title: Determinants and protective behaviours regarding tick bites among school children in the Netherlands: a cross-sectional study.
abstract: BACKGROUND
  Lyme borreliosis (LB) is the most common tick-borne disease in the United States and Europe. The incidence is 13.4 per 100,000 inhabitants in the United States and more than 300 per 100,000 inhabitants in Europe. Children are at highest risk of LB. In the Netherlands in 2007, the incidence of tick bites in children between 10-14 years varied from 7,000 -11,000 per 100,000, depending on age. This study among Dutch school children aimed to examine the knowledge, perceived threat, and perceived importance of protective behaviour in relation to tick bites and their potential consequences.
  
  
  METHODS
  In April 2012, the municipal health services (MHS) contacted primary schools to recruit children 9-13 years by telephone, e-mail, or advertisement in MHS newsletters. In total, 1,447 children from 40 schools participated in this study by completing a specifically developed and pretested compact paper questionnaire. Regression models were used to determine which covariates (e.g. forest cover, previous education, knowledge) are associated with our response variables.
  
  
  RESULTS
  70% (n = 1,015) of the children answered at least six out of seven knowledge questions correctly. The vast majority (93%; n = 1345) regarded body checks as very or somewhat important, 18% (n = 260) was routinely checked by their parents. More frequent body checks were associated with good knowledge about ticks and tick-borne diseases and knowing persons who got ill after tick bite. Children in areas with a higher forest cover were more likely to be checked frequently.
  
  
  CONCLUSIONS
  Most children have a good knowledge of ticks and the potential consequences of tick bites. Knowing persons who personally got ill after tick-bite is associated with a good knowledge score and leads to higher susceptibility and better appreciation of the need for body checks. Perceived severity is associated with a good knowledge score and with knowing persons who got ill after tick-bite. Is seems to be useful to additionally address children in health education regarding ticks and tick-borne diseases. The relationship between health education programs for children (and their parents) about ticks and their possible consequences and prevention of these deserves further study.
authors: National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P,O, Box 1, 3720, BA Bilthoven, The Netherlands. desiree.beaujean@rivm.nl.
authors: Desiree J M A
authors: DJ
authors: Beaujean
authors: Fedor
authors: F
authors: Gassner
authors: Albert
authors: A
authors: Wong
authors: Jim E
authors: JE
authors: Steenbergen van
authors: Rik
authors: R
authors: Crutzen
authors: Dirk
authors: D
authors: Ruwaard
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008193:Lyme Disease / Q000517:prevention & control / Q000523:psychology; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D064927:Tick Bites / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D013987:Ticks / Q000382:microbiology