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Am J Public Health. 2018 Nov;108(11):1478-1482. doi: 10.2105/AJPH.2018.304649. Epub 2018 Sep 25.

Evaluating the Evidence on Sitting, Smoking, and Health: Is Sitting Really the New Smoking?

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Jeff K. Vallance and Steven T. Johnson are with the Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Paul A. Gardiner is with the Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia. Brigid M. Lynch is with the Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia. Adrijana D'Silva is with the Faculty of Kinesiology, University of Calgary, Calgary, Alberta. Terry Boyle is with Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Lorian M. Taylor is with the Cumming School of Medicine, University of Calgary. Matthew P. Buman is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Neville Owen is with the Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne.


Sitting has frequently been equated with smoking, with some sources even suggesting that smoking is safer than sitting. This commentary highlights how sitting and smoking are not comparable. The most recent meta-analysis of sedentary behavior and health outcomes reported a hazard ratio of 1.22 (95% confidence interval [CI] = 1.09, 1.41) for all-cause mortality. The relative risk (RR) of death from all causes among current smokers, compared with those who have never smoked, is 2.80 (95% CI = 2.72, 2.88) for men and 2.76 for women (95% CI = 2.69, 2.84). The risk is substantially higher for heavy smokers (> 40 cigarettes per day: RR = 4.08 [95% CI = 3.68, 4.52] for men, and 4.41 [95% CI = 3.70, 5.25] for women). These estimates correspond to absolute risk differences of more than 2000 excess deaths from any cause per 100 000 persons per year among the heaviest smokers compared with never smokers, versus 190 excess deaths per 100 000 persons per year when comparing people with the highest volume of sitting with the lowest. Conflicting or distorted information about health risks related to behavioral choices and environmental exposures can lead to confusion and public doubt with respect to health recommendations.

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