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.
 
 1.  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

 2.  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
 

3.  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
 

 4. 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
5.  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
 

6. 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  

7.  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
 

8.  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
 

9.  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  

10.  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
 

11.  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
12. 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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1.

2.

3.

4.

5.

6.

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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)