Symptom Groups Associated with Smoking Among Persons with Relapsing-Remitting Multiple Sclerosis

Background:  The evaluation of the magnitude of the effect of cigarette smoking on the severity of multiple sclerosis MS)  may help to determine underlying disease mechanisms and is important, as studies have reported a high percentage of smokeing in people with MS (Marrie et al., 2009). Studies also suggest tobacco use increases the likelihood of developing MS, and a possible risk for increased disease severity and progression (Manouchehrinia et al., 2014).  But, we know little about co-occurring symptoms associated with tobacco use in persons with MS.

Objectives: The primary aim of this study was to identify symptoms and symptom groups associated with smoking behaviors in persons with relapsing-remitting MS (RRMS).

Methods: A cross sectional, descriptive study of persons with RRMS was utilized. Measures included: A subset of the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey tobacco questions, the MS-Related Symptom, Scale (MS-RS) revised version, and the Self-Report Expanded Disability Status Scale (SR-EDSS). Tobacco questions covered use ever, frequency, and quantity of use. Analysis used descriptive statistics, factor analysis to identify symptom groupings, and linear regression models

Results: The convenience sample was comprised of 101 participants with RRMS, who averaged 43 years old. The majority were female (83%), white (86%), and married (64%). A majority (52%) were ever smokers. The overall mean duration of MS disease and score on the SR-EDSS in ever smokers were 8.5 years and 3.5, respectively. Ever smokers were more likely to be single compared to never smokers (38% versus 20%, p =.03). Controlling for race and age, two symptom groups of co-occurring symptoms were identified according to smoking status: 1) Ever smokers had higher scores on the Mental/Emotional factor (symptoms: loneliness, depression, and anxiety) (p <.04); and 2) Regular, but not current, smokers had higher scores on the heat intolerance/vision factor (heat intolerance, co-occurring heat intolerance/vision, blurred vision, and double vision) (p< .03).

Conclusions: The current study is a first step in understanding the relationship between smoking behavior, MS symptom groupings, and disease course in persons with MS. Understanding the association between symptoms and tobacco use can improve management of MS through targeted person centered care. These findings can also increase the success of tobacco cessation efforts with resulting reduction in healthcare costs and improved quality of life.