Introduction

Injury research control and prevention in US Public Health Service (PHS) Region VIII poses unique challenges. PHS Region VIII includes the western and midwestern states of Colorado, Wyoming, Montana, Utah, South Dakota, and North Dakota (Figure 1).

Figure 1. US Public Health Service Regions

Rural Injuries and Public Health Service Region VIII

Injury prevention and control in US PHS Region VIII poses unique challenges. PHS Region VIII includes the following states: Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming (see Figure 1). 

Nationally, age-adjusted unintentional injury death rates are higher as counties become less urban (Eberhardt et al., 2001).  For males the death rate was 86% higher in the most rural counties compared with urban counties and for females the death rate was 80% higher (Eberhardt et al., 2001).    Unintentional injury death rates were especially high in the West with very high death rates among Hispanics and American Indians in nonmetropolitan counties in the West (Eberhardt et al., 2001).  Higher rural injury death rates have been attributed to motor vehicle crashes (Peek-Asa et al., 2004; Coben et al., 2006), traumatic occupational fatalities (Peek-Asa et al., 2004), residential fires (Peek-Asa et al., 2004), and delay in receiving trauma care (Peek-Asa et al. 2004).  Nonfatal injury rates have also been reported to be higher among rural residents compared with urban residents (Leff et al., 2003).  Traumatic brain injuries, which have been reported to be associated with death and disability (Eberhardt et al., 2001) are also higher in rural compared with urban counties (Gabella et al., 1997).

The population density in the six states in USPHS Region VIII is lower than the United States average (Table 1).  The region includes much of the Northern Rocky Mountains and a large winter and summer tourism industry.  Recreational activities associated with tourism not only produce unique hazards but also logistical problems due to remoteness with which injury control and trauma professionals must deal.  These problems are reflected in injury rates shown in Table 1.

Table 1: Selected characteristics of Public Health Service Region VIII by state

References:
Coben JH. (2006). Contrasting rural and urban fatal crashes: Scenic beauty or dead at the scene?  Annals of Emergency Medicine 47(6):574-576. 

Eberhardt MS, Ingram DD, Makuc Dm et al. (2001).  Urban and rural health chartbook.  Health, United States, 2001.  Hyattsville, MD.  National Center for Health Statistics.

Gabella B, Hoffman R, Marine W, Stallones L. (1997).  Urban and rural traumatic brain injuries in Colorado.  Annals of Epidemiology. 7:207-212.

Leff M, Stallones L, Keefe T, Rosenblatt R, Reeds M. (2003).  Comparison of urban and rural nonfatal injury: The results of a statewide survey.  Injury Prevention. 9:332-337.

Peek-Asa C, Zwerling C., Stallones L. (2004).  Acute traumatic injuries in rural populations.  American Journal of Public Health.  94(10):1689-1693.