Van et al. BMC Public Health 2010, 10:130 http://www.biomedcentral.com/1471-2458/10/130 in our cohort. The survey also identified that uptake of the H1N1 vaccine was three times as high in those aged 65 years and over (42%) than in those aged 18-64 years (14%), with no statistically significant difference between males and females [15]. We found that respondents who had received seasonal influenza vaccinations in the past were significantly more likely to accept the pandemic vaccine then their non-vaccinated counterparts. These findings are consistent with several recent studies on pandemic vaccine uptake [16,17]. Providing the vaccine through clinics or university health facilities should help bolster vaccine uptake, especially for international stu- dents, who may not have access to free healthcare. Of the participants surveyed, Asian-born respondents were the most likely to be anxious about the Australian pandemic situation, rate the situation as serious, under- take specific behavioural changes and comply with pub- lic health measures. It could be hypothesised that these respondents, their families, friends or members of their communities may have been exposed to previous infec- tious disease situations such as SARS and avian influ- enza [18,19]. If not exposed, at the least these respondents have lived in countries where their govern- ments have had to deal with these situations, leading to stricter infection control standards and higher levels of media exposure. Interestingly, Asian born respondents who have been settled in Australia for longer periods were less likely to have made any lifestyle changes com- pared to their counterparts who have been in the coun- try for only short amount of time. It would appear that living in Australia dilutes the tendency to adopt beha- vioural changes, and it would be beneficial for future studies to identify aspects of Australian culture which influence health behaviours. We acknowledge that this study has several limita- tions. These include: (1) the survey was restricted to the UNSW student, general and faculty staff, mostly highly educated Sydney residents; (2) the electronic format of the survey may have excluded persons without internet access; (3) we did not defin what “requested by the authorities meant” so it was open to the respondents interpretation and (4) the survey was not translated into other languages. However, English is the dominant lan- guage used in both teaching and communication and UNSW relies heavily on electronic communication with its campus population to disseminate other unrelated information in English. There was no established mea- sure of influenza protective behaviour, as most of the survey items were developed prior to the publication of the CDC Guidance for Responses to Influenza for Insti- tutions of Higher Education [5]. The declining number of participants who accessed the online survey towards the end of the survey period likely restricted analysis of how responses to the pandemic change over time. Page 8 of 9 Conclusions From the study results, several key messages should be drawn. Firstly, risk perceptions and anxiety are low and will remain so unless there is a major shift in the virus. This will continue to impact on compliance or uptake of mitigation strategies. Secondly, more effective health communication and management is needed to promote self-isolation and infection control in the event of illness especially amongst students. These students are unlikely to adopt behaviours that are unknown to them. There- fore the focus should be on handwashing and cough eti- quette. Lastly, universities must invest in online teaching resources and training during inter-pandemic periods. There also needs to be greater recognition for the need for online assignment submission and examinations to ensure minimal disruption to the students. Author details 1Faculty of Medicine, The University of New South Wales, Australia. 2School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Australia. 3University Health Service, The University of New South Wales, Australia. 4National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children’s Hospital at Westmead and Discipline of Paediatrics and Child Health, University of Sydney, New South Wales, Australia. Authors’ contributions DV/HS participated in the design of the study and survey, undertook the distribution and collection, performed the analysis and drafted the manuscript. MLM participated in the design of the study and survey, assisted with the analysis and reviewed the manuscript. JC/CRM participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript. Competing interests Raina MacIntyre receives funding from influenza vaccine manufacturers GSK and CSL Biotherapies for investigator-driven research. These payments were not associated with this study. The remaining authors have no competing interests. Received: 18 January 2010 Accepted: 14 March 2010 Published: 14 March 2010 References 1. Australian Government Department of Health and Ageing: Pandemic (H1N1) 2009 Update Bulletin, 13 October 2009. Canberra 2009. 2. Australian Department of Health and Ageing: Australian Influenza Surveillance Report No 6. 2010. 3. Nichol KL, D’Heilly S, Ehlinger E: Colds and influenza-like illnesses in University students: impact on health, academic and work performance, and health care use. Clin Infect Dis 2005, 40:1263-1270. 4. Peterson RA: On the Use of College Students in Social Science Research: Insights from a Second-Order Meta-analysis. J Consum Research 2001, 28:450-461. 5. CDC Guidance for Responses to Influenza for Institutions of Higher Education during the 2009-2010 Academic Year. http://pandemicflu.gov/ professional/school/higheredguidance.html. 6. UNSW: The University of New South Wales - Sydney Australia - The University.http://www.unsw.edu.au/about/pad/about.html. 7. Rubin GJ, Amlot R, Page L, Wessely S: Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey. BMJ 2009, 339:b2651. 8. OpenEpi: Open Source Epidemiological Statistics for Public Health, Version 2.3.http://www.OpenEpi.com.