Travel Health Knowledge, Attitudes and Practices among United States Travelers


  • Davidson H. Hamer,

    Corresponding author
    1. Davidson H. Hamer, MD FACP: Associate Professor of Medicine, Tufts University School of Medicine; Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center; Center for International Health and Development, Boston University School of Public Health, Boston, MA
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  • Bradley A. Connor

    1. Bradley A. Connor, MD: The New York Center for Travel and Tropical Medicine, New York, NY; Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, New York, NY.
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  • A portion of this study was presented at the 8th Conference of the International Society of Travel Medicine, New York, NY, May 2003.

  • Glaxo-Smith Kline provided an unrestricted grant to cover the expenses associated with carrying out the study.

Reprint requests: Davidson H. Hamer, MD, FACP, Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, 750 Washington St, Boston, MA 02111.


Background Large numbers of United States residents travel each year to countries where malaria, hepatitis A, hepatitis B and other vaccine-preventable diseases are prevalent. However, relatively little is known about how United States travelers perceive risks associated with travel or how they prepare for their international voyages. This airport survey was therefore performed to determine the travel health knowledge, attitudes and practices (KAP) of United States travelers.

Methods Questionnaires were administered to international travelers, aged 18 years or more, departing from the John F. Kennedy International Airport in New York who were going to destinations that were high risk for malaria or hepatitis A.

Results Overall, 404 questionnaires were completed, including 203 focused on malaria and 201 on vaccine-preventable diseases. Latin America and Asia were the most common destinations. Only 36% of travelers sought travel health advice, despite the fact that more than half prepared their trip at least a month in advance. Only 17% of travelers considered themselves at high risk for hepatitis A. Although the majority of travelers (73%) to a high-risk malaria-endemic region perceived malaria as a high health risk, only 46% of them were carrying antimalarial medications. Additionally, although the majority of travelers believed that vaccines were effective for prevention, few were vaccinated for their journey: 11% for tetanus, 14% for hepatitis A, 13% for hepatitis B, and 5% for yellow fever.

Discussion This airport survey demonstrated important shortcomings in the travel health KAP of international travelers. A substantial proportion of the travelers were not adequately protected against malaria, hepatitis A or hepatitis B. Future efforts need to focus on improving the level of awareness of travelers regarding their risk of disease acquisition overseas and the importance of pretravel education, immunizations, and malaria chemoprophylaxis.