Mortality from causes other than disease among children is related to accidents, poor quality of and access to health care, and exposure to social problems such as violence and substance abuse. Access to care, given fuller treatment elsewhere in this chapter, plays an important role with regard to timely and appropriate responses of providers to children who have suffered accidental injury. The leading causes of death among all children stem from various accidents and injuries, such as motor vehicle accidents, gun accidents, drowning, burning, suffocation, and poisoning, more than from any other means, including terminal illnesses (Grossman, 2000). Among rural children, farm-related accidents (especially from tractor mishaps) can be especially dangerous. According to DeMuri and Purschwitz (1999), about 100 children die every year from farm-related accidents and another 27,000 suffer injury. Despite knowing the dangers associated with operating farm machinery, farm fathers held ingrained beliefs about the importance of work, farming traditions, and the experiences that a farm boy should have (Lee, Jenkins, & Westaby, 1997). Other researchers found that fatal injuries were 44% higher among rural children than among urban children (Clark et al., 1999).Exposure to social problems (such as suicide, violence, acquired immunodeficiency syndrome) and involvement in risky behavior (drug abuse, alcohol consumption, sex) affect the health of all children and adolescents; these behaviors and suggestions for prevention are well known to researchers (for a summary of 137 studies, see Fahs et al., 1999). For example, suicide rates among rural boys aged 15-19 are higher than among urban boys of the same age (Clark et al., 1999).Violence also knows no boundaries. Since the early 1980s rural adolescents have been increasingly exposed to violent crimes. Gang activity at school is still three times higher in urban schools, but a substantial number of rural youths exhibit fear about violence at school. One in five students fears being attacked at school, and 13% of rural students fear being attacked while traveling to and from school (Bastian & Taylor, 1991).Drugs are widely available: 71% of rural students report that drugs are obtainable at their schools. The drugs of choice among rural youth, however, are alcohol and tobacco. Rural youths report using alcohol while driving, which increases their risk of motor vehicle fatalities. There is also a strong relationship between early age of initiation to use and the likelihood of subsequent misuse of alcohol and other drugs. A study of 374 rural fifth graders by Valois et al. (1998) revealed that 26% of boys and 16% of girls had tried tobacco. In sum, across race and gender, at the end of the first decade of their lives, one fifth to one quarter of youths were at least trying substances associated with some of the most negative health behaviors.Rural adolescents also have higher rates of risky sexual behavior than do their urban counterparts (DiClemente, Brown, Beausoleil, & Lodico, 199...