In earlier days, smoking was a common and accepted social behaviour, especially among men. And it is still often thought that smoking relates to social situations with friends or at certain occasions. But there has been substantial social change concerning smoking. Thus, the new study by Philip and colleagues is welcome (1). Based on the results the authors conclude that “the idea that smoking might be prosocial is a misconception”, since the results showed that smokers were more likely to be lonely and socially isolated than non-smokers.
A big question in putting this finding into context is the direction of causality–does smoking lead to loneliness or loneliness to smoking? The causal pathway could exist in both directions, suggesting a harmful cycle. If confirmed by other studies, it is in any case an important finding, because it is known that loneliness leads to health disadvantages like increased morbidity and mortality, especially in old age (2).
The literature on health and other harms of smoking is overwhelming and has given strong backing to the tobacco control measures following the global WHO Framework Convention on Tobacco Control (FCTC) rules (3). The social role of smoking is often given as one of the few benefits of smoking. But this study would remove even this argument since smoking does not seem to lead to enjoying more social contacts.
The study has many advantages, being rather large, national, and longitudinal. The study also has policy implications. Among older smokers, loneliness and other related social issues should be taken into account when shaping smoking cessation messages and programmes (4,5). A technical limitation is the low participation rate at different stages of the study. Smokers in the study cohort also include occasional smokers, among whom the social aspects may be different from addicted daily smokers.
It is also not certain whether there are differences between men and women, since the study was potentially underpowered to so these. Another reservation in the interpretation of the findings is that the study was restricted to people over 50 years. It has long been known that most people start smoking in youth and that peer pressure and selection are the main determinants (6,7). But at what age do the social aspects diminish? Is loneliness specific to older smokers? Is the loneliness at old age even because smoking friends have died? These questions remain to be answered.
Most countries have now widely implemented tobacco control regulations for smoke-free environments following the FCTC guidelines (8). Nowadays smoking is largely banned from workplaces and restaurants, and smoking has even reduced in private homes. Have these changes had an impact on social aspects of smoking, that has changed from “normal” to “abnormal” behaviour? The impact of this major environmental and social change on smoking, its social nature and on smoking cessation would be an interesting topic of further research. Especially since a number of countries have already started the “endgame” to achieving a smoke-free nation (9).
While some countries are aiming to become smoke-free, some of them prefer smokers moving to other nicotine-containing products considered less harmful, such as e-cigarettes in England or snus in Sweden. This study did not have data available to analyse the social aspects of these new products, and there is a need for future studies in this area.
- Philip K.E.J., Bu F., Polkey M.I., Brown J., Steptoe A., Hopkinson N.S. et al.
Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older adults in England. Lancet Regional Health – Europe, 2021;
- Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, Health and Morbidity in Old Age: A National Longitudinal Study. Soc Sci Med. 2012; 74(6):907-914.
- WHO. WHO Framework Convention on Tobacco Control. World Health Organization. Geneva, 2003.
- Martin JL, Barnes I, Green J, Reeves GK, Beral V, Floud S. Social influences on smoking cessation in midlife: respective cohort of UK women. PLoS One.2019; 14(12): e0226019.
Smoking Cessation and Socioeconomic Status: An Update of Existing Evidence from National Evaluation of English Stop Smoking Services. Biomed Res Int. 2015:2740565.
- Conrad KM, Flay BR, Hill D. Why children start smoking cigarettes: predictors of onset. British Journal of Addiction. 1992; 87(12):1711-1724.
- Mercken L, Steglich C, Sinclair P, Holliday J, Moore L. A longitudinal social network analysis of peer influence, peer selection and smoking behavior among adolescents in British schools. Health Psychology. 2012; 31(?): 450-459.
- WHO. WHO report on the global tobacco epidemic 2021: addressing new and emerging products. World Health Organization. Geneva, 2021.
- McDaniel PA, Smith EA, Malone RE. The tobacco endgame: a qualitative review and synthesis.Tob Control. 2016; 25:594-604.