title: Pretravel health preparation among US residents traveling to India to VFRs: importance of ethnicity in defining VFRs.
abstract: BACKGROUND
  International travelers visiting friends and relatives (VFRs) in lower income countries experience high rates of travel-related infections. We examined demographic characteristics and pretravel preparation practices among US residents traveling to India to determine factors that may contribute to higher infection rates and that would allow for improved prevention strategies.
  
  
  METHODS
  A cross-sectional study was conducted among US residents traveling to India in departure areas for flights to India at three US international airports during August 2005. Eligible travelers were US residents going to India who were English speaking and >or=18 years. Self-administered questionnaires were used to assess knowledge of and compliance with pretravel health recommendations.
  
  
  RESULTS
  Of 1,574 eligible travelers, 1,302 (83%) participated; 60% were male and the median age was 37. Eighty-five percent were of South Asian/Indian ethnicity and 76% reported VFR as the primary reason for travel. More than 90% of VFRs had at least a college education and only 6% cited financial barriers as reasons for not obtaining travel health services. VFRs were less likely than non-VFR travelers to seek pretravel health advice, to be protected against hepatitis A or typhoid fever, and less likely to be taking appropriate antimalarial chemoprophylaxis. However, when stratified by ethnicity, travelers of South Asian ethnicity were less likely than other travelers to adhere to pretravel health recommendations, regardless of VFR status.
  
  
  CONCLUSIONS
  Similar to previous studies, VFR status was associated with pretravel health practices that leave travelers at risk for important infectious diseases. This association differed by ethnicity, which may also be an important marker of nonadherence to pretravel health recommendations. These findings have important implications for identifying at-risk travelers and properly targeting prevention messages.
authors.affiliation: Division of Global Migration and Quarantine, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. hbaggett@cdc.gov
authors.forename: Henry C
authors.initials: HC
authors.lastname: Baggett
authors.forename: Susan
authors.initials: S
authors.lastname: Graham
authors.forename: Phyllis E
authors.initials: PE
authors.lastname: Kozarsky
authors.forename: Nancy
authors.initials: N
authors.lastname: Gallagher
authors.forename: Sena
authors.initials: S
authors.lastname: Blumensaadt
authors.forename: John
authors.initials: J
authors.lastname: Bateman
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Edelson
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arguin
authors.forename: Stefanie
authors.initials: S
authors.lastname: Steele
authors.forename: Michelle
authors.initials: M
authors.lastname: Russell
authors.forename: Christie
authors.initials: C
authors.lastname: Reed