Tobacco smoke incursion into private residences in Israel: a cross-sectional study examining public perceptions of private rights and support for governmental policies

Noa Theitler, Vaughan W. Rees, Maya Peled-Raz, Michal Bitan, Laura J. Rosen

Research output: Contribution to journalArticlepeer-review


Background: Tobacco smoke incursion (TSI) into private residences is a widespread problem in many countries. We sought to assess the prevalence of self-reported TSI and public attitudes about TSI in Israel, a country with a relatively high smoking prevalence and high population density. Methods: We conducted a random digit dial survey among residents in Israel (N = 285) in 2017, which examined the frequency, source, correlates of, and attitudes towards TSI and potential regulatory options. The cooperation rate was 63.9%. Results: Among respondents, 44.7% reported ever experiencing home TSI, with higher exposure among residents of multi-unit housing (MUH) (MUH versus private homes: aOR (Adjusted Odds Ratio): 3.60, CI (Confidence Interval): [1.96, 6.58], p <.001). Most respondents (69.8%), including nearly half of smokers, prioritized the right of individuals to breath smoke-free air in their apartments over the right of smokers to smoke in their apartments. Women and non-smokers were more likely to support the right to breathe smoke-free air (Women versus men: aOR: 2.77 CI: [1.48, 5.16], p =.001; Nonsmokers versus smokers: aOR: 3.21 CI [1.59, 6.48], p =.001). However, only about a quarter (24.8%) of respondents who ever experienced TSI raised the issue with the neighbor who smoked, the neighbor's landlord, or the building committee. The vast majority (85.2%) of all respondents, including three-quarters of smokers, supported smoke-free legislation for multi-unit housing (MUH), with those ever-exposed to TSI and non-smokers more likely to support legislation (ever-exposed versus never-exposed aOR = 2.99, CI [1.28, 6.97], p = 0.011; nonsmokers versus smokers aOR = 3.00, CI [1.28, 7.01], p = 0.011). Conclusions: Among study participants, tobacco smoke incursion was a common, yet unwelcome experience. Most respondents believed that the right to breathe smoke-free air in one's apartment superseded that of neighbors to smoke anywhere in their home, and most supported legislation to prevent TSI. Though further study is needed to understand better TSI and effective methods for its prevention, our findings suggest that policy interventions, including legal action at the level of the Supreme Court and/or the Knesset, are needed. Regulation, policy initiatives and campaigns to denormalize smoking in proximity to other people and private residences globally could reduce the scope of this widespread problem, protect individuals from home TSI, and improve population health.

Original languageEnglish
Article number25
JournalIsrael Journal of Health Policy Research
Issue number1
StatePublished - 21 Jul 2023

Bibliographical note

Funding Information:
LJR: Received research grants from: Israel National Institute of Health Policy, Flight Attendant Medical Research Institute, the International Union Against Tuberculosis and Lung Disease, and the Israel Justice Ministry. Provided three Expert Opinions on a pro bono basis regarding the current administrative case being heard in the Supreme Court regarding smoke incursion into residential apartments. Provided an expert opinion, also on a pro bono basis, for an administrative case filed in Tel-Aviv/Jaffa. VR: Received grant funding from National Cancer Institute, Department of Housing and Urban Development, Ford Foundation & National Science Foundation. Provided services to NIH as a reviewer. Provided expert testimony on behalf of plaintiffs in litigation against tobacco companies. Received support for travel to the E-Cigarette Summit, Washington DC, May 2022 & Tobacco Control meeting, Tel Aviv, July 2022. The authors have no other potential competing interests to declare.

Publisher Copyright:
© 2023, The Author(s).


  • Attitudes
  • Multi-unit housing
  • Neighbor smoking
  • Residential exposure
  • Secondhand Smoke (SHS)
  • Secondhand smoke (SHS)
  • Smoke-free housing
  • Support for policy
  • Tobacco Smoke Exposure (TSE)
  • Tobacco Smoke Incursion (TSI)

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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