Diabetes

Tobacco use continues to be the lead-ing cause of preventable premature mortality in the United States. Nic-otine addiction combined with type 2 di-abetes is an especially lethal combination because of increased risk of heart attack, stroke, and peripheral vascular disease. Smoking may increase the risk for type 2 diabetes. There is even some evidence that passive exposure to cigarette smoke may increase diabetes risk. People with type 2 diabetes need to stop smoking and most importantly, school children at increased risk for type 2 diabetes need to avoid smoking. School health programs to prevent tobacco use have enormous potential to increase life-span and quality of life in populations at increased risk for type 2 diabetes. As CDC Guidelines suggest, “School-based tobacco prevention education programs that focus on skills training approaches have proven effective in reducing the onset of smoking. ” The positive effect of school-based programs is magnified in settings such as ours, in Pine Ridge In-dian Reservation in southeastern South Dakota, where smoking and smokeless tobacco use are epidemic and the risk of type 2 diabetes is high. Tobacco Use And Diabetes Risk The dire consequences of having type 2 diabetes and continuing to smoke have been appreciated for decades. In recent years, research suggests that smoking may increase the risk of developing type 2 diabetes. For example, in a Harvard School of Public Health study of 114,247 female nurses, the risk of diabetes was nearly 50 percent higher among women who smoked 25 or more cigarettes per day compared with nonsmokers, after adjust-ing for obesity and other risk factors. The study suggested that the more women smoked, the greater the risk of diabetes (Rimm et al, 1993). The role of smoking as an independent risk factor for type 2 diabetes probably has been underappreciated. Most research on the causes of the diabetes epidemic have focused on the contributions of poor diet, lack of exercise, and genetic factors. There are many well-known reasons to discourage smoking in school children. Decreasing future risk of diabetes may be yet another