Letter to the Editor

A call to address Dokha smoking: an emerging form of tobacco use

Dokha is known to be one of the most rapidly spreading alternative tobacco products (ATPs) in the Middle East and North Africa (MENA) region. It is smoked using a pipe known as Midwakh. There is no scientific research published on the chemical composition of dokha and only very little was done to investigate its impact on human health. Three different types of dokha were included in this study. The trace metals content in the dokha samples were analyzed using inductively-coupled plasma-optical emission spectroscopy and energy-dispersive X-ray spectroscopy-scanning electron microscope. Dokha smoke was generated using a device that simulates human smoking/puffing. The smoke samples were collected on Tenax and activated carbon adsorbent tubes followed by chemical analysis using thermal desorption-gas chromatography–mass spectrometry. The results showed the presence of toxic metals in dokha samples such as cobalt, cadmium, chromium, and lead in amounts classified as harmful to human health. In addition, the presence of several potentially harmful and even toxic organic compounds in dokha smoke was identified based on the available clinical data. These included 22 irritants, 3 known carcinogens, and 5 central nervous system (CNS) depressants in addition to several other compounds with miscellaneous effects. The findings of this work demonstrate evidence for the presence of potentially harmful and toxic metals and compounds in dokha tobacco as well as dokha smoke. More research is required to further investigate the clinical impact of dokha on human health.