Loneliness as Unhealthy as 15 Cigarettes a Day, U.S. Surgeon General Says

Social media addiction and COVID lockdowns have left Americans less connected

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Health warnings on cigarette packages started in 1969 after the release of a report from the U.S. surgeon general about risks related to smoking. Now, the surgeon general’s office has found something as dangerous as smoking 15 cigarettes per day: loneliness.

The recently released 82-page report, “Our Epidemic of Loneliness and Isolation,” takes a troubling but hopeful look at who’s lonely and why it matters. The report offers recommendations that individuals can try right away to feel more connected, such as disconnecting from excessive social media use and spending less time in front of screens and more time in front of people. The report pulled information from many studies.

Loneliness is more than just a bad feeling. It harms individual and societal health, according to the report. It’s associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. The mortality impact of being socially disconnected is similar to smoking up to 15 cigarettes per day and is even greater than obesity and physical inactivity.

Large population studies have documented that among initially healthy people tracked over time, those who are more socially connected live longer, while those who experience social deficits, including isolation, loneliness, and poor-quality relationships, are more likely to die earlier, regardless of the cause of death, according to the report.

“The harmful consequences of a society that lacks social connection can be felt in our schools, workplaces, and civic organizations, where performance, productivity, and engagement are diminished. Given the profound consequences of loneliness and isolation, we have an opportunity—and an obligation—to make the same investments in addressing social connections that we have made in addressing tobacco use, obesity, and the addiction crisis,” Surgeon General Dr. Vivek Murthy wrote in the study’s introduction.

He called for building more connected lives in a more connected society.

Failure to connect with others will bring increased risk to personal and collective health, ultimately causing society to splinter and divide until we can no longer stand as a community or a country, Murthy said.

“We are called to build a movement to mend the social fabric of our nation. It will take all of us—individuals and families, schools and workplaces, health care and public health systems, technology companies, governments, faith organizations, and communities—working together to destigmatize loneliness and change our cultural and policy response to it,” he wrote. “Each of us can start now, in our own lives, by strengthening our connections and relationships. Our individual relationships are an untapped resource—a source of healing hiding in plain sight. They can help us live healthier, more productive, and more fulfilled lives. Answer that phone call from a friend. Make time to share a meal. Listen without the distraction of your phone. Perform an act of service. Express yourself authentically. The keys to human connection are simple but extraordinarily powerful.”

Most at Risk of Loneliness

Anyone can experience loneliness and isolation, but some people are at higher risk. They’re those with poor physical or mental health, those with disabilities, those struggling financially, those who live alone, single parents, and younger and older populations, according to the report.

While the highest rates of social isolation are found among older adults, young adults are almost twice as likely to report feeling lonely than those older than 65. The rate of loneliness among young adults has increased every year between 1976 and 2019.

Adults with lower incomes are more likely to be lonely than those with higher incomes. Sixty-three percent of adults who earn less than $50,000 per year are considered lonely, which is 10 percent higher than those who earn more than $50,000 per year.

Other groups with a heightened risk include individuals from ethnic and racial minority groups, LGBT individuals, rural residents, victims of domestic violence, and those who experience discrimination or marginalization.

Diminishing Traditional Values

Many traditional indicators of community involvement, including religious groups, clubs, and labor unions, show declining trends in the United States since at least the 1970s. According to the study, in 2018, only 16 percent of Americans reported feeling very attached to their local community.

Membership in organizations that have been important pillars of community connection has declined significantly. Research produced by Gallup, the Pew Research Center, and the National Opinion Research Center’s General Social Survey shows that since the 1970s, religious preference, affiliation, and participation among U.S. adults have declined. In 2020, just 47 percent of Americans said they belonged to a church, synagogue, or mosque. That’s down from 70 percent in 1999. It’s the first dip below 50 percent in the history of the survey question.

“Religious or faith-based groups can be a source for regular social contact, serve as a community of support, provide meaning and purpose, create a sense of belonging around shared values and beliefs, and are associated with reduced risk-taking behaviors,” the report reads. “As a consequence of this decline in participation, individuals’ health may be undermined in different ways.”

Family size and marriage rates have been in steady decline for decades. The percentage of Americans living alone has also increased from decade to decade. In 1960, single-person households accounted for only 13 percent of all U.S. households, according to the report. In 2022, that number more than doubled to 29 percent of all households.

The reasons people remain single, have smaller families, and live alone are varied, but these changes contribute to more social disconnection and fewer supports to draw upon in times of need.

A fraying of the social fabric can be seen more broadly in society, according to the report; trust in each other and major institutions is at near-historic lows. Polls conducted in 1972 show that roughly 45 percent of Americans felt they could reliably trust other Americans. That proportion shrank to roughly 30 percent by 2016.

Social Media Makes Us Less Social

Social media does have benefits. It can foster connection by providing opportunities to stay in touch with friends and family, offer support groups and information about social participation for those with disabilities, and create opportunities to find community.

The benefits are as familiar as the harms listed in the report. Social media displaces in-person engagement, monopolizes our attention, reduces the quality of our interactions, and diminishes our self-esteem. This can lead to greater loneliness, fear of missing out, conflict, and reduced social connection.

For example, frequent phone use during face-to-face interactions between parents and children or between family and friends creates distraction and reduces conversation quality. This lowers self-reported enjoyment of time spent together in person, the report states.

Social media, smartphones, virtual reality, remote work, artificial intelligence, and assistive technologies changed how we live, work, communicate, and socialize.

Nearly all teens and adults younger than 65 years of age—96 to 99 percent—and 75 percent of adults 65 and older say they use the internet. Americans spend an average of six hours per day on digital media, and 1 in 3 U.S. adults aged 18 and older report that they’re online “almost constantly.”

The percentage of teens aged 13 to 17 who say they’re online “almost constantly” has doubled since 2015.

When looking at social media specifically, the percentage of U.S. adults 18 and older who reported using social media increased from 5 percent in 2005 to roughly 80 percent in 2019.

Among teens aged 13 to 17, as of 2022, 95 percent reported using social media, with more than half reporting that it would be hard to quit social media.

Fewer Friends

The number of close friendships has also declined over several decades. Among people not reporting loneliness or social isolation, nearly 90 percent have three or more confidants. Yet 49 percent of Americans in 2021 reported having three or fewer close friends—only 27 percent said that in 1990.

Social connection declined more during the COVID-19 pandemic, with one study finding a 16 percent decrease in network size from June 2019 to June 2020 among participants.

Not only are social networks getting smaller, but levels of social participation are also declining.

Measures of social exposure from 2003 to 2020 found that social isolation—determined by average time spent alone—increased as follows:

• 2003: 285 minutes per day; 142.5 hours per month spent alone.
• 2019: 309 minutes per day; 154.5 hours per month spent alone.
• 2020: 333 minutes per day; 166.5 hours per month spent alone.

It amounts to an increase of 24 hours per month spent alone.

During this time, social participation in various relationships declined. The amount of time respondents engaged with friends socially in person decreased as follows:

• 2003: 60 minutes per day; 30 hours per month spent with friends.
• 2020: 20 minutes per day; 10 hours per month spent with friends.

That’s 20 fewer hours per month engaging with friends. For young people aged 15 to 24, time spent in-person with friends reduced by nearly 70 percent over almost two decades, from roughly 150 minutes per day in 2003 to 40 minutes per day in 2020.

COVID-19

“Many of us felt lonely or isolated in a way we had never experienced before. We postponed or canceled meaningful life moments and celebrations like birthdays, graduations, and marriages. Children’s education shifted online—and they missed out on the many benefits of interacting with their friends,” the report reads. “Many people lost jobs and homes. We were unable to visit our children, siblings, parents, or grandparents. Many lost loved ones. We experienced feelings of anxiety, stress, fear, sadness, grief, anger, and pain through the loss of these moments, rituals, celebrations, and relationships.”

Frontline workers had different experiences than those who could work from home.

Parents managing their own work and their children’s online school had a different experience than single young people unable to interact in person with friends.

One survey shows that by April 2021, 1 in 4 individuals reported feeling less close to family members than they did at the beginning of the pandemic. But at the same time, about 1 in 5 said they felt closer to family members. This may mean that the pandemic exacerbated existing family dynamics of connection or disconnection, the report states.

People Need People

Social connection is connected to human behavior, such as nutrition, sleep, and physical activity. It’s tied to psychological processes such as the sense of meaning, purpose, feelings of stress, safety, or hopefulness.

The report makes five broad recommendations:

1. Strengthen social infrastructure in local communities: Invest in local institutions that bring people together.

2. Enact pro-connection public policies: Consider social connection when writing policy.

3. Mobilize the health sector: Train health care providers and assess patients.

4. Reform digital environments: Establish and implement safety standards and support the development of pro-connection technologies.

5. Deepen our knowledge: Increase public awareness.

The report recommends that workplaces put in place policies that protect workers’ ability to nurture their relationships outside work, including respecting boundaries between work and nonwork time, supporting caregiving responsibilities, and creating a culture that supports these policies.

Recommendations for parents include investing in their relationships with their children by recognizing that strong, secure attachments are protective and a good foundation for other healthy relationships. And modeling healthy social connection, including constructive conflict resolution; spending time together; staying in regular contact with extended family, friends, and neighbors; setting time aside for socializing away from technology or social media; and participating in community events.

Recommendations for individuals include minimizing distraction during conversation to increase the quality of the time spent with others.

Don’t check your phone during meals with friends, important conversations, and family time. And look for ways to serve and support others, either by helping your family, co-workers, friends, or strangers in your community or by participating in community service.

Reflect on how you approach others in conversation and actions. Ask yourself, how might kindness change this situation? What would it look like to treat others with respect? How can I be of service? How can I reflect my concern for and commitment to others?