Midwakh/dokha tobacco use in the Middle East: much to learn

Abstract

Many alternative tobacco products (ATPs), such as hookahs, have grown in popularity and use beyond their locale of origin and are therefore becoming a significant global public health concern. This article provides an overview of an under-reported and understudied ATP, dokha, which is smoked in a midwakh pipe. It describes the state of tobacco control in the Arabian Gulf region where midwakh smoking appears to be most common, the history of midwakh and dokha use, and what is known about midwakh smoking from the published literature. On the basis of the stark lack of data on midwakh use, we suggest priority areas to focus future research. 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 Arabian Gulf region. If it is emerging as a new ATP outside this region, there could be a significant impact on tobacco control strategies globally.

Sociodemographic predictors of tobacco smoking among expatriate and national adolescents in the United Arab Emirates

“…Recently, several studies have highlighted an alarming increase in the use of unconventional forms of tobacco, including shisha and midwakh, particularly in the Gulf Region (17). Earlier reports from the GYTS suggest that the average rate of shisha smoking among (18).…”

The Resurgence of the Tobacco Pipe in the Gulf Region

“…Dokha use originated in northern Iran in the 15th century and widespread use among sailors along the Caspian Sea resulted in its introduction into the Middle East in the 1500s [6]. Whilst it was relatively uncommon 10 years ago in the region, the increase in dokha and midwakh use is of particular concern due to the rapidity of its uptake and the potential to appeal to the lesser-tapped child targets.…”

“…There are suggestions that midwakh smoking may emerge in Western countries among 'youth sub-cultures' based on the acceleration of websites selling midwakh and dokha and anecdotal observations of sales of midwakh and dokha in specialty stores in Western countries [6,[12][13][14][15][16].…”

Tobacco packaging and labelling policies in countries of the Eastern Mediterranean and Western Pacific Regions: Post-deadline assessment of the time-bound measures of WHO FCTC Article 11

“…For example, waterpipe tobacco was traditionally used across countries of the EMR and in few countries in the WPR, but it has recently surpassed cigarette use in some countries [37][38][39][40][41][42][43][44][45] . In Malaysia, one in three female tobacco users consumed smokeless tobacco alone, but PHWs were required by law on cigarettes only 20 .…”

“…Smokeless tobacco products and other forms of smoked tobacco (hand-rolled cigarettes, bidis, kreteks, cigars, cigarillos, pipe tobacco) are used in both regions [37][38][39][40][41][42][43][44][45] . For example, waterpipe tobacco was traditionally used across countries of the EMR and in few countries in the WPR, but it has recently surpassed cigarette use in some countries [37][38][39][40][41][42][43][44][45] .…”