1. An unattended finding: associations of agricultural airborne pesticide vapors attaining inhabited areas with respiratory symptoms of 7–11 years old children in Heves county, Hungary M. J. Varró 1, Z. Virágh 1, Gy. Gombkötõ 2, M. Szeremi 2, P. Rudnai 1 1 Fodor József National Center for Public Health, National Institute of Environmental Health; Budapest, Hungary; 2 National Public Health and Medical Officer Service, Institute of Heves County; Eger, Hungary NCPH NIEH NPHMOS

2. INTRODUCTION 1. Nat. Inst. Environ. Health Fodor József Nat. Center Publ. Health, (formerly: Nat. Inst. Hyg.,) Budapest, Hungary Nat. Publ. Health & Med. Officer Service series of highly uniform environmental epidemiologic surveys among 7–11 y children

3. NCPH NIEH NPHMOS INTRODUCTION 2. 1995/96 CESAR - international survey - 5 towns, N=3720 - questionnaire - questionnaire - physical examination - physical examination - spirometry - spirometry - measures of outdoor air pollutants - measures of outdoor air pollutants

4. NCPH NIEH NPHMOS INTRODUCTION 2. Questionnaire - health endpoints - health endpoints - indoor environmental factors - indoor environmental factors - other influencing factors - other influencing factors Main finding - respiratory symptoms - respiratory symptoms & yearly average cc PM

5. NCPH NIEH NPHMOS INTRODUCTION 3. 1997 12 towns,N=6221 1998 6 towns, N=1768 1999 3 towns,N=1579 2000 6 counties, N=2354 2001 Heves county, N=2540 2002 Budapest 2 distr.+1 suburban,N=567

6. ... arised: agricultural airborne pesticide sprays do attain inhabited areas (no report) Highly significant associations with health endpoints NCPH NIEH NPHMOS INTRODUCTION 4.

7. NCPH NIEH NPHMOS OBJECTIVE To evaluate the associations of pesticide sprays with respiratory symptoms - of 7–11year old children - in 40 villages of an area of Heves county - in 2001

8. Allergic symptoms - house dust - house dust - pollen - pollen - animal hair, feather - animal hair, feather - food - food - medicine - medicine - other - other - diagnosis: by a doctor? METHODS 1. NCPH NIEH NPHMOS

9. Neurotic symptoms: at least two of - lack of appetite - lack of appetite - fatigue - fatigue - headache - headache - irritability - irritability - anxiety - anxiety METHODS 2. NCPH NIEH NPHMOS

10. Head mucosal symptoms: at least one of - conjunctivitis - conjunctivitis - blocked nose - blocked nose - sinusitic complaints - sinusitic complaints - earache - earache METHODS 3. NCPH NIEH NPHMOS

11. Bronchitic symptoms regular cough - in autumn-winter - in autumn-winter - mornings - mornings - days/nights - days/nights - daily, >3 months - daily, >3 months - with sputum - with sputum METHODS 4. NCPH NIEH NPHMOS

12. Asthmatic symptoms - in the last 12 months - in the last 12 months - wheezing - wheezing - dry cough at night - dry cough at night - asthma - asthma - ever diagnosed by a doctor - ever diagnosed by a doctor METHODS 5. NCPH NIEH NPHMOS

13. METHODS 6. Data entry, - procession - Epi Info 6.04d - Epi Info 6.04dAnalysis - STATA 7.0 - STATA 7.0 - bivariate tabulation - bivariate tabulation - backward logistic models - backward logistic models

14. Reported symptoms 1. 7–11 years old children, Villages, Heves county, Hungary, 2001 % 0 50 50 21.8 21.820.3 N=1718 NCPH NIEH NPHMOS Allergic symptoms Min. 2 neur. sy.-s N=1647 25 25 N 0 =2437 N=181974.6%

15. N=1471 Reported symptoms 2. 7–11 years old children, Villages, Heves county, Hungary, 2001 % 0 50 50 46.3 46.3 14.1 N=1647 NCPH NIEH NPHMOS Head mucosal Asthmatic 25 25 15.5 15.5 Bronchitic N=1623

16. Agricultural airborne pesticide sprays attaining inhabited areas Villages, Heves county, Hungary, 2001 No sprays Sprays % 75 75 50 50 0 25 25 90.8 90.8 9.2 100 N=1666 NCPH NIEH NPHMOS 82.5% of the villages (n=40)

17. Agricultural airborne pesticide sprays attaining inhabited areas Villages, Heves county, Hungary, 2001 Vineyard territories General agricultural % 75 75 50 50 0 25 25 6.1 6.1 13.9 100 N=1013 NCPH NIEH NPHMOS 93.9 93.9 86.1 OR=2.48*** (95% CI= 1.76–3.44) N=653 No sprays Sprays

18. Agricultural airborne pesticide sprays/ inhabited areas and allergic symptoms 7–11 years old children, Villages, Heves county, Hungary, 2001 % OR=2.13*** (95% CI=1.48–3.07) OR=2.13*** (95% CI=1.48–3.07) mOR=2.23*** (95% CI=1.48–3.37) goodness-of-fit: p=0.69 50 50 0 25 25 20.1 20.1 34.9 34.9 75 75 N=146 NCPH NIEH NPHMOS N=1451 No sprays Sprays

19. Sprays % OR=2.19*** (95% CI=1.51–3.17) OR=2.19*** (95% CI=1.51–3.17) mOR=2.33*** (95% CI=1.55–3.51) goodness-of-fit: p=0.18 50 50 0 25 25 18.6 18.6 33.3 33.3 75 75 N=144 NCPH NIEH NPHMOS N=1391 Agricultural airborne pesticide sprays/ inhabited areas and neurotic symptoms 7–11 years old children, Villages, Heves county, Hungary, 2001

20. Agricultural airborne pesticide sprays/ inhabited areas and head mucosal sy.-s 7–11 years old children, Villages, Heves county, Hungary, 2001 % OR=1.51* (95% CI=1.08–2.14) OR=1.51* (95% CI=1.08–2.14) 50 50 0 25 25 45.1 45.1 55.6 55.6 75 75 N=144 NCPH NIEH NPHMOS N=1391 No sprays Sprays

21. % OR=1.93** (95% CI=1.28–2.92) OR=1.93** (95% CI=1.28–2.92) 50 50 0 25 25 14.5 14.5 24.6 24.6 75 75 N=138 NCPH NIEH NPHMOS N=1382 Agricultural airborne pesticide sprays/ inhabited areas and bronchitic sy.-s 7– 11 years old children, Villages, Heves county, Hungary, 2001 No sprays Sprays

22. % OR=1.82** (95% CI=1.20–2.78) OR=1.82** (95% CI=1.20–2.78) 50 50 0 25 25 13.3 13.3 21.9 21.9 75 75 N=146 NCPH NIEH NPHMOS N=1450 Agricultural airborne pesticide sprays/ inhabited areas and asthmatic sy.-s 7–11 years old children, Villages, Heves county, Hungary, 2001 No sprays Sprays

23. DISCUSSION 1. Whether it is really possible? - to check retrospectively - to check retrospectively - flight documentations - flight documentations - to check prospectively - to check prospectively - biological monitoring - biological monitoring NCPH NIEH NPHMOS

24. DISCUSSION 2. Chance - high p-values! - high p-values!Bias - recall bias? - recall bias?Confounding - not probable - not probable NCPH NIEH NPHMOS

25. SUMMARY 1. - Pesticide sprays do attain inhabited areas - Respiratory symptoms - 7–11 y children - N=1819 survey questionnaires NCPH NIEH NPHMOS

26. SUMMARY 2. - allergic and neurotic symptoms - prevalences: 21.8%, 20.3% - pesticide sprays attaining inhabited areas: 9% - odds ratios: 2.13*** (2.23***), 2.19*** (2.33***) NCPH NIEH NPHMOS

27. SUMMARY 3. - head mucosal, bronchitic, asthmatic sy.-s - prevalences: 46.3%, 15.5%, 14.1% - odds ratios: 1.51*, 1.93**, 1.82* NCPH NIEH NPHMOS

28. CONCLUSION Specially designed investigations - environmental health impact - environmental health impact - pesticide spraying - pesticide spraying Official measures NCPH NIEH NPHMOS

29. HUNGARIAN NEHAP SECRETARY Dr. Anna Páldy „Fodor József” NCPH NIEH DEPT. COMMUNITY HEALTH Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Renáta Szentmihályi, Györgyi Tóth SCHOOLS, MUNICIPALITIES, HEALTH SERVICES directorship of schools, class leaders, maires, youth and district nurses FAMILIES FAMILIES parents, children parents, children THANKS NCPH NIEH NPHMOS

30. Thanks for the attention NCPH NIEH NPHMOS