Non-pharmaceutical interventions (NPIs), such as hand hygiene, respiratory etiquette, and mask use, are recommended strategies to reduce transmission of seasonal respiratory infections, with implications for pandemic influenza preparedness. While the effectiveness of NPIs has been examined in healthcare settings, less is known about the effectiveness of these strategies in community settings.

We conducted a randomized controlled trial, the Reducing Influenza-like Illness among University Students (REDI-US) Study, to examine the effectiveness of a hand hygiene and respiratory etiquette intervention in reducing the occurrence of influenza-like illness (ILI) in a young adult population. The intervention consisted of access to an educational website and one-time provision of respiratory and hand hygiene supplies. A total of 2,300 students enrolled in the study and were randomly assigned to either an intervention or control group; the study was conducted from October 2007 to April 2008. Participants self-reported selected symptom and behavioral information via an online weekly survey. An episode of ILI was defined as having fever and cough and/or sore throat clustered within a 5-day period.

The results of three REDI-US Study investigations are presented in this dissertation: (1) an analysis of the effectiveness of the intervention in reducing the occurrence of ILI, (2) an assessment of the effectiveness of the intervention in improving hand hygiene and respiratory etiquette, and (3) a summary of participant-identified barriers to and factors influencing hand hygiene, respiratory etiquette, and mask use.

We found no evidence that the study intervention reduced the occurrence of ILI in this population (Chapter 2). The intervention was, however, effective in producing changes in certain hand hygiene and respiratory etiquette behaviors (Chapter 3). Participant-reported barriers to hand hygiene and respiratory etiquette were related to convenience, knowledge of appropriate behaviors, and availability of hand hygiene materials. Study results indicated that social acceptability of mask use is a major factor in participants' comfort-level in wearing a mask while sick (Chapter 4).

Evaluating the effectiveness of NPIs, as well as the barriers to use of these interventions in community settings, has important implications for efforts directed toward preventing and preparing for seasonal and pandemic respiratory infections.