Smoking Cessation Screening and Treatment Among Veterans With Multiple Sclerosis

Area of Science:

• Public Health
• Clinical Quality Improvement
• Health Services Research

Background:

• Cigarette smoking is a leading cause of preventable death, disproportionately impacting veterans.
• Smoking exacerbates multiple sclerosis (MS) progression, increasing relapses, disability, and mortality in veterans with MS (VwMS).
• Effective smoking cessation interventions are critical for VwMS to improve health outcomes and disease management.

Purpose of the Study:

• To describe current smoking cessation screening and treatment practices for VwMS within a VA hospital.
• To explore potential sociodemographic disparities in the delivery of smoking cessation care to VwMS.
• To identify gaps and opportunities for improving smoking cessation support for VwMS.

Main Methods:

• A quality improvement project utilizing a validated algorithm to identify VwMS who smoked between fiscal years 2020-2022.
• Retrospective chart review guided by the Consolidated Framework for Implementation Research, with reliability auditing.
• Analysis of within-group proportions to compare care receipt across sociodemographic factors.

Main Results:

• Only 58% of identified VwMS smokers were eligible for analysis due to lack of current screening, indicating a significant care gap.
• While most screened VwMS received offers of behavioral and pharmacological interventions, interest and referrals to cessation clinics were low.
• Disparities were noted, with women and minority veterans less likely to be assessed for smoking status and offered cessation strategies.

Conclusions:

• Low rates of smoking cessation screening, treatment interest, and delivery were observed among VwMS.
• Significant racial and sex disparities in care suggest systemic inequities in smoking cessation support.
• Barriers include EHR referral logistics, awareness, stigma, and fragmented care; further research involving VwMS and clinicians is needed.