Exposure to agricultural hazards among children who visit farms.

BACKGROUND: Children are commonly injured on farms, yet no studies provide evidence about exposures that leave rural children visiting farms at risk. OBJECTIVES: The objectives of this study were to study (a) how frequently rural nonfarm children are exposed to farms, farm work and associated activities; and (b) the safety conditions and practices on farms being visited. METHODS: A cross-sectional survey was administered in Saskatchewan, Canada to rural parents during 2014. Participation included reports on 458 farms visited by rural children, and then 549 children from 312 families who had been exposed to a farm in the past year. Child-level indicators included age, sex, farm safety education and training, engagement in farm work and play activities and exposure to specific farm safety hazards. Farm-level indicators included self-perceived safety conditions, and child supervision practices. RESULTS: One-third of the children sampled (n=549) had been exposed to a farm in the past year. Safety conditions, practices and supervision varied by demographic subgroup. Farm safety education and agriculture training were most common in the oldest age group (13 to 17 years; 24.7% and 9.2%, respectively) of which 40.8% had worked on a farm previously, averaging 10 hours/week (interquartile range 3 to 20) during summer months. Mechanized and nonmechanized work was observed for children of both sexes and rose with age. Physical hazards were reported both proximally (≤100 yards) and distally (>300 yards) to farm homes. CONCLUSIONS: Children who visit farms are potentially exposed to risk, and these risks increase with age as children take on formal work roles, leaving them vulnerable to farm injury.

Towards a deeper understanding of parenting on farms: A qualitative study.

BACKGROUND: Children living on farms experience exceptionally high risks for traumatic injury. There is a large body of epidemiological research documenting this phenomenon, yet few complementary studies that have explored the deep underlying reasons for such trends. Fundamental to this is understanding the decision-making processes of parents surrounding their choice to bring children, or not, into the farm worksite. OBJECTIVES: To (1) document farm parent views of the risks and benefits of raising children on a family farm, and, (2) understand more deeply why children are brought into the farm worksite. METHODS: Interviews were conducted as part of a larger cohort study, The Saskatchewan Farm Injury Cohort. Subsequent to an initial mail-out question focused on parental decision-making, 11 semi-structured telephone interviews were conducted with rural Saskatchewan farm parents. Interviews were digitally recorded and transcribed verbatim, then thematically analyzed using interpretive description methodology. FINDINGS: This parental decision-making process on farms fundamentally involves weighing the risks vs. benefits of bringing children into the worksite, as if on a balance scale. One side of this scale holds potential risks such as exposure to physical and chemical farm hazards, in the absence of full supervision. The other side holds potential benefits such as meeting family needs for childcare, labour, and family time; building work ethic and pride; and the positive impacts of involvement and responsibility. Decision-making 'tips the scales', in part dependent upon parental perceptions of the risk-benefit trade-off. This 'perceptual lens' is influenced by factors such as: the agricultural way of life, parents' prior knowledge and past experience, characteristics of children, and safety norms. CONCLUSIONS: This novel qualitative study provides deep insight into how Saskatchewan farm parents approach a fundamental decision-making process associated with their parenting. The proposed model provides insight into the etiology of pediatric farm injuries as well as their prevention.

Correction to: Cohort profile: the Saskatchewan Rural Health Study-adult component.

Following publication of the original article [1] the authors notified Production that the names of three authors-Valerie Elliot, Louise Hagel, and Roland Dyck-had been unintentionally omitted in the final online version of the manuscript. The corrected author list is shown in this Correction.

Resilience of Farm Women Working the Third Shift.

BACKGROUND: We examined physical health and work experiences in a Saskatchewan population of farm women, and determined how participation in the "third shift" (a phenomenon where women engage in off-farm employment, farm labor, and as homemakers) relates to their demographic, physical health, and work experiences. MATERIALS AND METHODS: This is a cross-sectional epidemiological study. Reports from 980 women who lived or worked on Saskatchewan farms were analyzed to describe their health status, comorbidities, use of medications, and exposures to farm work. Regression models were used to explore determinants of participation in the third shift. RESULTS: Two hundred and sixteen were women [22.0%] engaged in the "third shift", and these women consistently reported significantly longer mechanized and non-mechanized farm work hours. Compared to women not involved in the third shift, participants in the third shift were more likely to be: 41-50 years of age [ORAdj 2.06 (1.12, 3.77)], and involved in beef cattle production [ORAdj 1.62 (1.05-2.49)], large animal chores [ORAdj 1.66 (1.04-2.66)], use of shovels/pitchforks [ORAdj 1.67 (1.08-2.57)], combine operation [ORAdj 1.72 (1.08-2.74)], and have higher levels of education [e.g., ORAdj 0.46 (0.29-0.72) for high school or less]. Descriptively, reduced engagement in the third shift was associated with "fair or poor" health status [ORCrude 0.32 (0.14-0.76)] and more co-morbidities [e.g., ORCrude 0.50 (0.33, 0.75) for 2 or more versus none reported]. CONCLUSION: This study found that farm women often report high levels of work, including engagement in the third shift. Women engaged in the third shift are also generally healthier than non-engaged women, consistent with a healthy worker effect.

Cohort profile: the Saskatchewan Rural Health Study-adult component.

OBJECTIVES: Less is known about the respiratory health of general farming and non-framing populations. A longitudinal Saskatchewan Rural Health Study (SRHS) was conducted to explore the association between individual and contextual factors with respiratory health outcomes in these populations. Hence, the objectives are to: (i) describe the updated methodology of longitudinal SRHS-an extension of baseline survey methodology published earlier; (ii) compare baseline characteristics and the prevalences of respiratory health outcomes between drops-outs and completers; and (iii) summarize key findings based on baseline survey data. RESULTS: The SRHS was a prospective cohort study conducted in two phases: baseline survey in 2010 and a follow-up in 2014. Each survey consisted of two components, self-administered questionnaire and clinical assessments. At baseline, 8261 participants (≥ 18 years) (4624 households) and at follow-up, 4867 participants (2797 households) completed the questionnaires. Clinical assessments on lung functions and/or allergies were conducted among a sub-group of participants from both the surveys. To date, we published 15 peer-reviewed manuscripts and 40 abstracts in conference proceedings. Findings from the study will improve the knowledge of respiratory disease etiology and assist in the development and targeting of prevention programs for rural populations in Saskatchewan, Canada.

Lung function in relation to farm dwelling and farming activities in rural dwelling children.

BACKGROUND AND OBJECTIVE: The relationship between farming exposures and pulmonary function in a rural paediatric population was evaluated. METHODS: Baseline data collection records of the Saskatchewan Rural Health Study (SRHS), a population-based study, were used. A subset of children (6-14 years old) participated in clinical testing, including anthropometric measures and pulmonary function testing (PFT), using spirometry (n = 584). PFTs followed ATS criteria and all statistical analyses were controlled for age, sex and height. RESULTS: Among clinical testing participants, 47.5% were females and 54.5% were farm dwelling. Of those living on farms, 77.5% were livestock farms. Mean percent predicted value (PPV) for forced expiratory volume in 1 s (FEV1 ) and forced vital capacity (FVC) among children living on a farm were 104.8% and 105.4%, respectively. Mean PPV for FEV1 and FVC among children not living on a farm were 102.7% and 101.4%, respectively. After adjustment, higher FEV1 (=0.079, SE = 0.033, P = 0.03) and FVC (=0.110, SE = 0.039, P = 0.006) were seen among children living on a farm. A trend towards lower FEV1 /FVC ratio (-0.013, SE = 0.008, P = 0.09) among children living on a farm was seen compared with children not living on a farm. Higher FVC and lower FEV1 /FVC ratio were seen in children who regularly emptied grain bins (P < 0.05). Trends towards higher FEV1 (P = 0.14) and FVC (P = 0.08) were also seen with children living on a farm in the first year of life. Since the majority of the population was Caucasian (91%), the results were not race-corrected. CONCLUSION: We addressed the lack of knowledge regarding the association between lung function and rural exposures, and found that differences in lung function were seen between children living on a farm and not living on a farm in rural areas and certain farming activities, specifically emptying grain bins, where lung function was generally better in those living on a farm.

Prevalence, risk factors, and clinical outcomes of atopic and nonatopic asthma among rural children.

BACKGROUND: Because of time and cost constraints, objective classification of atopic and nonatopic asthma has been limited in large epidemiologic studies. However, as we try to better understand exposure-outcome associations and ensure appropriate treatment of asthma, it is important to focus on phenotype-defined asthma classification. OBJECTIVE: To compare atopic and nonatopic asthma in rural children with regard to risk factors and clinical outcomes. METHODS: We conducted a cross-sectional study in rural Saskatchewan, Canada, in 2011. Parents of 6- to 14-year-old children completed a health and exposure survey. Skin prick tests were completed in a subsample of 529 children. Asthma was based physician diagnosis. Asthma status was defined as no asthma, nonatopic asthma, and atopic asthma. RESULTS: Asthma prevalence was 14.7% of which 32.1% of cases were atopic. After adjustment, early respiratory illness and a family history of asthma were predictors of childhood asthma, regardless of atopic status (P < .05). Being overweight and having a dog in the home were associated with an increased risk of nonatopic asthma (P < .05). A mother with a history of smoking increased the risk of atopic asthma (P = .01). Compared with those with nonatopic asthma, in the past 12 months, children with atopic asthma were more likely to report a sneezy, runny, or blocked nose or have shortness of breath (odds ratio >2), whereas those with nonatopic asthma were more likely to have parents who missed work (odd ratio >3). Those with nonatopic asthma had significantly lower forced expiratory volume in 1 second compared w2ith those with atopic asthma. CONCLUSION: Exposures may contribute differentially to atopic and nonatopic asthma and result in differential clinical presentation or burden. The study of these characteristics is important for etiologic understanding and management decisions.

Gender Differences in the Association of Individual and Contextual Exposures with Lung Function in a Rural Canadian Population.

INTRODUCTION: To investigate the association of individual and contextual exposures with lung function by gender in rural-dwelling Canadians. METHODS: A cross-sectional mail survey obtained completed questionnaires on exposures from 8263 individuals; a sub-sample of 1609 individuals (762 men, 847 women) additionally participated in clinical lung function testing. The three dependent variables were forced expired volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. Independent variables included smoking, waist circumference, body mass index, indoor household exposures (secondhand smoke, dampness, mold, musty odor), occupational exposures (grain dust, pesticides, livestock, farm residence), and socioeconomic status. The primary analysis was multiple linear regression, conducted separately for each outcome. The potential modifying influence of gender was tested in multivariable models using product terms between gender and each independent variable. RESULTS: High-risk waist circumference was related to reduced FVC and FEV1 for both genders, but the effect was more pronounced in men. Greater pack-years smoking was associated with lower lung function values. Exposure to household smoke was related to reduced FEV1, and exposure to livestock, with increased FEV1. Lower income adequacy was associated with reduced FVC and FEV1. CONCLUSION: High-risk waist circumference was more strongly associated with reduced lung function in men than women. Longitudinal research combined with rigorous exposure assessment is needed to clarify how sex and gender interact to impact lung function in rural populations.

Impact of sleep on injury risk among rural children.

OBJECTIVES: To examine sleep patterns in a large cohort of rural children and explore the association between sleep patterns and injury occurrence. METHODS: Cross-sectional analyses of the baseline survey from a prospective cohort study (2012 to 2017) was conducted with 46 rural schools in Saskatchewan, Canada who distributed surveys to parents of 2275 rural dwelling farm and nonfarm children aged 0 to 17 years. Parents reported child sleep characteristics and farm or nonfarm injury in the previous calendar year. Multivariable log-binomial regression examined associations between sleep characteristics and injury risk. RESULTS: There was a significant trend of decreasing sleep duration with increasing age (P-trend < 0.001). Short sleep duration on weekdays (RR: 2.14; 95% CI: 1.25 to 3.66) and sleep debt (RR: 1.89; 95% CI: 1.21 to 2.95) increased injury risk in school-age children (7 to 12 years) but not in teens. A nearly fivefold increase in injury risk was identified among school-age children reporting all sleep problems (RR: 4.99; 95% CI: 1.99 to 12.50). Snoring in teens (13 to 17 years), often a symptom of obstructive sleep apnea, was associated with increased injury risk (RR: 1.98; 95% CI: 1.17 to 3.33). There were no statistically significant associations identified between sleep characteristics and injury risk in preschool children. CONCLUSION: Injuries to rural children are an important public health concern. This study highlights the impact of sleep problems on risk for injury among rural children. These findings are discussed in light of the recent American Academy of Pediatrics Technical Report on Insufficient Sleep in Adolescents and Young Adults.

Actual Body Weight and the Parent's Perspective of Child's Body Weight among Rural Canadian Children.

The prevalence of being overweight during childhood continues to increase in the USA and Canada and children living in rural areas are more at risk than their urban counterparts. The objectives of this study were to evaluate how well the parent's perception of their child's weight status correlated with objectively measured weight status among a group of rural children and to identify predictors of inaccurate parental perceptions of child's weight status. Participants were children from the Saskatchewan Rural Health Study conducted in 2010. Self-administered questionnaires were distributed through rural schools to parents of children in grades one to eight. Parents reported their child's height and weight and rated their child's weight status (underweight, just about the right weight, or overweight). Standardized body mass index (BMI) categories were calculated for clinically measured height and weight and for parental report of height and weight for 584 children. Logistic regression analysis was performed to identify predictors of misclassification of the parent's perception of child's weight status adjusting for potential confounders. Clinically measured overweight was much higher (26.5%) compared to parental perceived overweight (7.9%). The misclassification of the child's BMI was more likely to occur if the child was a boy (odds ratio (OR) = 1.58) or non-Caucasian (OR = 2.03). Overweight was high in this group of rural children and parental perception of weight status underestimated the actual weight status of overweight school-age children. Parental reporting of child weight status has implications for public health policy and prevention strategies. Future research should focus on assessing longitudinal effects of parental misperceptions of child's weight status.

Identifying and mitigating risks for agricultural injury associated with obesity.

In some occupational contexts overweight and obesity have been identified as risk factors for injury. The purpose of this study was to examine this hypothesis within farm work environments and then to identify specific opportunities for environmental modification as a preventive strategy. Data on farm-related injuries, height and weight used to calculate body mass index (BMI), and demographic characteristics were from the Phase 2 baseline survey of the Saskatchewan Farm Injury Cohort; a large cross-sectional mail-based survey conducted in Saskatchewan, Canada from January through May 2013. Multivariable logistic regression was used to examine associations between BMI and injury. Injury narratives were explored qualitatively. Findings were inconsistent and differed according to gender. Among women (n = 927), having overweight (adjusted OR: 2.94; 95% CI: 1.29 to 6.70) but not obesity (1.10; 95% CI: 0.35 to 3.43) was associated with an increased odds of incurring a farm-related injury. No strong or statistically significant effects were observed for men (n = 1406) with overweight or obesity. While injury-related challenges associated with obesity have been addressed in other occupational settings via modification of the worksite, such strategies are challenging to implement in farm settings because of the diversity of work tasks and associated hazards. We conclude that the acute effects of overweight in terms of injury do require consideration in agricultural populations, but these should also be viewed with a differentiation based on gender.

Ear Infection and Its Associated Risk Factors in First Nations and Rural School-Aged Canadian Children.

Background. Ear infections in children are a major health problem and may be associated with hearing impairment and delayed language development. Objective. To determine the prevalence and the associated risk factors of ear infections in children 6-17 years old residing on two reserves and rural areas in the province of Saskatchewan. Methodology. Data were provided from two rural cross-sectional children studies. Outcome variable of interest was presence/absence of an ear infection. Logistic regression analysis was conducted to examine the relationship between ear infection and the other covariates. Results. The prevalence of ear infection was 57.8% for rural Caucasian children and 43.6% for First Nations children living on-reserve. First Nations children had a lower risk of ear infection. Ear infection prevalence was positively associated with younger age; first born in the family; self-reported physician-diagnosed tonsillitis; self-reported physician-diagnosed asthma; and any respiratory related allergy. Protective effect of breastfeeding longer than three months was observed on the prevalence of ear infection. Conclusions. While ear infection is a prevalent condition of childhood, First Nations children were less likely to have a history of ear infections when compared to their rural Caucasian counterparts.

Factors Associated With the Prevalence of Prostate Cancer in Rural Saskatchewan: The Saskatchewan Rural Health Study.

PURPOSE: Prostate cancer is the most commonly diagnosed cancer in Canadian males, and it is the third most common cause of cancer-related deaths in men. Some studies suggest that occupational exposure may be associated with prostate cancer. However, the etiology of prostate cancer is ambiguous. The purpose of this study was to assess the rural occupational exposure, including farming, as a determinant of prostate cancer in rural men. We investigated the prevalence of prostate cancer and its putative relationship between rural exposures in the Saskatchewan province of Canada. METHODS: In 2010, a baseline mailed survey was conducted of 11,982 households located in 4 geographic regions (southwest, southeast, northwest, and northeast) of rural Saskatchewan, Canada. The questionnaires collected information on individual and contextual determinants from a rural population of men. In total 2,938 males older than 45 years were included in the logistic regression analysis. FINDINGS: The age-standardized prevalence of prostate cancer was 3.32%. Farm residence was a significant risk factor associated with prevalence of prostate cancer while farming occupation and duration were not. Men who were exposed to insecticides and fungicides together (OR [95% CI] = 2.23 [1.15-4.33], P = .02) at work showed an increased potential risk compared to the nonexposed. The effect of farm/nonfarm residence on prevalence of prostate cancer differed depending on personal smoking history and family history of cancer. CONCLUSION: Workplace exposure to insecticides and fungicides together were statistically significantly associated with prevalence of prostate cancer.

Early farm residency and prevalence of asthma and hay fever in adults.

BACKGROUND: Asthma and hay fever have been found to be both positively and negatively associated with farming lifestyles in adulthood. Lack of congruency may depend upon early life exposure. OBJECTIVE: To assess the importance of different periods of farm residency for asthma and hay fever in an adult Canadian population. METHODS: We conducted a questionnaire survey in rural Saskatchewan, Canada. We assessed a history of asthma and hay fever with five categories of farm residency that were mutually exclusive: first year of life only, currently living on a farm, both first year of life and currently living on a farm, other farm living, and no farm living. Generalized estimating equations were used to adjust for clustering effects of adults within households. RESULTS: Of the 7148 responding, 30.6% had an early farm living experience only, 34.4% had both early and current farm living experiences, while 17.4% had never lived on a farm. The overall prevalence of ever asthma and hay fever was 8.6% and 12.3%, respectively, and was higher in women. Sex modified the associations between ever asthma and hay fever with farm residency variables whereby women had a decreased risk for both asthma [adjusted odds ratio (ORadj): 0.67, 95% confidence interval (CI):0.47-0.96] and hay fever (ORadj: 0.60, 95% CI: 0.44-0.83) with an early farm exposure only. Men currently living on a farm without an early farm exposure had an increased risk for ever asthma (ORadj: 1.82, 95% CI: 1.02-3.24). CONCLUSION: Farm residency in the first year of life shows a protective effect for adult asthma and hay fever that appears to differ by sex.

Prevalence of Musculoskeletal Disorders Among Saskatchewan Farmers.

The extent of the musculoskeletal disorder (MSD) problem is not well understood among Canadian farmers, and little too is known about their epidemiology. The purpose of this study was therefore to (1) determine the prevalence of MSDs among farmers in one Canadian province; and (2) describe the types and severities of these disorders and patterns in their occurrence. This cross-sectional analysis was conducted using baseline survey data from the Saskatchewan Farm Injury Cohort Study. Reports of MSDs, demographic and health-related variables, reports of farm-related injuries, and economic conditions of individual farms were available for 2595 adult participants from 1212 farms in Saskatchewan, Canada. Relationships between MSDs and time spent doing farm work were investigated using tests of association. The participation rate was 48.8%. Most (85.6%) of participants reported having musculoskeletal pain in at least one body part over the past year. The lower back was most frequently affected (57.7%), followed by shoulders (44.0%), and neck (39.6%). More serious pain prevented 27.9% of respondents from performing regular work activities. MSD prevalence did not vary by sex, commodity type, or by total hours of farm work completed; prevalence was significantly (P < .05) related to time spent performing biomechanically demanding tasks such as heavy lifting and working with arms overhead. The most common MSD site in farmers was the low back, followed by the upper and then lower extremities. Although this study aimed to identify high-risk groups, lack of differences between demographic groups suggests that the majority of farmers are at risk for MSDs.

Prevalence and Risk Factors of Respiratory Symptoms in Rural Population.

Research has shown that respiratory symptoms, including chronic cough, chronic phlegm, shortness of breath, and wheeze, are important markers that contribute to hospitalization, lung function decline, and other respiratory illness. This report aims to estimate the prevalence of respiratory symptoms and associated environmental risk factors in farming and nonfarming rural-dwelling people. A baseline mail-out questionnaire to assess respiratory health outcomes as well as individual and contextual determinants in farm and small town cohorts was sent to 11,004 households within four geographical regions of Saskatchewan, Canada, in 2010. Completed questionnaires were received from 4624 households (8261 individuals). Outcome variables examined for this report were chronic cough, chronic phlegm, shortness of breath, and ever wheeze. Clustering effect within households was adjusted using generalized estimating equations. The prevalence of respiratory symptoms was chronic cough, 9.2% (farm vs. nonfarm: 8.1% vs. 10.0%); chronic phlegm, 8.2% (farm vs. nonfarm: 6.7% vs. 9.3%); shortness of breath, 29.1% (farm vs. nonfarm: 25.5% vs. 31.6%); and ever wheeze, 40.6% (farm vs. nonfarm: 38.1% vs. 42.5%). There was a significantly higher prevalence of each respiratory symptomin the nonfarming population compared with the farming population (P < .01). Respiratory symptoms were positively associated with smoking, allergic reaction to inhaled allergens, and other environmental factors for farming and nonfarming populations. The prevalence of respiratory symptoms was higher in the nonfarming rural population compared with the farming rural population. Environmental exposures such as work-related or home environment play an important role in the increased prevalence of respiratory symptoms in farming and nonfarming populations.

The Hierarchy of Control in the Epidemic of Farm Injury.

The application of the hierarchy of control (HOC) is a well-established approach to hazard reduction in industrial workplaces. However, it has not been generally applied in farm workplaces. The objective was to determine current practices of farmers in the context of a modified HOC, and the effect of these practices on farm injury outcomes. A self-reported mail survey of 1196 Saskatchewan farm operations was conducted in 2013. Selected survey questions were used as proxy measures of the farm owner-operator's practices relevant to each of the six steps of increasing importance in a modified HOC: (1) hazard identification; (2) risk assessment; (3) personal protection; (4) administrative controls; (5) engineering controls; and (6) elimination of the hazard. Analysis used basic descriptive statistics and logistic regression to examine associations of interest. When four of the six HOC steps were adhered to, there was a significant protective effect: odds ratio (OR) = 0.32 (95% confidence interval [CI]: 0.14-0.74) for any injury and OR = 0.27 (95% CI: 0.07-0.99) for serious injury in the overall study population. For farm owner-operators utilizing four of the six steps in the modified HOC, there was a significant protective effect for any injury (OR = 0.30, 95% CI: 0.11-0.83). Although there is a considerable absence of use of elements of the HOC among farm operators, for farmers who adhere to these steps, there is a significant reduction in their risk for injury. Prevention strategies that embrace the practice of these principles may be effective in the control of farm workplace injury.

Income adequacy and education associated with the prevalence of obesity in rural Saskatchewan, Canada.

BACKGROUND: Obesity is prevalent in rural communities in Canada, however little is known about the social determinants of health and obesity in rural populations. Socioeconomic status has been found to be inversely associated with the risk of obesity in developed countries. This study investigated the relationship between income adequacy, education and obesity in a rural setting. METHODS: The study used data from 5391 adults aged 18-69 who participated in the Saskatchewan Rural Health Study in 2010. Participants completed a survey that included questions about location of residence, body weight, height, and socio-demographic and behavioral factors. Obesity was defined as body mass index being ≥ 30 kg/m(2). Logistic regression using generalized estimating equation was conducted to assess the associations of income adequacy and education level with the prevalence of obesity taking covariates into consideration. RESULTS: Approximately a third of the participants were obese and the prevalence of obesity was similar for men and women. The prevalence of obesity was significantly higher for rural residents not living on farm compared with those living on farm (p < 0.05). After adjustment for potential confounders, the risk of obesity was increased for those with ≤ 12 years of education compared with those with > 12 years of education (aOR: 1.18; 95% CI: 1.05-1.34). Low income adequacy was significantly associated with an increased risk of obesity but only among those not living on farm (aOR: 1.80; 95% CI: 1.16-2.79). CONCLUSIONS: Home location was associated with obesity prevalence in rural Saskatchewan and modified the influence of income adequacy, but not the influence of education, on obesity. Adults not living on farm had an increased risk of obesity and showed a significant impact of income adequacy on obesity.

A community-based participatory research methodology to address, redress, and reassess disparities in respiratory health among First Nations.

BACKGROUND: To date, determinants of respiratory health in First Nations people living on reserves and means of addressing and redressing those determinants have not been well established. Hence the Saskatchewan First Nations Lung Health Project (FNLHP) is a new prospective cohort study of aboriginal people being conducted in two First Nations reserves to evaluate potential health determinants associated with respiratory outcomes. Using the population health framework (PHF) of Health Canada, instruments designed with the communities, joint ownership of data, and based on the 4-phase concept of the First Nations Regional Longitudinal Health Survey, the project aims to evaluate individual factors, contextual factors, and principal covariates on respiratory outcomes. The objective of this report is to clearly describe the methodology of (i) the baseline survey that consists of two components, an interviewer-administered questionnaire and clinical assessment; and (ii) potential intervention programs; and present descriptive results of the baseline data of longitudinal FNLHP. METHODS: The study is being conducted over 5 years (2012-2017) in two phases, baseline and longitudinal. Baseline survey has been completed and consisted of (i) an interviewer-administered questionnaire-based evaluation of individual and contextual factors of importance to respiratory health (with special focus on chronic bronchitis, chronic obstructive pulmonary disease, asthma and obstructive sleep apnea), and (ii) clinical lung function and allergy tests with the consent of study participants. The address-redress phase consists of potential intervention programs and is currently being rolled out to address-at community level (via green light program and environmental study), and redress-at policy level (via obesity reduction and improved diagnosis and treatment of obstructive sleep apnea) the issues that have been identified by the baseline data. RESULTS: Interviewer-administered surveys were conducted in 2012-2013 and collected data on 874 individuals living in 406 households from two reserve communities located in Saskatchewan, Canada. Four hundred and forty six (51%) females and 428 (49%) males participated in the FNLHP. CONCLUSIONS: The information from this project will assist in addressing and redressing many of the issues involved including the provision of adequate housing, health lifestyle practices, and in planning for health service delivery.

Factors Related to Self-perceived Health in Rural Men and Women.

This study examined self-perceived health status among men and women who live on farms, as well as variations in factors related to negative health status observed by gender. Data were collected in the province of Saskatchewan, Canada, in 2013 through the use of a cross-sectional survey. A multistage sample was developed consisting of farms nested within rural municipalities and then agricultural soil zones. The response rate was 48.8% at the farm level, with a final sample of 2,353 (1,416 men, 937 women) from 1,119 farms. Variables under study included self-reports of health status, as well as demographic, behavioral, and farm operational factors that could influence perceived health status. The analysis was initially descriptive followed by multilevel logistic regression analyses. Self-reports of diagnosed comorbidities were strongly associated with negative health status among both men and women. Daytime sleepiness was more modestly associated with negative health status in both genders. Among men, additional risk factors tended to be functional, and included older age, part-time work status, and binge drinking. Among women, additional risk factors included cigarette smoking, overweight or obesity, and lower levels of education. The study demonstrated that there were both similarities and differences between men and women on farms in the factors related to negative self-perceived health status. These findings should inform the content and targeting of health promotion programs aimed at rural populations.