title: A School-Based Intervention to Increase Lyme Disease Preventive Measures Among Elementary School-Aged Children.
abstract: Educational interventions to reduce Lyme disease (LD) among at-risk school children have had little study. The purpose of this study was to evaluate whether a short in-class LD education program based on social learning theory and the Health Belief Model (HBM) impacted a child's knowledge, attitude, and preventive behavior.
  
  
  
  Students in grades 2-5 in 19 elementary schools were selected in an area that was highly endemic for LD. The children received an educational intervention or were on a wait list as controls. Their knowledge, attitudes, and self-reported preventive behaviors were surveyed before implementing the program and 1 year later. General linear regression analyses adjusting for age, gender, and baseline variables were used to measure the impact of the intervention.
  
  
  
  There were 3570 participants in the study: 1562 received the intervention, and 2008 were controls. The mean age for both groups was 9.1 years, with 53% women in the intervention group and 50% women in the control group. The children in the intervention group increased their overall knowledge of LD more than the children in the control group (overall knowledge score improvement, mean difference (SD) 1.38 (1.3) vs. 0.36 (1.3) p < 0.0001). All children in classes receiving the intervention reported an increase in precautionary behavior, positive attitude toward taking precautions, and self-efficacy compared with the wait list controls. Two LD cases were confirmed during the follow-up period, one in the intervention group and one in the controls.
  
  
  
  These findings demonstrate that a short in-class educational program that includes elements of the HBM, including: (1) awareness and knowledge about the disease, (2) benefits of preventive behavior, and (3) confidence in ability to perform preventive behaviors can improve knowledge, attitude, and self-reported precautionary behavior among at-risk children. www.clinicaltrials.gov : NCT00594997.
authors.affiliation: 1 Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Shadick
authors.affiliation: 2 Advocates, Inc. , Framingham, Massachusetts.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Zibit
authors.affiliation: 1 Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nardone
authors.affiliation: 3 Bureau of Infectious Disease and Laboratory Sciences , Massachusetts Department of Public Health, Jamaica Plain, Massachusetts.
authors.forename: Alfred
authors.initials: A
authors.lastname: DeMaria
authors.affiliation: 1 Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Christine K
authors.initials: CK
authors.lastname: Iannaccone
authors.affiliation: 1 Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Jing
authors.initials: J
authors.lastname: Cui
mesh_terms: D000818:Animals; D002648:Child; D005260:Female; D015438:Health Behavior; D006266:Health Education / Q000379:methods*; D006293:Health Promotion; D006801:Humans; D008193:Lyme Disease / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D012572:School Health Services; D012574:Schools; D011795:Surveys and Questionnaires; D013984:Tick Infestations / Q000517:prevention & control; D013987:Ticks / Q000502:physiology
keywords: Ixodes; Lyme disease.