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Thank. You for downloading the More or

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Less podcast we your weekly, going to

1:41

the numbers in the news and been

1:43

life and on. Tom Coles. This

1:49

week is loneliness as bad few

1:52

smoking fifteen cigarettes a day. picked

1:55

up seems to think so lonely

1:57

this is the same negative called

2:00

This is a claim

2:02

that's circulating on social media

2:04

and also features in headlines in

2:07

major newspapers.

2:14

But where did it come from?

2:16

And is it true? Our

2:19

reporter, Parisia Caddell, saw this on her social

2:21

media pages and has been looking into it

2:23

for us. Hi Parisia. Hi Tom. So

2:26

if TikTok is the source, I'm pretty

2:28

sceptical. No, I would be too.

2:30

So you'll be happy to hear that

2:32

this claim actually comes from the US

2:34

Surgeon General, Dr Vivek Murthy. He's

2:37

basically the top spokesperson on public health

2:39

in the US. He put

2:41

this out there in a special report on

2:43

loneliness published in the wake of the pandemic

2:45

in 2023, in which it's written that... The

2:49

mortality impact of being socially disconnected is similar

2:51

to that caused by smoking up to 15

2:54

cigarettes a day. So already

2:56

I can see it saying something a bit

2:58

different to the simplified TikTok version. That's not

3:00

quite loneliness he seems to be talking about

3:02

there and it's up to 15 cigarettes

3:05

per day, which presumably could be one

3:07

cigarette or anywhere in between. Exactly.

3:10

This sentence in turn is based on

3:13

a big bit of research done by

3:15

Julianne Holt Lunschdad, a professor of psychology

3:17

and neuroscience at Brigham Young University in

3:19

the US, which is more nuanced still.

3:22

Now, I should say here that you

3:24

can't research something like this by doing

3:27

a big controlled experiment. You can't tell

3:29

people to smoke or make them socially

3:31

disconnected on purpose. Yeah, I can

3:33

see that there might be some ethical

3:35

problems there. Yes, but you can look

3:38

at scientific studies that monitor people's survival

3:40

over time. So whether they die in

3:42

a certain timeframe and also collect

3:45

information about their lifestyle, whether they are

3:47

lonely or smokers or whatever, and

3:49

see if there's a relationship between the two. And

3:52

what Professor Holt Lunschdad did was something

3:54

called a meta-analysis, a report that pulled

3:56

in the results from more than a

3:58

hundred of those studies and statistical

4:00

analysis to find the underlying trends

4:03

and it's those trends that are summarized in

4:05

the sentence from the US Surgeon General, we

4:08

spoke to Professor Holt-Lunstad to work out

4:10

what it actually means. The first

4:12

thing to understand is that in this area of

4:14

research there's a difference between

4:17

loneliness and social disconnection. The

4:19

way we often colloquially

4:21

use the term loneliness it

4:24

often refers to lacking

4:27

social connection but lacking social connection can

4:29

occur in a variety of ways. So

4:31

loneliness is something a little bit more

4:34

specific, it's a subjective distressing

4:36

feeling. So the US Surgeon General's stat

4:38

is about social connection which can be

4:41

measured in lots of different ways. You

4:43

can look at whether someone lives alone for example

4:46

but one of the things they look at is

4:48

whether people say they feel lonely and

4:50

that feeling is what loneliness specifically

4:52

means in these studies. The

4:54

association between feeling lonely and an

4:56

early death was one of the

4:58

things measured in Julian's meta-analysis but

5:01

it's not the source of the tick-tock claim. So

5:03

if we look specifically at the

5:05

data on loneliness it

5:07

still is a significant independent predictor

5:10

of earlier mortality and death but

5:12

the effect is not quite as

5:14

high. The effect was actually about

5:17

half the size according to her

5:19

studies. Okay so the source

5:21

for the original tick-tock claim is not

5:23

actually talking about the health risks of

5:26

feeling lonely which has a smaller effect

5:28

but rather using a broader definition of

5:30

loneliness that is better understood as a

5:32

lack of social connection. Yes and

5:35

this was measured in all kinds of ways. Alongside

5:38

whether someone lives alone some studies looked

5:40

at whether people were divorced or widowed

5:42

or whether they have regular contact with

5:44

other people or whether they have

5:46

a good support network of people around them.

5:49

Professor Holt-Lunstatt actually tends to talk in

5:51

general about the benefits of more social

5:53

connection rather than the harms of having

5:56

less so they should amount to

5:58

a similar thing. All of this means that

6:00

you might be categorised in these studies as

6:02

looking social connection, but not

6:04

say you feel lonely at all and still

6:06

have some people in your life just not

6:08

enough. So definitely not the

6:11

feeling of loneliness and it sounds like

6:13

quite a lot of statistical manipulation going

6:15

on there to amalgamate all kinds of

6:17

different sorts of study. But thanks

6:19

to well stats a nice round number

6:22

came out at the end. Overall

6:24

when everything was taken into account the

6:26

benefit of social connection was associated with

6:29

an odds ratio of 1.5 which means

6:31

in essence a 50% increase odds

6:34

of survival. So

6:39

people who were more socially connected were

6:41

50% more likely to be alive at

6:43

the follow-up compared to those

6:45

who are less socially connected. All those

6:48

original studies went back to their participants

6:50

over different periods of time to see

6:52

if they were still alive. The average

6:54

was seven and a half years and

6:56

the odds of being alive were improved by 50% if people

6:58

were more socially

7:00

connected. Independent of initial

7:03

health status, independent of age,

7:05

independent of several lifestyle factors,

7:07

we made sure to look

7:09

for and adjust for

7:12

all the potential confounders that could

7:14

be accounting for earlier mortality. I

7:16

think the key thing here is

7:18

to recognise that this process means

7:20

you are only identifying a correlation

7:22

between these factors and the odds

7:25

of dying. You can't assume

7:27

a lack of social connection causes the

7:29

deaths although it makes it more plausible.

7:32

At the same time Professor Hautlandstad pulled

7:34

together all these different measures of social

7:36

connection to come up with the 50% figure.

7:39

When you look at them individually none

7:41

of the risks are that high so

7:43

the increased odds of an early death

7:45

from the feeling of loneliness across different

7:47

studies is between 15 and

7:50

25%. From social isolation the risk is

7:52

around 30% and

7:54

it's around 30% also for living alone.

7:57

Right let's just quickly talk about the

7:59

smoking side. the equation, I'm guessing there's a

8:01

study which found a 50% increased

8:03

risk of an early death if you smoke up

8:06

to 15 cigarettes per day. Kind

8:09

of. It's another meta-analysis, this time

8:11

from 2008, which analysed 11 studies which

8:16

looked at the risk of premature death

8:18

from smoking, arranged into groups of light,

8:20

medium and heavy smokers. The

8:22

light group had around a 50% increased

8:24

risk of premature death, similar to

8:27

the decreased odds of survival from the

8:29

lack of social connection that Professor

8:31

Houtlandstag found. Then it's a

8:33

question of whether light smokers do indeed smoke

8:35

up to 15 cigarettes per day. And

8:38

this is a bit vague to be honest. Of

8:40

the 11 studies analysed, 5 defined it as

8:43

less than 10 cigarettes per day, 5

8:46

as less than 15 and 1 study as less

8:48

than 21. So only

8:50

one of those studies involves people actually

8:52

smoking 15 cigarettes per day? Yeah,

8:55

it looks like it. In half the studies

8:57

they might have been smoking up to 14, but some

9:00

were definitely smoking a lot less than that. At

9:03

the same time, in this same

9:05

meta-analysis, the medium smokers smoked between

9:08

10 and 25 cigarettes per day. So

9:11

some of them were also smoking 15 cigarettes a

9:13

day. They had an increased risk

9:15

of more than 100% compared

9:17

to non-smokers, which is double the risk

9:19

from the lack of social connection. And

9:22

this figure, the 100% increase

9:24

in risk, is the generally accepted rule

9:26

of some figure for the risk of

9:28

smoking versus non-smoking. So it's

9:30

normally associated with smoking a pack a

9:32

day or 20 cigarettes. Hmm,

9:35

so the up to 15 cigarettes

9:38

per day is doing quite a lot of

9:40

work there. And you could also say that

9:42

a lack of social connection has roughly half

9:44

the risk of smoking around 15 or 20

9:46

cigarettes per day using exactly

9:48

the same smoking study. You could.

9:51

Okay, so to sum it all up, it's

9:53

not right to say that loneliness is as

9:55

bad for you as smoking 15 cigarettes a

9:58

day. But there is a correlation between

10:00

loneliness and an increase in the

10:02

odds of an earlier death, particularly

10:04

if combined with other forms of

10:06

social isolation. Thanks, Parisha.

10:09

And thank you to Professor Julian

10:11

Holt-Lunstadt, Professor Pamela Coulter, and to

10:13

friend of the programme Kevin McConway,

10:15

Emeritus Professor of Applied Statistics at

10:17

the Open University, who helped

10:19

us figure this all out. That's it

10:22

for this week. If you've seen a number you

10:24

think we should look at, drop us an email

10:26

to moreorless at bbc.co.uk. We'll

10:29

be back next week. Until then, goodbye.

10:57

Because I can't wear the same suit

10:59

for fine dining AND kayaking. Total faux

11:01

pas. Then I need something casual for

11:03

the roller coasters. Oh, and

11:06

the music's testing. Meetings waterside.

11:08

Really? Looks like your work trip

11:10

to Tampa Bay just turned into a couple's

11:12

trip through the weekend. I'm for packing. Work

11:15

meets Play at Tampa Bay, where

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11:19

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