This simple approach could be among the strategies used by primar

This simple approach could be among the strategies used by primary care practitioners—especially DNA Damage inhibitor those who also provide immigrant health care—to detect impending VFR travelers. Almost 80% of families were planning to be abroad for >1 month, and prolonged duration of travel has been documented in other studies as one of the reasons underlying the apparent disproportionate burden of many infections among VFRs.1,9,10 We expected that variables such as time in the United States, education level, or having a child

abroad may influence travel intentions, but these factors did not reach statistical significance. The only factor found to be a significant predictor find more for firm plans to travel abroad within 12 months was Ghana nativity. Ghanaians represent the largest and best established African immigrant community in

New York City overall as well as in the Bronx specifically.6 These circumstances as well as a significantly higher level of advanced education (37.5% of Ghanaians were college graduates vs 10.5% of all other immigrant participants, p = 0.001) might explain the greater ease with which Ghanaian immigrant families can plan to travel internationally. The relatively small number of families involved in the study may have limited the power to detect other significant predictors for imminent future travel. Further, although we attempted to minimize selection oxyclozanide bias by having material available in English, Spanish, and French, there is a possibility of residual bias such that parents agreeing to be recruited into the study may have been more concerned about travel health than non-participants. This potential bias may explain why included families with previous travel reported a higher rate of pre-travel encounter than has been found in other VFR studies.2,4,8 Finally, our study

population may not be typical of all immigrant populations globally. However, with an educational attainment in our sample similar to that described for foreign-born US residents,6 our findings might be generalizable to other urban centers that are home to immigrant communities from a similar range of malaria-endemic regions. In conclusion, integration of screening for travel activity with routine health-care maintenance visits among immigrant families is a simple way to identify impending VFR travelers. Although there are many important preventive health measures that compete for opportunistic delivery, our findings suggest that there is merit in asking all immigrant families routinely about travel plans to identify high-risk travel. Highlighting this message for primary care physicians and nurse practitioners is likely to be even more valuable than for specialist physicians.

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