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Environ Health Perspect. 2018 Apr 18;126(4):047008. doi: 10.1289/EHP1943.

Integrated Social-Behavioral and Ecological Risk Maps to Prioritize Local Public Health Responses to Lyme Disease.

Author information

Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire (FMV), Université de Montréal, Saint-Hyacinthe, Québec, Canada
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Policy Integration and Zoonoses Division, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
Direction de santé publique de la Montérégie, Centre intégré de santé et de services sociaux Montérégie-Centre, Québec, Canada
Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada



The risk of contracting Lyme disease (LD) can vary spatially because of spatial heterogeneity in risk factors such as social-behavior and exposure to ecological risk factors. Integrating these risk factors to inform decision-making should therefore increase the effectiveness of mitigation interventions.


The objective of this study was to develop an integrated social-behavioral and ecological risk-mapping approach to identify priority areas for LD interventions.


The study was conducted in the Montérégie region of Southern Quebec, Canada, where LD is a newly endemic disease. Spatial variation in LD knowledge, risk perceptions, and behaviors in the population were measured using web survey data collected in 2012. These data were used as a proxy for the social-behavioral component of risk. Tick vector population densities were measured in the environment during field surveillance from 2007 to 2012 to provide an index of the ecological component of risk. Social-behavioral and ecological components of risk were combined with human population density to create integrated risk maps. Map predictions were validated by testing the association between high-risk areas and the current spatial distribution of human LD cases.


Social-behavioral and ecological components of LD risk had markedly different distributions within the study region, suggesting that both factors should be considered for locally adapted interventions. The occurrence of human LD cases in a municipality was positively associated with tick density (p<0.01) but was not significantly associated with social-behavioral risk.


This study is an applied demonstration of how integrated social-behavioral and ecological risk maps can be created to assist decision-making. Social survey data are a valuable but underutilized source of information for understanding regional variation in LD exposure, and integrating this information into risk maps provides a novel approach for prioritizing and adapting interventions to the local characteristics of target populations.

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