Utilization of Cancer Early Detection Services Among Farm and Rural Nonfarm Adults in Iowa

Abstract: An increase in the proportion of advanced malignancies among rural residents has been noted and may be due to a combination of factors, including availability of screening services, demographic characteristics, and access to health care facilities. A cross-sectional study was conducted in 33 nonmetropolitan Iowa counties among randomly selected middle-aged farm and rural nonfarm adults to compare utilization of cancer early detection services. A total of 1,126 adults in 600 farm households and 1,092 adults in 589 rural nonfarm households provided information through a 155-item in-home interview.
Differences in income, age, and health insurance coverage (including preventive services) between the farm and nonfarm study populations were found. Although farm men were less likely to have had a checkup during the past year than men in the nonfarm population, no difference was found for women. Overall, differences in screening behaviors were small. Larger differences between both populations were observed for use of mammograms, prostate examinations among men age 50 and older, use of sigmoidoscopy among women age 50 and older, and skin cancer examinations among both sexes. When controlling for demographic characteristics and insurance coverage, members of the farm and rural nonfarm population were equally likely to use multiple screenings according to ACS guidelines. Because of the increased risk of breast cancer, interventions aimed at increasing utilization of mammography among women age 50 and older should be implemented. Although the farm population was more likely to use skin examinations, prevalence should be increased substantially to counteract the continuing rise in skin cancer.     

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.     

Mammogram Utilization Among Farm Women

Abstract: Utilization of preventive health care services is lower in rural populations than in urban populations, possibly as a result of barriers to preventive health care that are characteristic of rural settings. This study was conducted to identify factors associated with mammogram utilization among farm women. Mammogram utilization among farm women from six southern Minnesota counties was examined as part of a larger community-based cancer intervention study. Farm women aged 40 and older were randomly selected from a list of farm households and interviewed by telephone to determine mammogram utilization and factors related to utilization. Of the 606 respondents, 78 percent reported ever having a mammogram and 49 percent reported a mammogram within the past year. Physician recommendation for a screening mammogram and family history of breast cancer were found to be associated with ever having a mammogram. Correct knowledge of mammogram screening guidelines was associated with a mammogram within the past 12 months. Overall, physician recommendation was the most influential determinant of utilization. As more emphasis is placed on prevention, patient education by physicians could have the greatest impact on mammogram utilization.     

Frequency, characteristics, and child and parent risk factors for nonfatal injury in rural children

PURPOSE: We sought to identify child and parent risk factors for nonfatal unintentional injury among rural children.METHODS: Design: cross-sectional health interview survey. Setting: a completely rural midwestern county not adjacent to a metropolitan area. Participants: stratified, random sample of farm, town, and nonfarm, nontown households, including parents of all children aged 0-17 years. Outcome measures: parent-reported injury episodes that occurred in the past 12 months in children that required professional care, restricted normal activities for at least four hours, or resulted in blacking out or losing awareness or memory. Potential risk factors included nine child factors and six parent factors.RESULTS: Of the 621 children in participating households, 137 or 22.1% were injured. Children on a sports team were 1.88 times (95% confidence interval: 1.07 to 3.31) more likely than other children to be injured. Track team members were more likely than non-members to have an injury (54.5% vs. 23.0%, chi square test, p = 0.001), and volleyball team members were more likely than non-members to have an injury (50.0% vs. 29.0%, chi square test, p = 0.009). Unrelated to injury status were the child's gender, rural stratum, emotional health, behavioral problems, impairment or medications. Also unrelated to child injury were the parent's marital status, alcohol dependence, binge drinking, antisocial personality, depression symptoms or fear of child abuse by spouse.CONCLUSIONS: Our findings illustrate the difficulty of discovering clues with potential to aid design of effective childhood unintentional injury prevention policies, programs, and practices. The instruments and processes in our study were of acceptable quality, therefore we failed to asses the true risk factors for childhood injury or our sample size was too small to detect associations with the factors that were included.     

Psychosocial Work Characteristics Predict Cardiovascular Disease Risk Factors and Health Functioning in Rural Women: The Wisconsin Rural Women''s Health Study

BACKGROUND: The aim of the present study is to investigate the association between psychosocial work characteristics and health functioning and cardiovascular disease risk factors among rural women of central Wisconsin and compare psychosocial work characteristics between farm and nonfarm women. METHODS: Stratified sampling was used to select a random sample (n = 1500) of farm and nonfarm women aged 25 to 71 years from the Central Marshfield Epidemiologic Study Area. The baseline examination included measurements of blood pressure, height, weight, and fasting blood lipids, glucose, and insulin. Psychosocial job condition was measured with the Karasek Job Content Questionnaires (JCQ). Health functioning was assessed by the Short Form-36 Health Survey. RESULTS: The analysis of JCQ showed that nonfarm residents were more likely to have jobs with high demand and high decision latitude compared to farm residents. Also, the farm residents (40.3%) were more likely to be occupied in passive jobs (jobs with low levels of demand and control) than the nonfarm residents (26.9%). Among farm residents, psychological job demand was associated with HDL level (beta = 0.17), triglycerides (beta = 0.0), their ratio (beta = 0.005), and blood insulin level (beta = 0.014), and among nonfarm residents, psychological job demand was associated with diastolic blood pressure (beta = 0.17) and total cholesterol level (beta = 0.002). CONCLUSION: Our results showed that rural farm residents had a higher prevalence of CVD risk factors and were more likely to be occupied in jobs with low levels of demand and control. Job stress predicted more CVD risk factors among farm residents compared to nonfarm residents. Therefore, interventions reducing job strain among rural farm residents are timely and necessary.     

Impact of social standing on injury prevention in a World Health Organization Safe Community--intervention outcome by household employment contract

BACKGROUND: Although social inequality in health has been an argument for community-based injury prevention programmes, intervention outcomes with regard to differences in social standing have not been analysed. The objective of this study was to investigate rates of injuries treated in health-care among members of households at different levels of labour market integration before and after the implementation of a WHO Safe Community programme. METHODS: A quasi-experimental design was used with pre- and post-implementation data collection covering the total populations <65 years of age during one year in the programme implementation municipality (population 41 000) and in a control municipality (population 26 000). Changes in injury rates were studied using prospective registration of all acute care episodes with regard to social standing in both areas during the study periods. RESULTS: Male members of households categorized as not vocationally active displayed the highest pre-intervention injury rates. Also after the intervention, males in households classified as not vocationally active displayed notably elevated injury rates in both the control and study areas. Households in the study area in which the significant member was employed showed a post-intervention decrease in injury rate among both men (P < 0.001) and women (P < 0.01). No statistically significant change was observed in households in which the significant member was self-employed or not vocationally active. In the control area, only an aggregate-level decrease (P < 0.05) among members of households in which the significant member was employed was observed. CONCLUSIONS: The study displayed areas for improvement in the civic network-based WHO Safe Community model. Even though members of non-vocationally active households, in particular men, were at higher pre-intervention injury risk, they were not affected by the interventions. This fact has to be addressed when planning future community-based injury prevention programmes.     

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.     

The Keokuk County Rural Health Study

ABSTRACT

The Keokuk County Rural Health Study is a unique, population-based, prospective study of an agricultural community. The study is expected to continue for twenty years. The research includes systematic assessment of respiratory disease, injury, and other health outcomes in relation to agricultural, occupational, and environmental exposures. The aims of the environmental surveys are: (1) to conduct a systematic assessment of rural households in order to characterize the environmental exposures associated with the resi-dences and properties of the study subjects comparing farm, rural non-farm, and town households; and (2) to characterize occupational exposures associated with activities of the study subjects, particular-ly those related to farming and the rural environment. The environ-mental surveys consist of a combination of personal interviews, walk-through observations, and measurement of a selected number of environmental parameters. The focus of these assessments is on the environment and operations of the household and farm. Four instruments are used to record data: a Home Environmental Ques-tionnaire; a Home/Grounds Environmental Checklist; a Farm Envi-ronmental Questionnaire; and a Farm Environmental Checklist. Pre-liminary results from the first 106 environmental assessments are described, including the first 26 farms. More than half of residences were built before 1950, and they are primarily heated with liquid propane gas, natural gas, or wood. Dangerously high levels of car-bon monoxide were measured in several homes during winter 1995/96. Only 77 of 148 smoke detectors functioned. Farms ranged from 7 to 1,600 acres, with a mean of 324 acres. Eleven raised swine in enclosed systems. The average age of tractors in use was 26 years. Twenty-eight percent of all tractors had cabs, 25% had ROPS, and 39% had PTO shields.     

Health and livelihood outcomes associated with participation in a community-based empowerment program for orphan families in semirural Kenya: a cross-sectional study

Over 40 million African children have lost one or both parents to death or desertion for various causes. Recent unconditional cash-transfer programs in sub-Saharan countries have been found effective at mitigating financial, health, and educational challenges concomitant with parental loss. Due to constraints on governmental resources useful for oversight, however, these gains have been less pronounced than in other contexts where governmental oversight allows cash transfers to be conditioned on preset social and health goods.

The present study presents cross-sectional survey data from a community-based intervention combining elements of conditional cash transfer, empowerment- and income-generating programs in rural Kenya. Orphan and vulnerable children (OVC)-headed households in the catchment area are eligible for inclusion in the 3-year program.

Survey questions addressed monthly income, yearly financial status, food and medical access, malaria net usage, water source and purification practices, years of completed school, literacy, and sexual practices. Significant differences were found in each of these areas between the three different cohorts, categorized by year of program entry, though sexual practices only varied among females across the three cohorts.

Findings suggest an overall protective effect as a function of exposure to the program. Households with longer program exposure report statistically significant improvements in weekly income, savings rates, food security, medical security, food independence, insecticide-treated net usage, water purification practices, completing 8 years of schooling, literacy and sexual practices among females compared to households in their first year.

This study supports the use of a community-based intervention hybridizing other standard interventions to reduce health risks among OVC in Kenya.     

Prevention of childhood injuries: evaluation of the Statewide Childhood Injury Prevention Program (SCIPP).

We evaluated the effectiveness of a community-based injury prevention program designed to reduce the incidence of burns, falls in the home, motor vehicle occupant injuries, and poisonings and suffocations among children ages 0-5 years. Between September 1980 and June 1982, we implemented five injury prevention projects concurrently in nine Massachusetts cities and town; five sites, matched on selected demographic characteristics, were control communities. An estimated 42 percent of households with children ages 0-5 years were exposed to one or more of the interventions over the two-year period in the nine communities. Participation in safety programs increased three-fold in the intervention communities and two-fold in the control communities. Safety knowledge and practices increased in both intervention and control communities. Households that reported participatory exposure to the interventions had higher safety knowledge and behavior scores than those that received other community exposure or no exposure to intervention activities. We found a distinct reduction in motor vehicle occupant injuries among children ages 0-5 years in the intervention compared with control communities, associated with participatory exposure of about 55 percent of households with children ages 0-5 years. We have no evidence that the coordinated intervention programs reduced the other target injuries--although exposure to prevention messages was associated with safety behaviors for burns and poisonings.     

Ill health and its potential influence on household consumptions in rural China

Ill health is very expensive and could have significant impact on household consumptions. The purpose of this study is to examine the differences in household consumption patterns among households with or without ill health family member(s) in rural China. We also examine the opportunity cost of ill health by estimating the marginal effects of medical spending on consumption patterns. The data used in this study are from the baseline survey of a community-based rural health insurance study in a poor rural area of China conducted in 2002. The unit of analysis in this study is the household; 4553 households are included in this survey. Fractional Logit model is used as our prediction model. Ill health is measured by the presence of hospitalization and presence of diagnosed chronic disease(s) in a household. Findings from this study reveal that ill health and medical expenditure reduces household investment in human capital, physical capital for farm production, and other consumptions that are critical to human well-being. Subgroup analysis displayed that the impacts of medical expenditure on household consumption patterns described above are more significant in low-income households than in high-income households. In addition, the decline of the percentages of other consumptions is much larger for households with hospitalization than for households with chronic diseases.     

The Keokuk County Rural Health Study

SUMMARY

The Keokuk County Rural Health Study is a population-based, prospective study of environmental exposures and health status of a large randomly-selected sample of residents from each of three strata in one rural Iowa county. The study focuses on injury rates and respiratory disease; in addition, it monitors health care de-livery; geriatric, reproductive, and mental health; and other health outcomes. Injury and disease prevalence are investigated in relation to occupational, agricultural, and other environmental exposures. This paper describes the sampling method, the protocol, and the demographic profile of adult subjects of the first 400 households en-rolled in the study. Farmers were slightly younger than rural non-farmers and townspeople and more farmers had lived in the county all of their lives. Females were more highly educated than were males, and less than half as many female farmers had lived in the county all their lives than had male farmers. Net household income figures were complex and are shown in a graph in Table 1.     

Severe back pain among farmworker high school students from Starr County, Texas: baseline results

PURPOSE: This cohort study is among the first to estimate the prevalence of and examine potential risk factors for severe back pain (resulting in medical care, 4+ hours of time lost, or pain lasting 1+ weeks) among adolescent farmworkers. These youth often perform tasks requiring bent/stooped postures and heavy lifting. METHODS: Of 2536 students who participated (response rate across the three public high schools, 61.2% to 83.9%), 410 students were farmworkers (largely Hispanic and migrant). Students completed a self-administered Web-based survey including farm work/nonfarm work and back-pain items relating to a 9-month period. RESULTS: The prevalence of severe back pain was 15.7% among farmworkers and 12.4% among nonworkers. The prevalence increased to 19.1% among farm workers (n = 131) who also did nonfarm work. A multiple logistic regression for farmworkers showed that significantly increased adjusted odds ratios for severe back pain were female sex (4.59); prior accident/back injury (9.04); feeling tense, stressed, or anxious sometimes/often (4.11); lifting/carrying heavy objects not at work (2.98); current tobacco use (2.79); 6+ years involved in migrant farm work (5.02); working with/around knives (3.87); and working on corn crops (3.40). CONCLUSIONS: Areas for further research include ergonomic exposure assessments and examining the effects of doing farm work and nonfarm work simultaneously.     

Mental health status among rural women of reproductive age: findings from the Central Pennsylvania Women's Health Study

Objectives. We sought to examine variables associated with mental health among rural women of reproductive age, with particular attention given to rural area type and farm residence.Methods. We analyzed data from the Central Pennsylvania Women’s Health Study, which included a random-digit-dialed survey of women aged 18 to 45 years. Hierarchical multiple linear and logistic regression models were estimated to predict 3 mental health outcomes: score on a mental health measure, depressive symptoms, and diagnosed depression or anxiety.Results. Mental health outcomes were associated with different factors. Farm residence was associated with higher mental health score, and the most isolated rural residence was associated with less diagnosed depression or anxiety. Elevated psychosocial stress was consistently significant across all models. A key stress modifier, self-esteem, was also consistently significant across models. Other variables associated with 2 of the outcomes were intimate partner violence exposure and affectionate social support.Conclusions. Farm residence may be protective of general mental health for women of reproductive age, and residence in isolated rural areas may decrease access to mental health screening and treatment, resulting in fewer diagnoses of depression or anxiety.Research on the mental health of rural women in the United States is sparse.1 Although some aspects of rural life—such as a slower pace and smaller, more tight-knit communities—are thought to be conducive to mental health, other aspects of rural life are stressful, especially for women. For example, women in rural areas may have fewer opportunities to participate in paid employment, may have restricted social contacts, or may have less access to social services and health care compared with women in more urbanized areas. In this study, we examined the variables associated with the mental health status of rural women of reproductive age, for whom mental morbidity could be important both for their own health and for the well-being of their children and families.Although rural areas vary with respect to population size, sociodemographic composition, cultural context, and socioeconomic factors, several generalizations can be made. First, because rural residents are disproportionately poor,2 rural women are likely to experience numerous stressors related to mental health problems. These stressors include economic deprivation, lack of job benefits such as health insurance, and social isolation in the smallest rural communities. Other aspects of small rural communities that might affect women’s mental health include the reinforcement of traditional gender roles, which can result in limiting women’s participation in employment or higher education and in creating barriers to women’s access to shelters or other social services for victims of intimate partner violence.3Some literature suggests that farm residents are at higher risk for health and mental health problems compared with nonfarm residents. Although some of these studies focus on the risk of suicide and farm-related injuries among men, it is noteworthy that many women who reside on farms are involved in farm work to some degree, and all women who reside on farms are involved in caregiving of family members engaged in farm work. The mental health risks to women of living on a farm and direct involvement in farming might include stressors such as the economic uncertainty of farming, low levels of job demand and control, lack of external recognition for their work, fatigue, emotional and social isolation, and the trauma associated with injuries and functional impairments.3^–5Although some studies have suggested that rural residence generally is not associated with higher levels of mental health problems compared with urban residence, with the exception of suicide among males,2^,6^,7 depression prevalence has been found to be slightly higher among residents of rural areas compared with residents of urban areas.8 Studies also showed that women consistently report higher levels of mental distress compared with men, regardless of place of residence. Also, to the extent that rural women, compared with urban women, have higher rates of some chronic conditions, such as obesity, and more limitations of activity caused by chronic conditions,2 they might be expected to experience greater levels of comorbid depression. A better understanding of the determinants of rural women’s mental health problems is needed to identify appropriate targets for interventions.Furthermore, because rural areas are often medically underserved, access to screening and treatment services for mental health problems is lower in rural areas, reducing the likelihood of diagnosis and receipt of needed care.9^–12 In particular, rural areas compared with urban areas have less availability of specialty mental health services, including mental health providers such as psychiatrists, child psychiatrists, and psychologists as well as inpatient psychiatric services.13Little research has focused on women’s mental health in various types of rural communities, comparing isolated areas with more populous rural areas. In this study, we examined 3 mental health outcomes among rural women of reproductive age living in these types of communities, with a focus on aspects of psychosocial stress and potential stress modifiers. Psychosocial stressors included acute or chronic demands or challenges as appraised by women, such as living in poverty or being exposed to domestic violence or discrimination on the basis of race/ethnicity or gender, which may affect their mental health and functioning. Stress modifiers included factors that have been found in previous research to buffer or exacerbate the individual’s response to stress, including religiousness or spirituality,14 self-esteem,15 and social support.16 We examined the following 3 research questions: (1) What are the correlates of mental health status among rural women of reproductive age? (2) Do modifiers of psychosocial stress, including religiousness, self-esteem, and social support, alter the effects of other predictors on mental health outcomes? (3) Does the type of rural residential setting or residence on a farm affect women’s mental health status after we controlled for other variables?On the basis of findings from previous mental health research, we hypothesized that rural women’s mental health status would be adversely affected by psychosocial stressors. We also expected that stress modifiers would reduce the effect of these stressors on mental health outcomes. In view of rural women’s potentially reduced access to social, economic, and health care resources, as well as the limited literature linking farm residence to mental health problems among rural men, we hypothesized that residing in more isolated rural settings and on farms would be associated with less optimal mental health outcomes among women in our sample.     

Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda

BACKGROUND: Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered in urban hospitals. Poor rural patients have difficulty accessing the drugs, making the provision of antiretroviral therapy inequitable. Initial tests of community-based treatment programs in Uganda suggest that home-based treatment of HIV/AIDS may equal hospital-based treatment; however the literature reveals limited experiences with such programs. THE RESEARCH: This intervention study aimed to; 1) assess the effectiveness of a rural community-based ART program in a subcounty (Rwimi) of Uganda; and 2) compare treatment outcomes and mortality in a rural community-based antiretroviral therapy program with a well-established hospital-based program. Ethics approvals were obtained in Canada and Uganda. RESULTS AND OUTCOMES: Successful treatment outcomes after two years in both the community and hospital cohorts were high. All-cause mortality was similar in both cohorts. However, community-based patients were more likely to achieve viral suppression and had good adherence to treatment. The community-based program was slightly more cost-effective. Per capita costs in both settings were unsustainable, representing more than Uganda's Primary Health Care Services current expenditures per person per year for all health services. The unpaid community volunteers showed high participation and low attrition rates for the two years that this program was evaluated. CHALLENGES AND SUCCESSES: Key successes of this study include the demonstration that antiretroviral therapy can be provided in a rural setting, the creation of a research infrastructure and culture within Kabarole's health system, and the establishment of a research collaboration capable of enriching the global health graduate program at the University of Alberta. Challenging questions about the long-term feasibility and sustainability of a community-based ARV program in Uganda still remain. THE PARTNERSHIP: This project is a continuation of previous successful collaborations between the School of Public Health of Makerere University, the School of Public Health of University of Alberta, the Kabarole District Administration and the Kabarole Research and Resource Center.     

How formative research can improve the effects of household economic strengthening programs for children

Household economic strengthening (HES) programs should increase the welfare of households and children so as to decrease cyclical poverty. Yet research shows that HES programs with positive household outcomes often fail to produce corresponding improvements in children’s lives. In-depth interviews (IDIs) with 96 households who were part of a HES program in Liberia provide a window into intra-household decision-making affecting children’s health and education. Two general themes were examined: (1) decision-making about household assets including cash, agriculture, and food, and (2) decision-making around children’s nutrition, health, and education. Findings indicate that children are a priority and household spending is concentrated in areas that are directly linked to child well-being; however, specific knowledge gaps were identified that may have hindered improvements, such as appropriate nutrition for child development and basic financial planning to increase savings. Results also show that decision-making is balanced between men and women; this identifies the need to address knowledge gaps among both men and women to produce greater impacts. Recommendations illustrate how greater understanding of intra-household decision-making can be used during program design to develop complementary programming and messages to maximize the benefit of HES programs on children’s well-being.     

农村健康促进的策略初探

目的：研究射阳县开展健康教育工作的成功经验，促进江苏省农村健康教育工作的全面发展。方法：通过相关资料回顾及有关人员访谈，研究射阳县在各相关部门共同参与下，选择适合当地实际情况的传播策略，探索广大农民喜闻乐见、易于接受的健康教育活动的新形式，持续开展农村地区的健康促进。结果：除了开发领导、制定规划、建立领导网络和工作网络等基础性工作以外，在总结示范点经验的基础上，制定健康教育示范户标准、健康教育普及村、健康教育普及乡镇标准，并组织评审，促进了农村健康教育的发展，提高了广大农民卫生知识水平和良好卫生行为的形成。结论：以健康教育示范户及健康教育普及村、乡镇的评选为载体，通过多种广大农民喜闻乐见、易于接受的活动形式，向其传播健康相关知识、改变其不良生活习惯，是农村开展健康教育与健康促进的成功策略之一。     

The Relationship of Farm Residency Status to Demographic and Service Characteristics of Agricultural Injury Victims in Central Wisconsin

Abstract: This study performed a surveillance of a defined population in central Wisconsin during a two-year period that included six months of follow-up. The study included those who worked and lived on farms and those who only worked on farms. The injury rate for farm residents was 3.15 injuries per 100 persons per year. However, 195 of the 510 injuries (38.2%) involved persons who were not farm residents. For nonfarm residents, 88.7 percent of the victims were male, whereas for farm residents 79 percent of the victims were male. More than one half of the farm residents who were injured were the owners and an additional 21 percent were juvenile children. Of those aged 18 to 29 years, 51.3 percent were nonfarm resident victims and 15.2 percent were farm resident victims. Of nonfarm residents, 41.1 percent were married; of farm residents, 65.3 percent were married. More than one half of all injured nonfarm residents were seen within two hours of injury while one quarter of the injured farm residents were seen more than 24 hours after the injury. Only 4 percent of the injured farm residents were self-insured, but 15 percent of the nonfarm residents were self-insured. However, the time of injury, actual injuries, diagnoses rendered, and services received were similar for injured farm residents and injured nonfarm residents. Effective attempts to intervene on agricultural injuries will need to consider different risk factors for injuries for nonfarm residents as compared to farm residents.     

Impact of a mentoring program on psychosocial wellbeing of youth in Rwanda: Results of a quasi-experimental study

Addressing the psychosocial needs of vulnerable children and youth is viewed increasingly as a priority of humanitarian programs, particularly in Africa, where the scale of the problem necessitates community-based solutions. This quasi-experimental study tested a model of adult mentorship and support to improve psychosocial outcomes among youth-headed households in a rural area of Rwanda. Two rounds of data were collected from youth who served as heads of their households. Following the baseline survey in 2004 (n?=?692), an adult mentorship program was implemented among half the sample. A follow-up survey was conducted after 18 months of intervention exposure (n?=?593). Through regular home visits, mentors developed a stable, caring relationship with youth in their community living without an adult caregiver. Each mentor was assigned 2–3 youth-headed households located within their own community to visit at least once a month for 2–3 hours in the home. Over an 18-month period, 156 trained adult mentors (60% male, 40% female) visited and supported 441 households. Multivariable analyses explored linkages between exposure to the intervention and four key psychosocial outcomes: perceptions of adult support, marginalization, grief and symptoms of depression. Over time, youth with a mentor reported a significant increase in perceptions of available adult support and decreases in marginalization. While grief in the comparison group grew significantly over time, grief levels in the intervention group remained stable, suggesting that the mentorship program may have mitigated grief among youth in the intervention areas. Intervention respondents also reported a slight, but significant, decrease in depressive symptoms. Findings suggest that the mentoring program enhanced available support and community connectedness among youth in this study. However, program impact on emotional wellbeing was more modest. More intensive interventions may be needed to reduce grief symptoms and for those with high levels of depressive symptoms.