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.

Effects of tick surveillance education on knowledge, attitudes, and practices of local health department employees

“…The proportion of participants planning to perform tick surveillance did increase from 15 to 20%, which was not statistically significant. There are conflicting reports on the effectiveness of increasing knowledge to promote preventative practices, but in the case of this study a significant association was not observed [ 27 , 30 , 33 , 34 ]. The lack of significant changes in practices may be related to some of the limitations of our study.…”

“…At least 80% of participants believed that TBDs were a public health problem, and over 70% indicated it was a problem in their own jurisdiction. High perceived risk of tick-borne diseases, such as that observed in our study, has been associated with increased willingness to perform preventive practices [ 27 , 29 , 30 ]. This was further confirmed by the significant positive correlation between perceived risk and perceived need for surveillance in our study following training.…”

“…There is a higher risk of infection with a TBDs when living or working in habitats where densities of infected ticks are high, and increased knowledge on TBDs has been correlated with increased preventive practices [ 24 , 25 ]. Studies in U.S. Forest Service employees and public health nurses have found knowledge scores related to TBDs or personal protective measures to be in the 80–90%, respectively [ 26 , 27 ]. Both populations had historically received training or educational materials related to tick safety and/or TBDs.…”

Tick bites in different professions and regions: pooled cross-sectional study in the focus area Bavaria, Germany

“…In line with these findings, prior studies also indicated a high prevalence of tick bites among forestry workers. It was found that forestry workers had a high seroprevalence of LB and other tick-borne diseases (TBD) as well as a background of high tick exposure at work and a self-reported history of TBD [ 33 – 36 ]. Since ticks are not only common in forests, the slightly lower risk for farmers could be attributed to modern agricultural methods with tall machinery that lead to less encounters with ticks attached to crops.…”

More than ticking boxes: Training Lyme disease education ambassadors to meet outreach and surveillance challenges in Québec, Canada

“…However, in order to be properly considered a “cascade”, the training developed lacks two main elements: knowledge evaluation (quality control, ideally ongoing, to determine trainer/trainee performance, teaching quality, knowledge retention and changes in behaviour), and network sustainability (ensuring long-lasting results with additional rounds of training) [ 68 ]. For instance, ambassadors could have been asked to complete a pre-test and post-test to evaluate their knowledge prior to and after workshops using a knowledge, attitudes, and practices study, and a similar assessment could have been done with their own trainees [ 69 ]. Making sure ambassadors and their trainees are able to make waves of their own with the proper information would ensure this program is solid and that it can be effective in the long-term.…”