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

2. NC STATE UNIVERSITY Understanding the Agricultural Health Study Part 1: Overview

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

4. NC STATE UNIVERSITY Word Association

5. NC STATE UNIVERSITY Disease? What Farming Exposures are Associated with

6. NC STATE UNIVERSITY 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. NC STATE UNIVERSITY Agricultural Health Study Reflects US Agriculture

8. NC STATE UNIVERSITY Agricultural Health Study Female Participants  3% of pesticide applicators are women  Farm wives: –51% are active in farm work –40% mix or apply pesticides

9. NC STATE UNIVERSITY  Farm work related  Environmental  Lifestyle  Medical history Self-reported Information

10. NC STATE UNIVERSITY Genetic Sample and Health Data  Rinse and spit sample from participants  Health Databases –Cancer registries –Death certificate

11. NC STATE UNIVERSITY Questions 1 2 3 4 5 6 Scientists Navigate a Maze of Information 7 Answers More Questions

12. NC STATE UNIVERSITY Understanding the Agricultural Health Study Part 2: Pesticide Exposure

13. NC STATE UNIVERSITY 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. NC STATE UNIVERSITY Top 11 out of 40 Pesticides Used 1993-1997 North Carolina Iowa PESTICIDETYPEPESTICIDETYPE GlyphosateH2,4-DH 2,4 DHGlyphosateH AtrazineHImazethapyrH ChlorpyrifosIAtrazineH Methyl bromideFUMDicambaH CarbarylIMetolachlorH HTrifluralinH ChlorothalonilFGChlorpyrifosI MetalaxylFGCyanazineH AlachlorHTerbufosI MalathionIAlachlorH

15. NC STATE UNIVERSITY 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. NC STATE UNIVERSITY 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. NC STATE UNIVERSITY Use of PPE Good 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. NC STATE UNIVERSITY African-American Farmers  Reported –Less pesticide use, fewer high exposure application methods –More PPE use (except chemically- resistant gloves) –Fewer health symptoms

19. NC STATE UNIVERSITY Estimating Pesticide Exposure: A New Formula Lifetime Applicator Pesticide Exposure =Pesticide application days/year X Years of pesticide use NoneLowMediumHigh X Average Work-Day Exposure Score X Average Work-Day Exposure Score

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

21. NC STATE UNIVERSITY Application Methods and Exposure

22. NC STATE UNIVERSITY 0 10 20 Low exposure  High Exposure 0 500 1000 2000 Low exposure  High Exposure Estimates for 2,4-D Exposure Agricultural Health Study Applicators Average Work-Day Exposure Score NC7.6 Farmers6.5 IA6.0 Commercial5.1 Lifetime Exposure Commercial 1692 NC 1249 IA 1116 Farmers 1096

23. NC STATE UNIVERSITY Testing the Exposure Formula by Measuring 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 predictor of actual exposure

24. NC STATE UNIVERSITY Understanding the Agricultural Health Study Part 3: Health Findings

25. NC STATE UNIVERSITY Previous Studies of Agriculture and Health 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

26. NC STATE UNIVERSITY Cancer Incidence  Overall cancer rate lower Applicators Spouses General Population  Applicators: Prostate cancer higher  Spouses: Skin melanomas higher

27. NC STATE UNIVERSITY Childhood Cancer Interpret with Caution  Children of Iowa Farmer Applicators –Slightly increased rates of  All childhood cancers  All lymphomas Children of Iowa Applicators General Population of Children in Iowa

28. NC STATE UNIVERSITY 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. NC STATE UNIVERSITY 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. NC STATE UNIVERSITY Pesticides Evaluated for Cancer among Applicators  Possible Association with Cancer –Alachlor –Atrazine –Carbofuran –Chlorpyrifos –Diazinon Users of Pesticide X Non-users of Pesticide X  No Clear Association with Cancer –Cyanazine –Pendimethalin –Diazinon –Dicamba –Fonofos –Glyphosate –Phorate

31. NC STATE UNIVERSITY Respiratory Health  Wheeze associated with –Pesticides –Diesel tractor use –Solvent use –Animal production  Poultry (eggs), dairy  Daily vet procedures

32. NC STATE UNIVERSITY Nervous System Health: Vision  Retinal degeneration associated with –Fungicide use  Applicators  Farm wives  Fungicide exposure study –Low use of eye protection

33. NC STATE UNIVERSITY 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. NC STATE UNIVERSITY Female Reproductive Health  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 Farmer’s Wives (Non-Users) Farmer’s Wives Female Applicators (Pesticide Users)

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

36. NC STATE UNIVERSITYRecommendations  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. NC STATE UNIVERSITY For Health Care Providers  Online continuing education course –Addresses pesticide health issues –www.AHEConnect.com www.AHEConnect.com  Recently updated  Free!

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

39. NC STATE UNIVERSITYACKNOWLEDGEMENTS  Authors: –Julia F. Storm, MSPH W. Gregory Cope, PhD Wayne G. Buhler, PhD Katherine McGinnis  Funding: –NIOSH through the Southern Coastal Agromedicine Center  Reviewers: –Agricultural Health Study Scientists and National Advisory Panel –Iowa State University Extension –Other Extension and industry colleagues

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