Smoking is often thought of as a social habit: stepping outside with colleagues for a cigarette, joining friends outside a bar or striking up a conversation by asking for a light. But a large European study suggests the picture may be very different.
Researchers analyzing data from more than 50,000 people across 15 countries found that smokers reported greater loneliness than nonsmokers. Their loneliness also increased more over time, raising the possibility that smoking carries a social and psychological cost alongside its well-established physical health risks.
The findings were presented at the European Respiratory Society Congress in Barcelona by Dr. Keir Philip, a clinical lecturer in respiratory medicine at Imperial College London’s National Heart and Lung Institute.
“Although we know smoking is bad for your physical health, we don't know what it does to our social health,” Dr. Philip said at the conference, according to News Medical. “Previous research has suggested that loneliness leads to smoking, but there has been very little research asking if smoking leads to loneliness. Smoking has been considered a 'social activity', but we regularly see people with smoking-related illnesses becoming increasingly socially isolated and lonely.”
Dr. Philip and his colleagues had previously found in research conducted in England that people who smoked became lonelier over time than those who did not. But because local culture and social norms could have influenced those results, the researchers wanted to know whether the pattern would also emerge elsewhere.
Measuring loneliness
The researchers analyzed information from the Survey of Health, Ageing and Retirement in Europe, known as SHARE.
Participants’ loneliness was measured using the UCLA Loneliness Scale, which evaluates how frequently people feel they lack companionship, feel left out or feel isolated from others. The researchers compared people who were smoking at the beginning of the study with those who were not and repeated the loneliness assessment two years later.
The cigarette may serve as a way to cope with stress, boredom or emotional distress
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The participants’ average age was 67. At the start of the study, 22% were smokers and 48.5% were living with more than two chronic illnesses. Smokers reported greater loneliness than nonsmokers even after researchers accounted for other factors that might influence the results, including age and sex.
They also experienced a greater rise in loneliness over time after demographic factors and their initial loneliness scores were taken into account. Only small differences were seen between regions of Europe.
“Smoking is associated with increasing loneliness in older people, suggesting smoking may damage psychosocial health in addition to physical effects. These findings support and build on previous research and show that the relationship is broadly consistent throughout Europe,” Dr. Philip said at the conference, according to News Medical.
When the cigarette becomes a relationship
How can a habit widely viewed as social end up becoming isolating? Tzach Shtiler, a specialist medical psychologist with Maccabi Healthcare Services in southern Israel, says one possible explanation lies in the nature of addiction itself, which can become a kind of relationship that competes with other relationships in a person’s life.
“The cigarette can become something a person repeatedly relies on for calming down, taking a break or coping,” he said. “The time, mental energy and attention devoted to self-regulation through smoking are, in a sense, taken away from other possible sources of reinforcement, including social involvement and interpersonal relationships.”
Tzach ShtilerPhoto: Yossi RozenboimAs dependence grows, he said, smoking may gradually shift from the social sphere into the private one. What begins as a cigarette with friends can become a habit tied to particular moments of the day or a way of coping with morning stress, pressure at work or time alone with one’s thoughts. “That creates exactly the opposite of smoking’s image as a social activity,” Shtiler said.
Dr. Philip suggested another possible mechanism. Smoking-related diseases can worsen over time, limiting mobility and making it harder for people to reach or participate in social activities.
Changing social norms may also play a role. Smoking bans in public places, along with private environments where smoking is discouraged, may make some spaces less accessible or appealing to smokers and reduce opportunities for social interaction.
Quitting smoking can be an opportunity to build new sources of connection, support and belonging
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Shtiler said the association does not necessarily have to be explained solely by smoking-related disease. “From a mental health perspective, it can be viewed as a circular loop,” he said.
Cigarette use, he explained, may interfere with natural emotional regulation, including the ability to tolerate stress and frustration. That, in turn, could weaken some of the interpersonal skills needed to initiate and maintain relationships.
Nicotine addiction may also alter the brain’s reward system in ways that reduce the satisfaction people receive from other sources of reward, including social interaction, he said.
Which comes first?
The findings do not rule out the opposite possibility: that people who already feel lonely may be more likely to begin smoking or continue the habit. For someone experiencing isolation, cigarettes can become a way of coping with stress, boredom or emotional distress.
“Smoking can become a way of regulating emotions, a kind of self-medication for anxiety, loneliness or alienation,” Shtiler said.
“Someone who already feels disconnected may turn to cigarettes for relief rather than reaching out to another person. The danger is that cigarettes can begin to take the place of human connection, reinforcing the very loneliness they were used to cope with.”
That means smoking could begin as a response to loneliness but eventually deepen it, creating a self-reinforcing cycle.
The same issue can become important when a person tries to quit. Stopping nicotine use alone may not automatically improve someone’s social life, Shtiler said. After quitting, people may realize that cigarettes had been serving functions beyond nicotine delivery, providing moments of calm, routine, connection or belonging. Recognizing those functions can help people seek alternatives.
Smoking may begin as a social activity, but as dependence develops, it can become an increasingly private habit
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“That is why quitting should be supported by interpersonal relationships and social support, so there is an appropriate replacement for what smoking provided socially and emotionally,” he said.
Smoking-cessation programs offered by health providers can therefore help not only with stopping cigarette use but also with building new habits and strengthening sources of social support, he added.
Starting socially, continuing alone
Although the participants in the European study had an average age of 67, Shtiler said the proposed mechanism may also be relevant to younger people.
“Teenagers often first experiment with cigarettes or e-cigarettes because they want to belong or feel part of a group,” said Shtiler. “But if use develops into dependence, something may change over time. Smoking becomes more private, more frequent and often disconnected from the social context in which it began.”
He said the shift may begin as early as adolescence, long before the patterns identified among older adults in the study fully emerge. A similar process may start earlier and more subtly among teenagers, though dedicated research in younger populations would be needed to establish that.
Dr. Philip said the new findings should also challenge the way smoking is described publicly. “Smoking is not social,” he said at the conference. “Our research shows that it leads to increased social isolation and loneliness.”
Shtiler recommends focusing on possible behavioral patterns rather than assigning personality traits to people who smoke. He said smokers should not be portrayed as “lonely” or “problematic,” and cautioned against broad generalizations such as saying that smokers are more socially isolated.
“The message can instead be that quitting is an opportunity to build new sources of support, connection and belonging,” he said. “That keeps the focus on expanding a person’s options and supporting them, rather than judging or blaming them.”