Arbovirus risk perception as a predictor of mosquito-bite preventive behaviors in Ponce, Puerto Rico

Mosquito-borne arboviruses are an important cause of morbidity and mortality in the Caribbean. In Puerto Rico, chikungunya, dengue, and Zika viruses have each caused large outbreaks during 2010–2022. To date, the majority of control measures to prevent these diseases focus on mosquito control and many require community participation. In 2018, the U.S. Centers for Disease Control and Prevention launched the COPA project, a community-based cohort study in Ponce, Puerto Rico, to measure the impact of novel vector control interventions in reducing arboviral infections. Randomly selected households from 38 designated cluster areas were offered participation, and baseline data were collected from 2,353 households between May 2018 and May 2019. Household-level responses were provided by one representative per home. Cross-sectional analyses of baseline data were conducted to estimate 1) the association between arboviral risk perception and annual household expenditure on mosquito control, and 2) the association between arboviral risk perception and engagement in ≥3 household-level risk reduction behaviors. In this study, 27% of household representatives believed their household was at high risk of arboviruses and 36% of households engaged in at least three of the six household-level preventive behaviors. Households where the representative perceived their household at high risk spent an average of $35.9 (95% confidence interval: $23.7, $48.1) more annually on mosquito bite prevention compared to households where the representative perceived no risk. The probability of engaging in ≥3 household-level mosquito-preventive behaviors was 10.2 percentage points greater (7.2, 13.0) in households where the representatives perceived high risk compared to those in which the representatives perceived no risk. Paired with other research, these results support investment in community-based participatory approaches to mosquito control and providing accessible information for communities to accurately interpret their risk.Author SummaryMosquito-borne disease is an important cause of illness and death in the Caribbean, including Puerto Rico. Most tactics to prevent these diseases rely on stopping mosquito bites, either by reducing the mosquito population or creating barriers between mosquitos and humans. These methods vary in the degree of community involvement required. This study used data collected from 2,353 households in Ponce, Puerto Rico from May 2018 to May 2019 to understand how household perception of risk of contracting these diseases related to 1) the amount of money households spent annually to prevent mosquito bites, and 2) the number of activities their household engaged in to prevent mosquito bites. We found that 27% of households perceived themselves at high risk of contracting these diseases, and 36% of households engaged in at least three activities to reduce their risk. On average, households that perceived themselves at high risk spent more money on mosquito bite prevention and engaged in more activities to prevent mosquito bites, compared to households that perceived no risk. Paired with other research in this area, these results support investment in community-based approaches to mosquito control and ensuring that communities have accessible information to understand their risk of mosquito-borne disease.