Intended Mosquito Avoidance Practices International Travel Behavior Model for Dengue Prevention in US Travelers

BACKGROUND: Imported Dengue to non-endemic regions presents an unwelcome opportunity for Dengue establishment.  Little is understood on transmissibility, vector density, thresholds and climactic impact in temperate zones like the United States. Travel recommendations for US travelers to Dengue endemic regions include the use of mosquito avoidance practices (MAP). To understand risk of Dengue establishment in the US, it is important to conduct research on travel behavior and significant factors that influence compliance with MAP, particularly in high-risk populations such as visiting friends and relatives (VFR) travelers and repeat travelers.

METHODS: A pre-travel behavioral assessment survey on MAP was developed and tested in travelers to the cultural celebration of Carnival in the Republic of Trinidad and Tobago in 2012. The survey used an adaptation of the Precaution-Adoption Process Model (PAPM) to identify stages of awareness to compliance with MAP for Dengue prevention. Data was collected using snowball sampling through social media. An exploratory factor analysis established construct validity and revealed a tentative intended MAP international travel behavior model (IMAP-ITB).  Field observations of comparative population samples were conducted as a complete participant/participant observer with travel groups to Brazil and Thailand. Field notes were collected for qualitative analysis to inform the tentative IMAP-ITB model.

RESULTS: The survey can identify PAPM-Dengue stage of the traveler to determine behavioral risk of Dengue acquisition. The IMAP-ITB model revealed cultural embededdness, risk distractions, type of travel and experiences as constructs associated with intended MAP. Field observations revealed social interactions as influential on actual MAP, insect repellent use was considered a personal responsibility for travelers, repeat travelers had lower risk perception for travel-associated illnesses, and social/physical environment directly influenced MAP based on cultural embededdness, risk perception and perceived severity in the travel destination.  

CONCLUSIONS: Social and physical environmental factors play an important role on intended and actual MAP. More research is needed to understand differences in travel experiences and the role of environment on actual travel behavior.