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Understanding the Agricultural Health Study

Understanding the Agricultural Health Study. 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. Long-term health study

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Understanding the Agricultural Health Study

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

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

  3. An Important Note • NO Agricultural Health Study participants are depicted in photos • Agricultural Health Study • Confidential • Secure • Ethical

  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: 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

  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. Cancer rates different? General Population Have disease No disease Exposures different? Non-users of Applicators Spouses Pesticide X Users of Different disease risk? Pesticide X 6 – Analyze the information

  19. 5 2 6 Answers More Questions 7 – Update Information • Repeat Steps • 2: Survey participants • 5: Collect health database info • 6: Analyze information

  20. 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

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

  22. 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

  23. 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

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

  25. 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

  26. Top 11 Pesticides Used 1993-97

  27. 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

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

  29. 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

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

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

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

  33. 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

  34. 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

  35. Testing the 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 estimate matches measurements

  36. 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)

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

  38. General Population Applicators Spouses Cancer Incidence Compared to General Population • Overall cancer rate lower • Rates for 18 of 20 cancers lower • Applicators: Prostate cancer higher • Spouses: Skin melanomas higher

  39. Children of Iowa Applicators General Population of Children in Iowa Childhood Cancer: Interpret with Caution • Children of Iowa Farmer Applicators • Slightly increased rates of • All childhood cancers • All lymphomas

  40. Pesticides and Prostate Cancer • Prostate cancer associated with • Methyl bromide • Chlorinated pesticides (in men over 50) • 5 pesticides and men with a family history of prostate cancer

  41. Pesticides and Other Cancers • Lung cancer in applicators • Possible association with metolachlor, pendimethalin, chlorpyrifos, diazinon • Breast cancer in farmer’s wives • NO clear association with 50 pesticides

  42. Alachlor Atrazine Carbofuran Chlorpyrifos Glyphosate Non-users of Pesticide X Users of Pesticide X Cancer and Exposure to Certain Pesticides

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

  44. Nervous System Health • Retinal degeneration associated with • Fungicide use • Applicators • Farm wives • Fungicide exposure studied

  45. Farmer’s Wives Female Applicators (Pesticide Users) Farmer’s Wives (Non-Users) Female Reproductive Health • Pesticide users • Longer menstrual cycles • Missed periods • Users of hormonally-active pesticides • Long cycles • Missed periods • Intermenstrual bleeding

  46. Summary • Agricultural Health Study • Important strengths, unique features • More info to come in next 10-15 years • Strongest findings as of 2005 • Methyl bromide and prostate cancer • Fungicides and retinal degeneration

  47. Recommendations • Review pesticide labels • Use PPE • Chemically-resistant gloves • Have PPE available for field repairs • Ask your doctor about: • Prostate cancer screening (if 50 or older) • Lung health screening and respirator use • Skin cancer screening • Cover up and use sunscreen

  48. Questions

  49. For More Information • Visit Understanding the AHS web site: http://extension.tox.ncsu.edu • Visit Agricultural Health Study web site: http://www.aghealth.org • Contact: julia_storm@ncsu.edu

  50. 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

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