This interview is with Dr Zubair Kabir, the Editor in Chief of Tobacco Use Insights and Visiting Scientist at the Harvard School of Public Health.

Tom: What would you say is the primary focus of your research effort (and how do you refer to your 'sub-area')?

Dr Kabir: To have been trained both in public health medicine and in epidemiological research, my research addresses the population health impact of life style factors from a disease outcome perspective. My primary research focuses on preventing and reducing tobacco use among all segments of the society but particularly among vulnerable population sub-groups such as pregnant women, young children and immigrant population. Specifically, my research looked at comprehensive tobacco control programs in the context of population health impacts (mainly cardiovascular, lung cancer and COPD) applying previously validated comprehensive epidemiologic models.

Tom: What do you consider to be the most significant developments arising from research in your area?

Dr Kabir: Significant policy developments have taken place with regard to tobacco control based on sound scientific evidence-driven research. The FCTC (Framework Convention on Tobacco Control) is the most significant development in tobacco control. The FCTC is the only international public health treaty to date that has been ratified by more than 160 countries across the globe. The WHO MPOWER package is a next significant development that embodies six proven strategies to combat tobacco use. The US has made great strides in introducing state-wide comprehensive tobacco control programs and workplace smoking bans. The next most probable significant step could be the FDA regulating tobacco products. Recent internal tobacco industry document analyses have marshalled the tobacco control advocates to fight against the tobacco industries. Many European countries have also introduced workplace smoking bans, with Ireland leading the way in March 2004. Positive health impacts are reported post smoking bans, thus averting many premature deaths. Such programs and bans are also underway in a few developing countries as well. Comprehensive nationwide 100% smoke-free-homes are also going to be significant health policy developments to further reduce second-hand-smoke exposure. So, has tobacco control reached the tipping point? I do not know!

Tom: What do you consider to be the most significant open questions and research challenges in your area?

Dr Kabir: Tobacco use has no geographical boundaries, and likewise tobacco control research. I think there is still a long way to go before ‘denormalizing’ and ‘deglamourising’ smoking behaviour in its entirety. It is high time that developing countries start learning from the experiences of the developed countries. Tobacco industries have hired the best scientists and are hugely resourced- now poisoning the East as stronger legislations are in place in the West. Our battle against the tobacco industries will continue until making smoking history worldwide. Nonetheless, local information and research supporting effective proven tobacco control strategies both in demand and in supply reductions are imperative. One size does not fit all! Smuggling of cigarettes is fast emerging as a barrier to effective tobacco control. Research is also limited in this area. The economics of tobacco use is also not overwhelmingly accepted and understood. Harm reduction methods, tobacco product regulations and illicit trading will be real challenges in the progress of tobacco control for the near future.

Tom: Tell us about your collaborative research. Who else do you directly work with and what are the aims of your collaboration?

Dr Kabir: Tobacco control research is a trans-disciplinary collaborative platform. The aims of my research are to reduce tobacco use both in the general population and in vulnerable population sub-groups through proven tobacco control strategies. However, I am also interested in evaluating tobacco control policies in the context of population health impact.
I am so deeply grateful to be working with several teams of astoundingly talented colleagues. These researchers include Gregory Connolly, Howard Koh, Hillel Alpert and Vaughan Rees from Harvard, Luke Clancy, Pat Goodman and Kathleen Bennett from Ireland, and Prakash Gupta from India. I am also fortunate that many of these outstanding researchers are represented on the editorial board of Tobacco Use Insights.

Tom: Is balancing all these activities challenging? How do you deal with it and what tools do you find useful in doing so?

Dr Kabir: Research is demanding. At the same time life is a meaningful journey- wonderful opportunities and sometimes herculean challenges. Setting and prioritizing activities in a very organized manner is essential to meeting tight deadlines. Working as a team with all kinds of support and infrastructure also makes life much easier. My most important mechanism, however, is seeking peace and solace through religious activities and getting that wonderful support from my family.

Tom: When did you decide to be primarily involved in the field that you are now in?

Dr Kabir: I was drawn to public health during my medical training in India. I worked as a primary care physician in India in the early 1990s and strongly felt the need for prevention rather than cure to a healthy population. However, population health research was never attractive or even a funding priority in India. I was trained further in epidemiologic and in population health science research in Ireland where my PhD dissertation was on lung cancer epidemiology. As a post-doctoral research fellow both in Ireland and in Harvard I refined and sharpened my skills and expertise surrounding tobacco control research programs. Now I feel rewarding that some of my research activities could be translated into public health policies in the foreseeable future. Tobacco use will kill a billion people by the turn of this century, and 70% of these will be in the developing countries.

Tom: What resources do you find indispensible for your research work?

Dr Kabir: Yes, computers and emails and all the 3G stuff! However, to keep going with research work one has to be funded. No government is soft on health research funding. Unfortunately, population health and epidemiologic research has never been that attractive to the most of the funding agencies. Securing research grants are competitive, uncertain and always time-consuming. An adequate research infrastructure is indispensable for any relevant research grant application. Timely application with the right balance of science and appropriate skills complemented by past experiences and recent collaborations might keep us resourced! Tobacco control research is trans-disciplinary and collaborative, involving substantial resources both human and financial. Innovative and relevant research ideas- not necessarily cutting-edge researches are cornerstones for successful research grant applications.

Tom: What do you think about the development of open access publishing and open access development? How has it changed your perspective on research or development practices?

Dr Kabir: Open access publishing is a modern age revolution- bridging the digital divide between print and electronic media. Open access publishing has reduced the time to publication from months to hours- a death to distance! I do not have to wait for months to see my articles indexed on PubMed- the barometer of research work. The knock-on effect of open access publishing is a faster translation of information into policies and also instant sharing of important scientific evidence with the global community. Quicker dissemination of scientific evidence also reduces the quantum of duplication of research work and burden. The deepest impact of an open access publishing (if provided free access) could be the wider accessibility to the scientists and to the research institutes of the low-income countries. Many open access publishing group journals although recently launched have gathered very high impact factors in a short span of period, thus attracting very high quality papers. I see open access publications growing further- but needs to be regulated and adequately monitored and well-resourced.

Tom: What books do you think should be required reading for researchers working in your area?

Dr Kabir: Tobacco control research is trans-disciplinary. Epidemiologic research is the bedrock and is fast evolving as an exact science. Obviously, I will recommend "Modern Epidemiology" (3rd Edition) by Ken Rothman (Amazon.com). To get an overview of tobacco epidemiology a recent Oxford University Press publication, edited by Peter Boyle and colleagues, Tobacco: Science, Policy and Public Health" would be a good start (Amazon.com).

In addition to text books, international tobacco control specialty journals are also helpful. Examples include Tobacco Control; Nicotine and Tobacco Research; Tobacco Induced Disease; Addiction to name a few PubMed indexed journals. A few selective international public health journals (Am J Pub Health, Eur J Pub Health, WHO Bulletin, etc) will also help a tobacco researcher stay updated and tuned. Also I think one should go through a few policy documents such as the WHO FCTC and the MPOWER (available on the WHO website).

Tom: What books are current on your reading list?

Dr Kabir: Definitely not the ‘Origin of Species’ at the moment! I will shortly embark on the widely-reviewed text book by the Harvard Historian Dr Alan Brandt, who took 20 long years to compose this! I think I can only do justice to this epoch book if I am able to assimilate the stuff at least not less than a year! You guessed right- I was referring to “Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America." (Amazon.com)

Tom: Do you teach any courses? If so, which ones?

Dr Kabir: I currently am not on any University faculty teaching courses, but tend to supervise both PhD and Masters Students especially in their thesis work affiliated to our Research Institute. However, I am involved in developing a curriculum on tobacco control research program in India in collaboration with the Tobacco Control Research Program based in Harvard School of Public Health.

Tom: Which historical research figures do you think have most influenced you in how you think about research? Why are they significant?

Dr Kabir: Recent stalwarts such as Sir Richard Doll and Former US Surgeon General- Dr Luther Terry. Both opened up a Pandora’s Box in relation to smoking and health effects in the early 1950s and the 1960s. Because of their scientific contributions our younger generation one day will live in a tobacco free society! However, my greatest inspiration is the Holy Quran which has answers to many of our still unsolved scientific mysteries! Not only the ill health effects of smoking and other addictives are clearly spelled out, but also the concept of circumcision and quarantine as means of public health measures were adopted 1400 years ago when recent medical science was just able to piece the so-called puzzle now!

Tom: Which meetings do you attend on a regular basis?

Dr Kabir: I regularly attend the Society for Research on Nicotine and Tobacco (SRNT) - the 2009 will be hosted in Dublin (April 2009) and the World Tobacco Conference- the 14th WCOTH will be held in Mumbai-March 2009. I also attend a few epidemiologic meetings such as the Society for Epidemiologic Research (SER) and the World Congress of Epidemiology.

Tom: If you could change something about how research in your area is conducted, used, perceived, or resourced, what would it be?

Dr Kabir: My vision is a tobacco free planet! However, I should be realistic at this stage when still 5 million tobacco-related deaths are continuing on a yearly basis and that will increase to 10 million deaths annually, to be mostly concentrated in low-resource settings. Tobacco control is a global phenomenon but local initiatives and local research are equally important. A critical mass of local tobacco control scientists is imperative but we have to work together in a trans-disciplinary fashion both at home and in the workplace. Charity begins at home. Each of us at the family level should be made aware of the harmful health effects of tobacco use (through science and advocacy) and with the support of local civil societies and religious groups a mass movement has to be generated. To generate such science, you do not have to go through a RO1 grant of the NIH. For instance, sending text messages on tobacco use to mobile phone users on a regular basis will not cost millions but can reach a billion people worldwide within minutes. Therefore, low-budget and high-impact tobacco control research projects can be equally attractive and rewarding!

My thanks to Dr Kabir.