Prevalence, attitudes, behaviours and policy evaluation of midwakh smoking among young people in the United Arab Emirates: Cross-sectional analysis of the Global Youth Tobacco Survey

Abstract

Introduction Non-cigarette tobacco products are an increasing public health concern globally. Little is known about midwakh, a pipe indigenous to the United Arab Emirates (UAE). This study aimed to assess the prevalence, attitudes, behaviours and policy evaluation of midwakh smoking among 13 to 15 year olds in the UAE. Methods We conducted secondary analyses of the 2013 UAE Global Youth Tobacco Survey. The main three outcomes were ever use, current use (past-30 days), and the number of midwakhs smoked per day. We assessed cessation, attitude, and policy measures. Regression models identified the association between each outcome measure and sex, school grade, nationality, weekly spending money, cigarette use, and parent and peer tobacco use. Results The prevalence of ever and current midwakh use were 18.5% and 9.0%, respectively. Daily midwakh users smoked a median of 8.0 per day while non-daily users smoked 3.8 per month. Higher midwakh prevalence was reported among wealthier males, older age groups, concurrent cigarette users and among participants having peers or parents who use tobacco. There was also variation by nationality. Reduced harm perception was greater among midwakh users than non-users. About 39.6% reported being declined a midwakh purchase due to age, and 35.5% reported noticing health warnings on packages. Conclusions Midwakh use is prevalent among 13 to 15 year olds in the UAE, and burden lies mainly with daily users. Further needed research should not delay implementation and evaluation of policies known to curb tobacco use among youth, including taxation, media campaigns, and provision of cessation services.

Gender differences in waterpipe tobacco smoking among university students in four Eastern Mediterranean countries

“…A recent study on adult UAE nationals reported that midwakh was the second most common type of smoking with a prevalence of 3.6% among males and rarely smoked by females 20 . Another UAE study on youth aged 13–15 years 21 reported a 9.7% prevalence among males, double that of females (3.4%), while a lower prevalence (6.7% and 2.7%, respectively) was reported from Lebanon 22 among youth aged 12–18 years. Smokeless tobacco was uncommon among waterpipe smokers in our study.…”

Evidence from the Lebanon Global School-based Student Health Survey on midwakh tobacco smoking in school students: a harbinger of the next global tobacco pandemic ?

“…More than 15% of ninth-grade male expatriate students in the United Arab Emirates were current smokers of midwakh and smoked it regularly (25 out of 30 days on average) and often (2-3 times a day) (11). In addition, data from the Global Youth Tobacco Survey on students in grades 10-12 in the United Arab Emirates indicated that about 21% had ever smoked midwakh, with no difference between national and expatriate students from the USA, Europe or Australia (12). At least two American websites offer access to midwakh products (19,20).…”

“…A more recent study found that the prevalence rates of ever and current smoking with a midwakh in expatriate school students (North American, Australian and/or European) in the United Arab Emirates were not significantly different from those of Emirati students (12). Therefore, while midwakh use has been most popular in the United Arab Emirates and other Gulf countries, this alternative tobacco product threatens to spread within and beyond the Arab world (5,12,13).…”

‘When I smoked it, it was like a slap in the face but it felt really good’: exploring determinants of midwakh use among young adults in Lebanon

“…However, since the majority of the population of the UAE is expatriate, midwakh may spread globally 12 13. Evidence indicates prevalence of midwakh smoking is similar among nationals and expatriate students 12…”

“…Research on the epidemiology, determinants and health effects of midwakh use is nascent, but provides evidence that midwakh smokers may be at risk of tobacco-related diseases comparable to that of cigarette smoking 4 6 7. Midwakh use has been documented mostly in the United Arab Emirates (UAE),8–12 among nationals and expatriates,10 12 with higher prevalence among males. Midwakh smoking has also spread beyond the UAE, as evident by ever smoking rates among 7th-12th graders in Lebanon 13.…”