# Smoking and multiple sclerosis: development and feasibility study of a MS-specific smoking cessation intervention

## TL;DR

A new smoking cessation program tailored for people with multiple sclerosis was developed and found to be feasible and acceptable based on feedback from patients and experts.

## Contribution

The development of an MS-specific smoking cessation intervention using behavior change theory and tailored video content.

## Key findings

- Six MS-specific smoking cessation videos were created and found to be understandable and appropriate in length.
- The intervention includes five online sessions over three weeks and integrates the videos into a structured program.
- Positive feedback from people with MS and MS experts suggests the program is feasible and acceptable.

## Abstract

Tobacco smoking is an established risk factor for accelerated multiple sclerosis (MS) progression and worse MS symptoms. Generic smoking cessation programs might not fully meet the needs of people with MS (pwMS), as they don’t address MS-specific barriers influencing smoking behavior (e.g., worries about relapses when quitting). Yet, no MS-specific smoking cessation interventions have been evaluated.

This study aimed to develop an MS-specific smoking cessation intervention.

This is an intervention development and initial feasibility study, informed by the Behavior Change Wheel and the design and evaluation framework for digital health interventions, which have been successfully utilized before, including in MS contexts.

Between January and December 2024, we developed MS-specific information videos to supplement an existing smoking cessation intervention. We used identified intervention functions and results from preceding studies to identify the most effective way to change smoking behavior in pwMS. For the evaluation of the videos, we developed a theory-based questionnaire, and recruited pwMS and MS experts via our MS day clinic for assessment. The evaluation informed final revised videos for integration into the existing program to form a MS-tailored smoking cessation intervention.

We identified five out of nine intervention functions from the behavior change wheel to be relevant and created six videos based on these functions. The content of the videos includes, among other things, education about the connection of smoking and MS, and persuasion and incentivization about the positive effects of quitting. Eleven pwMS and five MS experts assessed the material. Overall, the videos were perceived as understandable and appropriate in length in both groups. The modified smoking cessation intervention includes all videos, integrating them into a structure of five online-meetings across 3 weeks.

The successful development of education videos using the Behavior Change Wheel, as well as the positive findings from our feasibility testing underline the potential of our video-based approach in the context of smoking cessation for pwMS. Next, the modified smoking cessation intervention should be tested for feasibility, acceptability, and efficacy. If successful, this approach could be implemented widely for people with MS.

Developing a program to help people with multiple sclerosis to quit smoking

People with multiple sclerosis (MS) who smoke often experience faster disease progression and worse symptoms. However, existing programs that help people quit smoking may not be well-suited to meet the unique needs of those living with MS. To address this, we developed a smoking cessation program specifically for people with MS. Our team created six short videos that explain how smoking affects MS and how quitting can help. These videos were reviewed by people with MS and MS experts. Both groups gave positive feedback. The final program includes the videos and takes place over five online sessions in three weeks. The goal is to support people with MS in quitting smoking using content tailored to their condition. The next step is to test how well this new program works and whether people find it helpful. If it proves effective, it could become a widely used tool to help people with MS stop smoking.