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Sheldon Cohen, PhD; William J. Doyle, PhD; David P. Skoner, MD; Bruce S. Rabin, MD, PhD; Jack M. Gwaltney, Jr, MD

JAMA. 1997;277(24):1940-1944.

Abstract
Objective.
—To examine the hypothesis that diverse ties to friends, family, work, and community are associated with increased host resistance to infection.

Design.
—After reporting the extent of participation in 12 types of social ties (eg, spouse, parent, friend, workmate, member of social group), subjects were given nasal drops containing 1 of 2 rhinoviruses and monitored for the development of a common cold.

Setting.
—Quarantine.

Participants.
—A total of 276 healthy volunteers, aged 18 to 55 years, neither seropositive for human immunodeficiency virus nor pregnant.

Outcome Measures.
—Colds (illness in the presence of a verified infection), mucus production, mucociliary clearance function, and amount of viral replication.

Results.
—In response to both viruses, those with more types of social ties were less susceptible to common colds, produced less mucus, were more effective in ciliary clearance of their nasal passages, and shed less virus. These relationships were unaltered by statistical controls for prechallenge virus-specific antibody, virus type, age, sex, season, body mass index, education, and race. Susceptibility to colds decreased in a dose-response manner with increased diversity of the social network. There was an adjusted relative risk of 4.2 comparing persons with fewest (1 to 3) to those with most (6 or more) types of social ties. Although smoking, poor sleep quality, alcohol abstinence, low dietary intake of vitamin C, elevated catecholamine levels, and being introverted were all associated with greater susceptibility to colds, they could only partially account for the relation between social network diversity and incidence of colds.

Conclusions.
—More diverse social networks were associated with greater resistance to upper respiratory illness.

Author Affiliations
From the Department of Psychology, Carnegie Mellon University, Pittsburgh, Pa (Dr Cohen); Departments of Otolaryngology (Dr Doyle) and Pediatrics (Dr Skoner), Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Pathology, University of Pittsburgh School of Medicine (Dr Rabin); and Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville (Dr Gwaltney).

Footnotes
Reprints: Sheldon Cohen, PhD, Department of Psychology, Camegie Mellon University, Pittsburgh, PA 15213 (e-mail: SCOHEN@CMU.EDU).

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