It doesn’t take a degree in public health to see the impact that tobacco use has had on global health. We’ve all heard the shocking statistics that tout tobacco use as the top contributor to preventable death and disease. Even with all of the peer-reviewed and validated research on the harms of tobacco in all of its many forms, we have yet to make strides in smoking cessation on a global scale. As two current medical students, we are inundated daily with the importance of obtaining an accurate social history, making sure to document any use of tobacco, and, if necessary, employ motivational interviewing skills to assess our patient’s desire to quit smoking.

We are going into the business of ensuring that people live long and healthy lives, and a large part of that equation is preventing future illness. Central to preventative medicine is modifying behavior. Behavior is the hardest to change and influence as a health professional, yet it contributes more to your health outcomes than the quality of healthcare you receive, the environment in which you live, or even your genetics.

When thinking about possible capstone projects, we knew that these health behaviors were something that we would like to tackle, especially with the rise of unhealthy lifestyle trends in the UAE as evinced by the sharp rise in obesity, heart disease and type II diabetes. Just over 19 percent of the population has type II diabetes, which is usually associated with poor dietary and physical activity standards. Research also shows the alarming rise of tobacco use among the country’s youth. In one study, 12 percent of males aged 13 to 15 responded as current cigarette smokers. This is alarming; many behavioral experts agree that the teenage years are extremely formative in terms of the habits that we will carry into and reinforce in late adolescence and beyond. If we were to design an intervention to positively influence health behaviors, it would make sense to target a cohort in their teens.

As we discussed what a possible intervention to address these trends would look like, we couldn’t help but think that our experience as health educators in inner-city schools in the boroughs of New York could be manipulated to fit the cultural context of Abu Dhabi. An important aspect of this intervention would be the peer-to-peer aspect of its implementation. Our time volunteering in New York and numerous research studies from the United States and the United Kingdom convinced us that the efficacy of health education was amplified when peers were teaching it. We designed and implemented a workshop on tobacco in several private secondary schools within Abu Dhabi, along with a pre and post-survey to assess its efficacy.

This cohort was challenging in many ways, as we hoped not only to equip them with knowledge to make informed decisions about their health but also to confront respectfully the cultural norms that surround many forms of tobacco in the Middle East. For many of our students, tobacco use was something they positively associated with friends and family. As such, we decided to focus on empowering our students to care about their health and to speak out. The impacts of tobacco use on health are serious enough that no cultural norm or familial dynamic should keep anyone silent. In the classroom, the students were engaged, curious and, at times, shocked by the information we synthesized from the World Health Organization and the Centers for Disease Control.

But what did the survey data reveal? First, that a large percentage of the teens involved in our study were already experimenting with tobacco. Over 39 percent of the males we surveyed had tried shisha between the ages of 12 and 13. Other findings included signs of possible underlying eating disorders, insufficient levels of physical activity and several misconceptions regarding tobacco use, namely shisha and dokha. Many were under the assumption that shisha, for example, was less harmful to their health than cigarette smoking; current scientific research disputes that commonly held notion.

Put simply, these students were not in the optimal position to form habits to support lifelong health. Our survey analysis showed that our peer health model was an effective intervention for changing knowledge, attitudes and perspectives on tobacco use in the UAE. Our results call attention to an important educational gap in the UAE. Health education is not an integrated part of the schooling system, and it has been proven to play a valuable role in the lives of teenagers in this cultural setting. If it was effective for tobacco use, imagine how much more preventive impact we might have if schools were to expand to a comprehensive health curriculum.

We live in a generation of people that do not like to be told what to do. How often has a health professional told you to eat healthier, be more physically active or consider tobacco cessation? If we fail to empower people with the knowledge and skills to make healthy decisions at an early age, then the knee-jerk, scripted health advice will not make meaningful changes. It is tempting, and perhaps human nature, to avoid or procrastinate addressing the behaviors we engage in that are detrimental to our health. The consequences seem far away — an easily ignored outcome that is more likely to happen to someone else. Some people cling to anecdotes of others who have adopted these behaviors their whole lives without any health-related repercussions.

Not everyone is as fortunate, though. The number of patients with a tobacco-related condition continues to climb and increasingly strain the healthcare system. The stories are devastating because they are preventable. However difficult it may be, the push for preventative measures is more important now than ever before. The WHO estimates that around 6 million people die each year from tobacco use. That number is so large that it can be hard to appreciate, but it’s still is something that we should all be concerned about. With small but effective programs like the one we conducted in only a handful of high schools, we can build toward a more wholesome and healthy future by affecting health behaviors before they become a problem.