Smoking linked to greater loneliness across Europe

A large observational study of more than 50,000 older adults across 15 European countries found that current smokers reported greater loneliness than nonsmokers and experienced larger increases in loneliness over two years. The analysis, presented at the European Respiratory Society Congress in Barcelona, also showed that the association persisted after researchers accounted for demographic factors and participants’ loneliness at the start of the study. The findings indicate an association between smoking and worsening social well-being in older people, although the design cannot establish that smoking caused the observed differences.

Researchers used data from the Survey of Health and Ageing in Europe, known as SHARE, to compare current smokers with people who were not current smokers. Participants completed the same questionnaire two years later, allowing the team to examine both differences in loneliness at baseline and changes over time. Loneliness was measured with the UCLA loneliness scale, which assesses how often a person feels they lack companionship, feels left out and feels isolated from others. The sample had an average age of 67; 22% were smokers at the beginning of the research, and 48.5% had more than two chronic illnesses.

The analysis found that current smokers were lonelier than nonsmokers even after adjustment for factors that could influence the results, including age and gender. Smokers also had larger increases in loneliness during the two-year follow-up after the researchers further accounted for baseline loneliness and demographic characteristics. Differences between European regions were slight, suggesting that the relationship was broadly consistent across the countries included rather than being confined to one geographic area. The study therefore extends earlier work suggesting that smoking may contribute to poorer social health, while providing no evidence here that the relationship varied substantially by region.

Because the research was observational, several questions remain unresolved. The analysis can show that smoking and loneliness occur together and that changes in loneliness differed between groups, but it cannot determine whether smoking directly produced those changes or whether other influences affected both behaviors and well-being. The participants were older adults, many of whom had several chronic illnesses, so the results may not apply equally to younger people or populations outside Europe. Loneliness was also assessed through self-reported questionnaires rather than an objective measure of social participation or isolation. The proposed explanations—reduced mobility because of smoking-related illness and the effects of smoke-free environments on opportunities for social interaction—were mechanisms discussed by the researchers rather than variables directly tested in this analysis.

Dr Keir Philip, a clinical lecturer in respiratory medicine at the National Heart and Lung Institute, Imperial College London, presented the study. He said the findings supported and built on previous research indicating that the relationship between smoking and loneliness was broadly consistent throughout Europe. The reported association also fits the observation that people with smoking-related illnesses may become increasingly socially isolated as illness limits their ability to travel and participate in activities involving other people. Separately, public smoking restrictions and informal smoke-free environments could make shared spaces less appealing to some smokers, potentially narrowing opportunities for social interaction. Neither pathway, however, was established as the cause of the statistical association in the study.

Des Cox, a member of the European Respiratory Society’s Advocacy Council and Clinical Professor at University College Dublin, who was not involved in the research, said the results should be communicated without stigmatizing people who smoke. He described smoking as an important risk factor for loneliness and argued that the idea of smoking as a “social” activity should be challenged in light of the evidence. The researchers’ presentation places the findings within a wider public-health concern: beyond the well-established physical effects of tobacco use, smoking may also be associated with deterioration in psychosocial well-being among older adults. Direct experimental or longitudinal studies examining the mechanisms and causal direction of this relationship would still be needed to determine how much of the observed association is attributable to smoking itself.

Subject of Research: Association between smoking and loneliness among older adults in 15 European countries

Article Title: Smoking leads to increased loneliness

Article References: Smoking leads to increased loneliness. Original publication (Bibliographic details unavailable.)

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Keywords: smoking, loneliness, older adults, social isolation, SHARE survey, UCLA loneliness scale, observational study, European health, psychosocial health, tobacco, leads, increased