title: Attitudes and behaviors of international air travelers toward pandemic influenza.
abstract: BACKGROUND
  Air travelers play a significant role in the spread of novel strains of influenza viruses; however, little is understood about the knowledge, attitudes, and practices of international air travelers toward pandemic influenza in relation to public health interventions and personal protective behaviors at overseas destinations.
  
  
  METHODS
  Prior to the 2009 H1N1 influenza pandemic, we surveyed a convenience sample of 404 departing international travelers at Detroit Metropolitan Wayne County Airport. Presented with a hypothetical pandemic influenza scenario occurring overseas, the participants predicted their anticipated protective behaviors while abroad and recorded their attitudes toward potential screening measures at US ports of entry (POE). The survey also qualitatively explored factors that would influence compliance with health entry screening at POE.
  
  
  RESULTS
  Those who perceived pandemic influenza to be serious were more likely to state that they would be comfortable with screening (p = 0.006), and if they had influenza-like illness (ILI) overseas, would be more willing to see a physician and delay return travel (p = 0.006 and 0.002, respectively). Other demographic variables, including age and race, were associated with protective behaviors in response to ILI. Travelers also identified diverse information requirements which would influence their behavior in response to entry screening, including characteristics of the pandemic, severity of illness, and screening operations.
  
  
  CONCLUSIONS
  Demographic characteristics and perceived severity of illness are important factors that may influence the protective behaviors of travelers overseas. Our results indicate that educational material and advice directed to international travelers could be differentially tailored to traveler subpopulations.
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA. sharangpanir@michigan.gov
authors.forename: Ruta
authors.initials: R
authors.lastname: Sharangpani
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Boulton
authors.forename: Eden
authors.initials: E
authors.lastname: Wells
authors.forename: Curi
authors.initials: C
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000517:prevention & control* / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D058873:Pandemics; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D014195:Travel; D055815:Young Adult