title: Smoking and physical activity: examining health behaviors and 15-year mortality among individuals with multiple sclerosis.
abstract: OBJECTIVE
  To examine 2 modifiable health behaviors-smoking and physical activity-and their relationship to mortality among individuals with multiple sclerosis (MS).
  
  
  METHODS
  Secondary analysis of Large Health Survey.
  
  
  METHODS
  Data were obtained from a linkage of the Veterans Affairs (VA) MS National Data Repository, containing information on service provision to all individuals with MS receiving health services within the U.S. Department of Veterans Affairs; the VA 1999 Large Health Survey, containing information on smoking and physical activity; and the VA Vital Status File. All-cause mortality was examined for the 15-year period from 1999 through 2013.
  
  
  METHODS
  Participants (N=2994) with MS who completed the Large Health Survey containing information on smoking and physical activity.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Survival.
  
  
  RESULTS
  There were 1500 deaths (50.1%) during the study period. Cox proportional hazard analyses were conducted to examine the association between smoking and physical activity and 15-year mortality. After adjusting for demographic factors, physical functioning, mental health, and comorbid medical conditions, baseline smoking was associated with greater mortality (hazard ratio [HR]=1.38; 95% confidence interval [CI], 1.184-1.60). Higher levels of baseline physical activity were associated with lower mortality (activity 1-2 times/wk: HR=.64; 95% CI, .518-.798; activity ≥3 times/wk: HR=.53; 95% CI, .388-.715).
  
  
  CONCLUSIONS
  Results suggest that modifiable health behaviors represent a promising opportunity for intervention to improve the lives of individuals with MS.
authors.affiliation: VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA; VA Center of Excellence in Substance Abuse Treatment and Education, Seattle, WA; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: Aaron.Turner@med.va.gov.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Turner
authors.affiliation: VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Narineh
authors.initials: N
authors.lastname: Hartoonian
authors.affiliation: VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.affiliation: VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Leipertz
authors.affiliation: VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Jodie K
authors.initials: JK
authors.lastname: Haselkorn
mesh_terms: D000203:Activities of Daily Living; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000401:mortality*; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D014728:Veterans
keywords: Exercise; Mortality; Multiple sclerosis; Physical activity; Rehabilitation; Smoking