• assess disease incidence in children by their answer to question number seventeen on the follow up questionnaire consistent with disease. [ Time Frame: by end of grant ] [ Designated as safety issue: No ]
  

• study self-efficacy for regular performance of the avoidance behaviors avoiding tick areas, wearing protective clothing, applying tick repellent to themselves and their pets and self-efficacy for regular tick checks. [ Time Frame: at end of grant ] [ Designated as safety issue: No ]
  

The description of Lyme disease in 1976 and subsequent characterization of its mode of transmission, causative organism and treatment is one of the most remarkable advances in medicine in the last 25 years1-3. Nevertheless, Lyme disease continues to grow as a public health problem4. While Lyme disease affects all age groups, children have one of the highest rates4. Prevention remains a challenge in this group. The Lyme vaccine has been withdrawn from the market in February 20025, 6, and educational strategies among at-risk school children have been inadequately evaluated and none have been institutionalized.

We will target school-aged children living in Nantucket, Dukes County and Essex County. We have collaborated with the teachers and administration in many of the schools. We have collaborated with the teachers and administration in many of the schools. The intervention will be delivered by a member of our staff in conjunction with the teacher as well as a health education entertainer ('Screaming with Pleasure Productions'). Research assistants will distribute the enrollment questionnaires and "goody" bags. The basic content of the educational message has been designed by Drs. Shadick, Liang, DeJong and the late Dr. Daltroy, and has been used extensively on the Nantucket ferry study and in the "Feel Find Free" Program. The timing takes advantage of the classroom audience, is humorous and entertaining and the message is relevant to anticipated outdoor activities.

Primary Outcome: Lyme disease. We will assess disease incidence in children by their answer to question number seventeen on the follow up questionnaire We will confirm our cases with medical record review from individuals reporting a tick-borne illness or symptoms consistent with disease. All non-respondents will be contacted up to 3 times, after which they will be considered lost to follow-up. We will also record any episodes of babesiosis, or ehrlichiosis. We will also track the rate of Lyme disease in the towns by passive surveillance from the Mass.

Dept. of Public Health. Two independent clinicians blinded to group assignment will review charts.

Secondary Outcomes: Change in self-efficacy, behavioral intention, attitude and practice of health behaviors: We will study self-efficacy for regular performance of the avoidance behaviors avoiding tick areas, wearing protective clothing, applying tick repellent to themselves and their pets and self-efficacy for regular tick checks and recognizing early symptoms of Lyme disease on the children by the parents. We will study changes in baseline intention, perceived social support, attitudes and practice by children approximately one year after the education intervention. We hypothesize that the intervention will increase self-efficacy and intention to perform these behaviors. We will also assess practice of avoidance, tick checking and life style risk.