Predictors of Nicotine Dependence among Adult Male Midwakh and Cigarette Smokers

Abstract

Objectives: Midwakh is a popular form of smoking in the Middle East. This study aimed to assess predictors of nicotine dependence among exclusive cigarette and midwakh smokers in the United Arab Emirates (UAE). Methods: This cross-sectional study was conducted from September to December 2015 in Ajman, UAE. A convenience sampling strategy was used to recruit adult male smokers aged ≥18 years who exclusively smoked either cigarettes or midwakh. A validated self-administered questionnaire was used to collect data from the participants, with nicotine dependence assessed using the Modified Fagerström Test for Nicotine Dependence. In addition, testing was performed to determine levels of salivary cotinine and exhaled breath carbon monoxide (CO). Results: A total of 88 adult male smokers were included in the study, of which 40 (45.5%) were cigarette smokers and 48 (54.5%) smoked midwakh. Most participants were 26–35 years of age (48.9%), followed by 18–25 years (30.7%) and ≥35 years (20.5%). Use of midwakh was associated with a more than three-fold increase in the risk of moderate to high nicotine dependence in comparison with cigarette smoking. Moreover, for each unit increase in CO level, there was a 10% increase in the risk of nicotine dependency. There was also a significant association between nicotine dependence level and depth of inhalation (P = 0.023).  Conclusion: Type of smoking and CO levels were found to be significant predictors of nicotine dependence among adult male smokers. In particular, greater dependency was observed among midwakh smokers compared to those who smoked cigarettes.

Keywords: Tobacco Use; Cigarette Smoking; Addictive Behaviors; Nicotine; Risk Assessment; Carbon Monoxide; Cotinine; United Arab Emirates.