Lyme Disease Knowledge, Attitudes, and Behaviors -- Connecticut, 1992

Lyme disease (LD), caused by infection with the spirochete Borrelia burgdorferi, is the most commonly reported tickborne illness in the United States (1). Because no vaccine is available and effective measures to control tick populations are experimental, education is the most important approach to preventing LD. LD was identified in Connecticut in 1975 (2); in 1991, Connecticut had the highest rate of LD in the United States (36 per 100,000 population), and cases were reported in residents from 134 of Connecticut's 169 cities. To assess knowledge, attitudes, and behaviors related to LD, the State of Connecticut Department of Health Services and the University of Connecticut conducted a telephone survey of adults in Connecticut during the first 2 weeks of May 1992. This report summarizes the results of the survey.

A random sample of 200 households, stratified by the proportion of the state's households in each of Connecticut's eight counties, was contacted. Respondents were identified as the male or female head of household. The results may be interpreted with a plus or minus 7% error margin.

The median age of respondents was 43 years (range: 18-88 years); 109 (55%) were women, and 181 (91%) were white. Nearly two thirds (122 (61%)) resided in a suburban setting, 56 (28%) in a rural setting, and 22 (11%) in an urban setting. Nearly half (86 (43%)) reported knowing someone who has or had LD, and four (2%) reported having been told they have or had LD.

Fifty (25%) respondents reported they knew "a lot" about LD; 81 (41%), "some"; and 69 (34%), "a little." Most (194 (97%)) believed a person can acquire LD from the bite of an infected tick; 170 (85%), that LD is not transmitted by touching or other direct contact with a person with LD; and 125 (63%), that LD is not transmitted by touching or other contact with infected pets or other animals.

One hundred forty-five (73%) respondents believed that an expanding red rash was the most recognizable early symptom of LD. Most (127 (64%)) respondents believed that appropriate treatment of LD includes antibiotics and will result in recovery; 60 (30%) believed treatment of LD includes medication but that the infected person may not recover. Thirteen (6%) believed there was no treatment of LD or did not know of any treatment.

Respondents categorized their chances of acquiring LD in the coming year as high (15 (8%)), medium (60 (30%)), low (109 (54%)), or none (16 (8%)). Most (163 (82%)) believed LD is either fairly common or extremely common in Connecticut; 31 (15%), that it occurs rarely; and six (3%), did not know. Most (170 (85%)) believed LD is a serious or very serious disease; 22 (11%), that it is a problem but not a serious disease; and eight (4%), that it is either not a problem to worry about or that they were unsure of whether it is a problem.

Most (177 (89%)) respondents believed they could protect themselves from acquiring LD by looking for and removing ticks after they have been in wooded or grassy areas; 173 (87%), by wearing long pants in the woods; 171 (86%), by removing ticks from pets; 170 (85%), by avoiding wooded areas; and 113 (57%), by using insect repellent on their skin. Eighty-six (43%) had taken steps to prevent LD during the past year.

Respondents who reported they knew "a lot" about LD were more likely to have taken precautions to prevent LD during the past year (60% (30/50)) than were those who reported they knew "some" (54% (44/81)) or "a little" (17% (12/69)) about the disease (p less than 0.001; chi-square test for trend). Respondents who categorized their chances of acquiring LD in the coming year as high were more likely to have taken precautions to prevent LD during the past year (60% (9/15)) than were those who categorized their chance as medium (50% (30/60)), low (40% (44/109)), or none (21% (3/14)) (p=0.02; chi-square test for trend). Respondents who have personally known someone with LD were more likely to have taken precautions during the past year (53% (46/86)) than were those who did not know someone with LD (35% (40/114)) (relative risk=1.5; 95% confidence interval=1.1-2.1).

Most (110 (55%)) respondents believed the general public has been given "too little" information about LD; 82 (41%), that the right amount of information has been given; and two (1%), that too much information has been given; six (3%) respondents did not know. Respondents reported the most helpful sources of information on LD were articles in newspapers (81 (41%)), public service announcements (56 (28%)), and pamphlets and other written materials (47 (23%)). Sixteen (8%) believed no source was helpful.

Reported by: SW Brown, PhD, Univ of Connecticut, Storrs; ML Cartter, MD, JL Hadler, MD, State Epidemiologist, State of Connecticut Dept of Health Svcs. PF Hooper, PhD, Atlantic Marketing Research Co, Inc, Boston. Bacterial Zoonoses Br, Div of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: This is the first statewide survey of knowledge, attitudes, and behaviors related to LD. The preliminary findings in Connecticut support the importance of educating persons about LD and suggests that those who believe they are well-informed about, and at risk for acquiring, the disease are more likely to take precautions than are persons who do not. Additional studies can assist in targeting and evaluating the effectiveness of educational programs for LD.

Persons who live or travel in areas in which LD is endemic should be aware of the need to avoid tick bites, the importance of recognizing the early symptoms of LD (especially the expanding red rash known as erythema migrans), and the need to seek treatment for the disease as soon as symptoms develop.

The week of July 26-August 1, 1992, is National Lyme Disease Awareness Week. Many state and local health departments distribute educational materials on LD. Information about LD, including availability of educational materials, is available from many state and local health departments or CDC (telephone (303) 221-6453). Information about LD is also provided by the CDC Voice Information System; telephone (404) 332-4555.

References

1. CDC. Lyme disease surveillance -- United States, 1989-1990. MMWR 1991;40:417-21.

2. Steere AC, Malawista SE, Snydman DR, et al. An epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum 1977;20:7-17.

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