Abstract
EXECUTIVE SUMMARY
Lyme Disease, an infectious disease transmitted by the deer tick, is a growing health threat, especially in the Mid-Atlantic Region of the United States. In May 1993, 300 homeowners in high-risk communities from two counties in New Jersey were interviewed by telephone, making this the most comprehensive investigation yet undertaken concerning Lyme Disease beliefs, knowledge, experiences, and precautions. Among the key findings of the survey:
■ Because of the perceived risk of Lyme Disease, 20% of the respondents have completely abandoned at least one outdoor activity.
■ Twenty-two percent of the respondents reported having had a blood test for Lyme Disease within the last five years.
■ Four percent of the respondents reported having been diagnosed with Lyme Disease.
■ Seventy-three percent of those surveyed said that they knew at least one person (other than themselves) who has had Lyme Disease. The average number of people known with the disease was four.
■ Most people are concerned about Lyme Disease. Sixty-one percent of those surveyed said that their friends and neighbors were moderately or very concerned about the disease. Seventy-seven percent said that they personally had thought about Lyme Disease during the week preceding the survey.
■ Most of those surveyed overestimated the number of people in their county who have had Lyme Disease. The median estimate was that between 5% and 10% of the people in the county have had the disease. Although it uses a strict definition for reporting cases of Lyme Disease, according to New Jersey State Department of Health Statistics, only about one-third of one percent of the population of each county has had the disease over the last 14 years.
■ Ninety-eight percent of those surveyed said they knew something about Lyme Disease. Younger respondents rated their own knowledge as somewhat higher than older respondents did. Women rated their knowledge slightly higher than the men in the sample.
The survey suggests that there are some significant misconceptions about how the disease is transmitted, how it can be prevented, and what its consequences are. Among these misconceptions:
■ About 9% did not know that Lyme Disease is not spread from person to person.
■ Eighteen percent think that it may be possible to contract the disease from eating infected meat.
■ Twenty-seven percent think that it may be possible to contract the disease from the bite of an infected pet.
■ One-third of the sample did not know that deer ticks are carried by mice and birds.
■ Twenty-two percent do not think that ticks are present in Winter.
■ Twenty-two percent think that it may be possible for fleas, horseflies and mosquitoes to carry Lyme Disease.
■ One-third of those surveyed think that most ticks in New Jersey are carrying Lyme Disease.
■ Nearly 58% think that once a person is bitten by a tick carrying Lyme Disease, that person will usually get the disease.
■ About one-third of the sample believes that if they are bitten by a tick carrying Lyme Disease they will always get a bulls-eye rash.
■ Forty-two percent of the sample does not believe that DEET-based repellents are effective against ticks that carry Lyme Disease.
■ One-quarter of those surveyed believe that Lyme Disease is often fatal.
About 80% of those surveyed could name at least one precaution recommended against Lyme Disease. However, only about half of those who could name a precaution said that they were taking any precautions around their homes. About half of those surveyed said that they had never even considered taking precautions. Neither the perceived difficulty of curing Lyme Disease nor the perceived effectiveness of precautions was related to taking action. In fact, there was a strong feeling of fatalism.
■ A large majority felt that no amount of precautionary behavior could provide complete safety.
■ Those who did report taking precautions said that they felt only a little safer because of their actions.
■ There was no optimistic bias about one's personal chances of getting Lyme Disease.
Finally, in this context, risk perceptions appeared to have the most influence over behavior. The best predictors of precaution-taking were objective risk factors such as the proximity of the respondent's home to woods, having a pet in the household, and the amount of time spent on a deck. Perceptions of the relative number of ticks in one's yard was also a good predictor of taking precautions, as were experiences that make the risk of Lyme Disease particularly salient, such as someone in the household having had a tick on them, knowing people with Lyme Disease, having had a blood test for the disease within the last five years and having children in the home. Unlike many other health behaviors, however, both objectively measured knowledge and self-rated knowledge were also positively associated with taking precautions. These results are consistent with those found by Brown, Cartter, Hadler & Hooper in their telephone survey of households in Connecticut in 1992. In addition, the perceived likelihood of getting the disease, concern about the disease in the community, the frequency with which people read articles about the disease, and the frequency of thoughts about the disease were also good predictors of precaution-taking.
RECOMMENDATIONS
Efforts to educate the public must go beyond a basic description of how Lyme Disease is transmitted, diagnosed, and treated, with a sidebar listing recommended precautions. Most of those surveyed have obviously been exposed to this kind of information. Getting people to use this information is the next step. Helping people understand that Lyme Disease really is preventable to a large extent, and giving people a sense of the efficacy of particular precautions may be important in motivating people to take the precautions they may already know about. Agencies working to educate people about Lyme Disease prevention must also work to dispel the myths and misconceptions that are still present and to give people a sense that they can have considerable control over their risk, even if they can not reduce their risk to zero.