A Systematic Review of Loneliness and Smoking: Small Effects, Big Implications

Abstract

Background Research supports an association between smoking and negative affect. Loneliness is a negative affective state experienced when a person perceives themselves as socially isolated and is associated with poor health behaviors and increased morbidity and early mortality. Objectives In this paper we systematically review the literature on loneliness and smoking and suggest potential theoretical and methodological implications. Methods PubMed and PsycINFO were systematically searched for articles that assessed the statistical association between loneliness and smoking. Articles that met study inclusion criteria were reviewed. Results Twenty-five studies met inclusion criteria. Ten studies were conducted with nationally representative samples. Twelve studies assessed loneliness using a version of the UCLA Loneliness Scale and nine used a one-item measure of loneliness. Seventeen studies assessed smoking with a binary smoking status variable. Fourteen of the studies were conducted with adults and 11 with adolescents. Half of the reviewed studies reported a statistically significant association between loneliness and smoking. Of the studies with significant results, all but one study found that higher loneliness scores were associated with being a smoker. Conclusions/ Importance Loneliness and smoking are likely associated, however half of the studies reviewed did not report significant associations. Studies conducted with larger sample sizes, such as those that used nationally representative samples, were more likely to have statistically significant findings. Future studies should focus on using large, longitudinal cohorts, using measures that capture different aspects of loneliness and smoking, and exploring mediators and moderators of the association between loneliness and smoking.

Social Isolation, Loneliness, and Health Behaviors at Older Ages: Longitudinal Cohort Study

“…The negative relationship with overweight/obesity that we observed was unexpected and may be due to uncaptured subclinical health conditions or restricted eating behaviors that would cause lower BMI among isolated or lonely adults [62]. Our findings are also inconsistent with those observing relationships between loneliness and health behaviors [4,20,[41][42][43][44], especially one observing that baseline loneliness predicted reduced odds of physical activity over a 2 year follow-up in 229 older American adults [43]. These previous studies were all cross-sectional except for one and could not examine whether the observed relationships persisted over time.…”

“…Greater social connectedness has also been associated with being physically active [37]. The empirical evidence for loneliness and health-related behaviors is more equivocal than for social isolation, although loneliness has been associated with physical inactivity, problematic alcohol consumption, overweight/ obesity, and smoking [4,20,36,[41][42][43][44].…”

Factors affecting cigarette smoking among adolescents in South Korea, Vietnam, and Thailand

“…The smoking behavior of close friends and friend-related stress have been shown to be risk factors in cigarette smoking and the use of other substances (Chung & Joung, 2014a). Conversely, adolescents who are considered isolated also exhibit a tendency to smoke cigarettes (Dyal & Valente, 2015). The factor that has been consistently associated with nonsmoking among adolescents is satisfaction; with family, friends, school, and life in general (Cable et al, 2017).…”

Prevalence of Loneliness and Associated Factors among Older Adults in South Africa

“…Petitte (2015) found common chronic diseases such as metabolic disorders, cardiovascular disorders, hypertension, lung disease, and obesity to be associated with loneliness. Conflicting associations were found between smoking and loneliness (Dyal & Valente, 2015). There is a dearth of information on the factors associated with loneliness among older adult populations in Africa ( Van der Geest, 2004).…”