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Tag: middle east

  • From Tradition to Transition

    From Tradition to Transition

    By adrian_ilie825

    With the launch of its Sixhill heated-tobacco brand, Firstunion is offering smokers in the Middle East a less risky alternative to smoking.

    By Stefanie Rossel

    The Middle East is one of the last growth markets for combustible cigarettes. Tobacco has been deeply rooted in the culture since the 1600s, and regional smoking rates are among the highest in the world. With a male smoking prevalence of 57.6 percent in 2022, Jordan tops the list, followed by 49.1 percent in Egypt and 42.9 percent in Lebanon, according a report published by THR.net.

    Smoking is generally a male habit in the region. While cigarettes dominate the Middle Eastern tobacco market, other popular products include shisha, also known as waterpipe or hookah, and dokha, a powdered tobacco that comes in different varieties and strengths and is often mixed with spices, herbs and other substances.

    While the World Health Organization projects smoking rates in the Middle East to decrease from 33.3 percent in 2020 to 31 percent in 2025, this is the smallest anticipated decline among all WHO regions. Embracing tobacco harm reduction (THR) could accelerate the decline of smoking prevalence. Demand for e-cigarettes in the region has been growing in recent years, with some places adopting heated-tobacco products (HTPs) and nicotine pouches as well.

    “Increasing awareness of the health risks associated with smoking is driving demand for alternatives like HTPs and e-cigarettes, which are perceived as less harmful,” confirms Wayne Wu, senior director of business development (HTP BU) at Firstunion—Sixhill. “Younger demographics, particularly in countries such as the United Arab Emirates (UAE) and Saudi Arabia, are increasingly turning to e-cigarettes and heated-tobacco products as they become more conscious of lifestyle choices and trends.”

    While vape products are still banned in a few countries, including Iran, Omar and Qatar, most Middle Eastern states now permit the sale of e-cigarettes. Legislation differs by nation, with many countries regulating e-cigarettes using the European Union Tobacco Product Directive as a blueprint. However, several states, including Jordan, Bahrain, Saudi Arabia and the UAE, tax vapes and heated-tobacco products at a rate of 100 percent or more in an attempt to curb the spread of electronic smoking devices, particularly among children, and to address the disparities in taxes between traditional cigarettes and smoking alternatives.

    According to Wu, the evolution of the regulatory environment reflects ongoing efforts to improve product quality and advertising standards. “Additionally, some countries have established specific regulations for e-cigarettes and HTPs, defining product specifications, advertising and sales standards to foster more orderly market development,” he says.

    High-Potential Markets

    Founded in 2004 and headquartered in Shenzhen, China, Firstunion was a pioneer in the field of electronic atomization. The company offers a vast range of electronic nicotine-delivery system (ENDS) technologies, heated-tobacco solutions and atomizing equipment. In the Middle East, Firstunion launched its proprietary heated-tobacco brand, Sixhill, which it distributes through extensive partnerships in countries such as Saudi Arabia, Egypt, Bahrain and Iraq. “Firstunion focuses on the research, design and production of heated-tobacco products,” Wu explains. “We collaborate closely with major international HTP manufacturers, with our products marketed globally. We aim to provide premium, technology-driven and competitive products to our THP [tobacco-heating products] customers throughout the Middle East. We look forward to building deeper, stronger strategic collaborations with more clients across the region.”

    According to Wu, the Middle East markets that offer the highest potential for innovative HTP technology are the UAE, Saudi Arabia and Egypt. The UAE is one of the most open and affluent countries in the region, and since e-cigarettes and HTPs were legalized in 2019, demand for these products has steadily increased. “Young consumers and expatriates in the UAE show a high acceptance of HTP products, especially among middle-[income] and high-income groups focused on health and quality of life,” says Wu.

    “The UAE’s positive stance toward technological innovation makes it easier for new products and technologies to enter the market and potentially expand to other Middle Eastern countries. Furthermore, the UAE’s well-structured regulatory system allows compliant international brands to enter the market, which benefits the long-term growth of companies.”

    Saudi Arabia, the largest economy in the Middle East, has gradually relaxed regulations on smoking alternatives. Since 2019, the kingdom has permitted the sale of HTP products, fueling demand. “With Saudi Arabia’s economic transformation and a rising young population, especially under the Vision 2030 initiative, there is an increasing demand among young people for modern lifestyles and innovative technology,” says Wu. “Saudi Arabia’s substantial market size, combined with a strong consumer preference for international brands and high-tech products, offers significant growth opportunities for companies with innovative heated-tobacco technology.”

    Egypt, with its large population, is a crucial market too. Although HTP regulations are still evolving, the market holds immense potential, according to Wu. “There is a large number of smokers in Egypt, and demand for traditional cigarette alternatives, such as HTP products, is rising, particularly among young people and the middle class,” he says. “Given the market’s high price sensitivity, companies that can provide cost-effective, innovative technology will hold a competitive advantage in Egypt. Additionally, Egypt can serve as a gateway to the broader North African market.”

    Rise of Local Brands

    Regarding THR, Wu describes several trends in the Middle East, including the rise of local and international brands. “Leading international tobacco companies are actively expanding into the Middle East market, offering products that cater to local smokers seeking healthier and trendier options,” he says. “There also is an emergence of local brands: With a growing focus on health, many new tobacco brands have recently emerged across various Middle Eastern countries. These companies provide consumers with more health-conscious vaporized products and offer a more comprehensive, diverse service experience for local customers.” Firstunion collaborates with some of these brands, he adds.

    HTPs and e-cigarette products are now widely available in physical stores, such as supermarkets and convenience stores, as well as through online channels, making it easier for consumers to purchase these products, according to Wu. “Major global and local retail chains are increasing their offerings of heated tobacco and e-cigarette products,” he says.

    In recent years, the vaping industry in the region has diversified. “Besides traditional tobacco, products such as e-cigarettes, nicotine pouches, herbal cigarettes and heated tobacco have flooded the market, offering richer flavors and more advanced technology,” says Wu. “While smokers now have a broader range of differentiated choices, market competition has also intensified. Among these options, HTPs are increasingly favored by consumers.”

    Currently, Firstunion is promoting three heating technologies in the Middle East: Atine, which works with resistance heating; Insheat, which heats with induction; and Breelight, which is powered by infrared heating. Soon, the company plans to introduce its latest technology in the region: Alkaid technology. Launched this year and recognized with a “Best HnB innovation Award” at the 2024 Alternative Awards, Alkaid leverages the high-speed propagation of light to directly deliver energy to the tobacco, bypassing spatial constraints (see sidebar).

    Complex Environment

    Despite increasing demand, HTPs face several challenges in the region. “There is significant variation in tobacco product regulations across Middle Eastern countries, which increases complexity for manufacturers,” says Wu. “Regulations may change quickly due to public health campaigns or international agreements, making it challenging for manufacturers to remain compliant.”

    He also names cultural sensitivity, with views on smoking and e-cigarettes differing widely due to cultural and religious beliefs across the region. “Many consumers still favor traditional tobacco products such as shisha and cigarettes, which may hinder the adoption of e-cigarettes and heated-tobacco products,” says Wu.

    In addition, increasing concerns about health risks associated with e-cigarettes and HTPs could lead to stricter scrutiny and more stringent regulations, whereas misunderstandings about the safety and risks of HTPs may foster a negative public image, influencing regulatory actions. Strict advertising regulations could limit how manufacturers promote their products, affecting brand visibility and consumer awareness. Certain countries in the region may impose import restrictions or tariffs on e-cigarettes and HTPs, impacting pricing and supply.

    “Overall, HTP and e-cigarette manufacturers in the Middle East must operate within a complex landscape of regulations, cultural attitudes, competition and market dynamics,” Wu stresses. “Addressing these challenges effectively is essential for successful market entry and ensuring sustainable growth in the region.”

    Firstunion has made significant strides in the Middle East, focusing on establishing a strong market presence through partnerships, product innovation and strategic marketing, Wu says. “Our future plans include expanding our distribution network, customizing products for local markets, ensuring regulatory compliance and enhancing brand visibility to capitalize on the growing demand for e-cigarettes and heated-tobacco products in the region.”

    As Middle Eastern consumers increasingly prioritize sustainability, the company plans to integrate eco-friendly practices into its production and packaging processes. “This commitment to sustainability enhances our appeal to environmentally conscious consumers,” says Wu.

    The Power of Light

    Firstunion’s Alkaid heated-tobacco technology works with light. The emitted wavelength of Alkaid technology ranges from 200 nm to 1 mm, enabling energy transfer in a noncontact heating process through a vacuum, significantly reducing the limitations of traditional heat conduction.

    Alkaid’s light heating technology provides a continuous spectrum similar to sunlight, including ultraviolet, visible light, short-wave and mid-wave to long-wave infrared. The different wavelengths allow for varying penetration depths, achieving uniform and thorough heating of the entire tobacco segment, greatly enhancing nicotine and smoke release.

    In this mode, the temperature of the tobacco remains below traditional heating levels, effectively avoiding pyrolysis temperatures, which significantly reduces the release of harmful substances.

    Alkaid uses fully automated assembly line production, ensuring stable performance and a long lifespan, with tested cycles exceeding 10,000 times. Its outer casing is made from a material with high electromagnetic wave transparency, and the heating element can reach peak temperatures up to 2,000 degrees Celsius, effectively transferring energy through radiant heat. According to Firstunion, this excites nicotine and flavor compounds within the medium, delivering a rich and refined flavor with a higher nicotine conversion efficiency. —S.R.

    Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.
  • Quitting Camel Country

    Quitting Camel Country

    Photo: Medwakh

    Dokha, shisha, vapes: THR in the Middle East region

    By Cheryl K. Olson

    Tobacco has been part of daily life in the Middle East since the 1600s. An archeology journal describes excavations in Istanbul uncovering “massive numbers” of broken clay tobacco pipes from the centuries before the rise of cigarettes. Some of the highest smoking rates in the world are found in Middle East nations. Over half of men in Jordan smoke, for example.

    “The Middle East has got an extremely long culture in terms of smoking. That’s going to be really hard to turn round,” says Harry Shapiro, a U.K.-based educator who reports on global tobacco harm reduction. Based on data from the World Health Organization, smoking was projected to decrease among men in the region by less than 2 percentage points, from 33.1 percent in 2010 to 31.2 percent in 2025.

    Most of the top causes of death in countries in the region are either caused or worsened by smoking. New approaches are urgently needed. Yet there is a frustrating lack of information on where and how to start. A 2024 WHO report on global tobacco use trends notes that data in the Eastern Mediterranean region “are the least robust,” i.e., limited or outdated.

    What’s different about the Middle East when it comes to tobacco use? What’s the need for tobacco harm reduction? And what factors might support or block the uptake of reduced-risk products?

    Shisha, Dokha, Shammah

    A U.S. university professor who has studied tobacco use trends in the region (and asked to remain anonymous) shared his local experiences and findings with me. One issue he faced was collecting information on reduced-harm products not yet authorized by regulators. Given Middle East government policies, researchers can’t ask questions about illegal behaviors. “I could be compelled to give individual-level data regardless of what people signed about confidentiality,” he said.

    After the United Arab Emirates legalized e-cigarettes, his surveys found that vapes were widely used. “People shifted back and forth between cigarettes, e-cigarettes and a local tobacco called dokha, which means “dizzy.” Because you can inhale the equivalent of one cigarette’s worth in one or two quick puffs,” he said (see “Old School, Modern Market,” Tobacco Reporter, August 2014.)

    Tobacco use in the Middle East has largely centered on three products. Cigarettes currently dominate, with use rates hovering around 30 percent for men. In most of the region, smoking is culturally unacceptable for women. Given the reluctance to admit to smoking, reported female use rates of about 2 percent may in reality be several times higher. In Lebanon, the professor noted, women can openly smoke. There, use rates are around 30 percent for both genders. Concerningly, his colleagues in that country feel that Lebanon is the tobacco use trendsetter for the region.

    A second popular regional product is shisha tobacco, smoked through a water pipe or hookah. Use reportedly increased in the 1990s when flavored products emerged. “Previously, it was mostly grizzled old men in coffee shops,” the professor noted, “but the new products weren’t harsh or unpleasant in taste and became trendy among young people.” A 2020 review of research found “alarmingly high” use among university students in the region, including by women.

    Hookah smoking is a social activity. A college student in Abu Dhabi might go out with friends and smoke hookah once or twice a week or once per month. However, some users are addicted and will smoke daily.

    What sets shisha apart is the communal pipe. “There might be multiple hoses, but you’re still breathing through the same water and sharing germs,” the U.S. professor noted. “A session might go on for an hour and generate the same volume of smoke as five packs of cigarettes.” This means exposure to a huge quantity of smoke, even at the secondhand level. Even worse? Inhaling toxins and carbon monoxide from the charcoal burned to heat the waterpipe.

    Finally, there is dokha. This powdered tobacco comes in different varieties and strengths and is often mixed with herbs, spices and other substances. Dokha is smoked in a small pipe (usually wooden) called a midwakh. Some users perceive it as a safer alternative to smoking, but the limited research suggests that dokha may give off more toxins than cigarettes. Despite dokha being as common as cigarettes in countries such as the UAE, published studies on dokha use, effects and cessation have been rare.

    A regional oral tobacco product also merits mention and more study. Shammah is reportedly common in Saudi Arabia and Yemen. Locally made by mixing ground tobacco leaf with flavorings (including lime, ash, black pepper and oils), shammah contains a variety of potential carcinogens, including nitrosamines.

    Reducing Risk

    Several countries in the Middle East (such as Iran, Oman and Qatar) still ban e-cigarettes, and others (e.g., Saudi Arabia) ban snus. But in general, the region has bucked the global trend, loosening regulations on vaping and heated-tobacco products. Nicotine pouches are largely unregulated. (See the Global State of Tobacco Harm Reduction website, GSTHR.org, for country-by-country information.)

    More research is critically needed to help channel information and support to those Middle Eastern subgroups most endangered by their tobacco use behaviors. University students who occasionally smoke shisha, for example, likely face minimal risk.

    Most evidence on vaping originates from North America and Europe. As a recent paper on e-cigarettes in the Middle East points out, studies within the region suffer from “overreliance on university-based samples, the overuse of non-user samples, a lack of studies on behavior change, high variance in existing data and a lack of uniform instruments to measure e-cigarette use.”

    Shisha is a good example of the need for cultural sensitivity in promoting smoking cessation or a switch to less risky alternatives. “For hookah, people smoke very much for the social reason. It’s a social construct, not an addiction construct,” said the U.S. professor. “Most cessation interventions have not really worked because most have thought about hookah like cigarettes, with nicotine-replacement therapy and counseling.”

    As one college student in the UAE told him, “People don’t drink alcohol here. There are no drugs. We need a way to hang out with our friends.” Effective reduced-risk substitutes for waterpipe smoking must deliver that.

    Companies have begun creating reduced-harm products specifically for Middle East countries.

    For example, Dubai-based ANDS (short for alternative nicotine-delivery solutions) makes vaping and heated-tobacco products. A company called OOKA has developed a charcoal-free shisha device. Philip Morris International recently acquired a stake in Eastern Co., Egypt’s largest tobacco producer, with a stated goal of providing alternatives to cigarettes for adults who smoke.

    New technologies can make an attractive contrast to smelly old-fashioned cigarettes. “A lot of the vaping devices are really quite geeky—like a fancy electronic gadget that happens to deliver nicotine,” notes Shapiro. “They have touch-screens, and you can chart use on your laptop. So that’s likely to appeal to the younger generation of more wealthy urban groups” in the region. However, such products are likely to reach few lower income or rural people who smoke.

    Shapiro notes that two things are necessary for reduced-harm nicotine to gain a foothold and start displacing cigarettes. First, “Governments have got to be prepared to get tough on smoking: banning smoking in public areas and such.” Second, there needs to be proportionate promotion of novel products, including lower taxes versus cigarettes, and education that supports the option of harm reduction alongside cessation. As a recent Lancet commentary (by former WHO leadership) notes, “In some countries, substantial reductions in smoking prevalence have coincided with novel nicotine products.”

    “If a country does ban safer nicotine products, look at how much it relies on the tobacco industry—in terms of revenue from taxation or whether the country grows tobacco or exports it,” says Shapiro. “If state regulation is sympathetic, then these products will find a way into the shops.”

    The presence of the World Vape Show in Dubai, starting in 2021, sent a message that these alternatives could be acceptable. I will be part of two panels at the 2024 Global Vape Forum, which accompanies this year’s Dubai vape expo. We will stress the need to save lives by moving people off combustible tobacco, whether through cessation or switching to reduced-risk products.

    Getting doctors on board with harm reduction is another important step. Like their colleagues around the globe, Middle Eastern physicians frequently misperceive nicotine as the cause of cancer and other health risks of tobacco. Region-specific studies of doctors’ perceptions and needs are essential. I could locate only one small study. A 2019 Egyptian survey found that doctors were aware of e-cigarettes but viewed them less positively than their patients.

    Cheryl K. Olson is a California-based public health researcher who specializes in behavioral health issues and consults on tobacco product behaviors via McKinney Regulatory Science Advisors. She spent 15 years on the faculty of Harvard Medical School.

    References

    Al-Hamdani M, Hopkins DB (2023). E-cigarettes in the Middle East: The known, unknown, and what needs to be known next. Preventive Medicine Reports. https://doi.org/10.1016/j.pmedr.2022.102089

    Beaglehole R, Bonita R (2024). Harnessing tobacco harm reduction. The Lancet. https://doi.org/10.1016/S0140-6736(24)00140-5

    Fouad H, Commar A, Hamadeh RR et al. Smoking prevalence in the Eastern Mediterranean region. Eastern Mediterranean Health Journal. 2020;26:1. www.emro.who.int/emhj-volume-26-2020/volume-26-issue-1/smoking-prevalence-in-the-eastern-mediterranean-region.html

    Nasser AMA, Geng Y, Al-Wesabi SA (2020). The prevalence of smoking (cigarette and waterpipe) among university students in some Arab countries: A systematic review. Asian Pacific Journal of Cancer Prevention. https://journal.waocp.org/article_88992.html

    Samara F, Alam IA, ElSayed Y (2021). Midwakh: Assessment of levels of carcinogenic polycyclic aromatic hydrocarbons and nicotine in dokha tobacco smoke. Journal of Analytical Toxicology. https://doi.org/10.1093/jat/bkab012

    Raj AT et al (2019). Systematic reviews and meta-analyses of smokeless tobacco products should include shammah. Nicotine and Tobacco Research. https://doi.org/10.1093/ntr/nty144