VECTOR-BORNE AND ZOONOTIC DISEASES

Volume 00, Number 00, 2023

ª Mary Ann Liebert, Inc.
DOI: 10.1089/vbz.2023.0016

Open camera or QR reader and

scan code to access this article
and other resources online.

Citizen Science on Lyme Borreliosis

in Spain Reveals Disease-Associated Risk Factors
and Control Interventions

José de la Fuente,1,2 Agustı́n Estrada-Peña,3,4 Christian Gortázar,1 Rita Vaz-Rodrigues,1

Isabel Sánchez,5 and Juan Carrión Tudela5
Downloaded by Universidad de Castilla - from www.liebertpub.com at 07/19/23. For personal use only.

Abstract

Background: Lyme borreliosis (LB) caused by Borrelia burgdorferi sensu lato complex spirochetes is one of
the tick-borne diseases with high prevalence and social/economic burden in the United States, Spain, and other
European countries. The objective is to address limited information available about the incidence, prevalence,
and symptoms of LB, current prevention, and treatment interventions that are not adequately focused and thus
not very effective against this disease.
Methods: To address these limitations, in this study, we used a citizen science approach to evaluate the LB-
associated risks and implementation of control interventions in Spain. A total of 405 participants in the survey
were included in the analysis. Responses to the questionnaire were received during January—July 2022. The
questionnaire contained qualitative and quantitative questions. Homogeneity among binary variables was ana-
lyzed using a Fisher’s exact test.
Results: Despite limitations of the study associated with response to the questionnaire and information on tick
species, the results evidenced the effect of factors such as age, gender, tick bites, disease clinical signs, comor-
bidities such as alpha-gal syndrome, health care services, and treatment effectiveness affecting LB.
Conclusions: The main conclusions of the study highlight the need for better surveillance of tick infestations,
pathogen infection, and diagnosis of LB and related comorbidities. To advance in disease prevention, diagnosis,
and treatment, new interventions need to be developed and implemented in both public and private health care
services. Providing access to these results to the society, health care system, and scientists is important to fur-
ther advance in disease surveillance, diagnosis, control, and prevention.

Keywords: Lyme disease, Borrelia, tick, risk factors, citizen science

Introduction burden in Europe and the United States (Hook et al., 2022;
van den Wijngaard et al., 2017). LB is of obligatory decla-

L yme borreliosis (LB) or Lyme disease is a tick-borne

disease caused by Borrelia burgdorferi sensu lato com-
plex spirochetes with high prevalence and social/economic
ration in Europe.
Partnership between social community and researchers is
important. It provides a powerful tool for studying prevalence

1
SaBio (Health and Biotechnology), Instituto de Investigación en Recursos Cinegéticos IREC-CSIC-UCLM-JCCM, Ciudad Real, Spain.
2
Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma,
USA.
3
Department of Animal Health, Faculty of Veterinary Medicine, Zaragoza, Spain.
4
Group of Research on Emerging Zoonoses, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.
5
Asociación de Enfermedades Raras D’Genes, Totana-Murcia, Spain.

1
 2 DE LA FUENTE ET AL.

and educating society about the risks associated with tick- All participants included in the study agreed in the use
borne diseases and in encouraging tick bite prevention and and publication of this anonymous information. No ethical
better disease diagnosis by health care system (Iii and Mims, approval was required as this study was based on responses to
1999; Seifert et al., 2016; Sgroi et al., 2022). an anonymous questionnaire with privacy protection. The
To face challenges associated with LB in Spain (Garcia- data that support the findings of this study are available in the
Vozmediano et al., 2022), herein we used citizen science to Supplementary Data S1.
evaluate the disease-associated risks and implementation of
control interventions. Results and Discussion
Age, sex, history of tick bites, and LB
Methods
A total of 405 participants in the survey were included in
Characteristics of the survey and data transformation
the analysis. LB was diagnosed in 61% of male respondents
and statistical analysis
and in 81% of female respondents ( p < 0.001). Main diag-
Responses to the questionnaire were received during nostic tests included ELISA, Western blot, ELISpot, and
January–July 2022. The questionnaire contained qualitative PCR. Respondents between 30 and 60 years of age were less
questions: consent, sex, residence zip code, province, expo- likely to have been diagnosed with LB (34.1%) than younger
sure to tick bites, identified tick species, estimated place and (<30) or older (>60) respondents (49.2%; p = 0.015). The
month of tick bite, LB (No and no signs; No, but reports signs; spatial distribution showed that both respondents with LB
Downloaded by Universidad de Castilla - from www.liebertpub.com at 07/19/23. For personal use only.

Yes—clinical; and Yes—tested positive), date of disease diagnosed and/or symptoms or LB not diagnosed and without
diagnosis, symptoms compatible with LB (fever, sweat, chills, symptoms were located across Spain (Fig. 1). Respondent’s
fatigue, tiredness, throat pain, gastric or intestinal, respiratory, locations agree with higher abundance of Ixodes ricinus tick
muscular, vision, hearing, and nervous; for each one: No res- vector in northern Spain (Estrada-Peña et al., 2012; Vieira
ponse; Never; Sporadic; Frequent; and Very frequent), dis- Lista et al., 2022).
ease treatments and duration, type and results of treatment, Ticks of the I. ricinus complex are the main vectors of
role of public and private health system, allergic reactions to B. burgdorferi s.l. in Europe and multiple vertebrate species
mammalian meat consumption, and their perceptions reg- contribute to pathogen circulation (Estrada-Peña and de la
arding their general and mental health after disease diagnosis Fuente, 2017). The geographical range of the tick vector is
and treatment, and quantitative questions: birth year, age, and affected by temperature in northern and humidity in southern
age class (<30; 30–60; >60) (Supplementary Table S1). Europe, which translates into higher tick prevalence dur-
The questionnaire was anonymous and circulated through ing May–June and September–October in central Europe
Google Forms (https://forms.gle/Jwu3Jcg6eZ6utNfY8) with (Estrada-Peña et al., 2012).
privacy protection. By July 2022, we received 412 responses, Tick bites were reported more frequently by male res-
of which 405 participants were included in the study and pondents (80/118, 67.8%) than by females (140/284,
agreed in the use and publication of this anonymous infor- 49.3%; p < 0.001) and without difference between age clas-
mation. Main details on participants included in the study are ses. Tick bites were recorded in all months, except Febru-
disclosed in Table 1. Regarding their spatial distribution, ary with highest rates (9–20 respondents/month) between
respondents’ location zip codes were mapped using eSpatial April and October and consistently low rates from Novem-
(https://maps.espatial.com; accessed in January 2023). Homo- ber to March (0–3 respondents/month) (Fig. 2A). Exposure
geneity among binary variables was analyzed using a Fisher’s to tick bites was not associated with LB diagnosis and
exact test. The significance level was set at p < 0.05 using symptoms. However, respondents who reported frequent
SPSS statistical software. tick bites were more likely to have been diagnosed with

Table 1. Main Characteristics of Respondents Related to Lyme Borreliosis

LB not diagnosed and
Respondent characteristicsa LB diagnosed and symptoms (n = 302) without symptoms (n = 103)
Sex Males = 72; females = 229; other = 1 Males = 46; females = 55; other = 2
Age (years) mean (range) 45.39 (11–76) 47.46 (21–70)
Exposed to tick bites Yes = 159; no = 142; unknown = 1 Yes = 62; no = 40; unknown = 1
Health care service Public = 26; private = 196; no response = 80 Not applicable
Results of treatment Fully cured = 7; partially cured = 143; Not applicable
not cured = 72; no response = 80
Allergic reactions to mammalian Yes = 25; no = 197; no response = 80 Not applicable
meat consumption
Use of natural therapies Yes = 178; no = 44; no response = 80 Not applicable
Cure related to natural therapies Yes = 80; no = 98; no response = 124 Not applicable
Health status after diagnosis Recovered = 19; not recovered = 203; Not applicable
and treatment no response = 80
Mental health status after diagnosis Recovered = 49; not recovered = 173; Not applicable
and treatment no response = 80
a
A total of 405 participants in the survey were included in the analysis.
LB, Lyme borreliosis.
 Downloaded by Universidad de Castilla - from www.liebertpub.com at 07/19/23. For personal use only.

3
FIG. 1. Heatmap of spatial distribution of respondents with LB diagnosed and/or symptoms (LB) or LB not diagnosed and without symptoms (No LB). Location zip
codes were mapped using eSpatial (https://maps.espatial.com). LB, Lyme borreliosis.
 4 DE LA FUENTE ET AL.
Downloaded by Universidad de Castilla - from www.liebertpub.com at 07/19/23. For personal use only.

FIG. 2. Symptoms and tick bites reported by respondents to a questionnaire on LB in Spain, and their perceived
frequency. (A) Tick bites throughout the year and identified tick species. (B) Clinical signs associated with LB.

LB (20/25, 80%) than those reporting few or no tick bites Over time, B. burgdorferi s.l. is often controlled by innate
(239/381, 62.7%; not significant, p = 0.087). and adaptive immune responses (Steere et al., 2016) with
Regarding tick species, 9/11 (82%) respondents with tick improvement after antibiotic treatment in most patients
bite were identified as infested with B. burgdorferi s.l. tick (Dersch et al., 2016). However, LB is frequently under-
vector, I. ricinus. In addition, one each reported infestation diagnosed and overdiagnosed with social and economic
with Hyalomma sp. (9%) and Dermacentor reticulatus (9%), implications (Geebelen et al., 2022; Kobayashi et al., 2022).
which do not transmit B. burgdorferi (Fig. 2A). Of them, eight The absence of disease signs in many of test-positive diag-
respondents with identified tick species were reported in April– nosed cases in our study supports that diagnoses are fre-
June and four respondents in September–October (Fig. 2A). quently misattributed to LB. Recent studies have shown that
Although with limited evidence, these results agree with higher social factors such as insurance payor, primary care status,
tick prevalence during May–June and September–October in and diagnostic setting are positively/negatively associated
central Europe (Estrada-Peña et al., 2012). Three of the res- with the diagnosis of LB, suggesting that lower socioeco-
pondents, all with I. ricinus, were not diagnosed with LB. nomic status and less health care access may be associated
with disseminated disease stage (Moon et al., 2021).
Seventy-three of the 405 respondents (17.7%) reported spe-
Clinical signs and therapies
cific clinical symptoms attributed to LB, while only 3 (0.7%)
The main symptoms associated with LB may be non- reported no clinical symptom and 336 (81.5%) did not res-
disease specific and include localized and self-limiting skin pond to the individual clinical symptom-related questions.
manifestations, erythema migrans, and infection that dis- Fatigue was the most reported clinical symptom (69 respon-
seminate to the central nervous system (Dessau et al., 2015; dents), followed by muscular symptoms (65), digestive and
Hansen and Lebech, 1992; Hansen et al., 2013; Stanek nervous system signs (57 each), fever, sweat, or shiver (56), sore
et al., 2012). The most common neurological manifestations throat (48), vision and respiratory signs (46 each), and auditive
include facial nerve palsy, headache, polyradiculitis, and signs (35). The signs most often rated as ‘‘very frequent’’ were
encephalitis (van Samkar et al., 2023). Serology testing of fatigue, digestive, muscular, and nervous (Fig. 2B).
B. burgdorferi s.l. is the primary laboratory tool employed Nevertheless, all respondents subjected to LB tests
to diagnose LB (Kenyon and Chan, 2021). (n = 302) presented symptoms not necessarily associated to
 CITIZEN SCIENCE ON LYME BORRELIOSIS IN SPAIN 5

LB, but mainly associated with joint problems (pain in wrists, gal did not correlate to previous LB (Tjernberg et al., 2017),
ankles, and back), nervous disorders (paralysis of arms or the characterization of anti-alpha-gal IgE and IgM/IgG
legs and uncontrollable tremors in arms or legs), disorders antibody levels should be considered to evaluate risks for
that affected memory or sleep quality (recurring nightmares), AGS associated with LB as with other infectious diseases
balance or gait (walking or running), and red ‘‘bullseye’’- (Dupont et al., 2022; Vaz-Rodrigues et al., 2023).
shaped patch on the skin with a lighter center and dark edges. In agreement with recent reports (Oteo et al., 2023;
A total of 47 respondents reported erythema. All of them Rebman et al., 2023), new interventions, including rapid
have been diagnosed with LB. Of these, 4 belonged to the age diagnostics and physician awareness of early disease mani-
class <30 years of age, 36 to the class 30–60 years of age, and festations, need to be implemented in both public and pri-
6 to the class >60 years of age (excluding respondents who vate health care services to improve prevention, diagnosis,
did not declare age class). Fifteen were males and 32 females. and treatment of LB.
Mammalian meat allergy was reported by 25 respondents, These interventions include identification and analysis of
all of which were diagnosed with LB. Of these, 24 belonged pathogen DNA in ticks collected from infested individuals
to the age class 30–60 years of age (3 males and 21 females), (e.g., Clark and Herman-Giddens, 2023), microbiological
and 1 did not declare age. All these cases presented symptoms diagnosis using molecular tests, formation health care staff-
such as joint problems and disorders that affected memory or ing, education for reducing exposure to tick bites, especially
sleep quality, balance, or gait, some of which may be related in high-risk zones and environments and guiding tick remo-
to Lyme arthritis. Based on the association between allergic val, appropriate therapeutic and prophylaxis management
Downloaded by Universidad de Castilla - from www.liebertpub.com at 07/19/23. For personal use only.

reactions to mammalian meat consumption and alpha-gal (Govil et al., 2023), the development of effective vaccines
syndrome (AGS) (Vaz-Rodrigues et al., 2022), these results to control pathogen infection and reduce disease symptom-
suggest that LB and AGS may be comorbidities in response atology, adequate knowledge of the community of verte-
to tick bites. brates supporting the circulation of the pathogen at regional
The sample included 302 cases having an LB diagnosis or local scales, and the support for research to advance in the
or with compatible clinical signs. Of these, only 7 (2.3%) development and implementation of effective vaccines and
reported total recovery, 143 (47.3%) reported partial healing other interventions for the control of tick vector infestations
and normal life, and 72 (23.8%) stated that their clinical signs in key host species and the prevention of pathogen infection
remained as bad as when the treatment started. A total of 222 and transmission. The society, health care system, and sci-
of 412 (53.9%) respondents answered the questions regarding entists need to get access to these results to advance in disease
their general health and mental health perception after LB. surveillance, diagnosis, control, and prevention.
Of these, 203 (91.5%) reported that their general health had
not returned to prediagnosis levels, while 19 (8.5%) reported Acknowledgments
being back to normal. Regarding mental health, 173 (77.9%) The authors thank participants in the survey and colleagues
reported that their mental health had not returned to pre- from D’genes Lyme and other groups who assisted in the
diagnosis levels, while 49 (22.1%) reported being back to distribution of the survey.
normal. Most respondents used private health care services
(88%) and were either fully or partially cured (68%). Natural Authors’ Contributions
therapies were more commonly used among respondents
(80%), but without difference in recovery associated with J.F., A.E.-P., I.S., and J.C.T. designed the study. C.G.,
these therapies. R.V.-R., and J.F. analyzed the data. J.F., C.G., and A.E.-P.
interpreted the data and wrote the article. All authors revised
the article and approved the final version.
Conclusions
Author Disclosure Statement
This study has several limitations that may be considered.
The number of participants is limited and not all participants No conflicting financial interests exist.
provided response to the full questionnaire, and thus reduced
the number of entries for analysis. In addition, information bias Funding Information
from self-reported data should be considered. The information This study was partially supported by Ministerio de
on tick species is very limited, which highlights the need to Ciencia e Innovación/Agencia Estatal de Investigación,
improve interventions for the identification of ticks infesting Spain, and EU-FEDER [grant BIOGAL number PID2020-
cases with LB. Also, as recently published (Olechnowicz et al., 116761GB-I00]. R.V.-R. was funded by Universidad de
2023; Puppo et al., 2023), several factors affect individual Castilla-La Mancha (UCLM), Spain, and the European
perceptions of vulnerability and behaviors toward Lyme dis- Social Fund (ESF) [grant no. 2022-PRED-20675].
ease, with some patients presenting illness without chronic LB.
Despite these limitations, we conclude that a better sur- Supplementary Material
veillance is required for the identification of tick infestations,
pathogen infection, and diagnosis of LB and related Supplementary Table S1
comorbidities. Tick-borne pathogens such as B. burgdorferi
s.l. and Anaplasma phagocytophilum contain surface- References
exposed alpha-gal modifications triggering antibody res- Cabezas-Cruz A, Hodžić A, Mateos-Hernández L, et al. Tick-
ponse to this glycan, which may be associated with acquired human interactions: From allergic klendusity to the a-Gal
tick resistance, allergic klendusity, and AGS (Cabezas-Cruz syndrome. Biochem J 2021;478(9):1783–1794; doi: 10.1042/
et al., 2021). Although it has been reported that IgE to alpha- BCJ20200915
 6 DE LA FUENTE ET AL.

Clark KL, Herman-Giddens ME. Investigation of a symptom- understanding tick-borne disease attitudes. Ticks Tick Borne
atic tick bite patient confirms Borrelia burgdorferi in Ixodes Dis 2023;14(2):102120; doi: 10.1016/j.ttbdis.2023.102120
scapularis and white-footed mice in Ashe County, North Oteo JA, Corominas H, Escudero R, et al. Executive summary of
Carolina. Vector Borne Zoonotic Dis 2023;10.1089/vbz.2022 the consensus statement of the Spanish Society of Infectious
.0042; doi: 10.1089/vbz.2022.0042 Diseases and Clinical Microbiology (SEIMC), Spanish Society
Dersch R, Sommer H, Rauer S, et al. Prevalence and spectrum of Neurology (SEN), Spanish Society of Immunology (SEI),
of residual symptoms in Lyme neuroborreliosis after phar- Spanish Society of Pediatric Infectology (SEIP), Spanish
macological treatment: A systematic review. J Neurol 2016; Society of Rheumatology (SER), and Spanish Academy of Der-
263(1):17–24; doi: 10.1007/s00415-015-7923-0 matology and Venereology (AEDV), on the diagnosis, treatment
Dessau RB, Espenhain L, Mølbak K, et al. Improving national and prevention of Lyme borreliosis. Enferm Infecc (English ed.)
surveillance of Lyme neuroborreliosis in Denmark through 2023;41(1):40–45; doi: 10.1016/j.eimce.2022.11.011
electronic reporting of specific antibody index testing from Puppo C, Hansmann Y, Moinot L, et al. The social represen-
2010 to 2012. Euro Surveill 2015;20(28):21184; doi: tations of diagnosing Lyme disease. PLoS One 2023;18(2):
10.2807/1560-7917.es2015.20.28.21184 e0276800; doi: 10.1371/journal.pone.0276800
Dupont M, Carlier C, Gower-Rousseau C, et al. Incidence and Rebman AW, Yang T, Yoon I, et al. Initial presentation and
associated factors of cetuximab-induced hypersensitivity in- time to treatment in early Lyme disease. Am J Trop Med
fusion reactions in 1392 cancer patients treated in four French 2023;tpmd220437; doi: 10.4269/ajtmh.22-0437
areas: A possible association with Lyme disease? BMC Seifert VA, Wilson S, Toivonen S, et al. Community partner-
Cancer 2022;22(1):1219; doi: 10.1186/s12885-022-10192-4 ship designed to promote Lyme disease prevention and
Downloaded by Universidad de Castilla - from www.liebertpub.com at 07/19/23. For personal use only.

Estrada-Peña A, Ayllón N, de la Fuente J. Impact of climate engagement in citizen science. J Microbiol Biol Educ 2016;
trends on tick-borne pathogen transmission. Front Physiol 17(1):63–69; doi: 10.1128/jmbe.v17i1.1014
2012;3:64; doi: 10.3389/fphys.2012.00064 Sgroi G, Iatta R, Lia RP, et al. Tick exposure and risk of tick-
Estrada-Peña A, de la Fuente J. Host distribution does not limit borne pathogens infection in hunters and hunting dogs:
the range of the tick Ixodes ricinus but impacts the circulation A citizen science approach. Transb Emerg Dis 2022;69(4):
of transmitted pathogens. Front Cell Infect Microbiol 2017;7: e386–e393; doi: 10.1111/tbed.14314
405; doi: 10.3389/fcimb.2017.00405 Stanek G, Wormser GP, Gray J, et al. Lyme borreliosis. Lancet
Garcia-Vozmediano A, De Meneghi D, Sprong H, et al. A One 2012;379:461–473; doi: 10.1016/s0140-6736(11)60103-7
Health evaluation of the surveillance systems on tick-borne Steere AC, Strle F, Wormser GP, et al. Lyme borreliosis. Nat
diseases in the Netherlands, Spain and Italy. Vet Sci 2022; Rev Dis Primers 2016;2:16090; doi: 10.1038/nrdp.2016.90
9(9):504; doi: 10.3390/vetsci9090504 Tjernberg I, Hamsten C, Apostolovic D, et al. IgE reactivity to
Geebelen L, Devleesschauwer B, Lernout T, et al. Lyme bor- a-Gal in relation to Lyme borreliosis. PloS One 2017;12(9):
reliosis in Belgium: A cost-of-illness analysis. BMC Public e0185723; doi: 10.1371/journal.pone.0185723
Health 2022;22(1):2194; doi: 10.1186/s12889-022-14380-6 van Samkar A, Bruinsma RA, Vermeeren YM, et al. Clinical
Govil S, Capitle E, Lacqua A, et al. Common neurologic fea- characteristics of Lyme neuroborreliosis in Dutch children
tures of lyme disease that may present to a rheumatologist. and adults. Eur J Pediatr 2023;10.1007/s00431-022-04749-5;
Pathogens 2023;12(4):576; doi: 10.3390/pathogens12040576 doi: 10.1007/s00431-022-04749-5
Hansen K, Lebech AM. The clinical and epidemiological profile van den Wijngaard CC, Hofhuis A, Simões M, et al. Surveil-
of Lyme neuroborreliosis in Denmark 1985-1990. A pro- lance perspective on Lyme borreliosis across the European
spective study of 187 patients with Borrelia burgdorferi Union and European Economic Area. Euro Surveillance 2017;
specific intrathecal antibody production. Brain 1992;115: 22(27):30569; doi: 10.2807/1560-7917.ES.2017.22.27.30569
399–423; doi: 10.1093/brain/115.2.399 Vaz-Rodrigues R, Mazuecos L, de la Fuente J. Current and
Hansen K, Crone C, Kristoferitsch W. Lyme neuroborreliosis. future strategies for the diagnosis and treatment of the Alpha-
Hand Clin Neurol 2013;115:559–575; doi: 10.1016/b978-0- Gal Syndrome (AGS). J Asthma Allergy 2022;15:957–970;
444-52902-2.00032-1 doi: 10.2147/JAA.S265660
Hook SA, Jeon S, Niesobecki SA, et al. Economic burden of Vaz-Rodrigues R, Mazuecos L, Villar M, et al. Serum bio-
reported Lyme disease in high-incidence areas, United States, markers for nutritional status as predictors in COVID-19
2014-2016. Emerg Infect Dis 2022;28(6):1170–1179; doi: patients before and after vaccination. JFF 2023;101:105412;
10.3201/eid2806.211335 doi: 10.1016/j.jff.2023.105412
Iii F, Mims M. Amateur science: Strong tradition, bright future. Vieira Lista MC, Belhassen-Garcı́a M, Vicente Santiago MB,
Science 1999;284(5411):55–56. et al. Identification and distribution of human-biting ticks in
Kenyon SM, Chan SL. A focused review on Lyme disease diag- Northwestern Spain. Insects 2022;13(5):469; doi: 10.3390/
nostic testing: An update on serology algorithms, current ordering insects13050469
practices, and practical considerations for laboratory imple-
mentation of a new testing algorithm. Clin Biochem 2021;S0009- Address correspondence to:
9120(21)00318-0; doi: 10.1016/j.clinbiochem.2021.12.001 José de la Fuente
Kobayashi T, Higgins Y, Melia MT, et al. Mistaken identity: Many SaBio (Health and Biotechnology)
diagnoses are frequently misattributed to Lyme disease. Am J Med Instituto de Investigación en Recursos
2022;135(4):503–511.e5; doi: 10.1016/j.amjmed.2021.10.040 Cinegéticos IREC-CSIC-UCLM-JCCM
Moon KA, Pollak JS, Poulsen MN, et al. Risk factors for Lyme Ronda de Toledo 12
disease stage and manifestation using electronic health 13071 Ciudad Real
records. BMC Infect Dis 2021;21(1):1269; doi: 10.1186/ Spain
s12879-021-06959-y
Olechnowicz C, Leahy J, Gardner A, et al. Perceived vulnera- E-mail: [email protected];
bility for Lyme disease questionnaire: A social science tool for [email protected]