Tobacco Smoking Using Midwakh Is an Emerging Health Problem – Evidence from a Large Cross-Sectional Survey in the United Arab Emirates

INTRODUCTION: Accurate information about the prevalence and types of tobacco use is essential to deliver effective public health policy. We aimed to study the prevalence and modes of tobacco consumption in the United Arab Emirates (UAE), particularly focusing on the use of Midwakh (Arabic traditional pipe). METHODS: We studied 170,430 UAE nationals aged ≥ 18 years (44% males and 56% females) in the Weqaya population-based screening program in Abu Dhabi residents during the period April 2008-June 2010. Self-reported smoking status, type, quantity and duration of tobacco smoked were recorded. Descriptive statistics were used to describe the study findings; prevalence rates used the screened sample as the denominator. RESULT: The prevalence of smoking overall was 24.3% in males and 0.8% in females and highest in males aged 20-39. Mean age (SD) of smokers was 32.8 (11.1) years, 32.7 (11.1) in males and 35.7 (12.1) in females. Cigarette smoking was the commonest form of tobacco use (77.4% of smokers), followed by Midwakh (15.0%), shisha (waterpipe) (6.8%), and cigar (0.66%). The mean durations of smoking for cigarettes, Midwakh, shisha and cigars were 11.4, 9.3, 7.6 and 11.0 years, respectively. CONCLUSIONS: Smoking is most common among younger UAE national men. The use of Midwakh and the relatively young age of onset of Midwakh smokers is of particular concern as is the possibility of the habit spreading to other countries. Comprehensive tobacco control laws targeting the young and the use of Midwakh are needed

The global burden of multiple chronic conditions: A narrative review

Globally, approximately one in three of all adults suffer from multiple chronic conditions (MCCs). This review provides a comprehensive overview of the resulting epidemiological, economic and patient burden.There is no agreed taxonomy for MCCs, with several terms used interchangeably and no agreed definition, resulting in up to three-fold variation in prevalence rates: from 16% to 58% in UK studies, 26% in US studies and 9.4% in Urban South Asians.Certain conditions cluster together more frequently than expected, with associations of up to three-fold, e.g. depression associated with stroke and with Alzheimer's disease, and communicable conditions such as TB and HIV/AIDS associated with diabetes and CVD, respectively. Clusters are important as they may be highly amenable to large improvements in health and cost outcomes through relatively simple shifts in healthcare delivery.Healthcare expenditures greatly increase, sometimes exponentially, with each additional chronic condition with greater specialist physician access, emergency department presentations and hospital admissions. The patient burden includes a deterioration of quality of life, out of pocket expenses, medication adherence, inability to work, symptom control and a high toll on carers. This high burden from MCCs is further projected to increase.Recommendations for interventions include reaching consensus on the taxonomy of MCC, greater emphasis on MCCs research, primary prevention to achieve compression of morbidity, a shift of health systems and policies towards a multiple-condition framework, changes in healthcare payment mechanisms to facilitate this change and shifts in health and epidemiological databases to include MCCs. Keywords: Multiple chronic conditions, Multimorbidity, Chronic disease, Noncommunicable diseases, Communicable diseases, Health care costs, Health policy, Revie

A profile and approach to chronic disease in Abu Dhabi

Abstract As a country, the United Arab Emirates has developed very rapidly from a developing country with a largely nomadic population, to a modern and wealthy country with a Western lifestyle. This economic progress has brought undoubted social benefits and opportunities for UAE citizens, including a high and increasing life expectancy. However, rapid modernization and urbanization have contributed to a significant problem with chronic diseases, particularly obesity-related cardiovascular risk. In response the Health Authority of Abu Dhabi has significantly strengthened its data systems to better assess the baseline and measure the impact of targeted interventions. The unique population-level Weqaya Programme for UAE Nationals living in Abu Dhabi has recruited more than 94% of adults into a screening programme for the rapid identification of those at risk and the deployment of targeted interventions to control that risk. This article describes the burden of non-communicable disease in Abu Dhabi, and the efforts made by the Health Authority of Abu Dhabi to tackle this burden including the development of a whole population cardiovascular screening programme changes to health policy, particularly in terms of lifestyle and behaviour change, and empowerment of the community to enable individuals to make healthier choices. In addition, recommendations have been made for global responsibility for tackling chronic disease.</p

Physical activity is associated with improvements in other lifestyle behaviours

IntroductionWe tested whether physical activity (PA) engagement is subsequently associated with additional health-promoting behaviours in a large-scale, real-world programme leveraging technology and behavioural science to reward healthy lifestyle behaviours.MethodsIn this observational, longitudinal study, we compared participants’ verified and self-reported health behaviours prior to and following their first verified engagement in PA recorded on the Vitality programme between 2014 and 2017.ResultsOf 34 061 participants, the mean duration in the programme was 40.1 (SD 12.6) months, and the median time until the first PA was 13.1 (SD 16.6) months, with a mean age of 42.0 (SD 11.1) years and 14 881 (43.7%) being male. Baseline weekly PA minutes were mean 62.8 (SD 129.7), 98 (SD 26.0) and 282.9 (SD 230.0) for the low, moderate and high groups, respectively. In the 12 months following the first PA, the low group increased weekly active minutes by 156% (40 (95% CI 28.6 to 51.0) to 102 (95% CI 94.5 to 109.8)); the moderate group increased weekly active minutes by 60% (85.0 (95% CI 76.4 to 93.5) to 136 (95% CI 130.2 to 141.8)); and no change was seen for the high group. Overall, individuals exhibited an increase of 26% in their weekly active minutes from an average of 130 min (95% CI 121.2 to 139.4) to 164 min (95% CI 157.5 to 169.8). Overall, fruit and vegetable daily servings increased from 2.7 (95% CI 2.6 to 2.8) to 2.9 (95% CI 2.9 to 3.0); Kessler Stress Scores decreased from 17.4 (95% CI 17.2 to 17.6) to 17.0 (95% CI 16.9 to 17.1); sedentary hours decreased from 11.3 (95% CI 11.1 to 11.5) to 10.8 (95% CI 10.7 to 11.0); alcohol consumption decreased from 1.8 (95% CI 1.7 to 2.0) to 1.6 (95% CI 1.5 to 1.7) weekly units; sleep increased from 7.1 (95% CI 7.06 to 7.16) to 7.2 (95% CI 7.13 to 7.20) hours/night.ConclusionsPA was followed by other health-promoting behaviours. PA interventions should also evaluate the indirect impact on other health behaviours

Age and gender specific prevalence of smoking.

<p>Age and gender specific prevalence of smoking.</p

A scoping review of studies on the health impact of electronic nicotine delivery systems.

We conducted a scoping review of studies on health outcomes from electronic nicotine delivery systems (ENDS). The objective was to identify, narratively synthesize, assess the strength and quality of evidence and critically appraise studies that have reported disease end points associated with the use of ENDS. We included published literature on the health impact of ENDS from 01/01/2015 until 01/02/2020 following the PRISMA guidelines using PubMed, Embase, Scopus and Google Scholar. The database search identified 755 studies, and other sources 265; 37 studies met final eligibility criteria. Levels of evidence included 24(65%) cross-sectional, one (2.7%) case-control and six (16%) case studies, four (11%) cohort studies, one (2.7%) randomized controlled trial (RCT) and one (2.7%) meta-analysis; 27(73%) studies reported only on harms, eight (22%) reported on benefits, two (2%) on benefits and harms. Quality ratings were poor in 20 (54%), fair in 9(24%) and good in 8(22%) of studies. In our review, ENDS was not shown to be causative for harmful cardiovascular disease (CVD) outcomes and shown to be beneficial for hypertensive patients. Switching from cigarettes to e-cigarettes resulted in reduced exacerbations of chronic obstructive pulmonary disease (COPD), with no evidence of long-term deterioration in lung function. Mental Health, cancer and mortality were not adequately studied to form any consensus. Our review has not demonstrated ENDS to be causative of harmful CVD outcomes; furthermore switching from cigarettes to e-cigarettes was associated with improved hypertensive control and reduced exacerbations of COPD, with no evidence of increased asthma risk or long-term respiratory harm. Mental health, cancer and mortality outcomes have not been adequately studied to form a conclusion. Overall, the findings of our review did not provide evidence to counter the consensus held by many that ENDS use is safer than the risks posed from smoking cigarettes

Characteristics of tobacco smokers by type of tobacco smoked.

<p>Characteristics of tobacco smokers by type of tobacco smoked.</p