Running into the Lyme-light: A retrospective cross-sectional study of tick bite and Lyme disease prevalence and prevention in hill runners, Scotland, UK.

Running into the Lyme-light: A retrospective cross-sectional study of tick bite and Lyme disease prevalence and prevention in hill runners, Scotland, UK. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Running into the Lyme-light: A retrospective cross-sectional study of tick bite and Lyme disease prevalence and prevention in hill runners, Scotland, UK. Mabel Balfour, Rita Ribeiro, Harriet Auty, Alicia Heath This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7829276/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Jan, 2026 Read the published version in BMC Public Health → Version 1 posted 16 You are reading this latest preprint version Abstract Background Lyme disease (LD) incidence is increasing globally, driven by changes to habitat and human-vector interactions. Effective prevention relies on local and individual-level understanding of risk and ecosystem interactions. Despite frequent exposure to tick habitats, little is known about tick bites and LD risk among hill, trail, and mountain runners. This study aimed to evaluate the prevalence of tick bites and LD in hill runners in Scotland, UK and examine preventive behaviours. Methods A cross-sectional retrospective survey of Scottish hill runners was conducted in June-July 2024. Hill runners aged 18 + resident in Scotland for the 12 months preceding the survey were eligible. Period prevalence of self-reported tick bites was calculated for the 12 months preceding the survey. Suspected LD incidence was calculated for all participants and those registered in competitive hill running. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of having a tick bite, for variables including age, sex, running hours per week, proportion of which is hill running, other outdoor activity hours per week, frequency of insect repellent use, full leg and arm cover use, and full body tick checks. Results 212 hill runners (56.1% male) completed the survey. Period prevalence of at least one tick bite was 82.5% (95%CI 76.76–87.40). Incidence of treated suspected LD was 4245 per 100,000 (95%CI 1941.21-8058.87), and the minimum estimate in the competitive subset was 150 per 100,000 per year (95%CI 60.29-309.97). Most hill runners reported never/infrequently wearing full leg-cover (67.9%), arm-cover (58.0%), or using insect repellent (74.5%). Regularly/almost always conducting a tick-check was associated with higher odds of at least 1 tick bite (OR 8.52, 95%CI 3.29–22.90, p < 0.001), whereas regularly/almost always wearing full leg-cover was associated with lower odds (OR 0.35, 95%CI 0.13–0.89, p = 0.029), versus never/infrequently. Conclusions A high reported prevalence and incidence of tick bites among surveyed hill runners in Scotland aligned with the low adherence to tick bite prevention behaviours in this population. Improving adherence with leg-cover recommendations may lower the risk of tick bites. Raising awareness of tick bite risk and prevention may benefit hill runners internationally as the sport grows. Borrelia burgdorferi Hill running Ixodes ricinus Prevention Tick-borne infection Zoonoses Figures Figure 1 Figure 2 Figure 3 Background The incidence of Lyme disease (LD), caused by the bacteria Borrelia burgdorferi , is rising across Europe [ 1 ], including within the United Kingdom (UK) [ 2 , 3 ]. This tick-borne infection can cause significant health issues if left untreated, including arthritis, carditis and neurological symptoms [ 4 ]. Diagnosis can be made clinically via a localised erythema migrans rash specific to the infection or through serological testing [ 5 , 6 ]. Asymptomatic infections, which make the disease difficult to identify [ 4 , 7 ], and the occurrence of chronic disease even after antibiotic therapy [ 8 ] mean prevention is key to public health management. Effective targeted mitigation relies on accurate surveillance and a thorough understanding of transmission routes and risk factors [ 9 – 11 ]. Multiple indicators from national surveillance [ 2 ] and primary care research [ 6 ] suggest that Scotland has the highest incidence of LD in humans in the UK. Differences in estimates across the UK and internationally are likely to be multifactorial [ 12 ]. In part, differences in LD incidence estimates are related to variations in case definitions, diagnostic practices and data collection [ 12 ]. Surveillance worldwide is limited by the challenges of accurate diagnosis, as well as a lack of routine serological testing in clinical practice [ 5 , 6 , 12 , 13 ]. Reported incidence rates in the UK are likely underestimates given the lack of mandatory reporting of clinical cases [ 2 , 14 , 15 ]. Furthermore, access to accurate clinical diagnosis data is limited even within healthcare datasets due to the inconsistency of clinical case reporting and incomplete antimicrobial record keeping [ 6 , 15 ]. Variation in environmental tick abundance, driven by differences in climate, habitat suitability, and host distribution [ 10 , 11 ], also contributes to the likelihood of vector interactions. Human exposure to tick habitats [ 6 , 16 ], including long grasses, forests, moorlands, and even urban parklands and gardens [ 5 , 17 – 19 ], also differs. Changing vector distribution and non-native species introduction [ 20 ], and the spread of further pathogens, such as tick-borne encephalitis (TBE) in native UK tick populations [ 21 , 22 ], add to the complexity and importance of understanding the risk of tick-borne disease. Improving surveillance can help untangle reasons for differences in incidence across the UK and abroad [ 10 , 11 , 13 ]. Enhancing epidemiological evidence of local high-risk populations and risk factors for tick bites will enable more appropriate targeted preventive strategies for reducing LD burden [ 10 , 11 ]. However, a granular understanding of differences in regional burden [ 1 ] and high-quality evidence for effective prevention strategies [ 23 ] are currently lacking. Previously identified high-risk groups for tick-borne diseases include people in forestry and farming occupations as well as those participating in recreational outdoor activities [ 21 , 24 , 25 ]. Several online surveys have assessed tick bite frequency and found a strong association between the frequency of running and walking in forested areas in Scandinavia [ 26 ] and on marked trails in the USA, and acquiring tick bites [ 27 ]. In the latter study, running and walking had a higher risk for tick bites compared to orienteering and other outdoor activities [ 27 ]. However, these studies are limited by a reliance on self-reporting, and the combination of activities assessed makes it difficult to pinpoint the risk associated with any specific activity. Moreover, variability in the duration and frequency of individual activities were not taken into account. Nevertheless, these previous studies demonstrate how citizen science can lead to informative datasets containing key information, such as the spatial distribution of tick species and bite acquisition in populations previously poorly studied, and have helped to identify potential groups and activities with increased risk of tick bites [ 20 ]. Several international studies have demonstrated the high risk of tick bites in orienteering activities, despite full-body coverage being required during competition due to these risks [ 17 , 28 – 30 ], aligning with the behavioural interventions recommended by the National Health Service (NHS) [ 31 ]. Hill (or fell) running in the UK is similar to international trail and mountain running, but like orienteering, is a sport that often requires off-path running in tick habitat [ 17 , 30 , 32 , 33 ]. Only one previous survey has examined tick bites in hill runners, focusing on participants of a two-day event in Scotland in 2014, with 8.5–13.8% of runners reporting tick bites acquired during the event [ 34 ]. Variability in clothing was observed, with many wearing shorts and short-sleeved tops [ 34 ]. As no attire requirements are placed on hill runners, it is hypothesised that there may be differences in body cover and thus differences in tick bite and LD risk, compared to orienteers. These previous studies demonstrate that bite reports at mass participation sporting events can be useful indicators of tick activity in the environment [ 17 , 34 ]. However, there is a lack of data on the prevalence of tick bites and the impact of tick-borne disease outside of specific events among individuals exercising in high-risk terrain. This study aimed to evaluate the prevalence of tick bites and prevalence and incidence of reported LD diagnoses in hill runners in Scotland, UK, examine whether tick bite prevention behaviours are practised by this group, and evaluate whether these behaviours are associated with tick bites. Gaining a better understanding of the prevalence of tick bites and LD and the uptake and effectiveness of prevention behaviours in the hill running population in Scotland will enable appropriate targeted preventive action. As hill, trail and mountain running become increasingly popular internationally there is scope for research in this field to have wider impacts for these communities as the sphere of regulation and interest expands. Methods Design A retrospective, cross-sectional digital survey of hill runners was conducted in Scotland, UK. A 32-question questionnaire was developed for this study (Additional file 1), which captured hill running activity, including competitive racing and metrics of time spent running, with divisions by time spent over forestry, long grass and moorland (‘hill terrain’). Other questions included participant demographics, tick bite and LD history and related experiences, including antibiotic use. Specific questions explored tick bite prevention behaviours recommended by NHS Scotland [ 31 ]. Recruitment The number of persons taking part in hill running and identifying as a hill runner in Scotland is unknown; however, 4668 individual entrants (recorded by the Scottish Hill Runners (SHR)) took part in SHR-affiliated races in the 12 months preceding the survey. Potential participants were identified and recruited via email invitations and social media recruitment campaigns administered by the SHR to their members across Scotland (an estimated 550 in 2023). A recruitment poster and advertisement were also placed on Hill Runner social media pages (Facebook and Instagram). The survey was distributed digitally via Qualtrics survey software (Provo, UT). Volunteers self-selected to participate after reading the participant information sheets and signed a consent form at the start of the digital survey. Recruitment and survey completion took place from June to July 2024. Inclusion and exclusion criteria Only persons residing in Scotland for the 12 months preceding recruitment were eligible for inclusion to align with the period under investigation and minimise the confounding effects of geographic region, where recommendations and risk may differ. Participants were asked to confirm this, as well as specifying their county of residence. This ensured that findings could be attributed to running primarily in Scotland. A question regarding tick bites acquired outside of Scotland enabled investigation of risk attributable elsewhere. Participants self-identified as hill runners based on the SHR definition [ 35 ], assuming they could accurately identify the terrain they typically ran on during the study period. Hill running was defined as running over hills, moors and mountains. Additional questions enabled further clarity on the amount of training, for more accurate estimation of the prevalence of bites and LD stratified by time spent running over higher risk terrains, as well as competitive hill running to estimate the impact of competition on behaviours that may modify risk. Persons under the age of 18 years were excluded to align with restricted age groups in hill racing [ 35 ]. Participants who were ineligible based on inclusion and exclusion criteria were directed out of the survey and thanked for their interest in participating. Data processing Participants were grouped based on their competitive hill racing history over the past 12 months, to identify those who had taken part in SHR-affiliated races or other events they defined as a hill race. This information was included to explore potential differences in adherence to prevention behaviours among competitive hill runners compared with non-competitive hill runners. Preventive behaviours included the NHS recommendations of wearing full arm-cover, full leg-cover, applying insect repellent, and conducting full-body tick-checks, particularly between March to October [ 31 ]. The NHS recommendations generally align with increased tick activity and abundance in the environment, although it is acknowledged that seasonal tick activity may be changing [ 36 ]. The proportion of time complying with these behaviours between March and October, when on hill terrain (defined as heather, bracken, long grass and/or forestry), was divided into never/ infrequently, regularly, or almost always, as was the proportion of time running on hill terrain. Respondents reported the number of tick bites they had incurred in the 12 months preceding the survey (none, 1–5, 6–10, 11–15, 16–20, ≥ 21). For analyses, the main outcome was defined as having at least one tick bite in the 12 months preceding the survey (no/yes). A secondary outcome was suspected LD diagnosis in the preceding 12 months, derived from reported diagnosis of LD by a healthcare professional (no/yes) or reported erythema migrans (no/yes), and treated with a course of antibiotics (no/yes). Statistical analysis Differences between categorical variables under investigation were tested with a Fisher exact test and Pearson Chi-square test, and continuous variables with a Wilcoxon Rank Sum Test (ɑ=0.05). Period prevalence of tick bites was calculated as the proportion of survey participants reporting at least one tick bite in the 12 months preceding the survey, and separately, in their lifetime. Incidence of suspected LD was calculated using the number of participants as the denominator. Acknowledging that survey participation may be biased towards individuals who have previously been diagnosed with LD, an estimated minimum incidence of suspected LD was also calculated for the subset of participants who reported taking part in SHR-affiliated races, using the reported total denominator of 4668 racers provided by SHR. Multiple logistic regression modelling was conducted to assess the associations between all variables under investigation and the odds of having at least one tick bite in the 12 months preceding the survey. Variables evaluated included age (continuous), sex [ 37 ], hours per week of running (continuous) [ 17 ], the proportion of running that was hill running (continuous), and hours per week of other outdoor activities, including occupational activities (continuous), frequency of using insect repellent [ 23 , 38 ], and of wearing full arm cover, full leg cover and conducting full body tick checks (grouped as never/infrequently and regularly/almost always) [ 31 ]. Participants who gave implausible answers for average hours/week running (> 50 hours/week) or taking part in other outdoor activity (> 100 hours/week) were excluded from the regression analyses (n = 6). All variables included in the model were tested for multicollinearity using a variance inflation factor score, which was low (< 1.5) [ 39 ]. A McFadden’s pseudo-R-squared score was calculated to assess the proportion of variance in the outcome (having at least one tick bite) explained by the included variables. Dominance analysis for logistic regression [ 40 ] was conducted to analyse the relative importance of each variable. This was determined by comparing pairs of variables and assessing the additional contribution of each variable to the model. All statistical analyses were conducted in R version 4.1.0 [ 41 ]. Ethical considerations Ethical approval was obtained from Imperial College London’s Research Governance and Integrity Team (Imperial College Research Ethics Committee reference 7030885). The study was conducted following the recommendations for physicians involved in research on human subjects adopted by the 18th World Medical Assembly, Helsinki 1964 and later revisions. All participants gave informed consent in the digital survey form and confirmed they were aged 18 years or over. Results A total of 224 individuals responded to the survey. After exclusions due to residency outside Scotland (n = 9) and non-participation in hill running in the preceding 12 months (n = 3), 212 hill runners completed the survey, of which 56.1% (n = 19) were male and 43.9% (n = 93) female (Table 1 ). Individuals reporting participation in a SHR-affiliated race (n = 144) represented 67.9% of respondents, and 3.1% of the total number of 4668 racers registered in SHR-affiliated races in the 12 months preceding the survey. Table 1 Summary of survey responses from 212 hill runners in Scotland. Tick bite in the 12 months preceding survey a Treated suspected Lyme disease in the 12 months preceding survey b Variable Overall, N = 212 c No, N = 37 c Yes, N = 175 c p-value d No, N = 197 c Yes, N = 9 c p-value e Reported number of tick bites in preceding 12 months < 0.001 0.610 None 37 (17.5%) 37 (100.0%) 0 (0.0%) 35 (17.8%) 0 (0.0%) 1–5 59 (27.8%) 0 (0.0%) 59 (33.7%) 54 (27.4%) 3 (33.3%) 6–10 31 (14.6%) 0 (0.0%) 31 (17.7%) 29 (14.7%) 1 (11.1%) 11–15 30 (14.2%) 0 (0.0%) 30 (17.1%) 29 (14.7%) 1 (11.1%) 16–20 12 (5.7%) 0 (0.0%) 12 (6.9%) 11 (5.6%) 1 (11.1%) ≥ 21 43 (20.3%) 0 (0.0%) 43 (24.6%) 39 (19.8%) 3 (33.3%) Reported number of tick bites in lifetime preceding survey period < 0.001 0.120 None 18 (8.5%) 18 (48.6%) 0 (0.0%) 17 (8.6%) 0 (0.0%) 1–5 24 (11.3%) 12 (32.4%) 12 (6.9%) 24 (12.2%) 0 (0.0%) 6–10 21 (9.9%) 3 (8.1%) 18 (10.3%) 20 (10.2%) 0 (0.0%) 11–15 9 (4.2%) 1 (2.7%) 8 (4.6%) 6 (3.0%) 2 (22.2%) 16–20 16 (7.5%) 0 (0.0%) 16 (9.1%) 16 (8.1%) 0 (0.0%) ≥ 21 124 (58.5%) 3 (8.1%) 121 (69.1%) 114 (57.9%) 7 (77.8%) Sought medical attention for a tick bite in preceding 12 months 0.048 < 0.001 No 194 (91.5%) 37 (100.0%) 157 (89.7%) 188 (95.4%) 0 (0.0%) Yes 18 (8.5%) 0 (0.0%) 18 (10.3%) 9 (4.6%) 9 (100.0%) Antibiotics to treat tick bite in preceding 12 months 0.033 < 0.001 No 193 (91.0%) 35 (94.6%) 158 (90.3%) 187 (94.9%) 0 (0.0%) Yes 15 (7.1%) 0 (0.0%) 15 (8.6%) 6 (3.0%) 9 (100.0%) Not sure 4 (1.9%) 2 (5.4%) 2 (1.1%) 4 (2.0%) 0 (0.0%) Age (years) 40 (31, 49) 43 (31, 50) 40 (31, 48) 0.552 41 (31, 49) 34 (32, 37) 0.579 Sex 0.654 1.000 Female 93 (43.9%) 15 (40.5%) 78 (44.6%) 86 (43.7%) 4 (44.4%) Male 119 (56.1%) 22 (59.5%) 97 (55.4%) 111 (56.3%) 5 (55.6%) Competitive hill racing in the preceding 12 months 0.907 0.697 No 50 (23.6%) 9 (24.3%) 41 (23.4%) 45 (22.8%) 1 (11.1%) Yes 162 (76.4%) 28 (75.7%) 134 (76.6%) 152 (77.2%) 8 (88.9%) Hours per week of running 6.0 (4.2, 8.0) 6.0 (4.5, 8.0) 6.0 (4.5, 8.0) 0.877 6.0 (4.0, 8.0) 8.0 (7.0, 10.0) 0.054 Hill running 0.764 0.669 Never or infrequently 32 (15.1%) 7 (18.9%) 25 (14.3%) 29 (14.7%) 2 (22.2%) Regularly 142 (67.0%) 24 (64.9%) 118 (67.4%) 133 (67.5%) 5 (55.6%) Almost always 38 (17.9%) 6 (16.2%) 32 (18.3%) 35 (17.8%) 2 (22.2%) Hours per week of other outdoor activity 5.0 (3.0, 8.0) 5.0 (3.0, 6.5) 5.0 (3.0, 10.0) 0.465 5.0 (3.0, 8.0) 6.0 (4.0, 15.0) 0.128 Insect repellent use 0.946 0.431 Never or infrequently 158 (74.5%) 27 (73.0%) 131 (74.9%) 149 (75.6%) 6 (66.7%) Regularly 41 (19.3%) 8 (21.6%) 33 (18.9%) 37 (18.8%) 2 (22.2%) Almost always 13 (6.1%) 2 (5.4%) 11 (6.3%) 11 (5.6%) 1 (11.1%) Full leg cover 0.135 1.000 Never or infrequently 144 (67.9%) 21 (56.8%) 123 (70.3%) 133 (67.5%) 7 (77.8%) Regularly 53 (25.0%) 11 (29.7%) 42 (24.0%) 50 (25.4%) 2 (22.2%) Almost always 15 (7.1%) 5 (13.5%) 10 (5.7%) 14 (7.1%) 0 (0.0%) Full arm cover 1.000 0.644 Never or infrequently 123 (58.0%) 22 (59.5%) 101 (57.7%) 115 (58.4%) 4 (44.4%) Regularly 81 (38.2%) 14 (37.8%) 67 (38.3%) 74 (37.6%) 5 (55.6%) Almost always 8 (3.8%) 1 (2.7%) 7 (4.0%) 8 (4.1%) 0 (0.0%) Full body tick check < 0.001 0.645 Never or infrequently 29 (13.7%) 14 (37.8%) 15 (8.6%) 27 (13.7%) 2 (22.2%) Regularly 69 (32.5%) 12 (32.4%) 57 (32.6%) 66 (33.5%) 2 (22.2%) Almost always 114 (53.8%) 11 (29.7%) 103 (58.9%) 104 (52.8%) 5 (55.6%) a Reported tick bite (at least one) in the 12 months preceding the survey b Reported Suspected Lyme disease (either reported clinical diagnosis by healthcare professional or erythema migrans, treated with antibiotics) in the 12 months preceding the survey c n (%) for categorical variables; Median (interquartile range) for continuous variables d p-values estimated using Fisher's exact test or Pearson's Chi-squared test for categorical variables, or Wilcoxon rank sum test for continuous variables c p-values estimated using Fisher's exact test for categorical variables or Wilcoxon rank sum test for continuous variables Table 1 . Summary of survey responses from 212 hill runners in Scotland. [ Inserted at the end of manuscript ] More than half of respondents (51.9%, n = 110/212) were from three counties (City of Edinburgh (n = 42/212, 19.8%), Aberdeenshire (n = 37/212, 17.5%), and Highland (n = 31/212, 14.6%)), and participants from 10 counties contributed to 81% (n = 172/212 of responses (Table 2 ). Table 2 Participants’ primary county of residence and proportion who reported at least one tick bite. Tick bite in the 12 months preceding survey County of residence Overall , N = 212 a No , N = 37 a Yes , N = 175 a Aberdeenshire 37 (17.5%) 5 (13.5%) 32 (86.5%) Argyll and Bute 4 (1.9%) 0 (0.0%) 4 (100.0%) City of Aberdeen 9 (4.2%) 2 (22.2%) 7 (77.8%) City of Edinburgh 42 (19.8%) 6 (14.3%) 36 (85.7%) City of Glasgow 13 (6.1%) 1 (7.7%) 12 (92.3%) Dundee 4 (1.9%) 0 (0.0%) 4 (100.0%) Fife 6 (2.8%) 1 (16.7%) 5 (83.3%) Highland 31 (14.6%) 4 (12.9%) 27 (87.1%) Perth and Kinross 7 (3.3%) 1 (14.3%) 6 (85.7%) Scottish Borders 7 (3.3%) 3 (42.9%) 4 (57.1%) South Lanarkshire 7 (3.3%) 3 (42.9%) 4 (57.1%) Stirling 13 (6.1%) 1 (7.7%) 12 (92.3%) West Lothian 5 (2.4%) 2 (40.0%) 3 (60.0%) Other county 27 (12.7%) 8 (29.6%) 19 (70.4%) Study total 212 (100.0%) 37 (17.5%) 175 (82.5%) a n (%) Period prevalence of tick bites Among the 212 hill runners, 82.5% (n = 175/212, 95%CI 76.76–87.40) reported having been bitten by at least one tick in the 12 months preceding the survey, and 91.5% (n = 194/212, 95%CI 86.91–94.89) reported at least one tick bite in their lifetime (Table 1 ). Of the 212 participants, 24 reported being bitten by a tick outside of Scotland at least once in the 12 months preceding the survey (11.3%, 95%CI 7.39–16.37). Period prevalence and incidence of Lyme disease Of the 212 participants, nine (4.2%, 95%CI 1.96–7.91) reported treated suspected LD in the 12 months preceding the survey, of whom one reported no identified erythema migrans. The incidence of reported suspected LD was 4245.3 per 100,000 (95% CI 1941.21-8058.87). No participants reported having had a positive diagnostic test (either by the NHS or privately) for LD in the 12 months preceding the survey. For the lifetime period prior to the 12-month survey period, 17 participants reported a diagnosis of LD and antibiotics following a tick bite (8.0%, 95% CI 4.74–12.53, unadjusted for age), of whom eight (3.8%, 95% CI 1.64–7.30) had a positive diagnostic test, all conducted by the NHS. History of erythema migrans rash prior to the survey period was not surveyed. Among the 144 participants who reported taking part in SHR-affiliated races in the preceding 12 months, seven (4.9%, 95%CI 1.98–9.76) reported a suspected LD diagnosis. Assuming conservatively that this represents all LD diagnoses from the SHR membership of 4668, this results in a minimum suspected LD incidence of 150 per 100,000 (95% CI 60.29-308.97). Medical attention and antibiotic prescription Of those who reported a tick bite in the 12 months preceding the survey, 10.3% (n = 18/175) sought medical attention (pharmacy for treatment, a general practitioner or other hospital-based care) and 8.6% (n = 15/175) reported receiving antibiotics (Table 1 ). All participants who reported a clinical diagnosis of LD, or erythema migrans reported receiving a course of antibiotics in response to a tick bite (type and course duration were not recorded). Preventive behaviours Most hill runners reported regularly/almost always conducting tick-checks (86.3%, n = 183/212), but never/infrequently using insect repellent (74.5%, n = 158/212), wearing full leg-cover (67.9%, n = 144/212) or arm-cover (58.0%, n = 123/212) (Fig. 1 , Table 1 ). When asked for free-text reasons for not applying NHS recommended tick prevention behaviours, 68.4% (n = 145/212) of all survey participants responded that they were too warm to wear full-body cover when running (Table 3 ). Table 3 Summary of participant responses for non-adherence to tick bite prevention behaviours, and prevention methods used when hill running. a. Reported reason for non-adherence with preventive behaviours n Percentage (%) of total participants a Too warm or uncomfortable in body cover 145 68.4% Not previously thought of tick bites or Lyme disease as a concern to address 20 9.4% Forget to apply insect repellent, conduct checks or cover up 16 7.5% Concern for environmental or health impacts of insect repellents 11 5.2% Not previously aware of tick bite risk or prevention tools available 10 4.7% Not believed body cover or insect repellent to be effective 8 3.8% Find it easier to see tick bites on bare skin compared to when wearing body cover 4 1.9% Expense of insect repellent 2 0.9% Not sure what to look for with regards to finding tick bites 1 0.5% b. Reported other or additional method of tick bite prevention n Percentage (%) of total participants a Regular checks for tick bites during running activity 25 11.8% Where possible, avoiding crossing dense vegetation, e.g. bracken and known tick areas 13 6.1% Tucking trousers, including waterproofs, into socks 8 3.8% Spraying clothes and shoes with insect repellent treatment, e.g. permethrin 7 3.3% Wearing long and/or waterproof socks 6 2.8% Never sitting down or placing items on the ground 5 2.4% Showering straight away and/or washing off regularly e.g. in rivers 5 2.4% Keeping legs hair free 4 1.9% Keeping clothes separate or in sealed bags after running activity 2 0.9% Use of other chemicals, e.g. Deep Heat, Suncream 2 0.9% a Individuals may have given more than one reason for non-adherence or additional method; these are counted separately. Regularly/almost always conducting a full-body tick-check, compared with never/infrequently, was associated with proportionally more tick bites over the 12 months preceding the survey (p < 0.001, Fig. 2 A, Additional file 2), and with more tick bites in the respondents’ lifetime preceding the survey period (p < 0.001, Fig. 2 B). Reported number of tick bites between March to October when crossing heather, bracken, long grass and/or forestry, in A. the 12 months preceding the survey and B. over the participant’s lifetime. Yellow represents the highest number of tick bites and blue the lowest. The median age of participants who regularly/almost always conducted full-body tick-checks was younger than those who never/infrequently did (39 vs. 45 years, p = 0.036, Additional file 3). A higher proportion of males reported participating in competitive hill races in the preceding 12 months (84.0%, n = 100/119 vs. 66.7% for females; p = 0.003, Additional file 4), but a greater proportion of females (46.2%, n = 43/93) reported regularly/almost always wearing full leg-cover when running (compared with 21.0%, n = 25/119 of males, p < 0.001). Among males, the proportion of competitive hill racers who reported never/infrequently wearing full leg-cover was higher (84.0%, n = 84/100) than for non-competitive runners (52.6%, n = 10/19, p = 0.006, Fig. 3 ). Factors associated with tick bites Regularly/almost always performing full-body tick checks (compared to never/infrequent checks) was associated with higher odds of reporting at least one tick bite in the past 12 months (OR 8.52, 95%CI 3.29–22.90, p < 0.001). In contrast, regularly/almost always wearing full leg-cover (compared with never/infrequently) was associated with lower odds of having at least one tick bite (OR 0.35, 95% CI 0.13–0.89, p = 0.029, Table 4 ). Table 4 Multiple logistic regression analysis of at least one tick bite in the 12 months preceding survey. Tick bite in the 12 months preceding survey Variables Overall , N = 206 a No , N = 35 a Yes , N = 171 a OR 95% CI p-value Average Dominance R 2 b Ranking Full body tick check 0.094 1 Never or infrequently 29 (14.1%) 14 (40.0%) 15 (8.8%) 1.00 (reference) Regularly or almost always 177 (85.9%) 21 (60.0%) 156 (91.2%) 8.52 3.29, 22.90 < 0.001 Hours of running (per 1 hour/week increment) 6.0 (4.2, 8.0) 6.0 (4.5, 8.0) 6.0 (4.5, 8.0) 0.99 0.89, 1.13 0.928 0.034 2 Hours of other outdoor activity (per 1 hour/week increment) 5.0 (3.0, 8.0) 5.0 (3.0, 7.0) 5.0 (3.0, 9.0) 1.07 1.00, 1.20 0.116 0.03 3 Full leg cover 0.019 4 Never or infrequently 140 (68.0%) 19 (54.3%) 121 (70.8%) 1.00 (reference) Regularly or almost always 66 (32.0%) 16 (45.7%) 50 (29.2%) 0.35 0.13, 0.89 0.029 Sex 0.002 5 Female 90 (43.7%) 14 (40.0%) 76 (44.4%) 1.00 (reference) Male 116 (56.3%) 21 (60.0%) 95 (55.6%) 0.81 0.33, 1.97 0.640 Hill running 0.001 = 6 Never or infrequently 31 (15.0%) 7 (20.0%) 24 (14.0%) 1.00 (reference) Regularly or almost always 175 (85.0%) 28 (80.0%) 147 (86.0%) 0.97 0.30, 2.74 0.950 Insect repellent use 0.001 = 6 Never or infrequently 155 (75.2%) 26 (74.3%) 129 (75.4%) 1.00 (reference) Regularly or almost always 51 (24.8%) 9 (25.7%) 42 (24.6%) 0.85 0.34, 2.22 0.729 Full arm cover 0.001 = 6 Never or infrequently 119 (57.8%) 20 (57.1%) 99 (57.9%) 1.00 (reference) Regularly or almost always 87 (42.2%) 15 (42.9%) 72 (42.1%) 1.13 0.49, 2.68 0.775 Age (per 1 year increment) 40 (31, 49) 45 (30, 50) 40 (31, 48) 1.01 0.98, 1.05 0.487 0.001 7 Competitive hill racing in preceding 12 months < 0.01 8 No 46 (22.3%) 8 (22.9%) 38 (22.2%) 1.00 (reference) Yes 160 (77.7%) 27 (77.1%) 133 (77.8%) 1.00 0.34, 2.79 0.990 a Median (interquartile range) for continuous variables; n (%) for categorical variables b R 2 = McFadden’s Pseudo-R-Squared Abbreviations : OR = Odds Ratio, CI = Confidence Interval McFadden’s pseudo-R-squared value for the model was 0.18. Among the variables included, conducting a tick check explained the most variance in reporting at least one tick bite (0.094, Table 4 , Additional file 5). Table 4 . Multiple logistic regression analysis of at least one tick bite in the 12 months preceding survey. [ Inserted at end of manuscript ] Discussion This online cross-sectional survey found high period prevalence of reported tick bites and LD among the surveyed Scottish hill running population. Adherence with recommended prevention behaviours was generally low, however most hill runners reported regularly/almost always conducting full-body tick-checks, and this was associated with higher odds of having at least one tick bite. Regularly/almost always wearing full leg-cover was associated with lower odds of having at least one tick bite in the preceding 12 months. Period prevalence of tick bites in the study population (82.5%) was higher than the prevalence reported from mass participation events, including a Scottish hill running competition (8.5% to 13.8%) [ 34 ], and Scottish (33.3%) [ 17 ] and French (62.4%) [ 29 ] orienteering events. While this is not unexpected given the timeframe studied here, the prevalence was also higher than that found in comparable general population cross-sectional surveys conducted in 2016 across Denmark, Norway and Sweden (52%, 49.3% and 71.3% respectively) [ 26 ]. In addition, the proportion of respondents reporting ≥ 21 tick bites in the preceding 12 months was much higher in our study population (20.3%) than the 1.8% reported by Jore et al. in the Scandinavian general population [ 26 ]. A lack of tick bite data in the UK general population and other at-risk groups limits the ability to make comparisons to the wider population, which is further limited by not capturing data on tick bites acquired through occupational and other activities. Nevertheless, this study highlights that taking part in off-road running activity represents a particularly high-risk behaviour for tick bites [ 26 , 27 ]. The period prevalence of reported suspected LD (4.2%) was higher than the 2% reported by Jore et al. [ 26 ]. However, unlike this European study, where most individuals had a confirmatory serological test [ 26 ], no hill runners in our study reported a diagnostic test to confirm diagnosis in the 12-month period. Interpretation and generalisation of both tick bite and LD prevalence calculations for hill runners should be interpreted cautiously due to possible recall bias in the bite date, diagnosis date, the relatively small population studied, and potential motivation bias towards survey participation in those with experience of tick bites or LD, which may inflate the observed prevalence. However, the clinical LD diagnosis definition used here without confirmatory serological testing aligns with NICE guidelines for diagnosis and treatment of LD in the UK [ 4 ]. This is largely because the antibody response takes several weeks to become detectable, limiting the value of serological testing in acute treatment decisions [ 4 ]. As a result, none of the suspected LD cases reported here would be included in Scottish national surveillance, which reports on serological testing only [ 2 ]. This supports the previously acknowledged underestimates of LD incidence reported in Scottish national surveillance [ 2 , 15 ], which reinforces the case for including erythema migrans reporting as a key indicator in national surveillance [ 13 ], since similar studies utilising treated erythema migrans diagnosis have indicated much higher incidence rates [ 6 , 15 , 42 ]. Nevertheless, a lack of confirmatory testing increases the risk of inappropriate antibiotic use for misdiagnosed infections. Therefore, arguments remain for improving diagnostic capabilities for clinical patient management and for improving national surveillance validity. All those presenting with erythema migrans were treated with antibiotics as per NICE guidelines [ 4 ] (Table 1 ). However, 3.0% of those with a tick bite, but no reported rash or LD diagnosis from a clinician, also reported receiving a course of antibiotics following a bite, despite prophylaxis treatment not being a NICE recommendation [ 4 ]. This suggests either that health practitioners may be over-prescribing antibiotics, which has implications for antibiotic stewardship practices, or that there was high clinical suspicion of LD [ 4 ], and that other key signs or symptoms that are identified by prescribers were not captured in this study. The frequency of erythema migrans presenting in Borrelia infections and whether this is dependent on other factors is also unclear [ 4 ]; therefore, asymptomatic infections may not be captured by the case definition here. The estimated LD incidence in the study population, 4245.3 per 100,000 per year, may be biased towards overestimation due to (i) increased likelihood that runners who had experienced LD completed the questionnaire and (ii) possible inaccuracy in remembering exactly when an LD event occurred. In contrast, the estimated minimum incidence of LD among SHR competitive individuals, 150 per 100,000 per year, is likely an underestimate, given the low survey participation rate (3%) by the SHR competitive hill runner population. Nonetheless, both figures are higher than reported previous estimates which take into account treated erythema migrans, of 37.3 per 100,000 (95% CI 34.2–40.7) in the general population of Scotland in 2010–2012 [ 6 ]. This suggests hill runners may be at increased risk compared to the general population. However, this difference may also be partially explained by the time period between estimates, changes in vector distribution [ 20 ], and changes in human interactions with the environment, such as changes to outdoor leisure activity in general during and after the SARS-COV-2 pandemic [ 2 ]. Validating self-reported findings via medical records and improving case definition consistency in research and surveillance initiatives would enable more accurate comparisons in the UK and internationally [ 12 , 13 ]. Although study participants reported regular engagement in other outdoor activities or occupations in addition to hill running (Table 1 ), which could lead to an overestimation of the incidence within the study population, the results are closer to recent LD incidence estimates for the general population living in the highlands of Scotland (149–362 per 100,000) [ 42 ] and the Western Isles (53–574 per 100,000) [ 15 ]. Therefore, it is plausible that this study may simply reflect the high incidence of LD within the general Scottish population. Hall et al demonstrated high prevalence of tick bites at individual hill events and confirmed B. burgdorferi presence within ticks biting participants [ 34 ], but further long-term study is required to confirm the link between specific bites acquired when hill running and any attributable LD diagnosis. Research to define the hill running population denominators and understand other possible confounding variables is vital for more accurate incidence calculations and comparisons in specific groups, as well as improving surveillance of LD in Scotland. The higher odds of at least one tick bite being related to conducting a full-body tick-check has been demonstrated previously [ 43 ] and may be a form of detection bias. Searching for ticks may be inherently associated with the number of tick bites found. It is also possible that tick bites were missed by those not conducting checks. Because even an initial full-body check may not always be enough to completely detect all, especially small, ticks [ 29 ], overall prevalence may be underestimated. The association may also be related to previous experience of tick bites, which is supported by the strong relationship between higher numbers of tick bites over a participant’s lifetime and increased frequency of regularly/almost always conducting tick-checks. Additionally, associations between specific geographical locations of hill runs and factors such as the degree of exposure, prior education, or risk perception may influence the likelihood of conducting tick checks [ 43 , 44 ]. However, we were not able to comprehensively investigate these relationships here, although these factors were mentioned by some participants in free-text responses (Table 3 ). The overall low adherence with wearing full-body cover in hill runners is consistent with the perceived impacts on comfort and performance commented on by most survey respondents and was similarly observed in an earlier mass participation study of hill runners in Scotland [ 34 ]. The lower adherence in those engaging in competitive hill running also supports this, as racing is likely to be associated with higher energy output activity (and thus feeling hot/sweating) more regularly. It is unclear why women comply with full leg cover more frequently than men. Any compulsory measure for full leg-cover, in line with British orienteering [ 33 ], would need to be carefully balanced with other perceived health risks by participants, and be well evidenced, as perception of efficacy has been shown to relate to uptake [ 44 ]. This study provides new evidence suggesting that full leg-covering is protective for preventing tick bites, supporting previous evidence that body coverage during outdoor activities may reduce the risk of LD [ 23 ]. Adherence with insect repellent application was low but was within the range of use reported by orienteers (8.5–34.2%) in multi-day orienteering events [ 29 ]. Previous evidence for the effectiveness of insect repellent is of low quality, but a systematic review suggested that use reduces LD incidence rates [ 23 ], and more novel repellents have demonstrated efficacy in preventing tick bites in field trials [ 38 ]. Individual studies around permethrin-treated body cover clothing options are demonstrating some promise in preventing tick bites in trials with forestry workers. However, indications of limitations with durability of the treatment and inconsistent findings across studies limit the ability to conclude its potential use in other populations, such as hill runners [ 45 – 48 ]. In addition, it is unlikely that permethrin-treated clothing would be an easy recommendation to implement in hill running due to the apprehension to use full body cover. Nevertheless, a small number of participants reported the use of permethrin sprays on other items of clothing (Table 3 ). This study suggests there is potential to lower the risk of tick bites and LD by improving awareness of risk and promoting uptake of prevention strategies that can be easily adopted and supported within the community. Introduction of repellents and tick removal tools at registration and aid stations at events could potentially increase protection uptake by those citing a lack of knowledge of risk, forgetfulness or cost. A major strength of this study is that it rapidly surveyed a geographically dispersed population of hill runners in Scotland and investigated self-reported LD diagnosis over the previous year and lifetime, an area not directly addressed in previous studies of mass participation events [ 17 , 29 , 34 ]. A limitation is that it is possible participants may have incorrectly recalled or mistaken questing ticks, other insects or arachnids for tick bites. Ascertaining photographic evidence to validate tick bite findings would be valuable. There has never been a more important time to consider the impacts of vector borne diseases to people undertaking hill running, for which participation has risen in recent years in Scotland, in line with the increasing popularity of trail and mountain running internationally. Changing climate and the spread of TBE within native ticks and host populations of the UK [ 5 , 21 , 22 , 49 ], pose heightened dangers to high-risk groups such as hill runners. Climate shift towards warmer and wetter winters extends tick habitat range and phenology [ 50 ]. This includes extension of tick habitat to higher altitudes where previously tick survival was limited [ 36 , 49 ]. Such conditions give rise to more active ticks and more frequent bites to running and orienteering competitors in Scotland and elsewhere [ 17 , 34 ]. Taking a One Health approach, which considers the unique interactions between hill runners and other specific at-risk groups, to the changing environment, host abundance, and disease vectors, will be key to understanding changing risk and help to give rise to more effective interventions for reducing LD burden [ 10 , 11 , 51 ]. A longitudinal cohort study utilising medical records to validate LD diagnosis and prescribing in high-risk groups, and recording various exposures, could garner evidence for improving long-term surveillance of LD. Furthermore, sentinel surveillance of high-risk populations could capture the impacts beyond acute manifestations of LD and other tick-borne diseases. Conclusions This study provides new evidence that hill runners are an at-risk group for tick-borne diseases within Scotland and uncovered potential benefits of prevention behaviour adherence. There is scope to implement effective health protection recommendations to tackle tick-borne diseases and the support from hill runners in conducting this study demonstrates a motivation to improve evidence and understanding of risk within this community as well as the population more broadly. Abbreviations LD Lyme disease TBE Tick-borne encephalitis SHR Scottish Hill Runners Declarations Ethics approval and consent to participate Ethical approval was obtained from the Head of Imperial College London’s Research Governance and Integrity Team (Imperial College Research Ethics Committee reference 7030885). The study was conducted in accordance with the recommendations for physicians involved in research on human subjects adopted by the 18th World Medical Assembly, Helsinki 1964 and later revisions. All participants gave informed consent in the digital survey form, and indicated they were aged 18 years or over. Consent for publication Not applicable. Availability of data and materials A summarised dataset will be made available on reasonable request. Competing interests The first author is a hill runner taking part in the sport under study and a member of the Scottish Hill Runners (SHR) organisation, with a personal relationship with members of the committee, who provided support for survey distribution to SHR members and information on the number of individuals participating in SHR-affiliated races. All other authors declare that they have no competing interests. Funding No funding was provided for this research. Authors' contributions Author Contribution Mabel Balfour Conceptualisation of the study and methodology, project administration, acquisition and curation of data, statistical analyses, interpretation and visualisation of results, writing – original draft Rita Ribeiro Conceptualisation of the study and methodology, writing – reviewing and editing. Harriet Auty Supervision, conceptualisation of the study and methodology, writing – reviewing and editing. Alicia Heath Supervision, conceptualisation of the study and methodology, interpretation of results, writing – reviewing and editing. Acknowledgements We would like to thank to all anonymous participants for taking part in this research, and the Scottish Hill Runners organisation for sharing the survey and providing information on the total number of competitive hill runners in the year preceding survey. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7829276","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542020212,"identity":"b2effe60-5ac5-478f-8f37-c58f2d579863","order_by":0,"name":"Mabel Balfour","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBACAxDxAERIMDAe+ACk2diJ0ZIA0cJwcAZICzMpWg7zgBiEtJizn334IaHmcDT/7OYDh21+bZPnY2Zg/PAxB7cWy550Y4mEY4dzZ9w5lnA4t++2YRszA7PkzG14HHYgjY0hge1wbsONHIPDuT23GYFa2Jh58Wk5/wyo5d/h3Pk38j8ctuy5bU9Yyw2gLYlth3M33MhhOMzw43YiQS2WM54xSyT2peduvHPM4GBvw+3kNmbGZrx+MedPY/zw4Zt17rzbzQ8f/Phz23Z+e/PBDx/xaIGCZgjF2AYmGwiqB4I6KP2HGMWjYBSMglEw0gAAJgpZ95nhKDkAAAAASUVORK5CYII=","orcid":"","institution":"Imperial College London","correspondingAuthor":true,"prefix":"","firstName":"Mabel","middleName":"","lastName":"Balfour","suffix":""},{"id":542020213,"identity":"6c0a46b8-3525-4eb7-bf08-aca592ff328e","order_by":1,"name":"Rita Ribeiro","email":"","orcid":"","institution":"University of Glasgow","correspondingAuthor":false,"prefix":"","firstName":"Rita","middleName":"","lastName":"Ribeiro","suffix":""},{"id":542020214,"identity":"61ceef54-833d-4c34-be33-ccb9a6d338b8","order_by":2,"name":"Harriet Auty","email":"","orcid":"","institution":"University of Glasgow","correspondingAuthor":false,"prefix":"","firstName":"Harriet","middleName":"","lastName":"Auty","suffix":""},{"id":542020215,"identity":"e97cc1c8-01d5-4654-aafb-92ffc05d22a4","order_by":3,"name":"Alicia Heath","email":"","orcid":"","institution":"Imperial College London","correspondingAuthor":false,"prefix":"","firstName":"Alicia","middleName":"","lastName":"Heath","suffix":""}],"badges":[],"createdAt":"2025-10-10 17:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7829276/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7829276/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-26181-8","type":"published","date":"2026-01-13T16:29:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":95797767,"identity":"df992ac5-59f6-471a-ab1c-b1c54eea2002","added_by":"auto","created_at":"2025-11-13 08:10:25","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":217701,"visible":true,"origin":"","legend":"","description":"","filename":"TickBitesHillRunnersFinalManuscriptv0.2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/23def730014c3baeb01e1359.docx"},{"id":95798042,"identity":"827b6dd4-5b91-4276-a3c8-f3d7a92affe5","added_by":"auto","created_at":"2025-11-13 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08:16:57","extension":"xml","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":199375,"visible":true,"origin":"","legend":"","description":"","filename":"c2ad9750f3e5439dbf776b96495b29841structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/c462f35873fdd8b1c94d6720.xml"},{"id":95666077,"identity":"d1c1d4de-2742-4f76-b5ac-a525f23d44a5","added_by":"auto","created_at":"2025-11-11 16:50:05","extension":"html","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":211569,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/247ac3a26647926f5fca2116.html"},{"id":95666059,"identity":"3e465c0a-950b-48be-b9a2-5d71113eb48e","added_by":"auto","created_at":"2025-11-11 16:50:04","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":356918,"visible":true,"origin":"","legend":"\u003cp\u003ePrevention behaviours by report of at least one tick bite in the 12 months preceding survey.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/aed229c3f92b4e6f37af4209.jpeg"},{"id":95797187,"identity":"82475302-2613-4eec-b2b2-3dac9bbb5646","added_by":"auto","created_at":"2025-11-13 08:01:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":66733,"visible":true,"origin":"","legend":"\u003cp\u003eReported number of tick bites, by frequency of conducting full-body tick-checks.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/3346cc35c5810420b0e510ad.png"},{"id":95666066,"identity":"00441697-a47d-4b67-957b-79b2a2a49c2e","added_by":"auto","created_at":"2025-11-11 16:50:05","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":405917,"visible":true,"origin":"","legend":"\u003cp\u003ePrevention behaviours, by sex and competitive hill racing status in the 12 months preceding survey.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/3f7fbf7e1d7bfce895290c2a.jpeg"},{"id":100617763,"identity":"d5a9413d-9ec6-4b85-8a6c-659219723262","added_by":"auto","created_at":"2026-01-19 17:56:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2569419,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/0c1c3893-98ca-44cc-9b93-b58275476e7f.pdf"},{"id":95666060,"identity":"38d9b87a-d80b-4feb-b552-62571d747cfa","added_by":"auto","created_at":"2025-11-11 16:50:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":129574,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/dae01bfe877c3acd23a01c6a.pdf"},{"id":95666062,"identity":"8852accd-38bf-4bf4-8526-78fdf5a97b25","added_by":"auto","created_at":"2025-11-11 16:50:05","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":12607,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile2.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/e4303c6ce85f1aef84c1e95a.xlsx"},{"id":95666065,"identity":"5a38dbec-476b-492c-899f-527e703c2d92","added_by":"auto","created_at":"2025-11-11 16:50:05","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":11414,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile3.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/ca5d471769a45cd6c74c8574.xlsx"},{"id":95797959,"identity":"f837c3f7-0b1c-4b0e-9907-4514bfabb139","added_by":"auto","created_at":"2025-11-13 08:13:01","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":11818,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile4.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/bd0c6ac3ec125207f562d87a.xlsx"},{"id":95666075,"identity":"d65d0241-4874-45e0-9044-292b0233cb22","added_by":"auto","created_at":"2025-11-11 16:50:05","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":5258,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile5.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7829276/v1/f2ea4e1644f65e711e4d0633.pdf"}],"financialInterests":"Competing interest reported. The first author is a hill runner taking part in the sport under study and a member of the Scottish Hill Runners (SHR) organisation, with a personal relationship with members of the committee, who provided support for survey distribution to SHR members and information on the number of individuals participating in SHR-affiliated races. \n\nAll other authors declare that they have no competing interests.","formattedTitle":"Running into the Lyme-light: A retrospective cross-sectional study of tick bite and Lyme disease prevalence and prevention in hill runners, Scotland, UK.","fulltext":[{"header":"Background","content":"\u003cp\u003eThe incidence of Lyme disease (LD), caused by the bacteria \u003cem\u003eBorrelia burgdorferi\u003c/em\u003e, is rising across Europe [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], including within the United Kingdom (UK) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This tick-borne infection can cause significant health issues if left untreated, including arthritis, carditis and neurological symptoms [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Diagnosis can be made clinically via a localised erythema migrans rash specific to the infection or through serological testing [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Asymptomatic infections, which make the disease difficult to identify [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and the occurrence of chronic disease even after antibiotic therapy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] mean prevention is key to public health management. Effective targeted mitigation relies on accurate surveillance and a thorough understanding of transmission routes and risk factors [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMultiple indicators from national surveillance [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and primary care research [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] suggest that Scotland has the highest incidence of LD in humans in the UK. Differences in estimates across the UK and internationally are likely to be multifactorial [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In part, differences in LD incidence estimates are related to variations in case definitions, diagnostic practices and data collection [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Surveillance worldwide is limited by the challenges of accurate diagnosis, as well as a lack of routine serological testing in clinical practice [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Reported incidence rates in the UK are likely underestimates given the lack of mandatory reporting of clinical cases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Furthermore, access to accurate clinical diagnosis data is limited even within healthcare datasets due to the inconsistency of clinical case reporting and incomplete antimicrobial record keeping [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Variation in environmental tick abundance, driven by differences in climate, habitat suitability, and host distribution [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], also contributes to the likelihood of vector interactions. Human exposure to tick habitats [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], including long grasses, forests, moorlands, and even urban parklands and gardens [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], also differs. Changing vector distribution and non-native species introduction [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and the spread of further pathogens, such as tick-borne encephalitis (TBE) in native UK tick populations [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], add to the complexity and importance of understanding the risk of tick-borne disease. Improving surveillance can help untangle reasons for differences in incidence across the UK and abroad [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Enhancing epidemiological evidence of local high-risk populations and risk factors for tick bites will enable more appropriate targeted preventive strategies for reducing LD burden [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, a granular understanding of differences in regional burden [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and high-quality evidence for effective prevention strategies [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] are currently lacking.\u003c/p\u003e\u003cp\u003ePreviously identified high-risk groups for tick-borne diseases include people in forestry and farming occupations as well as those participating in recreational outdoor activities [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Several online surveys have assessed tick bite frequency and found a strong association between the frequency of running and walking in forested areas in Scandinavia [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and on marked trails in the USA, and acquiring tick bites [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In the latter study, running and walking had a higher risk for tick bites compared to orienteering and other outdoor activities [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, these studies are limited by a reliance on self-reporting, and the combination of activities assessed makes it difficult to pinpoint the risk associated with any specific activity. Moreover, variability in the duration and frequency of individual activities were not taken into account. Nevertheless, these previous studies demonstrate how citizen science can lead to informative datasets containing key information, such as the spatial distribution of tick species and bite acquisition in populations previously poorly studied, and have helped to identify potential groups and activities with increased risk of tick bites [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral international studies have demonstrated the high risk of tick bites in orienteering activities, despite full-body coverage being required during competition due to these risks [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], aligning with the behavioural interventions recommended by the National Health Service (NHS) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Hill (or fell) running in the UK is similar to international trail and mountain running, but like orienteering, is a sport that often requires off-path running in tick habitat [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Only one previous survey has examined tick bites in hill runners, focusing on participants of a two-day event in Scotland in 2014, with 8.5\u0026ndash;13.8% of runners reporting tick bites acquired during the event [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Variability in clothing was observed, with many wearing shorts and short-sleeved tops [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. As no attire requirements are placed on hill runners, it is hypothesised that there may be differences in body cover and thus differences in tick bite and LD risk, compared to orienteers. These previous studies demonstrate that bite reports at mass participation sporting events can be useful indicators of tick activity in the environment [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, there is a lack of data on the prevalence of tick bites and the impact of tick-borne disease outside of specific events among individuals exercising in high-risk terrain.\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate the prevalence of tick bites and prevalence and incidence of reported LD diagnoses in hill runners in Scotland, UK, examine whether tick bite prevention behaviours are practised by this group, and evaluate whether these behaviours are associated with tick bites. Gaining a better understanding of the prevalence of tick bites and LD and the uptake and effectiveness of prevention behaviours in the hill running population in Scotland will enable appropriate targeted preventive action. As hill, trail and mountain running become increasingly popular internationally there is scope for research in this field to have wider impacts for these communities as the sphere of regulation and interest expands.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eDesign\u003c/p\u003e\u003cp\u003eA retrospective, cross-sectional digital survey of hill runners was conducted in Scotland, UK. A 32-question questionnaire was developed for this study (Additional file 1), which captured hill running activity, including competitive racing and metrics of time spent running, with divisions by time spent over forestry, long grass and moorland (\u0026lsquo;hill terrain\u0026rsquo;). Other questions included participant demographics, tick bite and LD history and related experiences, including antibiotic use. Specific questions explored tick bite prevention behaviours recommended by NHS Scotland [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecruitment\u003c/p\u003e\u003cp\u003eThe number of persons taking part in hill running and identifying as a hill runner in Scotland is unknown; however, 4668 individual entrants (recorded by the Scottish Hill Runners (SHR)) took part in SHR-affiliated races in the 12 months preceding the survey. Potential participants were identified and recruited via email invitations and social media recruitment campaigns administered by the SHR to their members across Scotland (an estimated 550 in 2023). A recruitment poster and advertisement were also placed on Hill Runner social media pages (Facebook and Instagram). The survey was distributed digitally via Qualtrics survey software (Provo, UT). Volunteers self-selected to participate after reading the participant information sheets and signed a consent form at the start of the digital survey. Recruitment and survey completion took place from June to July 2024.\u003c/p\u003e\u003cp\u003eInclusion and exclusion criteria\u003c/p\u003e\u003cp\u003eOnly persons residing in Scotland for the 12 months preceding recruitment were eligible for inclusion to align with the period under investigation and minimise the confounding effects of geographic region, where recommendations and risk may differ. Participants were asked to confirm this, as well as specifying their county of residence. This ensured that findings could be attributed to running primarily in Scotland. A question regarding tick bites acquired outside of Scotland enabled investigation of risk attributable elsewhere.\u003c/p\u003e\u003cp\u003eParticipants self-identified as hill runners based on the SHR definition [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], assuming they could accurately identify the terrain they typically ran on during the study period. Hill running was defined as running over hills, moors and mountains. Additional questions enabled further clarity on the amount of training, for more accurate estimation of the prevalence of bites and LD stratified by time spent running over higher risk terrains, as well as competitive hill running to estimate the impact of competition on behaviours that may modify risk.\u003c/p\u003e\u003cp\u003ePersons under the age of 18 years were excluded to align with restricted age groups in hill racing [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Participants who were ineligible based on inclusion and exclusion criteria were directed out of the survey and thanked for their interest in participating.\u003c/p\u003e\u003cp\u003eData processing\u003c/p\u003e\u003cp\u003eParticipants were grouped based on their competitive hill racing history over the past 12 months, to identify those who had taken part in SHR-affiliated races or other events they defined as a hill race. This information was included to explore potential differences in adherence to prevention behaviours among competitive hill runners compared with non-competitive hill runners. Preventive behaviours included the NHS recommendations of wearing full arm-cover, full leg-cover, applying insect repellent, and conducting full-body tick-checks, particularly between March to October [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The NHS recommendations generally align with increased tick activity and abundance in the environment, although it is acknowledged that seasonal tick activity may be changing [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The proportion of time complying with these behaviours between March and October, when on hill terrain (defined as heather, bracken, long grass and/or forestry), was divided into never/ infrequently, regularly, or almost always, as was the proportion of time running on hill terrain.\u003c/p\u003e\u003cp\u003eRespondents reported the number of tick bites they had incurred in the 12 months preceding the survey (none, 1\u0026ndash;5, 6\u0026ndash;10, 11\u0026ndash;15, 16\u0026ndash;20, \u0026ge;\u0026thinsp;21). For analyses, the main outcome was defined as having at least one tick bite in the 12 months preceding the survey (no/yes). A secondary outcome was suspected LD diagnosis in the preceding 12 months, derived from reported diagnosis of LD by a healthcare professional (no/yes) or reported erythema migrans (no/yes), and treated with a course of antibiotics (no/yes).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eDifferences between categorical variables under investigation were tested with a Fisher exact test and Pearson Chi-square test, and continuous variables with a Wilcoxon Rank Sum Test (ɑ=0.05). Period prevalence of tick bites was calculated as the proportion of survey participants reporting at least one tick bite in the 12 months preceding the survey, and separately, in their lifetime. Incidence of suspected LD was calculated using the number of participants as the denominator. Acknowledging that survey participation may be biased towards individuals who have previously been diagnosed with LD, an estimated minimum incidence of suspected LD was also calculated for the subset of participants who reported taking part in SHR-affiliated races, using the reported total denominator of 4668 racers provided by SHR.\u003c/p\u003e\u003cp\u003eMultiple logistic regression modelling was conducted to assess the associations between all variables under investigation and the odds of having at least one tick bite in the 12 months preceding the survey. Variables evaluated included age (continuous), sex [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], hours per week of running (continuous) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the proportion of running that was hill running (continuous), and hours per week of other outdoor activities, including occupational activities (continuous), frequency of using insect repellent [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], and of wearing full arm cover, full leg cover and conducting full body tick checks (grouped as never/infrequently and regularly/almost always) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Participants who gave implausible answers for average hours/week running (\u0026gt;\u0026thinsp;50 hours/week) or taking part in other outdoor activity (\u0026gt;\u0026thinsp;100 hours/week) were excluded from the regression analyses (n\u0026thinsp;=\u0026thinsp;6). All variables included in the model were tested for multicollinearity using a variance inflation factor score, which was low (\u0026lt;\u0026thinsp;1.5) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. A McFadden\u0026rsquo;s pseudo-R-squared score was calculated to assess the proportion of variance in the outcome (having at least one tick bite) explained by the included variables. Dominance analysis for logistic regression [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] was conducted to analyse the relative importance of each variable. This was determined by comparing pairs of variables and assessing the additional contribution of each variable to the model.\u003c/p\u003e\u003cp\u003eAll statistical analyses were conducted in R version 4.1.0 [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEthical considerations\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e was obtained from Imperial College London\u0026rsquo;s Research Governance and Integrity Team (Imperial College Research Ethics Committee reference 7030885). The study was conducted following the recommendations for physicians involved in research on human subjects adopted by the 18th World Medical Assembly, Helsinki 1964 and later revisions. All participants gave informed consent in the digital survey form and confirmed they were aged 18 years or over.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 224 individuals responded to the survey. After exclusions due to residency outside Scotland (n\u0026thinsp;=\u0026thinsp;9) and non-participation in hill running in the preceding 12 months (n\u0026thinsp;=\u0026thinsp;3), 212 hill runners completed the survey, of which 56.1% (n\u0026thinsp;=\u0026thinsp;19) were male and 43.9% (n\u0026thinsp;=\u0026thinsp;93) female (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Individuals reporting participation in a SHR-affiliated race (n\u0026thinsp;=\u0026thinsp;144) represented 67.9% of respondents, and 3.1% of the total number of 4668 racers registered in SHR-affiliated races in the 12 months preceding the survey.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of survey responses from 212 hill runners in Scotland.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eTick bite\u003c/p\u003e\u003cp\u003ein the 12 months preceding survey\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eTreated suspected Lyme disease in the 12 months preceding survey\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall,\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;212\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo,\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;37\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes,\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;175\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003csup\u003e\u003cem\u003ed\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo,\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;197\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes,\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;9\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep-value\u003csup\u003e\u003cem\u003ee\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReported number of tick bites in preceding 12 months\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.610\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (100.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35 (17.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (27.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59 (33.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e54 (27.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (14.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (17.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29 (14.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (14.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (17.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29 (14.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (6.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11 (5.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (20.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43 (24.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e39 (19.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReported number of tick bites in lifetime preceding survey period\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.120\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (8.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (48.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17 (8.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (11.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (32.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (6.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24 (12.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (9.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (8.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (10.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20 (10.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (4.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (4.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (3.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16 (8.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124 (58.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (8.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121 (69.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e114 (57.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7 (77.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSought medical attention for a tick bite in preceding 12 months\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.048\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e194 (91.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (100.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e157 (89.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e188 (95.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (8.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (10.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9 (4.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9 (100.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAntibiotics to treat tick bite in preceding 12 months\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e193 (91.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (94.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e158 (90.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e187 (94.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (8.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (3.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9 (100.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot sure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 (2.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (31, 49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (31, 50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40 (31, 48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.552\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41 (31, 49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e34 (32, 37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.579\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.654\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93 (43.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (40.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (44.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e86 (43.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (44.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e119 (56.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (59.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97 (55.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e111 (56.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (55.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompetitive hill racing in the preceding 12 months\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.907\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.697\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (23.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (24.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (23.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45 (22.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e162 (76.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (75.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e134 (76.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e152 (77.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 (88.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHours per week of running\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.0 (4.2, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.0 (4.5, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.0 (4.5, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.877\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.0 (4.0, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.0 (7.0, 10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHill running\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.764\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.669\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever or infrequently\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (15.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (18.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29 (14.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegularly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e142 (67.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (64.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e118 (67.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e133 (67.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (55.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlmost always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (17.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (16.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (18.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35 (17.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHours per week of other outdoor activity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.0 (3.0, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.0 (3.0, 6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.0 (3.0, 10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.0 (3.0, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.0 (4.0, 15.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInsect repellent use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.946\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.431\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever or infrequently\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e158 (74.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (73.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e131 (74.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e149 (75.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 (66.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegularly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (19.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (21.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (18.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e37 (18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlmost always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11 (5.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFull leg cover\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever or infrequently\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e144 (67.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (56.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e123 (70.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e133 (67.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7 (77.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegularly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53 (25.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (29.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42 (24.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e50 (25.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlmost always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFull arm cover\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.644\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever or infrequently\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e123 (58.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (59.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e101 (57.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e115 (58.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (44.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegularly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (38.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (37.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67 (38.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e74 (37.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (55.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlmost always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8 (4.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFull body tick check\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.645\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever or infrequently\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (37.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (8.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27 (13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegularly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (32.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (32.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57 (32.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e66 (33.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlmost always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e114 (53.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (29.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103 (58.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e104 (52.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (55.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e Reported tick bite (at least one) in the 12 months preceding the survey\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e Reported Suspected Lyme disease (either reported clinical diagnosis by healthcare professional or erythema migrans, treated with antibiotics) in the 12 months preceding the survey\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e n (%) for categorical variables; Median (interquartile range) for continuous variables\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ed\u003c/em\u003e\u003c/sup\u003e p-values estimated using Fisher's exact test or Pearson's Chi-squared test for categorical variables, or Wilcoxon rank sum test for continuous variables\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e p-values estimated using Fisher's exact test for categorical variables or Wilcoxon rank sum test for continuous variables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Summary of survey responses from 212 hill runners in Scotland.\u003c/p\u003e\u003cp\u003e[\u003cem\u003eInserted at the end of manuscript\u003c/em\u003e]\u003c/p\u003e\u003cp\u003eMore than half of respondents (51.9%, n\u0026thinsp;=\u0026thinsp;110/212) were from three counties (City of Edinburgh (n\u0026thinsp;=\u0026thinsp;42/212, 19.8%), Aberdeenshire (n\u0026thinsp;=\u0026thinsp;37/212, 17.5%), and Highland (n\u0026thinsp;=\u0026thinsp;31/212, 14.6%)), and participants from 10 counties contributed to 81% (n\u0026thinsp;=\u0026thinsp;172/212 of responses (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipants\u0026rsquo; primary county of residence and proportion who reported at least one tick bite.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eTick bite in the 12 months preceding survey\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCounty of residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e, N\u0026thinsp;=\u0026thinsp;212\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e, N\u0026thinsp;=\u0026thinsp;37\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e, N\u0026thinsp;=\u0026thinsp;175\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAberdeenshire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (86.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArgyll and Bute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (100.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity of Aberdeen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (4.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (77.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity of Edinburgh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (19.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (85.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity of Glasgow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (7.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (92.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDundee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (100.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (2.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (83.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHighland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (14.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (12.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (87.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerth and Kinross\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (85.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScottish Borders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (42.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (57.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth Lanarkshire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (42.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (57.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStirling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (7.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (92.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWest Lothian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther county\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (12.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (29.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (70.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStudy total\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e212 (100.0%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e37 (17.5%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e175 (82.5%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;n (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePeriod prevalence of tick bites\u003c/p\u003e\u003cp\u003eAmong the 212 hill runners, 82.5% (n\u0026thinsp;=\u0026thinsp;175/212, 95%CI 76.76\u0026ndash;87.40) reported having been bitten by at least one tick in the 12 months preceding the survey, and 91.5% (n\u0026thinsp;=\u0026thinsp;194/212, 95%CI 86.91\u0026ndash;94.89) reported at least one tick bite in their lifetime (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Of the 212 participants, 24 reported being bitten by a tick outside of Scotland at least once in the 12 months preceding the survey (11.3%, 95%CI 7.39\u0026ndash;16.37).\u003c/p\u003e\u003cp\u003ePeriod prevalence and incidence of Lyme disease\u003c/p\u003e\u003cp\u003eOf the 212 participants, nine (4.2%, 95%CI 1.96\u0026ndash;7.91) reported treated suspected LD in the 12 months preceding the survey, of whom one reported no identified erythema migrans. The incidence of reported suspected LD was 4245.3 per 100,000 (95% CI 1941.21-8058.87). No participants reported having had a positive diagnostic test (either by the NHS or privately) for LD in the 12 months preceding the survey.\u003c/p\u003e\u003cp\u003eFor the lifetime period prior to the 12-month survey period, 17 participants reported a diagnosis of LD and antibiotics following a tick bite (8.0%, 95% CI 4.74\u0026ndash;12.53, unadjusted for age), of whom eight (3.8%, 95% CI 1.64\u0026ndash;7.30) had a positive diagnostic test, all conducted by the NHS. History of erythema migrans rash prior to the survey period was not surveyed.\u003c/p\u003e\u003cp\u003eAmong the 144 participants who reported taking part in SHR-affiliated races in the preceding 12 months, seven (4.9%, 95%CI 1.98\u0026ndash;9.76) reported a suspected LD diagnosis. Assuming conservatively that this represents all LD diagnoses from the SHR membership of 4668, this results in a minimum suspected LD incidence of 150 per 100,000 (95% CI 60.29-308.97).\u003c/p\u003e\u003cp\u003eMedical attention and antibiotic prescription\u003c/p\u003e\u003cp\u003eOf those who reported a tick bite in the 12 months preceding the survey, 10.3% (n\u0026thinsp;=\u0026thinsp;18/175) sought medical attention (pharmacy for treatment, a general practitioner or other hospital-based care) and 8.6% (n\u0026thinsp;=\u0026thinsp;15/175) reported receiving antibiotics (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All participants who reported a clinical diagnosis of LD, or erythema migrans reported receiving a course of antibiotics in response to a tick bite (type and course duration were not recorded).\u003c/p\u003e\u003cp\u003ePreventive behaviours\u003c/p\u003e\u003cp\u003eMost hill runners reported regularly/almost always conducting tick-checks (86.3%, n\u0026thinsp;=\u0026thinsp;183/212), but never/infrequently using insect repellent (74.5%, n\u0026thinsp;=\u0026thinsp;158/212), wearing full leg-cover (67.9%, n\u0026thinsp;=\u0026thinsp;144/212) or arm-cover (58.0%, n\u0026thinsp;=\u0026thinsp;123/212) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWhen asked for free-text reasons for not applying NHS recommended tick prevention behaviours, 68.4% (n\u0026thinsp;=\u0026thinsp;145/212) of all survey participants responded that they were too warm to wear full-body cover when running (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of participant responses for non-adherence to tick bite prevention behaviours, and prevention methods used when hill running.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ea. Reported reason for non-adherence with preventive behaviours\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%) of total participants\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToo warm or uncomfortable in body cover\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot previously thought of tick bites or Lyme disease as a concern to address\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eForget to apply insect repellent, conduct checks or cover up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConcern for environmental or health impacts of insect repellents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot previously aware of tick bite risk or prevention tools available\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot believed body cover or insect repellent to be effective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFind it easier to see tick bites on bare skin compared to when wearing body cover\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExpense of insect repellent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot sure what to look for with regards to finding tick bites\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eb. \u003cb\u003eReported other or additional method of tick bite prevention\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ePercentage (%) of total participants\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegular checks for tick bites during running activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhere possible, avoiding crossing dense vegetation, e.g. bracken and known tick areas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTucking trousers, including waterproofs, into socks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpraying clothes and shoes with insect repellent treatment, e.g. permethrin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWearing long and/or waterproof socks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever sitting down or placing items on the ground\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShowering straight away and/or washing off regularly e.g. in rivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKeeping legs hair free\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKeeping clothes separate or in sealed bags after running activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of other chemicals, e.g. Deep Heat, Suncream\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e Individuals may have given more than one reason for non-adherence or additional method; these are counted separately.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegularly/almost always conducting a full-body tick-check, compared with never/infrequently, was associated with proportionally more tick bites over the 12 months preceding the survey (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA, Additional file 2), and with more tick bites in the respondents\u0026rsquo; lifetime preceding the survey period (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eReported number of tick bites between March to October when crossing heather, bracken, long grass and/or forestry, in A. the 12 months preceding the survey and B. over the participant\u0026rsquo;s lifetime. Yellow represents the highest number of tick bites and blue the lowest.\u003c/p\u003e\u003cp\u003eThe median age of participants who regularly/almost always conducted full-body tick-checks was younger than those who never/infrequently did (39 vs. 45 years, p\u0026thinsp;=\u0026thinsp;0.036, Additional file 3). A higher proportion of males reported participating in competitive hill races in the preceding 12 months (84.0%, n\u0026thinsp;=\u0026thinsp;100/119 vs. 66.7% for females; p\u0026thinsp;=\u0026thinsp;0.003, Additional file 4), but a greater proportion of females (46.2%, n\u0026thinsp;=\u0026thinsp;43/93) reported regularly/almost always wearing full leg-cover when running (compared with 21.0%, n\u0026thinsp;=\u0026thinsp;25/119 of males, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among males, the proportion of competitive hill racers who reported never/infrequently wearing full leg-cover was higher (84.0%, n\u0026thinsp;=\u0026thinsp;84/100) than for non-competitive runners (52.6%, n\u0026thinsp;=\u0026thinsp;10/19, p\u0026thinsp;=\u0026thinsp;0.006, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFactors associated with tick bites\u003c/p\u003e\u003cp\u003eRegularly/almost always performing full-body tick checks (compared to never/infrequent checks) was associated with higher odds of reporting at least one tick bite in the past 12 months (OR 8.52, 95%CI 3.29\u0026ndash;22.90, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, regularly/almost always wearing full leg-cover (compared with never/infrequently) was associated with lower odds of having at least one tick bite (OR 0.35, 95% CI 0.13\u0026ndash;0.89, p\u0026thinsp;=\u0026thinsp;0.029, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple logistic regression analysis of at least one tick bite in the 12 months preceding survey.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"17\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"12\" nameend=\"c16\" namest=\"c5\"\u003e\u003cp\u003eTick bite in the 12 months preceding survey\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e,\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;206\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e,\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;35\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e,\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;171\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e\u003cb\u003eAverage Dominance R\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e\u003cb\u003eRanking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFull body tick check\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e0.094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNever or infrequently\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e29 (14.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e14 (40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e15 (8.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e\u003cp\u003e(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRegularly or almost always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e177 (85.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e21 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e156 (91.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e8.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3.29, 22.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHours of running (per 1 hour/week increment)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e6.0 (4.2, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e6.0 (4.5, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e6.0 (4.5, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.89, 1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.928\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHours of other outdoor activity (per 1 hour/week increment)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e5.0 (3.0, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e5.0 (3.0, 7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e5.0 (3.0, 9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e1.00, 1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFull leg cover\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNever or infrequently\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e140 (68.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e19 (54.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e121 (70.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRegularly or almost always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e66 (32.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e16 (45.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e50 (29.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.13, 0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e90 (43.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e14 (40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e76 (44.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e116 (56.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e21 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e95 (55.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.33, 1.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.640\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHill running\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e=\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNever or infrequently\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e31 (15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e7 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e24 (14.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRegularly or almost always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e175 (85.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e28 (80.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e147 (86.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.30, 2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.950\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInsect repellent use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e=\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNever or infrequently\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e155 (75.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e26 (74.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e129 (75.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRegularly or almost always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e51 (24.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e9 (25.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e42 (24.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.34, 2.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.729\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFull arm cover\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e=\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNever or infrequently\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e119 (57.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e20 (57.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e99 (57.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRegularly or almost always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e87 (42.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e15 (42.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e72 (42.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.49, 2.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.775\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (per 1 year increment)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e40 (31, 49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e45 (30, 50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e40 (31, 48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.98, 1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.487\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompetitive hill racing in preceding 12 months\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e46 (22.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e8 (22.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e38 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e160 (77.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e27 (77.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e133 (77.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.34, 2.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.990\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"16\" nameend=\"c16\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e Median (interquartile range) for continuous variables; n (%) for categorical variables\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;McFadden\u0026rsquo;s Pseudo-R-Squared\u003c/p\u003e\u003cp\u003e\u003cem\u003eAbbreviations\u003c/em\u003e: OR\u0026thinsp;=\u0026thinsp;Odds Ratio, CI\u0026thinsp;=\u0026thinsp;Confidence Interval\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMcFadden\u0026rsquo;s pseudo-R-squared value for the model was 0.18. Among the variables included, conducting a tick check explained the most variance in reporting at least one tick bite (0.094, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Additional file 5).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Multiple logistic regression analysis of at least one tick bite in the 12 months preceding survey. [\u003cem\u003eInserted at end of manuscript\u003c/em\u003e]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis online cross-sectional survey found high period prevalence of reported tick bites and LD among the surveyed Scottish hill running population. Adherence with recommended prevention behaviours was generally low, however most hill runners reported regularly/almost always conducting full-body tick-checks, and this was associated with higher odds of having at least one tick bite. Regularly/almost always wearing full leg-cover was associated with lower odds of having at least one tick bite in the preceding 12 months.\u003c/p\u003e\u003cp\u003ePeriod prevalence of tick bites in the study population (82.5%) was higher than the prevalence reported from mass participation events, including a Scottish hill running competition (8.5% to 13.8%) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and Scottish (33.3%) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and French (62.4%) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] orienteering events. While this is not unexpected given the timeframe studied here, the prevalence was also higher than that found in comparable general population cross-sectional surveys conducted in 2016 across Denmark, Norway and Sweden (52%, 49.3% and 71.3% respectively) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In addition, the proportion of respondents reporting\u0026thinsp;\u0026ge;\u0026thinsp;21 tick bites in the preceding 12 months was much higher in our study population (20.3%) than the 1.8% reported by Jore et al. in the Scandinavian general population [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. A lack of tick bite data in the UK general population and other at-risk groups limits the ability to make comparisons to the wider population, which is further limited by not capturing data on tick bites acquired through occupational and other activities. Nevertheless, this study highlights that taking part in off-road running activity represents a particularly high-risk behaviour for tick bites [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe period prevalence of reported suspected LD (4.2%) was higher than the 2% reported by Jore et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. However, unlike this European study, where most individuals had a confirmatory serological test [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], no hill runners in our study reported a diagnostic test to confirm diagnosis in the 12-month period. Interpretation and generalisation of both tick bite and LD prevalence calculations for hill runners should be interpreted cautiously due to possible recall bias in the bite date, diagnosis date, the relatively small population studied, and potential motivation bias towards survey participation in those with experience of tick bites or LD, which may inflate the observed prevalence. However, the clinical LD diagnosis definition used here without confirmatory serological testing aligns with NICE guidelines for diagnosis and treatment of LD in the UK [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This is largely because the antibody response takes several weeks to become detectable, limiting the value of serological testing in acute treatment decisions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. As a result, none of the suspected LD cases reported here would be included in Scottish national surveillance, which reports on serological testing only [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This supports the previously acknowledged underestimates of LD incidence reported in Scottish national surveillance [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], which reinforces the case for including erythema migrans reporting as a key indicator in national surveillance [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], since similar studies utilising treated erythema migrans diagnosis have indicated much higher incidence rates [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Nevertheless, a lack of confirmatory testing increases the risk of inappropriate antibiotic use for misdiagnosed infections. Therefore, arguments remain for improving diagnostic capabilities for clinical patient management and for improving national surveillance validity.\u003c/p\u003e\u003cp\u003eAll those presenting with erythema migrans were treated with antibiotics as per NICE guidelines [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). However, 3.0% of those with a tick bite, but no reported rash or LD diagnosis from a clinician, also reported receiving a course of antibiotics following a bite, despite prophylaxis treatment not being a NICE recommendation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This suggests either that health practitioners may be over-prescribing antibiotics, which has implications for antibiotic stewardship practices, or that there was high clinical suspicion of LD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and that other key signs or symptoms that are identified by prescribers were not captured in this study. The frequency of erythema migrans presenting in \u003cem\u003eBorrelia\u003c/em\u003e infections and whether this is dependent on other factors is also unclear [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]; therefore, asymptomatic infections may not be captured by the case definition here.\u003c/p\u003e\u003cp\u003eThe estimated LD incidence in the study population, 4245.3 per 100,000 per year, may be biased towards overestimation due to (i) increased likelihood that runners who had experienced LD completed the questionnaire and (ii) possible inaccuracy in remembering exactly when an LD event occurred. In contrast, the estimated minimum incidence of LD among SHR competitive individuals, 150 per 100,000 per year, is likely an underestimate, given the low survey participation rate (3%) by the SHR competitive hill runner population. Nonetheless, both figures are higher than reported previous estimates which take into account treated erythema migrans, of 37.3 per 100,000 (95% CI 34.2\u0026ndash;40.7) in the general population of Scotland in 2010\u0026ndash;2012 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This suggests hill runners may be at increased risk compared to the general population. However, this difference may also be partially explained by the time period between estimates, changes in vector distribution [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and changes in human interactions with the environment, such as changes to outdoor leisure activity in general during and after the SARS-COV-2 pandemic [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Validating self-reported findings via medical records and improving case definition consistency in research and surveillance initiatives would enable more accurate comparisons in the UK and internationally [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Although study participants reported regular engagement in other outdoor activities or occupations in addition to hill running (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), which could lead to an overestimation of the incidence within the study population, the results are closer to recent LD incidence estimates for the general population living in the highlands of Scotland (149\u0026ndash;362 per 100,000) [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] and the Western Isles (53\u0026ndash;574 per 100,000) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, it is plausible that this study may simply reflect the high incidence of LD within the general Scottish population. Hall et al demonstrated high prevalence of tick bites at individual hill events and confirmed \u003cem\u003eB. burgdorferi\u003c/em\u003e presence within ticks biting participants [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], but further long-term study is required to confirm the link between specific bites acquired when hill running and any attributable LD diagnosis. Research to define the hill running population denominators and understand other possible confounding variables is vital for more accurate incidence calculations and comparisons in specific groups, as well as improving surveillance of LD in Scotland.\u003c/p\u003e\u003cp\u003eThe higher odds of at least one tick bite being related to conducting a full-body tick-check has been demonstrated previously [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] and may be a form of detection bias. Searching for ticks may be inherently associated with the number of tick bites found. It is also possible that tick bites were missed by those not conducting checks. Because even an initial full-body check may not always be enough to completely detect all, especially small, ticks [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], overall prevalence may be underestimated. The association may also be related to previous experience of tick bites, which is supported by the strong relationship between higher numbers of tick bites over a participant\u0026rsquo;s lifetime and increased frequency of regularly/almost always conducting tick-checks. Additionally, associations between specific geographical locations of hill runs and factors such as the degree of exposure, prior education, or risk perception may influence the likelihood of conducting tick checks [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. However, we were not able to comprehensively investigate these relationships here, although these factors were mentioned by some participants in free-text responses (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe overall low adherence with wearing full-body cover in hill runners is consistent with the perceived impacts on comfort and performance commented on by most survey respondents and was similarly observed in an earlier mass participation study of hill runners in Scotland [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The lower adherence in those engaging in competitive hill running also supports this, as racing is likely to be associated with higher energy output activity (and thus feeling hot/sweating) more regularly. It is unclear why women comply with full leg cover more frequently than men. Any compulsory measure for full leg-cover, in line with British orienteering [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], would need to be carefully balanced with other perceived health risks by participants, and be well evidenced, as perception of efficacy has been shown to relate to uptake [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. This study provides new evidence suggesting that full leg-covering is protective for preventing tick bites, supporting previous evidence that body coverage during outdoor activities may reduce the risk of LD [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdherence with insect repellent application was low but was within the range of use reported by orienteers (8.5\u0026ndash;34.2%) in multi-day orienteering events [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Previous evidence for the effectiveness of insect repellent is of low quality, but a systematic review suggested that use reduces LD incidence rates [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and more novel repellents have demonstrated efficacy in preventing tick bites in field trials [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Individual studies around permethrin-treated body cover clothing options are demonstrating some promise in preventing tick bites in trials with forestry workers. However, indications of limitations with durability of the treatment and inconsistent findings across studies limit the ability to conclude its potential use in other populations, such as hill runners [\u003cspan additionalcitationids=\"CR46 CR47\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. In addition, it is unlikely that permethrin-treated clothing would be an easy recommendation to implement in hill running due to the apprehension to use full body cover. Nevertheless, a small number of participants reported the use of permethrin sprays on other items of clothing (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This study suggests there is potential to lower the risk of tick bites and LD by improving awareness of risk and promoting uptake of prevention strategies that can be easily adopted and supported within the community. Introduction of repellents and tick removal tools at registration and aid stations at events could potentially increase protection uptake by those citing a lack of knowledge of risk, forgetfulness or cost.\u003c/p\u003e\u003cp\u003eA major strength of this study is that it rapidly surveyed a geographically dispersed population of hill runners in Scotland and investigated self-reported LD diagnosis over the previous year and lifetime, an area not directly addressed in previous studies of mass participation events [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. A limitation is that it is possible participants may have incorrectly recalled or mistaken questing ticks, other insects or arachnids for tick bites. Ascertaining photographic evidence to validate tick bite findings would be valuable.\u003c/p\u003e\u003cp\u003eThere has never been a more important time to consider the impacts of vector borne diseases to people undertaking hill running, for which participation has risen in recent years in Scotland, in line with the increasing popularity of trail and mountain running internationally. Changing climate and the spread of TBE within native ticks and host populations of the UK [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], pose heightened dangers to high-risk groups such as hill runners. Climate shift towards warmer and wetter winters extends tick habitat range and phenology [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. This includes extension of tick habitat to higher altitudes where previously tick survival was limited [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Such conditions give rise to more active ticks and more frequent bites to running and orienteering competitors in Scotland and elsewhere [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Taking a One Health approach, which considers the unique interactions between hill runners and other specific at-risk groups, to the changing environment, host abundance, and disease vectors, will be key to understanding changing risk and help to give rise to more effective interventions for reducing LD burden [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. A longitudinal cohort study utilising medical records to validate LD diagnosis and prescribing in high-risk groups, and recording various exposures, could garner evidence for improving long-term surveillance of LD. Furthermore, sentinel surveillance of high-risk populations could capture the impacts beyond acute manifestations of LD and other tick-borne diseases.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides new evidence that hill runners are an at-risk group for tick-borne diseases within Scotland and uncovered potential benefits of prevention behaviour adherence. There is scope to implement effective health protection recommendations to tackle tick-borne diseases and the support from hill runners in conducting this study demonstrates a motivation to improve evidence and understanding of risk within this community as well as the population more broadly.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eLD\u003c/strong\u003e Lyme disease\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTBE\u0026nbsp;\u003c/strong\u003eTick-borne encephalitis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSHR\u0026nbsp;\u003c/strong\u003eScottish Hill Runners\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Head of Imperial College London’s Research Governance and Integrity Team (Imperial College Research Ethics Committee reference 7030885). The study was conducted in accordance with the recommendations for physicians involved in research on human subjects adopted by the 18th World Medical Assembly, Helsinki 1964 and later revisions.\u0026nbsp;All participants gave informed consent in the digital survey form, and indicated they were aged 18 years or over.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA summarised dataset will be made available on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first author is a hill runner taking part in the sport under study and a member of the Scottish Hill Runners (SHR) organisation, with a personal relationship with members of the committee, who provided support for survey distribution to SHR members and information on the number of individuals participating in SHR-affiliated races.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll other authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was provided for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"607\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eContribution\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMabel Balfour\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConceptualisation of the study and methodology, project administration, acquisition and curation of data, statistical analyses, interpretation and visualisation of results, writing – original draft\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRita Ribeiro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConceptualisation of the study and methodology, writing – reviewing and editing.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHarriet Auty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSupervision, conceptualisation of the study and methodology, writing – reviewing and editing.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAlicia Heath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSupervision, conceptualisation of the study and methodology, interpretation of results, writing – reviewing and editing.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank to all anonymous participants for taking part in this research, and the Scottish Hill Runners organisation for sharing the survey and providing information on the total number of competitive hill runners in the year preceding survey.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was a student project conducted by MB in fulfilment of the Master of Public Health at Imperial College London.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStark JH, Pilz A, Jodar L, Mo\u0026iuml;si JC. 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Behavioral risk factors associated with reported tick exposure in a Lyme disease high incidence region in Canada. BMC Public Health. 2022;22(1):807.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRichards SL, Driver J, Dyer MC, Mather TN, Funkhouser S, Mitchell C, Anne Balanay J, White A, Meshnick S. Assessing Durability and Safety of Permethrin Impregnated Uniforms Used by Outdoor Workers to Prevent Tick Bites after One Year of Use. J Med Entomol. 2022;59(2):615\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRichards SL, Balanay JAG, Harris JW. Effectiveness of permethrin-treated clothing to prevent tick exposure in foresters in the central Appalachian region of the USA. Int J Environ Health Res. 2015;25(4):453\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVaughn MF, Meshnick SR. Pilot study assessing the effectiveness of long-lasting permethrin-impregnated clothing for the prevention of tick bites. 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The Impact of Host Abundance on the Epidemiology of Tick-Borne Infection. Bull Math Biol. 2023;85(4):30.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Borrelia burgdorferi, Hill running, Ixodes ricinus, Prevention, Tick-borne infection, Zoonoses ","lastPublishedDoi":"10.21203/rs.3.rs-7829276/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7829276/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLyme disease (LD) incidence is increasing globally, driven by changes to habitat and human-vector interactions. Effective prevention relies on local and individual-level understanding of risk and ecosystem interactions. Despite frequent exposure to tick habitats, little is known about tick bites and LD risk among hill, trail, and mountain runners. This study aimed to evaluate the prevalence of tick bites and LD in hill runners in Scotland, UK and examine preventive behaviours.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cross-sectional retrospective survey of Scottish hill runners was conducted in June-July 2024. Hill runners aged 18\u0026thinsp;+\u0026thinsp;resident in Scotland for the 12 months preceding the survey were eligible. Period prevalence of self-reported tick bites was calculated for the 12 months preceding the survey. Suspected LD incidence was calculated for all participants and those registered in competitive hill running. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of having a tick bite, for variables including age, sex, running hours per week, proportion of which is hill running, other outdoor activity hours per week, frequency of insect repellent use, full leg and arm cover use, and full body tick checks.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003e212 hill runners (56.1% male) completed the survey. Period prevalence of at least one tick bite was 82.5% (95%CI 76.76\u0026ndash;87.40). Incidence of treated suspected LD was 4245 per 100,000 (95%CI 1941.21-8058.87), and the minimum estimate in the competitive subset was 150 per 100,000 per year (95%CI 60.29-309.97). Most hill runners reported never/infrequently wearing full leg-cover (67.9%), arm-cover (58.0%), or using insect repellent (74.5%). Regularly/almost always conducting a tick-check was associated with higher odds of at least 1 tick bite (OR 8.52, 95%CI 3.29\u0026ndash;22.90, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas regularly/almost always wearing full leg-cover was associated with lower odds (OR 0.35, 95%CI 0.13\u0026ndash;0.89, p\u0026thinsp;=\u0026thinsp;0.029), versus never/infrequently.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA high reported prevalence and incidence of tick bites among surveyed hill runners in Scotland aligned with the low adherence to tick bite prevention behaviours in this population. Improving adherence with leg-cover recommendations may lower the risk of tick bites. Raising awareness of tick bite risk and prevention may benefit hill runners internationally as the sport grows.\u003c/p\u003e","manuscriptTitle":"Running into the Lyme-light: A retrospective cross-sectional study of tick bite and Lyme disease prevalence and prevention in hill runners, Scotland, UK.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 16:50:00","doi":"10.21203/rs.3.rs-7829276/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-29T14:37:30+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"26756798646546017865601426831562944225","date":"2025-11-26T15:31:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66509380582600345301748748354247836921","date":"2025-11-25T13:19:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-13T13:05:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-12T17:05:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176890024378765401406702080436999790095","date":"2025-11-07T06:24:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280198649162848018286744559361659846825","date":"2025-11-04T17:32:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135512289924359865487418945332011388297","date":"2025-11-03T17:18:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19387758407182712961814868102048794394","date":"2025-10-31T07:37:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31667854522631424135174577081629362222","date":"2025-10-30T17:35:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300371867963779477794172882722235228155","date":"2025-10-29T15:07:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-29T14:33:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-23T12:57:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-15T10:20:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-14T10:25:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-10-14T10:22:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e16d9455-4ede-4d8a-8bb0-be5de9068354","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T17:23:46+00:00","versionOfRecord":{"articleIdentity":"rs-7829276","link":"https://doi.org/10.1186/s12889-025-26181-8","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-01-13 16:29:13","publishedOnDateReadable":"January 13th, 2026"},"versionCreatedAt":"2025-11-11 16:50:00","video":"","vorDoi":"10.1186/s12889-025-26181-8","vorDoiUrl":"https://doi.org/10.1186/s12889-025-26181-8","workflowStages":[]},"version":"v1","identity":"rs-7829276","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7829276","identity":"rs-7829276","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}