Peridomestic exposure to Borrelia burgdorferi-infected Ixodes scapularis nymphs is considered the dominant means of infection with black-legged tick-borne pathogens in the eastern United States. Population level studies have detected a positive association between the density of infected nymphs and Lyme disease incidence. At a finer spatial scale within endemic communities, studies have focused on individual level risk behaviors, without accounting for differences in peridomestic nymphal density. This study simultaneously assessed the influence of peridomestic tick exposure risk and human behavior risk factors for Lyme disease infection on Block Island, Rhode Island. Tick exposure risk on Block Island properties was estimated using remotely sensed landscape metrics that strongly correlated with tick density at the individual property level. Behavioral risk factors and Lyme disease serology were assessed using a longitudinal serosurvey study. Significant factors associated with Lyme disease positive serology included one or more self-reported previous Lyme disease episodes, wearing protective clothing during outdoor activities, the average number of hours spent daily in tick habitat, the subject’s age and the density of shrub edges on the subject’s property. The best fit multivariate model included previous Lyme diagnoses and age. The strength of this association with previous Lyme disease suggests that the same sector of the population tends to be repeatedly infected. The second best multivariate model included a combination of environmental and behavioral factors, namely hours spent in vegetation, subject’s age, shrub edge density (increase risk) and wearing protective clothing (decrease risk). Our findings highlight the importance of concurrent evaluation of both environmental and behavioral factors to design interventions to reduce the risk of tick-borne infections.

Background Improving the health of Americans is a primary goal of the Centers for Disease Control and Prevention (CDC). Breastfeeding, with its many known health benefits for infants, children, and mothers, is a key strategy to accomplish this goal. There are many ways that communities can support breastfeeding mothers and babies, and everyone plays a role. The CDC Breastfeeding Report Card provides information on breastfeeding practices and supports in all states. Public health practitioners can use the Report Card to monitor progress, celebrate success, and identify opportunities to work with health professionals and community members. What's new this year? Breastfeeding rates continue to rise in the United States. In 2011, 79% of newborn infants started to breastfeed. Yet breastfeeding did not continue for as long as recommended. Of infants born in 2011, 49% were breastfeeding at 6 months and 27% at 12 months. Professional lactation support can help mothers initiate and continue breastfeeding. The Report Card has been used to track the number of International Board Certified Lactation Consultants (IBCLCs) per 1,000 live births since 2006. This year's Report Card also includes the number of Certified Lactation Counselors (CLCs) per 1,000 live births. From 2006 through 2013, the number of IBCLCs increased from 2.1 to 3.5 per 1,000 live births. In 2013, there were 3.8 CLCs per 1,000 live births, compared to only 2.5 in 2011. In Alaska, Maine, New Hampshire, Oregon, and Vermont, there are now at least 6 IBCLCs per 1,000 live births; in 19 states, there are now at least 6 CLCs per 1,000 live births. However, there is limited availability of either type of professional in 11 states, with fewer than 3 IBCLCs and fewer than 3 CLCs per 1,000 live births.

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