we investigated risk perceptions and efficacy beliefs related to ai of a random sample of persons in 8 areas . random digital dialing was used to select the samples , and data were collected by using computer - assisted telephone interviewing . interviews were conducted from september 20 through november 22 , 2005 , in 5 european countries ( denmark , the netherlands , united kingdom , spain , and poland ) and 3 east asian areas ( singapore ; guangdong province , people s republic of china ; and hong kong , special administrative region , people s republic of china ) . at the time the telephone survey was conducted , on october 14 , 2005 , the media announced the introduction of ai in europe . we therefore ensured that at least 90 interviews were conducted in each country after october 18 , 2005 . the questionnaire focused on risk perception of ai and other infectious diseases , precautionary behavior , and use of information sources ; it was based on our earlier study of risk perception of severe acute respiratory syndrome ( sars ) ( 9 ) . respondents first received a brief explanation of ai . in line with the protection motivation theory ( 8) , a measure of risk perception was constructed by multiplication of seriousness ( scale 110 ) and vulnerability ( scale 15 ) . to make the scores comparable , the seriousness score was first divided by 2 . to normalize the skewed distribution of the new variable , a square - root transformation was performed , which resulted in a measure of risk perception on a scale from 1 ( low ) to 5 ( high ) . a total of 3,436 respondents were interviewed ; participation rates varied from 12.9% in asia to 81.1% in poland . european respondents were significantly older than asian respondents ( mean age 47 and 39 years , respectively , range 1875 years , t = 16,2 ; degrees of freedom [ df ] = 3,351 ; p<0.001 ) . overall , 45% of respondents thought they were likely or very likely to become infected with ai if an outbreak occurred in their country . this perception varied from 32% in denmark and singapore to 61% in poland and spain . risk perception scores varied significantly across countries ; the highest mean score was in poland and the lowest was in denmark ( table 2 ) . higher scores were observed in europe than in asia ( t = 5.2 ; df = 3,250 ; p<0.001 ) , and differences between individual countries within europe were significant . multivariate analysis showed that country , sex , and age group remained independent significant factors and showed a significant interaction between country and sex and between country and age group ( figure ) . in all countries , except singapore , risk perception was higher among women than men , but this difference was smaller in asian than in european countries . the effects of age also varied by country ; mean risk perception levels were higher in older age groups in europe but not in asia . * dnk , denmark ; pol , poland ; nld , the netherlands ; uk , united kingdom ; esp , spain ; chn , china ; hkg , hong kong ; sgp , singapore . * ci , confidence interval ; dnk , denmark ; pol , poland ; nld , the netherlands ; uk , united kingdom ; esp , spain ; chn ,  china ; hkg ,  hong kong ; sgp , singapore . differences in mean scores between europe and asia are significant for all measures ( p<0.001 ) . lines , predicted means ; dots , observed means ; solid line , male ; dashed line , female . response efficacy and self - efficacy also varied across countries ; levels were highest in china and lowest in the netherlands ( table 2 ) . mean response efficacy and self - efficacy were significantly higher in asia than in europe ( response efficacy t = 14 ; df = 2,868 ; p<0.001 ; self - efficacy t = 20 ; df = 2,701 ; p<0.001 ) . response and self - efficacy were inversely associated with risk perception ( p = 0.013 and p<0.001 , respectively ) . multivariate analysis also showed that country , but not sex or age , was significantly associated with response efficacy . country , sex , and age group were all significantly associated with self - efficacy . were lower for women compared with men and for the youngest age group compared with older respondents . risk perception and efficacy levels before and after the introduction of avian influenza in europe did not differ significantly . our study showed that risk perceptions for ai appear to be at an intermediate level and that efficacy beliefs are slightly lower . both differ according to country or region . no evidence was found that the introduction of ai in europe in october 2005 influenced perceptions of risk or efficacy . have reported on risk perception of ai in hong kong with a focus on live chicken sales ( 10 ) . although our results are difficult to compare with theirs , our study appears to indicate a higher feeling of vulnerability , with 41.8% of hong kong respondents thinking it likely or very likely that they would become infected with influenza during an outbreak . takeuchi s interviews on food safety practices of consumers in thailand found high levels of knowledge of ai but lower levels of risk perception and behavior change ( 11 ) . if we compare our results with those from several studies on perception of risk for sars , we find that perception of risk for sars in some of the asian countries was relatively low compared with that in the united states ( 12 ) . in the netherlands , however , perception of risk for sars was low , whereas our present study indicates that it is high for influenza ( 9 ) . the lower level of risk perception for ai in asia may be related to the proximity to the current outbreak and the experience with the sars epidemic . these experiences may have resulted in the notion that new epidemics of infectious diseases can be controlled . also , despite the fact that the first cases of h5n1 influenza among humans in asia were reported in 2003 , a larger outbreak did not ensue . accordingly , risk perception research has shown that the public may be more optimistic when familiar risks are perceived to be largely under volitional control ( 13,14 ) . although in all countries an influenza pandemic is perceived as a real risk , the level of self - efficacy appears to be rather low . when developing preparedness plans for an influenza pandemic , specific attention should therefore be paid to risk communication and how perceived self - efficacy can be increased ; otherwise , adherence to preventive measures may be low .
during autumn 2005 , we conducted 3,436 interviews in european and asian countries . 
 we found risk perceptions of avian influenza to be at an intermediate level and beliefs of efficacy to be slightly lower . 
 risk perceptions were higher in asia than europe ; efficacy beliefs were lower in europe than asia .