Feasibility of Obtaining Sufficient Numbers of Responses to Questions About Travel Intentions, Thereby Facilitating Effective Health Messaging

Document Type : Original Article


1 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

2 RIWI Corporation, Toronto, Canada

3 Department of Psychiatry, University of Toronto, Toronto, Canada



Introduction: The medical literature has identified a variety of health risks associated with travel. Risks depend on the susceptibility of the traveler, the specifics of the destination, the mode of transport, and on chance events. Ill-prepared travelers who underestimate travel risks may encounter a variety of health problems. In order to eventually increase the capability of travel risk prediction, the current study aimed to ascertain travel intent in China, a country traditionally difficult to penetrate through online survey.
Methods: This pilot survey study used a reliable, anonymous, online survey method to determine the feasibility of obtaining a sufficient response in China to enable travel risk prediction.
Results: The results are encouraging in that seven and a half thousand individuals in China responded over the course of one month. Most responders were from urban centers. Three to eleven percent of the respondents were over age 55 and planning to travel to potentially hazardous destinations.
Conclusion: The combination of older age and geographic risk increases the chance of ill health during travel. Knowing who is planning to travel, where they are from, and where, when, and how they are planning to arrive at their destination opens a corridor to effective preventive public health programming and educational initiatives.


  1. Mesquita EC, Varela MC, Alvarenga do Brasil PEA, et al. Addressing travelers’ perception of risk in pre-travel care: Reports from a travel clinic in Rio de Janeiro, Brazil. Rev Soc Bras Med Trop. 2019;52:e20180514. doi:10.1590/0037-8682-0514-2018.
  2. Fulford M, Keystone JS. Health risks associated with visiting friends and relatives in developing countries. Curr Infect Dis Rep. 2005;7(1):48-53. doi:10.1007/s11908-005-0023-z.
  3. Heywood AE, Zwar NA. Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence. J Travel Med. 2018;25(1):1-8. doi:10.1093/jtm/tay010.
  4. Thomson CA, Gibbs RA, Giele C, Firth MJ, Effler PV. Health seeking behaviours and knowledge of infectious disease risks in western Australian travellers to Southeast Asian destinations: an airport survey. Trop Med Infect Dis. 2016;1(1):3. doi:10.3390/tropicalmed1010003.
  5. Lopez-Velez R, Bayas JM. Spanish travelers to high-risk areas in the tropics: airport survey of travel health knowledge, attitudes, and practices in vaccination and malaria prevention. J Travel Med. 2007;14(5):297-305. doi:10.1111/j.1708-8305.2007.00142.x.
  6. International SOS. https://www.internationalsos.com/. Accessed June 25, 2019.
  7. Leder K, Torresi J, Libman MD, et al. GeoSentinel surveillance of illness in returned travelers, 2007–2011. Ann Intern Med. 2013;158(6):456-468. doi: 10.7326/0003-4819-158-6-201303190-00005.
  8. Freedman DO1, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med. 2006;354(2):119-130. doi:10.1056/NEJMoa051331.
  9. Guiu G, Monin J, Perrier E, Manen O. Epidemiology of inflight medical events. Int J Travel Med Glob Health. 2019;7(11):10-12. doi:10.15171/ijtmgh.2019.03.
  10. Lai S, Farnham A, Ruktanonchai NW, Tatam AJ. Measuring mobility, disease connectivity and individual risk: a review of using mobile phone data and mHealth for travel medicine. J Travel Med. 2019;26(3):1-9. doi:10.1093/jtm/taz019.
  11. Ruktanonchai NW, Ruktanonchai CW, Floyd JR, Tatem AJ. Using Google Location History data to quantify fine-scale human mobility. Int J Health Geogr. 2018;17(1):28. doi:10.1186/s12942-018-0150-z.
  12. Global Data. https://www.globaldata.com/store/. Accessed June 25, 2019.
  13. Ma T, Heywood A, MacIntyre CR. Chinese travellers visiting friends and relatives--A review of infectious risks. Travel Med Infect Dis. 2015;13(4):285-294. doi:10.1016/j.tmaid.2015.05.004.
  14. Barkemeyer R, Miklian J, Responsible business in fragile contexts: comparing perceptions from domestic and foreign firms in Myanmar. Sustainability. 2019;11(3):598. doi:10.3390/su11030598.
  15. Seeman MV, Seeman N, Cho JA. Worldwide preferences for natural remedies for ‘nervousness’ and common colds. J Psychiatry Brain Sci. 2018;3 (1):1. doi:10.20900/jpbs.20180001.
  16. Seeman N, Fogler SG, Seeman MV. Mental health promotion through collection of global opinion data. J Prevent Med Care. 2016;1(1):23-36.
  17. Seeman N, Ing A, Rizo C. Assessing and responding in real time to online anti-vaccine sentiment during a flu pandemic. Healthc Q. 2010;13:8-15. doi:10.12927/hcq.2010.21923.
  18. Seeman N, Reilly DK, Fogler S. Suicide risk factors in U.S. college students: Perceptions differ in men and women. Suicidology Online. 2017;8(2):20-26.
  19. Seeman N, Seeman B. Monitoring receptivity to online health messages by tracking daily Web traffic engagement patterns: A review of more than 13 million US Web exposures over 1,235 days. Healthc Q. 2017;20(3):47-51. doi:10.12927/hcq.2017.25288.
  20. Seeman N, Tang S, Brown AD, Ing A. World survey of mental illness stigma. J Affect Disord. 2016;190:115-121. doi:10.1016/j.jad.2015.10.011.
  21. Seeman N. Use data to challenge mental-health stigma. Nature. 2015;528(7582):309. doi:10.1038/528309a.
  22. Kato T, Kishida N, Umeyama T, Jin Y, Tsuda K. A random extraction method with high market representation for online surveys. Int J Business Innovation Res. 2019; In Press.
  23. Ebola outbreak spreads from Democratic Republic of Congo Outbreak spreads. CBC News. June 12, 2019. https://www.cbsnews.com/news/uganda-ebola-death-democratic-republic-of-congo-outbreak-spreads/. Accessed July 17, 2019.
  24. Measles. CDC website. https://wwwnc.cdc.gov/travel/notices/watch/measles-global. Accessed July 17, 2019.
  25. Nipah Virus in Kerala India. https://www.internationalsos. com/newsroom/news-releases/nipah-virus-in-kerala-india-jun-06-2019. Accessed July 17, 2019.
  26. Bylander J. Civil unrest, police use of force, and the public’s health. Health Aff (Millwood). 2015;34(8):1264-1268. doi:10.1377/hlthaff.2015.0717.
  27. Lu Y, Song S, Wang R, et al. Impacts of soil and water pollution on food safety and health risks in China. Environ Int. 2015;77:5-15. doi:10.1016/j.envint.2014.12.010.
  28. Miele CH, Schwartz AR, Gilman RH, et al. Increased cardiometabolic risk and worsening hypoxemia at high altitude. High Altitude Med Biol. 2016;17(2):93-100. doi:10.1089/ham.2015.0084.
  29. Fattore E, Paiano V, Borgini A, et al. Human health risk in relation to air quality in two municipalities in an industrialized area of Northern Italy. Environ Res. 2011;111(8):1321-1327. doi:10.1016/j.envres.2011.06.012.
  30. Drugs. Available at: https://travel.gc.ca/travelling/health-safety/drugs. Accessed July 17, 2019.
  31. Gautret P, Steffen R. Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence? Int J Infect Dis. 2016;47:46-52. doi:10.1016/j.ijid.2016.03.007.
  32. Khan ID, Khan SA, Asima B, Hussaini SB, Zakiuddin M, Faisal FA. Morbidity and mortality amongst Indian Hajj pilgrims: A 3-year experience of Indian Hajj medical mission in mass-gathering medicine. J Infect Public Health. 2018;11(2):165-170. doi:10.1016/j.jiph.2017.06.004.
  33. Memish ZA, Khan AA, Ebrahim S. Measles and the 2019 Hajj: the risk of magnifying the global measles surge. J Travel Med. 2019;taz041. doi:10.1093/jtm/taz041.
  34. Yanagisawa N, Wada K, Spengler JD, Sanchez-Pina R. Health preparedness plan for dengue detection during the 2020 summer Olympic and Paralympic games in Tokyo. PLOS Negl Trop Dis. 2018;12(9):e0006755. doi:10.1371/journal.pntd.0006755.
  35. Venezuela. CDC website. https://wwwnc.cdc.gov/travel/notices/warning/health-infrastructure-breakdown-venezuela. Accessed July 17, 2019.
  36. Korzeniewski K, Juszczak D. Travel-related sexually transmitted infections. Int Marit Health. 2015;66(4):238-246. doi:10.5603/IMH.2015.0045.
  37. Rogstad KE. Sexually transmitted infections and travel. Curr Opin Infect Dis. 2019;32(1):56-62. doi:10.1097/QCO.0000000000000513.
  38. Sundbeck M, Agardh A, Östergren PO. Travel abroad increases sexual health risk-taking among Swedish youth: a population-based study using a case-crossover strategy. Glob Health Action. 2017;10(1):1330511. doi:10.1080/16549716.2017.1330511.
  39. Sundbeck M, Emmelin A, Mannheimer L, Miörner H, Agardh A. Sexual risk-taking during travel abroad - a cross-sectional survey among youth in Sweden. Travel Med Infect Dis. 2016;14(3):233- 241. doi:10.1016/j.tmaid.2016.03.014.
  40. World Health Organization. Global report on drowning. http://www.who.int/violence_injury_prevention/global_report_ drowning/final_report_full_web.pdf. Published 2014. Accessed July 17, 2019.
  41. Buchan CA, Kotton CN, AST Infectious Diseases Community of Practice. Travel medicine, transplant tourism, and the solid organ transplant recipient - Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;e13529. doi:10.1111/ctr.13529.
  42. Felkai P, Kurimay T. The most vulnerable travelers: patients with mental disorders. World Psychiatry. 2011;10(3):237. doi:10.1002/j.2051-5545.2011.tb00063.x.
  43. McIntosh IB, Swanson V, Power KG, et al. Anxiety and health problems related to air travel. J Travel Med. 1998;5(4):198-204. doi:10.1111/j.1708-8305.1998.tb00507.x.
  44. World Health Organization (WHO) International Travel and Health. Psychological health. General considerations. 2014. http://www.who.int/ith/other_health_risks/psychological_health/en/. Accessed July 17, 2019.
  45. Palacios-Sánchez L, Botero-Meneses JS, Plazas Pachón R, et al. Stendhal syndrome: a clinical and historical overview. Arq Neuro- Psiquiatr. 2018;76(2):120-123. doi:10.1590/0004-282x20170189.
  46. Kumar S. An explorative look at Jerusalem syndrome and its validity? Eur Psychiatry. 2017;41:S574. doi:10.1016/j.eurpsy.2017.01.851.
  47. Seeman MV. Travel risks for those with serious mental illness. Int J Travel Med Global Health. 2016;4(3):76-81. doi:10.21859/ijtmgh-040302.