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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

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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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QuestionsQuestions

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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: julia_storm@ncsu.eduContact: julia_storm@ncsu.edu

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