Author(s): Kristina Angelo, Sarah Kohl

Students travel internationally for many reasons, including studying abroad, leisure travel during a gap year, providing health care, or participating in humanitarian activities. During the 2018–2019 academic year, nearly 350,000 US students studied abroad, an increase of 1.6% from the previous year. Study abroad notably declined by 53.1% the following academic year (2019–2020) because of the coronavirus disease 2019 (COVID-19) pandemic. The most common destination for US students to study abroad is Europe, but they also study in low- or middle-income countries, placing them at risk for acquiring infectious diseases that are not endemic at home.

Gap year travel, or travel during a year off from academic studies, is increasingly popular and can also be associated with travel-related health risks. Medical, nursing, or veterinary students studying abroad can be at increased risk for acquiring bloodborne pathogens or zoonotic infections, and students participating in humanitarian activities could experience stress-related problems and environmental hazards. The purpose of travel and the student’s planned activities should be captured at the pretravel consultation as part of the risk assessment.

Resources for students preparing to travel abroad include their institution’s study abroad program administrators, health care providers at a pretravel consultation, and other students who have returned from a similar trip (see Table 9-03 for additional, online study abroad resources). Appropriate preparation can help students stay healthy during travel and reduce the chances they will become ill or engage in behaviors abroad that can place their health at risk.

Predeparture Preparation

Health Care Providers: Roles & Responsibilities

When conducting pretravel consultations with student travelers, cover the core topics of risk assessment, risk mitigation, and preparation to respond effectively to health and safety problems while abroad (see Sec. 2, Ch. 1, The Pretravel Consultation). Make recommendations about vaccines, prophylaxis and self-treatment medications, provide information on country-specific health risks, and give guidance on how to obtain medical and dental care while abroad. Remind students who will be traveling abroad for >90 days to fill any prescriptions for the duration of their trip before they leave the United States and to pack a travel health kit (see Sec. 2, Ch. 10, Travel Health Kits).

Other relevant topics to discuss include alcohol and illicit drug use and dependency; bloodborne pathogen precautions (e.g., avoiding acupuncture, blood products, needles, piercings and tattoos, surgeries) while traveling; gender and sex-related health issues, including information for lesbian, gay, bisexual, transgender, queer (LGBTQ+) students; managing stress and other mental health issues associated with international travel (e.g., culture shock, altered sleep patterns, jet lag); and practicing safe sex, including what to do in the event of pregnancy. Share information on how to prevent unintentional injuries (see Sec. 4, Ch. 12, Injury & Trauma). Provide additional recommendations for students with disabilities or special needs (see Sec. 3, Ch. 2, Travelers with Disabilities), students with preexisting health conditions (see Sec. 3, Ch. 3, Travelers with Chronic Illnesses), and students participating in humanitarian activities (see Sec. 9, Ch. 5, Humanitarian Aid Workers).

Students should purchase travel insurance that covers major medical, evacuation, and repatriation (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance); “study abroad” insurance plans might be available through the school or parent institution and could provide a reasonable, cost-effective option. Encourage student travelers planning adventure activities (e.g., kayaking, skydiving) to include extreme sports coverage on their health insurance policy (see Sec. 9, Ch. 11, Adventure Travel). All students should register with the Department of State’s Smart Traveler Enrollment Program (STEP) and check the Centers for Disease Control and Prevention Travelers’ Health website destination pages for destination-specific advice (e.g., best practices for disease prevention, outbreak information) before departure.

Study Abroad Programs: Roles & Responsibilities

Study-abroad professionals should share instructions with students about whom to contact in the study abroad program in the event of emergency and nonemergency situations. If telehealth services are planned, the program should address internet connectivity and concerns about legal health jurisdiction prior to departure (see Sec. 2, Ch. 16, Telemedicine). The program might need contingency plans in the event of a disease outbreak or civil unrest. Study-abroad staff also should encourage students to familiarize themselves with codes of conduct for their home and host institutions, as well as local health and safety issues, cultural norms, laws, and political climate. Additionally, program staff should inform students and families about the responsibilities and qualifications of chaperones accompanying a study abroad program.

Specific Issues

Alcohol & Illicit Drugs

A lower minimum drinking age and cultural acceptability of alcohol consumption in the host country, combined with stress or mental health issues, can lead to increased alcohol consumption among students when abroad. Use and abuse of alcohol and illicit drugs pose serious health consequences, can increase the risk for accidents and injuries, and make students potential targets for crime and incarceration (see Sec. 3, Ch. 5, Substance Use & Substance Use Disorders). Moreover, availability or use of recreational drugs (e.g., cannabis) by citizens of host countries might not necessarily mean their use is legal for international travelers.

Although cannabis is legal under certain US state laws, its use continues to be illegal under US federal law. US airports and airlines operate under federal jurisdiction and, as such, do not recognize the medical marijuana laws or cards of any state. In countries outside the United States where cannabis is illegal, students found in possession of the drug—even those with a valid US prescription—can be arrested; if found guilty, they could be deported, fined, or imprisoned. The International Narcotics Control Board has country-specific information for students with prescription medications containing controlled substances.

Both health care providers and study abroad program personnel should counsel students about the consequences of alcohol and illicit drug use. Study abroad programs should strongly discourage all illicit drug use. Advise students to drink alcohol responsibly and in moderation, and to seek medical attention if they feel ill after drinking.

Bloodborne Pathogens

Students planning to provide medical, nursing, or veterinary care overseas should receive hepatitis B vaccination or have evidence of immunity. Inform these travelers about what to do in the event of a needlestick injury. At the pretravel consultation, consider providing postexposure HIV prophylaxis for students to take with them in the event of a bloodborne exposure if they will be providing care in a country with high HIV prevalence (see Sec. 9, Ch. 4, Health Care Workers, Including Public Health Researchers & Medical Laboratorians). Psychological counseling is essential after an occupational bloodborne exposure. Provide information on blood safety in the event the traveler has an emergency or needs a blood transfusion (see Sec. 6, Ch. 2, Obtaining Health Care Abroad). Warn students of the risks associated with getting acupuncture, piercings, or tattoos while abroad; sterility of needles or ink cannot be guaranteed.

Emergency Contact Information Card

Students should always carry their personal information and important telephone numbers as hard copies and electronically in their mobile devices. The Center for Global Education offers a printable sample emergency contact card. For students with additional mental health or physical needs, provide written documentation of all health issues, prescribed medications, and recommended care plans; students should ensure that this letter gets translated accurately into the local language(s). Students should leave photocopies of all travel documents at home with their emergency contacts and the study abroad program office.

Gender-Related Issues

Students, including those who self-identify as LGBTQ+, should familiarize themselves with cultural attitudes, local laws, and tolerance of gender identification and sexuality in their host country (see Sec. 2, Ch. 13, LGBTQ+ Travelers). Check the US Department of State website and specific US embassy or consulate websites in countries and cities around the world to obtain information on host country laws.

The International Lesbian, Gay, Bisexual, Trans, and Intersex Association (ILGA World) publishes a map of sexual orientation laws by country, including protection against discrimination and criminalization of same-sex sexual acts. Additional research and planning might be needed to identify health care providers in the host country with experience working with LGBTQ+ people, if needed.

Mental Health

International travel can be stressful for students who might be inexperienced travelers, reliant on their home support systems, or traveling for longer periods of time. Culture shock, fear, insecurity, isolation, and loneliness can exacerbate existing mental health issues or unveil new ones (see Sec. 2, Ch. 12, Mental Health). When deciding on a destination for study, students should consider their preexisting level of mental (and physical) well-being and the availability of local resources. Encourage students to take an active role in planning for care abroad by disclosing all chronic mental health conditions and support needs during the pretravel consultation, and to the study abroad program office before departure.

Advise students to continue their routine medications while abroad; assist with developing a plan to manage a flare of symptoms while traveling (e.g., seeking local care, consulting with current providers, repatriation in the event of severe mental health issues). Students should confirm that mental health services are covered by their travel health insurance. Recommend that students engage in self-care abroad by getting regular exercise, establishing good sleep patterns, joining interest groups, and maintaining contact with family and friends at home.

Safer Sex

Discuss safer sex practices (e.g., birth control, condom use, emergency contraception, HIV preexposure prophylaxis [PrEP]) with international student travelers and provide information about the prevalence of sexually transmitted infections (STIs) at their destination. Students should follow local social norms about public displays of affection and dating to avoid possible adverse consequences; they also should be empowered to report any episode of sexual harassment or assault to local authorities, emergency contacts, and the study abroad program.

During & After Travel Considerations

During their time abroad, students should seek health care immediately if they become ill, injured, or have a bloodborne pathogen exposure. Students should adhere to food and water precautions (see Sec. 2, Ch. 8, Food & Water Precautions), and use insect repellent (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods) to prevent vectorborne diseases.

Students who become ill after returning home should alert health care providers about their international travel. Students with fever ≤1 year after returning from study or travel in malaria-endemic areas (see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country, and Sec. 5, Part 3, Ch. 16, Malaria) merit testing for malaria. Students with new sexual partners while abroad should be tested for STIs, including chlamydia, gonorrhea, HIV, and syphilis if they develop symptoms while abroad; they also should be screened for STIs when they return home.

After returning home, students will undergo a period of readjustment. All students should have access to mental health services after return to help cope with events that occurred overseas and to assist with reverse culture shock.