Lyme Disease Survey 2018

Lyme Disease Survey

The Eau Claire City/County Health Department is working with adjunct faculty from the University of Wisconsin Milwaukee to measure the public’s understanding of Lyme disease (adults 18+) The survey is about five minutes long, is completely voluntary, and all responses are confidential. Information gathered in this survey will be used to plan future outreach on Lyme disease. Risks in taking this survey are no greater than risks encountered in everyday life. By completing the survey, you are consenting to taking the survey.

If you have any questions about this survey please contact Marisa Stanley at marisa.stanley@co.eau-claire.wi.us

Thank you!!

Question Title

* What is your age?

18-24

25-34

35-44

45-54

55-64

65-74

75 or older

Question Title

* To which gender do you most identify?

Male

Female

Other

Prefer not to answer

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* Highest level of education completed:

Less than high school

High school or G.E.D

Associate’s degree

Some college

College graduate

Post graduate degree

Question Title

* Where do you live?

Eau Claire County

Chippewa County

Clark County

Dunn County

Buffalo County

Pepin County

Trempealeau County

Jackson County

Fever

Chills

Headache

Fatigue

Muscle and joint aches

Swollen lymph nodes

Bullseye rash

All of the above

Question Title

* When participating in outdoor activities in the yard, I...

	Frequently	Often	Sometimes	Seldom	Never	Not Applicable
wear light-colored clothing	wear light-colored clothing Frequently	wear light-colored clothing Often	wear light-colored clothing Sometimes	wear light-colored clothing Seldom	wear light-colored clothing Never	wear light-colored clothing Not Applicable
use insect/tick repellent on skin and/or clothing	use insect/tick repellent on skin and/or clothing Frequently	use insect/tick repellent on skin and/or clothing Often	use insect/tick repellent on skin and/or clothing Sometimes	use insect/tick repellent on skin and/or clothing Seldom	use insect/tick repellent on skin and/or clothing Never	use insect/tick repellent on skin and/or clothing Not Applicable
check my body for ticks afterwards	check my body for ticks afterwards Frequently	check my body for ticks afterwards Often	check my body for ticks afterwards Sometimes	check my body for ticks afterwards Seldom	check my body for ticks afterwards Never	check my body for ticks afterwards Not Applicable

Question Title

* When participating in outdoor activities in the woods or brushy areas, I...

	Frequently	Often	Sometimes	Seldom	Never	Not Applicable
wear light-colored clothing	wear light-colored clothing Frequently	wear light-colored clothing Often	wear light-colored clothing Sometimes	wear light-colored clothing Seldom	wear light-colored clothing Never	wear light-colored clothing Not Applicable
use insect/tick repellent on skin and/or clothing	use insect/tick repellent on skin and/or clothing Frequently	use insect/tick repellent on skin and/or clothing Often	use insect/tick repellent on skin and/or clothing Sometimes	use insect/tick repellent on skin and/or clothing Seldom	use insect/tick repellent on skin and/or clothing Never	use insect/tick repellent on skin and/or clothing Not Applicable
wear long pants	wear long pants Frequently	wear long pants Often	wear long pants Sometimes	wear long pants Seldom	wear long pants Never	wear long pants Not Applicable
tuck my pants into my socks	tuck my pants into my socks Frequently	tuck my pants into my socks Often	tuck my pants into my socks Sometimes	tuck my pants into my socks Seldom	tuck my pants into my socks Never	tuck my pants into my socks Not Applicable
check my body for ticks afterwards	check my body for ticks afterwards Frequently	check my body for ticks afterwards Often	check my body for ticks afterwards Sometimes	check my body for ticks afterwards Seldom	check my body for ticks afterwards Never	check my body for ticks afterwards Not Applicable

Question Title

* I have used the following as insect/tick repellent (check all that apply)

DEET (Example: Off!)

Permethrin

Pre-treated tick repellent clothing

Picaridin

BioUD

IR3535 (Examples: Skinsosoft and Skinsmart)

Essential oils

Physical barriers (Examples: pants, long sleeve shirts, hat)

None

Other (please specify)

Question Title

* If you have pets, do you use insect/tick repellents on them? (this includes any type of product that is designed to repel insects/ticks)

Yes

Sometimes

Not Applicable

Question Title

* On average, I spend the following number of hours in my own yard or another yard each week during the...

	1-10 hours	11-20 hours	21-30 hours	30+ hours	Not applicable
Spring	Spring 1-10 hours	Spring 11-20 hours	Spring 21-30 hours	Spring 30+ hours	Spring Not applicable
Summer	Summer 1-10 hours	Summer 11-20 hours	Summer 21-30 hours	Summer 30+ hours	Summer Not applicable
Fall	Fall 1-10 hours	Fall 11-20 hours	Fall 21-30 hours	Fall 30+ hours	Fall Not applicable

Question Title

* What is your age?

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* To which gender do you most identify?

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* Highest level of education completed:

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* Where do you live?

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* The chance for tick bites is higher when the temperature is above 40° F.

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* People can get Lyme disease from tick bites only in the summer.

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* Using insect repellent does not protect against tick bites.

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* Putting clothing in the dryer for at least 10 minutes (or longer if clothes are wet) will kill any remaining ticks.

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* People can get Lyme disease after a tick bite.

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* A deer/bear tick has a higher chance of giving someone Lyme disease than a dog/wood tick.

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* What are the early signs and symptoms of Lyme disease? Check all that apply.

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* When participating in outdoor activities in the yard, I...

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* When participating in outdoor activities in the woods or brushy areas, I...

Question Title

* I have used the following as insect/tick repellent (check all that apply)

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* If you have pets, do you use insect/tick repellents on them? (this includes any type of product that is designed to repel insects/ticks)

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* On average, I spend the following number of hours in my own yard or another yard each week during the...

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* Do you work outdoors?

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* What activities do you like to do outdoors?

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* Have you ever had a tick bite (tick is attached to skin)?

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* Have you ever had Lyme disease?