Here’s Cheryl Olson’s Exclusive Insights on what she says she learned while writing her latest Tobacco Reporter article, about smoking and harm reduction in Middle East nations. 

Middle Eastern countries have some of the highest smoking rates in the world, at least among men. Rates of smoking-related disease are also high. WHO projects minimal decline in smoking rates—unless, unlike WHO, we factor in and push for harm reduction.  

One obstacle is the lack of data on where the greatest harm is coming from. We need to know more about who’s using what products, and about what’s in those products. Cigarettes are most popular, but other common tobacco products appear even more dangerous. For example, smoking shisha tobacco through a hookah (waterpipe) is a sociable activity popular among college students. Pipes are typically heated with charcoal, which gives off its own toxic fumes. A range of carcinogens, including nitrosamines, have been found in samples of shammah, an oral product that mixes leaf with additives like lime, ash, black pepper and oils. Since shammah is locally mixed to various recipes, it’s hard to assess the risks and to figure out what a satisfactory, lower-risk alternative might be. 

I talked with a professor at a prominent US university who works extensively in the Middle East. He asked to remain anonymous so that he could speak frankly. He noted that e-cigarettes have been used for years in the region, but that he couldn’t survey people about it in the UAE until a few years ago, when the products were legalized. That’s because he could not promise confidentiality to survey respondents (something we take for granted in the US). Along the same lines, he said that because smoking among women is frowned upon (except in Lebanon), only about two percent admit to smoking in surveys. But cotinine validation show a much higher proportion of women, around 12%, are actually smoking. 

The professor says we also need to know more about what popular Middle East tobacco products will substitute for others. He says hookah doesn’t seem to be a gateway to cigarette smoking so far, and that college students who use it occasionally and socially may grow out of the practice. However, dokha does substitute for cigarettes, and people will smoke dohka in a pipe perhaps 15 or 20 times a day. 

There are encouraging signs that harm reduction could catch on in the Middle East. As with much of the world, laws are in flux regarding various product categories, but are generally moving in a more open direction. I’m presenting on two panels at the Global Vape Forum, held in conjunction with a vaping trade show in Dubai from July 12-14. The fact that such events are permitted in Dubai sends a welcome message of tolerance. As my article notes, several companies are producing reduced-harm products tailored to the region, including ANDS (vaping) and OOKA (charcoal-free shisha device).