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J Epidemiol Community Health. 2012 Jul;66(7):605-10. doi: 10.1136/jech.2010.117002. Epub 2011 Jan 10.

Stress, adherence to preventive measures for reducing influenza transmission and influenza-like illness.

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  • 1Center for Social Epidemiology & Population Health, School of Public Health-University of Michigan, Ann Arbor, Michigan 48109-2029, USA.



Using data from a randomised intervention trial of facemask use and hand hygiene for reducing transmission of seasonal influenza among university students, we examined if levels of perceived stress were negatively associated with adherence to these preventive measures and incidence of influenza-like illness (ILI).


Longitudinal analyses using generalised estimating equations were examined. Perceived stress was self-reported at baseline using a validated scale. Compliance with preventive measures was self-reported throughout the study period and reported ILI symptoms were defined as cough and one or more of fever/feverishness, chills and body aches.


Higher levels of perceived stress were not associated with facemask or hand hygiene compliance. However, perceived stress was significantly associated with a greater ILI incidence (HR1.25, 95% CI 1.07 to 1.45) even after controlling for demographic and behavioural risk factors.


Among students in the university setting, higher levels of perceived stress affect ILI symptom reporting but not compliance with preventive measures for reducing transmission of influenza. Further studies are needed to examine whether psychological stress is a key mechanism explaining socio-demographic health disparities in confirmed influenza infection among healthy persons in the community setting.


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