With more than 20 years of tobacco control research experience in the US under his belt, Scott Sherman, associate professor of Medicine and Psychiatry at the NYU Langone Medical Center, turned his eyes to the global public health landscape with the realization that "most smokers aren't in the US." While there exists more than 50 years of research profiling cigarette smokers, mostly within Western cultures, there remain a lot of unknowns with regard to smokers and their behaviors in places like the UAE that have both higher incidences of smoking and different forms of tobacco inhalation — such as shisha and medwakh — than the US.
The opportunity to investigate uncharted territory in public health issues prompted Sherman and his colleagues at the NYU Langone Medical Center — Professor of Environmental Medicine and Population Health Richard Hayes; Professor of Medicine, Biochemistry, and Molecular Pharmacology and Pathology Ann Marie Schmidt; and Associate Professor of Medicine, Biochemistry, and Molecular Pharmacology Ravichandran Ramasamy — to establish a comprehensive Public Health Research Institute (PHRI) at NYU Abu Dhabi dedicated to investigating those issues that most seriously affect the UAE community: cardiovascular disease, obesity, diabetes, and tobacco use.
"There are so many questions we're finding that nobody knows the answers to, like what kinds of interventions for hookah smoking are culturally effective," Sherman said. "We've tried scouring the literature for valid, reliable measures to assess what people are eating in the UAE, but there are none. It's hard to intervene at a policy level if you don't know what people are eating; you can't assess a change if you don't know what you're starting with."
The public health landscape in the UAE and the Gulf region is unique, made up of distinct genetic, environmental, and societal factors and influences. Project investigators hope that a greater understanding of these factors will in turn inform the creation of more effective prevention and intervention policies.
It's hard to intervene at a policy level if you don't know what people are eating; you can't assess a change if you don't know what you're starting with.
Four Prominent UAE Health Concerns
The PHRI will consist of four individual centers that target specific and prominent public health concerns in the UAE: the Diabetes Research Center, the Center on Obesity and Genetic Susceptibility, the Human Oral Microbiome Research Center, and the Smoking Cessation Research Center.
Researchers at the centers hope to draw upon a shared resource of a central "Special Studies Cohort" to support the collection of raw data from a sample of 5,000 UAE Nationals in Abu Dhabi. The project investigators are currently working with the Health Authority — Abu Dhabi to develop a mechanism to gather the required information through questionnaires and biological tests from a sample representative of the population across age and gender. Through this access to primary data, the centers will identify environmental and genetic factors involved in public health issues, test novel interventions, and create a strong information resource in the Emirates on public health issues.
Diabetes Research Center
The Diabetes Research Center aims to discover mechanisms leading to metabolic and cardiovascular dysfunction in order to identify therapeutic targets to improve the problem, with a specific focus on the processes of microbiome and amino acid metabolism and glycation (which is the process through which sugar molecules like glucose bond with a protein or lipid molecule without the catalyst of an enzyme). Both factors have been shown to play a key role in metabolic dysfunction and may influence the development of insulin resistance, obesity, and diabetes. In addition to looking at biochemical markers, the research team will also survey eating and physical activity behaviors. By investigating the importance of a range of different factors — some that are modifiable and others that are not — to weight gain and diabetes, the group hopes to deliver practical information that can inform public health interventions that are most relevant to the local population.
Human Oral Microbiome Research Center
The Human Oral Microbiome Research Center will look into the relationship between periodontal disease (a condition caused by oral bacteria) and cardiovascular disease, a leading cause of death in the UAE. A number of studies have shown a correlation between the two, with periodontal disease believed to play a role in the vascular inflammation that causes a buildup of plaque in the walls of the arteries. Previous studies have shown that reduction in oral pathogenic bacteria leads to a regression of preclinical cardiovascular disease. This center will be the first in the UAE to comprehensively examine the role of oral microbiome in preclinical cardiovascular disease by identifying whether specific human oral microbiome profiles are correlated with levels of intima-media thickness, a specific indicator of arterial wall thickness that is an established preclinical marker of cardiovascular disease.
Smoking Cessation Research Center
The Smoking Cessation Research Center will explore some of the unique characteristics of smokers in the UAE, assess the effectiveness of tobacco control policy in the UAE, and test novel treatments that have proven effective in other parts of the world. The research team will also look more closely into the forms of tobacco consumed in the UAE, such as shisha and dokha, which are currently understudied and not well understood both in terms of their health impacts and in terms of health interventions that would be culturally effective.
While focused on the UAE population in particular, the Institute's findings will likely provide broader insights that may "serve as a lighthouse for the rest of the world," project investigators said. "The UAE is without a doubt a country that has been undergoing profound transformation over the past 40 years," Sherman said. "It can be a challenge to have the health catch up with the impact of prosperity. As we move from an agricultural society to one based on international business, the range of cultural and lifestyle changes that have taken place in the UAE are applicable to many other countries not only in the region, but to the rest of the world."