Physical activity and tobacco smoking in the German adult population

BackgroundPhysical inactivity and tobacco smoking remain leading causes of morbidity and mortality worldwide. In Germany, smoking prevalence is high at around 30% and only 45% achieve the World Health Organization recommendation for physical activity (PA). Understanding how smoking and physical inactivity co-occur can inform interventions targeting these behaviours. MethodsWe analysed data from 4,073 adults ([≥]18 years) participating in a national household survey between April and July 2022. We tested the association between PA level (not=reference/low/medium/very active) and smoking status (never=reference/ex/current smoker). Among current smokers, we tested associations between PA level and cigarettes smoked per day; time spent with, and strength of, urges to smoke; and motivation to stop smoking. ResultsOverall, 29.9% (95%CI=28.5;31.4) reported no leisure time PA; among current smokers it was 39.8% (95% CI=37.3;42.4). Higher PA levels were associated with lower odds of being a current vs. never smoker (OR=0.74, 95%CI=0.69;0.79). Among current smokers, higher PA levels were associated with smoking fewer cigarettes per day ({beta}=-0.98,95%CI=- 1.39;-0.56), weaker urges to smoke (OR=0.81,95%CI=0.74;0.89), and higher motivation to stop smoking (OR=1.13,95%CI=1.02;1.24). Time spent with urges to smoke showed a small overlap in the upper CI (OR=0.93,95%CI=0.85;1.02). ConclusionPeople who are more physically active are less likely to smoke. Current smokers with higher PA levels smoke less, are less dependent, and more motivated to quit. Further research is required to determine whether these associations are causal and, if so, whether interventions to increase PA could help people to quit smoking. What is already known on this topicSmokers are more likely to be physically inactive than non-smokers. The more cigarettes they smoke, the greater their risk of being physically inactive. Therefore, people who are physically inactive and smoke cigarettes have an increased risk of chronic diseases and premature death. What this study addsOur study adds detailed data on the relationships between physical activity (PA) levels and smoking habits in the German adult population. To build on existing studies that have explored the link between PA levels and either smoking status or the amount of cigarettes smoked per day, we also examined the associations between PA levels and both nicotine dependence and the motivation to quit smoking. How this study might affect research, practice or policyThese results indicate a clear need to increase PA levels in the population and reduce smoking prevalence. Understanding the relationships between PA levels and smoking habits can aid in developing prevention strategies and targeting specific groups, such as current smokers. Additionally, this knowledge can inform the design of effective public health campaigns on PA and smoking, highlighting the association between these behaviours. More research is needed to determine whether associations are causal.