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 article, 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.

Keywords :

• loneliness
• smoking
• cigarette
• tobacco

THE AUTHORS

Stephanie R. Dyal, B.S., is a doctoral candidate in health behavior research at the University of Southern California, Keck School of Medicine. She is currently working on her dissertation titled “Adolescent social networks, loneliness, and smoking.” Her research focuses on substance use, social networks, and associated socioemotional factors.

Thomas W. Valente, PhD, is a Professor in the Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, at the University of Southern California. He is author of Social Networks and Health: Models, Methods, and Applications (2010, Oxford University Press); Evaluating Health Promotion Programs (2002, Oxford University Press); Network Models of the Diffusion of Innovations (1995, Hampton Press); and over 140 articles and chapters on social networks, behavior change, and program evaluation. Valente uses social network analysis, health communication, and mathematical models to implement and evaluate health promotion programs designed to prevent tobacco and substance abuse, unintended fertility, and STD/HIV infections. He is currently working on specification for diffusion network models and implementing network interventions.

GLOSSARY

Loneliness: A negative affective state which is experienced when a person perceives themselves as socially isolated.

UCLA Loneliness Scale (ULS): Measure of loneliness with 20 questions answered on a likert scale. Does not contain the word lonely in any item.