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Crutzen R, Peters GJY. The regression trap: why regression analyses are not suitable for selecting determinants to target in behavior change interventions. Health Psychol Behav Med 2023; 11:2268684. [PMID: 37901096 PMCID: PMC10601507 DOI: 10.1080/21642850.2023.2268684] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Regression analyses are commonly used for selecting determinants to target in behavior change interventions, but the aim of this article is to explain why regression analyses are not suitable for this purpose (i.e. the regression trap). Methods This aim is achieved by providing (1) a theoretical rationale based on overlap among determinants; (2) a mathematical rationale based on the formulas that are used to calculate regression coefficients; and (3) examples based on real-world data. Results First, the meaning of regression coefficients is commonly explained as expressing the association between a determinant and a target behavior 'holding all other predictors constant.' We explain that this often boils down to 'neglecting a part of the psyche.' Second, we demonstrate that the interpretation of regression coefficients is distorted by correlations between determinants. Third, the examples provided demonstrate the impact this has in practice. This results in interventions targeting determinants that are less relevant and, thereby, have less impact on behavior change. Conclusion There are theoretical, mathematical, and practical reasons why regression analyses, and by extension multivariate analyses relying on correlations, are not suitable to select determinants to target in behavior change interventions. Instead, intervention developers should consider univariate distributions and bivariate association estimates simultaneously and there are freely accessible tools available to do so.
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Affiliation(s)
- Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| | - Gjalt-Jorn Ygram Peters
- Department of Theory, Methods & Statistics, Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
- Faculty of Psychology and Neuroscience, Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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Eisen L. Personal protection measures to prevent tick bites in the United States: Knowledge gaps, challenges, and opportunities. Ticks Tick Borne Dis 2022; 13:101944. [DOI: 10.1016/j.ttbdis.2022.101944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/27/2022] [Accepted: 03/24/2022] [Indexed: 01/07/2023]
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Omodior O, Anderson KR, Clark W, Eze P, Donohoe H. Preventing tick-bites among children in Indiana, USA: An analysis of factors associated with parental protective behaviors. Ticks Tick Borne Dis 2021; 12:101647. [PMID: 33445070 DOI: 10.1016/j.ttbdis.2020.101647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/27/2022]
Abstract
Despite evidence to the effect that there is low parental adoption of tick-bite personal protective behavior (PPB) for their children - a population at high risk for tick exposure, very limited information is available on factors associated with parental adoption of PPB. The objective of this study was to identify the most significant factors associated with parental adoption of tick-bite PPB on behalf of a child or children at risk of tick encounters. A cross-section of parents in Indiana, USA whose child had spent time outdoors in tick habitat during the summer were recruited from representative online panels maintained by Qualtrics. Binary logistic regression was used to model determinants of five tick-bite PPBs. Our results revealed that the application of tick repellent (89 %, n = 718) followed by conducting a tick check of the child's body soon after returning from the outdoors (84 %, n = 676) were the PPBs most frequently adopted by parents. Conversely, tucking one's shirt into pants and pants into socks was the least frequently adopted PPB (48 %, n = 386). Compared to other factors evaluated in logistic regression models, parents who reported implementing one or more residential tick control practices were significantly more likely to adopt nearly all five tick-bite PPBs for their children. Additionally, parents who were more worried about their health due to ticks and reported being more likely to avoid the outdoors because of ticks were more likely to adopt at least three PPBs on behalf of their children. To ensure children can most safely engage in outdoor activity, identifying the factors associated with parental adoption of tick-bite preventive behaviors represents an important mechanism in the prevention of tick-borne diseases.
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Affiliation(s)
- Oghenekaro Omodior
- Department of Health & Wellness Design, School of Public Health, Indiana University Bloomington, United States.
| | - Kristina R Anderson
- Department of Health & Wellness Design, School of Public Health, Indiana University Bloomington, United States
| | - William Clark
- Department of Epidemiology & Biostatistics, Indiana University School of Public Health-Bloomington, United States
| | - Paul Eze
- Department of Health Policy & Administration, Pennsylvania State University, University Park, United States
| | - Holly Donohoe
- Department of Economics and Geography, University of North Florida, United States
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Riccò M, Gualerzi G, Ranzieri S, Ferraro P, Bragazzi NL. Knowledge, Attitudes, Practices (KAP) of Italian Occupational Physicians towards Tick Borne Encephalitis. Trop Med Infect Dis 2020; 5:tropicalmed5030117. [PMID: 32708662 PMCID: PMC7559127 DOI: 10.3390/tropicalmed5030117] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 01/11/2023] Open
Abstract
Tick-Borne Encephalitis (TBE) is an occupational health threat with increasing incidence in the geographic area of Italy. Despite this, TBE vaccination rates have ranged from 10% to 40% in Italy, even in at-risk workers. The reasons for this low rate are investigated in this present study of the knowledge, attitudes, and practices of occupational physicians (OP) regarding TBE disease and vaccination in at-risk workers. A total of 229 OP participated in an internet-based survey by completing a structured questionnaire. Adequate general knowledge of TBE disease was found in 58% of OP. Accurate perception of TBE risk in occupational settings was found in 20%. TBE vaccination for at-risk workers was recommended by 19%. Willingness to recommend TBE vaccination was more likely by OP practicing in endemic areas (Odds Ratio 3.10, 95% confidence intervals 1.47–6.55), who knew the existence of the term “arboviruses” (3.10, 1.29–7.44), or exhibited a better understanding of TBE (2.38, 1.11–5.12)—and were positive predictors for promoting TBE vaccine, while acknowledging that TBE as a severe disease was a negative one. Tick-borne disorders in Italy are a still rare (but increasing) occupational health threat, and vaccination gaps for TBE virus may find an explanation in OP incomplete knowledge of evidence-based recommendations.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Occupational Health and Safety Service on the Workplaces of the Local Health Unit of Reggio Emilia (SPSAL), Via Amendola n.2, I-42122 Reggio Emilia, Italy
- Correspondence: or
| | - Giovanni Gualerzi
- Department of Medicine and Surgery, School of Medicine, University of Parma, Via Gramsci n.14, 43123 Parma, Italy;
| | - Silvia Ranzieri
- Department of Medicine and Surgery, School of Occupational Medicine, University of Parma, Via Gramsci n.14, I-43123 Parma, Italy;
| | - Pietro Ferraro
- ASL Foggia, Department of Prevention, Occupational Health and Safety Service on the Workplaces of the Local Health Unit of Foggia, Piazza Pavoncelli 11, I-41121 Foggia, Italy;
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada;
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Associations Between Personal Protective Measures and Self-Reported Tick-Borne Disease Diagnosis in Indiana Residents. J Community Health 2020; 45:739-750. [DOI: 10.1007/s10900-020-00789-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Riccò M, Bragazzi NL, Vezzosi L, Balzarini F, Colucci ME, Veronesi L. Knowledge, Attitudes, and Practices on Tick-Borne Human Diseases and Tick-Borne Encephalitis Vaccine among Farmers from North-Eastern Italy (2017). J Agromedicine 2019; 25:73-85. [PMID: 31456505 DOI: 10.1080/1059924x.2019.1659204] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Tick-borne diseases (T-BD) represent a potential health threat for outdoor workers in endemic areas, such as the Autonomous Province of Trento (APT). We conducted a questionnaire-based survey to assess T-BD knowledge, attitudes, and preventive practices among APT farmers, specifically focusing on the use of protective habits and the uptake of the tick-borne encephalitis (TBE) vaccine.Methods: A convenience sample of 106 farmers (all males, mean age 47.3 ± 13.6 years) attending pesticide training courses (12/2016-03/2017) completed the anonymous survey. Binary regression analysis, calculations of multivariate odds ratios (mOR) and 95% confidence intervals were used to assess knowledge, attitudes, and risk perceptions as predictors of preventive measures.Results: Though general understanding of T-BD was fairly low, the majority of the participants perceived TBE infection as a frequent (73.6%) and severe disease (61.3%). Overall, 43.3% of participants knew a TBE vaccine was available, and 24.5% had been vaccinated. Protective habits were reported by 53.8% of respondents, with self-checks for tick bites particularly low at 2.8% of participants. Better knowledge of T-BD and favorable attitudes toward vaccinations were associated with TBE immunization (mOR 4.708; 95%CI 1.273-17.409 and mOR 3.555; 95%CI 1.175-10.760, respectively), while previous history of tick bite and any interaction with T-BD significantly predicted adherence to protective measures (mOR 4.458; 95%CI 1.808-10.991, and mOR 9.433; 95%CI 1.127-78.973, respectively).Conclusions: Adherence to preventive measures (TBE vaccine) and protective habits was unsatisfactory in our sampled group, being a possible consequence of significant knowledge gaps. Public health communication on T-BD in farmers should, therefore, target understanding of health issues and appropriate preventive measures.
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Affiliation(s)
- Matteo Riccò
- Department of Public Health, AUSL- IRCCS di Reggio Emilia, Service for Health and Safety in the Workplace, Reggio Emilia (RE), Italy.,Autonomous Province of Trento Department of Prevention, Provincial Agency for Health Services (APSS), Operative Unit for Health and Safety in the Workplaces, Trento, Italy
| | - Nicola Luigi Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luigi Vezzosi
- Azienda Sanitaria dell'Alto Adige -Comprensorio di Brunico, Servizio di Igiene e Sanità Pubblica, Brunico, BZ
| | | | | | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Bouchard C, Aenishaenslin C, Rees EE, Koffi JK, Pelcat Y, Ripoche M, Milord F, Lindsay LR, Ogden NH, Leighton PA. Integrated Social-Behavioral and Ecological Risk Maps to Prioritize Local Public Health Responses to Lyme Disease. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:047008. [PMID: 29671475 PMCID: PMC6071748 DOI: 10.1289/ehp1943] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND The risk of contracting Lyme disease (LD) can vary spatially because of spatial heterogeneity in risk factors such as social-behavior and exposure to ecological risk factors. Integrating these risk factors to inform decision-making should therefore increase the effectiveness of mitigation interventions. OBJECTIVES The objective of this study was to develop an integrated social-behavioral and ecological risk-mapping approach to identify priority areas for LD interventions. METHODS The study was conducted in the Montérégie region of Southern Quebec, Canada, where LD is a newly endemic disease. Spatial variation in LD knowledge, risk perceptions, and behaviors in the population were measured using web survey data collected in 2012. These data were used as a proxy for the social-behavioral component of risk. Tick vector population densities were measured in the environment during field surveillance from 2007 to 2012 to provide an index of the ecological component of risk. Social-behavioral and ecological components of risk were combined with human population density to create integrated risk maps. Map predictions were validated by testing the association between high-risk areas and the current spatial distribution of human LD cases. RESULTS Social-behavioral and ecological components of LD risk had markedly different distributions within the study region, suggesting that both factors should be considered for locally adapted interventions. The occurrence of human LD cases in a municipality was positively associated with tick density (p<0.01) but was not significantly associated with social-behavioral risk. CONCLUSION This study is an applied demonstration of how integrated social-behavioral and ecological risk maps can be created to assist decision-making. Social survey data are a valuable but underutilized source of information for understanding regional variation in LD exposure, and integrating this information into risk maps provides a novel approach for prioritizing and adapting interventions to the local characteristics of target populations. https://doi.org/10.1289/EHP1943.
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Affiliation(s)
- Catherine Bouchard
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire (FMV), Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Cécile Aenishaenslin
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire (FMV), Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Erin E Rees
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire (FMV), Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Jules K Koffi
- Policy Integration and Zoonoses Division, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
| | - Yann Pelcat
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire (FMV), Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Marion Ripoche
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire (FMV), Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - François Milord
- Direction de santé publique de la Montérégie, Centre intégré de santé et de services sociaux Montérégie-Centre, Québec, Canada
| | - L Robbin Lindsay
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Nicholas H Ogden
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire (FMV), Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Patrick A Leighton
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire (FMV), Université de Montréal, Saint-Hyacinthe, Québec, Canada
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Beaujean DJMA, Gassner F, Wong A, Steenbergen JE, Crutzen R, Ruwaard D. Education on tick bite and Lyme borreliosis prevention, aimed at schoolchildren in the Netherlands: comparing the effects of an online educational video game versus a leaflet or no intervention. BMC Public Health 2016; 16:1163. [PMID: 27852247 PMCID: PMC5112636 DOI: 10.1186/s12889-016-3811-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/02/2016] [Indexed: 11/23/2022] Open
Abstract
Background Lyme disease or Lyme borreliosis (LB) is the most common tick-borne disease both in the United States and Europe. Children, in particular, are at high risk of contracting LB. Since child-specific educational tools on ticks, tick bites and LB are lacking, we developed an online educational video game. In this study, we compared the effectiveness of an online educational video game versus a newly developed leaflet aimed to improve prevention of tick bites and LB among Dutch schoolchildren. Methods A total of 887 children, aged 9–13 years and attending the two final years of primary schooling, were recruited from 25 primary schools in June and July 2012. They were assigned through cluster randomization to one of three intervention groups: ‘game’ (22.4%), ‘leaflet’ (35.6%) or ‘control’ (41.9%). Prior to and directly following intervention, the children were asked to complete a short questionnaire. The main outcome measures were knowledge, perception (perceived susceptibility and importance) and preventive behavior in relation to tick bites and LB. Generalized linear mixed models were used to analyze the data. Results In the game group, the leaflet group and the control group, knowledge about ticks and tick bites improved significantly. The game was also an effective tool for improving preventive behavior; the frequency of checking for ticks increased significantly. However, there were no significant differences in knowledge improvement between the interventions. The game outperformed the leaflet in terms of improving preventive behavior, whereas the frequency of tick checks increased significantly. But this frequency didn’t increase more than in the control group. Conclusions The positive knowledge effects observed in the control group suggests the presence of a mere measurement effect related to completion of the questionnaire. The game did not outperform the leaflet or control group on all outcome measures. Therefore, the game may be of value as a complementary role, in addition to other media, in child-specific public health education programs on ticks and LB. This trial was retrospectively registered on October 21, 2016 (trial registration number: ISRCTN15142369). Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3811-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D J M A Beaujean
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - F Gassner
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands
| | - A Wong
- Department of Statistics, Informatics and Mathematical Modeling, National Institute for Public Health and the Environment, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands
| | - J E Steenbergen
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.,Department of Infectious Diseases, Leiden University Medical Center, P.O. Box 9600, 2300, Leiden, The Netherlands
| | - R Crutzen
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200, Maastricht, MD, The Netherlands
| | - D Ruwaard
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200, Maastricht, MD, The Netherlands
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Aenishaenslin C, Bouchard C, Koffi JK, Ogden NH. Exposure and preventive behaviours toward ticks and Lyme disease in Canada: Results from a first national survey. Ticks Tick Borne Dis 2016; 8:112-118. [PMID: 27771334 DOI: 10.1016/j.ttbdis.2016.10.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
Lyme disease (LD) risk is increasing in Canada. In 2014, the government of Canada launched a national communication campaign to raise awareness and promote the adoption of individual preventive behaviours toward ticks and LD. The objectives of this study were to evaluate and compare the adoption of LD preventive behaviours and the exposure to tick bites of Canadians in the five main targeted regions (British Columbia, Prairie provinces, Ontario, Quebec and the Atlantic provinces). A national survey was conducted in December 2014 (n=2876) to collect data on LD awareness, behaviours and risk factors. Overall, the proportion of respondents reporting tick exposure was high (20%). The results suggest that even though LD awareness was found to be high (with only 12% of the respondents reporting that they never heard about LD), less than half of the Canadians who heard about it have adopted specific preventive behaviours toward tick bites, such as regular tick checks (reported by 52%), protective clothing (50%), using tick repellent (41%) or shower or bath (41%) after visiting a wooded area in a LD risk area. Moreover, significant differences were found between regions, gender, age groups and dog ownership status, regarding preventive behaviours and factors of exposure. A high level of knowledge of Lyme disease, living in the Prairie region, as well as having found a tick on oneself or a relative, were found to be associated with the adoption of preventive behaviours. This study underlines the importance to take into account specific regional characteristics of risk and to maintain public health communication efforts through time in order to increase the adoption of preventive behaviours of Canadians.
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Affiliation(s)
- Cécile Aenishaenslin
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Faculté de médecine vétérinaire, Université de Montréal, CP 5000, Saint-Hyacinthe, J2S 7C6, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1140 Pine Avenue, Montreal H3A 1A3, Québec, Canada.
| | - Catherine Bouchard
- National Microbiology Laboratory, Public Health Agency of Canada, CP 5000, Saint-Hyacinthe H2S 7C6, Québec, Canada
| | - Jules K Koffi
- Centre for Food-borne, Environmental & Zoonotic Infectious Diseases, Public Health Agency of Canada, CP 5000, Saint-Hyacinthe, H2S 7C6, Québec, Canada
| | - Nicholas H Ogden
- National Microbiology Laboratory, Public Health Agency of Canada, CP 5000, Saint-Hyacinthe H2S 7C6, Québec, Canada
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Hofhuis A, Bennema S, Harms M, van Vliet AJH, Takken W, van den Wijngaard CC, van Pelt W. Decrease in tick bite consultations and stabilization of early Lyme borreliosis in the Netherlands in 2014 after 15 years of continuous increase. BMC Public Health 2016; 16:425. [PMID: 27216719 PMCID: PMC4877959 DOI: 10.1186/s12889-016-3105-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nationwide surveys have shown a threefold increase in general practitioner (GP) consultations for tick bites and early Lyme borreliosis from 1994 to 2009 in the Netherlands. We now report an update on 2014, with identical methods as for the preceding GP surveys. METHODS To all GPs in the Netherlands, a postal questionnaire was sent inquiring about the number of consultations for tick bites and erythema migrans diagnoses (most common manifestation of early Lyme borreliosis) in 2014, and the size of their practice populations. RESULTS Contrasting to the previously rising incidence of consultations for tick bites between 1994 and 2009, the incidence decreased in 2014 to 488 consultations for tick bites per 100,000 inhabitants, i.e., 82,000 patients nationwide. This survey revealed a first sign of stabilization of the previously rising trend in GP diagnosed erythema migrans, with 140 diagnoses per 100,000 inhabitants of the Netherlands. This equals about 23,500 annual diagnoses of erythema migrans nationwide in 2014. CONCLUSIONS In contrast to the constantly rising incidence of GP consultations for tick bites and erythema migrans diagnoses in the Netherlands between 1994 and 2009, the current survey of 2014 showed a first sign of stabilization of erythema migrans diagnoses and a decreased incidence for tick bite consultations.
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Affiliation(s)
- Agnetha Hofhuis
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Sita Bennema
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Margriet Harms
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arnold J H van Vliet
- Environmental Systems Analysis Group, Wageningen University, Wageningen, The Netherlands
| | - Willem Takken
- Laboratory of Entomology, Wageningen University, Wageningen, The Netherlands
| | - Cees C van den Wijngaard
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wilfrid van Pelt
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Aenishaenslin C, Michel P, Ravel A, Gern L, Milord F, Waaub JP, Bélanger D. Factors associated with preventive behaviors regarding Lyme disease in Canada and Switzerland: a comparative study. BMC Public Health 2015; 15:185. [PMID: 25884424 PMCID: PMC4349712 DOI: 10.1186/s12889-015-1539-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 11/23/2022] Open
Abstract
Background Lyme disease (LD) is a vector-borne disease that is endemic in many temperate countries, including Switzerland, and is currently emerging in Canada. This study compares the importance of knowledge, exposure and risk perception for the adoption of individual preventive measures, within and between two different populations, one that has been living in a LD endemic region for several decades, the Neuchâtel canton in Switzerland, and another where the disease is currently emerging, the Montérégie region in the province of Québec, Canada. Methods A web-based survey was carried out in both study regions (814 respondents) in 2012. Comparative analysis of the levels of adoption of individual preventive measures was performed and multivariable logistic regression analyses were used to test and compare how knowledge, exposure and risk perception were associated with the adoption of selected measures in both regions and globally. Results In Montérégie, the proportion of reported adoption of five of the most commonly recommended preventive measures varied from 6% for ‘applying acaricides on one’s property’ to 49% for ‘wearing protective clothing’, and in Neuchâtel, proportions ranged from 6% (acaricides) to 77% for ‘checking for ticks (tick check)’. Differences were found within gender, age groups and exposure status in both regions. The perceived efficacy of a given measure was the strongest factor associated with the adoption of three specific preventive behaviors for both regions: tick check, protective clothing and tick repellent. Risk perception and a high level of knowledge about LD were also significantly associated with some of these specific behaviors, but varied by region. Conclusions These results strongly suggest that social and contextual factors such as the epidemiological status of a region are important considerations to take into account when designing effective prevention campaigns for Lyme disease. It furthermore underlines the importance for public health authorities to better understand and monitor these factors in targeted populations in order to be able to implement preventive programs that are well adapted to a population and the epidemiological contexts therein. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1539-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cécile Aenishaenslin
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Pavillon de la santé publique, Faculté de médecine vétérinaire, Université de Montréal, CP 5000, Saint-Hyacinthe, Québec, Canada.
| | - Pascal Michel
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Pavillon de la santé publique, Faculté de médecine vétérinaire, Université de Montréal, CP 5000, Saint-Hyacinthe, Québec, Canada. .,Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, CP 5000, Saint-Hyacinthe, Québec, Canada.
| | - André Ravel
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Pavillon de la santé publique, Faculté de médecine vétérinaire, Université de Montréal, CP 5000, Saint-Hyacinthe, Québec, Canada.
| | - Lise Gern
- Laboratoire d'Eco-Épidémiologie, Institut de Biologie, Université de Neuchâtel, 2000 Neuchâtel, Suisse.
| | - François Milord
- Institut national de santé publique du Québec, Montréal, Québec, Canada.
| | - Jean-Philippe Waaub
- Groupe d'étude et de recherche en analyse de la décision (GERAD), Université du Québec à Montréal, Montréal, Québec, Canada.
| | - Denise Bélanger
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Pavillon de la santé publique, Faculté de médecine vétérinaire, Université de Montréal, CP 5000, Saint-Hyacinthe, Québec, Canada.
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Braks M, Medlock JM, Hubalek Z, Hjertqvist M, Perrin Y, Lancelot R, Duchyene E, Hendrickx G, Stroo A, Heyman P, Sprong H. Vector-borne disease intelligence: strategies to deal with disease burden and threats. Front Public Health 2014; 2:280. [PMID: 25566522 PMCID: PMC4273637 DOI: 10.3389/fpubh.2014.00280] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/01/2014] [Indexed: 01/22/2023] Open
Abstract
Owing to the complex nature of vector-borne diseases (VBDs), whereby monitoring of human case patients does not suffice, public health authorities experience challenges in surveillance and control of VBDs. Knowledge on the presence and distribution of vectors and the pathogens that they transmit is vital to the risk assessment process to permit effective early warning, surveillance, and control of VBDs. Upon accepting this reality, public health authorities face an ever-increasing range of possible surveillance targets and an associated prioritization process. Here, we propose a comprehensive approach that integrates three surveillance strategies: population-based surveillance, disease-based surveillance, and context-based surveillance for EU member states to tailor the best surveillance strategy for control of VBDs in their geographic region. By classifying the surveillance structure into five different contexts, we hope to provide guidance in optimizing surveillance efforts. Contextual surveillance strategies for VBDs entail combining organization and data collection approaches that result in disease intelligence rather than a preset static structure.
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Affiliation(s)
- Marieta Braks
- Centre for Zoonoses and Environmental Microbiology, Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Jolyon M. Medlock
- Medical Entomology Group, MRA, Emergency Response Department, Public Health England, Salisbury, UK
| | - Zdenek Hubalek
- Medical Zoology Laboratory, Institute of Vertebrate Biology, Academy of Sciences, v.v.i., Brno, Czech Republic
- Faculty of Science, Department of Experimental Biology, Masaryk University, Brno, Czech Republic
| | - Marika Hjertqvist
- Public Health Agency of Sweden (Folkhälsomyndigheten), Solna, Sweden
| | - Yvon Perrin
- Centre National d’Expertise sur les Vecteurs, Centre IRD de Montpellier, Montpellier, France
| | - Renaud Lancelot
- CIRAD, UMR CMAEE, Montpellier, France
- INRA, UMR CMAEE 1309, Montpellier, France
| | | | | | - Arjan Stroo
- Centre for Monitoring of Vectors, Netherlands Food and Consumer Product Safety Authority (NWVA), Wageningen, Netherlands
| | - Paul Heyman
- Research Laboratory for Vector-Borne Diseases, Queen Astrid Military Hospital, Brussels, Belgium
| | - Hein Sprong
- Centre for Zoonoses and Environmental Microbiology, Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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Aenishaenslin C, Ravel A, Michel P, Gern L, Milord F, Waaub JP, Bélanger D. From Lyme disease emergence to endemicity: a cross sectional comparative study of risk perceptions in different populations. BMC Public Health 2014; 14:1298. [PMID: 25523355 PMCID: PMC4301662 DOI: 10.1186/1471-2458-14-1298] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022] Open
Abstract
Background Lyme disease (LD) is a tick-borne emerging disease in Canada that has been endemic in many temperate countries for decades. Currently, one of the main approaches for LD prevention is the promotion of individual-level preventive behaviors against ticks. Health behaviors are influenced by individual and social factors, one important of which is risk perception. This study aims to describe and compare risk perception of LD, within and between general populations and experts living in two different regions: the Neuchâtel canton in Switzerland, where LD is endemic, and the Montérégie region in Québec (Canada), where LD is emerging. Method A web-based survey was conducted in both study regions (814 respondents) in 2012, and a questionnaire was administered to 16 experts. Comparative analyses of knowledge, risk exposure and different components of LD risk perception were performed. Multivariate analyses were used to calculate a global risk perception score and to identify determinants of risk perception in both regions. Results In Montérégie, only 15% of the survey respondents had a good level of knowledge of LD compared to Neuchâtel where 51% of survey respondents had good levels of knowledge. In Montérégie, 24% of respondents perceived themselves as being at high or very high risk of contracting LD vs 54% in Neuchâtel; however, a higher percentage of respondents from this region believed that personal protection was simple to carry out (73% vs 58% in Montérégie). Based on the population surveys, almost all of the identified determinants of risk perception were different between both populations except for gender. A good level of knowledge, living in the risk zone and knowing someone who has had LD increased risk perception, while a high level of education and being 18–34 years of age decreased this perception. The majority of the studied components of risk perception were different between populations and their regional experts. Conclusion This study suggests that risk perception of LD differs between populations and regional experts living in different epidemiological situations. Monitoring of knowledge and risk perception in local populations may help to better target LD communication efforts in accordance with population specific attributes thereby enhancing prevention efficacy.
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Affiliation(s)
- Cécile Aenishaenslin
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Pavillon de la santé publique, Faculté de médecine vétérinaire, Université de Montréal, CP 5000, Saint-Hyacinthe J2S 7C6, Québec, Canada.
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