Tradition to Concern: Health Risks and Nicotine Dependence of Midwakh Use in Young Males in the UAE

Abstract Background Midwakh smoking, a traditional practice, poses a growing public health concern in the Middle East region. Despite global efforts to curb tobacco use, smoking rates, particularly among young men, remain high. This study explores nicotine dependency, assesses acute health effects, and measures carbon monoxide levels among midwakh smokers. Methods A quasi-experimental before-and-after study involved 103 young male midwakh smokers in the UAE. Data collection included surveys featuring the Hooked-on Nicotine checklist (HONC), clinical measurements, and pre/post-smoking saliva samples. Statistical analyses, including descriptive, paired samples, correlation, and regression, assessed associations between midwakh smoking, dependency, and health outcomes. Results Preliminary findings found that 33% of midwakh smokers were under 21 years, 68% had below undergrad education, and household incomes over 15,000 AED monthly. Smoking initiation was as early as 10 years. Smoking habits revealed 37% exclusive midwakh, 54% midwakh with e-cigarettes, 21% with shisha, and 34% with cigarettes. Post-smoking clinical measurements showed significant increases in blood pressure, heart, pulse and respiratory rates, and carbon monoxide levels (p ≤ 0.05). Significant differences in pre- (134.6 ng/ml) and post-smoking (154.4 ng/ml) saliva cotinine levels (p ≤ 0.05) were observed. Regression analysis identified predictors of nicotine dependency: initiation age (β= -.315; -0.579,0.0512), household income (β = 1.221; 0.297,2.146), multiple tobacco use (β = 0.576; 0.129,1.024), quit attempts (β = 1.555; 0.519,2.590) and smoking risk perception (β = 3.420; 1.950,4.890) Conclusions Midwakh smoking adversely affects clinical measurements, with early start correlating with higher nicotine dependency, worsened by using multiple tobacco products. Urgent action is needed, including tailored prevention campaigns and support systems to aid youth cessation and raise awareness of midwakh smoking’s harmful effects. Key messages • Midwakh smoking is deeply ingrained in UAE tradition but poses significant adverse health outcomes and nicotine dependency. • There is a need to establish specialized cessation programs offering support and resources to midwakh users, addressing both the health consequences and addictive nature of midwakh.