Stull et al.

BMC Public Health 2012, 12:553

http://www.biomedcentral.com/1471-2458/12/553

RESEARCH ARTICLE Open Access

Household knowledge, attitudes and practices

related to pet contact and associated zoonoses in
Ontario, Canada
Jason W Stull1,3*, Andrew S Peregrine1,3, Jan M Sargeant2,3 and J Scott Weese1,3

Abstract
Background: Many human infections are transmitted through contact with animals (zoonoses), including
household pets. Although pet ownership is common in most countries and non-pet owners may have frequent
contact with pets, there is limited knowledge of the public’s pet contact practices and awareness of zoonotic
disease risks from pets. The objective of this study was to characterize the general public’s knowledge, attitudes
and risks related to pet ownership and animal contact in southern Ontario, Canada.
Methods: A self-administered questionnaire was distributed to individuals at two multi-physician clinics in
Waterloo, Ontario, Canada during 2010. A single adult from each household was invited to participate in the study.
Results: Seventy five percent (641/853) of individuals approached completed the questionnaire. Pet ownership and
contact were common; 64% of participants had a pet in their household and 37% of non-pet owning households
had a member with at least weekly animal contact outside the home. Pet ownership was high (55%) for
households with individuals at higher risk for infections (i.e., < 5 yrs, ≥ 65 yrs, immunocompromised). Most
respondents (64%) indicated that they had never received information regarding pet-associated disease risks. When
given a list of 11 infectious pathogens, respondents were only able to correctly classify just over half on their
potential to be transmitted from pets to people (mean 6.4); independently, pet owners and those who recalled
receiving information in the past about this topic were able to make significantly more correct identifications. Pet
(36%) and non-pet owning households (10%) reported dog or cat bites or scratches during the preceding year.
Households with individuals at higher risk for an infection did not differ from the remaining households regarding
their perceived disease risk of pets, zoonotic disease knowledge, recall of being asked by their medical provider if
they owned any pets, or recall of having received information regarding pet-associated disease risks and preventive
measures.
Conclusions: These results suggest that there is a need for accessible zoonotic disease information for both pet
and non-owning households, with additional efforts made by veterinary, human and public health personnel.
Immediate educational efforts directed toward households with individuals at higher risk to infections are especially
needed.
Keywords: Zoonoses, Pet, Education, Knowledge, Bite, Scratch, Canada

* Correspondence: [email protected]
1
Department of Pathobiology, Ontario Veterinary College, University of
Guelph, Guelph, ON, N1G2W1, Canada
3
Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON,
N1G2W1, Canada
Full list of author information is available at the end of the article

© 2012 Stull et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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Background radiation therapy [24,25]. The increased disease risk for

Pet ownership is common. Although the proportion var- children is additionally imparted through closer physical
ies by continent and country, studies indicate that in most contact with household animals, reduced hand hygiene
countries the majority of households own pets [1–8]. and behaviours that include pica and exploration of
Cats and dogs are the most frequently owned pets, but the environment through mouthing. Not only are these
other species are often reported. A recent study esti- groups at increased risk for infection with a zoonotic
mated that 56% of Canadian homes have at least one dog pathogen, infection with many zoonotic pathogens is more
or cat, with a minority owning fish (12%), birds (5%), rab- likely to result in severe disease in high risk groups [24,25].
bits or hamsters (each 2%), lizards, guinea pigs, snakes, Pets often have frequent, close interactions with house-
frogs, turtles, ferrets, or gerbils (each 1%) [6]. In addition, hold members, such as licking of hands and sleeping in
people may come into contact with animals outside of beds [26], which can further increase pet-associated dis-
their homes such as in public settings (e.g., petting zoos, ease risks.
schools, fairs), through work-related activities, or recre- Many of the disease risks that occur with pet contact
ation (e.g., parks), yet little is known about the frequency can be eliminated or reduced through simple measures,
and nature of this type of animal contact. For the most such as hand hygiene, proper animal husbandry and al-
part, animal ownership and interaction is not discour- tered animal-contact behaviours. In order for infection
aged by healthcare professionals, as numerous studies prevention to be successful, however, individuals in con-
have confirmed the mental and physical benefits of pet tact with animals must be aware of these disease risks.
ownership and companionship [9], particularly among Thus, awareness of zoonotic disease risk is a prerequisite
children, the elderly and immunocompromised indivi- for effective disease prevention. To-date, few studies have
duals [10–16]. Thus, it is not surprising that several stud- evaluated the general public’s knowledge of pet-associated
ies have indicated that homes with children are more zoonoses [27,28]. A study conducted in 1986 revealed that
likely to have one or more pets than those without chil- many individuals in the general population lacked even
dren [3,17–19], and animal ownership practices of im- basic knowledge about zoonotic diseases (e.g., only 63%
munocompromised individuals appear to be similar to of household heads in De Kalb County, Georgia, USA
those of the general public [15,20,21]. Despite these believed pathogens from pets could be transmitted to
benefits, there are also potential health hazards asso- humans) [28]. A more recent study (2008) supported the
ciated with pet ownership and contact. earlier study’s findings of poor zoonotic disease knowledge
Animal bites are a serious public health problem, with by the general public (e.g., only 56% of dog owners in Bra-
an estimated 316,000 U.S. emergency room visits for a zos County, Texas, USA knew intestinal helminths could
dog bite-related injury in 2008 (rate: 104 visits per be transmitted from dogs to humans) [27]. Both studies
100,000 population) [22]. Dogs are responsible for ap- were limited in their geographic scope and did not inte-
proximately 80% of all bites, cats accounting for less grate human disease risk status (i.e., extremes of age, im-
than 20% and other pet species and wildlife responsible munocompromised), animal contact-related attitudes, and
for the remainder [23]. Bites may lead to painful disfig- zoonotic disease knowledge and risks. In addition, most
uring wounds, infection, altered function of the affected previous studies have only measured animal contact
area, and rarely death. Animal scratches can also have through pet ownership and did not include animal contact
important physical consequences depending on the area outside of the household. The objective of this study was
of the body affected. In addition to the physical damage to further characterize the general public’s household
of bites and scratches, pets can transmit pathogens to knowledge, attitudes and risks related to pet ownership
people (zoonoses). People can acquire pet-associated and animal contact. Furthermore, this study aimed to de-
zoonotic organisms through the skin and mucous mem- termine if those households with individuals at increased
branes (via animal bites, scratches, or other direct con- risk of disease differ in knowledge, attitudes, or practices
tact), contact with animal saliva, urine and other body from the remainder of the public.
fluids or secretions, ingestion of animal fecal material,
inhalation of infectious aerosols or droplets, and through Methods
arthropods and other invertebrate vectors [24]. Although Study location and selection of study sites
any exposed person can become infected with a zoonotic The site chosen for this study was the region of Water-
pathogen, risks are particularly high for those with a com- loo, located in southern Ontario, Canada. The Waterloo
promised or incompletely developed immune system, Region is composed of three urban and four rural muni-
such as the young (< 5 yrs), elderly (≥ 65 yrs), pregnant cipalities. This region was selected as it includes both
and those with immune function-reducing conditions or rural and urban settings and its population has similar
treatments, including diabetes, cancer, infection with demographics to the Province of Ontario and Canada as
human immunodeficiency virus (HIV), splenectomy and a whole. As of 2006, this region had a population of
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approximately 478,000 people in 178,000 private house- the respondent, a designation indicating if they or their
holds. The median age was 36.4 yrs, with 81% of the parents were born outside Canada, was assigned based
population aged 15 yrs and over, 6% less than 5 yrs, 12% on established criteria [31]. Demographic, health and in-
greater than 64 yrs, 22% immigrants and 13% of a visible jury information was requested for each individual who
minority (non-Caucasian in race or non-white in lived in the household at the time of completing the
colour). Average household size was 2.6 persons, with a questionnaire. The respondents’ general knowledge of
median annual income of $65,000 CAD [29]. These sta- zoonotic diseases was assessed by providing a list of in-
tistics are similar to those for the Province of Ontario fectious pathogens, diseases and syndromes (rabies, in-
and all of Canada, with the exception of a lower preva- testinal worms, human immunodeficiency virus (HIV)/
lence of visible minorities (23% for Ontario, 16% for acquired immune deficiency syndrome (AIDS), distem-
Canada) and a higher household median annual income per, Salmonella, Giardia, hepatitis, infectious diarrhea,
($60,000 for Ontario, $54,000 for Canada) [29]. ringworm, methicillin-resistant Staphylococcus aureus
In Canada, all residents receive medically necessary (MRSA), measles) and asking the respondents to indi-
healthcare services at no charge [30], thereby reducing cate which they believed could be transmitted from pets
the potential of biasing a study population drawn from to people. Components of this list were chosen based on
healthcare facilities. A convenience sample of multi- their use in previous studies [27,28] as well as the intent
doctor general practice physician offices located within to capture zoonotic and non-zoonotic pathogens that
the Waterloo region were approached to participate in are encountered or should be discussed with clients/
the study. Two practices, each with at least 4 physicians, patients with some frequency in veterinary or human
agreed to participate and were selected (clinic A in Kit- medicine. The syndrome infectious diarrhea was in-
chener, Ontario and clinic B in Cambridge, Ontario). cluded as it was used in a previous study [28] and to as-
sess the ability of respondents to recognize an important
Data collection syndrome verses a specific pathogen. A zoonotic disease
During 4 weeks in October and November, 2010, indi- knowledge score was calculated by summing the fre-
viduals present in the waiting areas of the participat- quency a participant correctly classified the diseases as
ing clinics between 9 am and 4 pm were individually pet-associated zoonoses (min-max: 0–11). A non-pet
approached by one of the authors (JWS) and invited household survey was created by discarding questions
to take part in the study. Individuals were eligible to specific to current pet ownership (Additional File 2:
participate if they were at least 18 yrs of age, able to Doc2). After agreeing to participate in the study, indivi-
read and speak English and no one from their house- duals were asked if they currently had any pets in their
hold had previously taken part in the study. Indivi- household and then provided with the appropriate ques-
duals who appeared to be in distress or pain were tionnaire. Household pets included pets that were in-
not approached. A single member from each household door only, outdoor only, and those that spent time both
was asked to complete an anonymous, confidential 10- indoor and outdoor. The study was approved by the
minute self-administered written questionnaire on-site University of Guelph’s Research Ethics Board.
or at a later time. Individuals in the latter group were
provided a stamped, addressed envelope to return the Data analysis
questionnaire. Data were entered into an Access database (Microsoft
A 5-page questionnaire was developed with guidance Corp., Redmond, WA, USA) and exported and analyzed
from epidemiologists, veterinarians, physicians and zoo- using Intercooled Stata version 10.1 (Stata Corp., College
notic disease experts. The questionnaire was piloted on Station, TX, USA). Descriptive statistics were computed
six members of the public with varying zoonotic disease for all variables and stratified by pet ownership. Blank
backgrounds and revised accordingly. The final ques- and “don’t know” responses were excluded from ana-
tionnaire utilized closed-ended, primarily multiple lyses. Statistical associations were assessed between pet
choice, questions (Additional File 1: Doc1). It gathered ownership and each variable. Associations with categor-
both individual and household-level data including ical variables were assessed using Pearson χ2 test or, if
demographics, pet and animal contact-related attitudes, any expected cell value was ≤ 1 or 20% or more expected
respondent knowledge of zoonotic diseases and sources cell values were ≤ 5, Fisher’s exact test [32]. The non-
for such information, the occurrence of animal contact parametric Cuzick test of trend was used for assessing
and pet-associated zoonotic disease and injury, health associations with ordinal variables. Student’s t-test as-
status of household members (i.e., ever diagnosed with suming unequal variances or, if a non-normal distribu-
HIV/AIDS, diabetes, cancer, hepatic cirrhosis, or other tion, the Mann–Whitney rank sum test was used for
cause for immune dysfunction) and types of pets (if any) assessing associations with continuous variables. The
in the household. The immigrant generation status of associations between respondents’ zoonotic disease
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knowledge score and the categorical variables (1) level suburban or rural areas and were less likely to have
of comfort with their zoonotic disease knowledge, and higher risk individuals living in the household (including
(2) previous receipt of information about pet-associated fewer elderly and individuals with an immunocompro-
zoonoses, were assessed using the one-way analysis of mising condition) as compared to non-pet owning
variance (ANOVA) test and Student’s t-test assuming households. Although households with elderly and im-
unequal variances (or Mann–Whitney rank sum test if munocompromised individuals were less likely to have
non-normal distribution), respectively. Multiple com- pets than households without these higher risk indivi-
parisons with Bonferroni adjustment were performed duals, pet ownership remained common (47% and 55%,
following a statically significant ANOVA test. The as- respectively). Diabetes and cancer (53% and 27% of im-
sociations between the presence of individuals at munocompromised respondents, respectively) were the
higher risk to infections (i.e., < 5 yrs, ≥ 65 yrs, im- most frequently reported immunocompromising condi-
munocompromised) in the household and select vari- tions, followed by “other cause” (9%); more than one
ables were assessed as stated above for continuous and cause (most frequently diabetes and cancer) were listed
categorical variables, while stratifying on pet ownership by the remaining immunocompromised respondents
as a potential confounder. When applicable, 95% confi- (11%). Respondents from pet owning households were
dence intervals (CI) were calculated using binomial statistically more likely to be female, younger and Cau-
exact methods. Statistical significance was based on a casian as compared to non-pet owning households.
P-value <0.05.
Pet and animal contact-related attitudes
Results Perceptions of pet ownership and zoonotic disease risk
During the 4-week period in which the survey was ad- varied significantly between pet and non-pet owning
ministered, 641 of the 853 individuals who were ap- households (Table 2). Amongst respondents from pet
proached (75.1%) completed the survey (114 refused, 98 owning households, significantly less concern was re-
did not return or complete the survey). The proportion ported for pet-associated disease for themselves and
responding was similar for both clinics [clinic A – 374/ household children than in non-pet owning households.
490 (76.3%), clinic B – 267/363 (73.6%)]. Twenty indivi- For both groups, a high percentage of respondents
duals were not approached as they appeared to be in (≥ 30%) reported they were not at all concerned about
pain or distress. Four hundred and eight respondents pet-associated disease. Households with young children
(63.7%; 95% CI: 59.8, 67.4) reported having one or more (< 5 yrs) and households with older children (5–15 yrs)
household pets. Dogs were the most frequently did not differ significantly in their concern for household
reported owned species (42.8% of respondents; 95% CI: children acquiring pathogens from pets (Fisher’s exact
38.9, 46.7), followed by cats (29.8%; 95% CI: 26.3, 33.5), test: pet owner: P = 0.13, non-pet owner: P = 0.32). Ap-
fish (8.3%; 95% CI: 6.3, 10.7), exotic companion ani- proximately one-third of respondents (n = 214) listed one
mals, such as gerbils and rabbits (4.5%; 95% CI: 3.1, or more pet-associated diseases that they considered to be
6.4), reptiles and birds (each 3.4%; 95% CI: 2.2, 5.2). of greatest concern to them. The majority of respondents
Cats or dogs were owned by 93% (379/408) of the pet were most concerned about rabies (n = 84; 39%) or endo/
owners. ecto parasite-derived disease (n = 85; 40%). Bacterial
(n = 26; 12%) and viral (excluding rabies) pathogens
Demographics (n = 17; 8%) were less frequently listed, with Salmonella,
Demographics on a total of 1,971 household members Escherichia coli and influenza virus being the most com-
were provided by the respondents. Demographics varied mon in those categories. Allergies/asthma (n = 11; 5%) and
slightly from reported statistics for the region, with a ringworm (n = 7; 3%) were also listed.
median age of 33 yrs, 77% aged 15 yrs and older, 8% less Households with pets were significantly more likely to
than 5 yrs, 8% greater than 64 yrs, 6% non-white, mean consider pets an important part of a family and believed
household size of 3.1 persons and median category for the benefits of owning a pet were greater than pet-
annual household income between $80,000 and associated health risks (Table 2). Although less frequent,
$120,000 CAD. Statistically significant associations were the majority of non-pet owning households stated they
observed between pet ownership and respondent sex, agreed or strongly agreed that pets are an important part
age, race, residence classification, number of individuals of the family (84%) and that the benefits of pet owner-
living in the household and presence of individuals at ship outweigh any health risks (67%). Households with
increased risk for acquiring an infectious disease living high risk individuals (i.e., <5 yrs, ≥ 65 yrs, immunocom-
in the household, including elderly and those with an promised) and without these individuals did not differ
immunocompromising condition (Table 1). Pet owning significantly in their beliefs regarding the benefits and
households tended to have more individuals, live in risks of pet ownership (Pearson χ2: pet owner: P = 0.54,
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Table 1 Demographics for survey respondents (Ontario, Canada; N = 641)

Variables Number Pet currently present in household P-value1
respondents (N)
Yes, N (%) No, N (%)
Respondent’s sex 638 0.011
Male 93 (56) 74 (44)
Female 314 (67) 157 (33)
Respondent’s age (years) 637 < 0.0012
Mean (SD) 44.1 (14.1) 48.8 (17.2)
Median (range) 44 (17–89) 49 (16–86)
Respondent’s race 616 < 0.001
White 380 (66) 200 (34)
Other3 11 (31) 25 (69)
Immigrant generation status of respondent4 595 0.27
First 45 (58) 32 (42)
Second 61 (70) 26 (30)
Third or more 269 (62) 162 (38)
Self-reported residence classification 632 < 0.001
City 263 (62) 161 (38)
Suburban 72 (75) 24 (25)
Town 31 (48) 34 (52)
Rural 38 (81) 9 (19)
Total household income during past 12 months (before taxes and deductions)
532 0.065
Less than Can$20,000 14 (61) 9 (39)
Between Can$20,000 and Can$39,999 46 (63) 27 (37)
Between Can$40,000 and Can$79,999 96 (58) 70 (42)
Between Can$80,000 and Can$120,000 104 (68) 49 (32)
More than Can$120,000 83 (71) 34 (29)
Highest level of education attained by anyone currently living in household
607 0.346
Elementary school 1 (25) 3 (75)
High school certificate, diploma, or equivalent 66 (68) 31 (32)
College, trade or other non-university 141 (64) 79 (36)
certificate or diploma
University certificate, diploma or degree 180 (63) 106 (37)
Number of individuals living in household 641 <0.0012
Mean (SD) 3.2 (1.4) 2.8 (1.5)
Median (range) 3 (1–9) 2 (1–8)
Children under 16 yrs living in household 641 0.10
Yes 183 (67) 89 (33)
No 225 (61) 144 (39)
Children under 5 yrs living in household 641 0.24
Yes 64 (59) 45 (41)
No 344 (65) 188 (35)
Adults ≥ 65 yrs living in household 641 <0.001
Yes 56 (47) 63 (53)
No 352 (67) 170 (33)
Anyone currently living in household ever diagnosed with an immunocompromising condition
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Table 1 Demographics for survey respondents (Ontario, Canada; N = 641) (Continued)

540 0.008
Yes 94 (55) 78 (45)
No 245 (67) 123 (33)
One or more individuals living in household < 5 yrs, ≥ 65 yrs, or ever diagnosed with an immunocompromising condition
572 <0.001
Yes 184 (55) 151 (45)
No 173 (73) 64 (27)
1
P-value for Pearson χ test, unless otherwise stated.
2
2
Mann–Whitney rank sum test.
3
Includes Arab, Black, Chinese, Filipino, Japanese, Latin American, South Asian, Southeast Asian, Western Asian, Other.
4
First generation, defined as born outside Canada; second generation, defined as born inside Canada with at least one parent born outside Canada; third
generation or more, defined as born inside Canada with both parents born inside Canada [31].
5
Non-parametric Cuzick test of trend.
6
Fisher’s exact test.

non-pet owner: P = 0.61). Ninety-three percent of pet- knowledge-base had higher knowledge scores than those
owners stated that removal of one or more pets would who were less comfortable. However, in pair-wise com-
negatively affect people in their household. parisons, only the two extreme comfort levels, “strongly
agree” (mean score = 6.7) and “strongly disagree” (5.9),
Zoonotic disease knowledge and educational sources differed significantly (P = 0.020). These associations were
When provided a list of 11 infectious pathogens, dis- not observed for non-pet owners (P = 0.47).
eases and syndromes, participants were able to correctly A minority of respondents (22%) reported ever being
classify just over half on their potential to be transmitted asked by a medical doctor or their staff if they owned a
from pets to people [mean zoonotic disease knowledge pet, while 6% reported a medical doctor or staff had at
score (SD) = 6.4 (1.4)], with a significant difference be- some point discussed the possible benefits of pet owner-
tween pet and non-pet owners (6.5, 6.2 respectively; ship; for both, pet owners more frequently reported
Table 3). Households with and without high risk indivi- these findings than non-pet owners (Table 3). House-
duals did not differ significantly in their mean zoonotic holds with and without high risk individuals did not
disease knowledge score (t-test: pet owner: P = 0.15, differ significantly in their reporting of ever being asked
non-pet owner: P = 0.64). Rabies and measles were most if they owned a pet (Pearson χ2: pet owner: P = 0.33;
often classified correctly (≥ 95%), while Giardia and non-pet owner: P = 0.80). Approximately 30% of respon-
MRSA were least frequently classified correctly (≤ 9%). dents reported ever receiving information from any
Significant differences in correct classification between source about diseases acquired from pets or precautions
pet and non-pet owners were observed for several of the to take with pets to reduce the risk of these diseases,
pathogens, diseases and syndromes, including Salmon- with a significantly higher percentage among pet owners
ella, Giardia and hepatitis, with pet owners more fre- as compared to non-pet owners (36%, 21%). Households
quently correctly categorising Salmonella and Giardia. with and without high risk individuals did not differ
Seventy percent of respondents were comfortable with significantly in reporting they had ever received this
their level of understanding of zoonotic diseases acquired information (Pearson χ2: pet owner: P = 0.89; non-pet
through pet contact, while 65% were comfortable with owner: P = 0.96). Respondents who reported they had
their level of understanding of ways to prevent such dis- received information in the past had a significantly
eases (Table 3). Significant associations were observed higher mean zoonotic disease knowledge score than
with pet ownership for both disease knowledge and pre- those who reported they had not [t-test; pet owners: 6.7
vention comfort levels, with pet owners being more likely vs. 6.3 (P = 0.018); non-pet owners: 6.8 vs. 6.1
to be comfortable with their level of understanding. (P = 0.008)]. As the content of pet-associated disease
Households with and without high risk individuals did education typically focuses only on diseases that are
not differ significantly in their disease knowledge and zoonotic, without discussing diseases that are not,
prevention comfort levels (Pearson χ2: pet owner: P = analysis was repeated calculating the zoonotic disease
0.20, P = 0.67; non-pet owner: P = 0.24, P = 0.26, respect- knowledge score for only the subset (7) of the patho-
ively). For pet owners, level of comfort with understanding gens, diseases and syndromes that are zoonotic. A
of zoonotic disease was significantly positively associ- similar finding was observed, with those who reported
ated with zoonotic disease knowledge score (ANOVA; receiving information having a significantly higher
P = 0.034); those who were more comfortable with their rank sum knowledge score than those who reported
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Table 2 Pet and animal contact-related attitudes of survey respondents (Ontario, Canada; N = 641)
Variables Number Pet currently present in household P-value2
respondents (N) 1 1
Yes, N (%) No, N (%)
How concerned are you that household children could catch a disease from your pets or pets of friends or family?3
268 0.001
Very concerned 9 (5) 10 (12)
Concerned 9 (5) 8 (9)
Somewhat concerned 14 (8) 13 (15)
Minimally concerned 69 (38) 29 (34)
Not at all concerned 81 (45) 26 (30)
How concerned are you that you could catch a disease from your pets or pets of friends or family?3
612 <0.001
Very concerned 12 (3) 14 (7)
Concerned 18 (4) 21 (10)
Somewhat concerned 29 (7) 29 (14)
Minimally concerned 140 (35) 59 (28)
Not at all concerned 204 (51) 86 (41)
Pets are an important part of the family
618 < 0.001
Strongly agree 340 (84) 76 (36)
Somewhat agree 62 (15) 101 (48)
Somewhat disagree 4 (1) 20 (9)
Strongly disagree 1 (0.3) 14 (7)
Benefits of owning a pet are greater than any health risks that occur with owning a pet
601 <0.001
Strongly agree 242 (61) 56 (28)
Somewhat agree 108 (27) 79 (39)
Somewhat disagree 37 (9) 37 (18)
Strongly disagree 11 (3) 31 (15)
Removal of one or more of my pets would negatively affect people in my household
401
Strongly agree 300 (75) ——
Somewhat agree 73 (18) ——
Somewhat disagree 18 (4) ——
Strongly disagree 10 (2) ——
1
Percentages in column may not sum to 100 % due to rounding.
2
P-value for non-parametric Cuzick test of trend.
3
Category “no contact with pets” removed from analysis due to low frequency.

they had not [Mann–Whitney rank sum test; pet owners’ listed, pet and non-pet owners named veterinarians and
median scores: 3 vs. 3 (P = 0.002); non-pet owners’ median the Internet as the most “useful” sources. Of the 82% of
scores: 3 vs. 2 (P = 0.0006)]. Sources providing this pet-owners who had taken a pet to the veterinarian in the
information varied between pet and non-pet owners, with past 12 months, only 27% reported having ever received
veterinarians (73%), the Internet (32%), books (29%), information from a veterinarian about pet-associated zoo-
television/newspaper/magazine (20%) and family physi- notic diseases. Pet and non-pet owners believed veter-
cians (20%) being the most common for pet owners; the inarians, family physicians and public health personnel (in
Internet (38%), friends/relatives (35%), family physicians that order) should be responsible for providing zoonotic
and veterinarians (each 29%) and books and television/ disease information to the public, with 86% of pet-owners
newspaper/magazine (each 25%) most commonly reported and 56% of non-pet owners looking toward veterinarians
for non-pet owners. When two or more sources were for this information.
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Table 3 Zoonotic disease knowledge and educational sources of respondents (Ontario, Canada; N = 641)
Variables Number Pet currently present in household P-value2
respondents (N) 1 1
Yes, N (%) No, N (%)
Which of the following diseases do you think can be transmitted from pets to people?
599
Rabies* 374 (96) 198 (94) 0.15
Intestinal worms* 214 (55) 103 (49) 0.14
HIV/AIDS 43 (11) 14 (7) 0.076
Distemper 43 (11) 19 (9) 0.43
Salmonella* 146 (38) 51 (24) 0.001
Giardia* 37 (10) 9 (4) 0.021
Hepatitis 52 (13) 17 (8) 0.050
Infectious diarrhea* 98 (25) 47 (22) 0.42
Ringworm* 215 (55) 103 (49) 0.12
Methicillin-resistant Staphylococcus 36 (9) 18 (9) 0.76
aureus (MRSA)*
Measles 14 (4) 12 (6) 0.23
Mean knowledge score (SD)3 6.5 (1.4) 6.2 (1.4) 0.0234
I am comfortable with my level of understanding of possible diseases that can occur with pet contact
577 <0.0015
Strongly agree 136 (35) 32 (17)
Somewhat agree 146 (38) 90 (47)
Somewhat disagree 65 (17) 43 (22)
Strongly disagree 37 (10) 28 (15)
I am comfortable with my level of understanding of ways to reduce diseases that can occur with pet contact
567 <0.0015
Strongly agree 121 (32) 26 (14)
Somewhat agree 143 (38) 81 (42)
Somewhat disagree 72 (19) 48 (25)
Strongly disagree 40 (11) 36 (19)
Medical doctors or their staff ever discussed the possible benefits of owning or keeping a pet
630 0.003
Yes 31 (8) 7 (3)
No 338 (84) 213 (93)
Don’t remember 33 (8) 8 (4)
Medical doctors or their staff ever asked if you owned any pets
630 0.029
Yes 99 (25) 39 (17)
No 243 (60) 139 (61)
Don’t remember 61 (15) 49 (22)
Ever received information from any source about diseases that you can get from pets or precautions to take with pets to reduce the risk of disease
630 < 0.001
Yes 145 (36) 48 (21)
No 227 (56) 162 (72)
Don’t remember 33 (8) 15 (7)
Sources that provided 190 NP
this information6
Family physician 28 (20) 14 (29)
Specialist physician 13 (9) 2 (4)
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Table 3 Zoonotic disease knowledge and educational sources of respondents (Ontario, Canada; N = 641) (Continued)
Nursing staff 6 (4) 4 (8)
Public health personnel 13 (9) 9 (19)
Veterinarian 103 (73) 14 (29)
Pet store 27 (19) 6 (13)
Animal breeder 14 (10) 1 (2)
Friends/relative 27 (19) 17 (35)
Internet 45 (32) 18 (38)
Books 41 (29) 12 (25)
Television/ newspaper/ magazines 29 (20) 12 (25)
Other 5 (4) 3 (6)
Most useful source 100 NP
(when 2 or more)
Family physician 1 (1) 2 (8)
Specialist physician 4 (5) 1 (4)
Public health personnel 1 (1) 1 (4)
Veterinarian 45 (59) 7 (29)
Pet store 1 (1) 0
Animal breeder 3 (4) 0
Friends/relative 2 (3) 4 (17)
Internet 8 (11) 5 (21)
Books 7 (9) 2 (8)
Television/ newspaper/ magazines 3 (4) 1 (4)
Other 1 (1) 1 (4)
Who do you believe should be responsible for providing information about diseases that can occur with pet contact?6
627 NP
Family physician 190 (47) 121 (55)
Specialist physician 26 (6) 15 (7)
Nursing staff 28 (7) 20 (9)
Public health personnel 127 (31) 120 (54)
Veterinarian 350 (86) 125 (56)
Breeder/ pet store/ shelter 18 (4) 10 (5)
Self 15 (4) 0
Media 3 (1) 8 (4)
None 34 (8) 22 (10)
Other 2 (0) 2 (1)
1
Percentages in column may not sum to 100 % due to rounding.
2
P-value for Pearson χ2 test, unless otherwise stated.
3
Calculated as the frequency participants correctly classified the listed diseases as transmitted from pets to people (Min-Max possible score: 0–11).
4
Student’s t-test, assuming unequal variances.
5
Non-parametric Cuzick test of trend.
6
Categories sum to greater than 100 % as some participants listed more than one category.
* Pathogens/syndromes transmitted from pets to people.
NP: Statistical analysis not performed.

Zoonotic disease risks owners and 10% of non-pet owners (P < 0.001) claimed
Four percent of respondents reported that someone in someone in their household had been bitten or scratched
their household had at some point acquired a disease by a dog or cat, resulting in a wound where the skin was
from a pet, with no statistical difference between pet and broken. Scratches were more common than bites, with
non-pet owners (Table 4). The most frequently reported the household pet often involved in pet owning house-
pathogen was ringworm (40%), followed by “worms” holds. Thirty one individuals from 27 households were
(12%). During the preceding 12 months, 36% of pet- reported being bitten by a dog during the preceding
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Table 4 Zoonotic disease risks for respondent households (Ontario, Canada; N = 641)
Variables Number Pet currently present in household P-value1
respondents (N)
Yes, N (%) No, N (%)
Has anyone in your household ever caught a disease from a pet?
633 0.74
Yes 14 (3) 9 (4)
No 392 (97) 218 (96)
During the past 12 months, has anyone in your household been bitten or scratched by any dog or cat, where the skin was broken?
616 <0.001
Yes 144 (36) 22 (10)
No 252 (64) 198 (90)
Type of injury2 166 NP
Scratched by own dog 53 (37) 3 (14)
Scratched by another dog 14 (10) 7 (32)
Bitten by own dog 15 (10) 1 (5)
Bitten by another dog 5 (3) 7 (32)
Scratched by own cat 68 (47) 3 (14)
Scratched by another cat 14 (10) 8 (36)
Bitten by own cat 24 (17) 2 (9)
Bitten by another cat 6 (4) 2 (9)
Does anyone in your household regularly (at least weekly) have physical contact with animals in places outside of the home?
573 0.68
Yes 128 (35) 76 (37)
No 238 (65) 131 (63)
Type of animal/location (subset listed) 204 NP
Dog and/or cat at friend’s or relative’s residence 80 (63) 51 (67)
Farm animals at work, lessons, or friend’s residence 17 (13) 2 (3)
Reptile at friend’s residence or work 3 (2) 1 (1)
Wildlife 1 (1) 1 (1)
Plan on acquiring a new pet in the next year
621 0.95
Yes 41 (10) 24 (11)
No 353 (90) 203 (89)
1
P-value for Pearson χ2 test.
2
Categories sum to greater than 100 % as some participants listed more than one category.
NP: Statistical analysis not performed.

12-months (number per household: median = 1; range = Approximately 10% of both pet and non-pet owners
1-2), corresponding to 1.6% (31/1971) of all reported planned on acquiring a new pet in the next year.
household members.
Thirty six percent of all respondents stated that some- Discussion
one in their household had physical contact with animals This study aimed to characterize household knowledge,
outside the home on a weekly basis. Pet ownership was attitudes and risks related to pet ownership and animal
not associated with animal contact outside the house. contact in Ontario, Canada. Despite the importance of
The most frequently reported type of contact outside of this topic due to the potential injury and disease risks
the home involved cats or dogs at a friend’s or relative’s posed by pets, the high proportion of households that
residence (63% pet owners; 67% non-pet owners), fol- own pets, and the close interaction pets often have with
lowed by farm animals (13% pet owners; 3% non-pet household members, few studies [27,28] have evaluated
owners). Contact with reptiles or wildlife (e.g., raccoons, this area. Furthermore, this study is unique in that it
skunks) outside of the home were infrequently reported broadly addresses animal contact within and outside the
for both pet and non-pet owners (≤ 2% each). home, and integrates household demographics, including
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human disease risk status (i.e., extremes of age, im- third of respondents reported having ever received infor-
munocompromised), animal contact-related attitudes mation about pet-associated diseases or precautions to
and zoonotic disease knowledge and risks. reduce the risk of these diseases. As previously noted
The animal ownership patterns we observed were con- [27,36], veterinarians and the Internet were most fre-
sistent with those previously reported for the surround- quently reported as providing this information to pet
ing area [19] and country [6], with over 63% of and non-pet owners, respectively. Only 25% of pet own-
households having one or more pets. Similar to a previ- ers recalled ever being asked by a physician or their staff
ous study [33], over 75% of respondent households had if they owned pets. The limited involvement of physicians
one or more members that had frequent animal contact and public health was not surprising. Several studies have
through household pets, animals outside the home, or indicated that physicians often rely on veterinarians for
both. These results highlight the common occurrence of advising the public about the potential for zoonotic dis-
direct animal exposure for the public. The perceived ease and thus discuss this topic with their patients less
benefits from pet ownership and contact were evident as frequently than veterinarians [37,38]. Although physi-
both pet and non-pet owners believed that the benefits cians believe educating patients about pet-associated
of pet ownership outweigh disease risks. health hazards is important, time constraints and com-
In order to assess zoonotic disease knowledge, respon- peting health messages were often cited for not doing so
dents were provided a list of infectious pathogens, dis- [39]. Similarly, although veterinarians were an important
eases and syndromes and asked to indicate which were source for zoonotic disease information in this study,
transmitted from pets to people. The decision as to there appear to have been many missed opportunities by
which of the listed pathogens, diseases and syndromes the profession. Analogous to a previous study [27], only
were pet-associated was based on the best available 27% of the individuals who had been to a veterinarian in
knowledge at the time the survey was administered. the past year indicated they had ever received zoonotic
Pathogens that could be transmitted from pets to people, disease information from a veterinarian.
even though the majority of such human infections are Although statistically significant, the mean zoonotic
acquired from non-pet sources (i.e., Salmonella, Giardia, disease knowledge score of pet owners was only margin-
MRSA) were considered pet-associated zoonoses. Hepa- ally greater than non-pet owners (6.5, 6.2 respectively).
titis was not considered pet associated, as Hepatitis A, B The similar scores between the two groups implies that
and C are non-zoonotic and Hepatitis E has only re- the additional resources available to pet owners (e.g.,
cently been thought to be transmitted from animals and veterinarians, targeted education provided by physicians
the scientific community has yet to resolve if pets play and public health) may not effectively provide a large
any role in human infection [34,35]. amount of additional knowledge. Further efforts by these
We found considerable variation in the respondents’ groups, such as readily available educational materials
ability to correctly classify different pathogens. As has on this topic provided in waiting rooms and during
been previously reported [27,28], the public appears to office visits are important. A recent study reported that
be well-informed of the potential for rabies transmission 43% of surveyed veterinarians did not have client educa-
from pets (95% answered correctly), however, is less tional materials on zoonotic diseases available in their
informed about less severe but more common patho- practices [40]. Due to the ever-increasing use of the
gens, diseases and syndromes, such as ringworm, Internet for personal and animal health information
Salmonella and infectious diarrhea (53%, 33%, 24% [41], it is critical to ensure reliable resources are also
answered correctly, respectively). Equally alarming, were available on-line.
the human or pet-specific diseases believed to be trans- From our results, it was evident that both the human
missible between species (i.e., HIV/AIDS, distemper, and veterinary fields have room for improvement in pa-
each 10%). As awareness of zoonotic disease risk is a tient/client education. Furthermore, increased communi-
prerequisite for effective prevention, the limited zoonotic cation between professions is needed to improve overall
disease knowledge of the public is a concern. Despite an zoonotic disease knowledge and develop optimal ap-
increased awareness by researchers over the past several proaches for reducing pet-associated pathogen transmis-
decades of the wide scope and magnitude of zoonotic sion and injury in households. These conclusions are
diseases, the public’s knowledge appears to have changed supported by previous studies that indicate that the ma-
little; our findings are consistent with those of a 1986 jority of veterinarians and physicians do not regularly
study [28] that reported similar proportions for the discuss zoonotic disease risks with clients, patients or
public’s correct classification of rabies, ringworm and each other [37,38,40,42]. The utility of such discussions
infectious diarrhea as pet-associated zoonoses. was evident in our study, as respondents who recalled
The low zoonotic disease awareness observed by re- having received zoonotic disease information in the past
spondents was perhaps not surprising as less than one- had a higher mean zoonotic disease knowledge score
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compared to those who had not. While there was no as- Veterinarians may also be reluctant to venture into
sessment of the type, timing and quality of information aspects of human health.
that was provided, this finding suggests that general zoo- A relatively low proportion (4%) of households
notic disease counselling can have a positive impact. reported having had a family member acquire a disease
Pet and non-pet owners were, for the most part, not from a pet. The accuracy of this estimate is unclear,
concerned about pet-associated zoonoses and were com- since it is prone to recall bias and various other factors
fortable with their level of knowledge and methods to that make it difficult to determine if an infection was
reduce zoonotic disease risk. As individuals who are not truly acquired from a pet (e.g., multiple routes of trans-
concerned, and are comfortable with their knowledge- mission for many zoonotic pathogens, subclinical shed-
base may be unlikely to seek additional knowledge from ding of pathogens by pets). The potential risk of
available resources, active methods may be required to zoonotic infection and injury, however, were clearly
improve awareness of pet-associated zoonoses. Such noted in our study with a high proportion (27%) of
methods may include brief waiting room surveys to as- households reporting one or more dog or cat-derived
sess disease knowledge and high-risk behaviours, fol- bites or scratches during the previous 12 months. This
lowed by improved physician and veterinarian-directed result is alarming, as such injuries can have serious
review of pet-associated zoonoses with patients/clients. health consequences. Previous studies vary widely in the
For pet owners, a significant positive association was reported incidence of animal bites, with most variation
observed between an individual’s zoonotic disease score likely due to the population sampled and sampling
and their level of comfort with their knowledge on this methods used [23]. A U.S. study that used a telephone
subject. Thus, for pet owners, inquiring about their level survey estimated a national annual incidence of self-
of comfort with this topic may be a reliable screening reported dog bites of 1.8% (18 per 1000 population) [45];
tool for identifying those in greatest need of additional by far the highest incidence reported to-date [23]. Our
education. study found 1.6% of all household members sustained a
Pet ownership was common in households with indivi- self-reported dog bite during the previous 12 months.
duals at higher risk of infections (e.g., < 5 yrs, ≥ 65 yrs, The high incidence of dog bites in our sample is unlikely
immunocompromised). Based on the limited studies that to be due to differences in case definitions or sampling
have previously surveyed this topic for the immunocom- bias as we requested data only on bites that broke the
promised [15,20] and extremes of age [19,33,43,44], this skin; the proportions of pet ownership and presence of
finding was expected, and given the positive aspects of children in the households, two commonly reported risk
pet contact, this in itself was not particularly concerning. factors for dog bites [23], were similar to previous
However, it was concerning that households with higher reports and census data for the region. This finding war-
risk individuals did not differ from the remaining house- rants further evaluation by additional studies to confirm
holds regarding their perceived risk of pet-associated the elevated rate and determine potential risk factors. In
disease, zoonotic disease knowledge score, recalling the interim, educational resources addressing safe pet
being asked by a medical provider if they owned any interaction and bite/scratch prevention strategies are
pets, or recalling having received information regarding strongly needed for this population.
pet-associated disease risks and preventive measures. We acquired our data as a convenience sample from
This suggests a troubling (but perhaps unsurprising) lack the waiting rooms of general practice physician offices in
of recognition or knowledge of the potential for pet- Ontario, Canada. All Canadian residents receive medic-
associated zoonoses. A history of contact with pets in ally necessary healthcare services at no charge [30], re-
the home and animal contact outside the home should ducing the potential that variable access to physicians
be part of every physician’s wellness evaluation, espe- would result in a biased study population. Despite this,
cially for individuals at higher risk of zoonotic disease. it is possible our source population or derived sample
Primarily relying on veterinarians for providing pet- were not representative of the surrounding general
associated disease information is problematic for several population. Barriers in access to health care services that
reasons. As noted by our study, animal contact fre- may disproportionately affect different groups, such as
quently occurred in both pet and non-pet owning house- new immigrants [46], over-representation of groups typ-
holds; many individuals with animal contact in the latter ically in need of increased health care visits, such as the
group will likely not consult a veterinarian. In addition, young, elderly, or immunocompromised, or use of a
veterinarians are often unaware of their clients’ immune non-randomized sampling approach were potential con-
status [37,40] and arguably other attributes of higher risk cerns. However, based on census data, our sample
households (such as extremes of age). Without this in- appeared to be representative of the region, with the ex-
formation, veterinarians are unable to adequately inform ception of a lower percentage of visible minorities and
and council clients on their household disease risks. over representation of higher income households. The
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finding that 59% of households had one or more indivi- possible that zoonotic disease knowledge, attitudes and
duals at higher risk of infectious disease was reasonable practices may vary by species owned, and by classifying
as the proportions of our sample < 5 yrs (8%) and households simply as pet and non-pet owners systematic
≥ 65 yrs (8%) were consistent with census data for the (bias) or nonsystematic error may have been introduced.
region (6% and 12%, respectively); the proportion of However, since cats or dogs were owned by 93% of the
households with immunocompromised members (32%) pet owners and other species were infrequently reported,
may be expected based on estimates for the United any such error was likely minimal.
States [47] and the expected prevalence of immunocom-
promising conditions, such as diabetes [48], for the Conclusions
population in the Waterloo region. This study characterized household knowledge, attitudes
Bias may have been introduced into our study. and risks related to pet ownership and animal contact in
Possible sources of bias include differences between Ontario, Canada. Despite frequent pet contact reported
respondents and non-respondents (however the high within and outside the house, awareness of the zoonotic
response proportion of 75% makes this less likely) and risks from pets was limited and no greater in households
the self-administered nature of the questionnaire where with people at increased risk of infection. Educational
questions may have been misinterpreted (misclassifica- efforts by human, veterinary and public health personnel
tion). In addition, respondents’ ability to recall informa- were infrequently recalled. As awareness of disease risk
tion or activities typically deteriorates as time elapses, is a prerequisite for effective disease prevention, further
with better recall for more recent experiences. For this efforts by these key groups are needed, such as readily
reason, it is possible the reported medical interactions available educational materials provided in waiting rooms
(i.e., ever asked by a physician if they owned pets, ever and accessible via the Internet, as well as active meth-
received zoonotic disease information from a physician) ods, such as discussions during office visits. Animal bite
are more reflective of the staff at the two surveyed and scratch-based health risks are likely the greatest con-
clinics than other medical staff used by respondents cern and materials should highlight these areas. Immedi-
previously. Due to the descriptive nature of the study, ate educational efforts are especially needed for households
analysis relied primarily on univariable statistics, not with individuals at higher risk of infections. Given the
accounting for possible correlation between the time constraints on healthcare professionals, techniques
variables. Furthermore, pet ownership was associated such as waiting room surveys and newsletters may be
with several demographics, as previously reported [27], helpful in initiating discussions with clients/patients. Both
that may have confounded the observed associations veterinarians and physicians are part of the family health-
between pet ownership and attitudes, knowledge, or care team and must work together to reach the common
behaviours. Since this was a cross-sectional study, there goal of reducing the public’s pet-associated disease risks.
are no data on the sequence of events relating to Finally, intervention studies, piloting various educational
variables such as knowledge score. materials and methods for distributing these materials,
We queried if respondents had pets in their household are needed to determine the most effective ways to im-
at the time of completing the survey and analyzed pet prove knowledge and reduce zoonotic disease risks.
ownership as a dichotomous variable, not accounting for
different pet species. Based on responses, it is likely that Additional files
some of the non-pet owners previously had pets (i.e.,
29% of non-pet owners who had previously received Additional file 1: Doc1 Questionnaire for households with pets.
zoonotic disease information, had received this informa- Additional file 2: Doc2 Questionnaire for households without pets.
tion from a veterinarian). It is possible this classification
scheme may have biased our results, likely falsely in- Competing interests
creasing the zoonotic disease knowledge score attributed The authors declare they have no competing interests.
to non-pet owners and reducing apparent differences be-
Authors' contributions
tween pet and non-pet owners. Thus, differences be- All authors participated in the study concept, design and questionnaire
tween pet-owning households and those that have never development. JWS enrolled participating clinics and administered
owned pets may be more pronounced than we observed. questionnaires to participating patients. JWS was responsible for data
analysis, data interpretation and manuscript preparation. All authors provided
In our analysis, we did not account for the ownership of input on data analysis, interpretation and final manuscript development. All
different pet species. Different species have varying lev- authors have approved the final version of the manuscript.
els of disease risk for particular pathogens (e.g., high
prevalence of Salmonella shedding by reptiles and Acknowledgements
The authors thank staff and students at the University of Guelph
amphibians), and owner demographics and other charac- (Departments of Population Medicine and Pathobiology), McMaster
teristics may vary by the species owned. Thus, it is University (Department of Pediatrics) and the Children’s Hospital of Eastern
Stull et al. BMC Public Health 2012, 12:553 Page 14 of 15
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Ontario (Division of Infectious Diseases) for their input into the questionnaire; 21. Abarca VK, Lopez Del PJ, Pena DA, Lopez GJC: Pet ownership and health
and the two medical practices and their patients for their participation. JMS status of pets from immunocompromised children, with emphasis in
was supported through a Canadian Institutes of Health Research (CIHR) zoonotic diseases. Rev Chilena Infectol 2011, 28:205–210.
Institute of Population and Public Health/ Public Health Agency of Canada 22. Holmquist L, Elixhauser A: Emergency Department Visits and Inpatient
Applied Public Health Research Chair. Stays Involving Dog Bites, 2008: Statistical Brief #101. In Healthcare Cost
and Utilization Project (HCUP) Statistical Briefs. Rockville (MD):; 2010:1–14.
Author details 23. Patronek GJ, Slavinski SA: Animal bites. J Am Vet Med Assoc 2009,
1
Department of Pathobiology, Ontario Veterinary College, University of 234:336–345.
Guelph, Guelph, ON, N1G2W1, Canada. 2Department of Population Medicine, 24. Mani I, Maguire JH: Small animal zoonoses and immuncompromised pet
Ontario Veterinary College, University of Guelph, Guelph, ON, N1G2W1, owners. Top Companion Anim Med 2009, 24:164–174.
Canada. 3Centre for Public Health and Zoonoses, University of Guelph, 25. Abbas AK, Lichtman AH, Pillai S: Congenital and acquired
Guelph, ON, N1G2W1, Canada. immunodeficiencies. In Cellular and molecular immunology. 6th edition.
Philadelphia: Saunders; 2007:463–488.
Received: 1 February 2012 Accepted: 25 July 2012 26. Westgarth C, Pinchbeck GL, Bradshaw JW, Dawson S, Gaskell RM, Christley
Published: 25 July 2012 RM: Dog-human and dog-dog interactions of 260 dog-owning
households in a community in Cheshire. Vet Rec 2008, 162:436–442.
References 27. Bingham GM, Budke CM, Slater MR: Knowledge and perceptions of dog-
1. Butler JR, Bingham J: Demography and dog-human relationships of the associated zoonoses: Brazos County, Texas, USA. Prev Vet Med 2010,
dog population in Zimbabwean communal lands. Vet Rec 2000, 93:211–221.
147:442–446. 28. Fontaine RE, Schantz PM: Pet ownership and knowledge of zoonotic
2. Baldock FC, Alexander L, More SJ: Estimated and predicted changes in the diseases in De Kalk County, Georgia. Anthrozoos 1988, 3:45–49.
cat population of Australian households from 1979 to 2005. Aust Vet J 29. Waterloo, Ontario. 2006 Community Profiles. [http://www12.statcan.ca/census-
2003, 81:289–292. recensement/2006/dp-pd/prof/92-591/index.cfm?Lang=E].
3. Downes M, Canty MJ, More SJ: Demography of the pet dog and cat 30. Health Canada: Canada Health Act Annual Report 2009–2010.; 2010.
population on the island of Ireland and human factors influencing pet 978-1-100-16312-3:4.
ownership. Prev Vet Med 2009, 92:140–149. 31. More information on generation status. [http://www12.statcan.ca/census-
4. Slater MR, Di Nardo A, Pediconi O, Villa PD, Candeloro L, Alessandrini B, recensement/2006/ref/dict/pop036a-eng.cfm].
Del Papa S: Cat and dog ownership and management patterns in central 32. Dohoo I, Martin W, Studahl H: Measures of association. In Veterinary
Italy. Prev Vet Med 2008, 85:267–294. Epidemiologic Research. 2nd edition. Edited by McPike SM. Prince Edward
5. Murray JK, Browne WJ, Roberts MA, Whitmarsh A, Gruffydd-Jones TJ: Island: VER Inc; 2009:135–150.
Number and ownership profiles of cats and dogs in the UK. Vet Rec 2010, 33. Westgarth C, Pinchbeck GL, Bradshaw JW, Dawson S, Gaskell RM, Christley
166:163–168. RM: Factors associated with dog ownership and contact with dogs in a
6. Perrin T: The business of urban animals survey: the facts and statistics on UK community. BMC Vet Res 2007, 3:5.
companion animals in Canada. Can Vet J 2009, 50:48–52. 34. Wilhelm BJ, Rajic A, Greig J, Waddell L, Trottier G, Houde A, Harris J, Borden
7. Alves MC, Matos MR, Reichmann Mde L, Dominguez MH: Estimation of the LN, Price C: A systematic review/meta-analysis of primary research
dog and cat population in the State of Sao Paulo. Rev Saude Publica 2005, investigating swine, pork or pork products as a source of zoonotic
39:891–897. hepatitis E virus. Epidemiol Infect 2011, 139:1127–1144.
8. U.S. pet ownership.; 2007 [http://www.avma.org/reference/marketstats/ 35. Pavio N, Meng XJ, Renou C: Zoonotic hepatitis E: animal reservoirs and
ownership.asp]. emerging risks. Vet Res 2010, 41:46.
9. Friedmann E, Son H: The human–companion animal bond: how humans 36. Palmer CS, Robertson ID, Traub RJ, Rees R, Thompson RC: Intestinal
benefit. Vet Clin N Am: Small Anim Pract 2009, 39:293–326. parasites of dogs and cats in Australia: the veterinarian's perspective
10. Reaser JK, Clark EE Jr, Meyers NM: All creatures great and minute: a public and pet owner awareness. Vet J 2010, 183:358–361.
policy primer for companion animal zoonoses. Zoonoses Public Health 37. Grant S, Olsen CW: Preventing zoonotic diseases in immunocompromised
2008, 55:385–401. persons: the role of physicians and veterinarians. Emerg Infect Dis 1999,
11. Poresky RH, Hendrix C: Differential effects of pet presence and 5:159–163.
pet-bonding on young children. Psychol Rep 1990, 67:51–54. 38. von Matthiessen PW, Sansone RA, Meier BP, Gaither GA, Shrader J: Zoonotic
12. Melson GF, Schwarz RL, Beck AM: Importance of companion animals in diseases and at-risk patients: a survey of veterinarians and physicians.
children's lives–implications for veterinary practice. J Am Vet Med Assoc AIDS 2003, 17:1404–1406.
1997, 211:1512–1518. 39. Villar RG, Connick M, Barton LL, Meaney FJ, Davis MF: Parent and
13. Carmack BJ: The role of companion animals for persons with AIDS/HIV. pediatrician knowledge, attitudes, and practices regarding pet-
Holist Nurs Pract 1991, 5:24–31. associated hazards. Arch Pediatr Adolesc Med 1998, 152:1035–1037.
14. Castelli P, Hart LA, Zasloff RL: Companion cats and the social support 40. Lipton BA, Hopkins SG, Koehler JE, DiGiacomo RF: A survey of veterinarian
systems of men with AIDS. Psychol Rep 2001, 89:177–187. involvement in zoonotic disease prevention practices. J Am Vet Med
15. Conti L, Lieb S, Liberti T, Wiley-Bayless M, Hepburn K, Diaz T: Pet ownership Assoc 2008, 233:1242–1249.
among persons with AIDS in three Florida counties. Am J Public Health 41. Volk JO, Felsted KE, Thomas JG, Siren CW: Executive summary of the Bayer
1995, 85:1559–1561. veterinary care usage study. J Am Vet Med Assoc 2011, 238:1275–1282.
16. Raina P, Waltner-Toews D, Bonnett B, Woodward C, Abernathy T: Influence 42. Stull JW, Carr AP, Chomel BB, Berghaus RD, Hird DW: Small animal
of companion animals on the physical and psychological health of older deworming protocols, client education, and veterinarian perception of
people: an analysis of a one-year longitudinal study. J Am Geriatr Soc zoonotic parasites in western Canada. Can Vet J 2007, 48:269–276.
1999, 47:323–329. 43. Westgarth C, Heron J, Ness AR, Bundred P, Gaskell RM, Coyne KP, German
17. Brandt JC, Grabill CM: Communicating with special populations: children AJ, McCune S, Dawson S: Family pet ownership during childhood:
and older adults. Vet Clin N Am: Small Anim Pract 2007, 37:181–198. findings from a UK birth cohort and implications for public health
18. Melson GF: Child development and the human–companion animal bond. research. Int J Environ Res Public Health 2010, 7:3704–3729.
Am Behav Sci 2003, 47:31–39. 44. Ramon ME, Slater MR, Ward MP: Companion animal knowledge,
19. Leslie BE, Meek AH, Kawash GF, McKeown DB: An epidemiological attachment and pet cat care and their associations with household
investigation of pet ownership in Ontario. Can Vet J 1994, 35:218–222. demographics for residents of a rural Texas town. Prev Vet Med 2010,
20. Siegel JM, Angulo FJ, Detels R, Wesch J, Mullen A: AIDS diagnosis and 94:251–263.
depression in the Multicenter AIDS Cohort Study: the ameliorating 45. Sacks JJ, Kresnow M, Houston B: Dog bites: how big a problem? Inj Prev
impact of pet ownership. AIDS Care 1999, 11:157–170. 1996, 2:52–54.
Stull et al. BMC Public Health 2012, 12:553 Page 15 of 15
http://www.biomedcentral.com/1471-2458/12/553

46. Asanin J, Wilson K: "I spent nine years looking for a doctor": exploring
access to health care among immigrants in Mississauga, Ontario,
Canada. Soc Sci Med 2008, 66:1271–1283.
47. Trevejo RT, Barr MC, Robinson RA: Important emerging bacterial zoonotic
infections affecting the immunocompromised. Vet Res 2005, 36:493–506.
48. Lipscombe LL, Hux JE: Trends in diabetes prevalence, incidence, and
mortality in Ontario, Canada 1995–2005: a population-based study.
Lancet 2007, 369:750–756.

doi:10.1186/1471-2458-12-553
Cite this article as: Stull et al.: Household knowledge, attitudes and
practices related to pet contact and associated zoonoses in Ontario,
Canada. BMC Public Health 2012 12:553.

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