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Prepared by Julia F. Storm, MSPH North Carolina Cooperative Extension

Prepared by Julia F. Storm, MSPH North Carolina Cooperative Extension North Carolina State University Department of Environmental & Molecular Toxicology. Understanding the Agricultural Health Study. Part 1: Overview. Agricultural Health Study.

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Prepared by Julia F. Storm, MSPH North Carolina Cooperative Extension

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  1. Prepared by Julia F. Storm, MSPH North Carolina Cooperative Extension North Carolina State University Department of Environmental & Molecular Toxicology

  2. Understanding theAgricultural HealthStudy Part 1: Overview

  3. Agricultural Health Study • A long-term health study of 90,000 pesticide applicators & farm familiesin Iowa and North Carolina • Conducted by scientists from: • National Cancer Institute (NCI) • National Institute of Environmental Health Sciences (NIEHS) • US Environmental Protection Agency (USEPA)

  4. Word Association

  5. are Associated with Disease? What Farming Exposures

  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. Agricultural Health StudyReflects US Agriculture

  8. Agricultural Health StudyFemale Participants • 3% of pesticide applicators are women • Farm wives: • 51% are active infarm work • 40% mix or apply pesticides

  9. Self-reported Information • Farm work related • Environmental • Lifestyle • Medical history

  10. Genetic Sample and Health Data • Rinse and spit sample from participants • Health Databases • Cancer registries • Death certificate

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

  12. Understanding theAgricultural HealthStudyPart 2: Pesticide Exposure

  13. 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

  14. Top 11 out of 40 PesticidesUsed 1993-1997

  15. High Pesticide Exposure Events (HPEE) • 14% of applicators reported an “unusually high personal exposure” while using pesticides • Risk factors • Repair application equipment • Delay in changing/washing

  16. 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

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

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

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

  20. Mix (0,3,9) + Repair (0,2) + Apply (1 to 9) X PPE(0.1 to 1) Average Work-Day Exposure = The lower the score (0-20), the lower the exposure intensity.

  21. Application Methods and Exposure

  22. Average Work-Day Exposure Score NC 7.6 Farmers 6.5 IA 6.0 Commercial 5.1 Lifetime Exposure Commercial 1692 NC 1249 IA 1116 Farmers 1096 Estimates for 2,4-D Exposure Agricultural Health Study Applicators 0 10 20 Low exposure  High Exposure 0 500 1000 2000 Low exposure  High Exposure

  23. Testing the Exposure Formula byMeasuring Pesticide Exposure • 100 farms; 8 field situations • 2,4-D and chlorpyrifos • Before, during, after application • Personal air (applicator) • Dermal patch (applicator) • Urine (applicator, spouse, children) • Formula is a good predictorof actual exposure

  24. Understanding theAgricultural HealthStudy Part 3: Health Findings

  25. Health Pluses: Live longer Lower heart disease death rate Lower death rate due to some cancers: Lung Esophagus Bladder Colon Health Problems: 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

  26. General Population Applicators Spouses Cancer Incidence • Overall cancer rate lower • Applicators: Prostate cancer higher • Spouses: Skin melanomas higher

  27. Children of Iowa Applicators General Population of Children in Iowa Childhood CancerInterpret with Caution • Children of Iowa Farmer Applicators • Slightly increased rates of • All childhood cancers • All lymphomas

  28. Pesticides and Prostate Cancer • Prostate cancer associated with • Methyl bromide • Chlorinated pesticides (in men over 50) • 6 pesticides (in men with a family history)

  29. Pesticides and Other Cancers • Breast cancer in farmer’s wives • Possible association with 2,4,5-T, captan, dieldrin, chlorpyrifos, dichlorvos and terbufos • Lung cancer in applicators • Possible association with metolachlor, pendimethalin, chlorpyrifos, diazinon

  30. Possible Association with Cancer Alachlor Atrazine Carbofuran Chlorpyrifos Diazinon Non-users of Pesticide X Users of Pesticide X Pesticides Evaluated for Cancer among Applicators • Diazinon • Dicamba • Fonofos • Glyphosate • Phorate • No Clear Association with Cancer • Cyanazine • Pendimethalin

  31. Respiratory Health • Wheeze associated with • Pesticides • Diesel tractor use • Solvent use • Animal production • Poultry (eggs), dairy • Daily vet procedures

  32. Nervous System Health: Vision • Retinal degeneration associated with • Fungicide use • Applicators • Farm wives • Fungicide exposure study • Low use of eye protection

  33. Other Nervous System Health • Parkinson’s Disease • Early studies suggest a link between pesticide exposure and PD • A case-control study is ongoing • Depression in farmer’s wives • Associated with a history of pesticide poisoning

  34. Female Reproductive Health Farmer’s Wives Female Applicators (Pesticide Users) Farmer’s Wives (Non-Users) • Pesticide users • Longer menstrual cycles • Missed periods • Later age at menopause • Gestational diabetes • Users of hormonally-active pesticides • Long cycles • Missed periods • Intermenstrual bleeding • Later age at menopause

  35. 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

  36. Recommendations • Carefully read and follow pesticide labels • Use PPE • Chemically-resistant gloves • Have PPE available for field repairs • Conduct respirator fit tests • Ask your doctor about: • Prostate cancer screening (if 50 or older) • Breast and colon cancer screening • Lung tests, respirator use and fit testing • Skin cancer screening • Cover up and use sunscreen

  37. For Health Care Providers • Online continuing education course • Addresses pesticide health issues • www.AHEConnect.com • Recently updated • Free!

  38. For More • Visit Understanding the AHS web: http://extension.tox.ncsu.edu • Visit Agricultural Health Study web: http://www.aghealth.org

  39. ACKNOWLEDGEMENTS • Reviewers: • Agricultural Health Study Scientists and National Advisory Panel • Iowa State University Extension • Other Extension andindustry colleagues • Authors: • Julia F. Storm, MSPHW. Gregory Cope, PhDWayne G. Buhler, PhDKatherine McGinnis • Funding: • NIOSH through the Southern Coastal Agromedicine Center

  40. 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

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