Journal of Agromedicine, 20:178–187, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 1059-924X print/1545-0813 online DOI: 10.1080/1059924X.2015.1010063
Factors Related to Self-perceived Health in Rural Men and Women William Pickett,1,2 Nathan King,1 Catherine Trask,3 Valerie Michaelson,4 Barbara L. Marlenga,5 Louise Hagel,3 and James A. Dosman,3 for the Saskatchewan Farm Injury Study Team 1 Department
of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada 3 Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada 4 School of Religion, Queen’s University Kingston, Ontario, Canada 5 Marshfield Medical Research Foundation, Marshfield, Wisconsin, USA
2 Department
ABSTRACT. 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.
KEYWORDS. Farm, gender, gender identity, health status, risk perceptions, rural health, social determinants of health
The Saskatchewan Farm Injury Cohort Study Team (Phase 2) consists of William Pickett and James Dosman (co-principal investigators), Louise Hagel, Robert Brison, Andrew Day, Joshua Lawson, Catherine Trask, Barbara Marlenga, Lesley Day, Niels Koehncke, and Donald C Voaklander. Address correspondence to: William Pickett, Department of Public Health Sciences, Queen’s University, Carruthers Hall, 2nd Floor, Kingston, ON K7L 3N6, Canada (E-mail: [email protected]). 178
Pickett et al.
INTRODUCTION Self-rated perceptions of personal health status are important indicators of health, morbidity, and mortality.1,2 Even after taking objective measures of health into account, these perceptions have been shown to predict future health complications,3 functional decline,4,5 use of medical services,6 and recovery times following illness.7 Interventions aimed at improving perceptions of health, whether through addressing health behaviors or by improving knowledge, have the potential to improve health outcomes. Knowledge of factors that are potential determinants of perceived health status could inform such interventions. One such factor is gender. Variations in disease outcomes are reported by gender for almost all populations and contexts.8 Such variations also exist for contextual hazards that can lead to disease,9,10 and for engagement in behavioral risks.11 Likewise, men and women differ in terms of how they form perceptions of their own health.12−14 Understanding of such differences and how health perceptions arise within specific settings could inform health promotion efforts that are tailored to men and women, separately. To our knowledge, no one has studied these issues specifically in rural contexts. Our research group has a longstanding interest in the health of rural populations. To that end, we have developed an ongoing study to examine health, safety, and their determinants among farmers and their families.15 In the current analysis, we therefore used this opportunity and context to explore perceptions of health and factors that influence their origins by gender. Factors available as predictors of perceived health status included demographic factors, measures of disease and functional health, health risk behaviors, and farm operational variables. If genderspecific differences emerged, this would present new information that could address the unique health promotion of men and women in rural farm settings.16,17
179
METHODS Sample The Saskatchewan Farm Injury Cohort Study (SFIC) was initiated in 2007. Its Phase 1 study was conducted from 2007 to 2012,15 with a subsequent Phase 2 ongoing. Both phases involved periodic surveys of farms that were purposefully sampled from across Saskatchewan. The baseline Phase 2 sample included farms from Phase 1 that agreed to ongoing participation (n = 588) as well as farms (n = 628) from a set of municipalities that were new entrants to the cohort, for an overall sample size of 2,849 individuals (1,416 males, 937 females) dwelling or working on 1,216 farms (48.8% response rate). The Phase 2 baseline survey was administered by mail from January through April 2013 and completed by a single informant on each farm. Data collection followed the Dillman total design method approach.18 The intention of the survey was to obtain a large and heterogeneous, although not necessarily representative sample of Saskatchewan farms in order to study patterns of health as well as relations between health outcomes and their possible determinants. Methods for data collection were similar across both phases of the study and most questions used in Phase 1 were retained in Phase 2. The Phase 2 questionnaire was, however, modified to include additional items that were central to our study objectives (daytime sleepiness, smoking status, height and weight [body mass index, BMI], and self-perceived health status). Human subject requirements were approved by the Behavioural Research Ethics Board, University of Saskatchewan. Inclusion criteria were (1) participation in the Phase 2 SFIC baseline survey (active operating farm in the province of Saskatchewan as of January 1, 2013); and (2) responses to questionnaire items assessing self-perceived health status, gender, and a variety of possible determinants of health status.
180
PERCEPTIONS OF HEALTH IN A RURAL POPULATION
Variables for Study Perceived health status was rated using an internationally validated scaled item with five possible responses.3 In order to provide sufficient cell sizes for stable estimation, a dichotomous variable was created (positive—“good,” “very good,” or “excellent” versus negative— “poor” or “fair”). Gender was indicated by whether each participant self-identified as either “male” or “female.” Demographic variables used in our predictive modeling included age (in years); highest level of formal education completed (“less than high school,” “high school,” “university,” “technical/community college”)19 ; and hours of farm and off-farm work averaged over the full year (“none,” “part-time” [
Factors Related to Self-perceived Health in Rural Men and Women William Pickett,1,2 Nathan King,1 Catherine Trask,3 Valerie Michaelson,4 Barbara L. Marlenga,5 Louise Hagel,3 and James A. Dosman,3 for the Saskatchewan Farm Injury Study Team 1 Department
of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada 3 Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada 4 School of Religion, Queen’s University Kingston, Ontario, Canada 5 Marshfield Medical Research Foundation, Marshfield, Wisconsin, USA
2 Department
ABSTRACT. 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.
KEYWORDS. Farm, gender, gender identity, health status, risk perceptions, rural health, social determinants of health
The Saskatchewan Farm Injury Cohort Study Team (Phase 2) consists of William Pickett and James Dosman (co-principal investigators), Louise Hagel, Robert Brison, Andrew Day, Joshua Lawson, Catherine Trask, Barbara Marlenga, Lesley Day, Niels Koehncke, and Donald C Voaklander. Address correspondence to: William Pickett, Department of Public Health Sciences, Queen’s University, Carruthers Hall, 2nd Floor, Kingston, ON K7L 3N6, Canada (E-mail: [email protected]). 178
Pickett et al.
INTRODUCTION Self-rated perceptions of personal health status are important indicators of health, morbidity, and mortality.1,2 Even after taking objective measures of health into account, these perceptions have been shown to predict future health complications,3 functional decline,4,5 use of medical services,6 and recovery times following illness.7 Interventions aimed at improving perceptions of health, whether through addressing health behaviors or by improving knowledge, have the potential to improve health outcomes. Knowledge of factors that are potential determinants of perceived health status could inform such interventions. One such factor is gender. Variations in disease outcomes are reported by gender for almost all populations and contexts.8 Such variations also exist for contextual hazards that can lead to disease,9,10 and for engagement in behavioral risks.11 Likewise, men and women differ in terms of how they form perceptions of their own health.12−14 Understanding of such differences and how health perceptions arise within specific settings could inform health promotion efforts that are tailored to men and women, separately. To our knowledge, no one has studied these issues specifically in rural contexts. Our research group has a longstanding interest in the health of rural populations. To that end, we have developed an ongoing study to examine health, safety, and their determinants among farmers and their families.15 In the current analysis, we therefore used this opportunity and context to explore perceptions of health and factors that influence their origins by gender. Factors available as predictors of perceived health status included demographic factors, measures of disease and functional health, health risk behaviors, and farm operational variables. If genderspecific differences emerged, this would present new information that could address the unique health promotion of men and women in rural farm settings.16,17
179
METHODS Sample The Saskatchewan Farm Injury Cohort Study (SFIC) was initiated in 2007. Its Phase 1 study was conducted from 2007 to 2012,15 with a subsequent Phase 2 ongoing. Both phases involved periodic surveys of farms that were purposefully sampled from across Saskatchewan. The baseline Phase 2 sample included farms from Phase 1 that agreed to ongoing participation (n = 588) as well as farms (n = 628) from a set of municipalities that were new entrants to the cohort, for an overall sample size of 2,849 individuals (1,416 males, 937 females) dwelling or working on 1,216 farms (48.8% response rate). The Phase 2 baseline survey was administered by mail from January through April 2013 and completed by a single informant on each farm. Data collection followed the Dillman total design method approach.18 The intention of the survey was to obtain a large and heterogeneous, although not necessarily representative sample of Saskatchewan farms in order to study patterns of health as well as relations between health outcomes and their possible determinants. Methods for data collection were similar across both phases of the study and most questions used in Phase 1 were retained in Phase 2. The Phase 2 questionnaire was, however, modified to include additional items that were central to our study objectives (daytime sleepiness, smoking status, height and weight [body mass index, BMI], and self-perceived health status). Human subject requirements were approved by the Behavioural Research Ethics Board, University of Saskatchewan. Inclusion criteria were (1) participation in the Phase 2 SFIC baseline survey (active operating farm in the province of Saskatchewan as of January 1, 2013); and (2) responses to questionnaire items assessing self-perceived health status, gender, and a variety of possible determinants of health status.
180
PERCEPTIONS OF HEALTH IN A RURAL POPULATION
Variables for Study Perceived health status was rated using an internationally validated scaled item with five possible responses.3 In order to provide sufficient cell sizes for stable estimation, a dichotomous variable was created (positive—“good,” “very good,” or “excellent” versus negative— “poor” or “fair”). Gender was indicated by whether each participant self-identified as either “male” or “female.” Demographic variables used in our predictive modeling included age (in years); highest level of formal education completed (“less than high school,” “high school,” “university,” “technical/community college”)19 ; and hours of farm and off-farm work averaged over the full year (“none,” “part-time” [
