Original article| Volume 96, ISSUE 3, P402-409, March 2015

Smoking and Physical Activity: Examining Health Behaviors and 15-Year Mortality Among Individuals With Multiple Sclerosis

  • Aaron P. Turner
    Corresponding author Aaron P. Turner, PhD, VA Puget Sound Health Care System, Rehabilitation Care Services, S-117-RCS, 1660 S Columbian Way, Seattle, WA, 98108.
    VA Puget Sound Health Care System, Seattle, WA

    VA Multiple Sclerosis Center of Excellence West, Seattle, WA

    VA Center of Excellence in Substance Abuse Treatment and Education, Seattle, WA

    Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
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  • Narineh Hartoonian
    VA Puget Sound Health Care System, Seattle, WA

    VA Multiple Sclerosis Center of Excellence West, Seattle, WA

    Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
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  • Charles Maynard
    VA Puget Sound Health Care System, Seattle, WA
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  • Steven L. Leipertz
    VA Puget Sound Health Care System, Seattle, WA

    VA Multiple Sclerosis Center of Excellence West, Seattle, WA
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  • Jodie K. Haselkorn
    VA Puget Sound Health Care System, Seattle, WA

    VA Multiple Sclerosis Center of Excellence West, Seattle, WA

    Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA

    Department of Epidemiology, University of Washington, Seattle, WA
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Published:November 06, 2014DOI:



      To examine 2 modifiable health behaviors—smoking and physical activity—and their relationship to mortality among individuals with multiple sclerosis (MS).


      Secondary analysis of Large Health Survey.


      Data were obtained from a linkage of the Veterans Affairs (VA) MS National Data Repository, containing information on service provision to all individuals with MS receiving health services within the U.S. Department of Veterans Affairs; the VA 1999 Large Health Survey, containing information on smoking and physical activity; and the VA Vital Status File. All-cause mortality was examined for the 15-year period from 1999 through 2013.


      Participants (N=2994) with MS who completed the Large Health Survey containing information on smoking and physical activity.


      Not applicable.

      Main Outcome Measure



      There were 1500 deaths (50.1%) during the study period. Cox proportional hazard analyses were conducted to examine the association between smoking and physical activity and 15-year mortality. After adjusting for demographic factors, physical functioning, mental health, and comorbid medical conditions, baseline smoking was associated with greater mortality (hazard ratio [HR]=1.38; 95% confidence interval [CI], 1.184–1.60). Higher levels of baseline physical activity were associated with lower mortality (activity 1–2 times/wk: HR=.64; 95% CI, .518–.798; activity ≥3 times/wk: HR=.53; 95% CI, .388–.715).


      Results suggest that modifiable health behaviors represent a promising opportunity for intervention to improve the lives of individuals with MS.


      List of abbreviations:

      HR (hazard ratio), LVHS (Large Veteran Health Survey), MCS (Medical Component Summary), MS (multiple sclerosis), PCS (Physical Component Summary), SF-36v (Medical Outcomes Study 36-Item Short-Form Health Survey–Veterans version), SIC (Seattle Index of Comorbidity), VA (Veterans Affairs)
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