Smoking can lead to social isolation and loneliness

By Dr. Tomislav Meštrović, MD, Ph.D.Jan 17 2022Reviewed by Emily Henderson, B.Sc.

A recent study published in the journal The Lancet Regional Health (Europe) shows how smoking can be linked with increased social isolation and loneliness in older individuals, implying it can have detrimental effects on several different aspects of their psychosocial health.

Study: Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older adults in England. Image Credit: NeydtStock / Shutterstock

Smoking is often considered prosocial due to its potential to provide a sense of social belonging and by facilitating social interactions across genders and identifying with smoking peers (the latter being particularly relevant for younger individuals).

However, while the hazardous impacts of smoking tobacco on physical health are well known, its effects on psychosocial factors (such as social isolation and loneliness) are not entirely understood.

Previous research has predominantly focused on the idea that social isolation/loneliness results in more smoking due to different reasons (including reduced exposure to social pressures and social contexts where smoking is discouraged).

Nonetheless, such relationships could be bi-directional, which means smoking may also lead to increased social isolation and loneliness. The underlying mechanisms include smoking-related diseases and impaired physical mobility, changed social norms around smoking, and smoke-free laws designated for public spaces – all of which could hamper social participation for smokers.

A research group led by Dr. Keir EJ Philip from the National Heart and Lung Institute at Imperial College London and the NIHR Imperial Biomedical Research Centre in London, United Kingdom, hypothesized that smoking would actually result in increased social isolation and loneliness, and decided to explore the issue in depth.

A nationally representative sample

In this cohort study, the researchers have utilized a nationally representative sample of community-dwelling adults aged 50 years and over, as well as their partners, from the English Longitudinal Study of Ageing (which was initially designed to appraise social, psychological, biological and economic factors relevant to the aging process).

Here, associations of self-reported smoking status at baseline have been assessed in relation to social isolation (explained as low social contact, domestic isolation, and social disengagement) and loneliness (with the aid of a 3-item UCLA loneliness scale). This was measured at baseline, and follow-up at 4, 8, and 12 years has been pursued with specific statistical regression models.

Certain limitations of the methodology must be emphasized, such as the inability to assume causality as this is primarily an observational study and the issue with data generalizability across different age groups and cultures.

Less social contact and more isolation

At baseline, smokers in this study were more likely to be lonely and socially isolated in comparison to non-smokers. More specifically, they were more likely to live alone, had less frequent social interactions with friends and family outside the household, and had a lower engagement with the community and cultural activities.

Furthermore, smoking at baseline was linked to much more significant reductions in social contact, increases in social disengagement, as well as substantial increases in loneliness at 4-year follow-up over time. Basically, there was no evidence to support to the notion that smoking might be prosocial.

Finally, no significant association has been found between smoking and any potential changes in cohabitation status, and there were only slight variations related to age and sex. These findings were independent of all detected confounders (i.e., sex, age, social class), as well as the presence of physical/mental health diagnoses.

Public health relevance

In the growing body of medical literature on the health impacts of smoking, these results imply that smoking is potentially detrimental to several different facets of psychosocial health. Moreover, the study emphasizes the intersection of two major public health priorities, which necessitate further attention.

“Preventing smoking uptake is important, but attention to strategies that will support older smokers to quit is also essential, in particular targeting less affluent groups, at-risk occupations, and people with mental health problems where smoking rates are disproportionately high,” underscore the authors of this study.

Even though causality cannot be assumed, and additional research is warranted, the notion held by some that smoking might be prosocial appears to be a true misconception – with substantial implications for health and wellbeing during the lifespan of an individual.