dokha

{{Expand section|section=1|more information with authoritative sources|talksection=History section expansion|date=November 2018|small=yes}}

Tobacco has been cultivated and used in Middle Eastern countries for approximately 500 years. It originated in Iran during the 15th century, as use spread among sailors in the Caspian Sea, which led to its eventual spread throughout all of the Middle East during the following centuries. Traditionally, dokha consists of dried and ground tobacco leaves and spices that are sometimes also mixed with dried flowers and fruits. Depending on local traditions, different species of native plants were also used.{{Cite journal|last1=Vupputuri|first1=S.|last2=Hajat|first2=C.|last3=Al-Houqani|first3=M.|last4=Osman|first4=O.|last5=Sreedharan|first5=J.|last6=Ali|first6=R.|last7=Crookes|first7=A. E.|last8=Zhou|first8=S.|last9=Sherman|first9=S. E.|date=2016-03-01|title=Midwakh/dokha tobacco use in the Middle East: much to learn|journal=Tobacco Control|language=en|volume=25|issue=2|pages=236–241|doi=10.1136/tobaccocontrol-2013-051530|issn=0964-4563|pmid=25342581|pmc=4789808}}

Modern dokha maintains many of the characteristics of its traditional forms, consisting of tobacco and spices.

Unlike most tobaccos, dokha is not fire cured and cut, but dried in the arid desert region where it is harvested. It is finely ground to preserve the strength, freshness and flavor of the tobacco. The tobacco is then blended with other spices and herbs to create the final product.{{citation needed|date=July 2023}} In many countries where dokha is used, there are a number of available tobacco strengths (typically described in Arabic as "hot", "warm" or "cold"), which indicate the harshness of a particular blend.{{citation needed|date=December 2019}}

{{See also|Tobacco smoking}}

{{Tobacco}}File:Stone Medwakh Pipe with Gold Finishing and Chanta.pngDokha is almost exclusively smoked out of an elongated pipe called a midwakh (alternatively spelled 'medwakh'). The traditional midwakh has no filter, but more recent variations contain a removable, stem-mounted filter. A small container called a chanta is sometimes used to store and dispense the tobacco. Approximately 0.5-1 grams of dokha tobacco is smoked at a time, and is usually consumed in about two inhalations. One study estimates that a typical daily user of dokha consumes approximately 6 grams of product in around 12 smoking sessions.{{Cite journal|last1=Shemmari|first1=Noora Al|last2=Shaikh|first2=Rizwana Burhanuddin|last3=Sreedharan|first3=Jayadevan|date=2015-02-25|title=Prevalence of Dokha Use among Secondary School Students in Ajman, United Arab Emirates|journal=Asian Pacific Journal of Cancer Prevention|volume=16|issue=2|pages=427–430|doi=10.7314/apjcp.2015.16.2.427|pmid=25684466|issn=1513-7368|doi-access=free}}{{Cite journal|last1=Hassona|first1=Y.|last2=Scully|first2=C.|date=2015-07-01|title=Dokha: an emerging smoking habit with possible oral effects|journal=Oral Diseases|volume=21|issue=5|pages=679–680|doi=10.1111/odi.12324|issn=1601-0825|pmid=25690423}}

A preliminary study that found dokha has significantly more nicotine than other tobacco products such as cigarettes.{{Cite journal|last1=Mahboub|first1=Bassam|last2=Mohammad|first2=Ayesha Begum|last3=Nahlé|first3=Ayssar|last4=Vats|first4=Mayank|last5=Al Assaf|first5=Omar|last6=Al-Zarooni|first6=Hamdan|date=2018-09-01|title=Analytical Determination of Nicotine and Tar Levels in Various Dokha and Shisha Tobacco Products|journal=Journal of Analytical Toxicology|volume=42|issue=7|pages=496–502|doi=10.1093/jat/bky029|issn=1945-2403|pmid=29750269|doi-access=free}} Nicotine is a highly addictive recreational drug which generally produces feelings of euphoria, increased alertness and a sense of relaxation{{Cite news|url=https://www.mydr.com.au/addictions/smoking-what-are-the-effects|title=Smoking: what are the effects? - myDr.com.au|last=(ADF)|first=Australian Drug Foundation|access-date=2018-11-16|language=en|archive-url=https://web.archive.org/web/20181117022259/https://www.mydr.com.au/addictions/smoking-what-are-the-effects|archive-date=2018-11-17|url-status=live}}{{Cite journal|last1=Pomerleau|first1=C. S.|last2=Pomerleau|first2=O. F.|date=1992|title=Euphoriant effects of nicotine in smokers|journal=Psychopharmacology|volume=108|issue=4|pages=460–465|issn=0033-3158|pmid=1410160|doi=10.1007/BF02247422|url=https://deepblue.lib.umich.edu/bitstream/2027.42/46338/1/213_2005_Article_BF02247422.pdf|hdl=2027.42/46338|s2cid=15911893|hdl-access=free}} and dokha is well known to quickly satisfy intense nicotine cravings.

Users sometimes describe the sensation as 'dizziness', which is where dokha's name (meaning 'dizziness' or 'vertigo' in Arabic) is presumed to be derived. Dokha does not traditionally contain cannabis, but in some cultures where dokha is uncommon, it has been reportedly mistaken for ground cannabis.{{Cite news|url=https://www.thenational.ae/uae/health/uae-s-medwakh-smokers-know-it-may-kill-them-one-day-but-they-carry-on-1.885300|title=UAE's medwakh smokers know it may kill them one day, but they carry on|last=Dajani|first=Haneen|date=2019-07-14|work=The National|access-date=2019-10-13|url-status=live|archive-url=https://web.archive.org/web/20190726135659/https://www.thenational.ae/uae/health/uae-s-medwakh-smokers-know-it-may-kill-them-one-day-but-they-carry-on-1.885300|archive-date=2019-07-26}}

While dokha is not a new tobacco product, use has increased intensely in the Middle East, particularly in the UAE, and especially among males aged 20–39, during the 2000s and 2010s.{{Cite journal|last1=Al-Houqani|first1=Mohammed|last2=Ali|first2=Raghib|last3=Hajat|first3=Cother|date=2012-06-15|title=Tobacco Smoking Using Midwakh Is an Emerging Health Problem – Evidence from a Large Cross-Sectional Survey in the United Arab Emirates|journal=PLOS ONE|language=en|volume=7|issue=6|pages=e39189|doi=10.1371/journal.pone.0039189|issn=1932-6203|pmc=3376102|pmid=22720071|bibcode=2012PLoSO...739189A|doi-access=free}}{{Cite web|url=https://www.dentistryiq.com/articles/2015/03/tobacco-risks-and-prevention-what-is-dokha.html|title=Tobacco use: What is dokha?|last=Perno Goldie|first=Maria|date=March 10, 2015|website=dentistryiq.com|archive-url=https://web.archive.org/web/20181116090235/https://www.dentistryiq.com/articles/2015/03/tobacco-risks-and-prevention-what-is-dokha.html|archive-date=November 16, 2018|url-status=live|access-date=2018-11-16|df=mdy-all}} Experts speculate this may be due to tobacco control efforts' exclusive focus on cigarette use, coupled with the fact that dokha and midwakh usage in these countries has become the second-most popular form of tobacco, after cigarettes.{{Cite news|url=https://www.khaleejtimes.com/news/uae-health/dokha-smoking-becoming-an-addiction-in-uae-say-experts|title=Dokha smoking becoming an addiction in UAE, say experts|last=Kuttab|first=Jasmine Al|date=2017-11-14|work=Khaleej Times|access-date=2018-11-27|archive-url=https://web.archive.org/web/20181127125701/https://www.khaleejtimes.com/news/uae-health/dokha-smoking-becoming-an-addiction-in-uae-say-experts|archive-date=2018-11-27}}

Culminating in legislative efforts in 2009 and 2018, there has also been particular concern in the UAE that teenagers may be getting easier access to dokha tobacco when they are unable to obtain cigarettes, and that dokha has quickly become popular among young adults.{{Cite news|url=https://gulfnews.com/uae/education/dubais-teenagers-take-to-dokha-1.1039067|title=Dubai's teenagers take to 'dokha'|access-date=2018-11-15|language=en|archive-url=https://web.archive.org/web/20181116000952/https://gulfnews.com/uae/education/dubais-teenagers-take-to-dokha-1.1039067|archive-date=2018-11-16|url-status=live}} Dokha's reported lack of lingering smells (compared to other forms of smoked tobacco) and the relatively smaller amount of material smoked in a given session, make it a convenient form of discreetly and quickly satisfying nicotine cravings, which has made dokha popular among underage smokers. One study assessing the prevalence of dokha smoking among secondary school students in the UAE found that 39% had ever smoked tobacco products, 36% had ever smoked dokha specifically, and 25% of them were now current users of dokha, which is very high compared to other forms of smoking.

Dokha use has seen some emergence in the Western world, and some health officials speculate this may be due to immigration, globalized commerce, and internet sales, but such a trend has not been definitively studied or proven. Retail companies specifically catering to dokha smokers can now be found in the United Kingdom, and more tobacco shops are stocking dokha and midwakh accessories to fill a gap in the market, which some company representatives claim is driven by increased immigration from Middle Eastern countries.{{Cite news|url=https://www.vice.com/en/article/uk-students-are-smoking-dokha/|title=Getting to Grips with Dokha, the Super-Strength Tobacco Becoming Popular in Britain|date=2015-10-28|work=Vice|access-date=2018-11-16|language=en-us|archive-url=https://web.archive.org/web/20181116085844/https://www.vice.com/en_us/article/4wb89p/uk-students-are-smoking-dokha|archive-date=2018-11-16|url-status=live}} There have been reports that Dokha may be spreading in popularity in some regions of India, due to one successful startup company.{{Cite news|url=https://www.thequint.com/news/india/why-are-so-many-young-indians-smoking-iranian-dokha|title=Why Are so Many Young Indians Smoking Iranian Dokha?|last=Rattanpal|first=Divyani|date=2016-02-23|work=The Quint|access-date=2018-11-17|archive-url=https://web.archive.org/web/20181117141701/https://www.thequint.com/news/india/why-are-so-many-young-indians-smoking-iranian-dokha|archive-date=2018-11-17|language=en}}{{Cite news|url=https://www.entrepreneur.com/article/292901|title=A Conglomerate Of Conceptions|date=2017-04-15|work=Entrepreneur Magazine|access-date=2018-11-17|archive-url=https://web.archive.org/web/20181117142620/https://www.entrepreneur.com/article/292901|archive-date=2018-11-17|publisher=Entrepreneur India|language=en}}

{{See also|Tobacco control|Smoking ban}}

Dokha is regulated by most countries in the same manner as they would other tobacco products.

The UAE passed "Federal Law No. 15 regarding Tobacco Control" in December 2009, making the legal age to purchase tobacco (including dokha) 18 years old. The law also made smoking in cars (with children under 12 present), houses of worship, educational campuses and health/fitness centers, illegal.{{Cite act|title=القانون الاتحادي رقم 15 بشأن مكافحة التبغ|trans-title=Federal Law No. 15 Regarding Tobacco Control|type=Law|number=|date=29 December 2009|url=https://www.tobaccocontrollaws.org/files/live/United%20Arab%20Emirates/United%20Arab%20Emirates%20-%20Cabinet%20Decision%20No.%2012-2011%20-%20national.pdf|language=ar}} This law was expanded in 2012 by adopting GSO standards that require tobacco packaging warning messages.{{Cite act|title=بطاقات عبوات منتجات التبغ|trans-title=Standard Specifications, Adopting GSO 246/2011 on Labeling of Tobacco Product Packages|type=Law|number=|date=9 August 2012|url=https://www.tobaccocontrollaws.org/files/live/United%20Arab%20Emirates/United%20Arab%20Emirates%20-%20UAE.S_GSO%202462011%20-%20national.pdf|language=ar|accessdate=23 November 2018|archiveurl=https://web.archive.org/web/20181124054948/https://www.tobaccocontrollaws.org/files/live/United%20Arab%20Emirates/United%20Arab%20Emirates%20-%20UAE.S_GSO%202462011%20-%20national.pdf|archivedate=24 November 2018}}

In October 2015, the Dubai Municipality issued warnings to 40 dokha shops to obtain certificates of conformity from the UAE Authority for Standardization and Metrology. The shops were required to discontinue the practices of allowing customers to sample dokha in the shop and cleaning their midwakh pipes for them in order to obtain these certificates.{{Cite news|url=https://gulfnews.com/uae/government/municipality-warns-40-dokha-stores-for-violation-1.1594168|title=Municipality warns 40 dokha stores for violation|last1=Botros|first1=Maria|date=2015-10-03|work=Gulf News|access-date=2018-11-27|archive-url=https://web.archive.org/web/20181127125128/https://gulfnews.com/uae/government/municipality-warns-40-dokha-stores-for-violation-1.1594168|archive-date=2018-11-27|last2=Bedirian|first2=Razmig|language=en}} Despite these efforts, there were still concerns from local leaders and health officials over shopkeepers illegally selling dokha and midwakh pipes to underage customers, and teenage use of tobacco continued to rise.

An excise tax was introduced on October 1, 2017, on tobacco products in an effort to discourage their consumption. There was confusion among dokha users and retailers as to whether all dokha products, or only specific dokha brands, were subject to the excise tax.{{Cite news|url=https://www.thenational.ae/uae/government/smokers-turn-to-dokha-as-sellers-are-yet-unsure-if-it-falls-under-excise-tax-regulations-1.664850|title=Smokers turn to dokha as sellers are yet unsure if it falls under excise tax regulations|last=Zacharias|first=Anne|date=2017-10-07|work=The National|access-date=2018-11-27|archive-url=https://web.archive.org/web/20181127130406/https://www.thenational.ae/uae/health/uae-smoking-poll-only-one-in-four-have-changed-their-habit-since-introduction-of-sin-tax-1.714421|archive-date=2018-11-27|language=en}} A poll the following year showed that one in four smokers said that the new tax changed their habit.{{Cite news|url=https://www.thenational.ae/uae/health/uae-smoking-poll-only-one-in-four-have-changed-their-habit-since-introduction-of-sin-tax-1.714421|title=UAE smoking poll: only one in four have changed their habit since introduction of 'sin tax'|last=Webster|first=Nick|date=2018-05-19|work=The National|access-date=2018-11-27|archive-url=https://web.archive.org/web/20181127130406/https://www.thenational.ae/uae/health/uae-smoking-poll-only-one-in-four-have-changed-their-habit-since-introduction-of-sin-tax-1.714421|archive-date=2018-11-27|language=en}}

In May 2018, new regulations were approved by the UAE's National Tobacco Control Programme by the Ministry of Health and Prevention. Intended to be in place by the end of the year, the regulations set purchase restrictions specifically on dokha products. They also ban the practice of bottling and refilling larger quantities at home or in shops, which has been the local custom, and require dokha product packaging to include pictorial warnings (the same way other types of tobacco products were required to have per the 2012 law).

{{Main|Health effects of tobacco}}Dokha is just as or more dangerous than cigarettes, and more research is needed to fully investigate the adverse effects, as there is little comparative study between dokha and other tobacco products.

{{As of|2019||df=}}, few studies have been performed on the acute effects specific to dokha use, but one uncontrolled study among male UAE medical university students assessed the following:{{Cite journal|last1=Shaikh|first1=Rizwana B.|last2=Abdul Haque|first2=Noor Mohammad|last3=Abdul Hadi Khalil Al Mohsen|first3=Hassan|last4=Abdul Hadi Khalil Al Mohsen|first4=Ali|last5=Haitham Khalaf Humadi|first5=Marwa|last6=Zaki Al Mubarak|first6=Zainab|last7=Mathew|first7=Elsheba|last8=Al Sharbatti|first8=Shatha|date=2012-01-01|title=Acute effects of dokha smoking on the cardiovascular and respiratory systems among UAE male university students|journal=Asian Pacific Journal of Cancer Prevention|volume=13|issue=5|pages=1819–1822|issn=1513-7368|pmid=22901128|doi=10.7314/apjcp.2012.13.5.1819|doi-access=free}}

• Increased systolic blood pressure
• Decreased diastolic blood pressure
• Increased heart rate and respiration

File:Nicotine and Tar Levels in Dokha and Shisha Tobacco Products.png

As dokha consists of tobacco and other plant material, health officials suspect the effects from prolonged use are similar or identical to that of cigarettes and other tobacco products, but {{As of|2020||df=|lc=y}} there have been no clinical studies to identify the long-term risks specific to it. Anecdotal evidence from chronic users suggests that long-term use may cause them to feel out of breath after strenuous activity, and they report difficulty quitting.

One study speculated that oral lesions are a possible chronic side effect of irritation from the midwakh pipe.

Some of the health risks of tobacco smoking in general, that have been identified, are:

• Chronic chest infections{{Cite journal|last1=Davies|first1=P. D. O.|last2=Yew|first2=W. W.|last3=Ganguly|first3=D.|last4=Davidow|first4=A. L.|last5=Reichman|first5=L. B.|last6=Dheda|first6=K.|last7=Rook|first7=G. A.|date=April 2006|title=Smoking and tuberculosis: the epidemiological association and immunopathogenesis|journal=Transactions of the Royal Society of Tropical Medicine and Hygiene|volume=100|issue=4|pages=291–298|doi=10.1016/j.trstmh.2005.06.034|issn=0035-9203|pmid=16325875}}{{Cite journal|last1=Jha|first1=Prabhat|last2=Jacob|first2=Binu|last3=Gajalakshmi|first3=Vendhan|last4=Gupta|first4=Prakash C.|last5=Dhingra|first5=Neeraj|last6=Kumar|first6=Rajesh|last7=Sinha|first7=Dhirendra N.|last8=Dikshit|first8=Rajesh P.|last9=Parida|first9=Dillip K.|date=2008-03-13|title=A nationally representative case-control study of smoking and death in India|journal=The New England Journal of Medicine|volume=358|issue=11|pages=1137–1147|doi=10.1056/NEJMsa0707719|issn=1533-4406|pmid=18272886|doi-access=free}}{{Cite journal|last1=Nuorti|first1=J. P.|last2=Butler|first2=J. C.|last3=Farley|first3=M. M.|last4=Harrison|first4=L. H.|last5=McGeer|first5=A.|last6=Kolczak|first6=M. S.|last7=Breiman|first7=R. F.|date=2000-03-09|title=Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team|journal=The New England Journal of Medicine|volume=342|issue=10|pages=681–689|doi=10.1056/NEJM200003093421002|issn=0028-4793|pmid=10706897|doi-access=free}}
• Obstructive pulmonary disease{{Cite journal|last=Devereux|first=Graham|date=2006-05-13|title=ABC of chronic obstructive pulmonary disease. Definition, epidemiology, and risk factors|journal=BMJ (Clinical Research Ed.)|volume=332|issue=7550|pages=1142–1144|doi=10.1136/bmj.332.7550.1142|issn=1756-1833|pmc=1459603|pmid=16690673}}
• Increased risk of larynx,{{Cite web|url=http://www.cancerresearchuk.org/about-cancer/type/larynx-cancer/about/risks-and-causes-of-laryngeal-cancer|title=Risks and causes {{!}} Laryngeal cancer {{!}} Cancer Research UK|website=cancerresearchuk.org|date=11 April 2015 |language=en|access-date=2018-11-16|archive-url=https://web.archive.org/web/20161127185959/http://www.cancerresearchuk.org/about-cancer/type/larynx-cancer/about/risks-and-causes-of-laryngeal-cancer|archive-date=2016-11-27|url-status=live}} respiratory"[http://www.legacyforhealth.org/PDFPublications/Lung_Cancer_and_Smoking.pdf Lung Cancer and Smoking] {{Webarchive|url=https://web.archive.org/web/20130315104053/https://www.legacyforhealth.org/PDFPublications/Lung_Cancer_and_Smoking.pdf |date=2013-03-15 }}" (PDF). Fact Sheet. http://www.LegacyForHealth.org. 2010-11-23. Retrieved 2012-05-06. or other organ cancers{{Cite journal|last=Boffetta|first=Paolo|date=September 2008|title=Tobacco smoking and risk of bladder cancer|journal=Scandinavian Journal of Urology and Nephrology. Supplementum|volume=42|issue=218|pages=45–54|doi=10.1080/03008880802283664|issn=0300-8886|pmid=18815916|s2cid=39577281}}{{Cite journal|last1=Iodice|first1=Simona|last2=Gandini|first2=Sara|last3=Maisonneuve|first3=Patrick|last4=Lowenfels|first4=Albert B.|date=July 2008|title=Tobacco and the risk of pancreatic cancer: a review and meta-analysis|journal=Langenbeck's Archives of Surgery|volume=393|issue=4|pages=535–545|doi=10.1007/s00423-007-0266-2|issn=1435-2451|pmid=18193270|s2cid=23516238}}
• Nicotine dependence and tolerance, increased risks of nicotine poisoning

A February 2018 study called for further research into the harmful effects of dokha smoke after it found that three different types of dokha tested from the Middle East and North Africa region contained toxic metals comprising "22 irritants, 3 known carcinogens, 5 central nervous system depressants, in addition to several other compounds with miscellaneous effects".

In September 2018, a University of Sharjah study compared the nicotine and tar levels in dokha to other tobacco products, which found dokha had significantly higher levels of both. Nicotine in dokha was measured at 23.83–52.8 mg/g compared to 0.8–20.52 mg/g in shisha, and 0.5–19.5 mg/g in cigarettes. Tar in dokha was measured at 21.6–45.02 mg/g compared to 1.68–11.87 mg/g in shisha and 5–27 mg/g in cigarettes.

In May 2019, a second study at the University of Sharjah attempted to quantify trace metals in dokha and shisha products, using EDXRF. Traces of aluminum, calcium, chromium, copper, iron, magnesium, manganese, nickel, potassium, strontium and zinc were detected in both product types. Across the 13 dokha products tested, the highest mean concentrations were of calcium, potassium and magnesium (8235.77 ± 144.51, 4467.50 ± 168.06, and 2096.20 ± 130.69 μg/g, respectively).{{Cite journal|last1=Mohammad|first1=Ayesha Begum|last2=Mohammad|first2=Shabber Hasan Khan|last3=Mohammad|first3=Masrath Khathoon|last4=Khan|first4=Abdus Sayeed|last5=Al-Hajjaj|first5=Mohamed Saleh|date=2019-05-01|title=Quantification of Trace Elements in Different Dokha and Shisha Tobacco Products using EDXRF|journal=Journal of Analytical Toxicology|volume=43|issue=4|pages=e7–e22|doi=10.1093/jat/bky095|issn=1945-2403|pmid=30462216}}

• [https://www.youtube.com/watch?v=ra1RdNNx2vY Vertigo (2016) – "a short documentary film on dokha smoking addiction" (YouTube)]
• {{IMDb title|qid=Q123536968|title=Vertigo|description=2016 documentary film}}

Category:Tobacco products

Category:Pipe smoking

Category:Smoking

Category:Tobacco in the United Arab Emirates