ByJUDY SIEGEL-ITZKOVICH

JULY 18, 2026 14:14

Since October 7, roughly 2,500 Israeli civilians and troops have been killed by terrorists. In addition, over 22,000 soldiers and security staff have sustained injuries resulting in physical or mental harm.

Less sensational yet equally devastating, tobacco-related illnesses have claimed 12,000 Israeli lives of every age since 2023, among them 900 nonsmokers harmed by secondhand exposure.

Hundreds of thousands more have developed serious conditions linked to smoking, such as chronic obstructive pulmonary disease that leaves patients gasping as though submerged, heart ailments, strokes, malignancies, and additional disorders. Regrettably, this toll exceeding three times the conflict-related deaths draws far less public concern.

While cigarette consumption falls across much of the globe, it has risen in Israel over recent years from one-fifth to one-quarter of adults. Contributing factors include wartime anxiety, vigorous marketing of novel nicotine devices by industry players, weak official oversight, and misconceptions among youth that vaping products differ from traditional smoking when they carry comparable risks.

Specialists in tobacco control gathered last week at Jerusalem's Shaare Zedek Medical Center for a full-day forum hosted by the Medical Society for Smoking Prevention and Cessation under the Israel Medical Association. The event carried the title Just to Breathe.

Dr. Ariel Rokach, who leads the respiratory care unit at SZMC and now chairs the society, observed that tobacco causes an average of 33 deaths daily and 1,000 weekly nationwide.

This information ought to have galvanized national attention, yet it passed largely unnoticed, he remarked.

Graphic warnings planned for packaging

He noted with approval that graphic depictions of smoking-related harm will soon appear on all tobacco products. Years earlier, former health minister Yaacov Litzman resisted the measure, arguing the images would frighten youngsters and proposing scenic Jerusalem photographs instead.

Within two years, tobacco items will lose duty-free status at airport outlets. Although Israel endorsed the WHO Framework Convention on Tobacco Control in 2005, enforcement of this rule had been absent until now.

Prof. Zvi Fried-Lender, head of Internal Medicine D and a senior pulmonologist at Hadassah University Medical Center, stated that tobacco has killed far more Israelis than wars have. Efforts to curb it have fallen short. Tobacco firms pour vast resources into sales and seek to place e-cigarettes near schools.

All participants in prevention and cessation work save lives daily, said Prof. Hagai Levine, epidemiologist and leader of the Israeli Association of Public Health Physicians. Industry tactics aim to expand the customer base; countering aggressive promotion is essential, and support from lawmakers opposed to smoking would help.

Prof. Yael Bar-Zeev, a public-health physician and behavioral scientist at the Hebrew University Braun School of Public Health, specializes in tobacco control and cessation strategies.

She noted that smoking involves not only physical dependence but also emotions, cognition, and beliefs. Expanding studies examine behavioral therapy, activation techniques, commitment approaches, and cognitive behavioral therapy to support quitting.

CBT disrupts the link between certain thoughts and the urge to smoke through mindfulness practices. Rather than I need a cigarette, individuals can reframe as I am not required to; I can align with my values. She added that modern cigarettes contain additives that heighten addiction compared with earlier versions.

Electromagnetic helmet therapy

A novel cessation method now offered in Israel is deep transcranial magnetic stimulation. This noninvasive approach employs electromagnetic fields to activate specific brain areas safely. Cleared by the FDA and Health Ministry, it addresses treatment-resistant depression, obsessive-compulsive disorder, and nicotine dependence.

A specialized helmet delivers magnetic pulses to deeper neural circuits than conventional TMS. The process modulates brain activity without surgery, anesthesia, or inpatient care, with the patient fully awake.

Treatment typically involves 20 to 36 sessions over four to six weeks, five days per week. The sole noted side effect is mild headache at the application site, which often diminishes after initial visits.

Bar-Zeev reported success with many heavy smokers. Patients currently cover costs privately, though inclusion in the national health basket remains a goal.

Some experts also advocate serotonin receptor agonists that influence nerve signaling related to mood and vascular function. Primarily used for migraines, depression, anxiety, and digestive complaints, these agents have been suggested for smoking cessation.

Close supervision is required for the single-session approach, as psychiatric conditions could worsen, Bar-Zeev cautioned. Future applications may emerge for individuals unresponsive to standard methods.

GLP-1 receptor agonists, first developed for Type 2 diabetes and now common for weight and heart health management, have shown promise in cessation efforts. These compounds mimic gut hormones to regulate blood sugar and appetite.

They appear to act on brain regions affected by nicotine. Small trials found participants reduced cigarette intake and delayed lighting up when offered, suggesting potential benefit.

Amos Hausner, chair of the Council for the Prevention of Smoking, cautioned that current cigarette residues will trigger deaths in 20 to 30 years for half of users. Tobacco companies may not remain solvent to provide compensation, as seen in Canada where firms faced bankruptcy after large liability rulings.

Israeli smokers confront a delayed health crisis. To prepare for victim support, companies selling tobacco here should deposit at least NIS 42 billion with the government, analogous to requirements for vehicle importers regarding future parts availability.

Hausner also offered fresh enforcement ideas for public smoking bans and age restrictions: offenders could attend prevention courses similar to those for traffic violators, and complaint hotlines could be prominently displayed in restricted areas.

This mirrors signage on trucks allowing reports of emissions or violations without direct confrontation.

For heavy smokers, low-dose CT screening offers early lung-cancer detection. The quick, low-radiation scan is provided free to current or former smokers aged 60 to 74.

Prof. Itamar Grotto, former Health Ministry public-health director, proposed Forest Therapy. Having taught in Cyprus, he observed forest-based activities that lower stress.

Seventy percent of relapses stem from elevated stress and mental load. Time in forests with mindfulness exercises can sustain stress reduction versus controls. While not standalone, it may complement other interventions.

Women who smoke and consume alcohol often enter menopause earlier with intensified symptoms, according to Dr. Avigail Maayani, a gynecologist who conducts cessation programs. Half of nonsmoking Israeli women encounter others smoke.

Female smokers face elevated risks of osteoporosis, endometrial and cervical cancers, and severe COPD. They also encounter greater difficulty quitting than men, typically smoking for stress relief while men respond more to physical dependence.

Speakers lacked details on AI applications for prevention, prompting a query to ChatGPT.

The response highlighted personalized coaching that adjusts messages according to age, stress, relapse history, motivation patterns, time of day, and triggers.

AI could detect high-vulnerability moments by learning daily patterns, adapting communication, integrating with nicotine therapies, and flagging relapse risks before conscious awareness.

While human counselors remain valuable yet scarce, AI could deliver round-the-clock multilingual, culturally tailored support to large populations at modest expense.

Israel possesses the digital health systems, AI capabilities, public-health knowledge, and data infrastructure to excel in this domain.