november 2009 . interviewers approached 132 licensed live - poultry retail businesses in wet markets and 23 wholesale establishments . the final sample was 360 poultry workers ( 194 retailers and 166 wholesalers ; response rate  68.1% ) . respondents were asked about their demographics , past month s work and preventive behavior , and avian influenza we asked perception questions based on the health belief model and the likelihood of adopting certain behavior patterns in the event of a local bird - to - bird or bird - to - human outbreak of avian influenza . related knowledge , current preventive behavior patterns , outbreak preparedness , and various perception domains . standard multivariable linear regression was conducted by using sas version 9.1.3 ( sas institute , cary , nc , usa ) with knowledge , practice , and preparedness scores as outcomes and potential predictors showing p<0.25 in unadjusted analyses as input variables . distribution of standardized residuals and their association with predicted values were examined to assess model assumptions . most ( 208 , 60.1% ) respondents were men 3554 years of age , of whom 192 ( 55.3% ) had worked a mean of 16.1 years in the poultry industry . respondents showed low mean summative scores for knowledge of avian influenza ( table a1 ) . nearly two thirds ( 232 , 64.1% ) of poultry workers reported that avian influenza virus ( h5n1 ) infects wild birds , but fewer workers reported that this virus could infect live poultry ( 212 , 60.1% ) , domesticated birds ( 159 , 44.8% ) , or humans ( 178 , 50.0% ) . a total of 242 ( 69.1% ) workers reported that consuming undercooked poultry could transmit the virus , and 210 ( 59.7% ) knew that infection could result from touching bird feces . for other transmission routes , awareness was lower , ranging from 14.0% ( 48 ) for eating undercooked eggs to 29.1% ( 102 ) for slaughtering poultry . ninety - six ( 27.4% ) workers were unsure whether avian influenza virus ( h5n1 ) infection had occurred in humans in hong kong , 198 ( 58% ) incorrectly believed that nearly everyone survives this infection , and 110 ( 32.8% ) incorrectly believed that a human vaccine for avian influenza was available . most ( 208 , 89.9% ) respondents were familiar with influenza - like symptoms of avian influenza virus ( h5n1 ) infection such as fever , but fewer workers were aware of respiratory and gastrointestinal symptoms of virus infection . the internet and other sources ( e.g. , health talks ) of information about avian influenza were strong independent predictors of greater knowledge . poultry workers reported low - to - moderate levels of compliance with hand hygiene and other preventive measures ( ranging from 7.3%   using eye protection to 65.2%   using handwashing with soap after slaughtering poultry ) . working in the poultry industry 10 years , lower perceived barriers to preventive behavior , and retail poultry work were independent predictors of higher preventive behavior scores . with regard to avian influenza  related perceptions , lack of training ( 277 , 83.4% ) and the view that compliance with all infection regulations is difficult during peak hours ( 218 , 64.9% ) were the most frequently cited barriers to adoption of preventive behavior . a total of 154 ( 46.4% ) workers believed that face masks reduced business , and 153 ( 46.1% ) believed that vaccination was expensive . low anxiety about illness was reported by 242 ( 76.6% ) respondents . in the event of a local outbreak , workers expressed various levels of acceptance for precautionary actions , ranging from 15.8% ( 56 ) for reducing work hours to 82.4% ( 290 ) for seeking medical care for influenza - like symptoms . greater perceived benefit of preventive behavior was the strongest independent predictor of higher preparedness scores ( table a2 ) . similar to other regions ( 811 ) , poultry workers in hong kong showed low risk perceptions for avian influenza , inadequate knowledge , and a wide range of compliance with preventive measures . because training ( 6 ) was not associated with overall preventive behavior or preparedness , there may be an unmet need for occupation - specific health information . higher levels of knowledge demonstrated by workers who accessed health information sources ( e.g. , internet ) that provide detailed information suggest that comprehensive , occupation - relevant information should be more widely accessible . however , occupational practices of animal workers might not be amenable to change solely on the basis of improvements in knowledge . only 129 ( 42.1% ) respondents reported that poultry workers could realistically adhere to all government guidelines ( 6 ) . interference with work , high cost , and reduction of business were repeatedly cited as impediments to the adoption of preventive behavior . even in the event of local outbreaks of avian influenza , most workers were not amenable to actions having adverse economic effects such as reducing work hours . animal workers are thereby unlikely to widely adopt preventive behavior if these measures conflict with their economic interests . despite the ongoing government regulations regarding avian influenza in hong kong ( 6 ) , a complete ban on live poultry is unrealistic because of the culturally entrenched demand for fresh poultry . increasing knowledge and risk perceptions while simultaneously reducing occupational barriers to preventive behavior thereby continues to be the cornerstone of effective zoonotic infection control among animal workers . implications of these findings extend to other poultry - borne pathogens , such as campylobacter spp . and salmonella spp . , which share common preventive measures . close adherence to workplace measures will likely reduce outbreak risk for other poultry - borne diseases . therefore , a framework for greater integration of risk management strategies and worker education of these poultry - borne infections tailored to the local context is worthwhile and cost - effective . in the spirit of the one health commission , which calls for an integrated , interdisciplinary approach to human veterinary  environmental health challenges ( 15 ) , the fight against global pandemics , such as those of avian influenza virus ( h5n1 ) , necessitates greater dialogue and collaborative leadership between governments and livestock industries .
in 2009 , a cross - sectional survey of 360 poultry workers in hong kong , china , showed that workers had inadequate levels of avian influenza ( h5n1 ) risk knowledge , preventive behavior , and outbreak preparedness . 
 the main barriers to preventive practices were low perceived benefits and interference with work . 
 poultry workers require occupation - specific health promotion .