Health issues continue emerging in relation to chemical or toxic consumption in the current generation. Substance abuse exists as a common source of chemical ingestion into the human body across nations. Despite wars and efforts to minimize those affected on a yearly basis, several categories still exist free for use under no legal restrictions. Among the substances abused in United Arab Emirates regions involve Dokha. The substance is taken through smoking. It comprises of various elements including tobacco, spices, herbs and other nicotine containing elements. As with the case of use and frequency, it has been less researched. The increased health complications emanating from smoking elements raise concern. The inclusion of various groups and reports identified among men, women and the youths indicate the presence of Dokha impacts in the human body systems. Smoking of Dokha occurs in a slightly different manner from cigarettes as it involves a pipe and cup-like holding the base for the required amount. The inhalation aspect is associated with dizziness as an instant outcome.
The substance has been classified as one of the tobacco products which is preferred due to the ease of use and lack of scent. In the current generation, smoking has serious impacts with respiratory, mouth cancer, heart defects and other health issues estimated to increase rapidly every year. The realization of Dokha use within the UAE territories has received less attention despite the increasing health issues touching on nicotine and other elements impacts on users. Observation on behavior has little documented information among concurrent users of the substance. Issues identified involve the presence of cotinine elements in blood of users and impacts like cardiovascular, cancer and respiratory impacts among smokers. The consumption of Dokha keeps on increasing similar to cigarette use across ages despite warnings on health effects.
Dokha smoking has recently not commonly been researched despite its existence as a tobacco component. Analyzing the case in UAE shows that Dokha exists as a common substance among old and young age users. Chemical analysis about the product comprises of nicotine composition in a similar context like other tobacco alternatives rich in cotinine element. Medical d8iagnosis identify diseases linked to nicotine and metabolite units as identified through testing urine samples on the presence of such elements in patients and users.
The use of tobacco products within the United Arab Emirates region reports the highest among other uses of smoking components. The region comprises of various options apart from cigarettes with Dokha and Shisha being among the common other elements embraced by smokers (Vupputuri, 2016). The historical background of use and adoption of Dokha has kept increasing in the last few years with a higher number of dependents reported. In the exploration of smoking trends, several elements are reported to occur and grow in numbers with young generation joining in the use of tobacco alternatives. The adoption of Dokha in the area has grown especially with the ban of cigarette smoking in public. The discovery of effects among smokers creates high demand for chemical analysis concept which has not yet materialized as per the historical neglect of the topic. Smoking tobacco alternative products among the Middle East and North Africa regions still take a similar form since ancient days like the case of UAE areas (Elsayed, Dalibalta & El Kouche, 2018). Dokha as a prominent component smoked using a pipe known as midwakh. The common features of smoking have had a high impact on the belief that it’s safe than other substance abuse. The case of Dokha involves increasing evidence of prevalence use even among students both in high school and at the college level. As an alternative to cigarette, it has been associated with cheaper affordability making it rampant among young people. Exploring the trends of use in a span of years since the 1980s, smoking has taken high strides to increase and intensification creating an interesting historical phenomenon. Historically, studies to determine the composition and presence of Dokha elements among users has remained undetermined. The issues about smoke effects on health since the 1980s have been researched through questionnaires filling inhibiting chemical assessment in labs (Feyerabend, Higenbottam & Russell, 1982). The current attempts within the Arab Emirates territory adopted urine and saliva test to identify smoke traces for both active and passive smokers who get exposed to tobacco elements. The lacking evidence connects to inadequate research from the past decades which prompted more aggressive examination on the health impacts of tobacco and alternative products like Dokha.
Its history of Dokha dates back before the 15th century when its popularity rose in the Middle East countries. Tobacco was apparently introduced to this region by sailors and travelers from the American traditional native tobacco. They arrived into the Middle Eastern saw increased use and modifications that saw the birth of Dokha as the best alternative to smoking tobacco. While the preparation has gradually changed over time, Dokha remains the best alternative to tobacco users to date (Cope, Nayyar, Gibbons & Bunce, 1997). It is also important to note that the Middle East was not the only place the American sailors introduced tobacco, but rather also into North Africa, Europe, and the Turkish region. Tobacco was initially an expensive product and was thus reserved for the elite of the time. Dokha was therefore essentially modified to create an equivalent that was a little cheaper but of the same product. The initial traditional forms were, therefore, a mixture of tobacco with some other materials like dried flowers, backs of trees, blending with molasses among other mixture materials. This would then produce a product that would be less expensive and affordable to many.
Use and spread of Dokha
The habit of Dokha smoking covers quite a large number of populations. Across different ages, Dokha use has been identified through questionnaire filling and even through urine and saliva tests. The presence of cotinine in blood among tested individuals exhibit recent encounter with tobacco smoke or having smoked in the past. There exist wide range on information on smokers and despite the longtime absence of research on Dokha as a tobacco alternative, recent developments on the studies about smoking and tobacco use identified quite important facts about the substance. Use of Dokha exist among the old, young and evidence explores its consumption in all genders. The reliance on Dokha has been on the rise with United Arab Emirate zone being among the known territories for use and production of the component (Jawad et al., 2019). The evidence on men, women and young people using the substance poses an important question on the health impacts in the current and future generations. The examination about the spread of use and intensification of dependents on Dokha show an increasing rate according to the assessment conducted in the UAE region concerning patterns of other tobacco substances, the report explores widespread use and self-reporting provides more evidence. The case of Dokha is currently known for its dominance in the various nations in the Middle East and North Africa. Following the report explored about the substance use, it was identified that personal reported use involved 36% men and 3% women while biochemical examination tested 42%men and 9% women (Al-Houqani et al., 2018). The realized values explain a constantly increasing number of smokers which coincide with Dokha use as an alternative to tobacco products in the current days. The increase of different types of non-cigarette products within the Eastern Mediterranean region highlights a growing percentage with many of the region ranging at 25%. The distinct implication of use varies with men highly represented among the high number of smokers.
Apparently, Dokha was traditionally and is presently taken to give its smokers a soothing head rush. It is perceived by its smokers to have a faster effect on cigarette although preliminary results show that it has lower contents of nicotine and other substances. Smokers essentially take two to three puffs and get some high feelings quickly and have an effect of a sudden high level of happiness. The modern form is, however, a little different from the traditional form apparently because of its components and mode of reparation (James, Tizabi & Taylor, 1998). Today, it cannot be said to be any different from the contents of cigarette because it is mixed with very little or no other substances in its preparation. Later developments in its history show that its cultivators grew the tobacco plants for making Dokha in the hot areas of middles eastern countries. The water levels area apparently controlled to allow the tobacco content to concentrate on high levels (Cope, Nayyar, Gibbons & Bunce, 1997). Further, Dokha cultivation is made purely with the use of fish meal and according to Jawad et al. (2019), no chemicals are used nor re-blended in its production.
The use of Dokha is very high in the Middle Eastern countries with the highest consumption being reported in the United Arab Emirates (UAE). Higher consumptions are particularly seen in males between the ages of 20 and 40, as a 2000-2010 study. Further, the high rates of Dokha smoking in the UAE have contributed to rising to the present day (Jayakumary, 2010). Scholars speculate the high rise has been due to the governments’ efforts to control the smoking of cigarettes. Most governments have continued a discouragement of uptake of cigarettes although they are legal because of the effect of nicotine in the cigarette (Oddoze, Pauli & Pastor, 1998). Nicotine is essentially consumed because of its psychological effect particularly in the stimulant and good feeling it gives its consumers. However, the smoke produced threats cancerous effects to the smoker’s lungs and to those who are around the smokers (El-Serafi et al., 2013). Most governments have as such controlled its smoking in public places and raised taxation to raise cigarette prices to discourage its consumers. Dokha, being an illegal product in most counties have been difficult to control through taxation and this remains a cheaper alternative to cigarette.
The use of Dokha has also been reported among the miners. In a study which aimed at investigating the prevalence of Dokha, researchers found out that 30% of high school students in the UAE had ever smoked a tobacco product while 36% had smoked dokha in particular (Culea, Cozar, Nicoara & Podea, 2005). Further, the study showed that 25% of the students were currently taking the product. The reports concluded that dokha was actually the highest form of substance smoking among high school students, more than even cigarettes (Oddoze, Pauli & Pastor, 1998). Speculators think that the high prevalence of dokha among the high school students is essential because its control has not been able to affect its price and thus there is high access to the cheap product. Further, the smoking of the product does not produce huge traces of smoke. The smoke produced by cigarette apparently stick to hair, clothes, hands and even on breath making people who come close to them to know that they actually smoke a cigarette. On the contrary, dokha smokers are immune to this suspicion, making it an easy choice by the high school students of the UAE (Cope, Nayyar, Gibbons & Bunce, 1997). Dokha has also spread to America and other parts of the world, although not in substantively significant levels. The spread is primarily necessitated by immigration.
Tobacco advertisements have been seen to increase the chances for minors to try and use dokha. In the United States, a study showed that minors around the age of 9 years and who are between grades 6 to 12 were engaging in tobacco use, including dokha (Lafay, Vulliet & Flament-Waton, 2009). Further, the exposure to these products in childhood, among adults who smoke, encourages most people to smoke. Current studies further do not find a substantive reason as to why most people begin smoking dokha while those who are already addicted would like to stop although they cannot. The factor of peer pressure is, however, the most present reason given by many users (Lafay, Vulliet & Flament-Waton, 2009). Growing observing it makes them think it is a fancy thing and can easily be drawn to it by peers. However, educating and warning people about its effects on their health have been found to be the most efficient means to prevent minors or any new users of the product.
Dokha reliance in the young population identifies another alarming issue in the Arab Emirate territories, the examination of use among high school users include a recent increase counting on the affordability and fast in the use, unlike other smoking substance that takes long. The exploration among the secondary school students included the examination of the rate of use in the ages between 13 and 15 years. With the dominance of Midwakh in the United Arab Emirates region, access and convenience of use among the young generation explicitly remain easy. The research conducted discovered a fascinating trend of assessment based on current users, ever use and the number of Midwakh utilized in a day. The elaboration of the findings discovered a close correlation with cigarettes and non-cigarette use despite the element of prominence among wealthier men as opposed to other low-income earners. The rates confined in the study involved the percentage outcome of 9% concurrent users and 18.5% those who have ever used the component t in the past years (Jawad et al., 2019). The relevance of the data examines an issue of concern depending on the increasing smoking-related disorders and health challenges on the subject of substance abuse. The chemical composition plays a crucial role in determining the future expected challenges at the community level. The existence of traces of cotinine in blood among men and women raises the question of whether the future generation is involved in the aspects of transfer and inheritance of genetic disorders. The high number of users among the youth also exerts a burden to the community. According to the Ajam report on ever, Dokha smokers ranging at 36% exceeding other general smokers explore a needy aspect to consider policy implementation for control (Shemmari, Shaikh & Sreedharan, 2015). The secondary school students managing to use Dokha on a daily basis express an element of serious prevalence on the alternative tobacco products. Tobacco has been known to cause serious issues and the medical concepts to handle such issues gives an astonishing reflection on who will cater to many young people have not even started income on their own. Establishment and implementation of tobacco laws are required with the urgent need possible to ensure future lives get secured and reclaimed from the challenge of smoking habits.
Dokha consumption is currently associated with various issues after studies on common complications among smokers. The chemical composition remained unknown and even up to date there remains a quality amount of uncertified findings of the components. In a research outline target frequently and one time users of Dokha, findings identified the substance to contain nicotine and cotinine key elements found in tobacco through urine tests (Cope, Nayyar, Gibbons & Bunce, 1997). The examination through urine, saliva and blood samples from identified smokers and non-smokers exposed to smoke explore the presence of such chemical toxicity in the human body fluids. For instance, in a study conducted using inductively-coupled plasma- optical emission device and a microscope indicating a correlation of various metal elements that prove toxic to the human body. The findings defined that Dokha comprises of harmful elements involving Cadmium, cobalt, lead, and chromium which adversely affect the body system. The chemical characterization study still identified other toxic components including three carcinogens, thirty-three irritants and other five nervous system depressants (Elsayed, Dalibalta & El Kouche, 2018). Further investigation on the constituents in Dokha by application of a nicotine measuring device which involves urine test for possible amount of the components. In various ways, the method helps consider nicotine and cotinine concentration in a process known as colorimetric assay (Cope, Nayyar, Gibbons & Bunce, 1997). The chemical elements present in cigarette smoke falls in the higher possibility to exist in other tobacco compounds apart from those added during manufacturing.
According to an article, (Jawad et al., 2019) dokha contains higher levels of nicotine and tar than all other forms of tobacco. Further, traces of iron, copper, and chromium have been identified which are perceived as harmful elements in the human body. Other metals available include aluminum and manganese although in lower levels. These were examined in the dokha products available in the market today. Speculators identify also that cigarettes have filters which is absent in shisha and Dokha, making dokha a dangerous form of tobacco smoking as these harmful metals could find their way into the human lungs. There is however no substantive evidence of the exact amounts chemical composition of dokha (Oddoze, Pauli & Pastor, 1998). The challenge in its determination emanates from its illegalization in many countries making it difficult to establish the standard composition of chemical elements. This lack of a standardized control makes the production by the same or different manufacturers to have widely varying components. There needs to be thorough research in order to give substantively significant findings of its composition in order to give evidence-based advice to the consumers.
The Dokha composition has a lot of work left without proof. It involves only a few researchers who have dedicated to going through the component to assess its full list of ingredients chemical structures and reaction capabilities. The exploration conducted by researchers on tobacco components using the mechanochemical extraction identified the several constituents that makeup cigarettes (Miller, Norris, Rollins, Tiffany & Wilkins, 2010). In a similar manner that Dokha majorly comprises of tobacco, it shares a comparable measure of components in other tobacco products. Dealing with the unaccomplished Dokha research, there exists much more to cover on the over hundred compounds estimated to be included in the substance. As a combination of untested herbs, flowers, spices, and tobacco it’s possible that several other substances make it severely harmful for human body functioning. The already conducted research majorly explore the tobacco majors exploring quality toxicity and harm associated with regular or one time use. Comparing novel tobacco products to cigarette smoke falls as another point of exploring the chemical elements. The Dokha product falls under novel tobacco through its consumption mode by burning to product an inhalation gas (Takahashi et al., 2018). The use of aerosol characterization and other novel tobacco combustion products explores complex chemical study. The identification of forty tobacco constituents under the research through visitor toxicological evaluation highlight the deeper meaning of the regular Dokha smoking. Knowledge gained through regular urine, blood and saliva tests express the interest to keep track of the composition and associated health implications.
Smoking generally of all tobacco products been associated with a wide range of diseases. Explaining on the prevalence of Dokha use, the increased risk of non-communicable diseases shows some linking relationship. Through observation, tobacco smoking has produced health complications involving cardiovascular disorders, respiratory difficulties, and cancer. The health care docket has been mobilizing the people to avoid as much smoking as possible for better health results (Versace, Sporkert, Mangin & Staub, 2012). The existence of high burden on dealing with smoking disorders globally is not a new phenomenon. Within the US, many deaths occur yearly resulting from smoking habits that result in serious issues. Monitoring the relationship between Dokha and health complications, it offers a very close inference with increasing instances of respiratory tract infections, lung cancer and heart rate increase being reported regularly among smokers (Miller, Norris, Rollins, Tiffany & Wilkins, 2010). In the research conducted on effects and principles about cigarette smoke chemical effects, the author discussed on matters pertaining to cardiovascular cases increase and breathing challenges among smokers without excluding a rising number of Dokha users.
Clinical cases associated with Dokha use involve a fascinating link to incidents like seizure occurrence. As a form of emergency scenarios, smoking Midwakh has been linked to random seizure development among users. As a common form of substance abuse among the Arabian Emirate youth’s, the case of seizure development was discovered through evaluation of a 14-year-old and 17-year-old males who developed a kind of epilepsy and sought medical attention. The instances were carefully explored and following a cross-check follow up basis seizures were found to decline with stoppage of Dokha smoking (Alsaadi et al., 2014). The various cases and admission of repetitive seizures after smoking Dokha expose a health threat leading to emergency issues in a presentation like normal epilepsy development. Understanding the results of evaluation requires further investigation with nicotine and cotinine elements reflecting in the human bloodstream and other fluids very fasts after short duration exposure or use of tobacco (Feyerabend, Higenbottam & Russell, 1982). Regular use and addiction to tobacco products are always reported as a common phenomenon among those who go seeking immediate medical attention. Deaths caused by smoking habits can be minimized by discovering the chemical compositions and advising users accordingly more than the current efforts.
Preliminary accounts of users and marketers about the health effects of dokha indicate that dokha is less harmful to cigarettes and other forms of tobacco. Users are specially meant to believe this because; the product is still in its original color-green and the notion that there are few additives in the production of dokha (Lafay, Vulliet & Flament-Waton, 2009). This makes the users assume that the product is less harmful although there are emergency cases for tobacco users including dokha smokers. Like any other tobacco product, dokha also causes addiction effects and poses all other threats tobacco causes. For instance, dokha like cigarette users exposes the user to both acute and chronic illnesses (Oddoze, Pauli & Pastor, 1998). Acute illnesses include increased blood pressure, and increased heart and respiratory rates. Chronic effects caused by dokha use include chronic chest problems, nicotine addiction and tolerance, obstructive pulmonary disease and increased likelihood of infection of the respiratory, larynx or any other organ (Xu, 2004). The use of dokha, with respect to evidence provided above, is dangerous and the perception of its users is mythical and can be considered a fallacy. It is, in fact, plausible to suggest that the use of dokha is more dangerous than cigarettes and shisha. The health effects observed in emergency rooms as well as with the uptake of the product are in order.
In a study (Lafay, Vulliet & Flament-Waton, 2009) which observed 105 tobacco smokers, over a period of 3 months, researchers found out that the length of stay in the emergency rooms averaged to 438 minutes which is approximately 7 hours. A higher number of cases would be dokha and shisha smokers essentially because the two have instant effects. Dokha smokers would have an immediate effect and thus call for immediate emergency attention because its effect is instant and comes in less than 30 seconds after inhalation. Smoking of dokha has been seen as a particular risk to patient safety as well as heightened cost because it is generally among the most prolonged length of stay (LOS) in the emergency centers (Miller, Norris, Rollins, Tiffany & Wilkins, 2010). In addition to the length of stay inside the emergency wards, other factors that are important to consider about the patients is the danger and seriousness of the cases. Tobacco use usually causes serious health issues with the respiratory tract, high plod pressure and heart rate (Culea, Cozar, Nicoara & Podea, 2005). This is a danger and on its worse may become a danger to the life of the patient. Further, addiction is the first and direct effect of tobacco use. Dokha also has tobacco dependency addiction and with particulate effect, which makes the users depend on the substance.
Clinical before and after smoking dokha
Although there are few scientific papers on dokha, present literature provides enough information about the clinical state of the users both before and after smoking dokha. Quite essentially, the effects are similar to those for cigarettes smokers because the chemical composition mainly contains tobacco (Miller, Norris, Rollins, Tiffany & Wilkins, 2010). Therefore nicotine and tar are in high amounts. The clinical assessment examines the effects the use of a substance has on the body of the user and consequently the effect this has on the quality of life of the victim. First, the user is exposed to dependency and d-addiction to the use of tobacco. As such, dokha users run into the risk of spending a lot of their income on the use of dokha which is mostly (Xu, 2004). Next, clinical complications that result from the use of dokha are dire and may cost a lot of expenditure on medical treatment and also may cost the user their life. Heart, lungs and blood artery problems are mainly the main life-threatening conditions the users risk into. As a result, the users should be warned of these health risks so that they are aware of its use.
The lack of filtration in the manufacture of the dokha smoking tubes is a huge clinical threat to the health of the user. The lack of filtration allows entry of solid particles of the burnt dokha remains, which from the preliminary findings contains some elements of harmful metals such metals include manganese and aluminum, among many other metals, discussed earlier in the paper, are dangerous to the human body (Miller, Norris, Rollins, Tiffany & Wilkins, 2010). When they are deposited into the lungs they may cause more infections, more than just respiratory problems. Among the most envious effects would be coughing problems and when absorbed into the body may induce cancerous cells. This may lead to lung cancer or blood cancers among other cancers in the body (Xu, 2004). The illegalization of dokha has made it difficult to control the standards into its manufacture and packaging. People have therefore gone ahead to adopt the traditional runs of smoking which does not put a future in the smoking tube. This is a danger to the health of the users and dire care should be taken to ensure that the product is examined on its health effects and more particularly, regulations should be made to protect the users from the harmful effects particularly so because of lack of controlled and standards manufacturing policies.
Dokha use has increased rapidly especially in the Gulf region. Use among all ages poses a high medical burden as the issues of non-communicable diseases keeps on rising. Young population encountering issues of emergency seizure development and mothers trapped in the smoking behavior explore an endangered future generation. The chemical examination records indicating a high number of possibly harmful and toxic elements in Dokha present a complex remedy process especially with the high number of daily users. The intensification of cancer, respiratory and cardiovascular-related health disorders explore a real challenge affecting substance control boards in relationship with the health departments. As a development context, research tools and techniques are required to expound on the Dokha dilemma and help identify several unrealized elements and their side effects. Like a class of tobacco products, midwakh remains harmful and needs proper exploration for public awareness reporting. The reliance on modern testing methods including gas/liquid chromatography-mass spectrometry examinations has helped discover how various components in smoke emissions while using or exposed to tobacco users fast gets into the body causing great damage instantly and gradually. Taking action is an important concept to ensure study and avoidance of Dokha wherever possible for healthy living.
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