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Preventive Behaviors and Knowledge of Tick-Borne Illnesses: Results of a Survey From an Endemic Area

Valente, Sara L. BS; Wemple, Daniel BA; Ramos, Sebastian BBA; Cashman, Suzanne B. ScD; Savageau, Judith A. MPH

Journal of Public Health Management & Practice: May/June 2015 - Volume 21 - Issue 3 - p E16–E23
doi: 10.1097/PHH.0000000000000098
Original Articles

Context: Lyme disease (LD) is the most commonly reported vector-borne illness in the United States. With physically and economically burdensome effects, it is a concern of public health officials.

Objectives: To assess knowledge and preventive behaviors of individuals in the endemic area of Martha's Vineyard, Massachusetts, to better understand how sociodemographic data and knowledge correlate with preventive behaviors, and to update previous island studies.

Design: A 30-item paper-based anonymous survey in either English or Portuguese based on language preference.

Setting: The island of Martha's Vineyard and the ferry between island and mainland.

Participants: A total of 946 participants were recruited at 1 of 4 island locations. The majority of participants were traveling by ferry to and from Martha's Vineyard. To reach 2 populations potentially at high risk, that is, youths and outdoor workers, 3 additional venues included the island high school, an English-as-a-Second-Language class, and a local Brazilian church.

Outcome Measures: Four specific preventive behaviors as well as an overall composite prevention score.

Results: Participants' knowledge of tick-borne illnesses was poor, and the frequency of practicing preventive behaviors was low; the most commonly reported behavior was checking one's skin for ticks (45%). Approximately one-third of respondents (37%) stated that they did not know the late symptoms of untreated LD, nor did they know early LD treatment options (49%). The 2 high-risk groups reported little participation in preventive measures. In multivariate analyses, only 4 characteristics—older age, confidence in telling deer tick from wood tick, seeing tick-borne illness as a serious threat, and certainty in ability to identify LD symptoms—attained significance associated with preventive behavior as an overall composite score.

Conclusions: Public health interventions focusing on accurately communicating risk, improving knowledge both of LD symptoms and of ticks that carry the disease, as well as teaching preventive behaviors may help reduce tick-borne illness rates.

This article provides results of a survey to assess knowledge and preventive behaviors of individuals in the Lyme disease endemic area, to better understand how sociodemographic data and knowledge correlate with preventive behaviors, and to update previous island studies.

Department of Family Medicine and Community Health (Dr Cashman and Ms Savageau), University of Massachusetts Medical School (Ms Valente and Messrs Wemple and Ramos), Worcester.

Correspondence: Sara L. Valente, BS, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655 (

Funding sources supporting the authors work came from the Massachusetts Area Health Education Center Network, which underwrote 3 investigators' ferry tickets for 1 trip to and from Martha's Vineyard. The authors thank Rebecca Rozin and Meghan Grafton King, University of Massachusetts Worcester Graduate School of Nursing, students who participated in data collection. They also thank Michael Loberg, a Tisbury, Martha's Vineyard Board of Health Commissioner and Chair of the Medical Education Commission of the Island's Boards of Health Program, to reduce the incidence and severity of tick-borne illnesses. Finally, they thank the Mass AHEC Network for travel support.

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The authors have no commercial associations that could pose a conflict of interest.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.