School of Public Health’s Baron-Epel Researches ‘Tobacco Control’
“If 100% of the population knows that smoking is dangerous, why do 26%-27% of the people still smoke?”
This is the question that Dr. Orna Baron-Epel rhetorically asks and has been trying to come up with answers and effective ways to reduce that latter percentage. A confirmed non-smoker all her life, Dr. Baron-Epel heads the Health Promotion section of the University’s new School of Public Health.
The percentage of smokers in the first paragraph refers to the situation in Israel, which she terms relatively good. Although the figure is higher than in the United States, it is lower than in Europe, she notes. It also represents a drop from the situation thirty years ago, when Israel’s smoking population numbered 40%-45%.
The biggest problem today, according to the public health educator, is with Israeli youth. They are starting to smoke at an earlier age than ever before, as young teens. Israelis used to start in their early twenties. “It’s not the number that has increased,” she remarks, “but the age has been lowered, so that the damage to health is greater.”
That smoking is directly harmful to one’s health is taken for granted, and Baron-Epel bristles at any suggestion that the connection is the realm of “may be injurious.”
She points to several other groups in Israel that have a smoking problem, targeting them for “tobacco control” programs the way tobacco company advertisements target specific populations for the opposite purpose.
One of these intervention programs is aimed at Israeli Arab men and involves the innovation of community participation. Working with Prof. Mark Farfel of Johns Hopkins University, Baron-Epel is attempting to construct a successful intervention program aimed at this specific group. The research, being funded in large part by the Ministry of Health, will take at least three years. The first stage is to ascertain what works in the Arab population, among which smoking is so socially acceptable—at least for men—that a smoker doesn’t even have to ask permission to light up when in someone else’s home.
The next step is to involve the community in making the change. The idea, she explained, is for the community itself to develop the specific patterns that will convince its members to give up smoking or not to begin in the first place. In other words, to change the culture, which she admits makes the job more difficult. Once she and her colleagues learn how to involve the community in this intervention, then the community-participation concept can be applied to other health problems in the population.
Another problematic group is that of young Russian immigrants, especially the girls. In their case, acculturation is given as the reason, or excuse, for their heavy smoking. But, Baron-Epel pointed out, older Russian immigrants do not smoke as much. Nor did the young immigrants when they were in the same age category (20-24) in Russia.
Ethiopian immigrants generally do not smoke. But, she added, there is one exception. Those who attend boarding schools have begun to be serious smokers. Apparently the absence of the influence of the home gives them this license.
Among native Israeli youth, Baron-Epel pointed out, there is a big difference between the educated and the less educated. Among the latter, perhaps 40% smoke. The government, she said, has not found a way to reach this population. The same is true in the United States, she added.
There, however, she continued, the laws against smoking in public places are more effective than in Israel. Socially, too, smoking is not as acceptable as it here. Warnings on cigarette packs are not, in her opinion, that effective. Nevertheless, Israel recently passed a law to increase the size of the printed warning. Another recent law is that no human figure can appear in a cigarette ad, and no advertisements for cigarettes are allowed on TV and the radio.
The anti-smoker complains, though, that there is little enforcement of the anti-smoking laws in Israel. Enclosed shopping malls are a notorious example. She herself has been actively involved in helping to keep a mall in Herzliya, where she lives, smoke free. “The public must be empowered to complain,” she advises. “Non-smokers are not insistent enough.” She would, in fact, like to investigate the social influence of non-smoker’s attitudes toward smokers.
Baron-Epel, who gained her doctorate in biology at Tel-Aviv University before deciding to do an MPH at the Hebrew University and go into the field of public health, believes the Ministry of Health has to do more campaigning in this area. In the end, though, “people have to take charge of their own lives. This comes from health education, health behavior. Our behavior is central to our health, and we have to take responsibility.”
She undoubtedly finds it frustrating that even Israeli nurses, who perhaps should know better, have a rate of smoking that, as she described it, is “low, but not good enough”—21%. Her study of nurses and smoking concluded that nurses who are smokers viewed their task in tobacco control as not important, whereas nurses who do not smoke see tobacco control as an important role for nurses..
Obviously, though, not even all nurses think as she does, that “people who smoke are addicted. And this addiction also causes huge damage to society in terms of health expenditure, suffering, treatment, and health care.” Even less understandably, smokers “do themselves harm knowingly.”
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