title: The association of alcohol consumption and smoking with quality of life, disability and disease activity in an international sample of people with multiple sclerosis.
abstract: BACKGROUND
  Modifiable lifestyle factors represent important targets for preventive intervention in multiple sclerosis (MS). We aimed to explore the association of cigarette smoking and alcohol consumption with major MS morbidity outcomes.
  
  
  METHODS
  We surveyed a large, international sample of people with MS recruited via Web 2.0 platforms about type of MS, relapse rates, disability, disease activity, health-related quality of life (HRQOL), alcohol use and smoking.
  
  
  RESULTS
  Of 2469 respondents with confirmed MS, 11.7% were current and 40.3% former smokers. Most (61.5%) consumed less than 15 g alcohol weekly; few (0.8%) drank large amounts. Moderate alcohol consumption was associated with increased HRQOL; and after controlling for age and gender, was associated with lower odds of significant disability (41% decrease). After controlling for age, gender and alcohol use, smokers had an increased likelihood of major mobility requirements by 90% compared to never smokers. There was no association between alcohol or smoking and relapse rate or disease activity after controlling for age and gender, however among former smokers, a longer duration of smoking cessation was associated with reduced disease activity. Smokers had significantly lower HRQOL than never smokers and former smokers; heavier smoking was associated with greater decreases in HRQOL.
  
  
  CONCLUSIONS
  This cross-sectional study supports previous research showing a link between morbidity indicators in MS and alcohol use and smoking. While people with MS should be advised of the potential risks of smoking, any risks and benefits of alcohol consumption require validation using a prospective cohort of people with MS.
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne (St Vincent's Hospital), Melbourne, Victoria, Australia. Electronic address: Tracey.Weiland@svhm.org.au.
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Weiland
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Hadgkiss
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: George A
authors.initials: GA
authors.lastname: Jelinek
authors.affiliation: Faculty of Medicine, Notre Dame University, Fremantle, Western Australia, Australia.
authors.forename: Naresh G
authors.initials: NG
authors.lastname: Pereira
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Claudia H
authors.initials: CH
authors.lastname: Marck
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Dania M
authors.initials: DM
authors.lastname: van der Meer
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods; D006233:Persons with Disabilities / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D038622:Internationality; D008019:Life Style; D008297:Male; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology
keywords: Alcohol; Disability; Multiple sclerosis; Quality of life; Relapse; Smoking; Survey