Yael Bar-Zeev

Hebrew University of Jerusalem | HUJI · Braun School of Public Health and Community Medicine

Background Tobacco regulation recently changed in Israel, including a partial advertisement ban. We assessed the impact of regulatory changes on Philip Morris International’s (PMI) IQOS and cigarette advertisements. Methods Weekly number of ads and weekly adspend of PMI’s IQOS and cigarettes were analysed descriptively and using Quasi-Poisson regr...

Electronic cigarettes might be superior to nicotine replacement therapy as a quitting aid for pregnant women — but enthusiasm is hampered by low rates of smoking cessation and unknown long-term harm.

Introduction: IQOS, a tobacco heating system, and accompanying tobacco sticks (HEETS) entered the Israeli market in 2016, prior to rapid regulatory change. This study assessed IQOS marketing strategies and regulatory compliance at IQOS/HEETS point-of-sale (POS) in Israel in December 17, 2019-January 7, 2020, after the ban on advertisement went int...

Community–academic partnerships can be useful models for sustainable interventions. The Jerusalem Community–Academic Partnership (J-CAP) was established to address local health needs identified by a population survey. It engaged stakeholders and public health students as part of their training. We describe the establishment and processes of this pa...

Background The 5A’s model for brief smoking cessation care (SCC) is recommended for dentists to reduce the negative impacts of smoking on oral health. This study investigates Israeli dentists' adherence to the 5A’s guidelines and explores factors influencing their knowledge, attitudes, and practices. Methods An online cross-sectional survey was co...

In the last decade, while tobacco consumption has decreased, there has been a significant rise in e-cigarette usage particularly among young people. Tobacco-free generations and other endgame strategies are being considered in several countries, moving from tobacco control towards ending the tobacco epidemic. This online survey of 18-34-year-olds e...

Background: Intrinsic, personal, or autonomous motivations are important in facilitating behavioral change. However, definitions of different motivations remain unclear, particularly when distinguishing between intrinsic and extrinsic motivations to quit smoking. This study describes the differences and interactions between motivations to both quit...

Background Philip Morris International’s IQOS, with its heatsticks (HEETS), is the heated tobacco product with the largest global market share. IQOS and/or electronic cigarettes use rate is higher among Arabs vs. Jews in Israel. This paper aims to compare IQOS point-of-sale marketing strategies, and regulatory compliance in Arab vs. Jewish neighbor...

Background Fewer than 2.5% of people who smoke in Israel use evidence based smoking cessation support each year. Electronic cigarettes (e-cigarettes( role in smoking cessation remains debated, with some clinical guidelines from other countries, albeit not in Israel, promoting it as a harm-reduction tool for people who smoke and are unable or unwill...

Background Philip Morris International’s (PMI) IQOS, a leading heated tobacco product globally, entered the Israeli market in 2016. IQOS and/or electronic cigarette use is higher in Israel’s Arab population (2.8% vs 1.2% of Jews). However, previous research indicated possible targeting of the Ultra-orthodox Jewish population with more IQOS paid ads...

Introduction It is unclear how tobacco companies respond to increasing restrictions on points-of-sale (POS) (eg, advertisement ban, display ban), especially regarding newer products, such as IQOS, a heated tobacco product. This study compared POS marketing strategies for IQOS (and HEETS tobacco sticks) before and after Israel implemented a display...

The marketing of heated tobacco products (HTPs), like IQOS, influences consumers’ perceptions. This mixed-methods study analyzed (i) survey data (2021) of 2222 US and Israeli adults comparing perceptions of 7 IQOS attributes (design, technology, colors, customization, flavors, cost and maintenance) and 10 marketing messages (e.g. ‘Go smoke-free…’)...

INTRODUCTION Little is known about media exposures to heated tobacco products (HTPs). In this study, we examined sources of HTP exposure, including from paid and unpaid media and social connections, in relation to HTP use and use intentions. METHODS In the fall of 2021, we conducted a cross-sectional survey among adult online panelists (aged 18–45...

Background The health and environmental benefits of legume consumption are reflected in dietary guidelines worldwide. However, legume intake fails to meet recommendations. Dietitians’ legume counseling practices can impact consumption patterns. This cross-sectional study assessed Israeli dietitians’ knowledge, attitudes, perceptions and practices r...

Introduction Heated tobacco products (HTPs), like IQOS, are marketed as innovative, stylish, harm-reduction products distinct from cigarettes and e-cigarettes. Research is needed to better understand how adults who are newly introduced to HTPs perceive them relative to cigarettes and e-cigarettes, and the impact of these perceptions on use outcomes...

Background The 5A’s model for brief smoking cessation care (SCC) is recommended for dentists to reduce the negative impacts of smoking on oral health. This study investigates Israeli dentists' adherence to the 5A’s guidelines and explores factors influencing their knowledge, attitudes, and practices. Methods An online cross-sectional survey was co...

Background: Philip Morris International’s (PMI) IQOS, with its heatsticks (HEETS), is the heated tobacco product with the largest global market share. IQOS and/or electronic cigarettes use rate is higher among Arabs vs. Jews in Israel. This paper aims to compare IQOS point-of-sale (POS) marketing strategies, and regulatory compliance in Arab vs. Je...

The tobacco industry has been influencing public opinion and disrupting health policy through sophisticated and deceptive methods for decades. As evidence has mounted supporting the undisputed deadly effects of tobacco products, corporations have found ways to remain profitable. They have succeeded in attracting enough new smokers to support indust...

INTRODUCTION As e-cigarette marketing strategies diversify, it is important to examine exposure to and impact of e-cigarette advertisements and non-advertising content (e.g. on social media) via multiple media channels among adults in different regulatory contexts. METHODS Using 2021 cross-sectional data among 2222 adults in the US (n=1128) and Is...

Background Health warning labels (HWLs) are evidence-based tobacco control strategies; however, their application to e-cigarettes and related impacts (e.g. on perceived risk), including across countries with different regulations, are understudied. Design and Methods Using 2021 survey data from 927 US and Israeli adults reporting past-month tobacc...

Background Health warning labels (HWLs) represent an evidence-based tobacco control strategy; however, their application to heated tobacco products (HTPs) and related impacts are understudied. This study examined the impact of HTP HWLs on HTP use intentions and risk perceptions among current tobacco users. Methods We analyzed cross-sectional surve...

Background In the US and Israel, non-medical (‘recreational’) cannabis use is illegal at the national level; however, use rates are high and decriminalization and legalization is spreading. Thus, theory-based intervention efforts, especially for youth prevention, are crucial. Methods This mixed-methods study of adults in the US (n = 1,128) and Isr...

Introduction: Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. This study aims to identify barriers and facilitators for implementing a smoke-free home and car among expectant Israeli fathers. `. Methods: Twenty-four qualitative semi-structured telephone interviews were audio-recorded, transcribed, an...

Background Despite the dangers of driving under the influence (DUI), little is known about DUI substance-specific risk perceptions or risk factors for riding with drunk/drugged drivers (RDD). Methods In this sequential exploratory mixed-methods study, we conducted: 1) multivariable analyses of cross-sectional survey data from 2,222 US and Israeli...

Introduction: IQOS entered the US market in October 2019, then received the Food and Drug Administration's modified risk tobacco product authorization (MRTPA) allowing use of "reduced exposure" claims in marketing in July 2020. A May 2021 court decision regarding patent infringement required IQOS' removal from the US market in November 2021. Meth...

Background and Objectives: IQOS is a heated tobacco product (HTP). it is the global HTP market leader and the only HTP in Israel. Smoking rates, as well as IQOS and/or electronic cigarette use, are higher in the Arab than the Jewish population in Israel. The point-of-sale (POS) environment is one of the under-studied marketing channels. The way IQO...

Heated tobacco products (HTPs; e.g., IQOS) are advertised as safer than cigarettes or an alternative, yet required health warning labels (HWLS) in many countries, including the US and Israel, do not consider whether HTP ads undermine HWLs, particularly those that do not explicitly address HTPs. In 2021, a randomized 4 x 3 factorial experiment amon...

Significance Newer tobacco products might be particularly likely to use social media as they emerge in the global market. Little is known about the official use of social media in marketing heated tobacco products (HTPs). This study examined Philip Morris International’s (PMI) social media marketing globally of its leading HTP, IQOS. Methods PMI I...

Objectives In Israel, in 2020, 57/257 local municipalities were part of the Healthy Cities Network (HCN). HCN municipalities have a strong political commitment to health promotion and reducing health inequalities. This research aimed to (1) explore local municipalities’ management of the pandemic and (2) assess whether belonging to the HCN impacted...

Significance Second hand smoke (SHS) exposure is a significant preventable cause of negative health effects during pregnancy. An important source of SHS exposure during pregnancy is due to partners smoking near the pregnant women. Reducing SHS exposure during pregnancy could have a significant impact on both maternal and infant morbidity and mortal...

Significance Heated tobacco products (HTPs) are increasingly popular globally. Philip Morris International (PMI)’s IQOS, the globalHTP leader, endured several regulatory changes in Israel - from no oversight (12/2016-04/2017), to minimal tobacco legislation(04/2017-12/2018), to progressive legislation that included a partial advertisement ban (exem...

Heated tobacco products (HTPs) have expanded globally. IQOS, a global HTP leader, was launched in Israel in 2016 and the US in 2019. To inform tobacco control efforts, it is critical to understand who is likely to use HTPs in different countries with distinct regulatory and marketing contexts. Thus, we conducted a cross-sectional survey among adult...

Despite tobacco marketing diversification, limited research has examined use profiles across countries, particularly in relation to consumer values (e.g. appeal of innovation, conscientiousness). Using 2021 data, latent class analysis assessed past-month use of seven tobacco products (cigarettes, electronic cigarettes [e-cigarettes], heated tobacco...

Background: Aboriginal and Torres Strait Islander women deserve improved smoking cessation support. Aboriginal health workers (AHW) and practitioners (AHP) can be central to the provision of culturally safe smoking cessation care (SCC). The objective of this study is to explore attitudes and the perceived role of AHWs/AHPs toward providing SCC to...

Background IQOS was the first heated tobacco product to receive Food and Drug Administration (FDA) authorisation for ‘reduced exposure’ marketing claims, which has been exploited globally. Methods In November–December 2021, we conducted a survey-based 3×3 factorial experiment among US (n=1128) and Israeli adults (n=1094). We presented: (1) reduced...

Background IQOS, manufactured by Philip Morris International (PMI), is the highest selling heated tobacco product globally. IQOS went through several regulatory changes in Israel: from no oversight to minimal tobacco legislation, to progressive legislation that included a partial advertisement ban (exempting print media) and plain packaging. We exa...

Introduction Tobacco is the leading preventable cause of morbidity and mortality for Aboriginal and Torres Strait Islander people. Accordingly, the provision of culturally safe and effective smoking cessation strategies are crucial. While previous research has suggested Aboriginal Health Workers/Practitioners are well placed to provide smoking cess...

Young adults’ perceptions and use of heated tobacco products (HTPs) are understudied. This mixed methods study analyzed (i) Fall 2020 survey data from 2470 US young adults (meanage = 24.67; 19.5% and 25.2% past-month cigarette and e-cigarette use; 4.1% ever HTP use) assessing HTP use intentions and perceptions (1 = not at all to 7 = extremely) and...

Introduction Despite increased heated tobacco product (HTP) marketing in the US, little is known about HTP perceptions and correlates of HTP use and use intentions among young adults. Methods Using 2020 cross-sectional data from 2,470 young adults (ages 18-34) from 6 US metropolitan areas, we conducted exploratory factor analysis to identify facto...

Objective: Little research has examined psychosocial influences differentially associated with driving under the influence of alcohol and marijuana (DUIA/DUIM) or of being a passenger in a vehicle driven by someone under the influence of alcohol or marijuana (PVA/PVM). Method: Using 2019 survey data among 2,375 young adults (M age = 24.66, 57.7%...

Background The point-of-sale (POS) is adapting to marketing restrictions, societal changes and the inclusion of new products, such as heated tobacco products (eg, Philip Morris International’s (PMI) IQOS device and HEETS sticks). We aimed to assess (1) PMI’s influences on IQOS/HEETS POS marketing and (2) the implications of the new legislation (POS...

IQOS is sold globally in over 60 countries and entered the US market in 2019 and by 17 May 2021, it was sold in four states: Georgia (Atlanta, Buford), Virginia (Richmond, Tysons), North Carolina (Charlotte, Raleigh), and South Carolina (Charleston, Myrtle Beach), and had 52 specialty stores and 400 retail outlets. While US sales stopped on 29 Nove...

Background Being on the COVID-19 frontline could negatively impact healthcare workers mental health. We examined smoking behavior changes and the association with changes in stress levels and sleeping patterns among hospital workers during the pandemic. Methods An online survey was conducted among employees of a large tertiary medical center in Is...

Background: Mental health impacts of the COVID-19 pandemic, especially among frontline health workers, have been widely noted. The aim of this study was to explore smoking behaviour changes and associations with perceived changes in stress levels and sleep duration among Israeli hospital workers during the COVID-19 pandemic. Methods: An online cros...

Background: Local municipalities have played a central role in the management of the COVID19 pandemic and the mitigation of its grave health, economic and social consequences. In Israel, 57 local municipalities (out of 257) are part of the Healthy Cities Network (HCN). HCN Municipalities have a strong commitment to health promotion and reducing hea...

Significance: Exploring proximity and density of heated tobacco product (HTP) and electronic nicotine delivery system (ENDS) points of sale (POS) to schools is critical for understanding youth marketing exposure and informing policy and enforcement to protect youth. This study examined IQOS and JUUL POS (prominent HTPs and ENDS), specifically their...

Introduction Given that the US Food and Drug Administration (FDA) authorised reduced exposure messaging to be used in IQOS marketing, we examined: (1) IQOS ad content; (2) advertising media channels and (3) changes in advertising efforts over time. Methods We conducted a mixed-methods study regarding IQOS ad content (headlines, themes, images), ad...

IQOS, the leading heated tobacco product globally, recently received 'reduced exposure' authorization from the US Food and Drug Administration. Independent research focusing on IQOS marketing and potential impact on consumers' perceptions and behavior, and ultimately public health, is critical. The literature to date has underscored several concern...

We analyzed advertisement expenditure (adspend) data for IQOS and Philip Morris cigarettes by regulatory period and population groups. We also conducted a content analysis of these ads and found how themes changed over time.

Following publication of the original article [1], the authors reported a couple of minor changes needed in the Abstract and Results section, including reference citations. In the result section of Abstract, “twelve on HP’s perspectives, 16 on PW’s perspectives” was amended to “13 on HP’s perspectives, 15 on PW’s perspectives” In the Results sectio...

Background Smoking cessation in pregnancy has unique challenges. Health providers (HP) may need support to successfully implement smoking cessation care (SCC) for pregnant women (PW). We aimed to synthesize qualitative data about views of HPs and PW on SCC during pregnancy using COM-B (Capability, Opportunity, Motivation, Behaviour) framework. Met...

Significance: The SARS-CoV-2 pandemic has caused devastating health, social and economic impacts globally. In order to mitigate potential health implications from the pandemic, Israel imposed severe restrictions during March-April 2020. The aims of this study were to explore changes in smoking behaviour and home smoking rules during the initial COV...

The COVID-19 pandemic has caused devastating impacts globally. To mitigate virus spread, Israel imposed severe restrictions during March–April 2020. An online cross-sectional survey was conducted in April 2020 among current and ex-smokers to explore changes in smoking behaviour and home-smoking rules during this period. Bivariate analysis and multi...

הקדמה: עישון טבק הוא הגורם הראשון בעולם לתחלואה, הניתן למניעה. שיעור המעשנים בקרב הלוקים בתחלואה נפשית הוא פי שניים ויותר בהשוואה לשיעורי העישון באוכלוסייה הכללית. אף על פי שגם בישראל העישון הוא גורם מרכזי לתחלואה ותמותה, אין כמעט ידע ומחקר לגבי מאפייני העישון בקרב הלוקים בתחלואה נפשית. מטרות המחקר: הערכה עדכנית של שכיחות העישון בישראל בקרב הלוקים...

Introduction: Tobacco smoking is the worldwide leading preventable cause of morbidity [1]. The prevalence of current smoking among individuals with mental illnesses is more than twice as that of the general population [2]. Despite it being a primary cause of morbidity and mortality in Israel too, there is little information and research on the fea...

Introduction: Aboriginal pregnant women who smoke experience barriers to quitting, including challenges to social and emotional well-being, but these are infrequently quantified. Finding an appropriate measurement tool in this setting is crucial to increase knowledge for holistic smoking cessation interventions. Aims: To pilot the Growth and Emp...

Introduction: Behavioural counselling is an effective method to improve smoking cessation during pregnancy. Audio recordings of consultations have been used previously to assess fidelity in specialized smoking cessation services, but not in primary care. Aims: The study is aimed at assessing the feasibility of audio-recording smoking cessation c...

Scientific reports on the possible protective effect of nicotine could influence perceptions and behaviours of people who smoke, and might have important public health implications. Public health professionals and researchers need to take these into account in the current era of uncertainty and COVID-19 misinformation.

Israel was once a leader in tobacco control, but fell behind other countries, particularly during the past decade, as smoking rates stagnated. Landmark tobacco control legislation, which banned advertising (with the exception of the print press) and limited marketing, was passed in Israel on Dec. 31rst, 2018. The changes occurred following years of...

Introduction During pregnancy, the imperative to stop smoking becomes urgent due to health risks for mother and baby. Aim Explore responses to a smoking-related, pregnancy-focused Risk Behaviour Diagnosis (RBD) Scale over time with Aboriginal ¹ pregnant women. Methods Six Aboriginal Medical Services in three states recruited 22 eligible women: ⩽2...

In response to tobacco control legislation in Israel, the tobacco industry employed various tactics to bypass legislative efforts. Tobacco control legislation and regulation need to use detailed wording to prevent alternative interpretations by the tobacco industry

Heated tobacco products (HTP), such as Philip Morris IQOS, have penetrated the global tobacco market. Currently the only HTP on the market in Israel, IQOS was introduced in 2016. The device is sold in specialty stores and online; while the heat sticks (HEETS) are sold at traditional retailers. In 01/2019 a ban on advertisements in all media (exclud...

Background: Non-communicable diseases are the leading causes of death, largely due to the last century's often-unhealthy lifestyles. Family medicine (FM) and other physicians can improve patients' lifestyle behaviors, yet FM residency programs in Israel and other countries do not uniformly deliver lifestyle medicine (LM) training. The readiness of...

Significance Tobacco control in Israel has been lagging, and smoking rates have remained stable in the last decade (~20%). In 2018, landmark legislation was passed to go into effect during 2019- 2020. The tobacco and vaping industry employed several tactics to circumvent and test the ability to enforce the new legislation. Examining industry respon...

Background Heated tobacco products (HTP), such as Philip Morris IQOS, have penetrated the global tobacco market. Currently the only HTP on the market in Israel, IQOS was introduced in 2016. The device is sold in specialty stores and online; while the heat sticks (HEETS) are sold at traditional retailers. In 01/2019 a ban on advertisements in all me...

Issue Tobacco control in Israel has been lagging, and smoking rates have remained stable in the last decade (∼20%). In 2018, landmark legislation was passed to go into effect during 2019- 2020. The tobacco and vaping industry employed several tactics to circumvent and test the ability to enforce the new legislation. Examining industry responses to...

Introduction Systemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training. Aim Assess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses. Methods National cross-sectional su...

The tobacco industry offers various products, including heated tobacco products (HTPs). Philip Morris International’s (PMI) “iQOS” has the greatest HTP market share, as well as research on its use and impact. iQOS was released in 2014 and is now in more than 40 countries. The U.S. Food and Drug Administration announced permission for PMI to sell iQ...

OBJECTIVE: To evaluate whether there is an association between prenatal smoking and gestational diabetes mellitus (GDM). METHODS: We conducted a secondary data analysis using data from the Pregnancy Risk Assessment Monitoring System from 2009 to 2015. Outcome measures included self-reported GDM and change in smoking status during pregnancy (nonsmo...

Background: Philip Morris International’s IQOS (“I Quit Ordinary Smoking”) device has increasingly penetrated the global tobacco market. In Israel, among the first countries with IQOS in its market, the IQOS device is sold in specialty stores and online; the heat sticks – HEETS – are sold at traditional retailers. Advertising restrictions in many...

Smoking during pregnancy is a national priority to improve Aboriginal health. Empowerment approaches underpin the priorities set by the government to improve Aboriginal health and wellbeing; however, empowerment is seldom evaluated within interventions for Aboriginal people. Literature was searched to April 2018 and data was extracted using an asse...

Background Smoking during pregnancy is a major risk factor for poor perinatal health for mothers and babies. Health providers (HPs) are important for smoking cessation care of pregnant women. This systematic review synthesized qualitative data about views of a) HPs providing smoking cessation care in pregnancy, and b) pregnant women's receipt of ca...