Risk perceptions regarding ticks and Lyme disease: a national survey

Am J Prev Med. 2004 Feb;26(2):135-40. doi: 10.1016/j.amepre.2003.10.010.


Background: Lyme disease (LD) is caused by the tickborne bacterium Borrelia burgdorferi and, in 2000, accounted for >90% of all reported cases of vectorborne illness in the United States. Aside from anecdotal and indirect evidence, little empirical evidence exists regarding what the U.S. public knows, says, or does about preventing LD.

Objectives: To examine knowledge, perceptions, and practices regarding prevention of tick bites and LD.

Methods: In 1998, a random-digit-dial frame was used to collect a cross-sectional sample (n =1500) from the 48 coterminous states plus the District of Columbia, and an over-sample (n =250) from six states with the highest incidence of LD.

Results: Forty percent of respondents reported doing something to avoid being bitten by ticks. Less than half (41%) used insect repellent. Ninety-two percent of those who had heard about LD stated their likelihood of ever getting the disease was </=50 on a 100-point scale (mean=29; standard deviation, 23.5). Being somewhat to very concerned about being bitten by ticks was strongly associated with taking preventive measures (odds ratio, 8.34; 95% confidence interval, 6.29-11.06).

Conclusions: Having seen ticks, being concerned about being bitten, perceiving insect repellent to be effective, having heard about LD, and knowing someone who had LD are the factors most predictive of specific tick-bite preventive behaviors (p <0.001). However, greater efforts are needed in promoting the effectiveness and safety of DEET-containing insect repellents.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Animals
  • Borrelia burgdorferi / pathogenicity
  • Cross-Sectional Studies
  • DEET / administration & dosage
  • DEET / adverse effects
  • Female
  • Health Behavior*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Incidence
  • Insect Repellents / administration & dosage
  • Insect Repellents / adverse effects
  • Interviews as Topic
  • Ixodes / microbiology
  • Ixodes / pathogenicity
  • Lyme Disease / epidemiology
  • Lyme Disease / microbiology
  • Lyme Disease / prevention & control*
  • Male
  • Protective Clothing / statistics & numerical data
  • United States / epidemiology


  • Insect Repellents
  • DEET