title: Tick-borne disease preventive practices and perceptions in an endemic area.
abstract: Lyme disease is the most commonly reported vector-borne illness in the United States. Since the institution of Nationally Notifiable surveillance efforts for Lyme disease in the United States in 1991, there has been a consistent increase in the number of reported cases. Thus, the need for targeted prevention strategies is underscored. The purpose of this study was to investigate knowledge about tick-borne diseases as well as beliefs and practices related to a variety of personal tick-borne disease prevention methods among individuals in southwestern Connecticut, a Lyme disease-endemic area. Between June and September 2014, an anonymous questionnaire was administered to 275 participants through a point-of-contact convenience sample obtained at community events in southwestern Connecticut. The questionnaire assessed individuals' general knowledge about tick-borne diseases, performance of four selected tick-borne disease prevention methods, and perceived effectiveness and burdensomeness of those four behaviors. Some 80% of participants were female; median age was 55 years (IQR 45-64 years); 30% reported having been treated for a tick-borne illness and 50% reported a family member having been treated for a tick-borne illness. Overall, participants' knowledge of tick-borne diseases was poor; the average knowledge score was only 57% (SD 22.6%). The reported frequency of performing preventive behaviors was variable. The most commonly reported behavior was performing a tick check (68%); use of tick repellent was the least commonly reported behavior (38%). Those who were more knowledgeable about Lyme disease were more likely to perform tick checks but knowledge score was not significantly associated with any of the other three behaviors studied. Respondents largely believed preventive behaviors to be effective at reducing the risk of tick-borne diseases. Belief that a prevention behavior is effective was highly correlated with performing that behavior but perceived burdensomeness does not appear to influence behavior performance. The reasons for differential uptake of preventive behaviors remains unknown; further study of barriers to performance of personal preventive behaviors is needed to better target public health interventions.
authors.affiliation: Department of Research and Innovation, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, United States. Electronic address: amber.butler@wchn.org.
authors.forename: Amber D
authors.initials: AD
authors.lastname: Butler
authors.affiliation: Yale School of Public Health, 60 College Street, New Haven, CT 06520, United States. Electronic address: tannaz.sedghi@yale.edu.
authors.forename: Tannaz
authors.initials: T
authors.lastname: Sedghi
authors.affiliation: Department of Research and Innovation, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, United States; University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405, United States. Electronic address: joann.petrini@wchn.org.
authors.forename: Joann R
authors.initials: JR
authors.lastname: Petrini
authors.affiliation: Department of Research and Innovation, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, United States; University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405, United States. Electronic address: ramin.ahmadi@wchn.org.
authors.forename: Ramin
authors.initials: R
authors.lastname: Ahmadi
mesh_terms: D000328:Adult; D000818:Animals; D003237:Connecticut / Q000453:epidemiology; D019353:Endemic Diseases / Q000517:prevention & control*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008193:Lyme Disease / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D017282:Tick-Borne Diseases / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013987:Ticks / Q000382:microbiology*
keywords: Lyme disease; Prevention; Preventive behaviors; Tick-borne disease; Ticks