. Author manuscript; available in PMC: 2016 Nov 10.

Published in final edited form as: Subst Use Misuse. 2015 Nov 10;50(13):1697–1716. doi: 10.3109/10826084.2015.1027933

Table 2.

Summaries of studies included in review

Publication Information	Location and year	Sample description	Loneliness Measure	Prevalence loneliness^†	Smoking Measure	Prevalence smoking^†	Results
Allen et al. (1994) Gender differences in selected psychosocial characteristics of adolescent smokers and nonsmokers	Central Mississippi County, USA	1679 adolescents sampled from 9^th– 12^th grades	ULS-R	Males: M=39.55, Females: M=36.76	“How many cigarettes do you smoke during an average day?” Smokers defined as those who report smoking 1+ cigs on an average day.	Males: 19.2%, Females: 15.8%, Overall: 17.5%	Smokers scored higher on loneliness than nonsmokers, F(1, 1678) = 7.73, p = .0055. Gender interaction found, male smokers more lonely than all other groups. No difference in loneliness for female nonsmokers and female smokers.
Alwan et al. (2011) Association between substance use and psychosocial characteristics among adolescents of the Seychelles	Seychelles, 2007	1417 nationally representative students aged 11– 17 participating in GSHS	“During the past 12 months, how often have you felt lonely?”	Males: 10.4% Females: 15.2%	“During the past 30 days, on how many days did you smoke cigarettes?” Current smokers were defined as having smoked on 1 or more days.	Males: 22%, Females: 10.6%	Loneliness was positively associated with smoking for males only in age- adjusted analyses [Males; OR=2.4, 95%CI=(1.3,4.5) p=.008, Females: OR=1.7, 95%CI =(1.0,3.2) p=.065]. The association does not reach significance in multivariate analyses.
Backović et al. (2006) Differences in substance use patterns among youths living in foster care institutions and in birth families	Belgrade, Serbia and Montenegro 2003–2004	303 adolescents aged 14–17 living in foster homes (n=58) and with birth family (n=245)	“Feelings of loneliness”, unspecified measure	Foster care: 32.8%, Birth family: 16.3%	Current Smoking, unspecified definition	Foster care: 55.2%, Birth home: 20.8%	Loneliness was positively associated with smoking for children in foster care, OR=4.85, 95%CI = (1.36, 17.31), p =.0149. No association for children living with birth families (p =.4773).
Cacioppo et al. (2002) Loneliness and Health: Potential Mechanisms	Ohio, USA	89 undergraduate students aged 18– 24 participating in an experimental study	ULS-R; pts included in analyses if they scored low or high on loneliness	M = 37.8	Average # of packs of cigarettes consumed weekly	Nonlonely= .4 packs/week Lonely= .3 packs/week	No association between smoking and loneliness (F< 1).
	Chicago, Illinois, USA	25 healthy adults aged 53–78 participating in experimental study	ULS-R, pts included in analyses if they scored low or high on loneliness	M = 35.1	Average # of cigarettes consumed daily	Nonlonely = 2.5 cigs/day, Lonely = 1.07 cigs/day	No association between smoking and loneliness (F< 1).
Christopherson & Conner (2012) Mediation of late adolescent health- risk behaviors and gender influences	California, USA	437 students attending a junior college, mean age = 19	Revised ULS version 3	M = 39.95	Composite of YRBS measures: How old were you when you smoked a whole cigarette for the first time?”; “During the past 30 days, on how many days did you smoke cigarettes?”; “During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?”	M=2.63 (TOB1), M=1.89 (TOB2), M=1.73 (TOB 3)	SEM indicates higher loneliness was significantly associated with higher scores on the smoking latent factor (Females: B=.28, Males: B=.21)]
Dewall & Pond (2011) Loneliness and smoking: The costs of the desire to reconnect	USA 1977– 2007	89,348 nationally representative high school seniors from MTF	“Alot of times I feel lonely.”	NR	“How frequently have you smoked cigarettes in the past 30 days?”, “Have you ever smoked cigarettes?’	NR	Loneliness associated with past 30 day cig use (b=0.04, p=.001), and ever having smoked cigarettes (b=0.05, p=.001). Year of administration, gender, and ethnicity included as covariates.
	USA, 2001– 2003	5692 nationally representative adults aged 18–99 from NCS-R	“Over the past month, how lonely did you feel?”	NR	“Have you ever smoked a cigarette, cigar, or pipe, even a single puff?”, “Was there ever a period in your life lasting at least two months when you smoked at least once per week?”, “Was there ever a year in your life when you smoked more than you did in the past 12 months?”, “Have you chain smoked for several days or more?”	NR	Loneliness was associated with having ever smoked[OR=1.17, 95% CI=(1.08,1.28), p<.001], increased likelihood of smoking once per week for at least two months[OR=1.37, 95% CI=(1.18, 1.59), p<.001], smoking more in a past year than in the past 12 months[OR=1.15, 95% CI=(1.05,1.25), p<.002], and chain smoking [OR=1.25, 95%CI=(1.13, 1.37), p<.001], Age, gender, and ethnicity included as covariates.
Grunbaum et al. (2000) Cultural, social, and intrapersonal factors associated with substance use among alternative high school students	Texas, USA, 1997	441 Alternative high school students	ULS, Roberts Version	NR	YRBS measure: Cigarette use in past month and alcohol use in past month combined.	60.7%	Loneliness was not associated with combined cigarette/alcohol use, OR=.98, 95% CI=(.94, 1.04).
Hays & DiMatteo (1987) A Short-form measure of loneliness	California, USA, 1981	199 college students aged 17– 48	ULS-20, ULS-8, ULS-4	ULS-20: M=32.6	Composite of quantity of cigarettes smoked (1 ½, 1, ½ less than ½ pack daily, or nonsmoker) and frequency (number of days smoked in past 6 months)	NR	Smoking was not correlated with any of the loneliness scales; r ranged from −.02 to −.03.
Lauder et al (2006) A comparison of health behaviours in lonely and non- lonely populations	Queensland, Australia 2003	1278 nationally representative adults, mean age= 46.25	De Jong Gierveld Loneliness Scale	35%	Participants were asked if they smoke.	22.3%	Loneliness was associated with smoking [OR=1.55, 95% CI=(1.14, 2.09)]. Marital status, age, employment, gender, and overweight/ obese status included as covariates.
Leung et al. (2008) Validation of the Chinese translation of the 6-item De Jong Gierveld Loneliness Scale in elderly Chinese	Hong Kong 2007–2008	103 Chinese elders aged 62–89	Formal Chinese translation of 6-item De Jong Gierveld Loneliness Scale	M= 1.5 (range=0–6)	Current smoking status in comparison to non or ex- smoker.	NR	Loneliness was correlated positively with current smoking status (r = 0.24; p = 0.014).
Malta et al. (2014) Psychoactive substance use, family context and mental health among Brazilian adolescents, National Adolescent School-based Health Survey (PeNSE 2012)	Brazil 2012	9^th grade, 109,104 students from PeNSA, sampled using stratified sampling methods	“In the past 12 months, how often have you felt lonely?” Dichotomized to never sometimes vs. most of the time, always	NR	Current smoking: “In the past 30 days, how many days did you smoke cigarettes?”, dichotomized to never smoked on any day or one or more days.	5.1%	Loneliness was associated with smoking [OR=1.27, 95% CI =(1.19, 1.37)], adjusted for all other significant variables in model including age, race, school type, living with parent(s), having meals with parents, family supervision, missing classes w/o permission, insomnia, and having no friends.
Moadel et al. (2012) A randomized controlled trial of a tailored group smoking cessation intervention for HIV-infected smokers	New York, USA	145 smokers living with HIV age 29–70 participating in a randomized controlled trial	Revised ULS version 3	Abstinent: M= 20.1, Non- abstinent: M=25.4	From CDC QIT inventory: “Now, think carefully about the last 7 days. Did you smoke cigarettes, even a puff, on any of those days?”	14.5% abstinent at end of study	Loneliness was associated with lower abstinence rates at 3 months [OR=.92, 95% CI=(.85,1.00), p=.04] (reported from intention-to-treat analyses, association retained significance in complete case analysis. Intervention condition, age, ethnicity, quit attempts in past year, positive affect, social situations score, and decisional balance pros score included as covariates.
Page et al. (2008) Cigarette Smoking and Indicators of Psychosocial Distress in Southeast Asian and Central- Eastern European Adolescents	Thailand, Taiwan, Philippines,	4518 Southeast Asian adolescent females	ULS-R	Smoker: M=40.26, Nonsmoker: M=38.59	“How often do you smoke cigarettes?” Current smoking defined as smoking cigarettes in the past 30 days.	Taiwan=7.6% Thailand=1.8% Philippines=3.2%	Loneliness was associated with increased smoking, F=9.06 (6, 3753), p = .0026^a.
	Hungary, Ukraine, Slovakia, Poland, Romania, Czech Republic	1705 Central- Eastern European adolescent females	ULS-R	Smoker: M=35.67, Nonsmoker: M=37.22	“How often do you smoke cigarettes?” Current smoking defined as smoking cigarettes in the past 30 days.	Hungary=36.9% Ukraine=21.3% Slovakia=28.8% Romania=36.5% Poland=35.2% Czech Republic=37.6%	Loneliness was associated with decreased smoking, F=9.35 (4, 1602), p = .0023^a.
	Thailand, Taiwan, Philippines,	4122 Southeast Asian adolescent males	ULS-R	Smoker: M=40.39, Nonsmoker: M=40.37	“How often do you smoke cigarettes?” Current smoking defined as smoking cigarettes in the past 30 days.	Taiwan=15.5% Thailand=5.4% Philippines=5.3%	Loneliness was not associated with smoking, F=0.00 (6, 3149), p = .9676^a.
	Hungary, Ukraine, Slovakia, Poland, Romania, Czech Republic	1392 Central- Eastern European adolescent males	ULS-R	Smoker: M=36.98, Nonsmoker: M=37.55	“How often do you smoke cigarettes?” Current smoking defined as smoking cigarettes in the past 30 days.	Hungary=31.4% Ukraine=32.6 % Slovakia=23.4% Romania=33.8% Poland=15.3% Czech Republic=34.8%	Loneliness was not associated with smoking, F=2.13 (3, 1061), p = .1452^a
Page et al. (2010) Psychosocial Distress and Substance Use Among Adolescents in Four Countries: Phillippines, China, Chile, and Namibia	Philippines, China, Chile, and Namibia 2003–2004	14370 adolescent males from GSHS. Data from Philippines and Namibia are nationally representative.	“During the past 12 months, how often have you felt lonely?”	Smoker= 11.9%, Nonsmoker= 7.6%	“During the past 30 days, on how many days did you smoke cigarettes?” Current smoking defined as smoking cigarettes in the past 30 days.	Philippines=37. 2%, China=18.2%, Chile=28.1%, Namibia=34.6%	Loneliness was associated with smoking for the overall sample [OR=1.46, 95% CI=(1.26,1.70)]and all country-specific subgroups with the exception of Filipino males.
	Philippines, China, Chile, and Namibia 2003–2004	16196 adolescent females from GSHS. Data from Philippines and Namibia are nationally representative.	“During the past 12 months, how often have you felt lonely?”	Smoker= 25.4%, Nonsmoker= 11.2%	“During the past 30 days, on how many days did you smoke cigarettes?” Current smoking defined as smoking cigarettes in the past 30 days.	Philippines=19. 7%, China=10.1%, Chile=29.1%, Namibia=30.2%	Loneliness was associated with smoking for the overall sample [OR=2.01, 95% CI=(1.76, 2.29)] and country-specific subgroups with the exception of Chinese females.
Peltzer (2009) Prevalence and correlates of substance use among school children in six African countries	Kenya, Namibia, Uganda, Zimbabwe^* 2003–2004	12740 students in grades 6–10 from GSHS. Data are nationally representative with exception of Zimbabwe sample.	“During the past 12 months, how often have you felt lonely?”	16.1%	Participants were asked if they smoked cigarettes and/or used any other form of tobacco in the past 30 days. Current tobacco use defined as using any tobacco product in the past 30 days.	Tobacco use aggregate= 12.6% Smoking= 11.7%	Loneliness was associated with tobacco use [OR=1.92, 95% CI = (1.89, 1.94), p<.001] in adjusted and unadjusted analyses.
Qualter et al. (2013) Trajectories of loneliness during childhood and adolescence: Predictors and health outcomes	England, UK	361 students surveyed from age 7 to 17	Peer-related loneliness subscale from the Loneliness and Aloneness Scale for Children and Adolescents	22% followed a high stable loneliness trajectory	“Do you smoke cigarettes everyday (1), somedays (2), or not at all (3)?”	Ranges between 1.43–1.60, reported by loneliness subgroup	Loneliness latent class not associated with smoking status. The high stable lonely group could not be differentiated from the non-lonely groups in terms of whether they were currently smokers (ORs ≤ 2.21, 95% CI = [.34 –14.51]). The group who increased on loneliness could also not be differentiated from the non-lonely groups (ORs ≤ 1.40, 95% CI = [.70 – 3.44])^d.
Shankar et al. (2011) Loneliness, social isolation, and behavioral and biological health indicators in older adults	England, UK 2004	8688 nationally representative older adults from ELSA	Three-Item Loneliness Scale	M=4.2 (range 3–9)	Participants classified as current smokers if they stated they currently smoke.	Current smoker and physically active:15.9%, Current smoker and physically inactive:6.0%	Loneliness was significantly associated with smoking in unadjusted analyses. When adjusted for social isolation loneliness was no longer a predictor of being a smoker [OR=1.04, 95% CI=(0.98, 1.09)] but did continue to be a predictor of being both a smoker and having low physical activity [OR=1.08, 95% CI =(1.02, 1.15)].
Siconolfiet al. (2013) Psychosocial and Demographic correlates of drug use in a sample of HIV-positive adults ages 50 and older	New York City, NY, USA 2005– 2006	811 HIV-positive adults age 50 and older	Revised ULS version 3	M=43.81	Self-reported if they used cigarettes in the prior 3 months.	57.2 %	Loneliness was not associated with cigarette use r=.01.
Steptoe et al. (2004) Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle- aged men and women	London, England, UK	240 civil servants age 47–59 from Whitehall II prospective cohort	ULS-R	M=36.3	Current smoking measured with yes/no question.	9.7%	Loneliness was not associated with smoking [OR= 0.98, 95% CI=( 0.93,1.02), p = 0.33]^d.
Stickley et al. (2014) Loneliness and health risk behaviours among Russian and U.S. adolescents: a cross- sectional study	Russia 2003	1995 Russian adolescents age 13–15 from SAHA	Adapted CESD, “I felt lonely.”	Females= 14.4%, Males= 8.9%	“During the past 30 days, on how many days did you smoke?” Current tobacco use defined as smoking cigarettes in the past 30 days.	Females= 31.1%, Males=37.1%	Loneliness was associated with smoking for males and females, the association did not retain significance in females after controlling for depression[Females: OR= 1.10, 95% CI=(.79,1.52), Males: OR=1.87, 95% CI =(1.08,3.24)]^c.
	USA 2003	2050 U.S. adolescents age 13–15 from SAHA	Adapted CESD, “I felt lonely.”	Females= 14.7%, Males= 6.7%	“During the past 30 days, on how many days did you smoke?” Current tobacco use defined as smoking cigarettes in the past 30 days.	Females= 11.2%, Males=7.0%	Loneliness was not associated with smoking for males; loneliness was associated with smoking for females, the association did not retain significance after controlling for depression [Females: OR=1.86, 95% CI=(.88, 3.94), Males: OR=.72, 95% CI=(.17, 2.97)]^c.
Stickley et al. (2013) Loneliness: Its Correlates and associations with Health behaviours and outcomes in nine countries of the Former Soviet Union	Armenia, 2010–2011	1605 nationally representative adults from HITT	“How often do you feel lonely?”	10.7%	“Do you smoke at least one cigarette (papirossi , pipe, cigar) per day?”	NR	Loneliness was not associated with smoking, OR=1.02, 95% CI=(0.60, 1.75)^b.
	Azerbaijan 2010–2011	1650 nationally representative adults from HITT	“How often do you feel lonely?”	4.4%	“Do you smoke at least one cigarette (papirossi, pipe, cigar) per day?”	NR	Loneliness was not associated with smoking [OR=1.03, 95% CI=(0.39, 2.77)]^b.
	Belarus, 2010–2011	1677 nationally representative adults from HITT	“How often do you feel lonely?”	8.9%	“Do you smoke at least one cigarette (papirossi, pipe, cigar) per day?”	NR	Loneliness was not associated with smoking [OR=0.99, 95% CI=(0.60, 1.66)]^b.
	Georgia, 2010–2011	1998 nationally representative adults from HITT	“How often do you feel lonely?”	12.3%	“Do you smoke at least one cigarette (papirossi, pipe, cigar) per day?”	NR	Loneliness was not associated with smoking [OR=1.34, 95% CI=(0.81, 2.21)]^b.
	Kazakhstan 2010–2011	1694 nationally representative adults from HITT	“How often do you feel lonely?”	5.4%	“Do you smoke at least one cigarette (papirossi, pipe, cigar) per day?”	NR	Loneliness was not associated with smoking [OR=1.32, 95% CI=(0.73, 2.39)]^b.
	Kyrgyzstan 2010–2011	1723 nationally representative adults from HITT	“How often do you feel lonely?”	7.9%	“Do you smoke at least one cigarette (papirossi, pipe, cigar) per day?”	NR	Loneliness was associated with smoking [OR=2.29, 95% CI=(1.36, 3.86) p<.01]^b.
	Moldova 2010–2011	1667 nationally representative adults from HITT	“How often do you feel lonely?”	17.9%	“Do you smoke at least one cigarette (papirossi, pipe, cigar) per day?”	NR	Loneliness was not associated with smoking [OR=0.64, 95% CI=(0.40, 1.03)]^b.
	Russia 2010– 2011	2549 nationally representative adults from HITT	“How often do you feel lonely?”	8.1%	“Do you smoke at least one cigarette (papirossi, pipe, cigar) per day?”	NR	Loneliness was not associated with smoking [OR=1.10, 95% CI=(0.72, 1.69)]^b.
	Ukraine 2010–2011	1768 nationally representative adults from HITT	“How often do you feel lonely?”	10.8%	“Do you smoke at least one cigarette (papirossi, pipe, cigar) per day?”	NR	Loneliness was not associated with smoking [OR=1.13, 95% CI=(0.68, 1.87)]^b.
Thurston et al. (2009) Women, Loneliness, and incident coronary heart disease	USA 1971– 1975	2616 nationally representative adults age 25–74 from NHANES	CESD, “I felt lonely.”	9.2%	Smoking status (current versus never/former)	Low loneliness: 38.8%, Medium=39.1%, High=45.6%	Loneliness was not associated with smoking (p=.12). Among women only, loneliness was associated with smoking (statistics not reported in paper).
Whisman (2010) Loneliness and the metabolic syndrome in a population- based sample of middle-aged and older adults	England, UK 2004–2005	3211 nationally representative adults age 50+ from ELSA	Three-Item Loneliness Scale	M=4.01 (range 3–9)	Current smoking status (smoker or nonsmoker)	NR	Loneliness was associated with smoking [OR =1.1, 95% CI=(1.0, 1.2), p< .01].

Note. NR=Not reported. GSHS= Global School-Based Health Survey, HITT= Health in Times of Transition, NHANES=National Health and Nutrition Survey, ELSA=English Longitudinal Study of Ageing, MTF=Monitoring the Future, NCS-R=National Comorbidity Survey-Replication, PeNSA=Pesquisa Nacional de Saúde dos Escolares (National Adolescent School-based Health Survey), SAHA=Social and Health Assessment, YRBS= Youth risk behavior survey. Sample sizes reported are the sample sizes used in analyses for the association of loneliness and smoking when data available.

= The overall study included Swaziland and Zambia, however, no data was available on tobacco use in either country and therefore their data was not included in analyses.

^†

= Percentages in column indicate the percent of participants who scored high on the loneliness measure/ indicated that they were lonely or the percent of participants who smoke. Prevalence may be reported only for subsamples in the reviewed article and therefore are presented by subsample here.

=Adjusted for country, age, grade, alcohol use in past week, marijuana or hashish use in past month, and illegal drug use other than marijuana or hashish in the past month.

= Adjusted for sex, age, marital status, education, location, household size, physical activity difficulty, locus of control, wealth, social support, and death of close relative.

=Adjusted for age, family structure, and parental education.

=Statistics not reported in paper. Authors were contacted for the statistical association.