Youngsters turn to‘high’ risk smoking in UAE

Dubai - With stricter checks in place on tobacco usage — especially on cigarettes — youngsters are rapidly shifting to cruder and more dangerous forms of smoking such as dokha to get their daily buzz, a compilation study has found.

Dokha — an alternative tobacco product (ATP) — is an Arabic term which means “dizzy” in English. It is a blend of finely shredded tobacco mixed with leaves, bark and herbs and is consumed using a pipe called midwakh.

The study — done locally and published in Tobacco Control journal in October 2014 — points out that many ATPs, such as hookahs, have grown in popularity and are used beyond the locale of their origin, thereby, becoming a significant global public health concern.

Misconceptions propagated by websites marketingdokha > As a totallydifferent smoking experience, you will finddokhaa more satisfying alternative to any other tobacco product. >Dokhatobacco ismuch more potent than other tobaccos and the “rush” you get from smokingdokhais very satisfying. > Saving time – youcan fully enjoy your smoke in a fraction of the time versus smoking cigarettes, cigars or typical pipe tobacco. > Less mess – becauseyou’re only smoking a small pinch ofdokha, there are hardly any ashes and certainly no cigarette/cigar butts. > Your house, clothesand breath will not reek of tobacco. > Since you aresmoking less tobacco at a time with natural organicdokha, you are receiving less tar into your lungs from the filtered midwakh. Also, certain chemical additives found in most cigarettes and cigarette papers are not present indokha. > Economical - with therising price of cigarettes, not only can you enjoy the product, but save some cash in the process with dokha as an alternative. > Yourmidwakhisbound to be a conversation piece amongst your friends and others around you. – compiled data. Results from a 2013 Global YouthTobacco Survey done in the UAE showed > 9.1% overall — 12.4%of boys and 5.7% of girls — currently smokemidwakh > 3.4% overall — 4.1%of boys, and 2.6% of girls — currently used tobacco.

This may pose challenges to the tobacco control efforts in the region, points out the study titled “Midwakh/dokha tobacco use in the Middle East: much to learn.”

“These products are cheap and easily available,” admits Dr Wedad Al Maidoor, head of the National Tobacco Control programme at the Ministry of Health. “The regulations are not as well enforced as we would like them to be,” she said.

The study takes into account two studies on the same subject and provides an overview of an under-reported and understudied ATP, dokha.

Dr Wedad said teenagers are more prone to using dokha since they believe that it is less injurious to health.

“Teenagers want to try everything … they believe that midwakh and shisha are less harmful which is a wrong belief, of course,” she said.

Professor Dr Mohammed Al Houqani, Assistant Professor and Assistant Dean for Education and Academic Affairs, UAE University who conducted the study said that 24 per cent of UAE nationals smoked dokha, while midwakh was the second most popular ATP in the UAE.

“Not much has been written about the dangers of midwakh,” he said. “It is very popular among Arabs but is beginning to be liked by other nationalities as well,” he added.

While warnings have been placed on cigarettes, consumption of dokha remains uncontrolled in the UAE. “Many times it is home-made too to add different flavours for pleasure but we don’t know the actual contents,” said Dr Houqani.

Control policies

Calling upon policy makers to put in place measures to control the product before the situation goes out of hand, Dr Houqani said youngsters were rapidly shifting towards this new trend.

“It is a health risk and needs to be controlled … people are promoting it in place of cigarettes thinking it is safe. But it is not.”

Dokha gives a ‘high’ after only one or two puffs. “Sometimes, users feel dizzy and get high for a few seconds,” said Dr Houqani who is working with policy makers to highlight the issue.

Dr Raghib Ali, Director Public Health Research Centre, NYU Abu Dhabi, said that the current evidence suggests that prevalence of midwakh is increasing. “It is increasingly becoming more popular than cigarettes … people are not aware of its negative effects on health.”

“More research needs to be done to assess if youngsters are aware of the negative impact on their health from the use of dokha,” he added.

This paper examines the use of midwakh/dokha which is widely used in the UAE and region. Cursory indications, such as the proliferation of dokha websites and dokha sales at tobacco retailers internationally, suggest that midwakh/dokha use could potentially emerge outside the Gulf region.

Similar to hookahs, the marketing of midwakh/dokha targets young people, the study notes.

It adds: “Preliminary data and observations from health providers and the public health sector suggest that midwakh smoking may pose challenges to the tobacco control efforts in the region.”

As per the study, tobacco control efforts continue to focus almost exclusively on curbing cigarette use (including smoking cessation training of health and education professionals, media campaigns, increased taxation and banning tobacco smoking in public places), despite the alarming new research indicating increased use of ATPs.

Largest study on the subject

One of the studies used to collate the dokha data included the largest study published to date on midwakh use in which a sample of 170,430 adult UAE nationals was taken.

Participants’ self-reported tobacco smoking habits via a questionnaire and data were collected over a period of two years. Midwakh use was the most common tobacco product used after cigarettes, accounting for 15 per cent of all tobacco smokers, and the users were predominantly men. Among midwakh users, on an average the age of the smokers was 30; duration of use was 9.3 years and frequency of use was 12 times a day.

The authors concluded that the use of midwakh, particularly at a young age, is an important concern for public health activities in Abu Dhabi.

The second study, a smaller survey comprising 104 students, aged 17–27 years, attending Gulf Medical University in Ajman, concluded that 30 per cent of males and five per cent of females reportedly smoked dokha.

Among dokha smokers, 33 per cent smoked more than 100 times in their lifetime and 17 per cent were reported to have smoked 26–100 times in their life. The findings were alarming as they are derived from a select group of individuals training to be physicians.

After reviewing the literature, Dr Houqani said, it was clear that very little research has been carried out to explore the potential harms that may result from midwakh smoking. -asmaalizain@khaleejtimes.com

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DOKHA (Arabic for ‘dizzy’) is the tobacco blend that is smoked in a pipe called a midwakh. It is a combination of tobacco leaves with a variety of barks, herbs, spices, dried flowers or dried fruit, and is known for its high nicotine content containing up to five times as much as a normal cigarette.