Using participatory epidemiology to understand differences in tick-borne disease perceptions from homeowners in the Ohio River valley

Tick-borne diseases (TBDs) are the most common vector-borne diseases reported annually in the United States. Lyme disease, caused primarily by the spirochetal bacterium <i>Borrelia burgdorferi</i> sensu stricto (s.s.) affects an estimated 476,000 people each year. <i>Borrelia burgdorferi</i> is transmitted by the tick <i>Ixodes scapularis</i> and is maintained in an enzootic cycle with small mammal reservoirs in the eastern United States. Since <i>B. burgdorferi</i> can infect humans and domestic animals, Lyme disease is an important One Health concern between humans and animals. People residing in endemic areas are likely to possess differences in knowledge and protective behaviors compared to people living in areas where Lyme disease is newly emerging. To better understand behavioral differences and perspectives of Lyme disease and other TBDs in these areas, elements of participatory epidemiology were incorporated by surveying homeowners from a Lyme disease endemic area (southwestern Pennsylvania) and an emerging area (eastern Ohio). The survey covered three main areas of interest: perceived risk of tick exposure and TBD health risks, personal protection methods used to prevent or reduce exposure to tick bites, and protection methods to reduce tick presence on residential properties. The results of our study suggest that residents in endemic regions may be more educated and aware of TBD risk and prevention methods based on their belief that TBDs pose at least a minor health risk. Additionally, more Pennsylvania residents used tick-bite prevention methods while outdoors on their property. Residents in Ohio were unlikely to make any changes to protect themselves or their property from ticks, which may be a result of a lack of education or motivation to change their behaviors. The findings from this study can inform public health education and interventions to increase awareness and reduce the risk of TBDs in endemic and emerging areas.