Amy Taylor

EFFECTS OF NEW INSULINS ON INSULIN AND C-PEPTIDE ANTIBODIES, INSULIN DOSE, AND DIABETIC CONTROL

24 diabetic patients stabilised on conventional bovine insulins and possessing insulin antibodies underwent a study of the immunological and clinical consequences of changes in both purity and species of their insulin preparations. After a 2-month run-in period patients were treated for 3 consecutive 4-month periods with (a) purified bovine insulin (20-40 ppm proinsulin), (b) highly purified porcine insulin, and (c) semisynthetic human insulin, without elective dose changes. Mean insulin antibody levels changed little on purified bovine insulin (22.2 leads to 23.4 micrograms/l) but fell on highly purified porcine (23.4 leads to 12.9 micrograms/l) and remained much the same on Semi-Synthetic human insulin. In contrast, C-peptide antibodies fell significantly and continuously throughout the study. The slower rate of fall in C-peptide antibody levels is likely to be due to the prolonged half-life of circulating exogenous proinsulin in the presence of insulin antibody. Although insulin dose remained constant the incidence of hypoglycaemic episodes did not increase and glycosylated haemoglobin levels rose significantly when patients were on porcine insulin. The deterioration in diabetic control may have been due to greater temporal mismatch between insulin needs and insulin availability with pork or human insulin than with beef insulins, and to reduced insulin antibody levels. The use of purer insulins which more closely resemble the human form can cause a significant reduction in levels of insulin and C-peptide antibodies. Although these changes may have other benefits they do not necessarily produce better diabetic control. Subcutaneous insulin regimens need to be tailored to the individual patient and, indirectly, to his antibody status.

A qualitative evaluation of a novel intervention using insight into tobacco industry tactics to prevent the uptake of smoking in school-aged children

BackgroundEvidence from the US Truth campaign suggests that interventions focusing on tobacco industry tactics can be effective in preventing smoking uptake by children. Operation Smoke Storm is the first school-based intervention based on this premise and comprises three classroom sessions in which students act as secret agents uncovering tobacco industry tactics through videos, quizzes, discussions, and presentations. We report a qualitative evaluation of its acceptability.MethodsWe conducted eight focus groups with 79 students aged 11-12 who participated in Operation Smoke Storm at two UK schools in Autumn 2013, and 20 interviews with teachers who delivered the intervention. These were digitally audio-recorded, transcribed verbatim and analysed using the framework method.ResultsStudents enjoyed the secret agent scenario and reported acquiring new knowledge about smoking and the tobacco industry, which seemed to strengthen their aversion to smoking. Teachers felt confident delivering the ‘off the shelf’ resource, although they would have welcomed more background information about the topic and guidance on steering discussions. Teachers highlighted a need for the resource to be flexible and not dependent on lesson length, teacher confidence, or expertise. Students and teachers endorsed the idea of developing a booster component for older students and supported the development of printed information complementing the resource to encourage parents to support their child not to smoke.ConclusionsThese findings demonstrate that Operation Smoke Storm can be delivered by teachers to raise awareness about smoking-related issues. The ideas and issues raised are now being used to improve and extend the resource for further evaluation.

Operation Smoke Storm: effectiveness of a school-based smoking prevention intervention providing insight into the tobacco industry

Abstract Background Assessment of the US Truth campaign showed that mass media campaigns informing children about tobacco industry practices are effective in preventing smoking uptake. The aim of this study was to assess the potential effectiveness of a school-based intervention, based on the premise of Truth, in reducing ever smoking and susceptibility to smoking among children in the UK. Methods Data come from a pilot study intended to test the acceptability of the intervention and ease of delivery, and to provide preliminary evidence of effectiveness before further assessment in a randomised trial. 445 students in two schools in the East Midlands, UK, completed anonymous questionnaires in Year 7 (ie, aged 11–12 years) and Year 8 (12–13), before and after receiving the Operation Smoke Storm intervention. This intervention consisted of three teacher-led sessions that combined interactive paper-based and audio-visual components in Year 7 and one booster session in Year 8. We used multilevel logistic regression (students nested within schools), adjusted for confounders, to compare the odds of smoking and susceptibility at follow-up in students who received Operation Smoke Storm with 1692 students in eight local schools who were asked identical questions about smoking behaviour as part of another survey but who did not receive the intervention. The study was approved by the University of Nottingham Medical School Research Ethics Committee (reference C13122012 CHS EPH Smoking). Findings Prevalence of ever smoking or susceptibility to smoking was similar in intervention and control schools in Year 7. In Year 8, 34 students (7·6%) who received Operation Smoke Storm reported ever smoking and 111 (24·9%) reported susceptibility to smoking; 175 students (10·3%) who did not receive Operation Smoke Storm reported ever smoking and 329 (19·4%) reported susceptibility. There was no significant difference in the odds of a combined outcome of ever smoking or susceptibility to smoking in students who received the intervention compared with controls (adjusted odds ratio 1·28, 95% CI 0·83–1·97; p=0·263), and no difference in odds of ever smoking (0·82, 0·42–1·58; p=0·549). Interpretation Operation Smoke Storm does not seem to have reduced smoking and susceptibility to smoking among students aged 12–13 years in two UK schools. Qualitative analysis is ongoing to explore students and teachers perceptions of Operation Smoke Storm and potential reasons to explain the apparent lack of effectiveness. Funding The National Institute for Health Research Public Health Research Programme (NIHR PHRP) (project number 11/3010/02). The funder had no role in the writing of the abstract or the decision to submit.

Operation Smoke Storm: qualitative evaluation of a novel intervention to prevent uptake of smoking in schoolchildren

Abstract Background 40% of smokers become addicted before age 16 years and those who start at an early age are less likely to quit and more likely to die from their habit than are those who start later. Evidence from the US truth campaign suggests that interventions focusing on the tactics of the tobacco industry can be effective in preventing smoking uptake by children. Operation Smoke Storm is the first UK intervention based on this premise and we report an evaluation of its acceptability and effectiveness. This resource comprises three classroom sessions in which students act as secret agents uncovering tobacco industry tactics through videos, quizzes, discussions, and presentations. Methods Eight focus groups were conducted with 80 students in year 7 (aged 11–12 years) who had participated in Operation Smoke Storm at two schools in the East Midlands, UK. 18 interviews were conducted with teachers who delivered the intervention. The focus groups and interviews were digitally audiorecorded, transcribed verbatim, and analysed with the Framework method. The study was approved by the University of Nottinghams medical school research ethics committee (reference C13122012 CHS EPH Smoking). Findings Students enjoyed the secret agent scenario and reported acquiring new knowledge about smoking and the tobacco industry, which seemed to strengthen their aversion to smoking. Most teachers felt confident about delivering the resource, but would have welcomed more background information about the topic and guidance on how to steer discussions. Teachers highlighted a need for the resource to be flexible and not dependent on lesson length, teacher confidence, or expertise. Students and teachers endorsed the idea of developing a booster component for year 8 students (12–13 years), though stressed practical considerations including computer access. Participants also supported the development of printed information complementing the resource to encourage parents to support their child to not experiment with tobacco. Interpretation Although data were only collected from two schools, this rigorously conducted study highlights that Operation Smoke Storm can be delivered by teachers to raise awareness about smoking-related issues. These promising findings are relevant for anyone looking to deliver a novel anti-smoking message to young people and for health policy makers aiming to reduce uptake of smoking. The ideas and issues raised by students and teachers are now being used to improve and extend the resource for further evaluation. Funding National Institute for Health Research Public Health Research Programme (project number 11/3010/02). The funder had no role in the writing of this abstract or the decision to submit.