Tickborne disease awareness and protective practices among U.S. Forest Service employees from the upper Midwest, USA

Abstract

Background: People with occupations that require them to spend time working outdoors in suitable tick habitats are predicted to be at an increased risk for tick-borne diseases (TBDs). However, few studies have assessed the risks of outdoor employees in the United States.

Methods: We conducted a cross-sectional survey to collect data on exposure to ticks and TBD infections among U.S. Forest Service employees in a high TBD incidence region of northern Wisconsin, and to examine employee knowledge, attitudes, and practices (KAPs) regarding TBDs to help guide future education and prevention programs. Chi-square contingency tables, calculations of odds ratios, and logistic regression models were used to identify associations among self-reported employee factors, the proportion of correctly answered knowledge questions, their ranked concern for TBDs, adherence to practicing preventive behaviors, and willingness to pay for protective measures.

Results: Ninety-five employees completed the survey. Nearly all respondents (97%) reported recent tick exposure, with 27% reporting encountering 10 or more ticks per week during peak tick season. Employee knowledge of TBD was high (median score: 80% correct). Fifty-nine percent of respondents had high concern for TBDs, and there was high adherence to conducting body checks for ticks (83% reported always doing them), but only moderate use of tick repellents (24% reported always and 60% reported occasionally using). High concern for TBD (adjusted odds ratio (aOR) = 6.32 [95% confidence intervals, 1.97-20.28]), a history of TBD diagnosis (aOR = 5.88 [1.41-24.55]), and older age (≥ 46 years) (aOR = 3.29 [1.00-10.84]) were positively associated with high practice adherence. Respondents suggested they would be willing to pay for personal protective methods and get a hypothetical vaccine for Lyme disease, but not community-wide efforts to control ticks.

Conclusions: Our study provides evidence that U.S. Forest Service employees in Wisconsin represent a high risk group for TBD, and despite relatively high TBD knowledge and engagement in tick protection activities, efforts are needed to reduce their risks for tick bites. More generally, our findings suggest that studies to better understand the factors related to the adoption and effectiveness of public health interventions are needed.

Keywords: Knowledge attitudes practices (KAP) survey; Lyme disease; Occupational risk; Personal protective measures; Tick bites; Tick-borne disease.

Fig. 1

U.S. Forest Service employee responses to the True/False knowledge section of the survey (Table S1). All items were completed by 95 respondents except the second item, which was completed by 94 respondents

Fig. 2

U.S. Forest Service employee responses to the LD vector identification section of the knowledge survey. Two other images not included here were an image of an adult bug (Hemiptera) and a spider; 95% of respondents correctly identified these latter two pictures as not being LD vectors. An answer was selected by 95 respondents for all, except the female I. scapularis and the spider pictures, which were answered by 94. * We considered “yes” as the incorrect answer for male I. scapularis because they are not known to feed for very long, and therefore, are not expected to transmit LD [34]; however, we are unaware of any experiments that have specifically examined transmission potential by males

Fig. 3

U.S. Forest Service employee responses to the willingness to pay for tick protection measures in the attitudes section of the survey. Participants responded to the question “Please rate your willingness to pay $20 or more per year for the following tick protection measures.” The sample size for the first three items was 93, and the sample size for the last two items was 92

Fig. 4

Tick protection practices reported by U.S. Forest Service employees. Participants responded to the question “Please provide information about the practices you may or may not engage in at work to protect yourself from ticks” Sample sizes for all items were 94, except for the fifth and ninth items, which were answered by 93 respondents