Helen Murphy-FNP/MHS Director of Outreach Pacific Northwest Agricultural Safety and Health Center

1. Pesticide Effects: Integration into Health Care Provider CurriculaFaculty and Student Champion Training: Part I Helen Murphy-FNP/MHS Director of Outreach Pacific Northwest Agricultural Safety and Health Center University of Washington May 31, 2006

2. Part I: Nurse Murf Rationale Exposure Pathways The Chemicals Health Effects Risk Communication Part II – Dr. Matt Environmental/public health context Diagnosis and treatment Referrals and Reporting Agenda

3. Did you know? • 5 million AG workers at risk for pesticide exposure (U.S. EPA, 1992) • 250-500 physician-diagnosed cases occur per 100,000 agricultural workers (Blondell, 1997). • Migrant and seasonal farmworkers are especially at high risk • 84% of American households used pesticides, most commonly insecticides (Whitmore et al, 1992) • Homeowners use 5-10 lbs/ acre/yr on their lawns and gardens, many times greater than farmers apply to corn and soybean fields (Robinson et al, 1994).

4. Did you know? • Widespread pesticide exposure through non -agricultural sources with use of disinfectants: (e.g., pine oil cleaners, bathroom cleaning products, and cleaning materials for swimming pools). • Non-Ag Sector a concern = pest control, nurseries, greenhouses, and landscaping. • The medical profession uses disinfectants to sanitize and sterilize surfaces and instruments. • Organophosphate and pyrethroid insecticides most implicated for poisonings. • Water chlorination is one of the largest (by tonnage) uses of pesticides.

5. Where Are Pesticides Used? • Forests to control insects and under-story vegetation. • Landscapes, parks, and recreational areas to control weeds, insects, and disease pests • Rights-of-way along railroads and under electric wires to control vegetation • Houses, schools, and commercial and office buildings to control insects, rodents, and fungi • Boat hulls to control fouling organisms;

7. 67% Washington State Pesticide Events - 2003 Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

8. Washington State Source of Case Reports 2002 and 2003 Combined Workman’s Comp Dept of AG Poison Control Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

9. Agricultural vs. Non-Agricultural Cases of Poisonings Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

10. Occupational versus Non-Occupational Cases of Pesticide Poisoning Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

11. Proportion of Poisonings Ranked 8th Cause of Poisonings = 102,754 cases in 2005 (4.2%) Adults Children Source: Watson WA. 2004 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

12. US: Intentional vs. Unintentional Accidental 84% Suicide 8% Out of 196,164 suicide fatalities 7 used pesticides

13. WHO Sentinel Surveillance

14. ROUTES OF EXPOSURE OP’s are readily absorbed: Across the SKIN with skin contact In the lungs with INHALATION of pesticide contaminated air/dust In the gut by INGESTION of pesticide residue on food/dirt/dust Source: EPA Protect Yourself from Pesticides-Guide of Agricultural Workers

15. Where Are Pesticides Used? • Aquatic sites • Wood products • Food preparation areas • Human skin • Household pets • Livestock

16. Non Occupational Pesticide Encounters • Accidental or intentional ingestion • Food and water residues • Contaminated clothing • Treated wood/structures • Residues on animals/carpets • Garden residues • Termite control • Hazardous waste sites/spills

17. Aerial equipment maintenance Agronomists Building maintenance work Emergency responders Entomologists Firefighters Forestry workers Formulating end product Greenhouse- nursery workers Hazardous waste workers Landscapers Livestock dippers and veterinarians Marina workers Medical personnel Park workers Plant pathologists Research chemistry Sewer work Storage/warehouse work Structural application Transporting pesticides Treating contaminated workers Vector control workers Wood treatment workers Work on highway or railroad rights of way Professions Exposed to Pesticides

18. Agriculture Pesticide Applications aerial Boom sprayer enclosed cab back pack-wand air blast sprayer

19. Agriculture Jobs mixer loader orchard thinner flagger picker

20. Agriculture Worker Risk Factors • Indonesia: • Cocktail mixture of multiple products • Spray frequency • Skin contact > wet clothing • Use of toxic products (1a/Ib, II) • Washington state: • Baseball caps? • Facial exposure – poor fitting masks? • Contaminated hands: urinating/eating? • Improper decontamination?

21. Children Are More Vulnerable To Pesticides • GREATER EXPOSURE • Hand to mouth behaviors • SKIN contact with floors and lawns • Lighter less clothing • Eat and drink more per weight • GREATER ABSORPTION •  Breathing rates •  Heart rates •  Skin surface/weight • GREATER SENSITIVITY • Sensitive developing organs • Less ability to detoxify

22. Children’s Exposure Children have twice the amount of pesticide by-products in their urine as adults. What behaviorsin young children that would explain this?

23. Behaviors • Hand to mouth: Taste their environment • Near the ground: Spend more time on the ground • Outdoors: Spend more time outside • Diet: consume more per weight (water and fruits)

24. Behavior: soil ingestion G. Selevan. EHP 2000;108 Suppl 3:451-455

25. Diet • Drinks 2 x more water per their weight than an adult • Eats 12x more apples per their weight than an adult

26. Biology: dermal & dietary dose G. Selevan. EHP 2000;108 Suppl 3:451-455

27. Pesticides in Urine of 22 ChildrenBefore, During, and After Organic Diet Intervention Organic diet Conventional diet Conventional diet Lu et al. 2005 Environ Health Perspect on-line

28. Maria’s husband is an applicator but his blood test (cholinesterase monitoring program) is normal. She likes to take her baby with her when she picks him up from work but was advised against this. She cannot understand why being around pesticides would be a problem for her baby when her husband who had direct contact is fine. Children’s Biologic Vulnerability What is it about a child’s body that would make it more vulnerable than an adult?

29. Child’s Biological Factors • Higher metabolic rate • More skin per body weight • Developing organs

30. Biology- Higher Dose By: • Skin • More permeable: highest at birth • 2.7 x more skin surface/weight than adults • Lungs • Inhales more per day (1.7x) than adult

31. Biology: inhalation dose

32. Vulnerability to Health Effects: Organs Still Developing “A little kid goes from a single cell to a laughing, sociable, intelligent, friendly human being over the course of two years. That’s dramatic growth and development!” Kenneth Olden, PhD, former Director, National Institute of Environmental Health Sciences

33. Ramon and Rosa’s 3 year old has small amounts of OP’s in his urine (he was recruited for a PNASH study). They are asking you how this could occur. The family live 5 miles from the closest orchard. Parent Activities Why is this? What things are the parents doing that would account for this? What questions will you ask and what things will you look for in the household

34. Sources – Child-Pesticide Encounters

35. Proximity Data from Agricultural Washington StatePNASH Center Research

36. Parental Take-Home

37. Parent Activity Questions • Source of food and water • Parent occupation? • Shower after working before holding children? • Work clothes and shoes in the house? • Laundry practices ? • Use household pesticides ? • Garden pesticides ? • House and car cleaning ? • Pesticide storage? • Location of day care? • House near fields?

38. Key Household Safety Points “ Partly Trained Gorillas Always Run Down Streets Doing Cartwheels” • Proximity • Take home • Garden • Animals • Recycle • Decant • Storage • Disposal • Child play/daycare pesticide

39. Pesticide ‘cide = to kill Disinfectants Fumigants

40. Pesticide Chemical Families-grouping based on similarities- • Similar chemically (similar structure) • Attacks pests in a similar way (toxicity) • Common treatment + antidote Pyrethroid PY Organophosphate OP Carbamate C Organochlorine OC Chlorophenoxy Paraquat Diquat

41. Pesticide Sample Label • Type of pesticide (used for?) • Company name • Brand name • Common/generic name (active ingredient) • Chemical family (? atropine under 1st aid) • Signal word (hazard level)

43. Pesticide Classification Table

44. Exercise: Classifying Pesticides Pesticide Labels Bayer Temik Aldicarb Insecticide Carbamate Danger-poison la Verdicon Sevin Carbaryl Insecticide Carbamate Caution ll UCP Alliance Thiodan Endosulfan Insecticide Organochlorine Warning ll Bayer Guthion Azinophos methyl Insecticide Organophospate Danger-poison lb Dow Dursban Chlorpyrifos Insecticide Warning ll Organophospate Syngenta Gramoxone Paraquat Herbicide Paraquat Danger-poison ll Helena Weed Rhap 2, 4-D Herbicide Chlorophenoxy Danger ll DuPont Asana Esfenverlate Insecticide Pyrethroid Warning lV Bayer Captan Captan Fungicide Danger-poison II Max Roundup Glyphosate Herbicide Caution U-IV Fungicide Mancozeb Dow U-IV Caution Dithane Cerexagri-Nisso III Ziram Fungicide Ziram Danger

45. How toxic is it? Source: Richards, Kerry Penn State University Extension Service

46. Source: Richards, Kerry Penn State University Extension Service

47. LD50 Lethal dose = Amount of chemical it takes to kill 50% of an experimental population

48. Source: Richards, Kerry Penn State University Extension Service

49. * * DANGER/POISON = extremely toxic by ingestion DANGER = extremely toxic high potential for skin and eye irritation Adapted from Richards, Kerry Penn State University Extension Service

50. Source: Richards, Kerry Penn State University Extension Service