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The Role of Human Awareness on the Spatial Patterns of the Tick-Borne Disease Human Monocytic Ehrlichiosis in Missouri." (2012)

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The Role of Human Awareness on the Spatial Patterns of the Tick-Borne Disease Human Monocytic Ehrlichiosis in Missouri. University of Louisville ThinkIR: The University of Louisville's Institutional Repository Electronic Theses and Dissertations 5-2012 The role of human awareness on the spatial patterns of the tick- borne disease human monocytic ehrlichiosis in Missouri. James Edward Nunn 1985- University of Louisville Follow this and additional works at: https://ir.library.louisville.edu/etd Recommended Citation Nunn, James Edward 1985-, "The role of human awareness on the spatial patterns of the tick-borne disease human monocytic ehrlichiosis in Missouri." (2012). Electronic Theses and Dissertations. Paper 1074. https://doi.org/10.18297/etd/1074 This Master's Thesis is brought to you for free and open access by ThinkIR: The University of Louisville's Institutional Repository. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of ThinkIR: The University of Louisville's Institutional Repository. This title appears here courtesy of the author, who has retained all other copyrights. For more information, please contact [email protected]. THE ROLE OF HUMAN AWARENESS ON THE SPATIAL PATTERNS OF THE TICK-BORNE DISEASE HUMAN MONOCYTIC EHRLICHIOSIS IN MISSOURI By James Edward Nunn III A Thesis Submitted to the Faculty of the College of Arts and Sciences of the University of Louisville in Partial Fulfillment of the Requirements for the Degree of Master of Science Department of Geography and Geosciences University of Louisville Louisville, Kentucky May 2012 Copyright 2012 by James Edward Nunn III All rights reserved THE ROLE OF HUMAN AWARENESS ON THE SPATIAL PATTERNS OF THE TICK-BORNE DISEASE HUMAN MONOCYTIC EHRLICHIOSIS IN MISSOURI By James Edward Nunn III A Thesis Approved on April 5, 2012 By the following Thesis Committee: Dr. Carol L. Hanchett Thesis Director Dr. Margath Walker Dr. Scott LaJoie ACKNOWLEDGEMENTS I would first like to thank my thesis advisor, Dr. Carol Hanchette for her guidance and direction over the past several years that has led to my interest in medical geography. I would also like to express my gratitude to Dr. Margath Walker for her unique perspective and guidance, without which I might not have taken this research project in the direction I did, and my third advisor, Dr. Scott Lajoie, for his invaluable insight, guidance, and time taken to work on this project with me. I also really appreciate all of the support and enthusiasm expressed by my fellow graduate students, as well as from friends and family. Lastly, I would like to specially express thanks to all the Postmasters of post offices of Ralls, Macon, Douglas and Carter Counties of Missouri, as well as all of the respondents who participated. Without their participation I would not have been able to complete this project. 111 ABSTRACT THE ROLE OF HUMAN AWARENESS ON THE SPATIAL PATTERNS OF THE TICK-BORNE DISEASE HUMAN MONOCYTIC EHRLICHIOSIS IN MISSOURI James Edward Nunn III April 5, 2012 Human monocytic ehrlichiosis (HME), a tick-borne disease that has recently surfaced in the United States, exists in regions where the tick vector population is established. This study utilizes methods that look beyond identifying high-risk regions, and investigates disparate awareness, self-perceived threat, and seriousness of HME to further enhance existing spatial modeling. The Health Belief Model provides a theoretical framework that encompasses the disease ecology aspect of medical geography to understand the relationship between people and their environment by surveying participants in study regions of Missouri. Results are suggestive that awareness differs between high/low incidence regions. Furthermore, education and income were found to be significant to overall awareness. The frequency of finding ticks, age, and overall concern and awareness were important factors in the decision to use preventative strategies against ticks. These results can be used to focus efforts by state health departments to increase awareness of this important disease. IV TABLE OF CONTENTS PAGE ACKNOWLEDGEMENTS ............................................................................................................ iii ABSTRACT .................................................................................................................................... iv LIST OF TABLES ......................................................................................................................... vii LIST OF FIGURES ....................................................................................................................... viii Statement of Purpose .................................................................................................................... 4 LITERATURE REVIEW ................................................................................................................. 7 Introduction .................................................................................................................................. 7 Medical Geography and Disease Ecology .................................................................................... 8 Tick Habitats and Lifecycles ...................................................................................................... 14 HME and Other Tick-borne Diseases in Missouri ..................................................................... 16 HME Research and GIS applications ......................................................................................... 18 Current Trends in Medical Geography ....................................................................................... 20 Health Belief Model ................................................................................................................... 22 Surveys ....................................................................................................................................... 23 Conclusion.................................................................................................................................. 24 RESEARCH METHODS ............................................................................................................... 27 Study Areas ................................................................................................................................ 27 The Survey ................................................................................................................................. 31 Respondents ............................................................................................................................... 33 Data Analysis .............................................................................................................. : .............. 34 Hypotheses ................................................................................................................................. 39 RESULTS ...................................................................................................................................... 42 v Survey Response ........................................................................................................................ 42 Analysis of Differences .............................................................................................................. 42 Awareness .................................................................................................................................. 43 Perceived susceptibility and severity ......................................................................................... 48 Efficacy of Preventative Strategies ............................................................................................ 50 Directional Cue to Action .......................................................................................................... 53 Limitations of the Study ............................................................................................................. 62 Future Research .......................................................................................................................... 63 REFERENCES ............................................................................................................................... 68 APPENDICES ................................................................................................................................ 73 CURRICULUM VITAE ................................................................................................................ 79 VI LIST OF TABLES TABLE PAGE 1. Respondents of the Survey ............................................................................................ 44 2. Results of Two Independent Sample t-tests .................................................................. 45 3. MUltiple Linear Regression Results for Selected Independent Variables ..................... 47 4. Discriminant Variables of Use of Preventative Measures ModeL ............................... 54 5. Discriminant Analysis Results ofthe Preventative Measures Model ........................... 54 Vll LIST OF FIGURES FIGURE PAGE 1. Disease Ecology Triangle ............................................................................................. 10 2. Photograph of the Lone Star Tick .................................................................................. 15 2. Modeled Risks of HME ................................................................................................ 21 3. Average Actual Annual Incidence
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