Predictors of Nicotine Dependence Among Adult Male Midwakh and Cigarette Smokers

OBJECTIVES: Midwakh is a popular form of smoking in the Middle East. This study aimed to assess the predictors of nicotine dependence among cigarette or 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 implemented 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, the levels of salivary cotinine and exhaled breath carbon monoxide (CO) were measured. RESULTS: Of the 88 adult male smokers included in the study, 40 (45.5%) were cigarette smokers and 48 (54.5%) smoked midwakh. The majority of participants were 26–35 years of age (48.9%), followed by 18–25 years (30.7%) and >35 years (20.5%). Midwakh use was associated with more than a three-fold increase in the risk of moderate-to-high nicotine dependence compared to 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 level were found to be significant predictors of nicotine dependence among adult male smokers. In particular, greater dependency was observed among midwakh smokers than cigarette smokers.