Tick-Borne Disease Prevention in Long-Distance Appalachian Trail Hikers: A Health Belief Model Approach

Introduction: Tick-borne-disease (TBD) risk is high along the Appalachian Trail (AT), yet little is known about how long-distance hikers practice recommended prevention behaviors. Because their prolonged outdoor exposure limits the feasibility of standard guidelines, understanding their behaviors and the beliefs shaping them is essential. This study examines TBD prevalence and prevention behaviors using the health belief model (HBM). Methods: A self-administered Qualtrics survey, pilot-tested for clarity, assessed demographics, AT hiking experience, diagnosis of TBD, prevention behaviors, and HBM constructs. Participants were ≥18 years old with AT experience. Recruitment occurred through in-person sampling, online forums, and snowball sampling. Prevention behaviors and HBM variables were analyzed using descriptive statistics and multiple regression models. Results: A total of 202 responses were analyzed. Over one-fifth of participants reported a previous TBD, most commonly Lyme disease. Prevention behaviors varied, with carrying tick removal devices, conducting daily tick checks, and using permethrin being the most frequently practiced. Regression models indicated that perceived barriers consistently predicted all prevention behaviors, while perceived benefits, susceptibility, and cues to action were significant in select models. Conclusions: Long-distance hikers demonstrated high TBD prevalence and inconsistent prevention practices. Tick checks, removal tools, and permethrin use were common prevention behaviors. Perceived barriers and perceived benefits were the strongest behavioral predictors, underscoring the need for interventions that reduce barriers and strengthen perceptions of effectiveness. Findings highlight opportunities to improve prevention strategies for hikers in high-risk environments.