Smoking is associated with higher levels of loneliness and with an increase in this feeling over time, a European study concluded after analyzing data from more than 50,000 people in 15 countries. The research was presented at the European Respiratory Society (ERS) Congress in Barcelona.
The researchers analyzed participants from the Survey of Health and Ageing in Europe (SHARE), with an average age of 67 years. At the start of the study, 22% were smokers and 48.5% had more than two chronic diseases.
To assess loneliness, the team used the UCLA Loneliness Scale, which measures how often a person feels a lack of companionship, feels excluded, or isolated from others. The results were compared between smokers and non-smokers, and the participants answered the same questionnaire again two years later.
Smokers exhibited higher loneliness levels than non-smokers, even after accounting for other potentially relevant factors, such as age and gender. Moreover, they recorded more pronounced increases in loneliness over the two years.
The difference was relatively similar across the various regions of Europe.
“Smoking is associated with an increase in loneliness among older people, suggesting that smoking may harm psychosocial health, in addition to the physical effects,” explains Keir Philip, clinical lecturer in Respiratory Medicine at the National Heart and Lung Institute, Imperial College London, and the author of the study.
Illness can limit social participation
The researchers acknowledge that one possible explanation for the observed association relates to the progressive impact of smoking-related diseases. As these diseases affect mobility, they can make it harder to leave home and participate in social activities.
Another possibility is related to the changing social norms around tobacco. Prohibitions on smoking in public spaces and the creation of smoke-free environments in homes may make certain places less attractive to smokers and limit opportunities for social interaction.
The research followed a previous study conducted in England, which had already identified an association between tobacco use and increased loneliness. The researchers wanted to determine whether the relationship held in other European countries, regardless of cultural differences and social norms.
“Smoking is a social activity” is an idea the authors say needs to be countered in light of the results.
“Smoking is not social; our investigation shows that it leads to increased social isolation and loneliness,” says Keir Philip, contending that the psychosocial impacts of smoking should be better understood, from public communication to health policies.
Support for those who want to quit smoking
Des Cox, a clinical professor at University College Dublin and a member of the Advocacy Council of the European Respiratory Society, who did not participate in the study, considers that the results are relevant for people who smoke, but stresses the importance of avoiding stigmatization.
“It is vital to support people to quit smoking without stigmatizing them,” he says.
According to the expert, the results suggest that, in addition to harming physical health, smoking may also affect dimensions of psychosocial health. “The idea that smoking can be ‘social’ should be questioned, since the evidence points to the opposite,” he adds.
The researchers also emphasize that loneliness is currently recognised as one of the major public health challenges and argue that smoking should be considered a possible risk factor, especially because there are effective treatments to help quit tobacco use.
