Ann M. Stromquist

Asthma and Farm Exposures in a Cohort of Rural Iowa Children

Epidemiologic studies of farm children are of international interest because farm children are less often atopic, have less allergic disease, and often have less asthma than do nonfarm children—findings consistent with the hygiene hypothesis. We studied a cohort of rural Iowa children to determine the association between farm and other environmental risk factors with four asthma outcomes: doctor-diagnosed asthma, doctor-diagnosed asthma/medication for wheeze, current wheeze, and cough with exercise. Doctor-diagnosed asthma prevalence was 12%, but at least one of these four health outcomes was found in more than a third of the cohort. Multivariable models of the four health outcomes found independent associations between male sex (three asthma outcomes), age (three asthma outcomes), a personal history of allergies (four asthma outcomes), family history of allergic disease (two asthma outcomes), premature birth (one asthma outcome), early respiratory infection (three asthma outcomes), high-risk birth (two asthma outcomes), and farm exposure to raising swine and adding antibiotics to feed (two asthma outcomes). The high prevalence of rural childhood asthma and asthma symptoms underscores the need for asthma screening programs and improved asthma diagnosis and treatment. The high prevalence of asthma health outcomes among farm children living on farms that raise swine (44.1%, p = 0.01) and raise swine and add antibiotics to feed (55.8%, p = 0.013), despite lower rates of atopy and personal histories of allergy, suggests the need for awareness and prevention measures and more population-based studies to further assess environmental and genetic determinants of asthma among farm children.

Financial loss and suicidal ideation in a rural community sample.

Turvey C, Stromquist A, Kelly K, Zwerling C, Merchant J. Financial loss and suicidal ideation in a rural community sample. Acta Psychiatr Scand 2002: 106: 373–380.

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.

Physical and emotional partner abuse reported by men and women in a rural community.

Intimate partner violence exacts an enormous toll each year in the United States, affecting 3% to 5% of adult intimate relationships.1–3 Compared with urban settings, much less is known about the prevalence and correlates of partner violence in rural areas.4–6 Rural women are more isolated, have access to fewer services, and face different attitudes and norms than urban women.5–7 This study examined the prevalence of severe physical abuse, measured by the Conflict Tactics Scale,8 and controlling emotional abuse, measured by Yllo’s Controlling Behavior Questions,9 as reported by a cohort of cohabiting couples in a rural Iowa county. The objectives were to estimate the prevalence of abuse victimization reported by men and women on each scale and to identify factors associated with violence against men and women.

Tractor Overturn Concerns in Iowa: Perspectives from the Keokuk County Rural Health Study

Agriculture remains one of the most hazardous industries in the U.S., with tractor overturns producing the greatest number of agricultural machinery-related fatalities. Rollover protective structures (ROPS) and seatbelts effectively reduce tractor overturn deaths. However, a large proportion of tractors in use in American agriculture are older tractors without ROPS and seatbelts. This article describes the tractor-related responses from participants in a population-based study conducted in Keokuk County, Iowa. This study was designed to measure rural and agricultural adverse health and injury outcomes and their respective risk factors. Questionnaires were partially developed from well-documented national surveys. Questions about agricultural machinery use, presence of safety equipment on the machinery, work practices, and attitudes about farm safety were included. Study participants on farms who owned tractors had an average of 3.1 tractors with an average age of 27 years. Only 39% of the 665 tractors had ROPS. Tractor age was associated with the presence of ROPS; 84% of tractors manufactured after 1984 were ROPS-equipped, whereas only 3% of tractors manufactured before 1960 were ROPS-equipped. ROPS-equipped tractors were significantly more common on larger farms and households with higher income. Only 4% of the farmers reported that their tractors had seatbelts and they wore them when operating their tractors. The results of this study support the findings of other studies, which indicate that many older tractors without ROPS and seatbelts remain in use in American agriculture. Until a dramatic reduction in the number of tractors in the U.S. operated without ROPS and seatbelts is achieved, the annual incidence of 120 to 130 deaths associated with tractor overturns will persist.

Prevalence of hearing impairment in a rural midwestern cohort : Estimates from the keokuk county rural health study, 1994 to 1998

Objective: The current paper estimates the prevalence of hearing problems in a rural population, analyzes the prevalence of hearing problems across age groups, and compares the prevalence of hearing problems in this population with results obtained in other populations. Design: Data were obtained from a random sample of the residents of a rural county, stratified by farm, rural non-farm, and town residence. Hearing test results were obtained from participants between the ages of 8 and 92 years (N = 1972; 47% male). Pure-tone thresholds were classified as normal or impaired using a number of metrics, including speech intelligibility index values. Selected comparisons of crude rates were made with previous population-based studies of hearing loss prevalence. Results: Nearly all (99%) of the participants in this study had significant hearing impairment. Atypical hearing impairment is most prevalent at 6 kHz. In males, this excess impairment shifts to lower frequencies with age but monotonically decreases in females. Notched configurations were most common among those between 30 and 59 years old. In females, the prevalence of hearing impairments sufficient to interfere with speech understanding begins to rapidly increase in the 6th decade (4th decade in males). Comparisons with prior population-based studies in the United States and Great Britain identified few significant differences. Conclusions: Significant hearing impairment is common in rural populations. The high prevalence in this population is similar to that found in other population-based studies. Future studies are needed to examine (1) the risk factors for hearing impairment, (2) the natural course of hearing problems across the life span, and (3) the effect of programs for the prevention of hearing impairment and rehabilitation for persons with existing hearing impairments.

Characterization of Agricultural Tasks Performed by Youth in the Keokuk County Rural Health Study

Injury and illness among youth working on farms are important problems. The types of farm tasks performed by children and the ages at which they begin these activities have not been well characterized. This cross-sectional study characterized agricultural work performed by adolescents in a rural Iowa county to better understand the patterns and extent of exposures to agricultural risk factors. This information will help to develop prevention strategies for agriculture-related injury and illnesses for children working on farms. The Keokuk County Rural Health Study is a prospective cohort study of randomly selected households in Iowa. In Round 2, all youth, aged 12 to 17 years participating in this population-based study, were asked about their use of farm machinery, work with livestock, pesticide handling, and other farm activities. The age at which they actually began these activities, the age they believed youth should start these activities, and sources of health and safety training they received were also ascertained. Adults in the study were asked the same questions about youth. Matched parental reports and opinions were compared to their childrens reports and opinions using McNemars chi-square tests. A total of 143 youth and 684 adults with farming experience completed the interviews. There were 118 pairs of parents and youth. Fifty percent of male youth, and 18 percent of females had performed agricultural work at some time in their life. Twenty-five percent of all male youth, and 5 percent of females were currently working on farms. Close to 30 percent had driven tractors, all-terrain vehicles, and pick-up trucks. Despite the legal prohibition of hazardous work by children under age 16, several younger children reported that they had driven a self-propelled combine, worked in silos, or handled and applied fertilizers in the past 12 months. Youth began riding on tractors at a mean age of 7. The mean ages for driving tractors and all-terrain vehicles were 11 and 10, respectively. The mean age for driving a self-propelled combine was 13. Children began applying or handling fertilizers at the age of 12. There were discrepancies between parent and youth reports regarding the frequencies, starting age, and opinions relative to performing agricultural tasks. These results suggest the need for implementing guidelines, particularly for age appropriate agricultural tasks.

Rural population survey of behavioral and demographic risk factors for loaded firearms

Objectives—In the United States, firearm deaths are almost as frequent as motor vehicle deaths. Firearm unintentional and suicide death rates are raised in rural areas. This study examines firearm prevalence and storage practices in three different types of rural households. Methods—Adults from a stratified random sample of 983 households in a rural Iowa county were interviewed. The χ2 test of independence was used to assess association between loaded, unlocked firearms and seven behavioral and demographic risk factors. Results—Nearly 67% of respondents reported firearms in their households. Nearly 7% of households had a loaded, unlocked gun. Prevalence of firearms at home was higher while prevalence of loaded, unlocked guns was lower than reported in other surveys. Prevalence of loaded, unlocked guns in farm households, 10.5%, was about twice the level in town households, 5.5% (χ2 test, p=0.033). Having taken a gun safety course was associated with more than double the prevalence of a loaded, unlocked gun, 13.5% v 5.1% (χ2 test, p=0.001). The prevalence of loaded, unlocked guns in households with a handgun, 19.3%, was four and one half times higher than in households with a long gun only, 4.2% (χ2 test, p=0.001). Households with someone with a lifetime prevalence of alcohol abuse or dependence were about twice as likely as other households, 13.0% v 6.6% (χ2 test, p=0.004), to report having loaded, unlocked firearms. Conclusions—Anyone interested in promoting safe storage of firearms in rural homes should consider these observations.

Risk factors for injury in rural Iowa: Round one of the Keokuk County Rural Health Study

BACKGROUND Unintentional injuries represent a major cause of morbidity and mortality in rural communities. This study aimed to determine the distribution of injury risk factors in a rural Iowa community and to identify the rural subgroups at highest risk for injury. METHODS We reported on 1583 participants, aged > or =25 years, from Round One of the Keokuk County Rural Health Study, a longitudinal panel study of a rural community. The self-reported data were collected during face-to-face interviews. RESULTS Our data suggested that several risk factors for injury are not uniformly distributed among rural populations. Male farmers were significantly less likely to wear their seatbelts than townspeople or rural nonfarmers. However, farm women were as likely to wear seatbelts as other women. Both male and female farmers were more likely to use all-terrain vehicles than townspeople or rural nonfarmers. In contrast, townspeople were more likely to ride bicycles than either farmers or rural nonfarmers. Townspeople were less likely to have firearms in their homes than either farmers or rural nonfarmers. Farmers were most likely to have fired a gun in the last year. Male farmers aged <65 years were less than half as likely as other men the same age to report a history of alcohol abuse. Binge drinking was equally frequent among farmers, rural nonfarmers, and townspeople. CONCLUSIONS These differences in risk behavior in a rural county suggest the possibility of targeting specific rural injury prevention interventions at those with the highest risk for dangerous behavior.

A population based study of reporting patterns and characteristics of men who abuse their female partners

Objective: This study estimates the prevalence of male abusive behavior reported by men and their female partners and identifies characteristics of abusive men. Design: Baseline survey from a population based cohort study of general health. Setting: A rural county in Iowa, USA. Subjects: 572 men and their cohabitating female partners. Main outcome measures: Male-to-female physical, emotional, and sexual abuse reported by either partner. Results: In this cohort, 13.6% of men had performed at least one act of physical abuse and 34.9% emotional abuse. More than 45% of abusive men reported their own behaviors. Alcohol problems, antisocial personality characteristics, depressive symptoms, and financial stress were all positively associated with both physical and emotional abuse, but suicidal thoughts were less likely among abusers. Conclusion: Identification of common characteristics of abusive men may predict proclivity towards partner violence and barriers to behavior modification.