Research Article: 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

Date Published: April 24, 2019

Publisher: Public Library of Science

Author(s): Mohammed Jawad, Mohammed Al-Houqani, Raghib Ali, Yehya El Sayed, Omar ElShahawy, Michael Weitzman, Scott E. Sherman, Stanton A. Glantz.


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.

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.

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.

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.

Partial Text

The use of non-cigarette tobacco products has grown substantially in recent decades [1]. About 36% of global tobacco consumers use non-cigarette tobacco products exclusively [2]. In India, bidis are as prevalent as manufactured cigarettes [3] and in the US, the value of non-cigarette tobacco product shipments almost doubled between 2000 and 2013, from $4 billion to $7.7 billion [4]. The Middle East has seen a resurgence in waterpipe tobacco use [5], where in many settings it has exceeded the prevalence of cigarette use [6]. Waterpipe use has also increased in many countries outside the Middle East [5], creating a global public health worry.




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