Smoking among veterans with multiple sclerosis: prevalence correlates, quit attempts, and unmet need for services

Abstract

Objective: To describe the prevalence and correlates of smoking as well as quit attempts and unmet need for smoking cessation services in a national sample of veterans with multiple sclerosis (MS).

Design: Cross-sectional cohort study linking computerized medical record information to mailed survey data from 1999.

Setting: Veterans Health Administration (VHA).

Participants: Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires, as well as a 20% random subsample (n=569) who completed a more extensive assessment of smoking.

Interventions: Not applicable.

Main outcome measures: Items assessing smoking, quit attempts, and unmet need for smoking services.

Results: Among all survey respondents with MS, 28.5% (95% confidence interval [CI], 26.9-30.2) endorsed current smoking. Of extended survey respondents, 54.5% (95% CI, 46.6-62.1) reported a quit attempt in the past year, and 59.0% (95% CI, 51.1-66.4) reported not getting needed services for smoking in the past year. In fully adjusted logistic regression, smoking was associated with younger age, lower levels of education, being unmarried, higher levels of physical pain, and poorer mental health. A quit attempt was associated with higher levels of education and greater pain intensity.

Conclusions: Smoking among veterans with MS is common, with rates similar to those for other veterans. There is substantial need for cessation services. Cessation interventions should address correlates of smoking including pain, poorer mental health, and social isolation.