INTRODUCTION:
Midwakh smoking is a traditional form of tobacco use that is increasingly prevalent in the Middle East; however, evidence on its acute cardiovascular and respiratory effects remains limited. This study examined short-term physiological changes associated with Midwakh smoking and compared health parameters between Midwakh smokers and non-smokers.

METHODS:
A quasi-experimental pre–post study with a comparison group was conducted among adult males in the United Arab Emirates. Midwakh smokers (n = 103) were assessed before and after smoking a single Midwakh session, while non-smokers (n = 20) underwent baseline assessments. Outcomes included cardiovascular measures, respiratory indices, pulmonary function, and biomarkers of smoke exposure. Paired and independent-sample tests were applied.

RESULTS:
At baseline, Midwakh smokers had significantly higher smoke exposure and poorer pulmonary function than non-smokers, including higher exhaled carbon monoxide (3.0 [2.0–4.0] vs 2.0 [1.0–2.0] ppm; p < 0.001), higher carboxyhemoglobin levels (1.11% [0.95–1.27] vs 0.95% [0.79–0.95]; p < 0.001), lower forced vital capacity (4.90 ± 1.27 vs 5.77 ± 1.41 L; p = 0.017) and forced expiratory volume in one second (FEV₁: 3.77 ± 0.78 vs 4.28 ± 0.64 L; p = 0.004). Following a Midwakh session, smokers continued to show significantly higher carbon monoxide exposure, higher carboxyhemoglobin, reduced lung function and a higher respiratory rate than non-smokers (17.5 ± 4.5 vs 14.7 ± 3.5 breaths/min; p = 0.004). Within-group analyses showed acute increases in blood pressure, pulse rate, respiratory rate, and smoke exposure biomarkers after smoking (all p < 0.05).

CONCLUSIONS:
Midwakh smoking is associated with immediate adverse cardiovascular and respiratory effects and consistently reduced pulmonary function compared with non-smokers, both before and after smoking. These findings underscore the need to address Midwakh smoking through tobacco control policies and inclusive public health interventions in the region.