title: Stress, adherence to preventive measures for reducing influenza transmission and influenza-like illness.
abstract: BACKGROUND
  Using data from a randomised intervention trial of facemask use and hand hygiene for reducing transmission of seasonal influenza among university students, we examined if levels of perceived stress were negatively associated with adherence to these preventive measures and incidence of influenza-like illness (ILI).
  
  
  METHODS
  Longitudinal analyses using generalised estimating equations were examined. Perceived stress was self-reported at baseline using a validated scale. Compliance with preventive measures was self-reported throughout the study period and reported ILI symptoms were defined as cough and one or more of fever/feverishness, chills and body aches.
  
  
  RESULTS
  Higher levels of perceived stress were not associated with facemask or hand hygiene compliance. However, perceived stress was significantly associated with a greater ILI incidence (HR1.25, 95% CI 1.07 to 1.45) even after controlling for demographic and behavioural risk factors.
  
  
  CONCLUSIONS
  Among students in the university setting, higher levels of perceived stress affect ILI symptom reporting but not compliance with preventive measures for reducing transmission of influenza. Further studies are needed to examine whether psychological stress is a key mechanism explaining socio-demographic health disparities in confirmed influenza infection among healthy persons in the community setting.
authors.affiliation: Center for Social Epidemiology & Population Health, School of Public Health-University of Michigan, Ann Arbor, Michigan 48109-2029, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Perez
authors.forename: Monica
authors.initials: M
authors.lastname: Uddin
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.forename: Arnold S
authors.initials: AS
authors.lastname: Monto
authors.forename: Allison E
authors.initials: AE
authors.lastname: Aiello
mesh_terms: D000293:Adolescent; D003140:Communicable Disease Control / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008824:Michigan; D013315:Stress, Psychological; D013334:Students / Q000523:psychology*; D016019:Survival Analysis; D014495:Universities; D055815:Young Adult