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What links: cigarettes, psoriasis and John Snow?

Intro

My name is Alex Trafford and I am a second year Epidemiology PhD student in the Division of Pharmacy and Optometry. I have quite a diverse academic background for somebody in my field, being unsure of which subjects I enjoyed most at school and splitting my A-levels between the sciences and humanities. I eventually decided to pursue an undergraduate degree in geography, with two years at Lancaster University and one year abroad at the University of North Carolina. In my final undergraduate year I took part in a module looking at health geographies - during this time I came across the field of epidemiology, which combined aspects of science and humanities, and decided that this was the direction I wanted to go in. In order to learn more about the field, I completed a master’s degree in Demography and Health at the London School of Hygiene and Tropical Medicine in 2017.

In late 2017, I received funding from the Global Psoriasis Atlas and started my PhD in Epidemiology at Manchester. My project here involves using huge datasets to understand how having psoriasis might make somebody more or less likely to get cancer.  

In Depth


Although epidemiology is not a field that is as well-known as others, like maths or chemistry, its results are often very well publicised and can shape how many people live their lives. The first epidemiological study was conducted in London by John Snow (not the one from Game of Thrones), who used a map of cases of ill health and interviews with local people to identify a contaminated water pump that was spreading cholera. Since this first study, epidemiology has been developed and used in a lot of different ways to improve health – from proving that smoking can be extremely bad for your health to recognising the role of mosquitos in the spread of yellow fever. Though more traditional methods are still used to quantify disease and its distribution - for example, in recent Ebola outbreaks - epidemiology has also evolved to use big data and more complex techniques, such as machine learning. 

In my research, I will be using big data to understand how having psoriasis may influence the risk of developing cancer. Although psoriasis presents as a condition of the skin, it involves chronic, systemic inflammation and this has been linked to an increased risk of cancer in other conditions, such as inflammatory bowel disease. However, attributing an altered risk of developing cancer to the inflammation involved in psoriasis is challenging due to the presence of other lifestyle behaviours, such as smoking. As it has been demonstrated that smoking is more common in people with psoriasis, it is challenging to say whether people with psoriasis develop cancer more often because of their psoriasis or because they are more likely to smoke – this is a concept known as confounding in epidemiology.

To try to understand whether people with psoriasis do develop cancer more, and whether it’s likely to be a result of their psoriasis or other lifestyle behaviours, I am analysing health data recorded by GPs and Hospitals in England. By following anonymous people with and without psoriasis through their health records, it is possible to compare the number of cancer diagnoses in each group. Having data for behaviours such as smoking then allows me to understand how these factors might be influencing any risk.

Gaining an understanding of whether people with psoriasis do develop cancer more, and what might be causing this, is vital for the current care of people with psoriasis and may also guide important future immunological research into the topic.


Going Further

To learn more about John Snow’s first epidemiological study - 

https://www.pastmedicalhistory.co.uk/john-snow-and-the-1854-cholera-outbreak/

To learn more about epidemiology –

https://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated/1-what-epidemiology

To learn more about psoriasis –

https://www.psoriasis-association.org.uk/

Population health at the University of Manchester –

https://www.research.manchester.ac.uk/portal/en/facultiesandschools/division-of-population-health-health-services-research--primary-care(19db7129-c98b-4029-a819-8c5ffe20e845).html

 

Self-Rewards, the key to quitting smoking ……for good?

by YPU Admin on August 11, 2016, Comments. Tags: masters, psychology, Research, Smoking, and UoM

Introduction

My name is Bethany Gill and I am a Master’s student at The University of Manchester. After completing my A-Levels in 2012 (Psychology, English, History, Biology, General Studies), I went on to study Psychology at UoM from 2012-2015. I graduating last year and chose to continue studying, beginning my Masters at UoM in September 2015. My main interests are clinical and health psychology, with the focus of my current research being around treatment preferences for mental health problems. I have always enjoyed creative writing, and I have recently found a way to combine this with my love of Psychology.

In Depth

Some smokers have tried everything to help them kick the habit without success, but psychologists may have found the answer.

Over the past few decades cigarette smoking rates have declined, due to: higher taxes on tobacco products, smoking restrictions and mass media campaigns. However, smoking is still a major health issue facing Britain, remaining one of the main causes of death in the UK. About half of all regular smokers will die due to smoking, equating to 100,000 smokers dying each year. Smoking is also a major contributor to respiratory diseases, and is accountable for over one third of respiratory deaths as well as one quarter of cancer deaths.

The government currently funds stop smoking services to help people quit smoking. But unfortunately due to government spending cuts, these are currently being decommissioned and disappearing from some areas completely. They also face the problem that their current techniques used to help people stop smoking are not working as well as they should.

Stop smoking services employ clinicians who use techniques rooted in psychology to help people stop smoking. These techniques stem from behaviour change techniques like setting goals and making action plans. They help people to make plans to avoid the temptation of cigarettes by thinking of alternative actions. For example, if they wake up and have a craving for a cigarette, they should go and do the dishes first. Or they make a goal of trying to cut down to five cigarettes by the end of the week.

These methods work, but are not working well enough. This is in part due to the stop smoking techniques not being carried out properly, as some advisors fail to deliver stop smoking techniques efficiently. Recent estimates suggest that these methods are not working for about 80% of smokers. Something needs to change because smokers who have been smoking for years are not receiving the support they need to help them quit smoking, and the amount of clinicians who can help are decreasing.

Now, psychologists at the University of Manchester have a solution. Health psychologists explore people’s attitudes and awareness of their own health. They research ways to prevent unhealthy behaviours, like quitting smoking, and promote healthy behaviours like going to the doctor to get your health checked.

Emma Brown a PhD researcher at the University has spent the past three years conducting trials researching how self-rewards can help kick the habit. These trials have been focusing on trying to reducing smoking rates amongst individuals from the community and from the prison population.

Self-rewards are a behaviour change technique where a reward is only given on successful completion of the specific behaviour. For example, people plan to get through a week of not smoking, then they will plan to give themselves the treat of a meal out on Friday night. This is different to the current techniques where plans are made to engage in an alternative behaviour to smoking, like making a cup of tea rather than having a cigarette.

Self-rewards are self-administered, but they do take a bit of planning. People need to plan what, how and when these self-rewards will happen. The reward doesn’t have to be anything grand, it just has to be something that you enjoy and can reasonably do.

Self-rewards are showing promising results for people trying to quit smoking. As Emma Brown explains that ‘people who use [self-rewards] are three times more likely to quit than those who don’t’. But due to the ongoing nature of the trials that Emma Brown is conducting, we will not know the full scope of the effectiveness of self-rewards until September 2016, when the trials end.

But using self-rewards to help people quit smoking is still new, and needs researching further. Emma Brown suggests that future research will need to look into how self-rewards can be administered on an individual basis, and how the NHS can use this valuable technique to help people quit smoking. At the moment, all we know is self-rewards work if people are supported by a clinician, to make sure that the rewards they set are feasible and realistic.

Although challenges still lie ahead on perfecting self-rewards, the hope of a technique that can be done individually and will help quit smoking for good, is a very promising thought indeed.

For now, the best advice to kick the habit once and for all may be set a goal, stick to it and treat yourself!