Improving young people’s health and well-being

Adolescents make up about one sixth of the world's population, so policy and practice that improves the lives of young people is hugely beneficial now and for the future. In the current economic climate, most countries in Europe are faced with widening socioeconomic inequalities. It is key to our understanding of how these inequalities impact on young people’s health, to be able to track and measure the differences in health outcomes among children of deprived versus affluent families. The Family Affluence Scale (FAS) devised by Professor Candace Currie, of the School of Medicine, has been used to describe and quantify socioeconomic inequalities in health among young people across Europe and North America and these findings have been published by the World Health Organisation in their report ‘Social Determinants of Health and Wellbeing among Young People’. The indicator has been adapted within the context of the Health Behaviour in School-Aged Children (HBSC), a major international study which involves 43 countries across Europe and North America. FAS has been used to demonstrate that material deprivation impacts negatively on wide ranging aspect of adolescent well-being, including mental health, social relations, bullying, physical activity, eating habits and obesity. This evidence has been incorporated into policy events including WHO-HBSC Forums, bringing together policy makers and health programme developers from all over Europe to discuss the relevance of the findings for guiding their work. The Child and Adolescent Health Research Unit (CAHRU), established by Professor Candace Currie in 2000 and at the St Andrews since 2011, has been designated World Health Organisation (WHO) Collaborating Centre for International Child and Adolescent Health Policy.

Tackling the global tobacco epidemic with geochemistry

One in two smokers will succumb to a smoking-related disease and one billion deaths in the 21st century will be attributable to smoking. The World Health Organisation (WHO) is responding to this global epidemic with a variety of strategies within the Framework Convention on Tobacco Control (FCTC) to which 176 countries are signatories. Geochemical research at the University of St Andrews has contributed to FCTC policies and supports their implementation by chemically characterising and monitoring potentially toxic environmental metals such as arsenic and cadmium in tobacco. The group’s research has been helping to combat the global trade in illicit tobacco and its major consequences for health and for government revenues through taxation and criminal activity.

The science 

Approximately 5% of tobacco (dry weight) is inorganic with its origins in soils, atmospheric particles (natural and anthropogenic pollutants) and agrochemicals. Some of this is taken up through the plant roots while particles tend to adhere to the sticky and hairy surface of the leaf. Among this diversity of material are several “heavy metals”. Fundamental to determining whether these metals or metalloids might be toxic to humans is their chemical form (valence and molecular speciation). The contribution each metal makes to the harmful effects of tobacco smoke is determined by a combination of concentration and speciation. As a result of research conducted in the Department of Earth and Environmental Sciences (e.g. Analysis of non-organic elements in plant foliage using polarised X-ray fluorescence spectrometry, DOI: 10.1016/j.aca.2004.08.015 and Source and health implications of high toxic metal concentrations in illicit tobacco products, DOI: 10.1021/es049038s), it became clear that toxic metal concentrations, determined primarily by geographical location and legal status, varied by an order of magnitude. The speciation of arsenic in tobacco has now been determined and combustion (i.e. smoking) has been shown to generate the most toxic form (inorganic trivalent arsenic) in respirable smoke (e.g. Controls on the Valence Species of Arsenic in Tobacco Smoke: XANES Investigation with Implications for Health and Regulation, DOI: 10.1021/es4039243).

Principal components analysis of inorganic elements in tobacco
from global sources demonstrating provincial variability.

Using an archive of tobaccos collected over more than a decade from most parts of the world, it proved possible for the first time to identify provinciality among tobaccos products. The figure illustrates that significant differences exist at the continental scale at least. This feature can be used to constrain the geographical origins of illicit products. The same dataset helps to identify regions on a global scale where tobacco smoking represents a major source of exposure to toxic metals.

Health and economic benefits 
Since 2004 FCTC has been the main driver of national and global policy on tobacco control. It is predicted that full implementation of FCTC will prevent over seven million premature deaths by 2050. The unexpected discovery by the University of St Andrews group of high toxic metal concentrations, including carcinogens such as cadmium and arsenic, in most counterfeit tobacco products prompted HMCE (now HMRC) to run a nationwide information campaign in 2004 ("Counterfeit Cigarettes") sponsored by HM Treasury. The illicit share of the UK cigarette market at that time was 18% but was halved to 9% by 2012-13. Evidence presented in Treasury revenue reports indicates that revenues recovered due to the range of UK policies for reducing the supply and demand for illicit tobacco since 2006 may exceed £1 billion. Evidence of the harmful nature of illicit products from the St Andrews laboratories was used to support this effort. Globally over $31 billion is lost in tax revenue. It has been suggested that 164,000 premature deaths might be avoided annually if illicit tobacco was eliminated.

The University of St Andrews research into toxic metals in commercial cigarettes also highlighted legal Chinese tobacco products as among the most heavily contaminated so far analysed (Cigarettes sold in China: design, emissions and metals, DOI: 10.1136/tc.2009.030163). China is the world’s largest tobacco-growing nation with the largest number of smokers. The adverse impact on health of habitual use of contaminated products by the Chinese population is not yet quantifiable but could be considerable. Currently, it accounts for one million deaths annually from tobacco use.

Psychological intervention to alleviate heightened fears of recurrence of cancer patients

Fear of recurrence is a major concern for many cancer patients, as highlighted in a major review by Professor Gerald Humphris and Dr Gozde Ozakinci of the School of Medicine. The Adjustment of Fear, Threat or Expectation of a Recurrence (AFTER), developed for general cancer patients, includes an innovative validated Fear of Recurrence (FoR) measure. The measure identifies patients with high fear of recurrence in NHS oncology services to enable psychological therapeutic treatments to be targeted, thus improving the quality of patient care. AFTER is being widely and successfully employed with cancer survivors in UK cancer services and international oncology centres to reduce their FoR and depression. Additional funding is ensuring further implementation of the AFTER intervention into cancer services through training workshops and staff supervision to build a targeted service for NHS patients. A clinical service of the AFTER intervention is provided in the NHS Lothian Edinburgh Cancer Centre for out-patients, and training workshops on the intervention are currently being conducted to enable health professionals in England in their use. Other European and International Cancer Centres are also adopting AFTER for use in the EU and North America.

Porous material use in the delivery of biologically active gases

Nitric oxide (NO) is an extremely toxic gas at high levels which is extremely beneficial for healthcare at the right doses. The trick is delivering it safely to the treatment site. Professor Russell Morris and his research team in the School of Chemistry have successfully solved the major problem of how to safely retain, transport and deliver NO and other medically active gases to offer novel and effective solutions for a variety of healthcare markets, including the treatment of chronic wounds, and related therapeutic and biomedical applications where eradication of bacterial biofilms is required.

Clinical studies on human skin show that zeolite-NO
technology is non-inflammatory compared with
a major competitor (acidified nitrite).

The zeolites and metal-organic framework (MOF) materials that Morris’ research group have developed store the gas in a stable form that can be delivered in a customised manner, in terms of dosage and rate of delivery, to the specific biomedical application.
The unique combination of highly porous materials and economically attractive, scalable chemistry offers cost-effective solutions to problems in industries as diverse as textiles, chemical consumer and water treatment. The research has resulted in seven patents and has led to the formation of two spin out companies: MOFgen Ltd, a spin out from the University of St Andrews: and Zeomedix LLC, a spin out in the US. Further interactions with ~70 companies internationally have resulted in 14 of the companies benefiting directly from the research, enabling entirely new products, entry to new markets and commercial opportunities.
Pre-startup funded by EPSRC and Scottish Enterprise.

"Sticking plaster" treatment for skin cancer and acne

A wearable light source that can treat many skin cancers and acne has been invented by Professor Ifor Samuel (School of Physics and Astronomy) working with Professor James Ferguson (Ninewells Hospital, Dundee) in light-emitting-polymers. Using support from Scottish Enterprise, they showed organic light-emitting diodes (OLEDs) could be used to make a light-emitting "sticking plaster" that provides a new light source for medicine. The light-based treatment is gentler than surgery and so leads to a better cosmetic outcome. It is an improvement over conventional photodynamic therapy (PDT), which is only available in a limited number of hospitals because of the specialised equipment involved, because the patient can move around during treatment, pain is reduced, and a hospital visit can be avoided.

Ambicare Health Ltd developed the prototype ambulatory devices into a form suitable for regulatory approval and manufacture. This resulted in two products, “Ambulight”, a portable, wearable light source with battery pack, used for treating non-melanoma skin cancers and dysplasia, and “Lustre” for the treatment of acne. The more effective, simplified treatment with Ambulight has meant an increase in the number of patients treated per clinic, a success rate of 84% of lesions being clear after one year, and patients having a comfortable, portable, home-based treatment. The advantage of Lustre is that it enables acne to be treated at home, using blue light treatment rather than drugs or chemicals. Both systems are in use in the UK and the Netherlands.