DETERMINANTS OF TICK-AVOIDANCE BEHAVIORS IN AN ENDEMIC AREA FOR LYME-DISEASE

Background: Tick bite control is an important initiative to pre vent L yme disease and other tickborne infections. While several studies have demonstrated that knowledge and awareness of Lyme disease in endemic areas are good, none has evaluated the relative importance of knowledg e with other attitudinal and health belief variables to determine moti vators of preventive behavior. Methods: We conducted a cross-sectional analysis of 304 commuter ferry passengers departing Martha's Vineyard Island, Massachusetts, in August 1992, to ascertain the prevalence of tick-avoidance behaviors among individuals from an endemic area of Ly me disease and to identify the knowledge, behavioral, and demographic variables that best determine precautionary behavior. Results: Overall , survey respondents (n = 304) had very good knowledge of Lyme disease (73% items correct on a knowledge test), but only 59% of respondents reported limiting time in tick areas, 58% usually wore protective clot hing, 40% wore tick repellent, and 66% usually performed tick checks. By stepwise linear regression analysis, determinants of tick-avoidance behaviors included perceiving the behavior's benefits as outweighing its inconvenience (P < .0001), having confidence in recognizing Lyme d isease symptoms (P < .0004), believing that Lyme disease is a serious illness (P < .0003), and believing that the avoidance behavior is effe ctive in reducing the risk of Lyme disease (P < .01). Younger responde nts (P < .05) performed fewer avoidance behaviors. Visitors (P < .0001 ) performed fewer tick checks than residents. Having confidence that o ne could find a tick on oneself with a tick check also predicted perfo rmance (P < .008). Increased general knowledge about Lyme disease did not predict any protective behaviors. Conclusions: Precautionary behav iors were underperformed in an at-risk population despite good knowled ge of Lyme disease symptoms and transmission. Instead, performance was related to confidence in finding a tick on oneself and a perception t hat a precaution's benefit outweighed its inconvenience and would adeq uately reduce risk for Lyme disease. These data have implications for Lyme disease prevention programs,which typically focus on enhancing ge neral knowledge as a means toward disease reduction. Medical Subject H eadings (MeSH): Lyme disease, health behavior, tickborne diseases.