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EP12 Study Abroad with PhD Student Sasha Guttentag
Deborah Onakomaiya: Hey guys, and welcome to another episode of I AM GPH. I am your host, Deborah Onakomaiya. On the show today we have Sasha Guttentag, who's a second year PhD student in the epidemiology track at NYU. She's here today to talk about her research experience abroad, as well as the PhD experience in general. Her public health interests are in health tech, behavior change and social epidemiology. As a doctoral student, she has worked in the mHealth Lab, led by Dr. Tom Kirchner, and she is also a member of the Doctoral Advisory Committee. In her free time, Sasha loves to play squash and she even started a Squash Club here at NYU. Let's go to our conversation with her. All right Sasha, thanks so much for being on our show today. It's really nice having you on.
Sasha Guttentag: Thank you. I'm excited to be here.
Deborah Onakomaiya: Awesome. Currently you are working in mHealth. So for our listeners, can you explain what mHealth is and why it's important?
Sasha Guttentag: I think at this point that mHealth is kind of a buzzword in society, not unlike the idea of a big data, if you're familiar with that. mHealth literally stands for mobile health and essentially refers broadly to the use of mobile technologies in healthcare. So fitness trackers are probably the most widely used example of mHealth. Another example is pregnancy monitoring smartphone application for pregnant women to keep track of how their gestation is progressing, which can help ensure healthy delivery for both mother and child. And there's a bunch of other examples. Myself, I think of mobile health as encompassing two sort of separate entities. One of the entities is sort of a more front end surface level mHealth that we're now quite used to seeing in our daily lives. Things like those pregnancy tracking apps, gamification of healthy behaviors, reminders to take prescription medicines, et cetera. And then the other side of mHealth is the more backend approach that involves using GPS technologies that all of our smartphones nowadays are equipped with to understand how people move throughout the day and how that can influence different health behaviors. I'd say these two entities are not mutually exclusive and I myself am particularly interested in how information that we receive on the backend can influence the front end mobile health applications. How we can further customize those smartphone applications based on information that we are possibly receiving from the backend. One example is cigarette smokers, so if someone is addicted to cigarettes and probably they're more likely to smoke a cigarette if they're in a setting where there's a lot of tobacco retail outlets or if they're in areas where people are much more likely to smoke, whether that's late nights outside of the clubbing districts, things like that. If we can get information about where someone is at a given point in time, we can customize the health behavior promotion messages that they would be receiving regardless. So if someone is trying to quit cigarettes and they're passing through or spending time in one of those condensed areas with a lot of tobacco retail outlets, we might want to send them a text message right at that time suggesting or encouraging the behavior that they've this far completed with refraining from smoking cigarettes.
Deborah Onakomaiya: A followup question to this is, is this just a proposed program with this example that you gave or this is something that has already been piloted and is going forward?
Sasha Guttentag: There's certainly already been research done into this. The technologies themselves are still being developed, so there will continuously be iterations on this. Of course there's the other pool of thought that says if someone's in an environment where there's a lot of nicotine cues, cigarette smoking cues, and then you send them a text message talking about cigarettes, that's going to make them still want to smoke. So it's sort of you have to balance these two different ideas. But this has been implemented at least in its beginning phases and I'm excited to see where further research takes us.
Deborah Onakomaiya: Oh wow! That's really interesting. Are you personally just interested in tobacco research or are you looking at other data?
Sasha Guttentag: I'm still developing what my dissertation thesis is going to be about, but the lab that I work in at NYU with my advisor, Dr. Thomas Kirchner, we do a lot of tobacco focused research, and so I find myself gravitating towards that.
Deborah Onakomaiya: At the end of the day the ultimate goal, especially for your particular project is to reduce tobacco use. And is this in a specific population or geographical area or just worldwide? What is the goal of this project that you're currently working on?
Sasha Guttentag: As I mentioned, mHealth involves a lot of different components and a lot of the research that I'm focused on is the more backend mHealth technologies. So one of the research projects I'm working on is evaluating the harm reduction potential of e-cigarettes. And most recently presented a protocol poster for this research at New York City Epidemiology Forum. But e-cigarettes are a very controversial topic lately and we are hoping to get a better understanding of the public health implications of e-cigarettes used as a harm reduction strategy. So we are testing the efficacy of using e-cigarettes and particularly placebo e-cigarettes with 0% nicotine to understand whether they can be used as a way for people to reduce their smoking and then hopefully eventually quit. It's just not unlike the nicotine patch but hopefully more effective version. And we’re interested in also evaluating whether the overall public health demonization that e-cigarettes currently are facing is deserved or not. So basically we will be getting smokers who really have no desire to quit smoking, giving them an e-cigarette, asking them to experiment with it as they wish, see what happens. And then hopefully we'll also be able to understand how their daily patterns using the GPS on their phones, how they traverse throughout their daily life. How that influences their cravings to smoke and what instances they reached for the e-cigarette versus a regular combustible cigarette. How we can use that information to better inform anti-smoking campaigns and the other aspect of mHealth, like that straight getting an SMS and responding to an SMS, that is entirely our data collection and that helps a lot with understanding how people's usage patterns and cravings for nicotine vary throughout the different times of the day as well.
Deborah Onakomaiya: I think my follow up question to that was that you said the e-cigarette is going to have placebo, like the nicotine patch has some amount of nicotine. So is there any other substance in the e-cigarette or it's basically steam?
Sasha Guttentag: That's a good question. I think the typical percentage of nicotine in e-cigarettes varies between 3 and 5% and we will be testing basically a 0% nicotine e-cigarette. So basically we're seeing whether it's not the actual nicotine that makes people continue smoking, whether it's the habit of reaching for the cigarette, inhaling, blowing out whether that behavior is really what subconsciously influences the desire to smoke. So it's pretty much brand new, so we'll see where it takes us.
Deborah Onakomaiya: Well, and that's really interesting. Are you going to compare them? Like is the test group going to be a group that has that placebo e-cigarette and then the control group be people that have nicotine and... Like it's the reverse, do you know, like what...?
Sasha Guttentag: Yeah, I think that we're still designing, making final changes to the design, but at the very minimum we'll have people using the placebo, people using nicotine e-cigarettes, and then a group that doesn't receive an e-cigarette just it's business as usual as the control.
Deborah Onakomaiya: All right. So Sasha, you're speaking to us today from Portugal. How did you get there? Why aren't you not in New York City?
Sasha Guttentag: NYU has a bunch of campuses worldwide to study in and I happened to choose what seems like the only country that doesn't have an NYU campus. So I'm not exactly studying abroad. I'm taking two online courses at CGPH and I'm doing research at the Institute of Public Health at the University of Porto. So as a PhD student at NYU, there's basically two tracks that you can be on. You can be a research assistant or a research fellow. I'm a research assistant, but I had the opportunity this semester to switch my funding to be a research fellow so I could come do research. I'm very grateful for the opportunity. It's really great that NYU was able to work with me to provide this switch in funding for the semester. So the reason why I wanted to come to Portugal is because the Institute of Public Health here ISPUP it's known for its research. It's a renowned institution, primarily because of the cohort studies it has. So it currently has three different cohorts. The EPIPorto cohort is a cohort of adults from the city of Porto followed up every few years for the last 15 years. EpiTeen is a similar cohort design, but amongst adolescents. So the first wave started when the adolescents were 13 years old in 2003 and they're evaluated every four years. The most recent cohort is a birth cohort that began in 2005 and so the day that mothers gave birth, they and the newborns were evaluated and the children and caretakers are followed up every few years. And so this is just a wealth of data and it's really exciting to get experience working with these cohort datasets. And the reason that I wanted to come here in particular to use this cohort is because of the geographic information systems or GIS aspect that is employed here. So the professor I'm working with here, her name is Ana Isabel Ribeiro and she is a public health geographer and she has made it a point to basically include and evaluate GIS components of the cohort dataset and using that we can understand how particularly she has worked to evaluate neighborhood deprivation in Porto and then a bunch of different ways to link that to health status and health outcomes and changes in health outcomes and all sorts of things. So I was really excited to get the chance to work with her in this type of study.
Deborah Onakomaiya: These cohorts... You're just looking at the type of data that's being collected about them is just everything, but for you your focus is on the geographical data.
Sasha Guttentag: Exactly. So you're exactly right. There's so much information collected on them. At every evaluation we get the GPS coordinates of where they reside. My current research proposal here is looking at residential mobility and how that influences smoking behavior. So if a family moves from a neighborhood that we would consider more deprived to a neighborhood that we would consider less deprived, does that therefore make them like, influence their smoking behavior? They were a heavy smoker and then more deprived area do they become a light smoker in the less deprived neighborhood and how quickly that those changes happen if they happen at all.
Deborah Onakomaiya: And that smoking piece, are you incorporating the mHealth piece into that research?
Sasha Guttentag: So in this research, the only sort of mobile health component is basically the GIS, which is not using cell phones, just another health technology piece.
Deborah Onakomaiya: I'm sure you've had several experiences aside the research in... Speaking as a student of NYU, what experiences have you had that are very different from your experience studying at NYU currently in Portugal?
Sasha Guttentag: So NYU does a great job of facilitating professor student collaboration, but here in Portugal it seems to be even more ingrained and profound. In my office here at ISPUP or my desk rather, I'm sitting right next to the professor I'm working with. So the doctoral students and the masters students who are doing research sit right next to professors and the post docs. And I think the fact that there even is a hierarchy would be much less obvious to an outsider than it might be at NYU. There's a couple other differences for doctoral students. For example, at NYU we take two years of coursework and we're sort of given a bit more leeway in coming up with our dissertation project, proposal, timeline, that kind of thing. In Portugal, they have one year of coursework and when you enter your first day you already know exactly what your project is going to be. There's much less room for fluidity in that. It's much more focused from the beginning. And I've actually really enjoyed the fact that NYU has given us time to explore our interests further before committing to what's going to be our dissertation.
Deborah Onakomaiya: That's really amazing. And it sounds like you're having a wealth of experience over there. Has there been a language barrier or have you found researching in a foreign country different?
Sasha Guttentag: I spent a year in Brazil as a Fulbright recipient and so I was like, "Oh, this is great. I speak Portuguese, I'm going to go to Portugal." And I came here and I'd felt basically I'm learning a new language because the dialects are so different. So that was a rude awakening. I think the silver lining is that a lot of Portuguese people can understand Brazilian Portuguese because I think there was a lot of influence from soap operas here that became really popular. It's much more difficult for Brazilians to understand Portuguese people. So at least... I feel for the most part people can understand me and I'm still getting the hang of the Portuguese accent in Portugal. But luckily everyone here... A lot of people here, most everyone here speaks English and the classes at ISPUP, which I occasionally sit in on are taught in English because for the doctoral students here, if they want EU PhD, they need to be completely proficient in English and need to have their classes taught in English and their dissertation defense is in English. And there are students also in at the university who don't speak Portuguese. So that's been an interesting thing to be a part of.
Deborah Onakomaiya: Are there any words of wisdom that you would have for PhD students who want to take their research beyond NYU?
Sasha Guttentag: I wouldn't necessarily recommend studying where there is not an NYU campus because I couldn't get credit here for the classes that even I'm sitting in on. But I think you'd have to be first of all know what you want, make connections in the country that you're interested in going in. Start early, start talking to people at NYU. I didn't really face any problems with... NYU was very flexible with me, but I would say be ready to defend the reasons why you want to go abroad and what that will do in giving you more experience towards your dissertation degree. And if you hear a no from someone, I wouldn't necessarily take that as a final decision, but it just says something to work around or try to develop further why it is that you need to go abroad. And then I would say don't be afraid to ask for help. I was emailing people all the time up to the last minute to try to help me with administrative issues. And I felt bad for... I felt maybe I was taking up too much of people's time, but they're really willing to help you and I really appreciated that the whole NYU team was able to help me with the visa. They were able to help me get international health insurance. And that's just been fantastic.
Deborah Onakomaiya: Wow! That sounds amazing. Thank you so much, Sasha, for being on our show. We've learned so much from you. Thank you so much.
Sasha Guttentag: Sure, thank you.