Risk factors for tick exposure in suburban settings in the Northeastern United States

Prevention of tick-borne diseases requires an understanding of when and where exposure to ticks is most likely. We used an epidemiologic approach to define these parameters for residents of a Lyme-endemic region. Two persons in each of 500 Connecticut households were asked to complete a log each night for one week during June, 2013. Participants recorded their whereabouts in 15 min increments (indoors, outdoors in their yard, outdoors on others' private property, or outdoors in public spaces) and noted each day whether they found a tick on themselves. Demographic and household information was also collected. Logs were completed for 934 participants in 471 households yielding 51,895 time-place observations. Median participant age was 49 years (range 2-91 years); 52% were female. Ninety-one participants (9.8%) reported finding a tick during the week, with slightly higher rates among females and minors. Household factors positively associated with finding a tick included having indoor/outdoor pets (odds ratio (OR) = 1.7; 95% confidence interval (CI): 1.1-2.9), the presence of a bird feeder in the yard (OR = 1.9; CI:1.2-3.2), and presence of an outdoor dining area (OR = 2.2; CI:1.1-4.3). Individual factors associated with finding a tick on a given day were bathing or showering (OR = 3.7; CI:1.3-10.3) and hours spent in one's own yard (OR = 1.2, CI:1.1-1.3). Nineteen participants found ticks on multiple days, more than expected assuming independence (p < 0.001). Participants who found ticks on multiple days did not spend more time outdoors but were significantly more likely to be male than those finding ticks on a single day (p < 0.03). Our findings suggest that most tick exposures in the study area occurred on private property controlled by the respective homeowner. Interventions that target private yards are a logical focus for prevention efforts.