NC STATE UNIVERSITY
Understanding the Understanding the Agricultural Health StudyAgricultural Health Study
Prepared by Julia F. Storm, MSPHPrepared by Julia F. Storm, MSPHNorth Carolina Cooperative ExtensionNorth Carolina Cooperative Extension
North Carolina State UniversityNorth Carolina State UniversityDepartment of Environmental & Molecular ToxicologyDepartment of Environmental & Molecular Toxicology
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Understanding the Understanding the Agricultural HealthAgricultural Health StudyStudy
Part 1: OverviewPart 1: Overview
Long-term health studyLong-term health study– certified pesticide applicators certified pesticide applicators
and farm familiesand farm families– Iowa and North CarolinaIowa and North Carolina
OverviewOverview– Who Who - Where- Where– WhatWhat - Why- Why– WhenWhen - How- How
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An Important NoteAn Important NoteNONO Agricultural Health Study Agricultural Health Study
participants are depicted in photosparticipants are depicted in photos
Agricultural Health StudyAgricultural Health Study– ConfidentialConfidential– Secure Secure – EthicalEthical
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Disease?Disease?
What ExposuresWhat Exposures
are associated withare associated with
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Agricultural Health StudyAgricultural Health StudyScientistsScientists
National Cancer InstituteNational Cancer Institute National Institute ofNational Institute of
Environmental Health SciencesEnvironmental Health Sciences US Environmental Protection US Environmental Protection
AgencyAgency
–University of Iowa College of Public HealthUniversity of Iowa College of Public Health–Battelle Centers for Public Health Research and Evaluation Battelle Centers for Public Health Research and Evaluation (North Carolina)(North Carolina)–National Institute for Occupational Safety and HealthNational Institute for Occupational Safety and Health
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Agricultural Health StudyAgricultural Health Study ParticipantsParticipants
Certified pesticide applicators Certified pesticide applicators and farmers’ spouses (89,658)and farmers’ spouses (89,658) – North Carolina:North Carolina:
Farmers (20,518)Farmers (20,518)Spouses (10,576)Spouses (10,576)
– Iowa:Iowa:Farmers (31,877)Farmers (31,877)Spouses (21,771)Spouses (21,771)Commercial applicators (4,916)Commercial applicators (4,916)
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Participants Reflect AgricultureParticipants Reflect Agricultureof Iowa . . .of Iowa . . .
Farmers: white malesFarmers: white males Farm Size: Farm Size:
75% > 500 acres75% > 500 acres Crops/LivestockCrops/Livestock
– Corn, SoybeansCorn, Soybeans– HogsHogs
Commercial applicatorsCommercial applicators– Younger than farmersYounger than farmers– Landscape, highway Landscape, highway
weed control, agriculturalweed control, agricultural
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. . . and North Carolina. . . and North Carolina FarmersFarmers
– Mostly maleMostly male– 3% African-American3% African-American
Farm Size: 55% <200 acresFarm Size: 55% <200 acres Diverse Crops/LivestockDiverse Crops/Livestock
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Agricultural Health StudyAgricultural Health Study Female ParticipantsFemale Participants
3% of Pesticide 3% of Pesticide Applicators are womenApplicators are women
Farm wives:Farm wives:– Active in Active in
farm workfarm work(51%)(51%)
– Mixed orMixed orapplied applied pesticidespesticides(40%)(40%)
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Previous StudiesPrevious Studiesof Agriculture and Healthof Agriculture and Health
Health Pluses:Health Pluses:
Live longerLive longer Lower heart Lower heart
disease death disease death rate rate
Lower death rate Lower death rate due to some due to some cancers:cancers:– LungLung– Esophagus Esophagus – BladderBladder– ColonColon
Health Problems:Health Problems:
Higher risk of injuryHigher risk of injury
Risk of lung diseaseRisk of lung disease(not lung cancer)(not lung cancer)
Skin conditionsSkin conditions
Higher rates of Higher rates of certain cancerscertain cancers
Other: immune, Other: immune, nervous, nervous, reproductive systemreproductive system
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QuestionsQuestions
11
22 33 44
55
66
Scientists Navigate Scientists Navigate a Maze of Informationa Maze of Information
77
AnswersAnswers
MoreMoreQuestionsQuestions
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1 - Enroll volunteers into the study1 - Enroll volunteers into the study
During 1993-1997During 1993-1997 ApplicatorsApplicators
– At pesticide safetyAt pesticide safetytraining classestraining classes
Spouses of farmersSpouses of farmers– At homeAt home
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Farm work relatedFarm work related
EnvironmentalEnvironmental
2 – Survey participants2 – Survey participants
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LifestyleLifestyle
Medical historyMedical history
2 – Survey participants2 – Survey participants
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Develop exposure Develop exposure formulaformula
Test formula in real world Test formula in real world – Measure pesticide exposure Measure pesticide exposure
on 100 farmson 100 farms
3 – Estimate pesticide exposure 3 – Estimate pesticide exposure
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4 – Collect a genetic sample4 – Collect a genetic sample
Rinse and spitRinse and spit– Mouthwash rinses Mouthwash rinses
cells from mouthcells from mouth– Cells contain DNA Cells contain DNA
Sample used in Sample used in laboratory studieslaboratory studies
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5 – Collect health data from 5 – Collect health data from databasesdatabases
Cancer registriesCancer registries– IowaIowa– North CarolinaNorth Carolina
Death certificateDeath certificate– StateState– NationalNational
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6 – Analyze the information6 – Analyze the information
Users of
Pesticide X
Non-users of
Pesticide X
Different disease
risk?
Have disease No disease
Exposures different?
Applicators Spouses
General Population
Cancer rates different?
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7 – Update Information7 – Update Information Repeat StepsRepeat Steps
– 2: Survey participants2: Survey participants– 5: Collect health database info5: Collect health database info– 6: Analyze information6: Analyze information
AnswersAnswers
More QuestionsMore Questions
2255
66
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Study TimelineStudy Timeline
1993–19971993–1997 Recruit &Recruit &survey participantssurvey participants
1998–20031998–2003 Field test exposure Field test exposure estimates; estimates; Collect genetic sampleCollect genetic sample
2004–20082004–2008 Assess disease rates & Assess disease rates & risk factorsrisk factors
2009–20132009–2013 Evaluate disease Evaluate disease mechanismsmechanisms
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High Pesticide Exposure Events High Pesticide Exposure Events Pesticides of InterestPesticides of Interest Estimating Exposure to ApplicatorsEstimating Exposure to Applicators Measuring Pesticide ExposureMeasuring Pesticide Exposure
Understanding theUnderstanding theAgricultural HealthAgricultural Health StudyStudy Part 2: Pesticide ExposurePart 2: Pesticide Exposure
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High Pesticide Exposure Events High Pesticide Exposure Events (HPEE)(HPEE)
14% of applicators reported HPEE14% of applicators reported HPEE Risk factors Risk factors
– Repair application equipmentRepair application equipment– Delay in changing/washingDelay in changing/washing
CharacteristicsCharacteristics– Mix pesticide/family washMix pesticide/family wash– Believe farming is highly riskyBelieve farming is highly risky– Farm in financial stressFarm in financial stress
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Medical Visits Medical Visits for Pesticide Exposurefor Pesticide Exposure
7% of applicators7% of applicators 3,733 medical visits3,733 medical visits Risk Factors:Risk Factors:
– Use insecticides and Use insecticides and fumigants vs. herbicides fumigants vs. herbicides
– Mix pesticides more Mix pesticides more than 50% of the timethan 50% of the time
– Repair own equipmentRepair own equipment
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African-American Farmers African-American Farmers ReportedReported
– Less pesticide use, Less pesticide use, fewer high exposure fewer high exposure application methodsapplication methods
– More PPE use More PPE use ((exceptexcept chemically- chemically-resistant gloves)resistant gloves)
– Fewer health symptomsFewer health symptoms
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Pesticides of InterestPesticides of Interest FirstFirst survey: survey:
50 crop/livestock pesticides50 crop/livestock pesticides– 40 Current-Use Pesticides40 Current-Use Pesticides
16 insecticides, 16 herbicides, 16 insecticides, 16 herbicides, 6 fungicides, 2 fumigants6 fungicides, 2 fumigants
– 10 Historical-Use Pesticides10 Historical-Use Pesticides Follow-upFollow-up surveys: surveys:
allall pesticides used in previous pesticides used in previous seasonseason
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Top 11 Pesticides Used 1993-97Top 11 Pesticides Used 1993-97
North CarolinaNorth Carolina IowaIowa
PESTICIDEPESTICIDE TYPETYPE PESTICIDEPESTICIDE TYPETYPE
Glyphosate H 2,4-D H
2,4 D H Glyphosate H
Atrazine H Imazethapyr H
Chlorpyrifos I Atrazine H
Methyl bromide FUM Dicamba H
Carbaryl I Metolachlor H
Metolachlor H Trifluralin H
Chlorothalonil FG Chlorpyrifos I
Metalaxyl FG Cyanazine H
Alachlor H Terbufos I
Malathion I Alachlor H
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Estimating Pesticide Exposure:Estimating Pesticide Exposure:A New ApproachA New Approach
LifetimeLifetime Applicator Pesticide Exposure Applicator Pesticide Exposure
==Pesticide application days/yearPesticide application days/year
X X Years of pesticide useYears of pesticide use
NoneNone LowLow MediumMedium HighHigh
X X Average Work-Day Exposure ScoreAverage Work-Day Exposure Score
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Average Work-Day Average Work-Day Exposure Score (0 to 20) =Exposure Score (0 to 20) =
MixMix(0,3,9)(0,3,9)
+ Apply+ Apply (1 to 9)(1 to 9)
+ Repair+ Repair (0,2)(0,2)
X PPE X PPE (0.1 to 1)(0.1 to 1)
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Iowa Example: 2,4-D ExposureIowa Example: 2,4-D Exposure
Farmer “Bill” grows Farmer “Bill” grows 1000 acres corn1000 acres corn
Applies 2,4-D to Applies 2,4-D to control weeds after control weeds after plant emergence plant emergence using boom sprayerusing boom sprayer
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Iowa Example: Bill’s 2,4-D Iowa Example: Bill’s 2,4-D Average Work-Day ExposureAverage Work-Day Exposure
FORMULAFORMULA VALUEVALUE WHAT BILL DOESWHAT BILL DOES
MixMix 99 Mixes > 50% of timeMixes > 50% of time
ApplyApply + 3+ 3 Uses boom on tractorUses boom on tractor
RepairRepair + 2+ 2 Repairs in fieldRepairs in field
= 14= 14
PPEPPE X .4X .4 Wears chemically Wears chemically resistant gloves, resistant gloves, gogglesgoggles
ScoreScore 5.65.6
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North Carolina Example: North Carolina Example: Chlorpyrifos ExposureChlorpyrifos Exposure
Farmer “Fred” grows Farmer “Fred” grows 300 acres peanuts300 acres peanuts
Applies granular Applies granular chlorpyrifos forchlorpyrifos forsouthern corn southern corn rootwormrootworm
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NC Example: Fred’s ChlorpyrifosNC Example: Fred’s Chlorpyrifos Average Work-Day Exposure Average Work-Day Exposure
FORMULAFORMULA VALUEVALUE WHAT FRED DOESWHAT FRED DOESMixMix 99 Mixes > 50% of timeMixes > 50% of time
ApplyApply + 1+ 1 Applies granular Applies granular formulationformulation
RepairRepair + 2+ 2 Repairs in fieldRepairs in field
=12=12
PPEPPE X .6X .6 Wears chemically-Wears chemically-resistant glovesresistant gloves
ScoreScore 7.27.2
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Iowa and NC Examples: Iowa and NC Examples: Lifetime ExposureLifetime Exposure
Iowa Corn Farmer “Bill’s” LifetimeIowa Corn Farmer “Bill’s” Lifetime2,4-D Exposure2,4-D Exposure=5.6 X 10 days/year X 15 years=5.6 X 10 days/year X 15 years==840840
NC Peanut FarmerNC Peanut Farmer “Fred’s” Lifetime “Fred’s” Lifetime Chlorpyrifos ExposureChlorpyrifos Exposure=7.2 X 3 days/year X 10 years =7.2 X 3 days/year X 10 years = = 216216
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2,4-D Exposure in the AHS2,4-D Exposure in the AHS
Average Work-DayAverage Work-Day
NC:NC: 7.67.6
Farmers:Farmers: 6.56.5
IA:IA: 6.0 6.0
““Bill”Bill” 5.65.6
Commercial:Commercial: 5.15.1
LifetimeLifetime
Commercial:Commercial:16921692
NC: NC: 12491249
IA:IA: 1116 1116
Farmers:Farmers: 10961096
““Bill”Bill” 840 840
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Testing the Formula byTesting the Formula byMeasuring Pesticide ExposureMeasuring Pesticide Exposure
100 farms; 8 field situations100 farms; 8 field situations 2,4-D and chlorpyrifos 2,4-D and chlorpyrifos Before, during, after applicationBefore, during, after application
– Personal air (applicator)Personal air (applicator)– Dermal patch (applicator)Dermal patch (applicator)– Urine (applicator, spouse, children)Urine (applicator, spouse, children)
Formula estimate matches Formula estimate matches measurementsmeasurements
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Use of PPEUse of PPEGood News/Bad NewsGood News/Bad News
Chemically-resistant glove use Chemically-resistant glove use doubleddoubled from 1980’s to 1990’s in NC from 1980’s to 1990’s in NC– 21% vs. 46%21% vs. 46%
PPE use greater inPPE use greater inIowa, exceptIowa, exceptrespiratorsrespirators
Never use PPENever use PPE– 4% (Iowa) 4% (Iowa) – 18% (NC) 18% (NC)
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Understanding theUnderstanding theAgricultural HealthAgricultural Health StudyStudy Part 3: Health FindingsPart 3: Health Findings
CancersCancers Nervous system Nervous system Respiratory systemRespiratory system Reproductive healthReproductive health
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Cancer Incidence Compared to Cancer Incidence Compared to General PopulationGeneral Population
Overall cancer rate lower Overall cancer rate lower Rates for 18 of 20 cancers lower Rates for 18 of 20 cancers lower
Applicators Spouses General Population
Applicators: Prostate cancer higherApplicators: Prostate cancer higher Spouses: Skin melanomas higherSpouses: Skin melanomas higher
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Childhood Cancer: Interpret with CautionChildhood Cancer: Interpret with Caution
Children of Iowa Farmer ApplicatorsChildren of Iowa Farmer Applicators– Slightly increased rates ofSlightly increased rates of
All childhood cancers All childhood cancers All lymphomasAll lymphomas
Children of Iowa Applicators
General Population of Children in Iowa
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Pesticides and Prostate CancerPesticides and Prostate Cancer
Prostate cancer Prostate cancer associated withassociated with– Methyl bromideMethyl bromide– Chlorinated pesticides Chlorinated pesticides
(in men over 50)(in men over 50)– 5 pesticides and men 5 pesticides and men
with a family history with a family history of prostate cancerof prostate cancer
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Pesticides and Other CancersPesticides and Other Cancers
Breast cancer in Breast cancer in farmer’s wivesfarmer’s wives– NONO clear association clear association
with 50 pesticides with 50 pesticides
Lung cancer in applicatorsLung cancer in applicators–PossiblePossible association with association with metolachlor, pendimethalin, metolachlor, pendimethalin, chlorpyrifos, diazinonchlorpyrifos, diazinon
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Cancer and Exposure toCancer and Exposure to Certain Pesticides Certain Pesticides
AlachlorAlachlor AtrazineAtrazine CarbofuranCarbofuran
ChlorpyrifosChlorpyrifos GlyphosateGlyphosate
Users of
Pesticide X
Non-users of
Pesticide X
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Respiratory HealthRespiratory Health Wheeze associated with Wheeze associated with
– PesticidesPesticides– Diesel tractor useDiesel tractor use– Solvent useSolvent use– Animal production Animal production
Poultry (eggs), dairyPoultry (eggs), dairyDaily vet proceduresDaily vet procedures
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Nervous System HealthNervous System Health Retinal degeneration Retinal degeneration
associated withassociated with– Fungicide useFungicide use
ApplicatorsApplicatorsFarm wivesFarm wives
Fungicide Fungicide exposure exposure studiedstudied
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Female Reproductive HealthFemale Reproductive Health
Pesticide users Pesticide users – Longer menstrual cyclesLonger menstrual cycles– Missed periodsMissed periods
Users of hormonally-active pesticidesUsers of hormonally-active pesticides– Long cyclesLong cycles– Missed periodsMissed periods– Intermenstrual bleedingIntermenstrual bleeding
Farmer’s Wives (Non-Users)
Farmer’s Wives Female Applicators
(Pesticide Users)
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SummarySummary
Agricultural Health StudyAgricultural Health Study– Important strengths, unique featuresImportant strengths, unique features– More info to come in next 10-15 yearsMore info to come in next 10-15 years
Strongest findings as of 2005Strongest findings as of 2005– Methyl bromide and prostate cancerMethyl bromide and prostate cancer– Fungicides and retinal degenerationFungicides and retinal degeneration
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RecommendationsRecommendations
Review pesticide labels Review pesticide labels Use PPEUse PPE
– Chemically-resistant glovesChemically-resistant gloves– Have PPE available for field repairsHave PPE available for field repairs
Ask your doctor about:Ask your doctor about:– Prostate cancer screening (if 50 or older)Prostate cancer screening (if 50 or older)– Lung health screening and respirator use Lung health screening and respirator use – Skin cancer screeningSkin cancer screening
Cover up and use sunscreenCover up and use sunscreen
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VisitVisit Understanding the AHS Understanding the AHS web site: web site: http://extension.tox.ncsu.eduhttp://extension.tox.ncsu.edu
Visit Agricultural Health Study web site: Visit Agricultural Health Study web site: http://www.aghealth.orghttp://www.aghealth.org
Contact: [email protected]: [email protected]
For More InformationFor More Information
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ACKNOWLEDGEMENTSACKNOWLEDGEMENTS Authors:Authors:
– Julia F. Storm, MSPHJulia F. Storm, MSPHW. Gregory Cope, PhDW. Gregory Cope, PhDWayne G. Buhler, PhDWayne G. Buhler, PhDKatherine McGinnisKatherine McGinnis
Funding:Funding:–NIOSH through the Southern NIOSH through the Southern Coastal Agromedicine CenterCoastal Agromedicine Center
Reviewers:Reviewers:–Agricultural Health Study Agricultural Health Study Scientists and National Scientists and National Advisory PanelAdvisory Panel–Iowa State University Iowa State University ExtensionExtension–Other Extension andOther Extension andindustry colleaguesindustry colleagues
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Study TimelineStudy Timeline
1993–19971993–1997 Recruit &Recruit &survey participantssurvey participants
1998–20031998–2003 Field test exposure Field test exposure estimates; estimates; Collect genetic sampleCollect genetic sample
2004–20082004–2008 Assess disease rates & Assess disease rates & risk factorsrisk factors
2009–20132009–2013 Evaluate disease Evaluate disease mechanismsmechanisms
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