Emiratis who use several types of tobacco are putting themselves at higher risk, study suggests

Research finds indicators of even greater ill-health among people who smoke multiple forms of tobacco

Shisha is one of a number of popular tobacco smoking methods in the region. Photo: The National

A seven-year nationwide study has found more than half of Emirati smokers use at least two forms of tobacco, raising concerns they are putting their health at greater risk as a result.

The research – based on information collected from more than 2,500 adult citizens – revealed 47 per cent of those who smoke used one type of combustible tobacco, 35 per cent used two types and 18 per cent used three or more.

Based on self-reported data, the new study found that such “poly tobacco” users on average had higher levels of fats called triglycerides in their blood, which can contribute to an increased risk of stroke, heart attack and heart disease.

The research also found that any kind of tobacco use was linked to similar indicators of possible cardiovascular disease, including higher levels in the blood of harmful forms of cholesterol.

Dr Sukhant Bagdia, a consultant pulmonologist at Burjeel Medical City in Abu Dhabi, emphasised the dangers posed to health by all forms of tobacco smoking.

“In my practice, I have multiple patients, who use not just cigarettes, but also medwahk, shisha and cigars.

“These are the risk factors for cardiovascular issues, even lung inflammation or bronchitis, or even to a certain extent, they would be also responsible for higher likelihood of cancer in the lungs and other organs.

“Those using multiple forms of smoking would be at a higher risk for cardiovascular and pulmonary disease, more comorbidity illness and other general health related issues.

“None of the smoking forms are safe, they all have their own bad side effects.”

Previous research in the UAE has found that medwakh users are more than three times as likely as cigarette smokers to be dependent on tobacco, while medwakh and shisha products have been found to contain larger amounts of metals associated with cancer.

Charting Emirati health

The findings were gathered between 2016 and 2023 as part of the UAE Healthy Future Study, which has recruited around 15,000 people and will follow many of them over time to assess how lifestyle choices, genetics and environment can impact risk factors for obesity, diabetes and heart disease.

The survey was launched in 2016 in a partnership between New York University Abu Dhabi and Tamkeen − which collaborates with leading institutions to deliver social, cultural and educational projects − with the support of the Ministry of Health and Prevention and other health bodies.

Health authorities have taken steps to reduce tobacco use in the UAE. Pawan Singh / The National

“Any tobacco use is associated with potential changes in cardiovascular disease markers. That’s the take-home message,” said Andrea Leinberger-Jabari, the first author of the study and the assistant director for tobacco research at New York University Abu Dhabi’s Public Health Research Centre.

Cardiovascular disease is one of numerous health problems linked to smoking, with others including cancer and respiratory conditions such as emphysema.

A 2019 study from the US indicated that the risk of death among cigarette smokers who additionally used other types of tobacco was “as high as and sometimes higher than those of exclusive cigarette smokers”.

Gender gap and global picture

Data for the study was supplied by 7,535 Emirati adults, of which 2,550 − 34 per cent − were smokers.

The seventh edition of The Tobacco Atlas − a global analysis of smoking – in 2022 found 15.5 per cent of men and 2.5 per cent of women used tobacco.

These figures represented the entire UAE population, taking into account both Emiratis and residents, with the Healthy Future Study only surveying citizens.

World Health Organisation data from 2022 indicated that 22.3 per cent of the world’s adult population uses tobacco.

Among Emiratis in the study, there is a huge disparity between the sexes when it comes to smoking, with 50 per cent of UAE national men using some form of combustible tobacco, but just seven per cent of women.

The work is part of the International Tobacco Control Policy Evaluation Project, which looks at the impact of tobacco-control policies in more than 30 countries that together are home to more than half the world’s population.

Published in Nicotine and Tobacco Research, the new paper is titled, Factors associated with single, dual and poly combustible tobacco use among Emirati adults in the United Arab Emirates: The UAE Healthy Future and ITC Survey results (2016 – 2023).

Ms Leinberger-Jabari said that the UAE Healthy Future Study would provide particularly useful information for researchers about because, being a longitudinal study, it would collect data from the same individuals over many years.

“It’s going to be an incredibly helpful study to keep following these individuals over time and look at how tobacco use behaviours might be changing.”

Anti-smoking strategy

The work will also mean that the UAE can be compared to other countries that are part of the ITC project and could inform global tobacco policy too, Ms Leinberger-Jabari said.

Curbing tobacco and e-cigarette use is a top priority for the UAE, with a key public health strategy implementing a smoke-free environment and increased public awareness of the health risks.

In 2017 the UAE brought in a 100 per cent tax on tobacco and tobacco products, meaning that 50 per cent of the total retail price is accounted for by tax.