NC STATE UNIVERSITY Understanding the Agricultural Health Study Prepared by Julia F. Storm, MSPH North Carolina Cooperative Extension North Carolina State

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  • NC STATE UNIVERSITY Understanding the Agricultural Health Study Prepared by Julia F. Storm, MSPH North Carolina Cooperative Extension North Carolina State University Department of Environmental & Molecular Toxicology
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  • NC STATE UNIVERSITY Understanding the Agricultural Health Study Part 1: Overview Long-term health study certified pesticide applicators and farm families Iowa and North Carolina Overview Who - Where What- Why When- How
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  • NC STATE UNIVERSITY An Important Note NO Agricultural Health Study participants are depicted in photos Agricultural Health Study Confidential Secure Ethical
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  • NC STATE UNIVERSITY Disease? What Exposures are associated with
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  • NC STATE UNIVERSITY Agricultural Health Study Scientists National Cancer Institute National Institute of Environmental 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
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  • 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)
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  • NC STATE UNIVERSITY Participants Reflect Agriculture of Iowa... Farmers: white males Farm Size: 75% > 500 acres Crops/Livestock Corn, Soybeans Hogs Commercial applicators Younger than farmers Landscape, highway weed control, agricultural
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  • NC STATE UNIVERSITY... and North Carolina Farmers Mostly male 3% African-American Farm Size: 55%
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  • NC STATE UNIVERSITY Agricultural Health Study Female Participants 3% of Pesticide Applicators are women Farm wives: Active in farm work (51%) Mixed or applied pesticides (40%)
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  • 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
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  • NC STATE UNIVERSITY Questions 1 2 3 4 5 6 Scientists Navigate a Maze of Information 7 Answers More Questions
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  • NC STATE UNIVERSITY 1 - Enroll volunteers into the study During 1993-1997 Applicators At pesticide safety training classes Spouses of farmers At home
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  • NC STATE UNIVERSITY Farm work related Environmental 2 Survey participants
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  • NC STATE UNIVERSITY Lifestyle Medical history 2 Survey participants
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  • NC STATE UNIVERSITY Develop exposure formula Test formula in real world Measure pesticide exposure on 100 farms 3 Estimate pesticide exposure
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  • NC STATE UNIVERSITY 4 Collect a genetic sample Rinse and spit Mouthwash rinses cells from mouth Cells contain DNA Sample used in laboratory studies
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  • NC STATE UNIVERSITY 5 Collect health data from databases Cancer registries Iowa North Carolina Death certificate State National
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  • NC STATE UNIVERSITY 6 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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  • NC STATE UNIVERSITY 7 Update Information Repeat Steps 2: Survey participants 5: Collect health database info 6: Analyze information Answers More Questions 2 5 6
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  • NC STATE UNIVERSITY Study Timeline 19931997Recruit & survey participants 19982003Field test exposure estimates; Collect genetic sample 20042008Assess disease rates & risk factors 20092013Evaluate disease mechanisms
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  • NC STATE UNIVERSITY High Pesticide Exposure Events Pesticides of Interest Estimating Exposure to Applicators Measuring Pesticide Exposure Understanding the Agricultural Health Study Part 2: Pesticide Exposure
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  • NC STATE UNIVERSITY 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
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  • 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
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  • 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
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  • 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
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  • NC STATE UNIVERSITY Top 11 Pesticides Used 1993-97 North Carolina Iowa PESTICIDETYPEPESTICIDETYPE GlyphosateH2,4-DH 2,4 DHGlyphosateH AtrazineHImazethapyrH ChlorpyrifosIAtrazineH Methyl bromideFUMDicambaH CarbarylIMetolachlorH HTrifluralinH ChlorothalonilFGChlorpyrifosI MetalaxylFGCyanazineH AlachlorHTerbufosI MalathionIAlachlorH
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  • NC STATE UNIVERSITY Estimating Pesticide Exposure: A New Approach 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
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  • NC STATE UNIVERSITY Average Work-Day Exposure Score (0 to 20) = Mix(0,3,9) + Apply (1 to 9) (1 to 9) + Repair (0,2) (0,2) X PPE (0.1 to 1)
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  • NC STATE UNIVERSITY 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
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  • NC STATE UNIVERSITY Iowa Example: Bills 2,4-D Average Work-Day Exposure FORMULAVALUE WHAT BILL DOES Mix 9 Mixes > 50% of time Apply + 3 Uses boom on tractor Repair + 2 Repairs in field = 14 PPE X.4 Wears chemically resistant gloves, goggles Score5.6
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  • NC STATE UNIVERSITY North Carolina Example: Chlorpyrifos Exposure Farmer Fred grows 300 acres peanuts Applies granular chlorpyrifos for southern corn rootworm
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  • NC STATE UNIVERSITY NC Example: Freds Chlorpyrifos Average Work-Day Exposure FORMULAVALUE WHAT FRED DOES Mix 9 Mixes > 50% of time Apply + 1 Applies granular formulation Repair + 2 Repairs in field =12 PPE X.6 Wears chemically- resistant gloves Score7.2
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  • NC STATE UNIVERSITY Iowa and NC Examples: Lifetime Exposure Iowa Corn Farmer Bills Lifetime 2,4-D Exposure =5.6 X 10 days/year X 15 years =840 NC Peanut Farmer Freds Lifetime Chlorpyrifos Exposure =7.2 X 3 days/year X 10 years = 216
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  • NC STATE UNIVERSITY 2,4-D Exposure in the AHS Average Work-Day NC:7.6 Farmers:6.5 IA:6.0 Bill5.6 Commercial:5.1 Lifetime Commercial:1692 NC: 1249 IA:1116 Farmers:1096 Bill 840
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  • NC STATE UNIVERSITY Testing the 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 estimate matches measurements
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  • NC STATE UNIVERSITY Use of PPE Good News/Bad News Chemically-resistant glove use doubled from 1980s to 1990s in NC 21% vs. 46% PPE use greater in Iowa, except respirators Never use PPE 4% (Iowa) 18% (NC)
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  • NC STATE UNIVERSITY Understanding the Agricultural Health Study Part 3: Health Findings Cancers Nervous system Respiratory system Reproductive health
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  • NC STATE UNIVERSITY Cancer Incidence Compared to General Population Overall cancer rate lower Rates for 18 of 20 cancers lower Applicators Spouses General Population Applicators: Prostate cancer higher Spouses: Skin melanomas higher
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  • 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
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  • NC STATE UNIVERSITY 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
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  • NC STATE UNIVERSITY Pesticides and Other Cancers Breast cancer in farmers wives NO clear association with 50 pesticides Lung cancer in applicators Possible association with metolachlo