1. 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

2. 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

3. NC STATE UNIVERSITY An Important Note  NO Agricultural Health Study participants are depicted in photos  Agricultural Health Study –Confidential –Secure –Ethical

4. NC STATE UNIVERSITY Disease? What Exposures are associated with

5. 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

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 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

8. NC STATE UNIVERSITY... and North Carolina  Farmers –Mostly male –3% African-American  Farm Size: 55% <200 acres  Diverse Crops/Livestock

9. 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%)

10. 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

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 1 - Enroll volunteers into the study  During 1993-1997  Applicators –At pesticide safety training classes  Spouses of farmers – At home

13. NC STATE UNIVERSITY  Farm work related  Environmental 2 – Survey participants

14. NC STATE UNIVERSITY  Lifestyle  Medical history 2 – Survey participants

15. NC STATE UNIVERSITY  Develop exposure formula  Test formula in real world –Measure pesticide exposure on 100 farms 3 – Estimate pesticide exposure

16. NC STATE UNIVERSITY 4 – Collect a genetic sample  Rinse and spit –Mouthwash rinses cells from mouth –Cells contain DNA  Sample used in laboratory studies

17. NC STATE UNIVERSITY 5 – Collect health data from databases  Cancer registries –Iowa –North Carolina  Death certificate –State –National

18. 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?

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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)

29. 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

30. NC STATE UNIVERSITY Iowa Example: Bill’s 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

31. NC STATE UNIVERSITY North Carolina Example: Chlorpyrifos Exposure  Farmer “Fred” grows 300 acres peanuts  Applies granular chlorpyrifos for southern corn rootworm

32. NC STATE UNIVERSITY NC Example: Fred’s 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

33. NC STATE UNIVERSITY Iowa and NC Examples: Lifetime Exposure  Iowa Corn Farmer “Bill’s” Lifetime 2,4-D Exposure =5.6 X 10 days/year X 15 years =840  NC Peanut Farmer “Fred’s” Lifetime Chlorpyrifos Exposure =7.2 X 3 days/year X 10 years = 216

34. NC STATE UNIVERSITY 2,4-D Exposure in the AHS Average Work-Day NC:7.6 Farmers:6.5 IA:6.0 “Bill”5.6 Commercial:5.1 Lifetime Commercial:1692 NC: 1249 IA:1116 Farmers:1096 “Bill” 840

35. 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

36. 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 greater in Iowa, except respirators  Never use PPE –4% (Iowa) –18% (NC)

37. NC STATE UNIVERSITY Understanding the Agricultural Health Study Part 3: Health Findings  Cancers  Nervous system  Respiratory system  Reproductive health

38. 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

39. 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

40. 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

41. NC STATE UNIVERSITY Pesticides and Other Cancers  Breast cancer in farmer’s wives –NO clear association with 50 pesticides  Lung cancer in applicators –Possible association with metolachlor, pendimethalin, chlorpyrifos, diazinon

42. NC STATE UNIVERSITY Cancer and Exposure to Certain Pesticides  Alachlor  Atrazine  Carbofuran  Chlorpyrifos  Glyphosate Users of Pesticide X Non-users of Pesticide X

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

44. NC STATE UNIVERSITY Nervous System Health  Retinal degeneration associated with –Fungicide use  Applicators  Farm wives  Fungicide exposure studied

45. NC STATE UNIVERSITY Female Reproductive Health  Pesticide users –Longer menstrual cycles –Missed periods  Users of hormonally-active pesticides –Long cycles –Missed periods –Intermenstrual bleeding Farmer’s Wives (Non-Users) Farmer’s Wives Female Applicators (Pesticide Users)

46. NC STATE UNIVERSITYSummary  Agricultural Health Study –Important strengths, unique features –More info to come in next 10-15 years  Strongest findings as of 2005 –Methyl bromide and prostate cancer –Fungicides and retinal degeneration

47. NC STATE UNIVERSITYRecommendations  Review pesticide labels  Use PPE –Chemically-resistant gloves –Have PPE available for field repairs  Ask your doctor about: –Prostate cancer screening (if 50 or older) –Lung health screening and respirator use –Skin cancer screening  Cover up and use sunscreen

48. NC STATE UNIVERSITYQuestions

49.  Visit Understanding the AHS web site: http://extension.tox.ncsu.edu http://extension.tox.ncsu.edu  Visit Agricultural Health Study web site: http://www.aghealth.org http://www.aghealth.org  Contact: julia_storm@ncsu.edu For More Information

50. 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

51. 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