Abstract
SummaryBackgroundSmoking is often colloquially considered “social”. However, the actual relationship of smoking with current and future social isolation and loneliness is unclear. We therefore examined these relationships over a 12-year follow-up.MethodsIn 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(SD) age 67(10) years. 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, using ordinary least squares regression models.FindingsAt baseline, smokers were more likely to be lonely (coef.=0·111, 95% CI 0·025 – 0·196) and socially isolated than non-smokers, having less frequent social interactions with family and friends (coef.= 0·297, 95%CI 0·148 – 0·446), less frequent engagement with community and cultural activities (coef.= 0·534, 95%CI 0·421 – 0·654), and being more likely to live alone (Odds Ratio =1·400, 95%CI 1·209 – 1·618). Smoking at baseline was associated with larger reductions in social contact (coef.=0·205, 95%CI 0·053 – 0·356, to 0·297, 95%CI 0·140 – 0·455), increases in social disengagement (coef.=0·168, 95%CI 0·066 – 0·270, to coef.=0·197, 95%CI 0·087 – 0·307), and increases in loneliness (coef.=0·105, 95%CI 0·003 – 0·207), at 4-year follow-up) over time. No association was found between smoking and changes in cohabitation status. Findings were independent of all identified confounders, including age, sex, social class and the presence of physical and mental health diagnoses.InterpretationSmoking is associated with the development of increasing social isolation and loneliness in older adults, suggesting smoking is detrimental to aspects of psychosocial health. The idea that smoking might be prosocial appears a misconception.FundingUK Economic and Social Research Council & Imperial College London.
Highlights
Given the strong relationships between social isolation, loneliness, and negative health outcomes,[20] the results presented here suggest that smoking may contribute to poor health and premature mortality via well-known direct and indirect tobacco-related pathways, and via exacerbating the effects of social factors on morbidity and mortality
Conclusions and study implications In conclusion, this study suggests that smoking leads to increased social isolation and loneliness in older adults
These associations were more prominent for social isolation than loneliness, especially in women, and differed slightly by age group, with smoking and loneliness more strongly associated in people aged 5265, than those aged 65 and above
Summary
Proposed mechanisms by which smoking could be perceived as prosocial include the potential to provide a sense of social belonging,[1] and possibly more relevant. In younger people, by facilitating social connections and interactions across genders, helping structure time and space in situations such as parties, and identification with smoking peers.[2,3] some people describe themselves as ‘social smokers’.4. Social isolation, and loneliness are all related to increased morbidity and mortality. The relationship between smoking and social isolation and loneliness is unclear. Identified research largely focuses on social isolation and loneliness leading to smoking, with very few studies considering the idea that smoking might increase or decrease social isolation and loneliness, with a particular lack of research examining whether smoking is related to changes in social isolation and loneliness over time
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