In this issue of The Journal (p 1176), Steffen and colleagues have helped to put into perspective the relative risk of acquiring diarrhea when a large number of persons trek from an industrialized region to countries that differ in their rates of endemicity of acute diarrhea. The number of the subjects (16,568), the diversity of the 13 world regions, and the methods of data collection make the study unique. Airline cabin crews of 162 charter flights administered a seven-page questionnaire to Swiss international tourists and to a limited number of German international tourists as they traveled home.
Evidence was presented that these captive participants complied with the study requirements if they were able to read the questionnaire and if the survey was not administered during the dark of night. Rates of diarrhea were high among travelers to tropical (East and West Africa, Sri Lanka, Thailand, the Far East, Brazil, and
Herbert L. DuPont, Charles D. Ericsson, Barbara E. Murray. Travelers' Diarrhea: Can It Be Eluded?. JAMA. 1983;249(9):1193–1194. doi:10.1001/jama.1983.03330330071042