Tick-Borne Disease Prevention in Long-Distance Appalachian Trail Hikers: A Health Belief Model Approach

Area of Science:

• Public Health
• Environmental Health
• Epidemiology

Background:

• Tick-borne diseases (TBDs) pose a significant risk along the Appalachian Trail (AT).
• Limited understanding exists regarding long-distance hikers' adherence to TBD prevention guidelines.
• Prolonged outdoor exposure necessitates tailored prevention strategies for this demographic.

Purpose of the Study:

• To investigate TBD prevalence among long-distance AT hikers.
• To assess TBD prevention behaviors and their underlying beliefs using the Health Belief Model (HBM).
• To identify factors influencing prevention practices in a high-risk environment.

Main Methods:

• A self-administered survey assessed demographics, hiking experience, TBD diagnosis, prevention behaviors, and HBM constructs.
• Participants were adults (≥18) with AT experience, recruited via multiple sampling methods.
• Descriptive statistics and multiple regression models analyzed prevention behaviors and HBM variables.

Main Results:

• Over 20% of 202 respondents reported a prior TBD, most commonly Lyme disease.
• Commonly practiced prevention behaviors included carrying tick removal devices, daily tick checks, and permethrin use.
• Perceived barriers consistently predicted all behaviors; perceived benefits, susceptibility, and cues to action were significant in select models.

Conclusions:

• Long-distance hikers exhibit high TBD prevalence and inconsistent prevention practices.
• Perceived barriers and benefits were the strongest predictors of prevention behaviors.
• Interventions should focus on reducing barriers and enhancing perceived effectiveness of prevention strategies for hikers.