Background: There are an estimated 476 000 diagnosed and treated cases of Lyme disease (LD) in the United States each year. The risk of infection depends on human contact with ticks infected with Borrelia burgdorferi, typically from outdoor activities in high-incidence areas. The population prevalence of the activities that confer risk is unknown.
Methods: We conducted online surveys of adults (ages 18+) and caregivers of children aged 1-17 in jurisdictions with a high incidence of LD, the states neighboring them, and selected counties in California and Oregon (CA/OR). The survey included questions on outdoor activities and occupation in forests, wooded areas, and areas with tall grass, residential characteristics, time spent in a yard, use of personal protection measures, history of LD and tick bites, and LD knowledge and risk perception. Data were weighted separately for each state-level sample and analyzed by region (ie, high incidence, neighboring, and CA/OR) and population (ie, adults and caregivers).
Results: A total of 44 330 adults and 28 380 caregivers completed the survey. Most respondents were aware of LD (range, 88-93%), spent time in a yard (adults, 88-92%; children, 96%-98%), or spent recreational time outside (adults, 70-79%; children, 83-84%). Always using prevention measures while doing outdoor recreational activities was reported for 34-40% of adults and 40-42% of children.
Conclusions: Despite the high population prevalence of LD awareness and of doing outdoor activities, less than half of surveyed respondents routinely used personal prevention measures to mitigate their risk of tick-borne diseases. More effective strategies and education are needed to prevent LD.
Keywords: Borrelia; Lyme disease; prevention; risk factors; tick-borne disease.
© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America.