Midwakh pipe smoking posing ‘significant’ health problems in UAE, scientists find

A traditional type of tobacco smoking locally known as midwakh is causing severe health problems and nicotine dependency among users in the United Arab Emirates (UAE), scientists from the University of Sharjah reported in a recent study.

The research’s findings are based on a quasi-experimental before-and-after study of 103 young male midwakh smokers in the UAE.

Midawkh is a traditional smoking practice involving a smoking pipe of Arabian origin and a mixture of tobacco from Iran. It is prevalent in Arabian Peninsula which includes the UAE, Oman, Qatar, Bahrain, Kuwait, and Saudi Arabia.

The Iranian element is represented in an imported sifted loose tobacco mixture locally known as dokha or dizziness that contains bark herbs and aromatic leaves.

“Midwakh smoking is deeply ingrained in UAE tradition but poses significant adverse health outcomes and nicotine dependency,” the scientists write.

Compared to shisha pipe smoking, another Middle Eastern traditional smoking practice, which has migrated to many western countries, the midwakh is more intense and even stronger.

Prof. Basema Saddik, the study’s lead author, said while global smoking rates were declining, the Middle East faced unique challenges. “Population growth and a younger demographic in the Middle East are leading to sustained high numbers of smokers despite global declines in smoking prevalence.

“This is particularly critical for the UAE, where vaping, shisha, midwakh and other alternative tobacco products are becoming increasingly popular among youth, potentially leading to significant health issues later.”

Although the results of the study are confined to data collected in the UAE, Prof. Saddik said the findings were bound to reverberate in countries where midwakh is common among smoking populations. 

“While the scope of this study is regional, its implications are significant and timely, especially as we continue to address nicotine dependence trends in this population.”

The research’s data collection included surveys featuring the Hooked-on Nicotine checklist (HONC), clinical measurements, and pre/post-smoking saliva samples. The scientists note, “Midwakh smoking adversely affects clinical measurements, with early start correlating with higher nicotine dependency, worsened by using multiple tobacco products.”

Prof. Saddik, who is director of Sharjah University’s Center of Excellence for Public Health, said the study’s findings showed that midwakh users “often develop early signs of nicotine dependence and reported various clinical issues, including elevated carbon monoxide and cotinine levels, which are indicators of harmful tobacco exposure.”

The authors’ preliminary findings pointed to severe health risks related to midwakh smoking particularly the young generation in the UAE. The study reported that “33% of midwakh smokers were under 21 years, 68% had below undergrad education, and household incomes over 15,000 AED (approx. $4000) monthly.  Smoking initiation was as early as 10 years.

“Smoking habits revealed 37% exclusive midwakh, 54% midwakh with e-cigarettes, 21% with shisha, and 34% with cigarettes. Post-smoking clinical measurements showed significant increases in blood pressure, heart, pulse and respiratory rates, and carbon monoxide levels.”

Prof. Saddik attributed the widespread use of midwakh in Arabia and specifically in the UAE to smokers mistakenly believing that the herbs and aromatic leaves in the tobacco – which lure many users – make it safer or less harmful than other cigarettes, leading to higher rates of initiation and dependence.

Research shows that a midwakh session, in terms of nicotine intake, can be the equivalent of smoking up to ten cigarettes, and in fact with much higher nicotine and tar levels. The diseases associated with midwakh smoking are no different from those caused by cigarette smoking including coronary artery disease, lung cancer and chronic obstructive pulmonary disease.

Prof. Saddik went on, “Clinical assessments also revealed negative health indicators, including elevated carbon monoxide levels which suggest that without intervention, a large portion of the UAE’s youth could face severe long-term health consequences.”

“Addressing these issues now with targeted prevention programs and regulations on alternative tobacco products is essential to change these projected outcomes.”

Prof. Saddik describes the findings of the study as “a wake-up call” for policy makers in the UAE and other countries with midwakh smokers to implement “strong smoking cessation policies and public education initiatives, particularly aimed at youth.

“The significance of our midwakh study lies in the immediate clinical impacts observed among users, with findings showing high nicotine dependency and harmful respiratory indicators.”

Prof. Saddik said the research had practical implications for health policy makers. The findings, she said, served as “a warning and a guide to protect future generations” in countries like the UAE “where alternative tobacco products are gaining popularity among youth.

“While alternative products like midwakh are often perceived as less addictive, our research reveals high nicotine levels and significant dependency among young users, ultimately impacting their health and future quality of life.”