Slunge et al.
Learning to live with ticks? The role of exposure and risk perceptions in protective behaviour against tick-borne diseases.
PLoS ONE 13 (6): e0198286

The authors have analyzed the role of exposure to ticks and risk perceptions for protective behavior against tick-borne diseases by an online-questionnaire among the Swedish population aged 18-85 years of age. Risks related to ticks may be overestimated due to perception that they are difficult to control, or because ticks cause feelings of disgust and are often portrayed in alarmist media headlines. Risk-reducing measures are unevenly used in areas where ticks and Lyme Borreliosis (LB) and/or TBE is endemic. One reason may be discomfort when wearing protective clothing in summer (too warm) or image issues (looking stupid with trousers tucked into socks) or health risks from using repellents.

A large share of the respondents of the questionnaire stated that they often check their body for ticks after outdoor activities in areas with ticks (63%), use protective clothing (64%) or avoid grass and bushes (48%). However, a much lower share regularly tuck their trousers into their socks (18%) or use repellents (16%) as protective measures. Considerably fewer respondents used a combination of protective measures. Experience with ticks and tick-borne diseases is common in Swedish respondents. Only 32% reported they had never had a tick bite, 11% reported to have been diagnosed with LB and 1% had been diagnosed with TBE or another tick-borne disease. 42% of the respondents thought that ticks generally constitute a rather large or very large risk to health. In comparison, 26% and 31% answered that air pollution and traffic accidents, respectively, constitute a rather or very large risk.

Considering the large difference in experience with ticks – living in tick areas of Sweden or in non-tick areas – there was surprisingly little difference between shares of respondents who use protective measures. A higher score on seven knowledge questions was passively associated with tick bites, protective clothing and use of repellents. People who get used to having tick bites adjust their risk perception and they learn that the probability of falling ill from a single tick bite is low, yet they perceive that the cumulative effect of repeated tick bites constitutes a serious health risk. People, younger than 30 years of age, are less likely to use protective clothing and people older than 65 are less likely to perform tick checks.

TBE Book