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Julia F. Storm, MSPH North Carolina State University

Understanding the Agricultural Health Study Educational Resources for Pesticide Safety Educators and the Agricultural Community. Julia F. Storm, MSPH North Carolina State University Department of Environmental & Molecular Toxicology. Resources. summarize first 12 years (’93-’04)

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Julia F. Storm, MSPH North Carolina State University

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  1. Understanding the Agricultural Health StudyEducational Resources for Pesticide Safety Educatorsand the Agricultural Community Julia F. Storm, MSPH North Carolina State University Department of Environmental & Molecular Toxicology

  2. Resources • summarize first 12 years (’93-’04) • 3-part publication series • Overview, Pesticide Exposure, Health Findings • PowerPoint presentation* • On-line course for health providers • Web site: extension.tox.ncsu.edu

  3. Understanding the Agricultural HealthStudy Part 1: Overview • Long-term health study • certified pesticide applicators and farm families • Iowa and North Carolina • Overview • Who • What • When • Where • Why • How

  4. are associated with Disease? What Exposures

  5. Agricultural Health StudyScientists • National Cancer Institute • National Institute ofEnvironmental Health Sciences • US Environmental Protection Agency • University of Iowa College of Public Health • Battelle Centers for Public Health Research and Evaluation (North Carolina) • National Institute for Occupational Safety and Health

  6. Agricultural Health Study Participants • Certified pesticide applicators and farmers’ spouses (89,658) • North Carolina: • Farmers (20,518) • Spouses (10,576) • Iowa: • Farmers (31,877) • Spouses (21,771) • Commercial applicators (4,916)

  7. Participants Reflect Agricultureof Iowa . . . • Farmers: white males • Farm Size: 75% > 500 acres • Crops/Livestock • Corn, Soybeans • Hogs • Commercial applicators • Younger than farmers • Landscape, highway weed control, agricultural

  8. . . . and North Carolina • Farmers • Mostly male • 3% African-American • Farm Size: 55% <200 acres • Diverse Crops/Livestock

  9. Agricultural Health StudyFemale Participants • 3% of Pesticide Applicators are women • Farm wives: • Active in farm work(51%) • Mixed orapplied pesticides(40%)

  10. Health Pluses for Farmers: Live longer Lower death rate from heart disease Lower death rate due to some cancers: Lung Esophagus Bladder Colon Potential Health Problems for Farmers: Higher risk of injury Risk of lung disease(not lung cancer) Skin conditions Higher rates of certain cancers Other: immune, nervous, reproductive system Previous Studiesof Agriculture and Health

  11. 5 4 3 2 Questions 1 Answers 6 MoreQuestions Scientists Navigate a Maze of Information 7

  12. 1 - Enroll volunteers into the study • During 1993-1997 • Applicators • At pesticide safetytraining classes • Spouses of farmers • At home

  13. 2 – Survey participants • Farm work related • Environmental

  14. 2 – Survey participants • Lifestyle • Medical history

  15. 3 – Estimate pesticide exposure • Develop exposure formula • Test formula in real world • Measure pesticide exposure >on 100 farms

  16. 4 – Collect a genetic sample • Rinse and spit • Mouthwash rinses cells from mouth • Cells contain DNA • Sample used in laboratory studies

  17. 5 – Collect health data from databases • Cancer registries • Iowa • North Carolina • Death certificate • State • National

  18. Non-users of General Population Applicators Spouses Pesticide X Users of Pesticide X 6 – Analyze the information • Long-term follow-up: Cancer rate ratios

  19. Cases Controls 6 – Analyze the information • Case-control study: identify disease risk factors (Don’t have disease) (Have disease)

  20. 6 – Analyze the information • Cross-sectional studies • Explore associations • Laboratory studies of DNA • Explore disease mechanisms and genetic role

  21. 5 2 6 Answers More Questions 7 – Update Information • Repeat Steps • 2: Survey participants • 5: Collect health database info • 6: Analyze information

  22. Study Timeline 1993–1997 Recruit &survey participants 1998–2003 Field test exposure estimates; Collect genetic sample 2004–2008 Assess disease rates & risk factors 2009–2013 Evaluate disease mechanisms

  23. Understanding theAgricultural HealthStudyPart 2: Pesticide Exposure • High Pesticide Exposure Events • Pesticides of Interest • Estimating Exposure to Applicators • Measuring Pesticide Exposure

  24. High Pesticide Exposure Events (HPEE) • 14% of applicators reported HPEE • Risk factors • Repair application equipment • Delay in changing/washing • Characteristics • Mix pesticide/family wash • Believe farming is highly risky • Farm in financial stress

  25. Medical Visits for Pesticide Exposure • 7% of applicators • 3,733 medical visits • Risk Factors: • Use insecticides and fumigants vs. herbicides • Mix pesticides more than 50% of the time • Repair own equipment

  26. African-American Farmers • Reported • Less pesticide use, fewer high exposure application methods • More PPE use (except chemically-resistant gloves) • Fewer health symptoms

  27. Pesticides of Interest • First survey: 50 crop/livestock pesticides • 40 Current-Use Pesticides • 16 insecticides, 16 herbicides, 6 fungicides, 2 fumigants • 10 Historical-Use Pesticides • Follow-up surveys: all pesticides used in previous season

  28. Top 11 Pesticides Used 1993-97

  29. None Low Medium High Estimating Pesticide Exposure:A New Approach Lifetime Applicator Pesticide Exposure = Pesticide application days/year X Years of pesticide use X Average Work-Day Exposure Score

  30. Mix (0,3,9) + Apply (1-9) + Repair (0,2) Average Work-Day Exposure Score (0–20) = X PPE (0.1-1)

  31. Iowa Example: 2,4-D Exposure • Farmer “Bill” grows 1000 acres corn • Applies 2,4-D to control weeds after plant emergence using boom sprayer

  32. Iowa Example: Bill’s 2,4-D Average Work-Day Exposure

  33. North Carolina Example: Chlorpyrifos Exposure • Farmer “Fred” grows 300 acres peanuts • Applies granular chlorpyrifos forsouthern corn rootworm

  34. NC Example: Fred’s Chlorpyrifos Average Work-Day Exposure

  35. Iowa and NC Examples: Lifetime Exposure • Iowa Corn Farmer Bill’s” Lifetime2,4-D Exposure=5.6 X 10 days/year X 15 years=840 • NC Peanut Farmer“Fred’s” Lifetime Chlorpyrifos Exposure=7.2 X 3 days/year X 10 years = 216

  36. Average Work-Day NC: 7.6 Farmers: 6.5 IA: 6.0 “Bill” 5.6 Commercial: 5.1 Lifetime Commercial: 1692 NC: 1249 IA: 1116 Farmers: 1096 “Bill” 840 2,4-D Exposure in the AHS

  37. Testing the Formula byMeasuring Pesticide Exposure • >100 farms; 8 scenarios • 2,4-D and chlorpyrifos • Before, during, after application • Personal air (applicator) • Dermal patch (applicator) • Urine (applicator, spouse, children) • Results being compiled by EPA

  38. Use of PPEGood News/Bad News • Chemically-resistant glove use doubled from 1980’s to 1990’s in NC • 21% vs. 46% • PPE use greater inIowa, exceptrespirators • Never use PPE • 4% (Iowa) • 18% (NC)

  39. Understanding theAgricultural HealthStudyPart 3: Health Findings • Cancers • Nervous system • Respiratory system • Reproductive health

  40. General Population Applicators Spouses Cancer Incidence Compared to General Population • Overall cancer rate lower • Rates for 19 of 20 cancers lower

  41. Cancer Incidence Compared to General Population • Prostate cancer elevated (14%) in male pesticide applicators • Associated with • Methyl bromide (dose-response) • Chlorinated pesticides (in men over 50) • Some pesticides (in men with a family history of prostate cancer) • Skin melanomas elevated (50%) in farmer’s wives

  42. Alachlor Atrazine Carbofuran Chlorpyrifos Glyphosate Non-users of Pesticide X Users of Pesticide X Cancer Evaluations Among Users of Certain Pesticides

  43. Pesticide-Cancer Results

  44. Other Cancers Evaluated • Lung cancer in applicators • Some evidence of association with metolachlor, pendimethalin, chlorpyrifos, diazinon • No association with 46 other pesticides • Breast cancer in farmer’s wives • No clear association with any of 50 pesticides used or with indirect exposure

  45. Childhood Cancer Interpret with Caution • 17,000 Children of Iowa Applicators • Slightly increased rates of • All childhood cancers • All lymphomas • No association with parental pesticide application • Increased odds for children of parents not using chemically resistant gloves

  46. Health Findings: Respiratory • Pesticides associated with wheeze • paraquat, EPTC, parathion, malathion, chlorpyrifos, atrazine and alachlor • Fogging and misting animals • Other exposures associated with wheeze • Diesel tractors • Frequent solvent use • Animal production associated with wheeze • Poultry (eggs), dairy • Farmers who do daily vet procedures

  47. Nervous System Health • Retinal degeneration in fungicide users(fruit growers) • In NC and Iowa • Dose-response trend • Also seen in spouses

  48. Nervous System Health • Result of cross-sectional study • Neurologic symptoms associated with exposure to • Insecticides (dose/response) • Strongest association with OP’s and OC’s • Fumigants • Ongoing case-control study of Parkinson’s disease

  49. Female Applicators Farmer’s Wives (Pesticide Users) Farmer’s Wives (Non-Users) Female ReproductiveHealth Findings • Pesticide users • Longer menstrual cycles • Increased odds of missed periods • Users of hormonally-active pesticides • Increased odds of long cycles, missed periods, intermenstrual bleeding

  50. When is there enough evidence to movefrom Association to Cause?

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