Similar analyses were done for testing differences in risk between the two knowledge groups (accurate risk perception Birinapant in vitro y/n) and between the two practice groups (protected y/n), allowing separate tests for low-to-intermediate- and high-risk destinations through entering the appropriate interaction terms into the models. The dependency of attitude (risk behavior score) on the risk factors was analyzed using multiple linear

regression analyses, modeled similarly to the above mentioned logistic regression analyses. Those regression analyses also allow testing differences between the two risk destination groups in knowledge, attitude, and practice within specific risk groups. Finally, it was tested in appropriate multiple logistic and linear regression models if the strength of the effect of the predetermined risk factors on KAP showed a significant time trend over the years 2002 to 2009. Across all 7 years in the period from 2002 to 2009 (except year 2006) a total of 3,050 questionnaires were received, of which 3,045 fulfilled the entry criteria and were included in the analysis (Figure 1). Of the 3,045 respondents, 2,374 respondents traveled to destinations with a high risk for hepatitis A. The remaining 671 respondents traveled to a low-to-intermediate-risk destination. The general characteristics of all respondents, grouped by risk for hepatitis A

in either a high-risk or a low-to-intermediate-risk destination, are shown in Table 1. Overall, 46.4% of responders were female and 53.6% were male. Almost 63% of the travelers to high-risk destinations and 38% of the travelers to low-to-intermediate-risk destinations were protected against hepatitis A. For 20.8% IDH inhibitor of the travelers since 2004 it was their first trip to a developing country (there was no first-trip item in the questionnaires of 2002 and 2003). Overall, 63.9%

indicated tourism as their purpose of travel. One in five to six responders were VFR, business travelers accounted for 15.0%. Few responders traveled for missionary reasons or for voluntary missions (2.2%), for purpose of research or education (0.7%), or for other reasons (1.0%). Metalloexopeptidase Many travelers (41.6%) were accompanied by their partner or spouse; 869 persons (30.3%) were traveling alone, 6.9% with friends, 11.7% with children. Travelers to high-risk destinations planned to stay significantly longer at their destination than travelers to low-to-intermediate-risk destinations (p < 0.001) and obtained pre-travel health advice more frequently before departure (p < 0.001). Overall, 24.1% went abroad for 1 to 7 days, 40.2% for 8 to 14 days, 26.1% for 15 to 28 days, and 9.5% for more than 28 days. Egypt was the most common high-risk destination (N = 418;17.6%), followed by Gambia (15.7%) and Mexico (7.6%), whereas among the low-to-intermediate-risk destinations Turkey (N = 428;63.8%) was the most common destination, followed by the Dominican Republic (7.9%) and Malaysia (5.8%) (Table 1). The majority of travelers (65.