Objectives: To identify the incidence, severity, and potential risk factors for sports/recreational injuries incurred by children and adults in a five state, rural, Midwest, agricultural household population. Methods: Computer assisted telephone interviews that included questions about all injuries were completed for eligible, participating households for 1999; 16 538 people participated, including 8488 children less than 20 years of age. Rates and 95% confidence intervals were calculated, and causal models guided multivariate models. Results: Of a total of 2586 injuries, 1301 (50%) were not related to agricultural activity. Among these, 733 (28%) were associated with sports/recreational activities including multiple person sports (64%), general play activities (19%), and single person sports (14%). The overall rate was 46.4 injury events per 1000 persons per year. Rates for children were 99.4 for boys and 64.3 for girls. For adults (aged 20 and above), rates were 11.9 for men and 4.8 for women. For children, 93% received health care, 44% were restricted for seven or more days, and 18% lost agricultural work time of seven or more days; the respective proportions for adults were 88%, 45%, and 17%. Multivariate analysis for children showed increased risks for Nebraska residents, males, and those 10-14 or 15-19 years. For adults, increased risks were identified for males and those 20-24 years; decreased risks were observed for Nebraska residents and those 45-54 years. Conclusions: Sports/recreational activities are an important source of injury with relevant consequences for this population, including significant restricted daily activity and lost agricultural work time. Key findings provide a basis for further study to address these burdens.