Smoking Increases Social Isolation and Loneliness

Summary: Previous research indicated social isolation and loneliness is a driver of smoking behaviors. A new study reports smoking itself may lead to social isolation and loneliness.

Source: Imperial College London

Previous research has found that people who are isolated and lonely are more likely to smoke. However, this latest study, which is the first of its kind, found that smoking itself may also lead to higher levels of isolation and loneliness.

The research, published this week in The Lancet Regional Health Europe and led by Imperial College London and UCL researchers, examined the relationship between smoking and the development of social isolation and loneliness.

It found that, over time, people who smoked saw their social contact reduce, and they became less socially engaged and more lonely, compared to non-smokers. With many people who smoke pledging to quit at the start of the new year, the authors hope that their new study will provide another incentive.

“Our research suggests smoking is bad for aspects of psychological and social health in addition to the well established physical impacts of smoking,” said study author, Dr. Keir Philip, from Imperial’s National Heart & Lung Institute.

“Some people think smoking is a social activity, but our study did not support this idea—smokers actually became more socially isolated and lonely than non-smokers over time.”

He adds that their “findings contribute to existing knowledge in this area, and suggest the existence of a vicious cycle of smoking, social isolation, and loneliness. This research provides yet more reasons why people should aim to stop smoking this new year, and adds justification to increase support for people trying to quit.”

The new study used data from the English Longitudinal Study of Ageing (ELSA), consisting of a nationally representative sample of 8,780 people aged 50 years and older in England. Participants’ social isolation and loneliness were assessed over 12 years (at the outset, then after 4, 8 and 12 years).

The researchers found that, at the outset of the study, current smokers were more likely to be lonely and socially isolated than non-smokers, having less frequent social interactions with family and friends, less frequent engagement with community and cultural activities, and being more likely to live alone.

Smoking was also associated with larger reductions in social contact, increases in social disengagement, and increases in loneliness over time.

These results remained even after considering factors like age, sex, and socioeconomic status.

Possible factors

The study is observational so cannot determine the cause of this association, but the authors speculate that it may be due to a range of factors.

For example, smokers are at an increased risk of developing breathlessness and other physical health problems, including lung and heart disease, which limit their ability to socialize.

Equally, smoking is associated with an increased risk of mental health problems, such as anxiety and depression, which may impact the amount someone socializes.

In addition, friends of people who smoke are more likely to have smoked themselves and are therefore more likely to have died prematurely.

Other social factors include the reduced social acceptability of smoking generally, and in particular the expansion of smoke free legislation introduced to reduce the harms from passive smoking.

Professor Nick Hopkinson, another study author from Imperial’s National Heart & Lung Institute, said that “most people already know that smoking is a risk to health. Our results suggest that smokers are also more likely to become socially isolated and lonely as they get older.”

“These findings are another reason for the government to press on with introducing the policies needed to achieve its ambition for a smoke-free 2030. These include a ‘polluter pays’ levy on tobacco industry profits and raising the legal age for tobacco sales from 18 to 21 years.”

“Stopping smoking can be difficult, but the NHS has a number of excellent resources; to ensure that people get the help they need. These include free and proven tools and advice that help people quit smoking for good.”

Abstract

Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older adults in England

Background

Smoking is often colloquially considered “social”. However, the actual relationship of smoking with current and future social isolation and loneliness is unclear. We therefore examined these relationships over a 12-year follow-up.

Methods

In this cohort study, we used a nationally representative sample of community dwelling adults aged 50 years and over from the English Longitudinal Study of Ageing (N=8780) (45% male, mean(SD) age 67(10) years. We examined associations of self-reported smoking status at baseline assessment, with social isolation (low social contact, social disengagement, domestic isolation), and loneliness (3-item UCLA loneliness scale), measured at baseline, and follow-up at 4, 8 and 12 years, using ordinary least squares regression models.

Findings

At baseline, smokers were more likely to be lonely (coef.=0·111, 95% CI 0·025 – 0·196) and socially isolated than non-smokers, having less frequent social interactions with family and friends (coef.= 0·297, 95%CI 0·148 – 0·446), less frequent engagement with community and cultural activities (coef.= 0·534, 95%CI 0·421 – 0·654), and being more likely to live alone (Odds Ratio =1·400, 95%CI 1·209 – 1·618). Smoking at baseline was associated with larger reductions in social contact (coef.=0·205, 95%CI 0·053 – 0·356, to 0·297, 95%CI 0·140 – 0·455), increases in social disengagement (coef.=0·168, 95%CI 0·066 – 0·270, to coef.=0·197, 95%CI 0·087 – 0·307), and increases in loneliness (coef.=0·105, 95%CI 0·003 – 0·207), at 4-year follow-up) over time. No association was found between smoking and changes in cohabitation status. Findings were independent of all identified confounders, including age, sex, social class and the presence of physical and mental health diagnoses.

Interpretation

Smoking is associated with the development of increasing social isolation and loneliness in older adults, suggesting smoking is detrimental to aspects of psychosocial health. The idea that smoking might be prosocial appears a misconception.