Ticks in America's Most Beautiful Place: Knowledge, Attitudes, and Practice in Employees and Visitors, Sleeping Bear Dunes National Lakeshore Michigan, 2012

BACKGROUND:   Sleeping Bear Dunes National Lakeshore (SLBE) is one of the most frequently visited tourist destinations in Michigan, seeing over a million visitors annually.  SLBE is located in an area of the state with an emerging blacklegged tick population.  Because of the possibility for tick-borne disease transmission, we were interested in assessing employee and visitor knowledge, attitudes, and practices regarding ticks and tick-borne illness.

METHODS:   SLBE visitors were recruited from June–September 2012 to complete a 16-question survey.  Employees completed a 25-question survey in June that was followed by a training lecture on ticks given by a medical entomologist.  An online follow-up survey was distributed to the same employees in September.  Questions addressed personal protective measure (PPM) use, reasons for not using PPM, and recent tick exposures.  We tabulated results from the employee surveys and then made comparisons to visitor responses.

RESULTS:   Forty-one employees (51%) completed both surveys.  Of the ten PPM assessed, only the proportion of employees who reported “bathing within 2 hours of going indoors” more than half the time increased after the training (p=0.0269).   The proportion who felt “very comfortable” answering visitors’ tick questions increased from 29% to 54%.  More employees reported concerns about insect repellent safety in the follow-up survey (37% to 54%).  Participating visitors (n=214) were more likely to use insect repellents on their skin (p=0.0001) than employees but were less likely to check their body for ticks (p<0.0001).  Only 32% of visitors reported seeing information about ticks/tick-borne illness at SLBE.

CONCLUSIONS:   We recommended that SLBE continue to actively promote tick/tick-borne illness education for employees and visitors.  Future trainings for employees should be tailored to contain specific messages to address gaps in use of PPM like insect repellents.  Because the abundance of ticks in the area is changing, visitor education through more visible materials is imperative.