Protective practices against tick bites in Denmark, Norway and Sweden: a questionnaire-based study

Tick-borne infections are of emerging and increasing concern in the Scandinavian countries Denmark, Norway and Sweden. Only few studies have investigated protective practices against tick bites in the general population. The aim of this multi-country study was to assess the use of protective practices and the perception of the efficacy of them. We surveyed the extent of using protective practices against tick bites, using the same questionnaire in three local languages. In addition, we surveyed perceptions of how good a protection the different practices provide. Altogether 783 individuals from Denmark, 789 from Norway and 1096 from Sweden participated in the study by completing an extensive online questionnaire in October 2016. Altogether 1011 respondents (37.9%) reported using at least three different protective practices either often or always when in areas where there are ticks, while 522 (19.6%) reported using none. Female gender was among the factors identified as positively associated with using several of the specific practices often or always when in areas where there are ticks. The gender-difference in extent of using protective practices against tick bites was particularly pronounced in Sweden. Based on a multivariable logistic regression model, being female, being from Sweden, and having experienced one or more tick bites were positively associated with using at least three different protective practices against tick bites either often or always when in areas where there are ticks (odds ratios 1.90, 1.87 and 1.88, respectively). The results of our study, especially the observed differences by country and by gender, can be useful in targeting future information to the public. In particular, our results suggest that men across all ages should be considered a specific target group for this information.