People who use medwakh tobacco pipes are more than three times more likely to be dependent on nicotine than cigarette smokers, new findings in the UAE have revealed.
The new study was conducted by scientists from Gulf Medical University in Ajman, Karnataka Institute of Medical Sciences in India, and New York University.
It is thought to be the first to look at levels of addiction specifically linked to medwakh, which are small pipes filled with tobacco popular in the Emirates.
The researchers behind the work said efforts should be made to make people understand the dangers of becoming dependent on medwakh.
One of the authors of the study, Dr Rizwana Shaikh, of Karnataka Institute of Medical Sciences in India, said the speed at which the tobacco in medwakh pipes was smoked may account for the greater level of dependence.
"Cigarettes are smoked over a period of at least four or five minutes. People take puffs leisurely and it's a kind of social activity," she said.
"When it comes to medwakh, the person is inhaling the nicotine in 30 seconds - it's two deep puffs. It burns up the entire tobacco that's there."
She added that the wide availability and low price of the dokha tobacco used in medwakh made the pipes popular with young people, particularly males, and it is often erroneously seen as less hazardous than cigarettes.
"It has to be brought to the fore that this form of smoking is harmful," said Dr Shaikh, a former associate professor at Gulf Medical University in Ajman.
The study looked at 88 adult smokers in Ajman, 40 of whom used cigarettes and the rest medwakh, and found there was 3.3 times the risk of moderate to high nicotine dependence in the latter group.
While the number of smokers assessed was modest, the results were statistically significant.
“Healthcare practitioners should be aware of the high risk of nicotine dependency among medwakh smokers when recommending smoking cessation strategies,” the authors wrote in the paper titled “Predictors of nicotine dependence among adult male medwakh and cigarette smokers".
The Fagerström test of nicotine addiction
To assess how addicted people were, the study used a modified form of one of the world's best-known measures of nicotine dependence, the Fagerström test.
This asks multiple-choice questions about a person’s smoking habits and gives higher scores to answers suggesting dependence.
Questions in the standard version include, “How soon after you wake up do you have your first cigarette?”, with possible responses being within five minutes, six to 30 minutes after waking, 31 to 60 minutes or more than 60 minutes.
The Fagerström test also asks if smokers find it difficult to refrain from lighting up in places such as the library or cinema, where it is forbidden.
Smokers are also quizzed on, among other things, whether they smoke more during the first hours after they wake up than later in the day, and whether they smoke even if they are so ill they are in bed most of the day.
Another result of the study was that nicotine dependence was almost twice as great among smokers who inhaled deeply, compared to those who did not, although this finding was not statistically significant.
Smoking, which the authors said was associated with an approximately 10-year reduction in life expectancy, remains a major concern in the UAE, with an estimated nine per cent of residents – including 15 per cent of men – using tobacco.
Medwakh is thought to be particularly popular among younger people, with the study quoting previous research indicating that 23.4 per cent of Dubai high school pupils used the pipes at least weekly.
The paper suggested the higher level of dependence linked to medwakh could be because the pipes were filled with dokha, a blend of tobacco and herbs.
Research published in 2018 found that dokha contained more nicotine and tar than cigarettes.
While the new study indicated that medwakh pipes may be particularly addictive, doctors said all forms of smoking were hazardous.
“It’s very commonly associated with risk for CVD [cardiovascular disease] here and all over the Middle East,” said Dr Davinder Pal Singh, a cardiologist at NMC Royal Hospital in Dubai Investments Park.
“All types, even shisha, contain some form of nicotine in varying amounts. All are dangerous … All types of smoking are contributing to CVD. Any type of smoking is not good.”
Another study from 2018, by scientists at New York University Abu Dhabi, found that regular medwakh use was linked to alterations in mouth bacteria associated with a greater risk of CVD.
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