Associations of leisure time and occupational physical activity with tobacco smoking and dual use of e-cigarettes among adults – a representative cross-sectional survey in Germany

Background Physical inactivity and tobacco smoking are risk factors for chronic diseases, and the combination of both further increase health risks. While leisure time physical activity (LTPA) improves cardiovascular health and is associated with lower smoking prevalence, occupational physical activity (OPA) may have adverse health effects and is associated with higher smoking prevalence. To date, there is limited evidence on the associations between LTPA, OPA and smoking behaviour – more specifically the use of tobacco and e-cigarettes, and their dual use – in the German adult population. Methods We used data from GEDA 2019/2020-EHIS, a representative cross-sectional survey of the German population conducted by structured computer assisted telephone interviews in people aged ≥ 18 years. Questions on physical activity and smoking were based on the European Health Interview Survey (EHIS) and Physical Activity Questionnaire (EHIS-PAQ). Multinomial and binary logistic regressions were applied to assess associations between LTPA, OPA, and their interaction effect and smoking status, cigarettes per day, dual use of tobacco and e-cigarettes, adjusted for confounding factors. Results Overall, 22,708 people responded. Active levels of LTPA were associated with lower odds of current vs. never tobacco smoking (e.g., OR for very vs. not active = 0.60, 95%CI = 0.54;0.67). Active levels of OPA were associated with higher odds (e.g., OR for very vs. not active = 1.70, 95%CI = 1.52;1.90). In addition, active levels of LTPA were associated with lower odds of dual-use with e-cigarettes vs. no dual-use (e.g., OR for moderately vs. not active = 0.56, 95%CI = 0.41;0.78). Active levels of OPA were associated with higher odds (OR for very vs. not active = 1.63, 95%CI = 1.24;2.15). The interaction effect of LTPA and OPA showed that being active during leisure time was associated with smoking fewer cigarettes per day, regardless of OPA level. Conclusion In the German population, people who are physically active during leisure time are less likely to be current tobacco smokers and dual users with e-cigarettes, while this was vice versa for people who are physically active during their occupation. Targeting tobacco control efforts, including smoking cessation programs, at physically demanding occupational environments seems to be important to prevent health risks in people working in such environments.