Although about a fifth of Israeli adults smoke cigarettes, 33% of the country’s children are exposed to environmental tobacco smoke, according to the Health Ministry’s National Biological Monitoring Program. 

The degree of exposure of Israeli children to passive smoking from July 2020 to June 2021 was determined by the urine levels of cotinine – a breakdown product of nicotine – as well as creatinine (a measure that indicates urine dilution in the urine) of a representative sample of 166 Israeli children aged four to 11 years from different localities (urban and rural) and different sectors (Jewish and Arab). 

Dr. Tamar Berman and Dr. Zohar Barnett-Yitzhaki from the ministry’s department of health and environment together with Dr. Efrat Rorman and Dr. Loda Groisman from the ministry’s National Public Health Laboratory. 

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Home smoking policy affects children’s exposure to smoking. In homes where smoking is not allowed indoors, the concentration of cotinine in the children’s urine was lower. An informed-consent form was signed by the parents, who also answered a questionnaire about their children’s exposure to smoking, parents’ smoking, smoking policy at home and questions about health status, lifestyle and demographics. 

In 33% of the children, cotinine concentrations above the quantification threshold of 0.5 micrograms per gram were measured. The children were exposed to environmental tobacco smoke in the days before the urine sample was delivered. 

The main places where children were exposed to environmental tobacco smoke (as reported by parents) were at home, with family members or friends and in public places. A correlation was found between the parents’ reports on the child’s exposure to environmental tobacco smoke and the level of cotinine in his urine. All results were found to be statistically significant. 

Children living in homes where none of their family members smoked had a lower cotinine median than children who had at least one member of their family smoked. It was also found that cotinine levels among children with smoking neighbors were high compared to cotinine levels among children whose neighbors do not smoke. These results were found both for children whose parents smoke and for children whose parents do not smoke.

A comparison was made between the children’s cotinine levels, according to the smoking policy at home: Is it allowed to smoke anywhere in the house? Is smoking allowed only allowed in the yard or on the balcony or smoking is not allowed anywhere? Smoking allowed anywhere in the house were high compared to cotinine levels among children living in the house where smoking is only allowed in the yard or on the balcony; These levels were high compared to cotinine levels in children living in homes where smoking was prohibited. 

No statistically significant differences were found between cotinine concentrations among children from the Arab sector and these concentrations among children from the Jewish sector. 

The level of cotinine in children was found to be inversely related to their household income; the higher the income, the lower the cotinine level, which was also found in an inverse relationship to the education of the parents (both mother and father); the more educated the parents, the lower the cotinine level.  

Earlier this year, petitioners to Israel’s High Court of Justice against the health minister, minister of environmental protection and the minister of internal security for failing to prohibit smoking on the balconies of homes.  

Some 2.8 million Israelis are exposed to cigarette smoke toxins precisely in their home because of the neighbors who smoke by the window or on the balcony. Six of them who were fed up with the smoke, and they petitioned the court to force the state to act on the matter. One of them was lawyer Reuven Leviev, only 52, who suffered a severe heart attack that almost killed him. He suffered a 100% blockage in a major coronary artery and needed four stents to be inserted to hole the blood vessels open. After he recovered, his doctor asked him how long he had been a heavy smoker. He told him he didn’t smoke all but had been exposed on his own balcony for 11 years to the smoke of a neighbor. 

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Married and a father of four, Leviev lives in a duplex in the city of Or Yehuda. The living room balcony of the apartment below faces directly towards the bedroom and his living room, at a distance of 1.40 meters. “Three years after we bought the apartment, the tenants downstairs changed and our lives became hell,” he recalled. “They regularly sit on the balcony, play poker and smoke. The doctor told me after the operation that I was exposed to very severe air pollution. Do I need to fight for my right to breathe clean air in the house? Why does the neighbor’s right to smoke on his balcony outweigh it? In the confrontation I had with the neighbor, his shocking answer was: “I don’t want my house to smell of cigarettes.”  

“The lawsuit was filed by lawyer Amos Hausner, who is head of the Israel Council for the Prevention of Smoking,, on behalf of the Avi Naki (“Clean Air” organization headed by Guy Ofir. 

Meanwhile, the Health Ministry announced that electronic cigarettes pose a “significant risk to public health, just as do other tobacco products and that it has completed action, together with the Tax Authority in the Finance Ministry, to equalize taxation on e-cigarettes and conventional cigarettes. “The ministry has led many moves to expand smoking prohibitions in the public space, marketing and advertising restrictions and establishing the National Telephone Rehab Center established to help smokers quit,” the ministry said. “Every year, some 8,000 Israelis die from smoking tobacco and from passive smoking.”