The SRHS is a large, prospective cohort study based on a modified conceptual framework of the PHF that was successfully used as a framework for a related injury cohort study . The purpose of the SRHS is to test the hypothesis that rural environments, as determinants of health, are associated with respiratory outcomes in farming and non-farming rural people. To our knowledge, no other Canadian study has been conducted to investigate the health determinants of respiratory health among rural people in this manner. Hence, the results of this study will contribute to understanding the health determinants of respiratory health status among rural farming and non-farming people. The complex methodological approach used in this study captured many factors associated with variability found in rural populations. Appropriate statistical methods that account for the nested and hence clustered nature of the sampling design (individuals nested within households, nested within RMs) will be utilized to test the major hypothesis for four primary respiratory health outcomes: chronic bronchitis, asthma, COPD, and lung function measurements. Based on our preliminary findings, quadrant level, location of home (farm versus non-farm) and sex will be examined in all future analyses.
This manuscript reports the results derived from the baseline data on farming and non-farming adults. The statistical analyses were conducted to compare demographic characteristics, individual and contextual factors, and important covariates among farming and non-farming people. As shown in Additional file 3 Table S3 non-farming residents were significantly older than farming residents in rural Saskatchewan. Fifty-two percent of residents were males in farming locations compared to 47.2% male residents in non-framing locations. Significantly higher number of farm residents were either married or lived as a common-law, or living together compared to non-farming residents. No difference was observed in the BMI distribution between farming and non-farming residents.
Compared to non-farming residents, a higher proportion of farming residents reported to be in excellent or very good health. A higher proportion of co-morbid conditions (diabetes, heart disease, heart attack, hardening of the arteries, high blood pressure, cancer) were observed in non-farming population.
There is limited literature available for comparison of our results and the definitions of farm and non-farm residents vary. The Wisconsin Rural Women’s Health Study reported that the prevalence of current smoking was significantly higher among non-farm women residents . Also, the same study reported that the prevalence of hypertension and obesity was significantly higher among farm women residents . In contrast to that for both men and women, we observed significantly higher prevalence in current smoking in the non-farm residents. Both non-farm men and women in our study reported significantly higher prevalence of obesity and co-morbid conditions including diabetes, heart disease, high blood pressure, lung disease and cancer.
The Iowa farm and non-farm household study reported greater pesticides exposure among farm residents compared to non-farm residents . Another study of children of Iowa farmers and non-farmers reported a significantly higher pesticide exposure among farm children . We also observed that a higher proportion of farm residents were ever exposed to pesticides (herbicides, fungicides and insecticides). Also significantly a higher proportion of farm-residents applied pesticides inside their homes compared to non-farm residents.
We observed that farm residents had a significantly higher household income level compared to non-farm residents. Similar to this Stiefelmeyer reported that on an average, total farm family income exceeds that of rural non-farm counterparts in Canada .
A study examining the importance of place of residence on use of health services observed that nonmetropolitan elderly, both farm and non-farm, make fewer physician visits than do their metropolitan counterparts . Also they reported significantly fewer physician visits for nonmetropolitan farm residents compared to nonmetropolitan non-farm residents . In our study we found no differences in physician visits between farm and non-farm residents.
Strengths and limitations of the SRHS
There are several major strengths to this study. A large sample size will provide adequate statistical power to test the major statistical hypothesis and several secondary hypotheses to investigate various etiologies of respiratory health, as evident in our descriptive analyses presented here. Extensive information has been obtained on individual and contextual factors and important covariates via self-administered mail-out questionnaires and clinical and allergy tests on a self-selected group of study participants. The population studied live in widespread locations in the four quadrants of the province representing a wide range of geographical areas in Saskatchewan. Hence a mail questionnaire survey was the best option for us. Other authors have discussed this issue and they have concluded that with the increasing cost of interviewing, a mail questionnaire surveys in widely spread geographical areas was the best [37, 57]. Our team consists of researchers from multi-disciplinary areas bringing a comprehensive set of perspectives on the topic of respiratory health in two rural cohorts.
One of the limitations of our study is that the rural areas examined have either no metropolitan influence zone (MIZ), or weak or moderate MIZ. There was no RM or small town with a strong MIZ. This indicates that our study population may not be representative sample of Saskatchewan rural population. Therefore, it is necessary to be cautious in generalizing our results related to the respiratory health outcomes (based on future analyses) to the entire Saskatchewan rural population. However, we may be able to generalize our results for rural areas with no, weak, or moderate MIZ.
Since Saskatchewan remains a considerably rural province, the information resulting from this project will assist in prevention programs and in planning for respiratory health service delivery to rural areas. Identification of factors that promote health and prevent disease in rural populations will help to inform strategies used to improve disease outcomes, including more effective public education programs and more rationally conceived health services delivery strategies. The findings from this study will help to inform policy in Saskatchewan at the Regional Health Authorities level, in addition to helping shape and determine national and provincial health services priorities.
Future directions of the SRHS
Phase 2, which will commence in 2014, will consist of a longitudinal survey follow-up of individuals who participated in the baseline survey. In order to maintain the high retention rate in our follow-up study, we will be in touch with the study populations, and RM and small town councilors via regular local newsletters, local newspapers, presentation of results at RM and small town council meetings, the project website (under construction) and other effective communication media.
The longitudinal component will consist of a follow-up questionnaire through which we will acquire data on principal individual and contextual factors of importance to respiratory health in farming and non-farming rural people in Saskatchewan, and clinical studies of principal lung function measurements and allergy tests as outlined above for the baseline survey. In our future articles, based on the Population Health Framework , we will test the overall hypothesis that rural environments as determinants of health are associated with respiratory outcomes in rural people.