{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T01:57:19Z","timestamp":1793066239840,"version":"4.5.0"},"reference-count":37,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T00:00:00Z","timestamp":1680220800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006310","name":"Swedish Medical Research Council","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100006310","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003792","name":"Swedish Brain Foundation","doi-asserted-by":"crossref","award":["FO2020-0077"],"award-info":[{"award-number":["FO2020-0077"]}],"id":[{"id":"10.13039\/501100003792","id-type":"DOI","asserted-by":"crossref"}]},{"name":"NEURO Sweden","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/100018367","name":"Swedish Foundation for MS Research","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100018367","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006636","name":"Swedish Research Council for Health, Working Life and Welfare","doi-asserted-by":"crossref","award":["2015-00195"],"award-info":[{"award-number":["2015-00195"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100006636","name":"Swedish Research Council for Health, Working Life and Welfare","doi-asserted-by":"crossref","award":["2019-00697"],"award-info":[{"award-number":["2019-00697"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"crossref","award":["2016-02349"],"award-info":[{"award-number":["2016-02349"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"crossref","award":["2020-01998"],"award-info":[{"award-number":["2020-01998"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Ugglas Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100004543","name":"Chinese Scholarship Council","doi-asserted-by":"crossref","award":["201907930017"],"award-info":[{"award-number":["201907930017"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2023,2,13]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:p>We aimed to study the influence of smoking habits, exposure to passive smoking and snuff use on disease progression, cognitive performance and quality of life in patients with multiple sclerosis (MS).<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Patients from two population-based case\u2013control studies were categorised based on tobacco exposure at diagnosis and were followed up to 15 years post diagnosis through the Swedish MS registry (n=9089) regarding changes in Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale 29 and Symbol Digit Modalities Test. We used linear mixed models to analyse long-term changes, and Cox regression models with 95% CI using 24-week confirmed disability worsening, reaching EDSS 3 and EDSS 4, respectively, physical and psychological worsening and cognitive disability worsening as end points. The influence of smoking cessation post diagnosis was also investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with non-smokers, current smokers had a faster EDSS progression (\u03b2\n                      <jats:sub>current smoking\u00d7time<\/jats:sub>\n                      =0.03, 95%\u2009CI 0.02 to 0.04). A faster EDSS progression was also associated with passive smoking (\u03b2\n                      <jats:sub>current passive smoking\u00d7time<\/jats:sub>\n                      =0.04, 95%\u2009CI 0.03 to 0.06). Smoke exposure negatively impacted all secondary outcomes. Those who continued smoking had worse outcomes than those who stopped smoking post diagnosis. Snuff users had a more favourable EDSS progression, compared with never users.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings indicate that both smoking and passive smoking have a negative influence on MS and that smoking cessation post diagnosis may be an important secondary preventive measure. Snuff use was associated with slower disease progression, suggesting that nicotine replacement therapy could be an attractive way to increase the chance of quitting smoking among patients with MS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnnp-2022-330848","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T13:23:34Z","timestamp":1680269014000},"page":"589-596","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":49,"title":["Influence of oral tobacco versus smoking on multiple sclerosis disease activity and progression"],"prefix":"10.1136","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6033-3734","authenticated-orcid":false,"given":"Jing","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Olsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7386-6732","authenticated-orcid":false,"given":"Jan","family":"Hillert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Alfredsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6612-4749","authenticated-orcid":false,"given":"Anna Karin","family":"Hedstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,31]]},"reference":[{"key":"2025021202350583000_94.8.589.1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awt139"},{"key":"2025021202350583000_94.8.589.2","doi-asserted-by":"crossref","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"},{"key":"2025021202350583000_94.8.589.3","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2009.122"},{"key":"2025021202350583000_94.8.589.4","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181b2a706"},{"key":"2025021202350583000_94.8.589.5","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1007\/s13760-020-01341-2","article-title":"Associations between smoking and walking, fatigue, depression, and health-related quality of life in persons with multiple sclerosis","volume":"121","author":"Kahraman","year":"2021","journal-title":"Acta Neurol Belg"},{"key":"2025021202350583000_94.8.589.6","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1001\/jamaneurol.2015.1788","article-title":"Effect of smoking cessation on multiple sclerosis prognosis","volume":"72","author":"Ramanujam","year":"2015","journal-title":"JAMA Neurol"},{"key":"2025021202350583000_94.8.589.7","doi-asserted-by":"crossref","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 Tob Res"},{"key":"2025021202350583000_94.8.589.8","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awab385"},{"key":"2025021202350583000_94.8.589.9","doi-asserted-by":"crossref","first-page":"103085","DOI":"10.1016\/j.msard.2021.103085","article-title":"Barriers and motivators for tobacco smoking cessation in people with multiple sclerosis","volume":"54","author":"Hunter","year":"2021","journal-title":"Mult Scler Relat Disord"},{"key":"2025021202350583000_94.8.589.10","doi-asserted-by":"crossref","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"},{"key":"2025021202350583000_94.8.589.11","doi-asserted-by":"crossref","first-page":"278","DOI":"10.17712\/nsj.2019.4.20190027","article-title":"Awareness of patients with multiple sclerosis in Saudi Arabia regarding the relationship between smoking and multiple sclerosis","volume":"24","author":"Bashamakh","year":"2019","journal-title":"Neurosciences (Riyadh)"},{"key":"2025021202350583000_94.8.589.12","doi-asserted-by":"publisher","DOI":"10.1177\/1352458512471879"},{"key":"2025021202350583000_94.8.589.13","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200909-1338OC"},{"key":"2025021202350583000_94.8.589.14","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20703"},{"key":"2025021202350583000_94.8.589.15","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22366"},{"key":"2025021202350583000_94.8.589.16","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-013-9853-4"},{"key":"2025021202350583000_94.8.589.17","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/124.5.962"},{"key":"2025021202350583000_94.8.589.18","doi-asserted-by":"publisher","DOI":"10.1177\/1352458514530489"},{"key":"2025021202350583000_94.8.589.19","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1177\/1352458518808204","article-title":"Symbol digit modalities test: a valid clinical trial endpoint for measuring cognition in multiple sclerosis","volume":"25","author":"Strober","year":"2019","journal-title":"Mult Scler"},{"key":"2025021202350583000_94.8.589.20","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1177\/13524585211049397","article-title":"Interpreting change on the symbol digit modalities test in people with relapsing multiple sclerosis using the reliable change methodology","volume":"28","author":"Weinstock","year":"2022","journal-title":"Mult Scler"},{"key":"2025021202350583000_94.8.589.21","unstructured":"Information. Available: www.scb.en [Accessed 18 Sep 2022]."},{"key":"2025021202350583000_94.8.589.22","unstructured":"Internet-based information. Available: www.who.int [Accessed 18 Sep 2022]."},{"key":"2025021202350583000_94.8.589.23","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s13690-021-00550-2","article-title":"Evaluating level of adherence to nicotine replacement therapy and its impact on smoking cessation: a systematic review and meta-analysis","volume":"79","author":"Mersha","year":"2021","journal-title":"Arch Public Health"},{"key":"2025021202350583000_94.8.589.24","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.2147\/JMDH.S319727","article-title":"Effectiveness and safety profile of alternative tobacco and nicotine products for smoking reduction and cessation: a systematic review","volume":"14","author":"Zakiyah","year":"2021","journal-title":"J Multidiscip Healthc"},{"key":"2025021202350583000_94.8.589.25","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1080\/14737175.2020.1743176","article-title":"Smoking and disability progression in multiple sclerosis","volume":"20","author":"Hedstr\u00f6m","year":"2020","journal-title":"Expert Rev Neurother"},{"key":"2025021202350583000_94.8.589.26","doi-asserted-by":"publisher","DOI":"10.1038\/nature11337"},{"key":"2025021202350583000_94.8.589.27","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0057820","article-title":"Systemic inflammation in progressive multiple sclerosis involves follicular T-helper, th17- and activated B-cells and correlates with progression","volume":"8","author":"Romme Christensen","year":"2013","journal-title":"PLoS ONE"},{"key":"2025021202350583000_94.8.589.28","doi-asserted-by":"crossref","first-page":"24122","DOI":"10.1038\/s41598-021-03476-5","article-title":"Smoking cessation reduces systemic inflammation and circulating endothelin-1","volume":"11","author":"Derella","year":"2021","journal-title":"Sci Rep"},{"key":"2025021202350583000_94.8.589.29","doi-asserted-by":"crossref","first-page":"3000605211019223","DOI":"10.1177\/03000605211019223","article-title":"Neutrophil\/lymphocyte ratio is correlated with levels of inflammatory markers and is significantly reduced by smoking cessation","volume":"49","author":"Komiyama","year":"2021","journal-title":"J Int Med Res"},{"key":"2025021202350583000_94.8.589.30","doi-asserted-by":"crossref","first-page":"12286","DOI":"10.1038\/s41598-021-91510-x","article-title":"Fourteen days of smoking cessation improves muscle fatigue resistance and reverses markers of systemic inflammation","volume":"11","author":"Darabseh","year":"2021","journal-title":"Sci Rep"},{"key":"2025021202350583000_94.8.589.31","doi-asserted-by":"publisher","DOI":"10.1007\/BF03402177"},{"key":"2025021202350583000_94.8.589.32","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.182.3.1730"},{"key":"2025021202350583000_94.8.589.33","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.0902212"},{"key":"2025021202350583000_94.8.589.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.expneurol.2010.09.020"},{"key":"2025021202350583000_94.8.589.35","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0107979","article-title":"The experimental autoimmune encephalomyelitis disease course is modulated by nicotine and other cigarette smoke components","volume":"9","author":"Gao","year":"2014","journal-title":"PLoS ONE"},{"key":"2025021202350583000_94.8.589.36","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjp.0707264"},{"key":"2025021202350583000_94.8.589.37","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1177\/1352458520968803","article-title":"Cotinine as a measure of smoking in observational studies of multiple sclerosis","volume":"27","author":"Hedstr\u00f6m","year":"2021","journal-title":"Mult Scler"}],"container-title":["Journal of Neurology, Neurosurgery &amp; Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jnnp-2022-330848","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T06:15:29Z","timestamp":1739427329000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnnp.bmj.com\/lookup\/doi\/10.1136\/jnnp-2022-330848"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,31]]},"references-count":37,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,7,13]]},"published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1136\/jnnp-2022-330848"],"URL":"https:\/\/doi.org\/10.1136\/jnnp-2022-330848","relation":{},"ISSN":["0022-3050","1468-330X"],"issn-type":[{"value":"0022-3050","type":"print"},{"value":"1468-330X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,31]]}}}