{"doi":"10.1093/ntr/ntad159","title":"Addressing Smoking in Persons With Multiple Sclerosis: State of the Science and Need for a Targeted Intervention","abstract":"Multiple sclerosis (MS) is an immune-mediated inflammatory disease that is primarily diagnosed between the ages of 20 and 40 and is the leading cause of non-traumatic disability in young adults.1 MS has both genetic and environmental risk factors, such as smoking tobacco, which increases the risk of developing MS by 50%.2 Smoking also leads to more rapid disease progression, for example, moving from one isolated symptomatic incident to definite MS, and from relapsing forms to progressive forms.2,3 Furthermore, smoking has been associated with worse disability, fatigue, depression, and quality of life in people with MS (PwMS).3 While 11.5% of adults smoke cigarettes, 38% of PwMS smoke at the time of MS onset.4,5 Therefore, timely cessation is critical for disease trajectory. Despite decades of evidence that smoking negatively impacts MS, and that cessation improves the disease course, we still lack targeted smoking cessation interventions for PwMS.6–8 Nascent work out of Australia revealed that 75% of PwMS reported being screened for smoking in any healthcare setting, yet only about 10% of providers assisted with cessation.9,10 One reason for low cessation support rates could be that specialty care providers may assume that primary care is addressing smoking with patients. For example, a qualitative study of MS providers highlighted that many believed that primary care was a better setting than neurology for cessation support.9 Primary care providers typically see patients more often and may be better informed to speak to cardiovascular and wider systemic effects of smoking, yet may have limited time to discuss smoking during visits. Referrals to smoking cessation clinics, when available, can help absorb some of the workload, but not all health systems have this resource. However, PwMS may hesitate to take steps to quit without discussions specific to potential interactions between cessation pharmacotherapy and MS treatment/immunotherapy.10 Furthermore, primary care or cessation clinic providers may not feel prepared to address these nuanced questions while recommending smoking cessation for PwMS. Importantly, patients with healthcare access barriers may forgo primary or referral clinic care and may only have contact with specialty care, suggesting that not addressing tobacco cessation in conjunction with MS care is a missed opportunity to provide smoking cessation support to patients. There is a paucity of educational materials and interventions to assist time-constrained clinicians with cessation discussions or in helping to educate PwMS. This is a critical gap as 40%–78% of PwMS report not knowing that smoking is associated with MS risk, treatment (eg, relapses, medications), or progression.9,10 Targeted interventions that can be used in multiple healthcare settings could help fill these health service and knowledge gaps to facilitate PwMS being more informed and motivated to quit smoking. Interactions between cessation and MS medications were the top priority topic to include in a targeted program according to 91.3% of PwMS who currently or formerly smoked.10 MS medications have burgeoned within the last decade to about 20, and not all are listed yet in clinical interaction databases. PwMS are also commonly prescribed antispasmodic, steroid, and pain medications, so understandably 51% of PwMS who smoke find it very or extremely important to get cessation support from someone knowledgeable about MS.10 Notably, a few studies have found that PwMS who smoke, potentially from heat-related inflammatory and immune responses, have increased risk of developing antibodies against MS medications, decreasing their ability to slow disease progression.1,11 Resources highlighting interactions and other key information that can be quickly reviewed could help facilitate timely clinical conversations that may otherwise not occur because of clinic appointment time constraints. Stress across the lifespan is intimately interwoven with smoking, ","journal":"Nicotine & Tobacco Research","year":2023,"id":362726,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.962,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":488488,"name":"Dana Rubenstein","orcid":"0000-0003-4103-9641","position":1,"is_corresponding":false},{"id":281945,"name":"Suma Shah","orcid":"0000-0003-3989-944X","position":2,"is_corresponding":false},{"id":264430,"name":"Jean C. Beckham","orcid":"0000-0001-8746-8949","position":3,"is_corresponding":false},{"id":264456,"name":"Patrick S. Calhoun","orcid":"0000-0001-6739-6634","position":4,"is_corresponding":false},{"id":380241,"name":"Devon Noonan","orcid":"0000-0001-6675-8736","position":5,"is_corresponding":false},{"id":766985,"name":"Carri S. Polick","orcid":"0000-0002-0555-5190","position":0,"is_corresponding":true}],"reference_count":25,"raw_metadata":null,"created_at":"2026-07-19T01:14:23.749325Z","pmid":"37625016","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}