title: Smoking among diabetes patients in Yogyakarta, Indonesia: cessation efforts are urgently needed.
abstract: OBJECTIVE
  To document the prevalence of tobacco use among male diabetes patients in a clinic based population of Yogyakarta Province, Indonesia; to examine patient's perceptions of smoking as a risk factor for diabetes complications; and to investigate whether patients had received cessation messages from their doctors.
  
  
  METHODS
  Twelve in-depth interviews and five focus groups (n = 21) with diabetic patients in 2004-2005, followed by a cross-sectional survey of 778 male diabetic patients in diabetes clinics in 2006-2007.
  
  
  RESULTS
  65% of male diabetes patients smoked before being diagnosed, and 32% smoked in the last 30 days. Most patients incorrectly perceived low level smoking safe for diabetics (mean of 3.6 cigarettes). The median range of cigarettes smoked per day was in excess of this 'safe' amount (4-10 cigarettes). Most respondents did not associate smoking with diabetes and its complications. Only 35% of all patients recalled being asked whether they smoked by their doctors, and there were no differences between smokers and non-smokers. Quit messages received by patients were seen as general health advice and not diabetes specific.
  
  
  CONCLUSIONS
  Many diabetic patients continue to smoke despite the hazard of smoking on diabetes complications and mortality. Smoking cessation is not commonly encouraged by health-care providers in Indonesia, and is not a routine part of diabetes counselling despite the risk of smoking to those with diabetes. Project Quit Tobacco International is currently developing cessation services for patients with diabetes and encouraging medical and nursing schools to incorporate disease specific tobacco education in its curriculum and skill based classes in tobacco cessation counselling.
authors.affiliation: Centre for Bioethics and Medical Humanities, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Retna Siwi
authors.initials: RS
authors.lastname: Padmawati
authors.forename: Nawi
authors.initials: N
authors.lastname: Ng
authors.forename: Yayi Suryo
authors.initials: YS
authors.lastname: Prabandari
authors.forename: Mark
authors.initials: M
authors.lastname: Nichter
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology*; D005194:Family Practice; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006301:Health Services Needs and Demand; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation; D011795:Surveys and Questionnaires