Blacklegged tick exposure and management among understudied rural human populations - PROJECT SUMMARY: This AREA research will conduct a synthetic investigation of environmental and social conditions contributing to tick exposure and willingness to adopt tick management strategies in a rural, high-Lyme disease incidence state. Residents of rural areas are disproportionately affected by tick-borne disease in the United States. In 2023, Lyme disease incidence was 194.4 per 100,000 people in rural counties, 20 percent higher than in non- rural counties, and Lyme disease incidence has increased by 302.3 percent in rural counties between 2013- 2023, 30 percent more than in non-rural counties over the same decade. Three recent large-scale case-control studies analyzing Lyme disease risk among urban, suburban, and rural populations have identified rural residence as a primary epidemiological risk factor. Yet despite this substantial health disparity, much of research in the North American Lyme disease system has taken place in suburban environments, while rural areas remain understudied. Many of our assumptions about where and how people are likely to encounter ticks and the most viable practices to reduce exposure risk may be challenged in rural communities due to a combination of ecological, behavioral, and economic considerations. Our research will take place in Maine, the U.S. state with the second-highest proportion of its human population residing in rural areas and the third- highest Lyme disease incidence per capita. Leveraging urban-rural gradients in established and emergent areas of Lyme disease transmission, our primarily undergraduate research team will investigate how rurality and tick-borne disease endemicity interact with tick bite exposure risk in three key dimensions. First, we will conduct field surveys to compare densities of the blacklegged tick, the principal vector for Lyme disease in the region, on residential properties and in high-use recreation areas spanning urban-rural gradients. Second, we will conduct a prospective study to analyze how people spend time outdoors and identify behavioral drivers of tick exposure spanning urban-rural gradients. In this study, adult participants will record their locations and activities in one-hour increments over two weeks and document any ticks found on themselves, and we will use these data to identify behavioral risk factors for encountering a tick. Third, we will conduct a survey of adults who reside, own property, and pay taxes in Maine to understand willingness to adopt integrated tick management practices on privately owned and public land. We will explore the current prevalence of different tick management practices on private property, residents’ willingness to pay a tax for tick control on public land (via an economic choice experiment), and the health, environmental, and normative beliefs that may contribute to tick control decision-making. Our findings will 1) illuminate ecological and social-behavioral drivers of Lyme disease exposure and 2) suggest viable avenues for tick management among an understudied human population, while 3) developing a conceptual framework and tools that we expect to be relevant to the study and management of tick-borne disease exposure risk in other tick-pathogen systems.
