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University of Iowa News Release

Dec. 21, 2004

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Researcher Examines Rural Injuries

Agriculture has long been considered one of the most dangerous occupations, but from a public health perspective, country living has plenty of other risks, too.

In addition to death caused by traumatic occupational injury, deaths from motor vehicle crashes, drowning, residential fires and suicide all are disproportionately higher in rural areas than urban areas.

Numerous factors contribute to increased rates of injury in rural settings, so prevention remains as important as ever, according to a University of Iowa researcher who studies injury patterns among rural and urban residents.

"Injuries are the leading cause of death for people between the ages of 1 and 45, and the fourth-leading cause of death overall," said Corinne Peek-Asa, Ph.D., professor of occupational and environmental health in the UI College of Public Health. "That's a huge public health toll. What's notable is that many of these types of injuries are preventable."

Peek-Asa examined dozens of previous studies to better understand differences in rates and types of injury among rural and urban populations. She summarized her findings in an article published in the October 2004 issue of the American Journal of Public Health.

Motor vehicle crashes are among the most common causes of death among rural residents, Peek-Asa noted. National Highway Traffic Safety Administration statistics indicate that fatal rural crashes account for 61 percent of all traffic fatalities but only 39 percent of vehicle miles traveled. Several factors may contribute to this. Unlike interstate or four-lane highways, most rural highways are two-lane roads and typically do not have crash reduction features like wide shoulders, graded curves, skid-reducing surfaces or lighted traffic signs. Crashes between motor vehicles and farm machinery or all-terrain vehicles and snowmobiles are more common in rural areas. Other than interstates, speeds are often higher on rural roads due to longer segments of uninterrupted roadway. In addition, rural residents are less likely than urban residents to wear seat belts or use child safety seats.

Residential fire injuries are another concern. Fire death rates per capita are 36 percent higher in rural than urban areas, Peek-Asa said. Residential fires may be more common in rural homes because these homes are older and may use more risky heating sources. She noted that heating is the leading cause of rural home fires, followed by cooking. Inadequate smoke alarms are another factor; studies suggest that nearly three-fourths of rural home fires occur in homes without operational smoke detectors.

"It's not that rural homes don't have smoke alarms because statistics show that as many as 80 percent of rural homes do," Peek-Asa said. "However, it is suggested that only a third of these homes are adequately protected because residents don't have enough alarms, or they're not in the right places or simply not mounted correctly." She and her colleagues currently are conducting a study looking at different smoke alarms technologies among nearly 700 homes in a rural Iowa county.

The remoteness of rural residents, meaning that medical care is often further away, also is a factor when it comes to serious injuries and death. However, one important step the state of Iowa has taken, Peek-Asa noted, has been to develop a statewide trauma system that helps standardize and coordinate triage and patient transportation between hospitals that have different treatment capabilities. Iowa is unique among rural states in developing a statewide system, she said.

Peek-Asa acknowledged that farm families and other rural residents can be independent-minded and may resist changing their behaviors or being told what to do to minimize their injury risks. She cited decreased seat belt use among rural residents as an example. Nevertheless, the "prevention message" is important, she said.

"I believe the 'chipping away' approach is good in that each time a person is reminded how they can prevent an injury to themselves or their family, it matters," Peek-Asa said. "Wearing a seat belt, installing a rollover protective structure on your tractor, checking smoke alarms, or even just letting someone know where you are working on the farm so that you can be found quickly if you are injured -- there are a lot of little things you can do. Even better are interventions that can change the environment, such as improvements in the roadway or safer designs for equipment, because these protections work without specific behavior changes."

Peek-Asa's work was supported by the UI Injury Prevention Research Center (IPRC) and by a grant from the National Center for Injury Prevention and Control. Co-authors on the paper included Craig Zwerling, Ph.D., M.D., UI professor of occupational and environmental health and director of the IPRC, and Lorann Stallones, Ph.D., professor of psychology at Colorado State University and director of the Colorado Injury Control Research Center at CSU.

STORY SOURCE: University of Iowa Health Science Relations, 5139 Westlawn, Iowa City, Iowa 52242-1178

MEDIA CONTACT: David Pedersen, (319) 335-8032, david-pedersen@uiowa.edu.