‘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

Abstract

BackgroundDokha (‘dizziness’ in English) is a type of alternative tobacco product (ATP) increasing in popularity in the Arab world; and smoked in a pipe called a midwakh. Midwakh use is common among nationals in the United Arab Emirates (UAE); yet, evidence indicates its spread among expats in the UAE as well as beyond the UAE. Research on midwakh use is nascent, and no qualitative research has been published. This paper explored the context and determinants of midwakh use among young adults in Lebanon using qualitative methods.MethodsWe conducted four focus group discussions with 18 midwakh ever smokers aged 18–25 years in Lebanon. Discussions were recorded, transcribed and thematically analysed using the Pragmatics, Attraction, Communication, Expectations framework.Results‘Pragmatics’ was evident in participants’ comments about availability of a supply of dokha. For ‘attraction’, participants described why they prefer midwakh smoking and compared it to other ATPs. Regarding communication, participants shared terms used to describe their use of midwakh (eg, ‘buzz’/taking a hit). Participants also described expectations from smoking midwakh, including stress relief.ConclusionMidwakh smoking is appealing to young adults due to factors such as the ‘buzz’, perceived harm reduction, stress relief and its ability to satisfy nicotine craving with small amounts of tobacco. As a result, despite experiencing negative effects on first use, young adults choose to continue to use midwakh, and find it hard to quit. These results have implications for prevention and control of midwakh smoking among young adults. Framework Convention on Tobacco Control guidance documents to address ATPs are critically needed to prevent the global spread of yet another tobacco product.

Prevalence of cigarette and waterpipe tobacco smoking among adults in three Eastern Mediterranean countries: a cross-sectional household survey

“…These small sample sizes may have resulted in unreliable estimates of the detailed patterns of cigarette and waterpipe smoking reported for females in the two countries. The study also did not report on use of other alternative smoking products such as electronic cigarettes, 17 27 heated tobacco and midwakh, 28 29 which are increasingly more available in the loosely regulated markets of those countries.…”