Smoking is not social and leads to increased loneliness, according to a large Europe-wide study presented at the European Respiratory Society (ERS) Congress in Barcelona, Spain [1].
The study was presented by Dr Keir Philip, Clinical Lecturer in Respiratory Medicine at the National Heart and Lung Institute, Imperial College London, UK.
Dr Philip told the Congress: "Although we know smoking is bad for your physical health, we don't know what it does to our social health. Previous research has suggested that loneliness leads to smoking, but there has been very little research asking if smoking leads to loneliness. Smoking has been considered a 'social activity', but we regularly see people with smoking-related illnesses becoming increasingly socially isolated and lonely.
"Our first study in England suggested that people who smoked became lonelier than those who didn't smoke, but it was possible the results were influenced by culture and social norms. We wanted to investigate if we saw the same relationship between smoking and loneliness across other countries too."
The researchers analysed data from over 50,000 people, across 15 countries [2], participating in the Survey of Health and Ageing in Europe (SHARE). They measured how lonely participants felt using the UCLA loneliness scale, which provides a loneliness score based how often a person feels they lack companionship, feel left out, and feel isolated from others. The researchers compared people who were current smokers with people who were not current smokers and followed up with the same questionnaire two years later.
The average age of the study participants was 67, 22% were smokers at the start of the research and 48.5% had more than two chronic illnesses.
The researchers found that current smokers were lonelier compared to non-smokers, even after considering other factors that might influence the results, such as age or gender. People who currently smoked also experienced larger increases in loneliness over time, also after considering demographics and their baseline level of loneliness.
There was only a slight variation between European regions.
Dr Philip explains: "Smoking is associated with increasing loneliness in older people, suggesting smoking may damage psychosocial health in addition to physical effects. These findings support and build on previous research and show that the relationship is broadly consistent throughout Europe."
Dr Philip believes one likely mechanism for smoking leading to increased loneliness is that progressive smoking related illnesses limit mobility, making it more difficult for people to access and participate in social activities.
He adds: "Another potential mechanism relates to social norms around smoking around other people. Smoking bans in public places and informal smoke free environments in people's homes may make such places less appealing to people who smoke, which could limit the potential for social interactions."
Dr Philip believes the next steps are to change the public narrative so that it aligns with the data. "Smoking is not social; our research shows it leads to increased social isolation and loneliness. Spreading the word through various routes will be key, from pubs to public policy – the psychosocial impacts of smoking need to be made clear," he adds.
Professor Des Cox, a member of the European Respiratory Society's Advocacy Council, and Clinical Professor at University College Dublin, Ireland, who was not involved in the research said: "This is important information for people who smoke. It is vital to support people to quit smoking without stigmatising them. From individual to policy level, these findings demonstrate that as well as damaging physical health, smoking appears to damage aspects of psychosocial health. The idea that smoking might be 'social' should be challenged, as the evidence indicates the opposite.
"With loneliness now recognised as one of the key public health challenges of our time, this research identifies smoking as an important risk factor for loneliness, and it's a factor for which effective treatments exist. We need to do all we can to help smokers to quit and to make sure young people do not become addicted to nicotine."
