Background:
With the introduction of potentially harm-reduced tobacco products and harm reduction claims by the tobacco industry in various countries, the public health community is confronted with dilemmas in how to present information about the new products to the broader public. Yet, many populations may still be poorly informed about risks due to use of the conventional lethal combusted cigarettes. This paper presents knowledge and perceptions about active smoking and tobacco smoke exposure (TSE) among Israeli adults.

Methods:
A nationally representative phone survey of the Israeli adult population was conducted with 505 participants (response rate=60%). Knowledge and risk perception questions about active smoking and tobacco smoke exposure (TSE) were included. Multi-variable models were used to identify variables associated with knowledge and risk perceptions.

Results:
Among respondents, only 15.8% accurately answered all four knowledge questions. Just 28.6% knew that smoking causes more damage than traffic accidents, many (30.3%) were unaware that TSE causes both lung cancer and heart disease, 27.7% did not know that smoking shortens life and injures quality of life and 31% did not know that all or most heavy smokers will suffer health problems from smoking. Current smokers had the lowest risk perceptions and never smokers the highest. Socio-economic status was associated with more accurate knowledge, and smoking status was associated with risk perception.

Conclusions:
Knowledge about risks of smoking combustible cigarettes are low in the Israeli population. Effective mechanisms for educating the broad public, including smokers and nonsmokers, about the full extent of known harms from smoking, tobacco, and nicotine products are essential to controlling tobacco use and damage in populations.