Social Network Index
Instructions: This questionnaire is concerned with how many people you see or talk to on a regular basis including family, friends, workmates, neighbors, etc. Please read and answer each question carefully. Answer follow-up questions where appropriate.
- Which of the following best describes your marital status?
____ (1) currently married & living together, or living with someone in marital-like relationship
____ (2) never married & never lived with someone in a marital-like relationship
____ (3) separated
____ (4) divorced or formerly lived with someone in a marital-like relationship
____ (5) widowed
- How many children do you have? (If you don't have any children, check '0' and skip to question 3.)
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
2a. How many of your children do you see or talk to on the phone
at least once every 2 weeks?
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
- Are either of your parents living? (If neither is living, check '0' and skip to question 4.)
____ (0) neither ____ (1) mother only ____ (2) father only ____ (3) both
3a. Do you see or talk on the phone to either of your parents at least once every 2 weeks?
____ (0) neither ____ (1) mother only ____ (2) father only ____ (3) both
- Are either of your in-laws (or partner's parents) living? (If you have none, check the appropriate space and skip to question 5.)
____ (0) neither ____ (1) mother ____ (2) father ____ (3) both ____ (4) not
only only applicable
4a. Do you see or talk on the phone to either of your partner's parents
at least once every 2 weeks?
_____ (0) neither _____ (1) mother _____ (2) father ____ (3) both
only only
- How many other relatives (other than your spouse, parents & children) do you feel close to? (If '0', check that space and skip to question 6.)
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
5a. How many of these relatives do you see or talk to on the phone
at least once every 2 weeks?
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
- How many close friends do you have? (meaning people that you feel at ease with, can talk to about private matters, and can call on for help)
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
6a. How many of these friends do you see or talk to at least once every 2 weeks?
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
- Do you belong to a church, temple, or other religious group? (If not, check 'no' and skip to question 8.)
_____ no _____ yes
7a. How many members of your church or religious group do you talk to
at least once every 2 weeks? (This includes at group meetings and services.)
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
- Do you attend any classes (school, university, technical training, or adult education) on a regular basis? (If not, check 'no' and skip to question 9.)
_____ no _____ yes
8a. How many fellow students or teachers do you talk to at least
once every 2 weeks? (This includes at class meetings.)
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
- Are you currently employed either full or part-time? (If not, check 'no' and skip to question 10.)
____ (0) no _____ (1) yes, self-employed _____ (2) yes, employed by others
9a. How many people do you supervise?
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
9b. How many people at work (other than those you supervise)
do you talk to at least once every 2 weeks?
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
- How many of your neighbors do you visit or talk to at least once every 2 weeks?
_____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
- Are you currently involved in regular volunteer work? (If not, check 'no' and skip to question 12.)
_____ no _____ yes
11a. How many people involved in this volunteer work do you talk to about
volunteering-related issues at least once every 2 weeks?
____0 ____1 ____2 ____3 ____4 ____5 ____6 ____7 or more
- Do you belong to any groups in which you talk to one or more members of the group about group-related issues at least once every 2 weeks? Examples include social clubs, recreational groups, trade unions, commercial groups, professional organizations, groups concerned with children like the PTA or Boy Scouts, groups concerned with community service, etc. (If you don't belong to any such groups, check 'no' and skip the section below.)
_____ no _____ yes
Consider those groups in which you talk to a fellow group member at least once every 2 weeks. Please provide the following information for each such group: the name or type of group and the total number of members in that group that you talk to at least once every 2 weeks.
Total number of group members
Group that you talk to at least once every 2 weeks
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This scale was used for the following journal article:
Cohen, S., Doyle, W. J., Skoner, D. P., Rabin, B. S., & Gwaltney, J. M. Jr. (1997). Social ties and susceptibility to the common cold. Journal of the American Medical Association, 277, 1940-1944. Link to full-text (pdf)