Addressing the Impact of COVID-19 on Social Isolation and Loneliness (2024)

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Introduction The COVID-19 pandemic has significantly impacted mental health by heightening social isolation and loneliness across various demographics, raising concerns for public health and individual and societal well-being (Cudjoe & Kotwal, 2020; Killgore et al., 2020; Loades et al., 2020). Data have shown that these effects have been experienced by almost all age groups―young children, adolescents, young adults, middle-aged adults, and older adults, especially those in residential care settings (Lisitsa et al., 2020; Oosterhoff et al., 2020). Although social isolation and loneliness affect people across the lifespan (O’Sullivan et al., 2021), research and interventions have focused on older adults in the context of aging (NASEM, 2020). Much less work has focused on other age groups. The terms “loneliness” and “social isolation” are closely related yet distinct concepts. Loneliness has been defined as the “subjective experience of a perceived discrepancy between actual and desired levels of social engagement” (Wickens et al., 2021, p. 103). Loneliness is significantly shaped by individual perceptions of social connectedness and their ability to form meaningful relationships, as well as psychological factors such as low self-esteem and mental health issues (Hawkely & Cacioppo, 2010). Social isolation is the “objective state of having few social relationships or infrequent social contact with others” (NASEM, 2020, p. 1). It is often influenced by structural and environmental factors, including geographic barriers, socioeconomic status, health and mobility issues, and access to technology and transportation, that limit opportunities for social interaction and engagement (NASEM, 2020). Whereas research has linked increased social isolation to increased loneliness, some people experience loneliness despite having an extensive network of friends and/or family. For example, one can feel lonely while being with others. Conversely, one can live alone and not feel lonely or experience social isolation (Bedard-Thomas et al., 2019; Perissinotto & Covinsky, 2014; Taylor, 2020). It is also important to note that loneliness can be a “normal, nonpathological reaction to changing circumstances” (Ernst et al., 2022, p. 12), or it can be chronic and sustained, leading to mental and physical health challenges (NASEM, 2020). IMPACT OF THE COVID-19 PANDEMIC ON SOCIAL ISOLATION AND LONELINESS Social isolation and loneliness were prevalent before the COVID-19 pandemic (Office of the Surgeon General, 2023; Thompson et al., 2021), with nearly 50% of Americans reported experiencing loneliness, 4 feeling left out and poorly understood, and lacking companionship (Polack, 2018). Prepandemic assessments focused on loneliness found it to be significantly elevated in both young adults and the oldest of the older adult population 5 (Child & Lawton, 2019; Luhman & Hawkley, 2016; NASEM, 2020; Nicolaisen & Thorsen, 2017; Victor & Yang, 2012). This baseline was exacerbated during the COVID-19 pandemic as a result of public health measures, including physical distancing, avoidance of public social spaces, stay-at-home orders, and physical isolation of high-risk individuals, coupled with the profound changes to everyday life brought about by the pandemic (Buecker & Horstmann, 2022; Ernst et al., 2022; Serlachius et al., 2020). A systematic review conducted in 2021 found that of the 12 studies reporting prevalence rates of loneliness before and after the COVID-19 pandemic, 9 found an increase in loneliness, 2 found stable rates, and 1 found a decrease (Buecker & Horstmann, 2022). The differences 4 The survey did not inquire about what kind of loneliness participants felt and whether they considered it a problem. 5 For example, a 2020 study by the National Academies of Sciences, Engineering, and Medicine reports that “approximately one-quarter (24%) of community- dwelling Americans aged 65 and older were socially isolated, and a significant proportion of adults in the United States reported feeling lonely (35% of adults aged 45 and older and 43% of adults aged 60 and older)” (NASEM, 2020, p. 17). JULY 2024 | 2 

in the findings of these studies reflect challenges of definition, measurement, and varied methodologies and populations. An American Association of Retired Persons (AARP) survey from August 2020 found that 66% of adults and 75% of young adults (aged 18–34) reported experiencing social isolation during the COVID-19 pandemic (AARP Foundation, 2020). The impact of COVID-19 was both immediate and long-term: the initial surge of loneliness and social isolation was due to the lockdowns, quarantines, and widespread fear of the virus, while extended adaptations and further effects are still unfolding. The literature indicates that the impact of social isolation and loneliness during the pandemic has varied significantly across different age groups, having a greater impact on the feeling of loneliness among younger people relative to the general population. Studies have shown that while older adults have indeed been impacted, younger adults, particularly those aged 18–24, have experienced more severe mental health outcomes as a result of social isolation (Carstensen et al., 2020; Vahia et al., 2020; Wolfe & Isaacowitz, 2021). Other research has highlighted the psychological impact and potential long-term consequences of the pandemic on children’s mental health (Beam & Kim, 2020; Chiesa et al., 2021). A rapid systematic review looking at the impact of social isolation and loneliness in children and adolescents found an increased risk for depression and anxiety in children (Loades et al., 2020). As localities experience shifts in pandemic-related supplemental federal resources, decision makers, health care providers, and other stakeholders have a timely opportunity and a pressing need to address these increases in social isolation and loneliness. This document describes a range of strategies, policies, and interventions that can be implemented to this end. 6 As noted earlier, people along the age continuum experience social isolation and loneliness differently. Therefore, it is important to understand their impacts on the entire spectrum of the population so that strategies and intervention approaches can be effectively designed to cover all age groups. STRATEGIES FOR PROMOTING SOCIAL CONNECTEDNESS AND REDUCING SOCIAL ISOLATION AND LONELINESS Strategies for addressing social isolation and loneliness at the structural, community, and individual levels need to encompass the multifaceted and interrelated nature of the two concepts. Most approaches do so by focusing on the goal of promoting social connectedness. There is no universally accepted definition of social connectedness; however, the term usually denotes a combination of interrelated constructs spanning social support, social networks, and the absence of perceived social isolation (Lamblin et al., 2017). The evidence base converges on promoting social connectedness, whether the research or intervention design was articulated to address social isolation, loneliness, or both together. A growing body of research considers where an individual or population falls along the continuum of social connectedness—connections to others through the existence of relationships and their roles, a sense of connection that results from actual or perceived support or inclusion, and connection to others based on positive relationship qualities (McAuley et al., 2000; Smith et al.,2023). Other work has highlighted the importance of the number of connections and their quality (including positivity and supportiveness), structure, and function (Cacioppo & Hawkley, 2009; Durlak et al., 2011). 6 The full statement of task states, “The National Academies of Sciences, Engineering, and Medicine will produce a rapid expert consultation, “Addressing the impact of COVID-19 on loneliness and social isolation,” to provide timely, actionable guidance to support state, tribal, territorial, and local decision-makers in addressing increased reports of loneliness and social isolation in the United States. The public health measures which were implemented to control the COVID-19 pandemic disrupted normal social interactions and contributed to increased feelings of loneliness and social isolation. Based on current research and evidence, the consultation will focus on groups who experienced heightened levels of loneliness and social isolation during the COVID-19 pandemic (including but not limited to older adults, youth, and individuals with pre-existing health conditions) and discuss strategies for promoting social connection and well-being. This rapid expert consultation will draw upon current research in psychology, psychiatry, behavioral health, sociology, public health, urban planning, community health, and gerontology. The rapid expert consultation will be designed for timely, practical use by decision-makers but will not make recommendations. It will be reviewed in accordance with institutional guidelines.” JULY 2024 | 3 

The following strategies focus on direct community interaction, technological innovations, and support systems that enhance individual and collective well-being. They also include strategies for creating and maintaining physical and systemic structures to foster social connectedness and community development. Summary tables offer a synthesis of examples that improve social connection to reduce social isolation, loneliness, or both. In the descriptions of the examples that follow each table, the terms used are those used explicitly in the research being reviewed. Strategies are provided for a range of age groups, although, as noted earlier, there have been more strategies and interventions designed for older adults than for younger people. COMMUNITY-BASED SUPPORTS Summary of Community-Based Support Strategies by Age Group and Setting Age Group/Setting Approach Strategy Example School-Age Children Promote social Structured after-school After-school programs focusing on connectedness activities sports, arts, and group projects (Durlak et al., 2011). Reduce Mindfulness interventions Smartphone-based mindfulness loneliness training to reduce loneliness (Lindsay et al., 2019). Young Adults Promote social Peer mentoring programs Volunteer work and community connectedness events can foster a sense of purpose and connection (Karcher, 2009). An example of this includes Active Minds. Promote social Community-based Group mentoring programs for connectedness mentoring programs with adolescents that include volunteer peer activities work (Karcher, 2009). Older Adults Promote social Community housing The Beacon Hill Village model connectedness options provides social, educational, and health activities (Graham & Scharlach, 2015). Reduce Psychosocial interventions Circle of Friends program with loneliness interactive sessions (Jansson & Pitkälä, 2021). Health care Settings Reduce social Screening and referral Camden Coalition links high-need isolation systems patients to essential services (Mullen et al., 2019). Reduce Mental health support Expand telehealth services to loneliness provide counseling (Mullen et al., 2019). Workplace Initiatives Promote social Social activities Team-building events, social connectedness gatherings, and company retreats (Lim et al., 2020). Promote social Skill-building sessions Workshops that enhance connectedness interpersonal skills and improve workplace relationships (Lim et al., 2020). JULY 2024 | 4 

Using existing community 7 service networks—collaborative structures that bring together various individuals, organizations, and agencies to leverage the strengths and resources of multiple stakeholders (Castillo et al., 2019)—can enhance opportunities for social connectedness and help individuals access care and support to meet their specific needs. These networks exist in a range of community contexts, such as schools, workplaces, and special housing (including accommodations designed for individuals living with disabilities, older adults, and people requiring specialized care). It is important that services be linked, as no single organization or department can provide all the services needed. To address these issues effectively requires a coordinated, multisectoral approach that includes collaboration among health care providers, community organizations, community members, local governments, educational institutions, and technology companies. Some localities have harnessed the power of volunteers and peers 8 to support community initiatives and individuals experiencing loneliness. Community-based mentoring programs can integrate different activities and approaches for young adults to support peer relationships and community connectedness (Fallavollita & Lyons, 2023). Through volunteer work and community events, mentoring activities can foster a sense of connection, purpose, and belonging (Keller et al., 2020). Research has shown that these events work best with multiple mentor-mentee pairs, with mentors allowing for reflections and peer discussions to create a shared experience and relationships among mentees (Fallavollita & Lyons, 2023). Adolescents in group mentoring programs exhibited significantly improved social skills, self-esteem, and academic performance compared with those in one-on-one mentoring settings (Karcher, 2009). Active Minds is an example of a mental health organization that targets college campuses to promote peer-to- peer support. The organization’s programs encourage social engagement through the building of meaningful relationships among youth on campuses, in the community, and at the workplace (Active Minds, n.d.). Another example is Threads Baltimore, which targets social isolation by creating a network of support and relationships for public school students, positively impacting their educational and personal outcomes (Threads, n.d.). For older adults, housing options that build community are effective in increasing social engagement (Graham et al., 2014; Hou et al., 2017). An example is the Beacon Hill Village 9 in Boston, which uses an aging-in-place community model to provide services, social activities, and support for older adults. The village model used by Beacon Hill Village comprises grassroots organizations that help older adults who are paying members age in their communities, providing social, educational, cultural, and health and wellness activities; transportation assistance; home maintenance; professional services; information; and referral to services (Scharlach et al., 2019). A study by Graham and Scharlach (2015) found that participants in such village model programs reported higher levels of social engagement, improved physical and mental health, and greater satisfaction with aging in place. The Circle of Friends 10 is an example of a psychosocial intervention that has proven effective and sustainable. It is an evidence-based group intervention designed to engage older adults in socializing and addressing loneliness through interactive activities generated from participant suggestions (Jansson & Pitkälä, 2021; Zubatsky et al., 2020). The intervention groups meet 12 times over 3 months, covering 7 The concept of community can be defined in various ways, such as a locale (a city neighborhood) or a group with a shared identity (gender identity, sexual orientation, language, culture, social identity). 8 Volunteers and peers may work differently, with volunteers suggesting a one-way direction, ‘I am here to help you,’ and peers suggesting mutual support, ‘we share lived experience’ (Corrigan, 2021). Peers might show mutual support that accentuates the ‘helper principle’- the degree to which one’s sense of self-esteem and self- efficacy is enhanced when in a helping relationship (Corrigan, 2021). 9 See https://www.beaconhillvillage.org. 10 See https://www.slu.edu/medicine/internal-medicine/geriatric-medicine/aging-successfully/circle-of-friends.php. JULY 2024 | 5 

themes that connect older adults experiencing loneliness, including narrative writing, creative arts, and health and exercise experiences. A goal is for the group to meet without the facilitator after the initial 12 sessions (Jansson & Pitkälä, 2021). Such programs also build a culture of connection and an environment where social connections are valued and nurtured. Approaches based in health care settings can also be effective, such as a model based on identifying patients experiencing social isolation and loneliness in the primary care setting and providing support directly or through referral systems. For example, screening for loneliness in a medical setting has been well-documented to improve physical health outcomes (Mullen et al., 2019). An example of a framework that can be used in clinical settings is the Educate, Assess, Respond (EAR) framework, which focuses on (1) educating patients about social connections and their impacts on illness; (2) assessing whether people have social support and are experiencing isolation or loneliness, identifying at-risk patients, and tracking their progress; and (3) reinforcing the need for social connection, integrating psychosocial support, and offering referrals tailored to patients’ needs (Holt-Lunstad & Perissinotto, 2023). A call has been issued to strengthen cross-sectoral referrals and facilitate community navigation for older adults (Smith et al., 2023). The Camden Coalition of Health care Providers 11 illustrates this approach, focusing on high-need, high-cost patients and providing them with integrated care and social services designed to improve health outcomes and reduce isolation. Linking patients to essential services, such as food assistance, housing support and mental health services, and using a person-centered approach helps address some of the root causes of social isolation and loneliness. Social initiatives in the workplace can target the working population to improve employee well-being and reduce feelings of isolation. Research shows that the loneliness of employees, influenced by the unsupportive social climate of organizations and a lack of workplace connections, adversely affects both the well-being of employees and their job satisfaction (Lim et al., 2020; Erdil & Ertosun, 2011). While research on workplace loneliness and interventions to address it is limited, authors of relevant studies suggest that such initiatives can enhance employee interactions, alleviate loneliness, and improve work performance. These initiatives may include: • Social activities that cater to the socioemotional needs of employees, fostering social connections (Ertosun & Erdil, 2012; Lam & Lau, 2012); • Skill-building sessions, such as those addressing conflict management (Ertosun & Erdil, 2012); • Leadership training programs that guide leaders in nurturing socioemotional relationships with their subordinates (Peng, et al., 2017); • Programs that help employees establish meaningful connections, especially new ones (Lam & Lau, 2012); • Counseling for lonely employees (Firoz & Chaudhary, 2022); and • Having employee resource groups that can help individuals from historically marginalized groups connect with other workers (Welbourne et al., 2017). The COVID-19 pandemic has intensified the challenges of workplace loneliness as more employees have adopted remote or hybrid work models (Bick et al., 2023; Wax et al., 2022). Although flexibility in work location has benefits, it may restrict employees’ social interaction. Initiatives can, therefore, foster social support and connections among colleagues outside the workplace and ensure equal opportunities for 11 See https://camdenhealth.org. JULY 2024 | 6 

informal social interaction for remote and in-office employees (Harkiolakis & Komodromos, 2023; Holt- Lunstad, 2018). Additionally, workplace policies that support paid family leave can help employees balance work and family life, reducing stress and loneliness experienced. For schoolchildren, existing school infrastructure can provide structured activities that promote social engagement. Studies have shown that training in social skills through structured after-school activities can significantly reduce feelings of isolation and improve social competence (Durlak et al., 2011; Ose et al., 2023; Vandell et al., 2010). Other programs focused on children have included mindfulness interventions to improve social-relationship processes and emotional regulation (Creswell & Lindsay, 2014; Lindsay et al., 2019). One study demonstrated the efficacy of a 2-week smartphone-based mindfulness training in reducing loneliness and increasing social contact in daily life (Lindsay et al., 2019). Other examples include the Beyond Differences program, which focuses on middle school learners, and programs designed to reduce social isolation in schools through national programs such as Know Your Classmates, No One Eats Alone, and Be Kind Online. 12 COMMUNITY LEADERSHIP Summary of Community Leadership Strategies Age Group Setting Approach Strategy Example All Ages Community Promote social Codesign Partnering with the connectedness community spaces community to design inclusive public spaces that meet their specific needs (Benz et al., 2024). Promote social Empower Support grassroots connectedness communities to organizations that address local issues address local issues, fostering a sense of responsibility (Smith et al., 2023). All Ages Community Promote social Forge inclusive, Create coalitions connectedness action-oriented that include coalitions representatives from different age groups to unify communities for a common purpose (Smith et al., 2023). 12 See https://www.beyonddifferences.org. JULY 2024 | 7 

Reduce loneliness Support The U.S. Coalition and social isolation comprehensive to End Social strategies to Isolation and address social Loneliness (CESIL) isolation and actively engages in loneliness policy advocacy, such as the "National Strategy for Social Connection Act" (Senate Bill S.2448, 2023). Reduce loneliness Promote Intergenerational intergenerational programs, such as programs those run by Generations United, foster relationships between younger and older community members, reducing loneliness and building community bonds (Generations United, 2021). Research shows that codesign, which involves partnering with the community to imagine, create, and operationalize services, can enhance social connection and well-being (Benz et al., 2024; Emery-Tiburcio et al., 2021). Empowering communities can build shared ownership and facilitate community empowerment and collective responsibility for communal well-being. Ensuring that the needs of community members are met requires community-level solutions that recognize the culture, interests, and resources of communities (Smith et al., 2023). Investing in inclusive practices and community-led solutions is important and can be accomplished by supporting initiatives driven by community needs and perspectives. One way of enhancing the community’s power is through inclusive, action-oriented strategic alliances that include community-level coalitions; faith-based or culturally based organizations; action alliances; and task forces that include representatives from different age groups, which can unify communities for a common purpose (Smith et al., 2023). These multiorganization cross-sector entities can raise awareness, create common nomenclature, adopt uniform screening, strengthen referrals, and leverage funding to improve social connectedness (Smith et al., 2023). Examples of successful models include the U.S. Coalition to End Social Isolation and Loneliness (CESIL). 13 The coalition, which employs a comprehensive strategy and active engagement in policy advocacy, public awareness, and research, has made significant strides in addressing these issues. Notable initiatives include funding numerous research studies and playing a key advocacy role in introducing Senator Chris Murphy's National Strategy for Social Connection Act (2023), which aims to develop a comprehensive strategy for addressing social isolation in the United States. Other examples of such coalitions include Generation United, a program that fosters relationships between younger and older community members, thereby reducing loneliness and building community bonds (Generations United, 2021). 13 See https://www.endsocialisolation.org. JULY 2024 | 8 

DIGITAL ENVIRONMENTS Summary of Digital Environment Strategies Age Group Setting Approach Strategy Example Older Adults Home/Community Promote social Provide online The Covia Well connectedness platforms for Connected support and social Program offers interaction virtual connections through phone and online activities (Mather LifeWays Institute on Aging, 2018). Promote social Use social media Be Me app connectedness apps to enhance combines social social networking with connectedness mental health resources for teens, reducing stigma and increasing support. Youth/Young Home/Community Promote social Utilize mobile Illinois' Call4Calm Adults/Adults connectedness devices to access and New York's information, Emotional Support resources, and Line provided services social connection and support during the COVID-19 pandemic. Reduce social Facilitate virtual The PEERS isolation events to engage Program offers and connect structured group participants sessions and virtual events tailored to participants' needs, reducing social isolation (Laugeson, 2017). All Ages Community/Technology Promote social Provide digital Programs like connectedness literacy training AARP Foundation’s Senior Planet provide digital literacy training for older adults, helping them navigate online platforms and stay connected (AARP Foundation, n.d.). Community/Technology Promote social Create virtual Virtual community connectedness community centers centers, like the Fairfax County Virtual Center for Active Adults offer classes, social JULY 2024 | 9 

groups, and activities online to keep older adults engaged (Fairfax County, n.d.). Adults Home/Community Reduce social Host virtual peer Platforms like 7 isolation support groups Cups provide online peer support and counseling, reducing feelings of isolation and offering emotional support (Baumel & Schueller, 2016). All Ages Home/Community Reduce loneliness Implement Telehealth telehealth services services enable remote access to mental health professionals, providing counseling and support to those experiencing loneliness (Howe et al., 2023). Digital interventions, including online support groups and positive social media interactions, can effectively promote social connectedness, particularly for those with mobility or accessibility issues. However, digital interventions are also fraught with risks that require attention, so these interventions need to be evidence-based. For example, the COVID-19 pandemic saw increased telehealth services, which helped reach at-risk older adults (Howe et al., 2023; Magid et al., 2024). Research has also found that access to mobile phones or computers is linked to a reduced likelihood of social isolation among older adults living in the community (Umoh et al., 2023). However, even among those who can utilize digital resources, research has shown that people may prefer in-person over virtual connections (Cacioppo & Cacioppo, 2014). Accordingly, digital tools can be used as complements rather than replacements for in-person connections. Social media applications could enhance older people’s social connectedness, especially for those with limited resources. Wu (2020, p. 2) documents the importance of mobile technologies, reporting that “92% of the Chinese American older adults with low income and education had a smart device, and 72% of them used WeChat, the most commonly used social media software application in the Chinese population.” Yet, while the number of older adults without internet access or digital literacy is declining, this remains a significant barrier for many (Finkelstein et al., 2023). Programs such as the AARP Foundation’s Senior Planet have been helping to bridge the gap by providing training and support tailored to older adults (AARP, n.d.). Other programs target adults with access. An example is the Library Lanes Virtual Bowling League in Brooklyn, operated by the Brooklyn Public Library, 14 which aims to promote social connectedness through physical activity and social interactions by hosting virtual bowling games (Klinenberg, 2018). Another example is virtual community centers, such as those operated by the Fairfax 14 See https://www.bklynlibrary.org/calendar/library-lanes-older-central-library-info-20190314. JULY 2024 | 10 

County Neighborhood and Community Services, which offer classes, social groups, and activities online to keep older adults engaged (Fairfax County, n.d.). For youth, social media apps such as Be Me, a mental health application designed for teens that combines social networking with access to mental health resources, have been shown to reduce stigma and increase social support. The Trevor Project, 15 which provides crisis intervention and suicide prevention services for LGBTQ+ youth and offers social networking to help youth connect with others. The PEERS Program for social isolation leverages the power of technology to facilitate social interaction by bridging the gaps created by physical distance. 16 The program targets preschoolers, adolescents, and young adults and includes activities like support groups and virtual events that match participants' interests and needs (Laugeson, 2017). The PEERS Program uses a community-driven platform that unites people and provides safe and inclusive spaces, allowing people to meet as they build relationships (Laugeson, 2017). It uses structured group sessions in which participants are taught different skills, including initiating conversations, active listening, conflict resolution, and cooperation using practical exercises, role-playing, and feedback (Laugeson, 2017). Reviews have shown that the program successfully enhanced social connectedness (Honan et al., 2023). Mobile technologies are important because they allow people to find information, access resources, deliver services, and connect with others. During the COVID-19 pandemic, for example, Illinois (Call4Calm) 17 and New York (Emotional Support Line) 18 provided social connection and support for any residents having emotional and mental issues, including anxiety and grief. The Covia Well Connected Program 19 provides virtual connections for older adults through phone and online activities. An evaluation conducted by the Mather LifeWays Institute on Aging found that participants in the Covia program experienced decreased loneliness, improved mental health, and greater overall well-being (Mather LifeWays Institute on Aging, 2018). California created the Neighbor-to-Neighbor Campaign, 20 encouraging residents to connect with others using the Nextdoor website or application (National Governors Association, 2020). Residents can safely check in on their neighbors, including older adults at risk of being socially isolated (National Governors Association, 2020). Other examples include platforms such as 7 Cups, which provides online peer support and counseling, reducing feelings of isolation and offering emotional support for adults (Baumel & Schueller, 2016). Given that the digital environment often depends on the internet’s infrastructure, devising strategies for expanding the coverage of affordable internet access for all people is crucial. Subsidizing internet services and providing low-cost internet access in public spaces such as community centers and libraries could enhance virtual connectivity. At the same time, it is important to acknowledge and address the potential barriers to technology access and digital literacy, particularly among older adults and socioeconomically disadvantaged populations (Sen et al., 2022). Digital interactions entail risks that need to be weighed, including concerns about privacy, identity theft, cyberbullying, and lack of security that may be specific to social media (Fingerman et al., 2020). Admittedly, there have been ongoing debates on the positive and negative effects of the use of digital technology on social connectedness, particularly among youth, and it is important to emphasize 15 See https://www.thetrevorproject.org/. 16 See https://www.semel.ucla.edu/peers. 17 See https://namiillinois.org/call4calm-emotional-support-line. 18 See https://nyprojecthope.org. 19 See https://frontporch.net. 20 See https://www.californiavolunteers.ca.gov/neighbor-to-neighbor-interest. JULY 2024 | 11 

the healthy use of digital technology and avoidance of excessive screen time (Allen et al., 2014; Pandya & Lodha, 2021). Current congressional debates on social media safety include the Kids Online Safety Act (2023), which aims to hold social media platforms accountable for the mental health impacts on young users. Studies on social media and social relationships have been mixed, with some suggesting that social media reduces loneliness and distress (Cauberghe et al., 2021; Thomas et al., 2020). On the other hand, poorer mental health outcomes and higher levels of loneliness have been linked to high levels of social media use (Bonsaksen et al., 2021; Helm et al., 2022). The key takeaway is that while in-person social engagement should not be compromised by excessive social media use, digital interventions can enhance social connectedness, especially when face-to-face interactions are hindered by such factors as lack of transportation or a pandemic. SOCIAL INFRASTRUCTURE Summary of Social Infrastructure Strategies Age Group Setting Approach Strategy Example All Ages Community Promote social Develop mixed-use Urban planning connectedness neighborhoods with strategies accessible prioritizing diverse amenities like neighborhood walkable streets amenities reduce and green spaces loneliness (Lyu & Forsyth, 2022). Promote social Design and The High Line Park connectedness maintain inclusive in New York offers community places green space for and spaces walking, socializing, and cultural events, enhancing social connectedness (Friends of the High Line, 2017). Older Adults Community Promote social Facilitate The N4 Connect connectedness community program in Nevada connections provides through accessible transportation transportation options for older services adults and people with disabilities, mitigating social isolation (Lyu & Forsyth, 2024). Promote social Promote social Community gardens connectedness interaction through provide a space for community gardens social engagement and intergenerational activities (Smith et al., 2023). JULY 2024 | 12 

All Ages Community Promote social Implement age- Age-Friendly NYC connectedness friendly community includes measures initiatives such as improving public transportation, housing accessibility, and community centers, enhancing social participation among older adults (New York City Department for the Aging, 2017). Promote social Establish multi-use Multi-use connectedness community centers community centers in cities like Seattle offer spaces for educational programs, recreational activities, and social services, fostering a sense of community and belonging (Reed & Bohr, 2021). All Ages Community/Technology Promote social Support digital The Covia Well connectedness inclusion programs Connected program offers virtual connections through phone and online activities, enhancing social connectedness among older adults by helping them stay connected digitally (Mather LifeWays Institute on Aging, 2018). A growing body of research shows the importance of local environments in shaping individual- and population-level outcomes, including by promoting social well-being and increasing social connectedness (Klinenberg, 2018; Latham & Layton, 2019; Reed & Bohr, 2021). For example, the availability of diverse neighborhood amenities is associated with lower levels of loneliness (Bower et al., 2023; Lyu & Forsyth, 2022). A rich variety of nearby destinations, encompassing public and commercial offerings such as libraries, parks, shops, cafes, and restaurants, fosters social connections (Lyu & Forsyth, 2022). Thus, urban planning strategies that prioritize mixed land use, facilitating the proximity and accessibility of these amenities, have a key role in promoting social connections. Mixed-use neighborhoods with accessible amenities and public transportation can enhance opportunities for spontaneous social interactions and community engagement (Lyu & Forsyth, 2022). How public spaces are designed, maintained, and activated can determine their level of inclusivity. Making community places and spaces inclusive can promote social connectedness by increasing mobility JULY 2024 | 13 

and connectivity, particularly for older adults with impairments, individuals from socially disadvantaged backgrounds, and those in rural areas (Reed & Bohr, 2021; Smith et al., 2023). These spaces include libraries, public parks, public transportation, community gardens, and community centers (Foundation for Social Connection, 2024; Smith et al., 2023). Restorative environment theory suggests that places that promote feelings of soft fascination, 21 curiosity, and being away from everyday life can make people feel socially connected (Pasini et al., 2021). The High Line Park 22 in New York improves social connectedness by offering green space for walking, socializing, and cultural events. A report on the park highlights increased foot traffic, improved mental well-being of visitors, and enhanced community engagement for all age groups (Friends of the High Line, 2017). Creating accessible environments also includes prioritizing transportation systems that facilitate community connections. These systems include walking, cycling, and public transport infrastructure, complemented by special transportation services. The availability of these systems is important for populations with lower mobility, such as older adults and persons with disabilities, across sociodemographic characteristics, including rurality, gender, age, income, disability status, and ethnicity. Research shows that accessibility, affordability, awareness of the existence of transportation options and how to use them, and flexibility of transportation services all shape how people experience these services (Cochran, 2020; Kotwal et al., 2021). Providing nearby transit stops, pedestrian- and cyclist-friendly environments, and rural and specialized transportation services could help mitigate social isolation and loneliness (Lyu & Forsyth, 2022). The N4 Connect program 23 in Nevada, for example, has provided older adults and people with disabilities with transportation options, including Lyft rides and vouchers. The program estimates 200 total rides a month among eligible riders. In the future, these programs could collect metrics from riders related to social needs. As autonomous vehicle (AV) technology advances, AV shuttle bus services could offer convenient door-to-door transportation to meet the social needs of older adults and those with disabilities (Lyu & Forsyth, 2024). COMPREHENSIVE POLICY INITIATIVES Summary of Comprehensive Policy Initiatives Age Group Setting Approach Strategy Example All Ages Community/Policy Promote social Develop and The National connectedness implement policies Strategy for Social to enhance social Connection Act connections proposes creating an Office of Social Connection Policy to promote social connectivity (Senate Bill S.2448, 2023). 21 The concept of soft fascination refers to the gentle engagement of the mind in natural environments, which can help restore cognitive function and reduce mental fatigue (Berman et al., 2008). 22 See https://www.thehighline.org. 23 See https://neighbornv.org/what-we-do/n4-transportation/n4-lyft. JULY 2024 | 14 

Promote social Implement state- Age-Friendly NYC connectedness level initiatives to includes support social improvements in programs and public community transportation, engagement housing accessibility, and community centers, increasing social participation among older adults (NYC Department for the Aging, 2017). Reduce social Standardize data The Gravity Project isolation collection and develops sharing to improve consensus-based service delivery and data standards to policy making integrate social determinants of health into clinical care (Gravity Project, n.d.). Reduce loneliness Provide ongoing The AARP Make funding for Room Campaign community and raises awareness social programs to about loneliness ensure sustainability and encourages social connections among older adults (AARP Foundation, n.d.). Older Adults Community/Policy Promote social Create policies to The Older connectedness support aging in Americans Act place with provides funding for community services that help resources and older adults remain services in their homes and communities, such as meal delivery, transportation, and caregiver support (Older Americans Act of 1965, as amended, 2020). All Ages Community/Policy Promote social Promote workplace The Healthy connectedness policies that support Workplaces, social interaction Healthy Families Act and mental health requires employers to provide paid sick leave, which can reduce stress and improve overall well- being, indirectly addressing social isolation (Healthy Workplace Healthy Family Act, 2014). JULY 2024 | 15 

Children and Youth Community/Policy Promote social Implement school- Minnesota's Safe connectedness based programs to and Supportive promote social skills Schools Act focuses and peer on creating a interactions positive school climate to enhance student engagement and reduce bullying, promoting better social connections among students (Safe and Supportive Schools Act, 2023). All Ages Community/Policy Promote social Support funding for The Fixing connectedness public transportation America's Surface to enhance Transportation community (FAST) Act provides connectivity funding for public transportation infrastructure, which can improve accessibility and reduce isolation (Federal Transit Administration, n.d.). State leaders can consider legislation and policies that define loneliness and social isolation, communicate its adverse effects, and implement a portfolio of approaches to enhance social connections. Leveraging this opportunity can involve employing a “systems approach to reduce societal silos, unify communities, and promote social connectedness” (Smith et al., 2023, p. 2). Establishing policies that provide ongoing support for community and social programs can mitigate the tendency for interventions to fail because of a lack of sustained investments. Policy initiatives can include actions by decision makers to recognize and draw attention to social isolation and loneliness. Examples at the federal level include the resolution introduced in Congress by U.S. Congressman Mike Flood (2023), which recognizes that feelings of loneliness or isolation affect Americans of all ages and supports continued research into efforts to combat loneliness and isolation. As mentioned previously, Senator Chris Murphy has also proposed the National Strategy for Social Connection Act (2023), which entails creating an Office of Social Connection Policy that would develop and coordinate federal strategies for promoting social connectivity and coordinating federal agencies to combat the structural causes of loneliness. Similar legislative efforts in states and cities could bring resources and awareness. An example of a comprehensive policy initiative implemented for older adults with impacts across the lifespan is Age-Friendly NYC, 24 a citywide effort to make New York City more inclusive and accessible for older adults through policy changes and investments in infrastructure. The initiative encompasses improved public transportation, housing accessibility, public safety measures, and community centers, as well as social support programs to increase engagement among older adults. The initiative has improved intergenerational social interactions (New York City Department for the Aging, 2017). An evaluation of the initiative by the New York Academy of Medicine highlights significant improvements in accessibility, social participation, and community support for older adults (The New York Academy of Medicine, 2015). 24 See https://www.health.ny.gov/health_care/age-friendly_health_system. JULY 2024 | 16 

Policies that support funding for public transportation, such as Age-Friendly NYC, can benefit all age groups and address social isolation by removing barriers to connection. At the federal level, the Fixing America’s Surface Transportation (FAST) Act (2015) provides funding for improving public transportation (Federal Transit Administration, n.d.). Similar policies across state and local jurisdictions could reduce social isolation by improving accessibility and promoting social connection, particularly for older adults, people living with disabilities, and those living in rural areas (Heaps et al., 2021). During the COVID-19 pandemic, Nevada developed the COVID-19 Aging Network Rapid Response Plan, which included a Social Support Action Team (SSAT), and the Nevada Ensures Support Together (NEST) Collaborative, which focused on increasing social support for older adults and their engagement in meaningful social interaction, as well as assessing other social and community needs. The NEST Collaborative engaged multigenerational volunteers to offer weekly social support through one-to-one phone conversations during and after the COVID-19 pandemic (Nolan et al., 2022). An evaluation of the NEST Collaborative intervention showed “promising trends in improvement for outcomes associated with social isolation in older adult participants” (Nolan et al., 2022, p. 9). Supporting such aging-in-place policies can have significant benefits for older adults, including health benefits, improved quality of life, and increased community engagement, and can be cost-effective (Owusu et al., 2023; Ratnayake et al., 2022). An example is the Older Americans Act of 1965 (as amended, 2020), which has been reauthorized several times and provides funding and support for services that help older adults remain in their homes by creating age-appropriate housing and community environments that can adapt to the changing needs of aging residents. Workplace policies are important in promoting overall well-being and enhancing social connectedness. Some useful policies include integrating social connections into workplace wellness programs, supporting flexible work hours, providing ample paid leave, and encouraging reasonable workweeks (Holt-Lunstad, 2018). The California Healthy Workplaces, Healthy Families Act (2014), a policy that provides paid sick leave, has been credited with reducing stress and improving overall well-being (California Department of Industrial Relations, n.d.). School-based policies can create a positive school climate for children and youth and promote better social connections. An example is the Minnesota Safe and Supportive Schools Act (2014), which has promoted social connections through enhanced school safety, staff training, and inclusive policies for students from diverse backgrounds, including LGBTQ+ individuals and those living with disabilities (Minnesota Department of Education, 2020). Policy strategies also can contribute to a comprehensive approach to the issues of social isolation and loneliness by focusing on data. The Gravity Project, for example, develops consensus-driven data standards and harmonizes terminology and medical codes 25 (Council of State Governments, 2021). More specifically, the Gravity Project activities include three workstreams: (1) terminology, which involves creating vocabulary and definitions for social factors that can be applied across various health-related fields; (2) technical, which addresses documenting and exchanging data on social determinants of health within the digital system; and (3) pilots, which tests the created terminologies and guides (Gravity Project, n.d.) The project has successfully established standard codes for various domains of the social determinants of health, such as housing instability, food insecurity, and transportation needs, which are now recognized by major health information technology standards organizations (American Medical Association, 2023). 25 See https://thegravityproject.net. JULY 2024 | 17 

One application of these data sets is mapping geographic areas, such as creating a “loneliness heat map” (Freedman & Nicolle, 2020, p.178). This approach can help increase the reach of local agencies to individuals at risk of social isolation, loneliness, and other challenges (Cann, 2023). An example of this mapping is the AARP Foundation’s Connect2Affect, which shows the geography of social isolation in older adults by county. 26 Funding initiatives focused on preventing social isolation through proactive public health strategies can also promote social connection and well-being. The AARP Make Room Campaign aims to raise awareness about the impact of loneliness on health and encourage social connections among older adults (AARP & National Building Museum, n.d.). It also aims to assist local leaders in adapting to the diverse and ever-changing housing needs of people of all ages. RESEARCH OPPORTUNITIES AND LIMITATIONS While this document focuses on the COVID-19 pandemic, the identified impacts on social isolation and loneliness can be anticipated in other public health emergencies, such as natural disasters, pandemics, or widespread economic crises. These events often disrupt social networks, create barriers to social interaction, and increase stress and anxiety, leading to similar outcomes. The strategies recommended herein, such as enhancing community infrastructures, promoting digital inclusion, and improving community support, apply broadly to various public health emergencies. These strategies, which aim to strengthen social support networks and community resilience, are critical in any crisis. To enhance social connectivity and well-being effectively, strategies need to be supported by evidence. In the National Academies’ 2020 report Social Isolation and Loneliness in Older Adults, a review of large- scale interventions to address social isolation and loneliness in older adults reveals that the evidence supporting their effectiveness is often of poor quality. The report highlights several weaknesses, including insufficient long-term follow-up, inconsistent definitions and distinctions between social isolation and loneliness, varied measurement tools and outcomes, small sample sizes, and a narrow age range of participants considered “older adults” (NASEM, 2020). The report notes further that persistent challenges, including the limited number of studies available to quantify the interventions’ impact, variability in the concepts measured, and difficulty recruiting people who are extremely and/or chronically isolated or lonely, make the interventions more difficult to evaluate. The “translation of evidence from socialization projects into practice is complicated by the lack of studies assessing the implementation and scalability” of programs delivered by community-based organizations (Jiménez et al., 2021, p. 3). The National Academies report notes that successful interventions often had key features in common, including: • active participation among older adults, • an educational focus, and • a group-based rather than individual-based approach (NASEM, 2020). Identifying and filling research gaps related to social isolation and loneliness can potentially enhance community services and support focused on these issues. As noted, although social isolation and loneliness affect people across the lifespan, research has focused primarily on older adults. As a result, there is a stronger evidence base to develop and evaluate interventions for this group relative to others, 26 See https://connect2affect.org/map. JULY 2024 | 18 

even as researchers and providers still call for recommendations on best practices. There is a need to reframe how social isolation and loneliness are conceptualized, measured, addressed, and evaluated, including by considering for whom social isolation and loneliness may be lifelong conditions versus conditions due to specific, episodic life events among different age groups (O’Sullivan et al., 2021). Accordingly, a common nomenclature for use across sectors is needed to foster shared understanding, facilitate efficiency, and encourage collaboration (Fortune et al., 2021; Pomeroy, Mehrabi et al., 2023; Smith et al., 2023). A common nomenclature would involve standardized definitions and terms related to social connection, isolation, and loneliness to ensure consistency and clarity in research and policy discussions. CONCLUSION The increase in social isolation and loneliness due to the COVID-19 pandemic could be addressed through a range of strategies focused on education for professionals and general public awareness, direct community interaction, technological innovations, and support systems. Also effective are strategies designed to enhance individual and collective well-being while creating and maintaining physical and systemic structures that foster social connectedness and community development. Promoting social connectedness and reducing social isolation and loneliness at the structural, community, and individual levels reflects these issues' multifaceted and complex nature. Proactive policymaking that defines social isolation and loneliness, communicates their impacts, and invests in community programs can sustain ongoing efforts. SEAN is interested in your feedback. Was this rapid expert consultation useful? Send comments to sean@nas.edu or (202) 334-3440. JULY 2024 | 19