Chronic disease and injury in an agricultural county: The Keokuk County Rural Health Cohort Study

Animal-Related Injuries and Fatalities in the AgInjurynews Collection

OBJECTIVES

This research had three objectives. The first was to characterize reports of animal-related injuries found in the AgInjuryNews Dataset. The second objective was to compare the results of the AgInjuryNews reports to that of the Regional Rural Injury study. The third objective was to qualitatively and quantitatively assess the utility of using the AgInjuryNews database.

METHODS

A total of 104 reports on animal-related incidents representing 112 victims were sourced from AgInjuryNews. Chi square tests were performed comparing fatal and non-fatal injuries across age, gender, role in incident, animal, and activity. Additional chi square tests were performed to compare AgInjuryNews data with the results of Regional Rural Injury Study II across age, gender, animal, and activity. Utility of the dataset was assessed by examining the distribution of reports across states, the availability of articles, and qualitative observations.

RESULTS

Chi square results comparing fatal and nonfatal injuries were significant for victim gender. Results of the comparison of the two studies were significant for age and activity. A mismatch between the states with the highest populations of large animals and the states with the most reports in the AgInjryNews.org database was detected. Approximately 42% of reports the original articles were not accessible. Media bias plays a role in which cases are reported, but the size and accessibility of the dataset increases its utility.

CONCLUSION

Despite the limitations inherent to the dataset, the amount of freely accessible information and the level of insight provided make AgInjuryNews a valuable resource for agricultural injury research.

Anxiety and Associated Stressors Among Farm Women in England and Wales

OBJECTIVES

The findings presented here derive from a wider study that sought to establish a baseline understanding of mental health and wellbeing among the agricultural community in England and Wales. This paper focuses on selected questions that investigated levels of anxiety and associated stress factors among farm women, a group which has been relatively neglected within previous research on farming mental health in the United Kingdom.

METHODS

A questionnaire survey was widely distributed to members of the agricultural community in England and Wales (n = 15,296) in both paper and online formats. The survey included a number of standardised instruments to assess mental health and wellbeing, including the Generalised Anxiety Disorder-7 scale (GAD-7). Focusing on a sub-sample of female respondents (n = 3487), this paper details the findings from the GAD-7, alongside those from a selection of other questions investigating sources of stress, loneliness and perceived business viability.

RESULTS

A significant proportion of female respondents were experiencing anxiety at the time of survey completion, with 23.3% reaching the threshold for clinically relevant anxiety based on their GAD-7 scores (medium or severe anxiety, scores≥10). A further 34.6% were classified as experiencing mild anxiety (scores 5-9) whilst 42.1% were not suffering from anxiety (scores 0-4). Medium/severe anxiety was identified as being associated with a number of stress factors, feelings of loneliness and pessimistic perceptions of farm business viability. There were important age-based differences, with working-aged women identified as more likely to suffer from anxiety, loneliness and certain stressors than older women.

CONCLUSION

The findings reported here indicate concerning levels of anxiety among farming women and this should be seen as a call to action. There are clear associations between anxiety and a range of stressors and, although we cannot ascertain causality, these point to issues that demand attention in efforts to improve mental health within this social group. The factors contributing to anxiety are, however, multiple and complex and farm women may be affected by particular gender-based challenges that have not yet been explicitly explored in relation to mental health. Further research is needed to investigate and understand these issues in greater depth.

The association of forced expiratory volume in one second with occupational exposures in a longitudinal study of adults in a rural community in Iowa

PURPOSE

The Keokuk County Rural Health Study (KCRHS) is a longitudinal population-based study conducted in rural Iowa. A prior analysis of enrollment data identified an association of airflow obstruction with occupational exposures only among cigarette smokers. The current study used spirometry data from all three rounds to investigate whether level of forced expiratory volume in one second (FEV1) and longitudinal change in FEV1 were associated with occupational vapor-gas, dust, and fumes (VGDF) exposures, and whether these associations were modified by smoking.

METHODS

This study sample comprised 1071 adult KCRHS participants with longitudinal data. A job-exposure matrix (JEM) was applied to participants' lifetime work histories to assign exposures to occupational VGDF. Mixed regression models of pre-bronchodilator FEV1 (millimeters, ml) were fit to test for associations with occupational exposures while adjusting for potential confounders.

RESULTS

Mineral dust had the most consistent association with change in FEV1, including ever/never ( - 6.3 ml/year) and nearly every level of duration, intensity, and cumulative exposure. Because 92% of participants with mineral dust also had organic dust exposure, the results for mineral dust may be due to a combination of the two. An association of FEV1 level with fumes was observed for high intensity ( - 91.4 ml) among all participants, and limited to cigarette smokers with results of  - 104.6 ml ever/never exposed,  - 170.3 ml high duration, and  - 172.4 ml high cumulative.

CONCLUSION

The current findings suggest that mineral dust, possibly in combination with organic dust, and fumes exposure, especially among cigarette smokers, were risk factors for adverse FEV1 results.

Psychological Morbidity in the Farming Community: A Literature Review

The mental health of the farming community across industrialised nations has long been a major concern. Using an adapted procedure for a systematic literature review of observational epidemiological studies reporting prevalence (informed by the Joanna Briggs Institute method), this paper reviews peer-reviewed literature that explicitly compares farmer and non-farmer mental health (n = 48). In doing so, it provides a central and accessible evidence base for researchers and practitioners, and simultaneously reveals a stark lack of consensus; specifically, 54.0% of measures deployed to assess farmer mental health determined it to be the same as or even better than non-farming populations. This ambiguity sits in sharp contrast to the unequivocally worrisome farmer suicide statistics. Informed by the literature, the paper discusses potential reasons for this mismatch, including (i) farmers' progression through a different "pathway" to suicide that is not always preceded by mental illness, and (ii) a failure of current methods to accurately gauge the mental health status of farmers. The paper concludes by recommending more research into farmers' "pathway" to suicide, and highlights the need for a dedicated and multi-disciplinary programme of methods research that will afford a more culturally appropriate and effective means of understanding mental health in the farming community.

The association of chronic bronchitis and airflow obstruction with lifetime and current farm activities in a sample of rural adults in Iowa

OBJECTIVE

Farmers have an increased risk for chronic bronchitis and airflow obstruction. The objective of this study was to investigate the association of these health outcomes with farm activities.

METHODS

We evaluated the Keokuk County Rural Health Study (KCRHS) enrollment data for farm activities and the two health outcomes chronic bronchitis based on self-reported symptoms and airflow obstruction based on spirometry. We used logistic regression to model the health outcomes, yielding an odds ratio (OR) and 95% confidence interval (95% CI) for farm activities while adjusting for potential confounders and other risk factors.

RESULTS

Of the 1234 farmers, 104 (8.4%) had chronic bronchitis, 75 (6.1%) fulfilled the criteria for airflow obstruction, and the two outcomes overlapped by 18 participants. Chronic bronchitis without airflow obstruction (n = 86) had a statistically significant association with crop storage insecticides (OR 3.1, 95% CI 1.6, 6.1) and a low number of years (≤ 3) worked with turkeys (OR 3.3, 95% CI 1.2, 9.4). The latter result should be interpreted with caution because it is based on a small number of cases (n = 5). Airflow obstruction with or without chronic bronchitis (n = 75) was significantly associated with ever working in a hog or chicken confinement setting (OR 2.2, 95% CI 1.0, 4.5).

CONCLUSIONS

These results suggest that work with crop storage insecticides or turkeys may increase the risk for chronic bronchitis and work in hog or chicken confinement may increase the risk for airflow obstruction.

Expanding Clinical Trials Designs to Extend Equitable Hearing Care

Clinical trials are critically important to translate scientific innovations into clinical practice. Hearing healthcare depends on this translational approach to improve outcomes and quality of life. Across the spectrum of healthcare, there is a lack of diverse participation in clinical trials, a failure to recruit and retain underrepresented and underserved populations, and an absence of rigorous dissemination and implementation of novel research to broader populations. The field of hearing healthcare research would benefit from expanding the types and designs of clinical trials that extend hearing healthcare and novel interventions to diverse populations, as well as emphasizing trials that evaluate factors influencing how that care can be delivered effectively. This article explores the following: (1) the role, value, and design types of clinical trials (randomized controlled, cluster randomized, stepped wedge, and mixed methods) to address health equity; (2) the importance of integrating community and stakeholder involvement; and (3) dissemination and implementation frameworks and designs for clinical trials (hybrid trial designs). By adopting a broader range of clinical trial designs, hearing healthcare researchers may be able to extend scientific discoveries to a more diverse population.

Perceptions of COVID-19 Mitigation Strategies between Rural and Non-Rural Adults in the US: How Public Health Nurses Can Fill the Gap

The purpose of this study was to capture the perceptions of COVID-19 mitigations’ efficacy of rural and non-rural participants, using the health belief model (HBM), as well as to describe where public health nursing may be able to fill behavior gaps in rural communities. Rural and non-rural participants completed electronic surveys. Surveys collected demographic information and perceptions of various mitigation strategies’ effectiveness. Rurality was significantly associated with perceptions of the effectiveness of public health mitigation strategies including wearing facemasks, limiting time indoors, avoiding gatherings, non-essential business closure, and staying home. Our findings suggest people in rural areas perceive mitigations to be effective. Other researchers have consistently shown rural residents are least likely to partake in the same mitigations. Rural public health nurses on the front line serve as the key to closing the aforementioned gap. Understanding where their community’s perceptions lie is pivotal in creating educational programs to continue mitigation efforts as we embark on the second year of this pandemic.

Defining Disparities in Cochlear Implantation through the Social Determinants of Health

Hearing loss is a global public health problem with high prevalence and profound impacts on health. Cochlear implantation (CI) is a well-established evidence-based treatment for hearing loss; however, there are significant disparities in utilization, access, and clinical outcomes among different populations. While variations in CI outcomes are influenced by innate biological differences, a wide array of social, environmental, and economic factors significantly impact optimal outcomes. These differences in hearing health are rooted in inequities of health-related socioeconomic resources. To define disparities and advance equity in CI, there is a pressing need to understand and target these social factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which include the following domains: healthcare access/quality, education access/quality, social and community context, economic stability, and neighborhood and physical environment. This article defines these domains in the context of CI and examines the published research and the gaps in research of each of these domains. Further consideration is given to how these factors can influence equity in CI and how to incorporate this information in the evaluation and management of patients receiving cochlear implants.

Impacts of the COVID-19 Pandemic on Communication and Healthcare Access for Adults With Hearing Loss

OBJECTIVE

Adults with hearing loss are at risk of negative impacts of the pandemic. Specific factors, such as hearing loss severity and location of residence, may disproportionately impact patients during the pandemic. The objective of this study was to assess the relative impact of the COVID-19 pandemic on hearing loss patients, based on hearing device type and location of residence.

STUDY DESIGN

Prospective cross-sectional questionnaire study.

SETTING

Tertiary referral center.

PATIENTS

Adults with hearing loss.

MAIN OUTCOME MEASURES

Data included sociodemographic data, communication challenges, pandemic preparedness, access to healthcare, and mental and emotional health.

RESULTS

A total of 614 patients responded (27.8% response rate). Compared with hearing aid users, cochlear implant users reported more difficulty communicating with family/friends (53% versus 41%, p = 0.017), obtaining pandemic information (10% versus 3%, p = 0.002), and understanding live broadcasts (47% versus 17%, p = 0.001) during the pandemic. CI users were less likely than hearing aid users to seek general (52% versus 69%, p = 0.001) and hearing healthcare services (20% versus 34%, p = 0.002). Rural residents reported greater difficulty than urban residents communicating with friends/family (53% versus 39%, p = 0.001), obtaining food/supplies (41% versus 20%, p = 0.004), understanding live broadcasts (31% versus 20%, p = 0.001) during the pandemic. Compared with urban residents, rural residents reported greater difficulty accessing general (57% versus 42%, p = 0.004) and hearing healthcare (49% versus 34%, p = 0.043). Rural residents reported poorer mental/emotional health than urban residents.

CONCLUSIONS

Among adults with hearing loss, cochlear implant users and rural residents experience greater challenges in communication, pandemic preparedness, and access to healthcare during the COVID-19 pandemic.

A Systematic Review and Meta-Analysis of Depression among Farming Populations Worldwide

A systematic review and meta-analysis were conducted to determine the overall prevalence of depression among farming populations globally, and explore any heterogeneity present. Eligible studies were primary research articles published in English, which involved the collection of data for the purpose of determining the prevalence of depression among a farming population. Four relevant databases were searched in January 2019. Potential for bias was assessed using a modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. From 7662 records, 72 articles were deemed relevant and had data extracted. Of these, 45 utilized the Center for Epidemiologic Studies—Depression Revised scale (CES-D/DR) to quantify depression, 42 of which were conducted in the United States (U.S.). As a result, meta-analyses were restricted to this geographic location. Substantial heterogeneity was seen in the initial whole-group analysis (I² = 97%), and while sub-group exploration suggested a significantly higher prevalence of depression among migrant farm workers (26%, 95% CI = 21–31%) than in studies examining a non-migrant farming population (12%, 95% CI = 8–17%), substantial heterogeneity remained (I² = 96%), indicating that the majority of between study variation was due to factors other than sampling error. Additionally, the majority of studies (81%) in migrant farm worker populations were published since 2010, while only 21% of studies in non-migrant farming populations were published in this timeframe. It is possible with recent efforts to de-stigmatize mental illness, participants in more recent studies may be more likely to self-report depressive symptoms. Hence, while it appears that migrant farmworker populations may have an elevated prevalence of depression, it is also apparent that little research in the U.S. has been done to evaluate depression among non-migrant farming populations in recent years. Perhaps a reporting bias may account for some of the difference between the two populations. A research gap also appears to exist in estimating the prevalence of depression among farming populations outside of the US. Assessment for bias at the study level revealed challenges in reporting of key study design elements, as well as potential for selection bias in the majority of studies.

Relationship Between Sleep Duration and Suicidal Ideation Among Farmers: Safety for Agricultural Injuries of Farmers Cohort Study of Jeju, Korea

Background

This study was conducted to identify the association between sleep duration and suicidal ideation among farmers in Korea.

Methods

We used Safety for Agricultural Injuries of Farmers cohort data collected from September 2015 to June 2018, which was an agricultural survey on the health and behaviors of adult farmers in Jeju island, Korea.

Results

A total of 964 participants were included in the analysis, and 3.7% of them were identified with having suicidal ideation. The frequencies of average daily sleep duration of <6 h (short sleep), 6-8 h (normal sleep), and >8 h (long sleep) were 24.4%, 70%, and 5.6%, respectively. Multivariate analyses revealed that short sleep duration was significantly associated with suicidal ideation compared with normal sleep duration (odds ratio = 2.49, 95% confidence interval = 1.07-5.77).

Conclusion

Our findings suggest that short sleep duration in farmers result in higher suicidal ideation. Because individuals who have suicidal ideation often commit suicide, careful monitoring is required to prevent suicide in farmers with short sleep duration.

The Association of Airflow Obstruction with Occupational Exposures in a Sample of Rural Adults in Iowa

A recent article reported that occupational exposure to vapor-gas, dust, and fumes (VGDF) was more common in a sample of rural adults than in a sample of adults in urban settings. In another study of the same urban adults, airflow obstruction (AO) was associated with occupational VGDF and the combination of smoking and occupational exposure. The goal of the current study was to determine if similar associations were evident in the sample of rural adults. We analyzed enrollment data from the Keokuk County Rural Health Study (KCRHS), which investigated the health of rural residents in Iowa. We used the same methods as the study of urban adults. A job-exposure matrix (JEM) assigned an occupational VGDF exposure level based on each participants' last reported job. The health outcome was AO, defined as both the forced expiratory volume in one second (FEV1) and the FEV1/forced vital capacity (FVC) ratio < lower limit of normal. Of the 1699 KCRHS participants, 436 (25.7%) had high total VGDF occupational exposure, 661 (38.9%) had ever smoked cigarettes, and 110 (6.5%) had AO. The crude frequency of AO increased across the joint categories of smoking (never, ever) and high exposure (no, yes) (p < 0.05 for linear trend). After adjusting for potential confounders, AO was associated with high total occupational VGDF exposure only among smokers (OR = 1.81, 95% CI 1.002 to 3.26). In conclusion, the association of AO with occupational exposure in the current study of rural adults was similar to what was previously observed among urban adults.

Gender differences in respiratory health outcomes among farming cohorts around the globe: findings from the AGRICOH consortium

Purpose: Respiratory hazards of farming have been identified for centuries, with little focus on gender differences. We used data from the AGRICOH consortium, a collective of prospective cohorts of agricultural workers, to assess respiratory disease prevalence among adults in 18 cohorts representing over 200,000 farmers, farm workers, and their spouses from six continents.Methods: Cohorts collected data between 1992 and 2016 and ranged in size from 200 to >128,000 individuals; 44% of participants were female. Farming practices varied from subsistence farming to large-scale industrial agriculture. All cohorts provided respiratory outcome information for their cohort based on their study definitions. The majority of outcomes were based on self-report using standard respiratory questionnaires; the greatest variability in assessment methods was associated with chronic obstructive pulmonary disease (COPD).Results: For all three respiratory symptoms (cough, phlegm, and wheeze), the median prevalence in men was higher than in women, with the greatest difference for phlegm (17% vs. 10%). For asthma, women had a higher prevalence (7.8% vs 6.5%), with the difference associated with allergic asthma. The relative proportion of allergic asthma varied among cohorts. In two of eight cohorts for women and two of seven cohorts for men, allergic asthma was more common than non-allergic asthma.Conclusions: These findings indicate that respiratory outcomes are common among farmers around the world despite differences in agricultural production. As women in the general population are at higher risk of asthma, exploring gender differences in occupational studies is critical for a deeper understanding of respiratory disease among agricultural workers.

Risk for Depressive Symptoms and Suicide Among U.S. Primary Farmers and Family Members: A Systematic Literature Review

Background: About 84% of the agriculture, fishing, and forestry occupational sector is comprised of farmers. This sector is at high risk for suicide in the United States. Recent disasters and trade upheavals may make farmers and their families more vulnerable to depression and suicide. This review focused on the risk for depression and suicide among United States’ primary farm operators and their families. Methods: A systematic search of the literature published between January 2000 and June 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was conducted. Results: A total of 30 articles met full inclusion criteria. Seventeen reports emanated from the midwest. Twenty studies used a cross-sectional design, primarily assessing a convenience sample or random stratified sample from a limited geographic area. We discovered only one intervention evaluation study. Depressive symptoms were assessed as part of the studies, but it was not the major focus. A variety of instruments measured depressive symptoms, with the Centers for Disease Control Epidemiologic Studies—Depression (CES-D) Scale used more frequently than other scales. Thirteen studies focused on the relationship between pesticide/chemical exposure and depression or suicide risk. Increased stress, poor physical health, compromised financial position, and previous injury were among the leading indicators of depression. Conclusion/Application to Practice: The limited number of studies that was discovered identified the need for more robust science where the risk for depression and suicide is the primary focus of the study and for intervention studies grounded in science. Occupational health providers should be vigilant about farm exposure and be aware of factors that may influence depressive symptoms of workers who operate farm establishments.

The Role of Telemedicine in Auditory Rehabilitation: A Systematic Review

OBJECTIVE

The purpose of this study was to assess the feasibility and effectiveness of live telemedicine applications in hearing amplification and cochlear implantation.

DATA SOURCES AND STUDY SELECTION

A systematic search was performed in PubMed, MEDLINE, PsychINFO, CINALH, and Web of Science to identify peer-reviewed research. Inclusion criteria were titles containing words from the search terms 1) audiology, otolaryngology, and hearing impairment, 2) rehabilitative methods, and 3) telemedicine. Exclusion criteria were: 1) non-English articles, and 2) non-original research.

DATA EXTRACTION AND SYNTHESIS

Twelve eligible studies were identified. The studies employed a prospective design in nine of the articles and retrospective case series in three. The use of telemedicine for the provision of cochlear implant services was examined in eight of the articles and with hearing aids in four of the articles. The types of services include intraoperative cochlear implant telemetry; implant programming and assessment of electrode-specific measures and speech recognition after implantation. Hearing aid programming and remote gain assessments were also reported. Many studies assess patient and provider satisfaction along with encounter time comparison. The studies occurred from 2009 to 2014 and took place in seven countries.

CONCLUSIONS

This review examined the feasibility of remote telemedicine connection to provide in auditory rehabilitation services through hearing aids and cochlear implants. There are significant concerns regarding Internet bandwidth limitations for remote clinics. There is a paucity of research examining reimbursement and cost-effectiveness for services. Further prospective research investigating cost-effectiveness and bandwidth limitations is warranted to assess long-term sustainability of remote audiological rehabilitative service delivery.

Patterns and predictors of local health department accreditation in Missouri

BACKGROUND

The Healthy People 2020 goal for the public health system is "to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services." To address this goal, Missouri established the first statewide, voluntary accreditation program of local health departments (LHDs) and began accrediting the LHDs in 2003. The purpose of this study was to identify organizational, structural, and workforce factors related to accreditation status of LHDs in Missouri.

METHODS

Using data from the National Association of County & City Health Officials (2010) and the Missouri Department of Health & Senior Services (2012), binary logistic regression analysis was performed to predict accreditation status of LHDs. Likelihood ratio tests were used to examine whether the addition of each predictor added significantly to the model compared with a model including total revenues alone. Adjusted odds ratios (aORs), 95% confidence intervals, the significance level of the likelihood ratio test, and the overall Nagelkerke pseudo-R for each model are reported.

RESULTS

Having a community health improvement plan (aOR = 6.2), a strategic plan (aOR = 7.9), evaluating programs (aOR = 3.6), being in a region with a high proportion of accredited LHDs (aOR = 5.5), and participating in multijurisdictional collaborations (aOR = 6.4) all increased the likelihood of accreditation. Barriers of time (aOR = 0.1) and cost (aOR = 0.3) were negatively associated with accreditation.

CONCLUSIONS

Accredited LHDs were more likely to have completed the prerequisites for accreditation and collaborate with other LHDs. These activities help LHDs meet the accreditation standards. In addition, with shrinking budgets, LHDs will need additional financial and technical support to achieve accreditation. Assisting LHDs to find ways to increase the staff is important. Through collaborations with other LHDs, regional or multicounty positions can be created. Also collaborations with universities, specifically colleges or schools of public health, can provide opportunities for internships at LHDs giving practical experience while providing important assistance to LHDs.

Investing in prospective cohorts for etiologic study of occupational exposures

Prospective cohorts have played a major role in understanding the contribution of diet, physical activity, medical conditions, and genes to the development of many diseases, but have not been widely used for occupational exposures. Studies in agriculture are an exception. We draw upon our experience using this design to study agricultural workers to identify conditions that might foster use of prospective cohorts to study other occupational settings. Prospective cohort studies are perceived by many as the strongest epidemiologic design. It allows updating of information on exposure and other factors, collection of biologic samples before disease diagnosis for biomarker studies, assessment of effect modification by genes, lifestyle, and other occupational exposures, and evaluation of a wide range of health outcomes. Increased use of prospective cohorts would be beneficial in identifying hazardous exposures in the workplace. Occupational epidemiologists should seek opportunities to initiate prospective cohorts to investigate high priority, occupational exposures.

Pesticide use practices in rural Armenia

Pesticide use can have adverse effects on both human health and the environment. Inappropriate use of pesticides increases the health risk to those who work with or live around pesticides. Educational programs for agricultural workers on the proper use of pesticides and personal protective equipment coupled with pesticide regulations are important tools to reduce the associated health risks. The authors conducted a survey (N = 2336) on pesticide use practices in the Ararat Valley of Armenia in 2000-2006. This study was a cross-sectional design. A multistage sampling method was implemented in the selection of the study population. The authors developed a questionnaire containing 173 questions to evaluate demographic characteristics, health conditions, and details of pesticides use practices. The intensity of pesticide use was high; 82.8% of respondents used them. More than 150 brand names of pesticides were in use. Unregistered, obsolete, expired, and banned compounds were found in active use. Poor compliance with the basic rules of pesticide safety was found throughout the study population, with 21.3% using gloves and only 11% using respirators. The agricultural workers' knowledge of the toxic properties of these pesticides as well as basic hygienic norms was very low. In some instances, the number of agrichemical applications to crops, particularly cucumbers and melons, reached 40 applications during the growing season. Better protection and training of pesticide users in Armenia is needed.

Predictors of depressive symptoms in older rural couples: the impact of work, stress and health

PURPOSE

Older farmers experience a high rate of suicide, and depression is closely aligned with suicide among agricultural workers. Depressive symptoms may be influenced by work patterns, work satisfaction, stress, and health status. In addition, members of a couple may affect each other's depressive symptoms. The purpose was to determine whether depressive symptoms score is predicted by hours worked on the farm, satisfaction with work, number of health conditions, perceived stress, and demographics in a sample of older farm couples, and to assess the degree of influence on depressive symptoms spouses have on each other.

METHODS

A total of 494 couples participated in the initial interview for a longitudinal study of farmers aged 50 and above. Data from husbands and wives were used together in a multilevel, dyad-based regression model to determine predictors of depressive symptoms.

FINDINGS

Men's depressive symptoms scores were predicted by their own number of health conditions and stress and by their wives' stress and health conditions. Women's depressive symptoms scores were predicted by their own work satisfaction, stress, and number of health conditions and their husbands' time spent working on the farm and stress.

CONCLUSIONS

Stress management may be particularly important in older farm couples, since perceived duress of 1 member of the dyad impacts both. Work factors and health conditions also affect depressive symptoms in older rural couples, but these may be less easily modified.

The association of intimate partner violence and depressive symptoms in a cohort of rural couples

PURPOSE

The purpose of this study was to estimate the prevalence of physical and emotional intimate partner violence (IPV) perpetration and victimization among adult, cohabitating couples. The association between IPV and depressive symptoms, as well as the severity of depressive symptoms, was reported for both males and females.

METHODS

In a rural cohort study, 548 couples completed survey items concerning physical and emotional IPV, and mental health.

FINDINGS

Males and females who perpetrated physical IPV were 17.7 and 11.5 times more likely, respectively, to also be victims of physical IPV. Male and female perpetrators of emotional IPV were 18.7 and 5.2 times as likely, respectively, to also be victims of emotional IPV. Males and females with IPV histories were 3.0 and 2.4 times more likely, respectively, to have depressive symptoms (P < .001) than those without abuse histories. Females reported higher scores than males on the depressive symptoms index.

CONCLUSIONS

This study suggests that many couples in rural areas use physical and emotional violence against each other in their relationships, and that both males and females who report a history of IPV are more likely to report depressive symptoms. These findings support IPV screening for physical and emotional violence among all patients and providing follow-up intervention programs in health care settings.

Indoor and outdoor particulate matter and endotoxin concentrations in an intensely agricultural county

The objectives of this study were to characterize rural populations' indoor and outdoor exposure to particulate matter (PM)(10), PM(2.5), and endotoxin and identify factors that influence these concentrations. Samples were collected at 197 rural households over five continuous days between 2007 and 2011. Geometric mean (GM) indoor PM(10) (21.2 μg/m(3)) and PM(2.5) (12.2 μg/m(3)) concentrations tended to be larger than outdoor PM(10) (19.6 μg/m(3)) and PM(2.5) (8.2 μg/m(3)) concentrations (PM(10) P=0.086; PM(2.5) P<0.001). Conversely, GM outdoor endotoxin concentrations (1.93 EU/m(-3)) were significantly larger than indoor (0.32 EU/m(3); P<0.001). Compared with measurements from previous urban studies, indoor and outdoor concentrations of PM(10) and PM(2.5) in the study area tended to be smaller, whereas ambient endotoxin concentrations measured outside rural households were 3-10 times larger. Contrary to our initial hypothesis, seasonality did not have a significant effect on mean ambient PM(10) concentrations; however, endotoxin concentrations in the autumn were almost seven times larger than winter. Excluding home cleanliness, the majority of agricultural and housing characteristics evaluated were found to be poorly associated with indoor and outdoor particulate and endotoxin concentrations.

Relative exposure to swine animal feeding operations and childhood asthma prevalence in an agricultural cohort

Large swine animal feeding operations (AFOs) have become the model of livestock production throughout the United States. Epidemiological studies have consistently shown an increase in adverse respiratory symptoms among workers at AFOs. However, the impact on communities surrounding these facilities is still being investigated. We evaluated the association between relative environmental exposure to AFOs and the prevalence of prescribed medication for wheeze and/or childhood asthma in rural Iowa. Demographic and health information on 565 children aged 0-17 was obtained from a previous population-based cohort study while data on the AFOs were collected from publically available tax records. We created a metric of each child's relative environmental exposure to swine CAFOs which incorporated the size of the AFO as well as distance and wind direction. We determined the association between self-reported prescription medication for wheeze and/or self-reported physician diagnosed asthma and relative exposure while controlling for recognized risk factors using correlated logistic regression. The prevalence of childhood asthma in the cohort was 11.0% while 22.7% of children had been previously prescribed medication for wheeze or had a lifetime asthma diagnosis. Children with a larger relative environmental exposure to AFOs had a significantly increased odds of both outcomes (OR=1.51, p=0.014 asthma; OR=1.38, p=0.023 asthma or medication for wheeze). When stratified into exposure quartiles a linear trend was observed with asthma or medication for wheeze as the dependent variable but not with asthma alone. This study is the first to investigate children's cumulative relative exposure to smaller AFOs and adds to the growing volume of literature supporting a link between proximity to swine AFOs and adverse respiratory health.

Effects of common agricultural tasks on measures of hearing loss

BACKGROUND

Among agricultural populations, hearing loss caused by excessive noise exposure is common. However, examinations of associations between exposure to agricultural tasks and hearing loss are limited.

METHODS

Audiometry and lifetime exposure to 11 agricultural tasks were analyzed among 1,568 participants. Gender stratified multivariable linear regression was used to estimate associations between exposure duration and three hearing loss metrics.

RESULTS

Among men, significant associations were observed between hearing loss and hunting or target shooting, all-terrain vehicle (ATV) or motorcycle riding, chain saw use, electric or pneumatic tool use, living on a farm, and all agricultural tasks combined. When all significant exposure metrics were included in a single model, associations remained for hunting or target shooting, electric or pneumatic tool use and living on a farm. Significant associations were sparse among women, and in all cases paradoxical.

CONCLUSIONS

Despite imprecise estimation of noise exposure, specific agricultural tasks were associated with hearing loss.

At what age should children engage in agricultural tasks?

PURPOSE

We compared parents' perceived-as-appropriate ages with actual-performance ages for their children engaging in selected agricultural tasks or practices, and we examined the factors associated with age discrepancy.

METHODS

We analyzed data from the Keokuk County Rural Health Study collected among parents of children age 17 or younger. Parents were interviewed separately regarding the age of their children's involvement in 14 selected agricultural tasks and their opinions about appropriate age of involvement.

FINDINGS

Of the 264 families included, 86.5% with a son and 69.8% with a daughter reported having children involved in at least 1 of 14 selected agricultural tasks. The average actual-performance ages for children to be involved in any of the tasks were younger than those that parents perceived appropriate. Furthermore, in 6 of the 9 North American Guidelines for Children's Agricultural Tasks (NAGCAT) that we assessed, parents' perceived-as-appropriate ages were younger than minimum ages recommended by the NAGCAT. Driving an all-terrain vehicle (ATV) was the most common task with actual-performance age younger than the NAGCAT-recommended age; 53.0% of boys (n = 106) and 36.1% of girls (n = 61) did so under the recommended age. Boys and children who live on a farm, or whose parents have been or are farmers, were significantly more likely to perform agricultural tasks at earlier ages.

CONCLUSIONS

Our results suggest farm parents and other rural stakeholders need to be better educated and encouraged to follow the NAGCAT guidelines, and that multilevel interventions need to be developed to ensure protection of children from agricultural injury and death.

Smoke alarm tests may not adequately indicate smoke alarm function

Smoke alarms are one of the most promoted prevention strategies to reduce residential fire deaths, and they can reduce residential fire deaths by half. Smoke alarm function can be measured by two tests: the smoke alarm button test and the chemical smoke test. Using results from a randomized trial of smoke alarms, we compared smoke alarm response to the button test and the smoke test. The smoke alarms found in the study homes at baseline were tested, as well as study alarms placed into homes as part of the randomized trial. Study alarms were tested at 12 and 42 months postinstallation. The proportion of alarms that passed the button test but not the smoke test ranged from 0.5 to 5.8% of alarms; this result was found most frequently among ionization alarms with zinc or alkaline batteries. These alarms would indicate to the owner (through the button test) that the smoke alarm was working, but the alarm would not actually respond in the case of a fire (as demonstrated by failing the smoke test). The proportion of alarms that passed the smoke test but not the button test ranged from 1.0 to 3.0%. These alarms would appear nonfunctional to the owner (because the button test failed), even though the alarm would operate in response to a fire (as demonstrated by passing the smoke test). The general public is not aware of the potential for inaccuracy in smoke alarm tests, and burn professionals can advocate for enhanced testing methods. The optimal test to determine smoke alarm function is the chemical smoke test.

AGRICOH: a consortium of agricultural cohorts

AGRICOH is a recently formed consortium of agricultural cohort studies involving 22 cohorts from nine countries in five continents: South Africa (1), Canada (3), Costa Rica (2), USA (6), Republic of Korea (1), New Zealand (2), Denmark (1), France (3) and Norway (3). The aim of AGRICOH, initiated by the US National Cancer Institute (NCI) and coordinated by the International Agency for Research on Cancer (IARC), is to promote and sustain collaboration and pooling of data to investigate the association between a wide range of agricultural exposures and a wide range of health outcomes, with a particular focus on associations that cannot easily be addressed in individual studies because of rare exposures (e.g., use of infrequently applied chemicals) or relatively rare outcomes (e.g., certain types of cancer, neurologic and auto-immune diseases). To facilitate future projects the need for data harmonization of selected variables is required and is underway. Altogether, AGRICOH provides excellent opportunities for studying cancer, respiratory, neurologic, and auto-immune diseases as well as reproductive and allergic disorders, injuries and overall mortality in association with a wide array of exposures, prominent among these the application of pesticides.

Noise exposures of rural adolescents

PURPOSE

This project was conducted to characterize the noise exposure of adolescents living in rural and agricultural environments.

METHODS

From May to October, 25 adolescents ages 13 through 17, living either on a farm or a rural nonfarm, were enrolled in the study. Subjects received training on the correct operation and use of personal noise dosimeters and the proper way to record their daily tasks on activity cards. Subjects completed 4 days of self-monitoring noise dosimetry, 2 days in the first round (May-July) and 2 days in the second round (August-October). In addition to dosimetry, subjects completed activity logs of their daily tasks.

RESULTS

The mean daily noise exposures of adolescents living on farms and in nonfarm rural homes were between 55.4 dBA (A-weighted decibels) and 103.5 dBA, with 44% of the daily measurements greater than the National Institute of Occupational Safety and Health Recommended Exposure Level of 85 dBA. Task-based analysis of noise exposures found that activities involving mechanized equipment resulted in the highest exposures, while activities in the home resulted in the lowest exposure. No particular demographic group had a statistically higher noise exposure; therefore, specific factors apart from activities and noise sources could not be identified as risk factors for exposure to hazardous noise levels.

CONCLUSIONS

The results of this project indicate that rural adolescents complete a variety of activities and are exposed to noise sources with a broad range of decibel levels. While the exposures may change from day to day, there are occasions when exposure to noise exceeds the recommended levels.

Smoke alarm and battery function 42 months after installation: a randomized trial

BACKGROUND

This randomized trial presents findings from the longest follow-up study of smoke alarm and battery function to date.

PURPOSE

The purpose of this study is to examine differences in long-term function of smoke alarm and battery combinations.

METHODS

A total of 691 households in an ongoing cohort study were randomly allocated into smoke alarm groups of ionizing and photoelectric and battery groups of zinc and lithium. Smoke alarm function was measured in 633 (91.6%) households from January 2007 through February 2008, 42 months following original smoke alarm/battery installation. Data analyses were conducted in 2009.

RESULTS

After 3.5 years, 81.9% of the 1898 smoke alarms were functional. Ionizing alarms with zinc batteries were the least likely to function (72.7%). In comparison, photoelectric alarms with lithium batteries were 2.9 times (95% CI=1.8, 4.5) more likely to function; ionizing alarms with lithium batteries were 2.0 times (95% CI=1.3, 3.1) more likely to function; and photoelectric alarms with zinc batteries were 1.7 times (95% CI=1.1, 2.5) more likely to function. Functionality was strongly tied to number of reports of nuisance alarms, which was higher for ionizing than photoelectric alarms.

CONCLUSIONS

Photoelectric smoke alarms and lithium batteries are the most likely to function long after smoke alarm installation, and may be worthwhile investments despite their increased cost.

Challenges of conducting a large rural prospective population-based cohort study: the Keokuk County Rural Health Study

The Keokuk County Rural Health Study (KCRHS) is a population-based, prospective study of health status and environmental exposures of a large stratified random sample of residents in one rural Iowa county. The study focuses on injury and respiratory disease and monitors health care delivery, geriatric health, mental health, and other health outcomes, as well as behavioral risk factors for disease and injury. Injury and disease prevalence is investigated in relation to occupational, agricultural, and other environmental exposures. The KCRHS enrolled 1004 families in Round 1 (1994 to 1998) and 1002 families in Round 2 (1999 to 2004). Participants range in age from newborn to 98 years of age and are about equally divided between males and females. The families live in farm, rural nonfarm, and town households, representing men, women, and children, the elderly, farmers, and nonfarmers. The KCRHS is currently in Round 3 (2006-2011). Although the sample is stratified by residence type, the entire county is, by definition, rural, because the largest town has fewer than 2500 residents. Using the Keokuk County Rural Health Study as an example, this paper describes the methodological challenges faced in conducting a large rural prospective population-based cohort study. Some of these challenges are inherent in any large cohort study; others are unique to rural cohort studies. Topics considered include planning the study, developing the protocol, sampling, recruiting and tracking subjects, data collection and management, sustaining funding, relating to the community, and sharing data.

Prevalence and changes in chronic diseases among South Korean farmers: 1998 to 2005

Background

Epidemiologic studies have suggested a unique pattern of disease among farmers in Western countries, but limited information is available about the magnitude of disease prevalence and their changes over time in Asian farmers. The aim of this study was to compare the prevalence and changes in chronic diseases among farmers with those of other occupational groups in South Korea.

Methods

Using data from three consecutive cross-sectional national surveys: the Korean National Health and Nutrition Examination Survey 1998 (n = 39,060), 2001 (n = 37,769), and 2005 (n = 34,145), we calculated age and gender-standardized prevalence of chronic diseases by the direct method and compared the prevalence changes from 1998 to 2005.

Results

Female farmers had significantly higher chronic disease prevalence than other occupational groups in all three surveys. Arthritis was the most prevalent chronic disease among farmers for both men and women. Compared with other populations, farmers demonstrated a higher prevalence of arthritis and intervertebral disc disorders. Farmers showed higher prevalence changes for intervertebral disc disorders than other occupational workers.

Conclusion

Our findings support that South Korean farmers have a distinct pattern of diseases prevalence from other populations. More detailed studies investigating the risk of musculoskeletal diseases and intensive intervention efforts to reduce the prevalence these diseases, particularly among female farmers, are required.

Field and wind tunnel comparison of four aerosol samplers using agricultural dusts

Occupational lung disease is a significant problem among agricultural workers exposed to organic dusts. Measurements of exposure in agricultural environments in the USA have traditionally been conducted using 37-mm closed-face cassettes (CFCs) and respirable Cyclones. Inhalable aerosol samplers offer significant improvement for dose estimation studies to reduce respiratory disease. The goals of this study were to determine correction factors between the inhalable samplers (IOM and Button) and the CFC and Cyclone for dusts sampled in livestock buildings and to determine whether these factors vary among livestock types. Determination of these correction factors will allow comparison between inhalable measurements and historical measurements. Ten sets of samples were collected in swine, chicken, turkey, and dairy facilities in both Colorado and Iowa. Pairs of each sampling device were attached to the front and back of a rotating mannequin. Laboratory studies using a still-air chamber and a wind tunnel provided information regarding the effect of wind speed on sampler performance. Overall, the IOM had the lowest coefficient of variation (best precision) and was least affected by changes in wind speed. The performance of the Button was negatively impacted in poultry environments where larger (feather) particulates clogged the holes in the initial screen. The CFC/IOM ratios are important for comparisons between newer and older studies. Wind speed and dust type were both important factors affecting ratios. Based on the field studies (Table 6), a ratio of 0.56 is suggested as a conversion factor for the CFC/IOM (average for all environments because of no statistical difference). Suggested conversion factors for the Button/IOM are swine (0.57), chicken (0.80), turkey (0.53), and dairy (0.67). Any attempt to apply a conversion factor between the Cyclone and inhalable samplers is not recommended.

Pesticide handling and exposures among cotton farmers in the gambia

OBJECTIVES

There are substantial health hazards to farmers and the environment associated with pesticide use in developing countries. Based on observations by the authors and previous reports, most previous studies in Africa are descriptive in nature. The aim of this study was to investigate how cotton farmers are exposed to pesticides in The Gambia and quantify their pesticide exposures and provide information for the formulation of a policy on pesticide safety for the country.

METHODS

A representative sample of 20 cotton farmers in the Central and Upper River Divisions (CRD and URD) of The Gambia were surveyed by questionnaires. Dermal pesticide exposures among a subset of 10 farmer/pesticide applicators were assessed by dermal patch samples, observation, and postapplication questionnaires.

RESULTS

The study revealed that a toxic organochlorine insecticide, Callisulfan (endosulfan), is frequently sprayed on cotton plants by the farmers. The farmers wore no protective equipment and were inadequately dressed for work with this pesticide. Laboratory analysis of the mixed formulation showed a wide range in the concentration of the pesticide solution among the farmer/pesticide applicators and dermal patch samples showed very high residues of endosulfan analytes on their body surfaces.

CONCLUSIONS

A low level of awareness of pesticide toxicity prevails amonsg cotton farmers in The Gambia. There is a less than adequate control of pesticides and other hazardous agrichemicals in the country.

Keokuk County rural health study: self-reported use of agricultural chemicals and protective equipment

The Keokuk County Rural Health Study is a population-based study of an agricultural community in Iowa. The study includes in-depth evaluations of respiratory disease, injury, and other health outcomes in relation to environmental and occupational exposures. This article reports descriptive findings on pesticide use from among the 1191 participants completing occupational surveys. Fifty-one percent (612) of respondents (farmers and non-farmers) had applied insecticides including lawn and garden chemicals at home during the past year. Thirty-three percent (395) of respondents had personally mixed or applied farm chemicals during their life. One-hundred and four had a current pesticide applicator's license. Information on the specific types of pesticides and protective measures used was obtained for the 144 individuals who had mixed or applied pesticides on farms within the previous year. Of these individuals, 67% worked with fertilizers, 49% used herbicides, 48% used crop insecticides, 28% used crop storage insecticides, 45% applied livestock insecticides, and 9% worked with fungicides. The use of personal protective equipment such as gloves, aprons, and respirators varied depending on the chemical. A substantial proportion did not use gloves even for mixing. Thirty-five percent reported at least one suspected work-related symptom after working with pesticides during the previous year. The lack of differences in protective equipment use between applicators who have completed pesticide applicator training courses and those who have not suggests a need to develop more effective training methods. The increased use of protective equipment when applying odorous agrochemicals suggests that addition of an odorant to more toxic pesticides may be a successful intervention strategy.

Smoke alarms by type and battery life in rural households: a randomized controlled trial

BACKGROUND

Although the use of smoke alarms is widely recommended, little guidance is available on the types of alarms and batteries that function best. This study examined smoke alarm and battery function 12 months after installation in rural residential households.

METHODS

An RCT, involving the installation of either a photoelectric or ionizing smoke alarm with either a lithium or carbon-zinc battery, was conducted in 643 rural Iowa households in July 2003. The functionality of each installed smoke alarm was tested 12 months later. Generalized estimating equations were used to model the effects of alarm type and battery type on alarm function and false alarms 12 months after installation.

RESULTS

Of 643 study homes, 98.8% had at least one functioning alarm, and 81.5% had all alarms functioning 12 months after installation. No difference was observed in alarm function between photoelectric alarms and ionizing alarms 12 months after installation (OR=1.30, 95% CI=0.88, 1.92). However, photoelectric alarms had significantly lower odds of false alarms than ionizing alarms. Alarms with lithium batteries had 91% higher odds of functioning than those with carbon-zinc batteries. The main reasons for nonfunctioning included a missing battery (30.7%); a missing alarm (28%); and a disconnected battery (11.3%).

CONCLUSIONS

Although lithium batteries and photoelectric alarms are more expensive than their counterparts, the financial investment might be worthwhile in terms of overall performance.

Kansas primary care weighs in: a pilot randomized trial of a chronic care model program for obesity in 3 rural Kansas primary care practices

CONTEXT

Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care.

PURPOSE

To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary care.

METHODS

We enrolled 107 participants to a 6-month, 2-armed, randomized trial comparing a CCM for obesity with usual care. The primary outcome was weight change at 90 days. The usual care arm received educational weight loss materials and outcome assessments at day 0, 90, and 180. The active arm received the same elements as the usual care arm plus a multicomponent obesity CCM.

FINDINGS

The Day 90 mean +/- SD weight change for the active arm (n = 34) and control arm (n = 33), respectively, was -4.5 +/- 7.7 pounds and -2.4 +/- 8.1 pounds (P = .27 for difference). The Day 180 mean +/- SD weight change for the active (n = 27) and control (n = 27) arms, respectively, was -9.4 +/- 10.3 pounds and -2.1 +/- 10.7 pounds (P = .01 for difference). There was no significant change in physical activity, or fruit and vegetable intake at day 90 or day 180.

CONCLUSIONS

Improving the recognition and treatment of obesity in primary care settings is a critical initiative. Rural populations suffer disproportionately with obesity, and better methods of delivering obesity care are needed for this population. Further research is needed to establish the effectiveness of a CCM approach for obesity care.

Monitoring risks in association with exposure levels among wastewater treatment plant workers

OBJECTIVE

To investigate the relationship between exposure to hydrogen sulfide and endotoxin during specific job tasks and health symptoms among wastewater treatment plant (WWTP) workers.

METHODS

The exposure levels for specific tasks were measured by personal monitoring. The health symptoms of WWTP workers were compared with those of water treatment plant workers through a questionnaire survey.

RESULTS

Exposure levels for all monitored tasks were less than 1 ppm for hydrogen sulfide and 91 EU/m (endotoxin units/m) for endotoxin. Statistically higher odds ratios of respiratory, ocular and skin irritation, neurology, and gastrointestine symptoms were shown among WWTP workers compared with water treatment plant workers. Tasks related to sludge handling and plant inspection showed statistically significant associations with memory/concentration difficulties, throat irritation, and stomach pain.

CONCLUSIONS

These results suggest that exposure control programs for specific job tasks and work locations are needed.

Does Parental Physical Violence Reduce Children's Standardized Test Score Performance?

PURPOSE

Many negative cognitive and behavioral outcomes have been identified among children living in households with parental violence, but few studies have examined academic performance. In a rural population-based cohort, we examine the role of parental violence on standardized test score performance.

METHODS

The cohort included 306 children ages 6 through 17. Parents responded to a health interview that included questions about physical violence. Children's standardized test scores were collected prospectively for 5 years after the parent interview. Hierarchical multivariate models clustering on school, household, and repeated individual test scores and controlling for children's and parent's characteristics were run to predict test score performance.

RESULTS

One in five children lived in a household in which parents reported at least one act of physical violence. Children whose parents reported intimate partner violence (IPV) performed an average of 12.2 percentile points lower than children whose parents reported no IPV (95% CI, -19.2--5.2; p < 0.001). Parent-reported IPV led to larger test score reductions for girls than for boys and for children less than 12 years old than for older children.

CONCLUSIONS

Parental physical violence was common, and children in homes with violence had significantly poorer performance on standardized test scores.

Risk factors for insomnia in a rural population

PURPOSE

This study compared in one data set the relative importance of most previously examined risk factors for different symptoms of insomnia.

METHODS

Data were obtained from personal interviews of 1,588 adults in a rural area. Statistical methods evaluated the association of 42 risk factors with any insomnia and each of four insomnia subtypes: difficulty with initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), and restless sleep (RS).

RESULTS

Insomnia rates were greater in this rural population than most U.S. studies and greater in the United States than other countries. The correlations between insomnia subtype and energy level was highest for RS, -0.29, and lowest for EMA, -0.11. All sleep disturbances increased monotonically with depressive symptoms, but the increase was greatest for RS (r = 0.57) and weakest for EMA (r = 0.24). Anxiety and pain also were independently associated with each insomnia subtype. Insomnia problems of spouses were uncorrelated. Other risk factors were independently associated with some insomnia subtypes but not others. For example, the association of age with difficulty maintaining sleep was independent of health measures.

CONCLUSION

The results suggest that different insomnias have different rates and risk factors and therefore possibly different etiologies and management strategies.

Rurality and ethnicity in adolescent physical illness: are children of the growing rural Latino population at excess health risk?

CONTEXT AND PURPOSE

This study's objectives are to: investigate potential additive and multiplicative influences of rurality and race/ethnicity on chronic physical illness in a nationally representative sample of youth; and examine intra-Latino processes using a Latino sub-sample. Specifically, we examine how rurality and individual psychosocial processes reflected by acculturation proxies (generational status and use of the English language at home) link to chronic physical illness of Latino youth. Finally, we examine whether these associations and the levels of chronic illness differ across Latino subgroups.

METHODS

Logistic-normal (binomial) modeling analyses examine multilevel influences on physical health using longitudinal data from a nationally representative sample (N = 13,905) of white, African American, Latino, Asian, and Native American adolescents between the ages of 12 and 19 participating in the National Longitudinal Study of Adolescent Health.

FINDINGS

Prevalence rates of certain chronic illnesses (obesity, asthma, and high cholesterol) among Latino adolescents exceed rates for the same illnesses among white adolescents. Comparisons between rural and non-rural youth reveal a rurality disadvantage in terms of any chronic illness likelihood among Latino, Asian, and Native American youth not evident among whites or African Americans. Among Latino youth (N = 2,505), Mexican Americans show lower health risk for any chronic illness compared to other Latino groups. However, third generation Latinos and those who primarily speak English at home experience higher risk for any chronic illness than do those of first or second generation status, with amplification of the risk linked to English use at home among Latino youth living in rural areas.

Concordance of patient-physician obesity diagnosis and treatment beliefs in rural practice settings

CONTEXT

Although clinical guidelines recommend routine screening and treatment for obesity in primary care, lack of agreement between physicians and patients about the need for obesity treatment in the primary care setting may be an unexplored factor contributing to the obesity epidemic.

PURPOSE AND METHODS

To better understand this dynamic, we surveyed 439 obese patients (body mass index >or=30) at the time of clinic visits in 2003 at diverse primary care settings in rural Kansas and conducted same-day interviews with their physicians (N = 28). We used Spearman's correlation to describe and compare patient and physician responses.

FINDINGS

Most patients were women (66%). Their mean age was 55.8 years, and mean body mass index was 37.7. Half (51%) reported discussing their weight on that visit date. Overall, 51% of patients wanted to discuss weight more often with their physician and 54% wanted to discuss weight sooner. Patients and physicians gave similar assessments of the patient's preference for discussing weight loss, how often weight was discussed at visits, and the patient's motivation for weight loss. Spearman's correlations on these variables were .33, .54, and .25, respectively (all P < .001).

CONCLUSIONS

These patients and their physicians demonstrated a weak to moderate agreement on several variables crucial to initiating and continuing obesity care. Understanding patient and provider beliefs and preferences regarding obesity diagnosis and treatment is essential in designing obesity interventions for primary care.

Risk Factors for Rural Residential Fires

CONTEXT AND PURPOSE

Rural households report high fire-related mortality and injury rates, but few studies have examined the risk factors for fires. This study aims to identify occupant and household characteristics that are associated with residential fires in a rural cohort.

METHODS

Of 1,005 households contacted in a single rural county, 691 (68.8%) agreed to participate. One household with missing information on a reported fire was excluded from the analysis. We used logistic regression to examine the independent association of occupant and household characteristics with reported fires, controlling for years lived in the residence. We also examined the association between the occurrence of previous fires and the adoption of safety measures.

FINDINGS

A total of 78 (11.3%) households reported a residential fire. Occupant characteristics that were associated with significantly higher odds of reported fires included the presence of an occupant with alcohol problems (OR = 1.82, 95% CI = 1.01-3.28) and being married (OR = 2.11, 95% CI = 1.14-3.91). Rural farm households were associated with significantly higher odds (OR = 1.72, 95% CI = 1.01-2.93) of reporting a fire when compared to residences in towns, after controlling for all other occupant and household characteristics. The presence of a fire extinguisher (OR = 2.00, 95% CI = 1.10-3.64) was the only fire safety measure that had a statistically significant association with reported fire.

CONCLUSIONS

Rural farm households report higher incidences of fire when compared to households located in towns. Experiencing a fire is not associated with an increased likelihood of adopting safety measures to prevent injuries once a fire has started.

Depressive symptoms as a risk factor for unintentional injury: a cohort study in a rural county

OBJECTIVE

The authors used data from a population based prospective cohort study to determine if depressive symptoms predicted incidence of unintentional injury.

METHODS

The Keokuk County Rural Health Study, based in Iowa, is a prospective cohort study of health status that includes injury outcomes. Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale at the beginning of the study on 1493 participants. Quarterly follow up phone calls were made to measure injury incidence.

RESULTS

471 injuries were reported for an overall injury rate of 9.8 per 100 person-years. Crude injury rates were significantly higher for those with depressive symptoms (p = 0.0003). Those with depressive symptoms had a 41% increased risk for injury after controlling for antidepressant medication use, gender, prior injury, income, and sleepiness (RR = 1.41, 95% CI 1.10 to 1.80). Depressive symptoms remained a risk factor for injury regardless of current antidepressant medication use (no medication use, RR = 1.43, 95% CI 1.09 to 1.88; medication use, RR = 1.31, 95% CI 0.76 to 2.26).

CONCLUSIONS

Depressive symptoms were found to be risk factors for unintentional injury. Medical practitioners should consider talking about safety with their patients, especially those reporting symptoms of depression, and recognize that an increased risk for injury remains until the depressive symptoms subside.

The Green Acres Effect: The Need for a New Colorectal Cancer Screening Campaign Tailored to Rural Audiences

National health communication campaign developers have ignored rural audiences in campaign development and testing, despite the health disparities that exist for this group. Researchers in a rural Midwestern state tested the appropriateness of CDC's national colorectal cancer screening campaign, Screen for Life. Based on focus groups and a quasiexperimental design evaluation, researchers determined that the national campaign did not adequately address the needs of the rural audience. A new print and radio campaign was developed based on previous findings, grounded in social marketing and the health belief model. New tailored campaign materials were refined in focus groups. Final versions were tested in two quasiexperimental designs. Results support the campaign's reach and efficacy. Those in the intervention county were significantly more likely than the unexposed to (a) report recent exposure to ads, (b) plan to seek out information regarding screening, and (c) plan to get screened in the near future.

When one is not enough: prevalence and characteristics of homes not adequately protected by smoke alarms

OBJECTIVE

The National Fire Protection Association (NFPA) has specific recommendations about the number, location, and type of smoke alarms that are needed to provide maximum protection for a household. No previous studies have examined whether or not homes are completely protected according to these guidelines. The authors describe the prevalence and home characteristics associated with compliance to recommendations for smoke alarm installation by the NFPA.

DESIGN, SETTING, AND SUBJECTS

Data are from the baseline on-site survey of a randomized trial to measure smoke alarm effectiveness. The trial was housed in a longitudinal cohort study in a rural Iowa county. Of 1005 homes invited, 691 (68.8%) participated.

MAIN OUTCOME MEASURES

Information about smoke alarm type, placement, and function, as well as home and occupant characteristics, was collected through an on-site household survey.

RESULTS

Although 86.0% of homes had at least one smoke alarm, only 22.3% of homes (approximately one in five) were adequately protected according to NFPA guidelines. Fourteen percent of homes had no functioning smoke alarms. More than half of the homes with smoke alarms did not have enough of them or had installed them incorrectly, and 42.4% of homes with alarms had at least one alarm that did not operate. Homes with at least one high school graduate were nearly four times more likely to be fully protected. Homes that had multiple levels, a basement, or were cluttered or poorly cleaned were significantly less likely to be fully protected.

CONCLUSION

These findings indicate that consumers may not be knowledgeable about the number of alarms they need or how to properly install them. Occupants are also not adequately maintaining the alarms that are installed.