Smoking-reduction strategies could ease loneliness and social isolation

Health behavior experts have a question: If loneliness results in the same risk of dying early as smoking up to 15 cigarettes a day, could the strategies that greatly reduced smoking in the United States a half century ago also potentially ease the loneliness epidemic today?

To get closer to the answer, a team led by the Texas A&M University School of Public Health built on a recent benchmark study on social isolation, loneliness and smoking by aligning its strategies for reducing tobacco use with those of the U.S. Surgeon General’s advisory on the current epidemic of loneliness and social isolation.

“What I think might shock people is that if you feel lonely or socially isolated, you have about a 30% increased risk of heart disease and stroke, and older adults who experience these conditions chronically have about a 50% greater risk of developing dementia,” said Tyler Prochnow, who spearheaded the commentary, which was published in Public Health Report. “This increase in risk is similar to the increased risks of cardiovascular disease, stroke and cancer that we see with tobacco use.”

In addition, he said more than one out of every five adults in the United States say they are socially isolated, and half feel lonely.

“This is a growing public health crisis that needs a coordinated, long-term, systemic approach, but our responses to this problem haven’t been able to move the needle yet,” he said.

He noted that while social isolation and loneliness are both forms of social disconnection, isolation is typically an objective condition defined by little interaction with others, while loneliness is a subjective feeling of distress when current connections don’t match the desired level and quality of connection.

“People can experience both at the same time, but that may not always be the case, which complicates the problem,” he said. “You could feel a deep sense of loneliness while being surrounded by people, while others may have one connection that fulfills their social needs.”

For their commentary, the team aligned the recommendations of the benchmark study with six strategic areas used to successfully reduce tobacco use: policy implementation, environmental changes, systemic reforms, educational programs and shifts in social norms.

Among other strategies implemented to reduce tobacco use that could be considered to reduce loneliness and social isolation, the researchers identified the following:

• Policy changes. Just as age restrictions and warning labels effectively reduced smoking, warning labels and age restrictions could be mandated for devices or apps; public health funding could be used to promote social connection initiatives; and social impact assessments could be required for new policies or large-scale projects.
• Environmental changes. Like the smoke-free designations in public places, public spaces and workplaces could be designed to foster social engagement.
• Systems-level change. Tobacco screenings are now part of routine health care, and support systems such as quitlines exist for people who want to quit using tobacco. Likewise, social connection screenings and loneliness support helplines should be supported and promoted.
• Health education programs. The prevention programs introduced in schools and the media to reduce tobacco use could be adapted to address social connection.
• Social norm changes. Tobacco use decreased following its denormalization in the media and elsewhere, and similar approaches could be used to promote strong social connections, as well as to destigmatize loneliness and seeking help to address it.

“We believe that the comprehensive, multifaceted framework that successfully reduced tobacco use provides public health professionals and others with a useful approach for addressing the growing epidemic of loneliness and social isolation,” Prochnow said. “When we recognize the health risks and the number of people affected by loneliness and social isolation, we know we have to meet this problem with the urgency, coordination and sustained commitment.”

Others involved in the study were Texas A&M researchers Matthew Lee Smith and Megan Patterson and colleagues from the University of Cincinnati, Brigham Young University and National Opinion Research Center.

Those dealing with social isolation, loneliness or crisis are encouraged to contact the National Suicide Prevention Lifeline at 1-800-273-8255, the Suicide and Crisis Lifeline at 998, or the Crisis Text Line (text HELLO to 741741). More information and support can be found at the Foundation for Social Connection or Centers for Disease Control and Prevention.