Invited Commentary: Cassel's "The Contribution of the Social Environment to Host Resistance"-A Modern Classic.

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John Cassel's 1976 paper "The Contribution of the Social Environment to Host Resistance" (Am J Epidemiol. 1976;104(2):107-123) is widely regarded as a classic in epidemiology. He makes the compelling argument that the quality of a person's social relationships, that is, the degree to which her relationships are more stressful than supportive (or vice versa) influences her susceptibility to disease independent of genetic endowment, diet, physical activity, etc. Cassel's provocative thesis was anchored in a cogent synthesis of findings from animal experiments and observational studies on diverse human populations. Beginning in the late 1970s, the paper stimulated an explosion of epidemiologic research on social support and human health. Beyond advancing epidemiologic theory, Cassel showed how findings from various epidemiologic study designs could be marshalled to build a persuasive causal argument that impaired social bonds increase the risk of premature disease and death. The paper also foreshadowed core ideas of later theoretical constructs, such as weathering and allostatic load, regarding the power of chronic environmental stressors to accelerate biological aging across multiple organ systems. Cassel's assessment of the research and practice implications of his conclusions has remarkable contemporary resonance for the field of epidemiology.





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James, Sherman A (2017). Invited Commentary: Cassel's "The Contribution of the Social Environment to Host Resistance"-A Modern Classic. Am J Epidemiol, 185(11). pp. 1032–1034. 10.1093/aje/kwx070 Retrieved from

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Sherman A. James

Susan B. King Distinguished Professor Emeritus of Public Policy

Sherman A. James is the Susan B. King Distinguished Professor Emeritus of Public Policy at the Sanford School of Public Policy, Duke University. He also held secondary professorships, at Duke, in Sociology, Community and Family Medicine, and African and African American Studies. Prior to Duke, he taught in the epidemiology departments at the University of North Carolina-Chapel Hill (1973-89) and at the University of Michigan (1989-03). At Michigan, he was the John P. Kirscht Collegiate Professor of Public Health, the Founding Director of the Center for Research on Ethnicity, Culture and Health (CRECH), Chair of the Department of Health Behavior and Health Education, and a Senior Research Scientist in the Survey Research Center at the Institute for Social Research.

Dr. James was awarded the A.B. degree (Psychology and Philosophy) in 1964 from Talladega College (AL), and the PhD degree (Psychology) in 1973 from Washington University in St. Louis. His research focuses on the social determinants of US racial, ethnic, and socioeconomic disparities in health and health care. He is the originator of the John Henryism Hypothesis which posits that repeated high-effort coping with chronic social and economic adversity rooted in structural racism is an important factor in the early onset of hypertension and related cardiovascular diseases in African Americans.

Dr. James was elected to the National Academy of Medicine (formerly the Institute of Medicine) of the National Academy of Sciences in 2000. In 2001, he received the Abraham Lilienfeld Award from the Epidemiology section of the American Public Health Association for career excellence in the teaching of epidemiology; a Health Policy Investigator Award from the Robert Wood Johnson Foundation in 2008; the John Cassel Distinguished Lecture and Award from the Society for Epidemiologic Research in 2013; the Wade Hampton Frost Award from the Epidemiology Section of the American Public Health Association for career contributions to the field of epidemiology in 2016; the Kenneth J. Rothman Career Accomplishment Award from the Society for Epidemiologic Research in 2019; and a residential fellowship at the Stanford University Center for Advanced Study in the Behavioral Sciences in 2019-2019.

Dr. James is a Fellow of the American Academy of Political and Social Science, the American Epidemiological Society, the American College of Epidemiology, the American Heart Association, and the Academy of Behavioral Medicine Research. In 2007-08, he served as president of the Society for Epidemiologic Research, the largest professional society of epidemiologists in the world. 

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