Evidence from the Lebanon Global School-based Student Health Survey on midwakh tobacco smoking in school students: a harbinger of the next global tobacco pandemic?

Background: Cigarette smoking is the most common form of tobacco consumption but other methods have grown in popularity. In the United Arab Emirates and other Gulf countries, smoking dokha, a form of tobacco mixed with herbs and spices in a midwakh pipe, is common. Aims: The aim of this study was to determine the prevalence of midwakh use in school students in Lebanon and factors associated with its use. Methods: Data on tobacco use from the Lebanon Global School-based Student Health Survey (GSHS), 2017 were analysed, including current midwakh use (defined as midwakh use at least once in the 30 days before the survey). The survey includes school students in grades 7-12 (12-18 years). Current midwakh use was analysed according to sociodemographic and tobacco-related variables using bivariate and logistic regression analyses. Results: Of the 5590 students included in the analysis, 4.6% were current midwakh users. Current midwakh use was significantly more prevalent in students 13 years and older and in male students (P < 0.01). Current use was also statistically significantly more prevalent in students in public than private schools. Current cigarette smoking (OR = 15.22; 95% CI: 11.08-20.90), ever use of a waterpipe (OR = 9.61; 95% CI: 6.66-13.86) and parental smoking (OR = 1.56; 95% CI: 1.05-2.31) were also significantly associated with current midwakh use. Conclusion: Although midwakh use is low in Lebanon, the patterns of association of midwakh use are similar to those of cigarette and waterpipe smoking in young people. Further research is needed to understand the context of midwakh use and prevent it from spreading.'