Is Smoking Social? The Relationship of Smoking with Current and Future Social Isolation and Loneliness: 12-Year Follow-Up of 8,780 Older Adults in England

Abstract

Background: Smoking is often colloquially considered “social”. However, the relationship between smoking with current and future social isolation and loneliness is unclear. Therefore, we 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 age of 67 years, standard deviation of 10). 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 after. Findings: At baseline, smokers were more likely to be lonely and socially isolated than non-smokers, having less frequent social interactions with family and friends, having less frequent engagement with community and cultural activities, and being more likely to live alone. Smoking at baseline was associated with larger reductions in social contact, increases in social disengagement, and loneliness over time. No evidence was found for the association between smoking and changes in cohabitation status. These 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. The idea that smoking might be prosocial appears a misconception. The intersection of these public health priorities requires further attention. Funding: UK Economic and Social Research Council & Imperial College London. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form and declare: support from the National Institute of Ageing, a consortium of UK government departments coordinated by the Economic and Social Research Council; Imperial College London; and the Wellcome Trust for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: The study received ethical approval from the National Research Ethics Service and all participants provided informed consent.