Form 0920-1150 Main Survey

Confidential

Upper Midwest Tick Prevention Study Minnesota
Questionnaire

Page 1 of 13

Form Approved
OMB Control No.: 0920-1150
Expiration date: 12/31/2019

On behalf of the Minnesota Department of Health, thank you for your interest in our research study.
This questionnaire will be available from July 8, 2019, through August 9, 2019, or until 1,000 participants have
submitted their responses. Please complete the questionnaire as soon as possible.
Answer the following questions to find out if you are eligible to participate.
You must be 18 years of age or older to participate
in this research study. Are you 18 years of age or
older?

Yes

No

We're sorry. You must be 18 years of age or older to take part in this research study. Please have the adult in your
household with the most recent birthday complete the questionnaire.
To help us get responses from a variety of adults, we
are asking for the adult in the household with the
most recent birthday to participate in this research
study.

Yes
No

Are you the adult in your household with the most
recent birthday?
We're sorry. In order for us to get responses from a variety of adults, you must be the adult in your household with
the most recent birthday to take part in this research study. Please have the adult who can answer these questions
complete the questionnaire.
You are eligible to participate in our research study!
This voluntary questionnaire will take 5 to 10 minutes to complete. You may refuse to answer any question and you
can stop the questionnaire at any time by simply closing your browser.
If needed, you may stop the questionnaire at any time and return to it later. Click the "Save & Return Later" button at
the bottom of any page. You will be given instructions to write down a RETURN CODE (this is different than the
Access Code in your invitation postcard), then use the link in your invitation to restart the questionnaire. After
completing the questionnaire, please click the "SUBMIT" button on the last page. Once you click "SUBMIT" you will
not be able to re-enter the questionnaire.
All of your information will be held in strict confidence. A summary of the data will be published or shared upon
request but none of this information could be used to identify you or your household. If you have questions, problems
accessing the questionnaire, or would like to withdraw your responses, please email Dr. Jenna Bjork at
[email protected] or call 651-201-5803. If you have any questions about your rights as a participant, please
call or email. For more information on confidentiality protections, please visit the Centers for Disease Control and
Prevention.
Please click "Next Page" below to start the questionnaire now!

Public reporting burden of this collection of information is estimated to average 10 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to a collection of information unless it displays a currently
valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance
Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-1150
Of
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Section 1 of 5
The first questions ask about your experiences with ticks and diseases spread by ticks.
On average, between the months of April through
October, how often do you spend time in places where
ticks could get on you, like wooded or brushy areas?

Every day
Every week
Every month
Less than once a month
Once or twice a season
Never

Have you ever removed a tick from your skin or
clothing?

Yes
No

In the last year, have you removed a tick from your
skin or clothing?

Yes
No

How likely are you to get ticks on you...
Not at all

Slightly

Somewhat

Very

Extremely

...around your home?
...around your cabin or vacation
home?
...while at work?
...around recreational areas in
your community?
...at other locations or doing
other activities?

You answered that you may get ticks on you while at
work. What is your occupation?
You answered that you are likely to get ticks on you
doing other activities not listed above. Please
describe these activities.

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__________________________________

__________________________________

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Not applicable

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Page 3 of 13

Which of the following illnesses have you heard of?
Yes

No

Lyme disease
Anaplasmosis
Babesiosis
Ehrlichiosis
Powassan virus disease
Rocky Mountain spotted fever
How serious do you feel each of the following illnesses are?
Not at all

Slightly

Somewhat

Very

Extremely

Don't know

Lyme disease
Anaplasmosis
Babesiosis
Ehrlichiosis
Powassan virus disease
Rocky Mountain spotted fever
In the community where you live, how common do you
think diseases spread by ticks are?

Not at all
Slightly
Somewhat
Very
Extremely

In the coming year, how likely do you think it is
that you or another person in your household will
get a disease spread by ticks?

Not at all
Slightly
Somewhat
Very
Extremely

Has any person in your household, including yourself, ever been diagnosed by a health care provider as having a
disease spread by ticks?
Yes

No

In the past year
1 to 5 years ago
More than 5 years ago

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Section 2 of 5
The following questions ask about what precautions you take to protect yourself and others in
your household from ticks.
After being outdoors in places where you could get
ticks, how often do you check yourself thoroughly
for ticks?

Which of the following are reasons why you do not
always check yourself thoroughly for ticks?

Are there other reasons why you do not always check
yourself thoroughly for ticks?

When you are outdoors in places where you could get
ticks on you, how often do you use bug repellent on
your skin or clothing?

Which of the following are reasons why you do not
always use bug spray on your skin or clothing?

Are there other reasons why you do not always use bug
repellent on your skin or clothing?

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Never
Rarely
Sometimes
Most of the time
Always
You forget
You think it is too much trouble
You do not think you could find a tick on yourself
You check for ticks but not thoroughly
You are not worried about ticks
(Check all that apply)

__________________________________________
Never
Rarely
Sometimes
Most of the time
Always
You forget to use or bring bug spray
You are concerned about the cost of bug spray
You are concerned about the safety of bug spray
for yourself or your family
You did not know this might prevent tick bites and
diseases spread by ticks
You do not like bug spray
You are not worried about ticks
(Check all that apply)

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Page 5 of 13

Have you ever treated your property, either at your
home or at a cabin or vacation home, with a
pesticide to kill ticks?

Yes
No
Don't know

Did you treat your property with pesticide yourself
or did you hire a professional to do it?

Treated it myself
Hired a professional
Do not remember
(Please check all that apply)

Which of the following are reasons why you have not
treated your property with a pesticide to kill ticks?

You did not know lawn-based pesticides to kill
ticks were available
It seemed like too much work
You are concerned about the cost
You are concerned about the health or safety of
yourself, your family, or the environment
You are not worried about ticks on your property
(Check all that apply)

Are there other reasons why you have not treated your
property with a pesticide to kill ticks?

Have you ever treated your property, either at your
home or at a cabin or vacation home, with devices
that apply pesticide to rodents to kill ticks?

__________________________________________
Yes
No
Do not know

Examples of devices like this are the Damminix or
Thermacell tick tube.
Did you treat your property with these rodent devices
yourself or did you hire a professional to do it?

Treated it myself
Hired a professional
Do not remember
(Please check all that apply)

Which of the following are reasons why you have not
treated your property with devices that apply
pesticide to rodents to kill ticks?

You did not know such rodent devices with
pesticide were available
It seemed like too much work
You are concerned about the cost
You are concerned about the health or safety of
yourself, your family, or the environment
You are not worried about ticks on your property
(Check all that apply)

Are there other reasons why you have not treated your
property with devices that apply pesticide to
rodents to kill ticks?

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Section 3 of 5
The following questions ask about prevention methods you may be willing to do to protect
yourself and others in your household from ticks. The methods listed may be available now or
may become available in the future. Assume that all of the methods listed are safe and
effective.
Before or after spending time in places where ticks
could get on you, which of the following would you
be willing to do to protect yourself and others in
your household from ticks?

Check for ticks at least once a day
Shower or bathe within two hours of being outdoors
Tumble-dry clothing or gear on high heat for at
least ten minutes
Treat pet(s) with a product to prevent tick bites
Use a natural bug repellent, like oil of lemon
eucalyptus, on your skin or clothing
Use a synthetic bug repellent, like DEET, on your
skin or clothing
Wear clothing that has been pretreated with a
long-lasting bug repellent, like permethrin
(Check all that apply)

Imagine you are considering private options for
controlling ticks on your own property. Suppose you
were able to use products that would not threaten
human or animal health and would pose minimal risk
to the environment. Use of the products would cut in
half the probability that someone in your household
gets a disease spread by ticks.

Apply over-the-counter tick control products to
the property yourself
Hire a pest control company to do the work
Do nothing, as you are not interested in property
level tick control

Which one of the following best describes what you
would do in this situation?
Annually, how much money would you be willing to spend for the following yard-based options to protect yourself
and others in your household from ticks?
$0 each year

$1 to $49
each year

$50 to $99
each year

$100 to $299
each year

$300 to $499
each year

More than
$500 each
year

Natural pesticide application
Synthetic pesticide application
Devices that apply pesticide to
rodents to kill ticks
Landscaping such as adding
hardscaping, rock or mulch
borders, and leaf or brush
removal

Annually, how much money would you be willing to spend for the following yard-based options to protect yourself
and others in your household from ticks?

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$0 each year

$1 to $99
each year

$100 to $299
each year

$300 to $499
each year

$500 to $999
each year

Natural pesticide application

More than
$1000 each
year

Synthetic pesticide application
Devices that apply pesticide to
rodents to kill ticks
Landscaping such as adding
hardscaping, rock or mulch
borders, and leaf or brush
removal

Now imagine that local officials are considering a county-wide tick control program. Suppose they will use products
that would not threaten human or animal health and would pose minimal risk to the environment. The program
would cut in half the number of people in the county who get a disease spread by ticks. In your county, surrounding
your home, cabin, or vacation home, which of the following would you be in favor of?
Yes

No

Spraying with a natural pesticide
Spraying with a synthetic
pesticide
Treating rodents with a pesticide
Treating deer with a pesticide
Changing landscaping, such as
maintaining trails, mowing
frequently, and removing leaves
and brush

Next, imagine that local officials are considering
publicly funded options for a county-wide tick
control program. The program would be paid for by
adding an annual per household surcharge to local
taxes from county residents. If a majority of
residents were in favor of the program, your local
taxes would go up by $10 per year.

Yes
No

Would you vote yes or no for this program?
Suppose instead that your household would pay $30 per
year in additional local taxes for the program.
Would you vote yes or no?

Yes
No

Finally, imagine that your household surcharge would
be $50 per year for the program. Would you vote yes
or no?

Yes
No

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Section 4 of 5
The following questions will help us understand how you prefer to learn about the prevention
of diseases spread by ticks.
Prior to taking part in this study, have you seen any
information about ticks or the prevention of
diseases spread by ticks from the Minnesota
Department of Health, such as its website,
brochures, posters, or speakers?

Yes
No
Don't know

How helpful would you or others in your household find each of the following resources for preventing diseases
spread by ticks?
Not at all

Slightly

Somewhat

Very

Extremely

Online resources such as a
website, archived webinars,
podcasts, or YouTube videos
Printable resources such as fact
sheets, tick identification cards,
or brochures
Community resources such as
billboards, posters, or signs
In-person presentations or
discussions
Regular email or text updates
A smartphone app
Are there any particular topics you would like to
know more about in order to help you or others in
your household protect yourselves from ticks?

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Section 5 of 5
The final section of this survey asks a few demographic questions about you and your
household.

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Page 10 of 13

Currently, in which county do you live?

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Aitkin
Anoka
Becker
Beltrami
Benton
Big Stone
Blue Earth
Brown
Carlton
Carver
Cass
Chippewa
Chisago
Clay
Clearwater
Cook
Cottonwood
Crow Wing
Dakota
Dodge
Douglas
Faribault
Fillmore
Freeborn
Goodhue
Grant
Hennepin
Houston
Hubbard
Isanti
Itasca
Jackson
Kanabec
Kandiyohi
Kittson
Koochiching
Lac qui Parle
Lake
Le Sueur
Lincoln
Lake of the Woods
Lyon
Mahnomen
Marshall
Martin
McLeod
Meeker
Mille Lacs
Morrison
Mower
Murray
Nicollet
Nobles
Norman
Olmsted
Otter Tail
Pennington
Pine
Pipestone
Polk
Pope
Ramsey
Red Lake
Redwood
Renville
Rice
Rock
Roseau
Scott
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Sibley
Stearns
Steele
Stevens
St. Louis
Swift
Todd
Traverse
Wabasha
Waseca
Washington
Watonwan
Wilkin
Winona
Wright
Wadena
Yellow Medicine
Which one of the following best describes the type of
area in which you currently live?

Urban
Suburban
Town
Rural

What is your gender?

Female
Male
Other
Prefer not to answer

You said that you identify as a gender other than
female or male. Please tell us:
What is your age (in years)?

__________________________________

__________________________________

How do you describe your ethnicity?

Hispanic or Latino
Not Hispanic or Latino
Prefer not to answer

How do you describe your race?

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Prefer not to answer

What is the highest level of education you have
completed?

Never attended school
Some high school or less
Completed high school or obtained GED or
alternative credential
Trade school such as cosmetology school or
electrical school
Some college
Associate's degree or a 2-year college degree
Bachelor's degree or a 4-year college degree
Master's degree
Advanced degree such as a Ph.D, a law degree, or a
medical degree
Prefer not to answer

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Including all sources, what is your current total
annual household income before taxes?

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Less than $25,000
$25,001 to $40,000
$40,001 to $55,000
$55,001 to $65,000
$65,001 to $75,000
$75,001 to $100,000
More than $100,000
Prefer not to answer

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Thank you for your time today! Your responses will help inform tick bite prevention efforts.
The last question of the survey is important for you to receive your thank-you letter and gift
card.
IMPORTANT! You must click on the "SUBMIT" button below and then the "CLOSE SURVEY"
button on the next page to make sure you receive your $10 gift card.
Please look at the address listed on your postcard.
Is this the address to which you would like your
gift card mailed?

Please enter the mailing address to which you would
like your gift card mailed. If you prefer to call or
email us this information instead, please indicate
this in the text box so it is not left blank.

Yes
No
Prefer not to answer
(Please select "no" to change the mailing address
on file or to provide more detail to your current
mailing address (such as unit number or name).)

__________________________________________
(If you prefer not to submit your address with
your survey responses but would still like to
receive a gift card, you must contact the study
coordinator, Dr. Jenna Bjork, by calling
651-201-5803 or emailing [email protected]
before September 1st, 2019.)

If you prefer not to tell us your address then we will not be able to send you a gift card for participating in our study.
Please answer "Yes" or "No" to the previous question if you would like to receive a gift card or click on the "SUBMIT"
button below to proceed with submitting your questionnaire.

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