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Media reports of the ‘new smoking’ have proliferated with little consideration of the disease burden of emergent risk factors. We consider the example of prolonged sitting in particular. The ‘new smoking’ analogy is a powerful heuristic device that draws on the well-known dangers of tobacco smoking. Such attention-grabbing ‘factoids’ are rapidly disseminated and perpetuated,1 and can be difficult to dispel later.
We quantified which health risks have been called the ‘new smoking’ and consider the epidemiological evidence for and the implications of these comparisons. We searched the Factiva database for news stories containing the phrases ‘is the new smoking’ or ‘as bad as smoking’ in 2012–2016. News stories containing these phrases were independently coded for the health risk being compared with smoking, along with article characteristics (eg, headline, name of publication, date of publication).
Sitting and obesity dominate the media as ‘new smoking’
We identified 614 unique news stories that contained the target phrases. The top 10 mentioned health risks and behaviours compared with smoking are presented in table 1. The most dominant topics were sitting and obesity, with 55% and 12% of stories, respectively. The total number of ‘new smoking’ or ‘as bad as smoking’ comparisons increased over 12-fold from 2012 to 2016. Every year, prolonged sitting was the leading health behaviour likened to smoking.
We further examined the ‘sitting is the new smoking’ articles (n=299) to see who contributed to this claim. We found 126 articles quoted information from specific sources. Of these articles, there were 148 attributions made to scientists or medical professionals (66%), spokespersons from for-profit businesses (18%), spokespersons from non-government or charity organisations (11%), and laypeople (2%), while 3% quoted an unspecified source that could not be attributed to a person, publication or organisation.
No scientists were quoted as saying ‘sitting is the new smoking’ specifically. However, some technical statements from interviews and press releases could have been misinterpreted in the translation to lay terms by journalists. For example, one study found the link between sedentary behaviour and adverse health outcomes was ‘over and above other lifestyle factors such as our diet and physical activity’2; ‘over and above’ in statistical terms could have been interpreted as ‘more harmful’ or ‘more important’ in lay terms. A minority of individual experts contributed to the ‘sitting is the new smoking’ perception. For example Dr James Levine from the Mayo Clinic, who was quoted in 10% of ‘sitting is the new smoking’ articles, made statements such as ‘Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death’.3
Population attributable fraction of prolonged sitting
The WHO estimated the population attributable fraction (PAF) for all-cause mortality for tobacco use, physical inactivity, and overweight and obesity to be 8.7%, 5.5% and 4.8%, respectively, in 2009.4 More recent research suggests the PAF for physical inactivity is higher: 9.4% of deaths from all causes, 5.8% deaths from cardiovascular disease, 7.2% deaths from type 2 diabetes and 10.4% of deaths from colon cancer would not occur if population physical inactivity were eliminated.5 For sitting time, PAFs for all-cause mortality of 3.8%6 and 5.9%7 have been estimated. Thus, it appears that comparing physical inactivity with smoking could be justified based on the epidemiological evidence. However, ‘sitting is the new smoking’ comparisons are not warranted, as prolonged sitting is a distinct behaviour and not equivalent to being physically inactive.8
Communications from peak bodies and journalists need to be wary of elevating other novel risk factors as comparable in health impact with tobacco smoking. While the ‘new smoking’ messaging may be effective for quickly getting the public’s attention about new risks, it could have negative impacts on the steady gains in tobacco control and smoking prevention by overselling perceptions of other health risks.
This is because calling something the ‘new smoking’ implies that tobacco control has achieved its end goal, and it is now time to move on to dealing with a ‘new’ health issue, while also diminishing the enormous health burden posed by tobacco smoking that still exists. Policymakers may relax tobacco control efforts as well as be inoculated to the emotive power of this analogy. The success of tobacco control initiatives in educating the public about the harms of smoking is now being misappropriated as cultural shorthand to signify the danger of other health products and behaviours. Scientists and journalists should be wary of overstating the harms of emergent risk factors such as prolonged sitting.
Twitter @jochau, @DrBFreeman, @AdrianBauman
Contributors JYC and BF conceived of this study. GR-M conducted the searches with guidance from JYC and BF. GR-M, ACRB and JYC analysed the data. JYC and GR-M drafted the manuscript. All authors contributed to interpretation of results and critically reviewed and revised the manuscript.
Funding JYC was supported by a Postdoctoral Fellowship (#100567) from the National Heart Foundation of Australia. BF was supported by the Australian National Health and Medical Research Council Early Career Fellowship (APP1089403).
Competing interests JYC has directly received consulting funds from the WHO and Bill Bellew Consulting Associates; and travel reimbursement from Marsh. BF has directly received travel reimbursement and/or consulting funds from the WHO, the Sax Institute, Cancer Council Australia, Cancer Council NSW, NSW Health, the Union for International Cancer Control, The Thoracic Society of Australia and New Zealand, and the Asian Center for WTO & International Health Law and Policy, National Taiwan University, College of Law.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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