By Jamie Ducharme
May 1, 2018

America’s next big public health issue may be loneliness, which a new study finds affects most Americans. But the group most at risk isn’t the oldest generation — it’s one of the youngest.

The research, conducted by health insurer Cigna and the market research firm Ipsos, found that young people ages 18 to 22 are the most likely to be lonely. Loneliness is a major threat to Americans’ mental, physical and emotional well-being and can have huge consequences for public health, given the well-researched connections between loneliness and health issues ranging from substance abuse to heart disease.

“The biggest takeaway is that most Americans are considered lonely. This is an alarming statistic,” says Dr. Doug Nemecek, chief medical officer of behavioral health at Cigna. “But more importantly, if everyone who comes into contact with this data can ask themselves what they can do in their communities to affect change, that would be a really meaningful first step.”

In the study, about 20,100 U.S. adults took the UCLA Loneliness Scale, a 20-question survey that asks people how often they agree with prompts such as, “There is no one I can turn to,” and “I feel part of a group of friends.” Loneliness scores are calculated based on those responses. The study authors classified anything above a 43 as loneliness. The average score was 44, suggesting that loneliness is reaching “epidemic levels” in the U.S., according to a release accompanying the report.

Some signs of loneliness were present throughout the study group. Almost half of people said they sometimes or always feel alone or left out, 43% said they sometimes or always feel that their relationships are not meaningful and only 53% said they have meaningful in-person interactions on a daily basis.

Yet certain demographics were worse off than others. Generation Z — adults between the ages of 18 and 22 — were the loneliest generation, with an average loneliness score of 48.3; more than half of respondents of this generation identified with 10 of 11 survey prompts associated with loneliness. And while it would be easy to blame rampant social media use for this effect, the study found that the most digitally active respondents’ loneliness scores weren’t very different from those of their peers, suggesting that other factors may be at play. However, the study didn’t look at what was causing people to feel lonely.

“While we know that this is a group that’s coming of age and making life transitions, these findings give us a very real and striking picture of how this generation perceives themselves,” Nemecek says. “It’s something that we, as a society, need to explore to understand how we can address it.”

MORE: How to Make Friends as an Adult — and Why It’s Important

Retirees and older generations, meanwhile, were the least likely to be lonely, according to the study. The “Greatest Generation,” or adults older than 72, had an average loneliness score of 38.6, far lower than any other age group. “It appears that this group has found a community of people they can rely on for mental and emotional support when they need it,” Nemecek says.

And while loneliness may be a risk factor for health issues, the report also says the relationship can work both ways — that is, ailing health may also be a predictor of loneliness.

“When a person has a chronic illness or is in poor health, it can limit their ability to get out and interact with others,” Nemecek says. “But also, when someone is lonely, it can impact how they take care of themselves, how they eat, manage their medicines and stay active, which can all lead to worse health outcomes.”

However, good health may also keep loneliness at bay. In addition to common-sense ways to improve your social life — things like staying engaged in your community and prioritizing face-to-face interactions with friends and family — everyday habits such as getting enough sleep, exercising regularly and maintaining work-life balance are associated with lower loneliness scores, according to the study.

Write to Jamie Ducharme at jamie.ducharme@time.com.

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