Partnering for health promotion: A collaboration between state tobacco cessation and diabetes programs

In California there are over 2 million people diagnosed with diabetes; 18% use tobacco. Tobacco use increases insulin resistance, worsens diabetes control, increases the risk of cardiovascular disease and other complications. To increase the use of the state's quitline by people with chronic diseases, the California Diabetes Program, California Smokers' Helpline, and the California Tobacco Control Program collaborated to create multifaceted intervention strategies that focus on increasing health care providers' ability to ask patients if they smoke, advise them to quit, and refer them to the quitline. These strategies also integrate awareness of diabetes into the quitline's services and of tobacco use into the diabetes program. A toolkit was developed for providers that included training presentations, intervention scripts, and provider and patient fact sheets; implemented a proactive patient fax referral to the quitline from federally qualified and Indian health centers; partnered with the state's diabetes educators to create an outreach campaign and continuing education program; and launched a public relations campaign reaching over 200,000 providers nationally. These strategies were integrated into California Diabetes Program tools and resources, Helpline counselors were trained in basic diabetes education, and a screening question to identify callers with diabetes was integrated into the quitline's intake process. This partnership effort has proven to be successful in increasing provider awareness about the importance of tobacco cessation for their patients with diabetes, in increasing referrals to the helpline, and in creating a sustainable collaboration between tobacco and diabetes programs. It could easily be replicated for other chronic diseases.