Applying a Goal-Directed Behavior Model to Determine Risk Perception of COVID-19 and War on Potential Travelers' Behavioral Intentions.

The purpose of this study is to verify the influence of the relationship between risk perception of COVID-19 and the war-applied Model of Goal-directed Behavior (MGB) based on stimulus-organism-response (SOR) and potential travelers' behavioral intention. In addition, this study attempted to verify the relationship among uncertainty toward international travel, mental well-being toward international travel, and desire toward travelers' behavioral intention. Moreover, we examined the moderating effect of gender (female vs. male) among all variables for dependents. The survey was conducted on potential travelers in Korea. As for the survey period, a survey was conducted for one month beginning on 2 September 2022. Of the total 413 surveys, 361 surveys were used for the final analysis, and 52 unfaithful surveys were excluded. In addition, demographic, CFA, correlation analysis, structural equation modeling, and moderation effect analysis were verified using SPSS and AMOS. For the data analysis, we used SPSS 18.0 and Amos 20.0 to perform factor analysis and SEM. Significant effects were found in support for Hypotheses 1-5. Further, when it comes to the difference of gender on the relationship between all the variables, while no significant effect was found for Hypotheses 6a,c,e,g, a significant effect was found for Hypotheses 6b,d,f. Thus, H6a,c,e were rejected and H6b,d,f were supported. It was found that females had a greater influence on mental health and desire for overseas travel than males, but it was found that there was no difference between females and males in the relationship between desire and behavioral intention. Therefore, it was possible to verify that the MGB desire is an important psychological variable for both females and males. Furthermore, these findings offer academic practical implications to travel and tourism companies by presenting basic data based on the results of empirical research analysis in the context of the current dangerous situation.

Exploring the emotional costs of abortion travel in the United States due to legal restriction.

OBJECTIVES: Pregnant people have traveled across state and national borders for the purpose of abortion since at least the 1960s. Scholarship has robustly documented the financial and logistical costs associated with travel, but less work has examined the emotional costs of abortion travel. We investigate whether abortion travel has emotional costs and, if so, how they come about. STUDY DESIGN: We conducted in-depth interviews with 30 women who had to travel across state borders in the United States for abortion care because of their gestation. We analyzed findings thematically. RESULTS: Interviewees described having to travel to obtain abortion care as emotionally burdensome, causing distress, stress, anxiety, and shame. Because they had to travel, they were compelled to disclose their abortion to others and obtain care in an unfamiliar place and away from usual networks of support, which engendered emotional costs. Additionally, travel induced feelings of shame and exclusion because it stemmed from a law-based denial of in-state abortion care, which some experienced as marking them as deviant or abnormal. CONCLUSIONS: People who have to travel for abortion care experience emotional costs alongside financial and logistical costs. The circumstances of that travel-specifically, being forced to travel because of legal restriction and service unavailability-are foundational to the ensuing emotional burdens. Findings add to the emerging literature on how laws and other structures produce the stigmatization of abortion at interpersonal and individual levels. IMPLICATIONS: With abortion bans following the overturning of the right to abortion and existing gestational limits in the US, more people will have to travel for abortion care. Attention to the emotional costs of abortion travel can help providers understand what their patients may be experiencing when they present for care.

Traveling to California from out of state to receive abortion services at a hospital-based clinic: A qualitative study of people's experiences.

OBJECTIVE: People seeking abortion care in the Western United States face unique challenges. We conducted a qualitative study among people who traveled to California from out of state to receive abortion services, with the aim of characterizing the interplay of motivators, costs, and facilitators to accessing abortion in this region. METHODS: We recruited English-speaking people residing outside of California who accessed care at an urban abortion clinic in San Francisco between October 2017 and May 2018. Interested participants completed a brief demographic survey and in depth semi-structured telephone interview. We relied on grounded theory methods to perform thematic analysis and stopped recruitment upon reaching thematic saturation. RESULTS: We conducted 18 in-depth interviews. People mostly had to travel to California for abortion due to local clinic gestational age limits, medical necessity, and to reduce cost. Participants also lamented that travel necessitated unwanted disclosure of their abortion, however this disclosure enabled them to get the logistical support needed for travel. People mostly relied on their networks of family and friends to facilitate these logistics. CONCLUSIONS: This study highlights the interplay of motivators, costs, and facilitators people who travel to California from nearby states face when seeking abortion services. IMPLICATIONS: We position the concept of 'unwanted disclosure' as both an emotional cost and an operator that often served to enable people to get the support (logistical, financial, professional) they needed to actualize their abortion in California. These people may benefit from additional financial and social support services in order to actualize their abortion.

Study on Tourism Consumer Behavior and Countermeasures Based on Big Data.

In our study, through consulting, summarizing, and analyzing a large number of related literature studies on tourism consumer behavior, tourism big data, text data analysis, and so on, a framework of research ideas on tourism consumption was constructed. The train browser, NLPIR, and other software packages are used to crawl, preprocess, and mine the travel sample data, and the word frequency analysis, co-occurrence analysis, content analysis, sentiment analysis, network analysis, and other methods are used to analyze the characteristics and decision-making behavior of tourists. Based on the results of behavioral analysis, we proposed tourism development strategies from three aspects: reforming and promoting tourism marketing strategies, improving tourism product and service quality, and improving tourism destination management methods. The results show that (1) for the tourist characteristics, taking into account the factors of climate and geographical location, the domestic market is divided into four grades of markets, and different marketing strategies are adopted according to different market characteristics; (2) for the tourism decision-making behavior, a "push-pull resistance" tourism decision-making model was established through word frequency analysis, co-occurrence analysis, and content analysis; (3) for the tourism consumption preferences, through network analysis of scenic spots, it is found that there are three tourist routes preferred by tourists; and (4) for the tourism perception evaluation behavior, based on the "cognitive-emotional" model, this study describes the tourism image from the two dimensions of the cognitive image and emotional image. Generally speaking, tourists show a positive perception state. The research on tourism consumer behavior based on UGC (user-generated content) data can help scenic spots and other tourism companies to understand the characteristics and rules of tourists' behavior, understand the consumption preferences of different tourism groups, develop diversified tourism products, improve the quality of tourism services, and further cater to market segments. This research provides a new idea for tourist attractions and tourism management departments to monitor tourist behavior through big data analysis.

Digital Tourism and Wellbeing: Conceptual Framework to Examine Technology Effects of Online Travel Media.

The current pandemic is accelerating the wide-spreading popularity of digital tourism. Given that technology innovation has broadened the horizon of tourist experiences to the realm of virtual environments, this study aims to (re)conceptualize travel experience and develop a theoretical framework to examine media technology effects on virtual travel experience, destination image, and tourists' well-being. As a conceptual work, this study adopts technological perspectives on online travel media to decompose technology attributes and articulate distinctive effects of technology-centric variables. The proposed framework illustrates five propositions that specify and explain the relationships among technology-centric variables (modality, agency, interactivity, and navigability), three groups of moderators (user-centric, content-centric, and situation-centric variables), virtual travel experience, destination image, and psychological wellbeing. By adopting the variable-centered approach to decompose online travel media, this study provides a new theoretical lens to understand the psychological mechanism of media technology effects in digital tourism. The framework will serve as useful methodological guidelines to conduct experiments to investigate the distinctive effect of a particular affordance or a specific technical feature. The potential benefits of digital tourism to enhance tourists' wellbeing are discussed by highlighting the environmentally friendly and inclusive aspects.

Analysing the impact of COVID-19 risk perceptions on route choice behaviour in train networks.

INTRODUCTION: Unlike previous pandemics, COVID-19 has sustained over a relatively longer period with cyclical infection waves and numerous variants. Public transport ridership has been hit particularly hard. To restore travellers' confidence it is critical to assess their risk determinants and trade-offs. METHODS: To this end, we survey train travellers in the Netherlands in order to: (i) quantify the impact of trip-specific, policy-based, and pandemic-related attributes on travellers' COVID-19 risk perceptions; and (ii) evaluate the trade-off between this risk perception and other travel attributes. Adopting the hierarchical information integration approach, in a two-stage stated preference experiment, respondents are asked to first rate how risky they perceive different travel situations to be, and then to choose between different travel options that include their own perceived risk rating as an attribute. Perceived risk ratings and choices between travel options are modelled using a linear regression and a mixed multinomial logit model, respectively. RESULTS: We find that on-board crowding and infection rates are the most important factors for risk perception. Amongst personal characteristics, the vulnerability of family and friends has the largest impact-nearly twice that of personal health risk. The bridging choice experiment reveals that while values of time have remained similar to pre-pandemic estimates, travellers are significantly more likely to choose routes with less COVID-19 risk (e.g., due to lower crowding). Respondents making longer trips by train value risk four times as much as their shorter trip counterparts. By combining the two models, we also report willingness to pay for mitigating factors: reduced crowding, mask mandates, and increased sanitization. CONCLUSION: Since we evaluate the impact of a large number of variables on route choice behaviour, we can use the estimated models to predict behaviour under detailed pandemic scenarios. Moreover, in addition to highlighting the importance of COVID-19 risk perceptions in public transport route choices, the results from this study provide valuable information regarding the mitigating impacts of various policies on perceived risk.

Understanding the Tradeoffs Between Travel Burden and Quality of Care for In-center Hemodialysis Patients.

BACKGROUND: Renal dialysis is a lifesaving but demanding therapy, requiring 3 weekly treatments of multiple-hour durations. Though travel times and quality of care vary across facilities, the extent to which patients are willing and able to engage in weighing tradeoffs is not known. Since 2015, Medicare has summarized and reported quality data for dialysis facilities using a star rating system. We estimate choice models to assess the relative roles of travel distance and quality of care in explaining patient choice of facility. RESEARCH DESIGN: Using national data on 2 million patient-years from 7198 dialysis facilities and 4-star rating releases, we estimated travel distance to patients' closest facilities, incremental travel distance to the next closest facility with a higher star rating, and the difference in ratings between these 2 facilities. We fit mixed effects logistic regression models predicting whether patients dialyzed at their closest facilities. RESULTS: Median travel distance was 4 times that in rural (10.9 miles) versus urban areas (2.6 miles). Higher differences in rating [odds ratios (OR): 0.56; 95% confidence interval (CI): 0.50-0.62] and greater area deprivation (OR: 0.50; 95% CI: 0.48-0.53) were associated with lower odds of attending one's closest facility. Stratified models were also fit based on urbanicity. For rural patients, excess travel was associated with higher odds of attending the closer facility (per 10 miles; OR: 1.05; 95% CI: 1.04-1.06). Star rating differences were associated with lower odds of receiving care from the closest facility among urban (OR: 0.57; 95% CI: 0.51-0.63) and rural patients (OR: 0.18; 95% CI: 0.08-0.44). CONCLUSIONS: Most dialysis patients have higher rated facilities located not much further than their closest facility, suggesting many patients could evaluate tradeoffs between distance and quality of care in where they receive dialysis. Our results show that such tradeoffs likely occur. Therefore, quality ratings such as the Dialysis Facility Compare (DFC) Star Rating may provide actionable information to patients and caregivers. However, we were not able to assess whether these associations reflect a causal effect of the Star Ratings on patient choice, as the Star Ratings served only as a marker of quality of care.

The mediation of perceived risk's impact on destination image and travel intention: An empirical study of Chengdu, China during COVID-19.

Perceived risk clearly impacts travel behavior, including destination selection and satisfaction, but it is unclear how or why its effect is only significant in certain cases. This is because existing studies have undervalued the mediating factors of risk aversion, government initiatives, and media influence as well as the multiple forms or dimensions of risk that can mask its direct effect. This study constructs a structural equation model of perceived risk's impact on destination image and travel intention for a more nuanced model of the perceived risk mechanism in tourism, based on 413 e-questionnaires regarding travel to Chengdu, China during the COVID-19 pandemic, using the Bootstrap method to analyze suppressing effect. It finds that while perceived risk has a significant negative impact on destination image and travel intention, this is complexly mediated so as to appear insignificant. Furthermore, different mediating factors and dimensions of perceived risk operate differently according to their varied combinations in actual circumstances. This study is significant because it provides a theoretical interpretation of tourism risk, elucidates the mechanisms or paths by which perceived risk affects travel intention, and expands a framework for research on destination image and travel intention into the realms of psychology, political, and communication science. It additionally encourages people to pay greater attention to the negative impact of crises and focuses on the important role of internal and external responses in crisis management, which can help improve the effectiveness of crisis management and promote the sustainable development of the tourism industry.

Reducing the burdens of forced abortion travel: Referrals, financial and emotional support, and opportunities for positive experiences in traveling for third-trimester abortion care.

In the United States, travel is a fact of the abortion care provision landscape. This is largely due to the uneven geographical distribution of providers and state-level gestational duration bans that constrain what abortion care is available locally. When abortion travel is compelled by legal restriction, it is forced travel. Research has comprehensively documented that forced abortion travel is burdensome; people who must travel for abortion experience financial, logistical, and emotional burdens. Generally overlooked, however, is variation in the experience of travel-related burdens and whether and how such burdens can be reduced. Given current political hostility to abortion, the number of people who must travel and the distances they must travel for abortion are likely to grow, making the question of how travel-related burdens can be reduced in the absence of policy change of increasing relevance. Using thematic analysis of semi-structured interviews with 30 cisgender women in the United States who were forced to travel to obtain third-trimester abortion care, I identify three ways that the burdens of forced abortion travel can be mitigated without policy change: prompt referrals; financial and practical support for travel; and emotional support. In some instances, respondents experienced the received emotional support as so valuable as to offset the other burdens of travel, pointing to the possibility that some people might prefer to travel for abortion care whether or not they are forced to do so. Respondents also reported unexpected positive aspects of traveling, including experiences of kindness and human connection, underscoring that not all aspects of abortion travel are negative. Findings thicken our understanding of forced abortion travel and identify structural and interpersonal practices that can reduce the associated burdens, complementing legal and policy-oriented critiques of legal regulation that makes abortion travel necessary.

The challenges arising from the COVID-19 pandemic and the way people deal with them. A qualitative longitudinal study.

The conducted qualitative research was aimed at capturing the biggest challenges related to the beginning of the COVID-19 pandemic. The interviews were carried out in March-June (five stages of the research) and in October (the 6th stage of the research). A total of 115 in-depth individual interviews were conducted online with 20 respondents, in 6 stages. The results of the analysis showed that for all respondents the greatest challenges and the source of the greatest suffering were: a) limitation of direct contact with people; b) restrictions on movement and travel; c) necessary changes in active lifestyle; d) boredom and monotony; and e) uncertainty about the future.

The availability of psychological support following road travel injuries in Namibia: A qualitative study.

Road traffic injuries (RTIs) are a major problem worldwide with a high burden of mental health problems and the importance of psychological support following road injury is well documented. However, globally there has been very little research on the accessibility of psychological services following road injury. Namibia is one of the countries most affected by RTIs but no previous studies have been done on this. In this qualitative study we investigated the availability of psychological services to RTI injured in Namibia. Our study findings are in line with those of other global studies in showing inadequate access to psychological support for injury survivors and we discuss the reasons. It is hoped these findings will help policymakers develop ways of enhancing access to psychological support for the many people injured in RTIs in Namibia. The models they develop may also be of use to other LMICs countries with high RTI rates.

Perceptions of tourists of the resources, ecological service functions and recreation value of the Guanwu National Forest Recreation Area.

This study surveyed visitor perceptions of the resources of the Guanwu National Forest Recreation Area (GNFRA) in Taiwan', their perceptions toward the ecosystem service functions of the GNFRA, their expectations and opinions on its management, and their recreational activities. Independent sample t-tests and one-way analysis of variance (ANOVA) were used to examine the influences of the backgrounds of respondents on their perceptions toward the ecosystem service functions of the GNFRA. The importance-performance analysis (IPA) method was used to explore evaluations by tourists on the management of the GNRFA. Finally, a global positioning system (GPS) was used to process records of recreational activities by tourists within the GNFRA to understand the movement of tourists during their recreational activities within the GNRFA. The results showed that visitors to the GNRFA regarded its recreational resources to be valuable and that they had a high willingness to revisit. The visitors also showed a certain understanding of the ecosystem services provided by the forest ecosystem. There were significant differences in perceptions of ecosystem services among visitors of different backgrounds. In addition, the results of IPA showed the "importance" of perceptions and "performance" within the opinions of tourists on the management of the forest recreation area. The records of recreational activities by tourists showed that they experienced the most benefits when experiencing picturesque scenery along walking trails. The results of this study can contribute to future management of the GNRFA.

An interpretable framework for investigating the neighborhood effect in POI recommendation.

Geographical characteristics have been proven to be effective in improving the quality of point-of-interest (POI) recommendation. However, existing works on POI recommendation focus on cost (time or money) of travel for a user. An important geographical aspect that has not been studied adequately is the neighborhood effect, which captures a user's POI visiting behavior based on the user's preference not only to a POI, but also to the POI's neighborhood. To provide an interpretable framework to fully study the neighborhood effect, first, we develop different sets of insightful features, representing different aspects of neighborhood effect. We employ a Yelp data set to evaluate how different aspects of the neighborhood effect affect a user's POI visiting behavior. Second, we propose a deep learning-based recommendation framework that exploits the neighborhood effect. Experimental results show that our approach is more effective than two state-of-the-art matrix factorization-based POI recommendation techniques.

Association of Travel Distance to Nearest Abortion Facility With Rates of Abortion.

Importance: Travel distance to abortion services varies widely in the US. Some evidence shows travel distance affects use of abortion care, but there is no national analysis of how abortion rate changes with travel distance. Objective: To examine the association between travel distance to the nearest abortion care facility and the abortion rate and to model the effect of reduced travel distance. Design, Setting, and Participants: This cross-sectional geographic analysis used 2015 data on abortions by county of residence from 1948 counties in 27 states. Abortion rates were modeled using a spatial Poisson model adjusted for age, race/ethnicity, marital status, educational attainment, household poverty, nativity, and state abortion policies. Abortion rates for 3107 counties in the 48 contiguous states that were home to 62.5 million female residents of reproductive age (15-44 years) and changes under travel distance scenarios, including integration into primary care (<30 miles) and availability of telemedicine care (<5 miles), were estimated. Data were collected from April 2018 to October 2019 and analyzed from December 2019 to July 2020. Exposures: Median travel distance by car to the nearest abortion facility. Main Outcomes and Measures: US county abortion rate per 1000 female residents of reproductive age. Results: Among the 1948 counties included in the analysis, greater travel distances were associated with lower abortion rates in a dose-response manner. Compared with a median travel distance of less than 5 miles (median rate, 21.1 [range, 1.2-63.6] per 1000 female residents of reproductive age), distances of 5 to 15 miles (median rate, 12.2 [range, 0.5-23.4] per 1000 female residents of reproductive age; adjusted coefficient, -0.05 [95% CI, -0.07 to -0.03]) and 120 miles or more (median rate, 3.9 [range, 0-12.9] per 1000 female residents of reproductive age; coefficient, -0.73 [95% CI, -0.80 to -0.65]) were associated with lower rates. In a model of 3107 counties with 62.5 million female residents of reproductive age, 696 760 abortions were estimated (mean rate, 11.1 [range, 1.0-45.5] per 1000 female residents of reproductive age). If abortion were integrated into primary care, an additional 18 190 abortions (mean rate, 11.4 [range, 1.1-45.5] per 1000 female residents of reproductive age) were estimated. If telemedicine were widely available, an additional 70 920 abortions were estimated (mean rate, 12.3 [range, 1.4-45.5] per 1000 female residents of reproductive age). Conclusions and Relevance: These findings suggest that greater travel distances to abortion services are associated with lower abortion rates. The results indicate which geographic areas have insufficient access to abortion care. Modeling suggests that integrating abortion into primary care or making medication abortion care available by telemedicine may decrease unmet need.

The role of traditional restaurants in tourist destination loyalty.

The aim of this study is to examine the effect that visitor satisfaction with traditional restaurants has on perceptions of the local gastronomy, the overall image of a city and loyalty to that destination. Fieldwork has been carried out in Córdoba, a city in southern Spain famous for being a UNESCO World Heritage city and for its traditional gastronomy. The methodology used is based on structural equation modeling (PLS-SEM). This paper makes a novel contribution in that no previous studies to date have explored satisfaction with traditional restaurants, with respect to the food, the service and the atmosphere. To achieve the proposed objective, a structured questionnaire has been used to find out the opinions of diners in renowned restaurants that base their cuisine on traditional dishes made with quality local ingredients. The results obtained confirm that a satisfactory experience with the food of a traditional restaurant has a positive effect on the image of the destination and the gastronomy of the place, as well as on visitors' intentions to recommend and repeat the visit to said destination. Based on the analysis carried out, effective strategies are suggested to help manage these types of restaurants. The study provides theoretical and practical implications from a gastronomic perspective, which can enable tourism managers to employ new strategies to retain tourists visiting a city, based on increasing their post-experience satisfaction with restaurants featuring local cuisine.

Experiences and Views of Domestic Summer Travelers During the COVID-19 Pandemic: Findings from a National Survey.

Domestic travel creates a serious risk of spreading COVID-19, including novel strains of the virus. Motivating potential travelers to take precautions is critical, especially for those at higher risk for severe illness. To provide an evidence base for communication efforts, we examined the experiences and views of travelers during the summer of 2020 through a telephone survey of 1,968 US adults, conducted in English and Spanish, July 2 through July 16, 2020. The survey found that more than one-quarter (28%) of adults had traveled domestically in the prior 30 days, most commonly for "vacation" (43%), and less than half wore masks (46%) or practiced social distancing (47%) "all of the time." Although high-risk adults were significantly less likely to travel than non-high-risk adults (23% vs 31%; P < .001), they were no more likely to take precautions. Many travelers did not wear a mask or practice social distancing because they felt such actions were unnecessary (eg, they were outside or with friends and family). Although a substantial share of travelers (43% to 53%) trusted public health agencies "a great deal" for information about reducing risks while traveling, more travelers (73%) trusted their own healthcare providers. Findings suggest that outreach may be improved by partnering with providers to emphasize the benefits of layering precautions and provide targeted education to high-risk individuals. Messages that are empathetic to the need to reduce stress and convey how precautions can protect loved ones may be particularly resonant after more than a year of pandemic-related restrictions.

Environmental awareness and guests' intention to visit green hotels: The mediation role of consumption values.

The paper aimed at examining the influence of consumer's environmental awareness on their intention to visit green hotels in north Cyprus, the mediation role of consumption values. Research on eco-friendly hotels stressed that conventional hotels do not make available to consumers the environmental awareness and consumption values, whereas, there is possibility that these benefits might not sit well with the hotel potential consumers. Aside highlighting the features of green hotels, it is imperative to examine how consumers perceive consumption values. A questionnaire-based survey was used to examine the study's objectives. A total of 400 customers at 20 five-stars hotels that were randomly selected across the 3 big cities in north Cyprus (Girne, Lefkosa, and Magusa) were approached and invited to participate. The structural model was tested using structural equation modeling (SEM). The configuration model was analyzed using the partial least square (PLS) method. The finding from the SEM results shows that environmental concern directly and positively influenced the guests' intentions to visit hotels in north Cyprus. Moreover, functional and emotional values were found to mediate the relationship between environmental concern and knowledge on the guests' intention to visit north Cyprus hotels. Finally, the study suggest that the research will be of benefit to the managers of hotels in north Cyprus to know the significance of developing consumer's green awareness and to market it to the customers.

The Power of Place: Travel to Explore Structural Racism and Health Disparities.

PROBLEM: Dismantling structural racism is essential to achieving health equity, but there is little guidance for medical educators who wish to teach learners to recognize and confront structural racism. APPROACH: Critical consciousness provides a framework to identify and dismantle structural racism. Using a critical consciousness approach, the authors developed a novel 5-day travel experience to the American South for medical residents and faculty to explore the history and legacy of structural racism and the Civil Rights Movement. The purpose of the travel was to examine the connection between structural racism, especially anti-Black racism, and health disparities to better address health inequities within the participants' own home environment. Throughout the trip, faculty leaders applied principles of cultural humility and techniques from critical pedagogy, including recognizing the value of everyone in the room, creating cognitive disequilibrium, and promoting authentic dialogue. OUTCOMES: End-of-week surveys revealed that the trip was well received. Organizers learned important lessons related to faculty and resident dynamics, race-based affinity group meetings, and the respectful use of stories as a tool for learning. Post-trip surveys at 1, 6, and 12 months revealed 3 major themes: participants experienced (1) transformed understanding of systemic racism, (2) increased motivation and bravery to act when witnessing interpersonal and structural racism, and (3) increased practice of cultural humility. NEXT STEPS: Cultural humility and critical pedagogy can be used with travel to support learners in recognizing and confronting structural racism. The application of such techniques should be explored in local learning environments to foster commitment and action toward dismantling structural racism. In teaching structural racism, medical educators must be willing to consider new ways of teaching and learning.