BUFFALO, N.Y. -- When a serious threat of a flu epidemic arises,
public health officials advise persons to stay away from crowds
and, as importantly, avoid shaking hands.
But a Viewpoint
piece in the current issue of Public Health Reports, authored
by University at Buffalo public health faculty members, illustrates
that, in certain situations, social pressures make such
The setting in question was the 2009 commencement ceremony for
UB's School of Public Health and Health Professions. As pointed out
in the Viewpoint article, concern was growing at that time about
the seriousness of the then-novel H1N1 virus.
Before presenting the diplomas, Lynn T. Kozlowski, PhD, dean of
the school, announced from the stage that, given the potential of
spreading the virus, shaking hands when receiving a diploma was
optional. A doff of the cap would be a suitable substitute sign of
"The results of the handshaking-optional announcement were
striking," says Kozlowski. "All 200 graduates shook hands without
It was clear that the brief ceremonial encounter involving a
handshake and a few congratulatory words was important to the
graduates. "I felt that we were caught up in a moment of great
significance and emotional importance that overshadowed the
then-existing health concern about the flu," says Kozlowski.
The authors -- UB public health faculty members Marc Kiviniemi,
PhD, and Pavani Ram, MD, in addition to Kozlowski -- comment in the
article that graduation is an important rite of passage and
graduates did not consider passing on the handshake a genuine
"The behavior of individuals in social settings is based on a
complex web of social and environmental forces that guide
individuals toward or away from certain behaviors in certain
situations," they write.
"A graduation is a socially significant gathering and a ritually
charged ceremony, marking a personally and socially important
transition. Handshaking is part of the dramatic scripting of the
graduation ceremony, and is expected of those who take part."
Kozlowski says that seeing the first graduate shake hands may
have put pressure on the second graduate, and the third graduate,
and so on, to do the same.
He notes that when public health officials have serious concerns
about disease transmission, they need to issue a mandate, or
outright ban, on handshaking or other behaviors, rather than
The authors report that at the same time as the UB graduation in
2009, the Indiana state health commissioner explicitly recommended
in a press conference that "Indiana stop shaking hands." As a
result, several Indiana universities announced that no handshaking
would take place at graduation. Everyone adhered to the ban.
"The take home message," says Kozlowski, "is 'Beware the power
of social demands.' Preventing disease transmission by social
distancing may be easier said than done.
"We recommend that communications aimed at preventing infectious
disease transmission in public gatherings provide guidance that is
both socially and behaviorally practical, even though those
practical steps may require more extreme measures, such as banning
handshaking or canceling events, if preventing disease transmission
is to be truly effective."
The University at Buffalo is a premier research-intensive
public university, a flagship institution in the State University
of New York system and its largest and most comprehensive campus.
UB's more than 28,000 students pursue their academic interests
through more than 300 undergraduate, graduate and professional
degree programs. Founded in 1846, the University at Buffalo is a
member of the Association of American Universities.