title: Smokers with MS have greater decrements in quality of life and disability than non-smokers.
abstract: BACKGROUND
  Tobacco smoke plays a pathogenic role in multiple sclerosis (MS) and may accelerate disease progression, yet, some people with MS continue to smoke after disease onset. The average smoker reports diminished health-related quality of life (HRQOL) across many populations.
  
  
  OBJECTIVE
  To describe the relationships between smoking status and HRQOL, disease activity, and global disability in a US population with MS.
  
  
  METHODS
  We compared smokers to non-smokers in 950 responders to the Spring 2014 update survey completed by North American Research Committee on Multiple Sclerosis (NARCOMS) registry participants. HRQOL was assessed using Short Form-12 version 2 (SF-12v2), disease activity was investigated using eight Performance Scales (PS) and three Functionality Scales (FS). Global disability was evaluated using Patient Determined Disease Steps (PDDS) and an item response theory (IRT) summed score based on the PS and FS.
  
  
  RESULTS
  Smokers had lower HRQOL ( p < 0.0001), reported more disease activity ( p < 0.05) and greater deficits in all PS and FS ( p = 6 × 10-7to 0.05), except mobility. Smokers and non-smokers did not differ by PDDS but had substantially greater IRT global disability ( p = 2 × 10-7).
  
  
  CONCLUSIONS
  Active smoking is meaningfully associated with deficits across multiple domains in people with MS and adds to the growing literature of the need for MS-tailored smoking cessation programs.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Farren Bs
authors.initials: FB
authors.lastname: Briggs
authors.affiliation: Center for Health Care Research and Policy, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Gunzler
authors.affiliation: Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ontaneda
authors.affiliation: Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000503:physiopathology*; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology
keywords: Multiple sclerosis; disability; item response theory; quality of life; smoking