title: From Lyme disease emergence to endemicity: a cross sectional comparative study of risk perceptions in different populations.
abstract: BACKGROUND
  Lyme disease (LD) is a tick-borne emerging disease in Canada that has been endemic in many temperate countries for decades. Currently, one of the main approaches for LD prevention is the promotion of individual-level preventive behaviors against ticks. Health behaviors are influenced by individual and social factors, one important of which is risk perception. This study aims to describe and compare risk perception of LD, within and between general populations and experts living in two different regions: the Neuchâtel canton in Switzerland, where LD is endemic, and the Montérégie region in Québec (Canada), where LD is emerging.
  
  
  METHODS
  A web-based survey was conducted in both study regions (814 respondents) in 2012, and a questionnaire was administered to 16 experts. Comparative analyses of knowledge, risk exposure and different components of LD risk perception were performed. Multivariate analyses were used to calculate a global risk perception score and to identify determinants of risk perception in both regions.
  
  
  RESULTS
  In Montérégie, only 15% of the survey respondents had a good level of knowledge of LD compared to Neuchâtel where 51% of survey respondents had good levels of knowledge. In Montérégie, 24% of respondents perceived themselves as being at high or very high risk of contracting LD vs 54% in Neuchâtel; however, a higher percentage of respondents from this region believed that personal protection was simple to carry out (73% vs 58% in Montérégie). Based on the population surveys, almost all of the identified determinants of risk perception were different between both populations except for gender. A good level of knowledge, living in the risk zone and knowing someone who has had LD increased risk perception, while a high level of education and being 18-34 years of age decreased this perception. The majority of the studied components of risk perception were different between populations and their regional experts.
  
  
  CONCLUSIONS
  This study suggests that risk perception of LD differs between populations and regional experts living in different epidemiological situations. Monitoring of knowledge and risk perception in local populations may help to better target LD communication efforts in accordance with population specific attributes thereby enhancing prevention efficacy.
authors.affiliation: Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Pavillon de la santé publique, Faculté de médecine vétérinaire, Université de Montréal, CP 5000, Saint-Hyacinthe J2S 7C6, Québec, Canada. cecile.aenishaenslin@umontreal.ca.
authors.forename: Cécile
authors.initials: C
authors.lastname: Aenishaenslin
authors.forename: André
authors.initials: A
authors.lastname: Ravel
authors.forename: Pascal
authors.initials: P
authors.lastname: Michel
authors.forename: Lise
authors.initials: L
authors.lastname: Gern
authors.forename: François
authors.initials: F
authors.lastname: Milord
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Waaub
authors.forename: Denise
authors.initials: D
authors.lastname: Bélanger
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008193:Lyme Disease / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D012306:Risk; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult