The connection between smoking and cancer is well documented.  Less well known, however, is the fact that smoking exacerbates complications for people with diabetes. Smokers with diabetes are eleven times more likely to have a heart attack or stroke than people who don't have diabetes and don't smoke.

Still, 13 percent of Californians who have diabetes also smoke. "Smoking has devastating effects on a person with diabetes," says Tami MacAller, Senior Health Promotion Specialist of the California Diabetes Program.  "Most of these smokers see a primary care doctor who may not have all the tools and answers regarding smoking and diabetes.  Our goal is to connect with healthcare providers, to let them know about the tools and resources available for smoking cessation."

California's anti-smoking programs

California has done well in its efforts to control smoking. In 2005, the prevalence of adult smoking nationwide was 20.9 percent, but California's smoking prevalence was only15.2 percent, the lowest in the United States after Utah. Since 1988, when California passed Proposition 99, a comprehensive tobacco control initiative, smoking prevalence in California has declined by 33 percent.

California's success has been attributed to its cigarette tax policy, an aggressive anti-smoking media campaign, its smoke-free indoor air policies, and its effective community tobacco education programs. According to a study by the Department of Health Management and Policy, University of Michigan, Ann Arbor, "The observed correlation between California's tobacco control efforts and ensuing results is encouraging and suggests that California could be used as an example for the United States to learn from and emulate."

Despite speculation that California's unique demographics impact its smoking population, the authors of the study concluded that "tobacco control efforts seem to have played a major role in the state's achievements in reducing smoking....We hope that California's experience with tobacco serves as an example for the United States to follow, validating once again the old saying, ‘As California goes, so goes the nation.'"

Smoking and diabetes

A collaboration between the California Diabetes Program, the California Smokers' Helpline (1-800-NO BUTTS), and the Tobacco Control Program in the Department of Public Health is working with healthcare professionals to promote smoking cessation among their patients with diabetes.  Clinicians can easily refer patients to the Helpline, where they can quickly get self-help materials and county referral lists and work with a smoking cessation counselor.

Dr. Jennifer Tuteur, Medical Director of San Diego's National Medical Association Comprehensive Health Center, was introduced to the Helpline by the California Diabetes Program.  "Physicians don't always have a lot of time to spend with patients, nor are we trained to provide counseling services.  So having this free service to refer patients to is great."

Dr. Tuteur, who is a family practitioner, also appreciates the Helpline Gold Cards that she  shares with her patients.  The cards look like a credit card, but display the California Smokers' Helpline toll free number (1-800 NO BUTTS).  They're intended to help motivate and inspire people to quit smoking and call the Helpline for free services.  "The Gold Card is fabulous.  I pass out several each week," says Dr. Tuteur.  "It's handy.  People put it in their purse or wallet." 

"The Gold Card is a great reminder, but the biggest thing that has helped our patients stop smoking is the one-on-one counseling provided by the California Smokers' Helpline," adds Dr. Tuteur.  She says her patients enjoy the individualized attention and establish a connection with their counselor.

I tried to quit twice, but this time it's going to work

"I started smoking when I was a teenager because it was the cool thing to do," says Sharon Van Alstine, who was diagnosed with type 2 diabetes 18 years ago.  "Smoking is not cool.  Not only is it an expensive habit, but it's also destroying my body....I just had cataract surgery on my left eye. My advice to anyone is to not start smoking."

Van Alstine quit twice before, but went back to smoking both times. Her story isn't unusual.  "For the majority of smokers, it'll take six to eight attempts to be successful at quitting," says California Smokers' Helpline Program Director Chris Anderson.  Sharon hopes her third try will be the charm and is working with a counselor to come up with a smoking plan she can stick to. 

Support systems

"I need a buddy system," says Van Alstine.  "My counselor gives me great ideas.  I now work on crossword puzzles or eat popcorn when I'm nervous.  I won't automatically light up."  For many smokers, the challenge of quitting is huge. "The last thing we want to do is give them extra assignments that are so foreign to them," explains Anderson. "Our counselors work with them to help determine their triggers and to keep them motivated to quit." Helpline counselors also typically call smokers several times throughout their quitting process to help them stay on track.

Carolyn Salinas, a Kaweah Delta Healthcare District Hospital Registered Nurse, visited the Helpline in San Diego.  "I wanted to make certain the person on the other side of the line had the skills to help our patients succeed," says Salinas, who's been a certified diabetes educator for nine years.  "These people are well educated, some working on their masters or doctorates, and really know the business of smoking cessation.  I'm on the bandwagon now!"

Helpline services are available six days a week in English, Mandarin, Cantonese, Korean, Spanish and Vietnamese, as well as via a TDD line for the hard of hearing.  There are also specialized services for teens, pregnant women, and those who chew tobacco.  "We're on their side," explains California Smokers' Helpline's Anderson. "We've got all the facts of what smoking does to your health, but we're not here to nag them. We're here to help them.  When someone calls us, they're going to get a supportive, caring person, a counselor who is nonjudgmental."  Anderson adds that research shows that the counselors are having an effect.  "People who use our telephone counseling are twice as likely to quit successfully as those trying to quit on their own."

California Diabetes Program: caldiabetes.org or call 1-916-552-9888

The California Smokers' Helpline: nobutts.org or call 1-800 NO BUTTS

Agency for Healthcare Research & Quality (AHRQ): ahrq.gov
Smoking Cessation leadership Center: smokingcessationleadership.ucsf.edu
or call 1-800-Quit-Now

American Academy of Family Physicians (AAFP): aafp.org

Download the "Do you cAARd?" toolkit and other resources

Sources: California Diabetes Program of the CDPH, UCSF, and "Tobacco Control Success vs. Demographic Destiny: Examining the Causes of the Low Smoking Prevalence in California," American Journal