Culturally sensitive research in United Arab Emirates pinpoints indoor air quality risks

With the swift modernization of the country, UAE governmental agencies have not yet performed the research necessary to pinpoint health risks, the study reports. The need to develop governmental research capacity makes collaborations with U.S. research teams vital, but the studies must be conducted in a culturally appropriate way.

Dr. Karin Yeatts

“This is an important area of investigation, and the UAE is completely under-researched,” said Karin Yeatts, PhD, epidemiology assistant professor and lead study author. “There are many good scientific questions that need to be answered, and this area of the world is very deserving of science and public health work.”

It’s important to know about indoor air quality risks, she said, because people in the UAE spend between 80 percent and 95 percent of their time indoors, escaping the high temperatures.

In the study, published May 1 in Environmental Health Perspectives, Yeatts coordinated a research team from UAE and UNC’s public health school to test air quality in 628 urban and rural family residences from October 2009 to May 2010.

Researchers collected data for five air pollutants – sulfur dioxide, nitrogen dioxide, hydrogen sulfide, formaldehyde and carbon monoxide – through two home visits.

During the first visit, the team determined the number of family members at the residence and set up air-monitoring equipment. A total of 1,590 people participated in the study, including men, women and children, ages 6 to 18.

A week later, three research interviewers returned for a second visit. They recorded readings from the monitoring equipment, removed it from the home, and interviewed family members about their past and present medical histories, respiratory symptoms, housing characteristics, possible environmental household exposures, as well as behavioral and lifestyle factors, such as smoking and exercise. Heads of households also provided information about socioeconomic status, residential history and overall environmental exposures.

Collected data revealed 30 percent of homes had quantifiable levels of sulfur dioxide, and 29 percent had quantifiable levels of formaldehyde. For nitrogen dioxide and hydrogen sulfide, 9 percent and 12 percent of households, respectively, had quantifiable concentrations.

Researchers compared the results to households without significant pollutant levels and discovered family members in homes with quantifiable sulfur dioxide, nitrogen dioxide, and hydrogen sulfide were twice as likely to have doctor-diagnosed asthma. The team also found an increased prevalence of wheezing, including symptoms that limited speech, with these same pollutants. Neurological difficulties, such as difficulty concentrating, were loosely linked to quantifiable exposure of formaldehyde.

UAE households also are exposed to pollutants not found as frequently in the United States, specifically incense. Roughly 86 percent of UAE homes burn incense at least once a week, and formaldehyde levels are three times higher among those households that do so more frequently. Family members in these homes are more likely to report headaches, forgetfulness and difficulty concentrating.

“Burning incense in this region of the world is an important cultural practice, but I do think there are things people can do to reduce exposure,” Yeatts said. “People can reduce their exposure by opening windows, burning incense for a shorter time and/or burning smaller amounts.”

This research also provides important cultural context for future public health studies in the region, Yeatts said. For example, careful consideration should be given to air pollutant monitoring equipment placement because some families, continuing with nomadic traditions, use less furniture than families in the United States. Researchers also should remember to respect the privacy of prayer times during the day and carefully consider whether to conduct research during Ramadan, as families deviate substantially from their normal activities during the month-long religious observance. In addition, data collection in the summer should be analyzed with the knowledge that many families leave their homes to escape the heat.

Ultimately, Yeatts said, researchers hope this data collection and analysis will be used to improve public health knowledge in the UAE and support campaigns to limit exposures and risks associated with indoor air pollutants.

“In the short term, we have been able to give this information to the UAE government, and they can share it with the public,” Yeatts said. “It’s possible that they’ll do further research to evaluate the effects of the pollutants. This data provides them with a strong basis for designing future studies on indoor air pollutants and health.”

Other study authors from the public health school’s epidemiology department include Ronna L. Chan, PhD, reproductive/perinatal epidemiologist and visiting scholar, and Andrew F. Olshan, PhD, professor and department chair.

From the environmental sciences and engineering department, study authors include Maryanne G. Boundy, research associate and Baity Laboratory director; Jacqueline MacDonald Gibson, PhD, professor; David Leith, ScD, professor; Ivan Rusyn, PhD, professor; and Chris B. Trent, doctoral student.

David Couper, PhD, biostatistics associate professor and deputy director of the Collaborative Studies Coordinating Center; William Kalsbeek, PhD, biostatistics professor and director of the Carolina Survey Research Laboratory; and Christopher A. Davidson, UNC Eshelman School of Pharmacy’s director of educational technology research and development, round out the UNC team.

Other study authors include Mohamed Y. Hasan, UAE University dean of the faculty of community medicine; Fatma Al-Maskari, Mohamed El-Sadig, and Taoufik Zoubeidi, members of the UAE University community medicine faculty; William E. Funk, PhD, Northwestern University anthropology assistant professor; and Maamoon M. Kassab, UAE National Bureau of Statistics.

Yeatts’ study was funded by the Environment Agency-Abu Dhabi and partially supported by a grant from the National Institutes of Health’s National Institute of Environmental Health Sciences. The paper is available online.

UNC Gillings School of Global Public Health contact: Linda Kastleman, communications editor, (919) 966-8317 or linda_kastleman@unc.edu.