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 Future of Food to Tackle Climate and Health – Reflections from COP26

A shift in how we obtain protein from our diets, away from intensive farming and fishing, towards cleaner sources, be they animal or plant-based, will form an essential part of the solution to achieving the pledges formalised following COP26. This can be achieved through many different approaches including reduction, substitution, reducing the frequency of consumption, blending into hybrid products, and without the necessity of a complete eschewal of animal-based products. The new paradigm of ‘planetary health’, which focuses on the interdependence of human health, animal health and environmental health, will greatly facilitate meeting the ambitious and near-term targets set. This commentary discusses these issues in depth, with a focus on solutions to promote both planetary and human health in unison

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

Communication of Risk in Covid-19: An Urgent Need for Clarity

The Covid-19 pandemic has resulted in an unprecedented spotlight on health risks. This article discusses how such risks have been communicated to the public, arguing the approaches used may have inflated perceptions of risk amongst younger and disease-free individuals. This has led to undue anxiety and had a deleterious effect on other health behaviours, including sleep and exercise. We advise that more conventional public health messaging approaches would have been useful - deploying clear, non-jargon language, keeping advice consistent and presenting a combination of absolute health risks and comparisons with other everyday risks. This may have facilitated more accurate understanding of risk levels in different population segments. The evidence-base on effective ways to communicate to encourage health-seeking behaviour change – such as emphasizing the benefits of compliance to recommendations rather than the risks of non-compliance and highlighting the social impacts of Covid-19 preventative measures – must be more effectively leveraged in future to support risk mitigation efforts and implementation of vaccines during their forthcoming rollout

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