title: Determinants of tick-avoidance behaviors in an endemic area for Lyme disease.
abstract: BACKGROUND
  Tick bite control is an important initiative to prevent Lyme disease and other tickborne infections. While several studies have demonstrated that knowledge and awareness of Lyme disease in endemic areas are good, none has evaluated the relative importance of knowledge with other attitudinal and health belief variables to determine motivators of preventive behavior.
  
  
  METHODS
  We conducted a cross-sectional analysis of 304 commuter ferry passengers departing Martha's Vineyard Island, Massachusetts, in August 1992, to ascertain the prevalence of tick-avoidance behaviors among individuals from an endemic area of Lyme disease and to identify the knowledge, behavioral, and demographic variables that best determine precautionary behavior.
  
  
  RESULTS
  Overall, survey respondents (n = 304) had very good knowledge of Lyme disease (73% items correct on a knowledge test), but only 59% of respondents reported limiting time in tick areas, 58% usually wore protective clothing, 40% wore tick repellent, and 66% usually performed tick checks. By stepwise linear regression analysis, determinants of tick-avoidance behaviors included perceiving the behavior's benefits as outweighing its inconvenience (P < .0001), having confidence in recognizing Lyme disease symptoms (P < .0004), believing that Lyme disease is a serious illness (P < .0009), and believing that the avoidance behavior is effective in reducing the risk of Lyme disease (P < .01). Younger respondents (P < .05) performed fewer avoidance behaviors. Visitors (P < .0001) performed fewer tick checks than residents. Having confidence that one could find a tick on oneself with a tick check also predicted performance (P < .008). Increased general knowledge about Lyme disease did not predict any protective behaviors.
  
  
  CONCLUSIONS
  Precautionary behaviors were underperformed in an at-risk population despite good knowledge of Lyme disease symptoms and transmission. Instead, performance was related to confidence in finding a tick on oneself and a perception that a precaution's benefit outweighed its inconvenience and would adequately reduce risk for Lyme disease. These data have implications for Lyme disease prevention programs, which typically focus on enhancing general knowledge as a means toward disease reduction.
authors.affiliation: Department of Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Shadick
authors.forename: L H
authors.initials: LH
authors.lastname: Daltroy
authors.forename: C B
authors.initials: CB
authors.lastname: Phillips
authors.forename: U S
authors.initials: US
authors.lastname: Liang
authors.forename: M H
authors.initials: MH
authors.lastname: Liang
mesh_terms: D000328:Adult; D000818:Animals; D003430:Cross-Sectional Studies; D019353:Endemic Diseases / Q000517:prevention & control; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008193:Lyme Disease / Q000517:prevention & control* / Q000628:therapy; D008297:Male; D011322:Primary Prevention; D012309:Risk-Taking; D013987:Ticks