![]() ![]() There is an increasing body of literature describing the use of smartphone app technology as a platform for EMA implementation, particularly within psychology and substance abuse research. As a research tool, it includes epidemiological surveys using ecological momentary assessments (EMA) to gather quantitative behavioral data within the context of a participant’s daily routine. To address these issues, we developed a smartphone app, The Tick App, to (1) serve as a research tool to better understand human behaviors affecting tick exposure and (2) engage the general public in active tick prevention and reporting in different regions of the United States. In addition, survey results are often affected by recall bias and do not capture specific intrasubject variability, particularly when participants are required to generalize an experience or behavior. Traditional mechanisms of data collection of human behavior (eg, retrospective questionnaires) are subject to uncertainties in the degree to which findings can be generalized beyond the investigation depending on how and where they are administered surveys administered through an app can help expand the population surveyed at a lower cost. The links between human activity, mobility patterns, and tick exposure, however, have not been well documented in Lyme disease–endemic areas of the United States, in part, because of methodological limitations. In turn, prior exposure to ticks may trigger multiple behavioral responses to reduce exposure, such as avoidance of tick habitat and the use of personal protection measures. Human behaviors that have been shown to influence tick exposure include the frequency and type of outdoor activities and adaptive responses following interactions with tick habitat. Human exposure to ticks depends on the density of infected ticks, but this association is strongly modified by local conditions, including human behavior. The association between human cases and nymphal activity can be in part attributed to the small size of nymphal ticks compared with adults, resulting in prolonged or undetected attachment. ![]() scapularis nymphal activity nymphs are abundantly active from May to early August, peaking in early-mid summer. ![]() The seasonality of human cases mirrors that of I. In these areas, Lyme disease risk is determined by human exposure to infected Ixodes scapularis ticks, which can occur either peridomestically or within natural areas. Lyme disease is the most commonly reported vector-borne disease in the United States, with 300,000 cases estimated per year, the majority of which are reported from the northeastern and north-central states. These are limited to the country level in Europe. Most mHealth apps applied to vector-borne disease research have targeted mosquito-borne diseases and only a few have targeted tick vectors. Although apps have been widely implemented in chronic diseases and psychology, their potential use in the research of vector-borne diseases has not yet been fully exploited. The widespread use of smartphone apps can be thought of as a 2-way communication channel between affected users and researchers. Moreover, the use of mHealth can leverage smartphone features to turn them into research tools with the potential to reach a larger section of the population in a more cost-effective manner than traditional epidemiological methods and transform survey instruments into high-frequency (fine temporal resolution), spatially resolved data collection tools. In the context of public health, mHealth is particularly suited for patient education, disease self-management, and remote monitoring of patients. mHealth allows the general public to access a health service where and when they need it. As a result, mobile health (mHealth) technology is becoming an important part of health care service provision and is changing the way in which people use health information and communicate with health organizations and health professionals. The ubiquity of smartphones provides a unique opportunity to gather and share information about health and disease, given the capabilities such as location sensing and software apps. It is estimated that 81% of the adult population owns a smartphone compared with 15% of the population owning a normal mobile phone. In the United States, the number of adults who own a smartphone has been steadily increasing over time for every age group within the adult population. The Use of Mobile Health in Vector-Borne Diseases The Tick App users were equally represented across genders and evenly distributed across age groups. Between May and September 2018, 1468 adult users enrolled in the app.
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