to be cost-effective, meaning they involve costs, but ultimately save the health system money.

These include raising the tax on cigarettes (which just happened, adding NIS 2 per pack of cigarettes), taking large doses of Champix tablets (2 milligrams a day), or drug therapy combined with a telephone hotline for quitters in crisis.

The second list includes methods that don't save the health establishment money. But they were found to be more cost-effective for the smoker: Each shekel invested in these methods had a considerable contribution to the health of both the actual smoker and his associates, who may suffer the effects of passive smoking. This list also contains Pfizer's Champix tablets, but at a lesser dosage of 1 milligram a day, as well as the drug Zyban. Nicotine patches also make this list, as did counseling.

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Tobacco firms outspent Health Ministry 25 to 1  

A Health Ministry report reveals a fact that cigarette companies would prefer to keep quiet: Tobacco companies spent NIS 37.5 million on advertising in 2007.

That's more than 25 times the anti-smoking advertising budget of the Israel Cancer Association and Health Ministry combined, the figures show.

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Israel Celebrates "A Day Without Smoking"  

The Israeli Ministry of Education and the Israeli Cancer Association have created a special project to help prevent teenage smoking.

Students popular in their school, and willing to take part in the project, were trained to speak to their friends about the dangers of smoking and about addiction in general.

[Adi Karas, Participant of the Project]: "They were really surprised by what we told them because they didn't really know what the cigarette contains or how dangerous it is to use drugs. And after we talked to them and told them stories about people who used drugs and what happened to them or what may actually happen to them, so they were amazed and some of them even thanked me."

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• Class action suit filed over menthol cigarettes 

What is being described as the world's first class action lawsuit on behalf of people who developed lung cancer from smoking menthol cigarettes has been initiated by Israel's leading anti-tobacco attorney, Amos Hausner, The Jerusalem Post has learned.

He is representing the family of a Rehovot mother of four who died of a tumor at age 47 after many years of smoking Dubek's Montana brand of cigarettes. He is also acting on behalf of an estimated 3,000 other menthol-cigarette smokers who developed cancer here during the past seven years. The statute of limitations on a manufacturer's responsibility for damage caused by its products runs out after seven years.

The Jerusalem lawyer is asking the Central District Court to recognize the case as a class action suit against Dubek - Israel's largest tobacco manufacturer - for NIS 3 billion. It will probably be several months before the court gives its response.

Research conducted by tobacco companies a decade or more ago to identify additives that increase tobacco addiction showed that menthol did the trick, and the companies made a special effort to market cigarettes with this additive.

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Health Ministry Mulls Cigarette Tax, Obama Cited as Role Model  

Deputy Health Minister Yaakov Litzman (United Torah Judaism) proposed a shekel-a-pack tax on cigarettes on Thursday, saying that it could add NIS 300 million in revenue to the state annually. Litzman proposed that the money be used for increased awareness of the dangers of smoking -- including workshops for kicking the habit -- and medical help for the lower 20 percent of the population.

The Israel Cancer Association (ICA) welcomed the proposal, noting that 10,000 Israelis die each year from cigarette-related diseases. The society also noted that the proposal is in line with tobacco-control efforts of the World Health Organization. . . .

The ICA stressed the importance of heavily taxing smokers as an incentive for them to quit, noting that the U.S. has significantly raised the federal purchase tax on cigarettes, “at an amount in addition to [helping the] American economy, will finance medical insurance for children.” It noted that U.S. President Barack Obama addressed his own smoking habits in the first days of his presidency.

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• Bedouin Smugglers Armed Hamas 

A Bedouin man who works with his family as a cigarette smuggler has been charged with helping Hamas bring weapons to Gaza. Hassan Ali Suarcha was charged on Monday in the Be'er Sheva District Court with weapons smuggling and providing material aide to a terrorist organization.

Police say the Suarcha family, a Bedouin clan based primarily in the Sinai Peninsula, is involved in smuggling cigarettes and tobacco from Egypt to Israel. Cigarette smuggling is a lucrative trade – smugglers can earn twice the average monthly salary in just one day, and the trade as a whole brings in tens of millions of shekels each year.

Hassan Suarcha was one of several smugglers who began using his route to bring dozens of Kalashnikov rifles to Hamas, police say. The rifles were hidden in sacks of tobacco.

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