{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:21:45Z","timestamp":1758759705472,"version":"3.44.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"9-10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Cigarette smoking is a leading cause of preventable death in the United States and disproportionately affects veterans. While smoking cessation is the goal for all veterans, it is especially critical for veterans with multiple sclerosis (MS; VwMS), for whom smoking is more detrimental to health and function. Smoking is associated with more MS relapses\/flares, greater disability, faster disease progression, and earlier MS-related death. This quality improvement project aims to describe current practice pathways for screening and treating smoking cessation in VwMS and explore whether these differ by sociodemographic factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>A validated algorithm was used to identify VwMS who were current or former smokers at one VA hospital in North Carolina from fiscal year 2020 to 2022 who had been screened for smoking and could be followed for 1\u2009year. A chart review was conducted by 2 reviewers and 25% of charts were audited for reliability. Data extraction was guided by the Consolidated Framework for Implementation Research. Within-group proportions were used to help compare receipt of care across different groups in the context of sociodemographic factors. This work was deemed quality improvement and not subject to IRB review.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of all VwMS (n\u2009=\u2009309), 39.5% (n\u2009=\u2009122) were identified as current or former smokers. Of those, only 58% (n\u2009=\u200971) were eligible largely because many VwMS lacked a current screen, which was an identified gap in care. Among those screened, most screenings had taken place through primary care services (73%), and most were offered behavioral interventions at screening (n\u2009=\u200966), yet few were interested (n\u2009=\u20094) or received a referral to the cessation clinic (n\u2009=\u20092). One additional referral was given during the follow-up year. Most VwMS were also offered pharmacological interventions (n\u2009=\u200968), with more interest (n\u2009=\u200911) and cessation medication prescriptions (n\u2009=\u20098). Eleven additional VwMS received prescriptions throughout the follow-up year, but a third of those (36%) were required due to inpatient hospitalizations. While subgroup sample sizes were limited, potential disparities were noted. For example, women veterans and veterans from minoritized populations were less likely to be assessed for smoking status and offered cessation strategies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study identified relatively low rates of smoking cessation screening, interest in treatment, and treatment delivery for VwMS. Important racial and sex disparities were noted. There are several potential barriers and facilitators including Electronic Health Record referral logistics, veteran and provider awareness of the relationship between smoking and MS, stigma of behavioral interventions, fragmented care, and competing demands on clinicians. This work was done at one local VA hospital within North Carolina, the leading state in tobacco production, and is not necessarily representative of other hospital screening and treatment practices. The role of specialty providers (e.g., mental health and neurology) in smoking cessation for VwMS should be further explored and may be an important opportunity for improving screenings and tailored discussion. Future work, incorporating VHA clinician and VwMS perspectives, is needed to further characterize and address barriers\/facilitators to improve smoking cessation care and health of VwMS.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaf110","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T12:34:51Z","timestamp":1744202091000},"page":"e2227-e2234","source":"Crossref","is-referenced-by-count":0,"title":["Smoking Cessation Screening and Treatment Among Veterans With Multiple Sclerosis"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0555-5190","authenticated-orcid":false,"given":"Carri S","family":"Polick","sequence":"first","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System , Durham, NC 27705,","place":["United States"]},{"name":"School of Nursing, Duke University , Durham, NC 27710,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine A","family":"Sims","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System , Durham, NC 27705,","place":["United States"]},{"name":"Division of Rheumatology, Department of Medicine, Duke University , Durham, NC 27710,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Meckes","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System , Durham, NC 27705,","place":["United States"]},{"name":"VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center , Durham, NC 27705,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna T","family":"Magnante","sequence":"additional","affiliation":[{"name":"VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center , Durham, NC 27705,","place":["United States"]},{"name":"W.G. (Bill) Hefner VA Healthcare System , Salisbury, NC 28144,","place":["United States"]},{"name":"Department of Neurology, Wake Forest School of Medicine , Winston-Salem, NC 27101,","place":["United States"]},{"name":"College of Health and Behavioral Sciences, Regent University , Virginia Beach, VA 23464,","place":["United States"]},{"name":"Cascade Neuropsychology , Bellingham, Washington 98225,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiffany J","family":"Braley","sequence":"additional","affiliation":[{"name":"Division of Multiple Sclerosis and Neuroimmunology, Michigan Medicine , Ann Arbor, MI 48109,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah M","family":"Wilson","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System , Durham, NC 27705,","place":["United States"]},{"name":"Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, NC 27710,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A","family":"Dennis","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System , Durham, NC 27705,","place":["United States"]},{"name":"Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, NC 27710,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick S","family":"Calhoun","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System , Durham, NC 27705,","place":["United States"]},{"name":"VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center , Durham, NC 27705,","place":["United States"]},{"name":"Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, NC 27710,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,4,9]]},"reference":[{"issue":"10","key":"2025092416181749500_R1","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1001\/jama.291.10.1238","article-title":"Actual causes of death in the United States, 2000","volume":"291","author":"Mokdad","year":"2004","journal-title":"JAMA"},{"issue":"2","key":"2025092416181749500_R2","doi-asserted-by":"publisher","first-page":"16","DOI":"10.3138\/jmvfh-2020-0038","article-title":"The prevalence rate of smoking among Veterans: a forgotten epidemic","volume":"7","author":"Mshigeni","year":"2021","journal-title":"J Mili Veteran Fam Health"},{"issue":"2","key":"2025092416181749500_R3","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1080\/08995605.2011.570589","article-title":"Characteristics and correlates of tobacco use among U.S. veterans returning from Iraq and Afghanistan","volume":"23","author":"Acheson","year":"2011","journal-title":"Mil Psychol"},{"issue":"29","key":"2025092416181749500_R4","doi-asserted-by":"publisher","first-page":"633","DOI":"10.15585\/mmwr.mm7329a1","article-title":"Adult smoking cessation\u2014 United States, 2022","volume":"73","author":"VanFrank","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"article-title":"Veterans Health Administration Directive 1056","year":"2019","author":"Department of Veterans Affairs","key":"2025092416181749500_R5"},{"issue":"1","key":"2025092416181749500_R6","doi-asserted-by":"publisher","first-page":"29","DOI":"10.7205\/milmed-d-00-3108","article-title":"Evidence-based national initiatives to address tobacco use as a public health priority in the Veterans Health Administration","volume":"174","author":"Hamlett-Berry","year":"2009","journal-title":"Mil Med"},{"issue":"6","key":"2025092416181749500_R7","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1136\/tc.2009.035147","article-title":"Using policy to increase prescribing of smoking cessation medications in the VA healthcare system","volume":"19","author":"Smith","year":"2010","journal-title":"Toba Control"},{"issue":"2","key":"2025092416181749500_R8","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1093\/ntr\/ntad159","article-title":"Addressing smoking in persons with multiple sclerosis: state of the science and need for a targeted intervention","volume":"26","author":"Polick","year":"2024","journal-title":"Nicotine Tobacco Res"},{"issue":"2","key":"2025092416181749500_R9","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1001\/jamaneurol.2019.4271","article-title":"Association between cigarette smoking and multiple sclerosis: a review","volume":"77","author":"Rosso","year":"2020","journal-title":"JAMA Neurol"},{"issue":"4","key":"2025092416181749500_R10","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1177\/1352458517690271","article-title":"A systematic review of the effects of modifiable risk factor interventions on the progression of multiple sclerosis","volume":"23","author":"Hempel","year":"2017","journal-title":"Mult Scler J"},{"issue":"5","key":"2025092416181749500_R11","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1093\/ntr\/ntx084","article-title":"Smoking cessation and the reduction of disability progression in multiple sclerosis: a cohort study","volume":"20","author":"Tanasescu","year":"2018","journal-title":"Nicotine Tobacco Res"},{"issue":"10","key":"2025092416181749500_R12","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1136\/jnnp-2013-307187","article-title":"Tobacco smoking and excess mortality in multiple sclerosis: a cohort study","volume":"85","author":"Manouchehrinia","year":"2014","journal-title":"J Neurol Neurosurg"},{"issue":"9","key":"2025092416181749500_R13","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1177\/1352458518791753","article-title":"Smoking is associated with increased disease activity during natalizumab treatment in multiple sclerosis","volume":"25","author":"Petersen","year":"2019","journal-title":"Mult Scler J"},{"issue":"8","key":"2025092416181749500_R14","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1177\/1352458513515086","article-title":"Smokers run increased risk of developing anti-natalizumab antibodies","volume":"20","author":"Hedstr\u00f6m","year":"2014","journal-title":"Mult Scler J"},{"issue":"11","key":"2025092416181749500_R15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0162752","article-title":"Occurrence of anti-drug antibodies against interferon-beta and natalizumab in multiple sclerosis: a collaborative cohort analysis","volume":"11","author":"Bachelet","year":"2016","journal-title":"PLoS One"},{"issue":"7","key":"2025092416181749500_R16","doi-asserted-by":"publisher","first-page":"e593","DOI":"10.1212\/WNL.0000000000004949","article-title":"Smoking affects the interferon beta treatment response in multiple sclerosis","volume":"90","author":"Petersen","year":"2018","journal-title":"Neurology"},{"author":"Veterans Affairs","key":"2025092416181749500_R17","article-title":"Multiple sclerosis centers of excellence"},{"issue":"18","key":"2025092416181749500_R18","doi-asserted-by":"publisher","first-page":"e1810","DOI":"10.1212\/WNL.0000000000200150","article-title":"The economic burden of multiple sclerosis in the United States: estimate of direct and indirect costs","volume":"98","author":"Bebo","year":"2022","journal-title":"Neurology"},{"issue":"2","key":"2025092416181749500_R19","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1111\/1468-0009.12124","article-title":"Tobacco-control policies in tobacco-growing states: where tobacco was king","volume":"93","author":"Fallin","year":"2015","journal-title":"Milbank Q"},{"key":"2025092416181749500_R20","doi-asserted-by":"publisher","first-page":"S54","DOI":"10.1097\/PHH.0000000000001132","article-title":"State preemption: impacts on advances in tobacco control","volume":"26","author":"Kang","year":"2020","journal-title":"J Public Health Manage Pract"},{"key":"2025092416181749500_R21","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1007\/s11606-017-4144-5","article-title":"Validation of veterans affairs electronic medical record smoking data among Iraq- and Afghanistan-era veterans","volume":"32","author":"Calhoun","year":"2017","journal-title":"J Gen Intern Med"},{"issue":"1","key":"2025092416181749500_R22","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implem Sci"},{"issue":"4","key":"2025092416181749500_R23","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013308","article-title":"Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation","volume":"2019","author":"Lindson","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"2025092416181749500_R24","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.3513","article-title":"Investigating disparities in smoking cessation treatment for veterans with multiple sclerosis: a national analysis","volume":"14","author":"Polick","year":"2024","journal-title":"Brain Behav"},{"issue":"11","key":"2025092416181749500_R25","doi-asserted-by":"publisher","first-page":"2553","DOI":"10.1007\/s11606-023-08227-y","article-title":"Ask and ask again: repeated screening for smoking increases likelihood of prescription for cessation treatment among women veterans","volume":"38","author":"Than","year":"2023","journal-title":"J Gen Intern Med"},{"article-title":"National Veteran Health Equity Report\u2014Black or African American Veteran Chartbook: Focus on Veterans Health Administration Patient Experience and Health Care Quality","year":"2023","author":"Washington","key":"2025092416181749500_R26"},{"issue":"8","key":"2025092416181749500_R27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0289885","article-title":"Perspectives of VA healthcare from rural women veterans not enrolled in or using VA healthcare","volume":"18","author":"Rohs","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"2025092416181749500_R28","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jacr.2021.08.027","article-title":"Association of rurality with annual repeat lung cancer screening in the Veterans Health Administration","volume":"19","author":"Spalluto","year":"2022","journal-title":"J Am College Radiol"},{"key":"2025092416181749500_R29","doi-asserted-by":"publisher","DOI":"10.1016\/j.josat.2023.209191","article-title":"A smoking cessation intervention for rural veterans tailored to individual risk factors: a multicenter randomized clinical trial","volume":"156","author":"Vander Weg","year":"2024","journal-title":"J Subst Use Addict Treat"},{"issue":"3","key":"2025092416181749500_R30","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1111\/jrh.12609","article-title":"Coordinating women\u2019s preventive health care for rural veterans","volume":"38","author":"Kinney","year":"2022","journal-title":"J Rural Health"},{"issue":"7","key":"2025092416181749500_R31","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1177\/13524585241245637","article-title":"Depression is a core symptom of multiple sclerosis","volume":"30","author":"Feinstein","year":"2024","journal-title":"Mult Scler"},{"issue":"10","key":"2025092416181749500_R32","doi-asserted-by":"publisher","first-page":"4790","DOI":"10.3390\/ijerph10104790","article-title":"Smoking behaviour and mental health disorders\u2014mutual influences and implications for therapy","volume":"10","author":"Minichino","year":"2013","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"2025092416181749500_R33","doi-asserted-by":"publisher","first-page":"341","DOI":"10.3390\/sclerosis2040022","article-title":"Resilience, mental health, sleep, and smoking mediate pathways between lifetime stressors and multiple sclerosis severity","volume":"2","author":"Polick","year":"2024","journal-title":"Scler"},{"issue":"9","key":"2025092416181749500_R34","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0291562","article-title":"Multimodal smoking cessation treatment combining repetitive transcranial magnetic stimulation, cognitive behavioral therapy, and nicotine replacement in veterans with posttraumatic stress disorder: A feasibility randomized controlled trial protocol","volume":"19","author":"Young","year":"2024","journal-title":"PLos One"},{"issue":"7","key":"2025092416181749500_R35","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1177\/0890117118761886","article-title":"Long-term outcomes from repeated smoking cessation assistance in routine primary care","volume":"32","author":"Bailey","year":"2018","journal-title":"Am J Health Promotion"},{"issue":"7","key":"2025092416181749500_R36","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-059637","article-title":"Smoking habits, awareness and support needs for cessation among people with multiple sclerosis in Australia: findings from an online survey","volume":"12","author":"Weld-Blundell","year":"2022","journal-title":"BMJ Open"},{"issue":"1","key":"2025092416181749500_R37","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-20998-5","article-title":"Motivators and barriers for smoking cessation in people with multiple sclerosis: a qualitative study to inform the design of a tailored intervention","volume":"24","author":"Keller","year":"2024","journal-title":"BMC Public Health"},{"key":"2025092416181749500_R38","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.drugalcdep.2019.01.011","article-title":"Effects of motivation phase intervention components on quit attempts in smokers unwilling to quit: a factorial experiment","volume":"197","author":"Engle","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"3","key":"2025092416181749500_R39","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1093\/pubmed\/fdu065","article-title":"Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey","volume":"37","author":"Bellis","year":"2015","journal-title":"J Public Health"},{"issue":"3\u20134","key":"2025092416181749500_R40","doi-asserted-by":"publisher","first-page":"e509","DOI":"10.1093\/milmed\/usad290","article-title":"Reliability of electronic health records in recording veterans\u2019 tobacco use status","volume":"189","author":"Sun","year":"2024","journal-title":"Mil Med"},{"issue":"10","key":"2025092416181749500_R41","doi-asserted-by":"publisher","first-page":"1825","DOI":"10.1093\/rheumatology\/keu213","article-title":"Smoking cessation advice by rheumatologists: results of an international survey","volume":"53","author":"Naranjo","year":"2014","journal-title":"Rheumatology (Oxford)"},{"key":"2025092416181749500_R42","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2020.101091","article-title":"Smokers\u2019 reports on receiving a doctor\u2019s advice to quit smoking; receiving the advice is more prevalent among smokers with Crohn\u2019s disease relative to smokers with ulcerative colitis","volume":"18","author":"Soulakova","year":"2020","journal-title":"Prev Med Rep"},{"key":"2025092416181749500_R43","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2021.103289","article-title":"Improving smoking cessation support for people with multiple sclerosis: a qualitative analysis of clinicians\u2019 views and current practice","volume":"56","author":"Grech","year":"2021","journal-title":"Mult Scler Relat Disord"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/9-10\/e2227\/62898519\/usaf110.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/9-10\/e2227\/62898519\/usaf110.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T20:18:24Z","timestamp":1758745104000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/190\/9-10\/e2227\/8109347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,9]]},"references-count":43,"journal-issue":{"issue":"9-10","published-online":{"date-parts":[[2025,4,9]]},"published-print":{"date-parts":[[2025,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaf110","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"type":"print","value":"0026-4075"},{"type":"electronic","value":"1930-613X"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,4,9]]}}}