title: Factors associated with preventive behaviors regarding Lyme disease in Canada and Switzerland: a comparative study.
abstract: BACKGROUND
  Lyme disease (LD) is a vector-borne disease that is endemic in many temperate countries, including Switzerland, and is currently emerging in Canada. This study compares the importance of knowledge, exposure and risk perception for the adoption of individual preventive measures, within and between two different populations, one that has been living in a LD endemic region for several decades, the Neuchâtel canton in Switzerland, and another where the disease is currently emerging, the Montérégie region in the province of Québec, Canada.
  
  
  METHODS
  A web-based survey was carried out in both study regions (814 respondents) in 2012. Comparative analysis of the levels of adoption of individual preventive measures was performed and multivariable logistic regression analyses were used to test and compare how knowledge, exposure and risk perception were associated with the adoption of selected measures in both regions and globally.
  
  
  RESULTS
  In Montérégie, the proportion of reported adoption of five of the most commonly recommended preventive measures varied from 6% for 'applying acaricides on one's property' to 49% for 'wearing protective clothing', and in Neuchâtel, proportions ranged from 6% (acaricides) to 77% for 'checking for ticks (tick check)'. Differences were found within gender, age groups and exposure status in both regions. The perceived efficacy of a given measure was the strongest factor associated with the adoption of three specific preventive behaviors for both regions: tick check, protective clothing and tick repellent. Risk perception and a high level of knowledge about LD were also significantly associated with some of these specific behaviors, but varied by region.
  
  
  CONCLUSIONS
  These results strongly suggest that social and contextual factors such as the epidemiological status of a region are important considerations to take into account when designing effective prevention campaigns for Lyme disease. It furthermore underlines the importance for public health authorities to better understand and monitor these factors in targeted populations in order to be able to implement preventive programs that are well adapted to a population and the epidemiological contexts therein.
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, Québec, Canada. cecile.aenishaenslin@umontreal.ca.
authors.forename: Cécile
authors.initials: C
authors.lastname: Aenishaenslin
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, Québec, Canada. pascal.michel@phac-aspc.gc.ca.|Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, CP 5000, Saint-Hyacinthe, Québec, Canada. pascal.michel@phac-aspc.gc.ca.
authors.forename: Pascal
authors.initials: P
authors.lastname: Michel
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, Québec, Canada. andre.ravel@umontreal.ca.
authors.forename: André
authors.initials: A
authors.lastname: Ravel
authors.affiliation: Laboratoire d'Eco-Épidémiologie, Institut de Biologie, Université de Neuchâtel, 2000 Neuchâtel, Suisse. lise.gern@unine.ch.
authors.forename: Lise
authors.initials: L
authors.lastname: Gern
authors.affiliation: Institut national de santé publique du Québec, Montréal, Québec, Canada. francois.milord@usherbrooke.ca.
authors.forename: François
authors.initials: F
authors.lastname: Milord
authors.affiliation: Groupe d'étude et de recherche en analyse de la décision (GERAD), Université du Québec à Montréal, Montréal, Québec, Canada. waaub.jean-philippe@uqam.ca.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Waaub
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, Québec, Canada. denise.belanger@umontreal.ca.
authors.forename: Denise
authors.initials: D
authors.lastname: Bélanger
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000818:Animals; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008193:Lyme Disease / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011481:Protective Clothing / Q000706:statistics & numerical data; D017678:Sex Distribution; D013557:Switzerland; D013987:Ticks; D055815:Young Adult