Pesticide usage and health consequences for women in developing countries: out of sight, out of mind?

Knowledge and perception of cereal farmers and extension agents on fungicide use in northern Ghana

BACKGROUND

Agricultural pesticide use in sub-Saharan Africa has doubled over the past three decades, with a greater relative increase for fungicides. As pesticide inputs continue to rise, so does the potential for the development of resistance. Here, we report on a survey conducted to understand pesticide resistance awareness, pesticide-use knowledge and practices of growers and agricultural extension officers (AEOs) in the cereals growing-belt of northern Ghana, with emphasis on fungicides. The results may inform development of strategies for improving pesticide literacy including resistance awareness, extension services and crop protection outcomes.

RESULTS

The survey revealed a low level of pesticide-use knowledge for AEOs and growers. This was more so for growers with low education, predominantly women. Education level (and indirectly gender) influenced perceived effectiveness of fungicides and levels of adoption of cultural and agrochemical best practices. Only 28% of growers and 11% of AEOs practiced crop and fungicide rotations, respectively. More than half (53%) of the respondents indicated that fungicides used in northern Ghana are not effective.

CONCLUSION

Given the low level of pesticide literacy of AEOs and growers, training programs on best practice for the use of pesticides, with targeted initiatives for female growers, would improve crop protection outcomes and safety. The limited adoptions of crop rotation and repeated use of fungicides with the same active ingredients, along with >50% of respondents reporting 'fungicides not working' suggest the potential presence of fungicide resistance cases in growers' fields in the Northern region of Ghana. Further work is needed to determine the incidence of resistance in the region. It is recommended that a key policy priority should focus on understanding broader agrochemical-use practices, crop losses and household-level food security in the presence of resistance risks. © 2024 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Examination of urinary pesticide concentrations, protective behaviors, and risk perceptions among Latino and Latina farmworkers in Southwestern Idaho

INTRODUCTION

Studies have documented high levels of pesticide exposure among men farmworkers; however, few have examined exposures or the experiences of women farmworkers. Data gaps also exist regarding farmworkers' perceived risk and control related to pesticides, information that is critical to develop protective interventions.

OBJECTIVE

We aimed to compare urinary pesticide biomarker concentrations between Latino and Latina farmworkers and examine associations with occupational characteristics, risk perceptions, perceived control, and protective behaviors.

METHODS

We enrolled a convenience sample of 62 farmworkers (30 men and 32 women) during the pesticide spray season from April-July 2022 in southwestern Idaho. Participants were asked to complete two visits within a seven-day period; at each visit, we collected a urine sample and administered a questionnaire assessing demographic and occupational information. Urine samples were composited and analyzed for 17 biomarkers of herbicides and of organophosphate (OP) and pyrethroid insecticides.

RESULTS

Ten pesticide biomarkers (TCPy, MDA, PNP, 3-PBA, 4-F-3-PBA, cis- and trans-DCCA, 2,4-D, Glyphosate, AMPA) were detected in >80% of samples. Men and women had similar urinary biomarker concentrations (p = 0.19-0.94); however, women worked significantly fewer hours than men (p = 0.01), wore similar or greater levels of Personal Protective Equipment (PPE), and were slightly more likely to report having experienced an Acute Pesticide Poisoning (26% of women vs. 14% of men; p = 0.25). We observed inconsistencies in risk perceptions, perceived control, and protective behaviors among men.

DISCUSSION

Our study is one the first to examine pesticide exposure and risk perceptions among a cohort of farmworkers balanced on gender. Taken with previous findings, our results suggest that factors such as job tasks, biological susceptibility, or access to trainings and protective equipment might uniquely impact women farmworkers' exposure and/or vulnerability to pesticides. Women represent an increasing proportion of the agricultural workforce, and larger studies are needed to disentangle these findings.

Pesticide Safety Awareness among Rural Farmers in Dadinkowa, Gombe State, Nigeria

INTRODUCTION

Because of the longer growing season and warmer climate, weeds and insect pests spread are on the rise, thereby increasing the demand for pesticide use and consequently harmful emissions that further exacerbate climate change. Unsafe occupational exposure to pesticide residue is associated with a lack of product knowledge and safety awareness among farmers in low- and middle-income countries (LMICs).

MATERIALS AND METHODS

A cross-sectional descriptive study design was adopted for this study in which a face-to-face administered questionnaire was used to collect data from 285 respondents who were selected using convenient snowball sampling technique. Knowledge, awareness, and practices related to pesticide storage, handling, application, and containers disposal among the farmers were measured. Categorical variables were analysed and presented using descriptive statistics in the form of frequency count and percentage, while numeric items were summarized using mean and standard deviation.

RESULTS

Dichlorvos and Perfekthion 2.5 EC listed in the WHO Group I pesticide classification were among the most frequently used pesticides. Symptoms of pesticide intoxication reported include headaches (56.1%), dizziness (56.5%), skin irritation (53.3%), and fatigue (45.6%), respectively. Farmers' behaviour during pesticide application include blowing clogged nozzle with mouth (42.7%), talking while spraying (59.8%), and mixing pesticide with bare hands (31.1%). Furthermore, 38.5% of them use pesticide containers for other domestic purposes.

CONCLUSIONS

Socioeconomic factors, i.e., educational level, age, and years of farm practice, influenced farmers safety behaviour. Based on these findings, an approach that will help strengthen capacity building programmes and the enhancement of knowledge-based initiatives around the adoption of non-synthetic pest-control methods should be encouraged.

Sex-difference in air pollution-related acute circulatory and respiratory mortality and hospitalization

BACKGROUND

Numerous studies have estimated adverse effects of short-term exposure to ambient air pollution on public health. Few have focused on sex-differences, and results have been inconsistent. The purpose of this study was three-fold: to identify sex-differences in air pollution-related health outcomes; to examine sex-differences by cause and season; and to examine time trends in sex-differences.

METHODS

Daily data were collected on circulatory- and respiratory-related mortality (for 29 years) and cause-specific hospitalization (for 17 years) with hourly concentrations of ozone (O3), nitrogen dioxide (NO2), and fine particulate matter (PM2.5). For hospitalization, more specific causes were examined: ischemic heart disease (IHD), other heart disease (OHD), cerebrovascular disease (CEV), chronic lower respiratory diseases (CLRD), and Influenza/Pneumonia (InfPn). Generalized Poisson models were applied to 24 Canadian cities, and the city-specific estimates were combined for nationwide estimates for each sex using Bayesian hierarchical models. Finally, sex-differences were tested statistically based on their interval estimates, considering the correlation between sex-specific national estimates.

RESULTS

Sex-differences were more frequently observed for hospitalization than mortality, respiratory than circulatory health outcomes, and warm than cold season. For hospitalization, males were at higher risk (M > F) for warm season (OHD and InfPn from O3; IHD from NO2; and InfPn from PM2.5), but F > M for cold season (CEV from O3 and OHD from NO2). For mortality, we found F > M only for circulatory diseases from ozone during the warm season. Among the above-mentioned sex-differences, three cases showed consistent time trends over the years: while M > F for OHD from O3 and IHD from NO2, F > M for OHD from NO2.

CONCLUSIONS

We found that sex-differences in effect of ambient air pollution varied over health outcome, cause, season and time. In particular, the consistent trends (either F > M or M > F) across 17 years provide stronger evidence of sex-differences in hospitalizations, and warrant investigation in other populations.

Conhecimentos, atitudes e práticas de agricultores familiares brasileiros sobre a exposição aos agrotóxicos

Resumo O artigo discute conhecimentos, atitudes e práticas (CAP) de agricultores familiares brasileiros a respeito dos impactos na saúde e no ambiente gerados pelo uso de agrotóxicos. Trata-se de um estudo transversal misto, realizado em 2014 em São José de Ubá, RJ. A pesquisa é composta por uma etapa qualitativa, baseada em observações em campo e entrevistas com 25 participantes sobre CAP, no que se refere ao uso de agrotóxicos. A etapa quantitativa abrange avaliação sociodemográfica e de exposição aos agrotóxicos de 78 agricultores. Apesar de reconhecerem parcialmente os perigos dos agrotóxicos, os agricultores enfrentam os riscos da exposição e comumente adotam práticas laborais inadequadas. Fatores como a carência de apoio técnico e treinamento laboral, baixa escolaridade, dificuldade de compreensão das orientações de bulas e rótulos dos agrotóxicos, valor elevado e desconforto causado pelo equipamento de proteção individual (EPI), além da crença da dependência do uso de agrotóxicos, explicam parcialmente as atitudes não seguras. É preciso promover práticas agrícolas mais sustentáveis, fortalecer o apoio técnico e treinamento laboral, melhorar a comunicação e o gerenciamento dos riscos e reduzir as desigualdades de gênero entre os agricultores brasileiros, como a forma mais eficaz e imediata de prevenir os agravos relacionados ao trabalho com agrotóxicos.

Pesticides Hazardous Hotspots: Empirical Evidences from North India

The pesticide use in Indian agriculture showed a declining trend in the late 1990s and early 2000s. Since 2007, pesticide use gained an upward trend. To study the pesticide use pattern and identify pesticide hotspots, we collected data from a sample of 1201 apple, rice, vegetable, and cotton growers from the temperate Kashmir Valley, subtropical Jammu, and Punjab. Our study provided some interesting empirical results: prophylactic pesticide applications in apple crop making it a pesticide guzzler [25.2 kg of active ingredient (ai)/ha] with use of riskiest carcinogen pesticides (9 kg of a.i/ha) and field use environmental impact quotient (FEIQ) (620.4/ha) being the highest, the Kashmir Valley is the "pesticide hottest spot", followed by cotton and rice areas of Punjab and vegetable cultivation in Jammu subtropics. Pesticides banned for use in vegetables, such as monocrotophos were also applied by farmers in vegetable crops. However, rice areas in Kashmir and Jammu were only treated with herbicides. The protective measures taken by farmers while mixing and applying pesticides were primitive, resulting in localized mild/moderate pesticide poisoning besides loss of consciousness. We also found that the official data on the pesticide use are underreported and hence unreliable. Our study shows that neither the pesticide use by mass nor the pesticide use frequency, in combination or alone, is the robust indicator to measure the pesticide hazardous hotspots; besides these, FEIQ and less hazardous pesticides that are not probable or possible carcinogen should be rather used in conjunction.

Occupation and maternal mortality in Brazil

OBJECTIVE

To estimate maternal mortality ratio according to occupation in Brazil.

METHODS

This is a mortality study conducted with national data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC) in 2015. Maternal mortality ratios were estimated according to the occupation recorded in death certificates, using the Brazilian Classification of Occupation (CBO), version 2002.

RESULTS

A total of 1,738 maternal deaths records were found, corresponding to a maternal mortality ratio of 57.6/100,000 live births. It varied among occupational groups, with higher estimates among service and agricultural workers, particularly for domestic workers (123.2/100,000 live births), followed by general agricultural workers (88.3/100,000 live births). Manicurists and nursing technicians also presented high maternal mortality ratio. Maternal occupation was not reported in 17.0% of SIM registers and in 13.2% of SINASC data. Inconsistent records of occupation were found.“Housewife” prevailed in SIM (35.5%) and SINASC (39.1%).

CONCLUSIONS

Maternal mortality ratio differs by occupation, suggesting a work contribution, which requires further research focusing occupational risk factors. Socioeconomic factors are closely related to occupation, and their combination with work exposures and the poor access to health services need to be also addressed.

Acute pesticide poisoning amongst adolescent girls and women in northern Tanzania

BACKGROUND

Acute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production.

METHODS

Over the period of 12 months, health facility-based surveillance for cases of APP was implemented in 10 Tanzanian healthcare facilities in 2006.

RESULTS

The study identified 108 APP cases of whom 31 (28.7%) occurred amongst adolescent girls. Suicide was the leading poisoning circumstances (60.2%) and the most vulnerable women were 20-29 years old who comprised 38.4% of all cases with suicide as circumstance. Organophosphates (OPs), zinc phosphide, paraquat and endosulfan were common amongst known reported poisoning agents. The annual APP incidence, mortality and Case Fatality Rate for women were 5.1/100,000, 0.2/100,000 and 3.7/100, respectively.

CONCLUSION

APP amongst women in Tanzania is common and this call for diverse preventive interventions to reduce poisoning incidents.

Comparative Analysis of Pesticide Use Determinants Among Smallholder Farmers From Costa Rica and Uganda

Pesticides are used globally in agriculture and pose a threat to the health of farmers, communities, and the environment. Smallholder farmers in low- and middle-income countries have generally a low socio-economic status and educational level. Consequently, they are particularly vulnerable to negative impacts of pesticides on their health, yields, or land. In a Knowledge, Attitude, and Practices study, we compared the pest management practices between a market-oriented farming system in Zarcero County, Costa Rica, and a subsistence-based farming system in Wakiso District, Uganda. We conducted a cross-sectional survey among smallholder farmers from Costa Rica (n = 300) in 2016 and from Uganda (n = 302) in 2017. We enrolled conventional and organic farmers, but also farmers with mixed practices and non-applicators of any pest management strategy. We found that the majority of pesticides used in both case studies are classified as highly hazardous by the World Health Organization. While more than 90% of smallholder farmers from both countries were aware of the negative health effects of pesticide exposure, <11% in Costa Rica and <2% in Uganda reported using personal protective equipment every time they handled or applied pesticides. Hygiene and other safe use practices were not adopted by all farmers (<61%), especially among farmers applying more hazardous pesticides. Conventional farmers from Costa Rica (14%) and Uganda (19%) reported disposing pesticide residuals into rivers. Using a logistic regression we found that organic farmers were more likely to having been trained on safe pesticide use practices. Using a robust regression, we observed that smallholder household income was primarily driven by education and not directly by the use of synthetic pesticides. Our results suggest that negative effects of pesticides can be managed over the whole life cycle, from purchase, via storage and application to residual and waste management by fostering professionalization of farmers. We advise future safe use and handling interventions to consider the pesticide use-related socioeconomic and demographic findings highlighted in this paper.

Health problems from pesticide exposure and personal protective measures among women cotton workers in southern Pakistan

Women are the main cotton pickers in Pakistan even from their childhood, but due to unawareness of pesticide risks and poor knowledge of personal protection opportunities, they typically do not use personal protective measures. Albeit a major agricultural topic in Pakistan, relevant research is limited. The present study illustrates health problems from pesticide exposure during cotton harvest and the use of personal protective measures among 260 female cotton-picking workers from Shaheed Benazirabad District of Sindh Province in southern Pakistan. Skin injury, eye injury, headache, stomachache, and fever were the main health problems due to pesticide exposure according to workers' experience. Medical treatment costs of health problems were more than double (2.48 times higher) than preventive measures costs. More than half of the cotton workers surveyed did not use any protective measure during cotton picking, while 22.3% used a muffler/scarf/cloth for covering their face and 10.8% used gloves. Covering face with muffler/scarf/cloth was higher in young (P < 0.05), married (P < 0.05), and high experienced workers (P < 0.05), while no significant trends were found in the use of gloves. The use of protective measures was positively correlated with education and some experience in cotton picking. Binary logit regression showed that advanced age and high picking experience were positively associated with the use of personal protective measures, while illiteracy, traditional treatment, and medical treatment in case of illness were negatively associated with the use of personal protective measures. Findings shed new light on the topic of personal safety among women cotton pickers in Pakistan. Increasing formal education and implementing training programs for personal protective measures are important to reduce health risk and health cost by pesticides among women workers.

Biomonitoring of Acetylcholinesterase (AChE) Activity among Smallholder Horticultural Farmers Occupationally Exposed to Mixtures of Pesticides in Tanzania

Biomonitoring of pesticides exposure has currently become a matter of great public concern due to the potential health effects of pesticides. This study assessed levels of acetylcholinesterase (AChE) inhibition and associated health effects in uncontrolled smallholder farming systems in rural Tanzania. A cross-sectional study was conducted of 90 exposed farmers and 61 nonexposed controls from horticultural zones. A structured questionnaire was administered, and a capillary blood sample of 10 μl was used to measure AChE activity using an Erythrocyte Acetylcholinesterase Test Mate Photometric Analyzer kit (Model 400). A multiple logistic regression model was used to investigate determinants of pesticide exposure. The study revealed that smallholder farmers are occupationally exposed to pesticides. Exposed farmers had significantly lower AChE levels. The use of personal protective equipment (PPE) did not significantly reduce the likelihood of AChE inhibition. Women, younger and older farmers, and underweight, overweight, and obese farmers were at increased risk of AChE inhibition. Increase in age (10 years) increased likelihood of AChE inhibition by 6.7%, while decrease in BMI increased likelihood of AChE inhibition by 86.7% while increased pesticides contact hours increased risk of having lower AChE at about 3 times. The number of exposure symptoms (14.10 ± 7.70) was higher in exposed farmers than unexposed. Self-reported symptoms are confirmed to correlate to lower AChE. Prevalence of tiredness (71.6% against 15.5%), fatigue (64.8% against 27.6%), soreness in joints (59.1% against 20.7%), thirst (52.3% against 12.1%), skin irritation (52.1% against 17.2%), salivation and abdominal pain (50% against 8.6% and 31.0%, respectively), muscle weakness (47.7% against 24.1%), and memory loss (47.7% against and 29.3%) differed significantly between exposed and control. This study provides useful information regarding the level of occupational and environmental exposure to pesticides in smallholder horticultural production systems. Pesticides use needs to be controlled at farm level by developing pesticides monitoring and surveillance systems.

A comprehensive approach of the gender bias in occupational cancer epidemiology: A systematic review of lung cancer studies (2003-2014)

BACKGROUND

In occupational epidemiology, a male-centered perspective often predominates. We aimed to describe current research practices in terms of gender consideration at different stages of epidemiological studies.

METHODS

A systematic review of occupational lung cancer publications indexed in PubMed was conducted over the period 2003-2014. Articles were described according to the sex composition of their study sample.

RESULTS

In 243 studies, 7 (3%) were women-only, 101 (41%) were mixed, with a disproportionate men-to-women ratio (P50 = 3.5; P75 = 12.4). A shift was observed from mixed and unspecified source populations to men-only final samples. Our results also suggest implicit generalization of results from men-only studies, a lack of tests of interaction and often unjustified sex-adjustment for mixed studies.

CONCLUSIONS

The lower proportion of women in studies cannot be fully explained by their under-representation in the target populations, since there were large numbers of women among both potentially exposed workers and patients diagnosed with lung cancer.

Health hazards and adoption of personal protective equipment during cotton harvesting in Pakistan

The use of personal protective equipment (PPE) during cotton harvesting is critical for securing better health for female cotton pickers in the developing countries where health facilities are not sufficiently available to the masses in the rural areas. Despite increasing the efforts in increasing awareness about the benefits of PPE among the farm workers, a vast majority of the farm workers including pickers don't use the PPE. The present study examines health impacts of cotton harvesting in Pakistani Punjab along with the factors affecting the use of PPE among the cotton pickers. Cross-sectional data collected from Vehari district is used. The study estimates health cost and the use of PPE among the young and elder cotton pickers. Headache, sleeplessness, cough, flue/fever, skin and eyes problems are reported by the young and elder cotton pickers. Personal protective equipment is rarely used during picking. However, the young pickers relatively adopt more PPE compared to the elder cotton pickers. Health cost of cotton picking is US$2.96 and 3.06 per season during the year for the young and elder cotton pickers, respectively. Results of logit model show that health cost, age, education below 8^th grade, perception of temporary impact and health problems are important determinants of adopting PPE among the cotton pickers. The findings of the study conclude that the use of PPE can be realized through proper training and education of cotton pickers and farm workers.

Pesticide Exposure and Health Problems Among Female Horticulture Workers in Tanzania

Commercialization of horticulture farming, expansion of farms, and the practice of monoculture favor the proliferation of pests, which in turn increases the need for pesticides. Increased exposure to pesticides is associated with inadequate knowledge on the hazardous nature of pesticides, poor hygiene practices, lack of availability of washing facilities, and insufficient adherence to precautionary instructions on pesticide labels. Mitigating the risks posed by pesticides is considered a less compelling interest than alleviating poverty. Women working in horticulture in Tanzania usually have low levels of education and income and lack decision-making power even on matters relating to their own health. This contributes to pesticide exposure and other health challenges. Because of multiple factors, some of which act as study confounders, few studies on exposure to pesticides and health effects have been conducted among women. This review identified factors that contribute to the increased health effects among women working in the horticultural industry and how these effects relate to pesticide exposure.

Characterization of Pesticide Exposure in a Sample of Pregnant Women in Ecuador

Few studies have detailed the prenatal pesticide exposure levels of women employed in or residing near large-scale agricultural industries. This study reports pesticide metabolite levels during and shortly after pregnancy in a pilot study of workers in Ecuador. Urine samples were collected for 16 rose workers and 10 nonagricultural workers enrolled into the study in early pregnancy. We measured six nonspecific organophosphatedialkylphosphate (DAP) pesticide metabolites, two alkylenebis-dithiocarbamate pesticide metabolites [ethylene thiourea (ETU) and propylene thiourea (PTU)], 3,5,6-trichloro-2-pyridinol (TCPy), malathion dicarboxylic acid, and two pyrethroid metabolites (2,2-dimethylcyclo propanecarboxylic acid and 3-phenooxybenzoic acid). We collected 141 urine samples (mean: 5.4 per woman). We observed high detection frequencies for five DAP metabolites and ETU, PTU, and TCPy. We report elevated levels of ETU in the entire sample (median 4.24 ng/mL, IQR 2.23, 7.18), suggesting other possible non-occupational pathways of exposure. We found no statistical differences in pesticide levels by current employment status, although the highest pesticide levels were among rose workers. We observed within-woman correlation in TCPy and PTU levels, but not in ETU or DAP levels. The present study is the first to characterize prenatal pesticide exposure levels among working women in Ecuador. Limitations include a small sample size and use of a convenience sample. Strengths include a longitudinal design and multiple urine samples per woman. Results provide an initial characterization of prenatal pesticide exposure levels and how these levels vary over pregnancy in a community impacted by agricultural industry and will inform further studies in the region.

Gender in occupational health research of farmworkers: a systematic review

Background

Farmwork is one of the most hazardous occupations for men and women. Research suggests sex/gender shapes hazardous workplace exposures and outcomes for farmworkers. This paper reviews the occupational health literature on farmworkers, assessing how gender is treated and interpreted in exposure-outcome studies.

Methods

The paper evaluates peer-reviewed articles on men and women farmworkers' health published between 2000 and 2012 in PubMed or SCOPUS. Articles were identified and analyzed for approaches toward sampling, data analysis, and use of exposure indicators in relation to sex/gender.

Results

18% of articles reported on and interpreted sex/gender differences in health outcomes and exposures. Sex/gender dynamics often shaped health outcomes, yet adequate data was not collected on established sex/gender risk factors relating to study outcomes.

Conclusion

Research can better incorporate sex/gender analysis into design, analytical and interpretive approaches to better explore its mediation of health outcomes in light of emerging calls to mainstream gender research. Am. J. Ind. Med. 57:1344–1367, 2014. © 2014 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Asthma associated with pesticide exposure among women in rural Western Cape of South Africa

BACKGROUND

Few studies have investigated asthma and pesticides among women farm workers in developing countries.

METHODS

A cross-sectional study was conducted to investigate the association between pesticides and asthma among rural women (n = 211). Outcome measurements included respiratory symptoms (European Community Respiratory Health Survey questionnaire), immunological status (Phadiatop, serum IgE to mite allergens) and lower airway inflammation (fractional exhaled nitric oxide (FeNO) levels). Exposure variables included self-reported pesticide exposure and whole blood cholinesterase (ChE).

RESULTS

The prevalence of ocular-nasal symptoms (ONS), doctor-diagnosed asthma and current asthma was 24%, 11%, and 6% respectively. ONS was positively associated with re-entering a sprayed field (OR = 2.97; CI: 0.93-9.50). Asthma symptom score was associated with low ChE (OR = 1.93; CI: 1.09-3.44). Participants with high FeNO (>50 ppb) also had an elevated odds of having low ChE (OR = 4.8; CI: 0.80-28.00).

CONCLUSION

Pesticide exposure among women farm workers is associated with increased risk of ocular nasal symptoms and an elevated asthma symptom score.

Communicating pesticide neurotoxicity research findings and risks to decision-makers and the public

The extensive research findings on neurotoxic risks of pesticides tend to remain in academic publications rather than being comprehensibly communicated to decision-makers and the public. Protecting health and promoting risk reduction, particularly in developing countries, requires access to current findings in a format that can inform policy, regulations, behaviour change and risk reduction. Successfully communicating research findings may require multiple strategies depending on the target audience's varying comprehension skills (e.g., numeracy literacy, visual literacy) and ability to interpret scientific data. To illustrate the complexities of risk communication, a case study of exposure to neurotoxic street pesticides amongst poor, urban South African communities attempting to control poverty related pests, is presented. What remains a challenge is how to communicate neurotoxicity research findings consistently and in a meaningful manner for a lay audience, consisting of both the general public and decision makers. A further challenge is to identify who will monitor and evaluate the ways in which these findings are communicated to ensure quality is maintained. Ultimately, researchers should carry the responsibility of knowledge translation and engaging with communication specialists when appropriate. Additionally, institutions should reward this as part of promotion and academic accolade systems, and funders should fund the translational process. Ethics review boards should also play an instrumental role in ensuring that knowledge translation is part of the ethics review requirement, while professional societies should take more responsibility for disseminating research findings to non-academics.

Pesticide residues, heavy metals, and DNA damage in sentinel oysters Crassostrea gigas from Sinaloa and Sonora, Mexico

Pesticides and heavy metals were analyzed in sentinel Crassostrea gigas oysters placed in six aquaculture sites close to a contaminated agricultural region. Each site was sampled twice. Tests revealed the presence of organochlorine (OC) pesticides in the oysters at concentrations varying from 31.8 to 72.5 μg/kg for gamma-hexachlorocyclohexane (γ-HCH); from 1.2 to 3.1 μg/kg for dichlorodiphenyldichloroethylene (4,4-DDE); from 1.6 to 2.3 μg/kg for endosulfan I; and from 1.4 to 41.2 μg/kg for endosulfan II, as well as heavy metals in concentrations that exceeded Mexican tolerance levels (405.5 to 987.8 μg/g for zinc; 4.2 to 7.3 μg/g for cadmium; and 7.2 to 9.9 μg/g for lead). Significant levels of DNA damage in oyster hemocytes were also detected. There was a significant, positive correlation between genotoxic damage and concentration of nickel or the presence of endosulfan II. Cellular viability evaluated by cytotoxic analyses was found to be high at 80%. Marked inhibition in activity of acetylcholinesterase (AChE ) and induction of glutathione S-transferase (GST) activity was noted. Data demonstrated a significant relation between AChE activity inhibition and presence of endosulfan II, γ-HCH, copper, lead, and 4,4-DDE, as well as between AChE and GST activity at different sites.

Human exposure to p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) in urban and semi-rural areas in southeast Spain: a gender perspective

p,p'-Dichlorodiphenyldichloroethylene (p,p'-DDE) is the main metabolite of pesticide dichlorodiphenyltrichloroethane and a marker of past exposure to this organochlorine pesticide. p,p'-DDE is considered a persistent organic pollutant with potential adverse effects on human health. The aims of the present study were to assess p,p'-DDE levels in serum and adipose tissue from a cohort of adults in southern Spain and to explore the predictors of exposure from a gender perspective. Chemical analyses were performed using gas chromatography-coupled mass spectrometry in tandem mode. The study population (n=387) was intraoperatively recruited in two areas of Granada Province (southern Spain), and data on potential predictors of these concentrations were gathered by questionnaire. The statistical analysis was performed by means of multivariable linear regression models. All participants showed detectable concentrations of p,p'-DDE in both serum and adipose tissue, with median concentrations of 175.7 and 93.0 ng/g lipid, respectively (p<0.001), and the two measurements showed positive correlations. Women showed higher concentrations than men (115.8 and 66.2 ng/g lipid, respectively, p<0.001). Concentrations in both matrices were positively associated with fatty food consumption, as well as with age and BMI, the latter only in adipose tissue. The multivariate model showed that, among women, adipose tissue concentrations were approximately 40% higher in those residing in the semi-rural area and 2-fold higher in those whose mothers had participated in agricultural activities during the pregnancy. In this study population, gender and place of residence play a key role in human exposure to p,p'-DDE and can be used to identify subjects at special risk of long-term exposure.

Serum concentrations of p,p'-dichlorodiphenyltrichloroethane (p,p'-DDE) in a sample of agricultural workers from Bolivia

Organochlorine pesticide p,p'-dichlorodiphenyltrichloroethane (DDT) is still used for vector control in several tropical and subtropical areas of South America and there is evidence of recent illegal use in agriculture. Its main breakdown product in the environment and living organisms is p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE), which is considered a marker of past exposure to DDT. The aim of the present study was to assess human exposure to p,p'-DDE in a sample of agricultural farmers from three rural communities in eastern Bolivia. In addition, o,p'-DDT was analyzed as a surrogate of a potential ongoing exposure to the pesticide. Face-to-face questionnaires were performed, and serum samples were analyzed by high-resolution gas chromatography with mass spectrometry. p,p'-DDE was found in 100% of the samples, with a median concentration of 19.7ngmL(-1) (4788.7ng/g lipid), while o,p'-DDT was detected in 3 samples (4.3%). Serum p,p'-DDE concentrations were associated with time of residence in the study area, personal hygiene after work, and body mass index in adjusted multinomial logistic regression models with tertiles of p,p'-DDE as the dependent variable. The present results revealed high levels of exposure to p,p'-DDE, which might be derived from a heavily polluted local environment and past occupational exposure. These findings deserve further attention due to the potential associated health risks and point to the need for the continuous monitoring of these populations.

Occupational pesticide exposure among Yemeni women

OBJECTIVES

Limited research on the nature and extent of pesticide exposure among women in developing countries is available. The aim of this study was to describe potential pesticide exposure among women living in Yemen that occurs through agricultural work.

METHODS

In this cross-sectional study, 410 women who had a daughter enrolled in high school during 2011-2012 were surveyed regarding pesticide exposure.

RESULTS

Of the 410 women who responded to the survey, 171 women reported working on farms during their lifetime. Of these 171 women, 147 reported working on a farm prior to marriage and 108 reported working on a farm after marriage. Among the women who reported working on a farm before marriage, 47% had worked on farms where pesticides were used. Among those women who reported working on farms after marriage, 69% of women worked on farms where pesticides were used. Among women who reported working on a farm before marriage where pesticides were used, 45% reported not using any protective equipment. This proportion was 33% among women who worked on a farm after marriage. Among the 28 commercial pesticides that were listed within the questionnaire, the banned compound dimethoate was the most commonly reported pesticide to be used on farms.

CONCLUSIONS

The findings suggest that improving safe pesticide management practices among farmers and enforcing effective banning of the most toxic pesticides is needed to reduce pesticide exposure among Yemeni women.

Gender differences in acute pesticide-related illnesses and injuries among farmworkers in the United States, 1998-2007

BACKGROUND

Farmworkers have a high risk for acute pesticide-related illness and injury, and the rate among female farmworkers is approximately twice as high as that among males. Surveillance data were used to identify reasons for this gender difference.

METHODS

We identified acute pesticide-related illness and injury cases among farmworkers from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program and the California Department of Pesticide Regulation. Gender-specific associations with acute pesticide-related illness and injury were assessed using chi-square tests. National Agricultural Workers Survey data were also examined.

RESULTS

The over-representation of females among farmworker illness and injury cases was confined to females who did not handle pesticides (non-handlers). Female non-handler farmworkers who were affected were more likely to be working on fruit and nut crops, to be exposed to off-target pesticide drift, and to be exposed to fungicides and fumigants compared to males.

CONCLUSIONS

Although there is an increased risk for acute pesticide-related illness and injury among female farmworkers, the absolute number of farmworkers with acute pesticide-related illness and injury is far higher among males than females. Furthermore, farmworkers have little or no control over many of the identified contributing factors that led to illness and injury. Stringent enforcement of existing regulations and enhanced regulatory efforts to protect against off-target drift exposures may have the highest impact in reducing acute pesticide-related illness and injury among farmworkers.

Work-related pesticide poisoning among farmers in two villages of Southern China: a cross-sectional survey

Background

Pesticide poisoning is an important health problem among Chinese farm workers, but there is a paucity of pesticide poisoning data from China. Using the WHO standard case definition of a possible acute pesticide poisoning, we investigated the prevalence and risk factors of acute work-related pesticide poisoning among farmers in Southern China.

Methods

A stratified sample of 910 pesticide applicators from two villages in southern China participated in face-to-face interviews. Respondents who self-reported having two or more of a list of sixty-six symptoms within 24 hours after pesticide application were categorized as having suffered acute pesticide poisoning. The association between the composite behavioral risk score and pesticide poisoning were assessed in a multivariate logistic model.

Results

A total of 80 (8.8%) pesticide applicators reported an acute work-related pesticide poisoning. The most frequent symptoms among applicators were dermal (11.6%) and nervous system (10.7%) symptoms. Poisoning was more common among women, farmers in poor areas, and applicators without safety training (all p < 0.001). After controlling for gender, age, education, geographic area and the behavioral risk score, farmers without safety training had an adjusted odds ratio of 3.22 (95% CI: 1.86-5.60). The likelihood of acute pesticide poisoning was also significantly associated with number of exposure risk behaviors. A significant "dose-response" relationship between composite behavioral risk scores calculated from 9 pesticides exposure risk behaviors and the log odds of pesticide poisoning prevalence was seen among these Chinese farmers (R² = 0.9246).

Conclusions

This study found that 8.8% of Chinese pesticide applicators suffered acute pesticide poisoning and suggests that pesticide safety training, safe application methods, and precautionary behavioral measures could be effective in reducing the risk of pesticide poisoning.

A growing role for gender analysis in air pollution epidemiology

Epidemiologic studies of air pollution effects on respiratory health report significant modification by sex, although results are not uniform. Importantly, it remains unclear whether modifications are attributable to socially derived gendered exposures, to sex-linked physiological differences, or to some interplay thereof. Gender analysis, which aims to disaggregate social from biological differences between males and females, may help to elucidate these possible sources of effect modification. Studies of children suggest stronger effects among boys in early life and among girls in later childhood. The qualitative review describes possible sources of difference in air pollution response between women and men, which may vary by life stage, coexposures, hormonal status, or other factors. The sources of observed effect modifications remain unclear, although gender analytic approaches may help to disentangle gender and sex differences in pollution response. A framework for incorporating gender analysis into environmental epidemiology is offered, along with several potentially useful methods from gender analysis.

Gender and sex differences in job status and hypertension

OBJECTIVES

Studies have shown greater health risks associated with blue-collar manufacturing employment for women than men. It remains challenging, however, to distinguish gendered job status (affected by family composition and other personal characteristics) from sex-linked biological differences influencing physiological response to workplace physical hazards.

METHODS

We examined the effects of hourly (blue-collar) status on incident hypertension among men and women, using health claims data for 14, 618 white- and blue-collar aluminium manufacturing employees in eight US states. To explore gender differences in job status, we developed sex-stratified propensity score models identifying key socioeconomic predictors of hourly status for men and women. To examine the effects of hourly employment on hypertension risk, after adjusting for gender differences in job status, we applied time-weighted logistic regression models, stratified by propensity score, with additional adjustment for socioeconomic confounders.

RESULTS

Family structure (partnership, parity) influenced job status for both sexes; single mothers were more likely to hold hourly jobs (OR 2.02; 95% CI 1.37 to 2.97) and partnered men with children less likely (OR 0.68; 95% CI 0.56 to 0.83). Education, age at hire and race influenced job status for both sexes. The effect of hourly status on hypertension was significant only among women predicted to be hourly (OR 1.78; 95% CI 1.34 to 2.35).

CONCLUSIONS

Our results indicate significant risks of hypertension associated with hourly status for women, possibly exacerbated by sociodemographic factors predicting hourly status (eg, single parenthood, low education). Greater attention to gender differences in job status, and finer exploration of sex-linked biological differences influencing responsivity to workplace exposures, is warranted.

Work and its role in shaping the social gradient in health

Adults with better jobs enjoy better health: job title was, in fact, the social gradient metric first used to study the relationship between social class and chronic disease etiology, a core finding now replicated in most developed countries. What has been less well proved is whether this correlation is causal, and if so, through what mechanisms. During the past decade, much research has been directed at these issues. Best evidence in 2009 suggests that occupation does affect health. Most recent research on the relationship has been directed at disentangling the pathways through which lower-status work leads to adverse health outcomes. This review focuses on six areas of recent progress: (1) the role of status in a hierarchical occupational system; (2) the roles of psychosocial job stressors; (3) effects of workplace physical and chemical hazard exposures; (4) evidence that work organization matters as a contextual factor; (5) implications for the gradient of new forms of nonstandard or "precarious" employment such as contract and shift work; and (6) emerging evidence that women may be impacted differently by adverse working conditions, and possibly more strongly, than men.

A growing role for gender analysis in air pollution epidemiology

OBJECTIVE

Epidemiologic studies of air pollution effects on respiratory health report significant modification by sex, although results are not uniform. Importantly, it remains unclear whether modifications are attributable to socially derived gendered exposures, to sex-linked physiological differences, or to some interplay thereof. Gender analysis, which aims to disaggregate social from biological differences between males and females, may help to elucidate these possible sources of effect modification.

DATA SOURCES AND DATA EXTRACTION

A PubMed literature search was performed in July 2009, using the terms "respiratory" and any of "sex" or "gender" or "men and women" or "boys and girls" and either "PM2.5" (particulate matter <or= 2.5 microm in aerodynamic diameter) or "NO2" (nitrogen dioxide). I reviewed the identified studies, and others cited therein, to summarize current evidence of effect modification, with attention to authors' interpretation of observed differences. Owing to broad differences in exposure mixes, outcomes, and analytic techniques, with few studies examining any given combination thereof, meta-analysis was not deemed appropriate at this time.

DATA SYNTHESIS

More studies of adults report stronger effects among women, particularly for older persons or where using residential exposure assessment. Studies of children suggest stronger effects among boys in early life and among girls in later childhood.

CONCLUSIONS

The qualitative review describes possible sources of difference in air pollution response between women and men, which may vary by life stage, coexposures, hormonal status, or other factors. The sources of observed effect modifications remain unclear, although gender analytic approaches may help to disentangle gender and sex differences in pollution response. A framework for incorporating gender analysis into environmental epidemiology is offered, along with several potentially useful methods from gender analysis.

Suicide and potential occupational exposure to pesticides, Colorado 1990-1999

A number of occupational studies have reported high rates of suicide among selected occupations, including farmers. Limited work has focused on occupational exposures that may increase the risk of suicide. The purpose of this study is to describe suicide among individuals potentially exposed to pesticides through their occupation. Data from Colorado death certificate files for the period 1990-1999 were obtained. Eligible records were those individuals who were Colorado residents at the time of death who had an occupation listed on their death certificates. Cases had suicide listed as the primary cause of death on the death certificates. The comparison group included Colorado residents who died from any cause during the same period other than cancer, mental disorders and injuries. A total of 4,991 suicide deaths were included and a total of 107,692 other deaths served as the comparison group. Occupations considered pesticide exposed included: veterinarians; pest control occupations; farmers and farm workers; farm managers and supervisors; marine life cultivators; nursery workers; groundskeepers and gardeners; animal caretakers; graders, sorters and inspectors of agricultural products; and forestry workers, supervisors and loggers. All other occupational categories were coded as unexposed. Logistic regression was used to compare the groups, separately for males and females. After controlling for age, race, Hispanic ethnicity, years of education, and marital status, males who were in pesticide exposed occupations had higher odds of suicide (odds ratio 1.14; 95% confidence interval 0.97, 1.34) and females in pesticide exposed occupations also had higher odds of suicide (odds ratio 1.98; 95% confidence interval 1.01, 3.88).

Acute chlorpyrifos poisoning in pregnancy: a case report

BACKGROUND

Pesticide exposures and poisoning are common and generally under-reported in poorly resourced countries where women are mainly involved in agricultural work. Cases of organophosphate poisoning in pregnancy are unusual.

CASE REPORT

A 22-year-old woman in her 29th week of pregnancy presented to King Edward VIII Hospital, Durban, South Africa having had multiple generalized tonic-clonic seizures at home. An initial presumptive diagnosis of eclampsia was made and treatment using intravenous MgSO(4) was initiated. Signs of OP toxicity included a garlic odor; vomiting, diarrhea, fecal incontinence; hypersecretions with airway compromise, diffuse rhonchi; pinpoint pupils; and muscle weakness and fasciculations. The patient responded to intravenous doses of atropine; oximes were not available. Although the mother survived, the infant was born prematurely and died two days after birth without showing any OP signs.

CONCLUSIONS

Organophosphate poisoning may mimic acute complications in pregnancy, such as eclampsia and seizures. Immediate management includes general supportive measures and use of specific pharmacological agents such as atropine and oximes. Poisoning during pregnancy may result in serious adverse effects for both mother and the fetus or neonate. Prompt diagnosis and treatment are necessary to avoid adverse outcomes.

Suicide and exposure to organophosphate insecticides: cause or effect?

BACKGROUND

Suicide using pesticides as agent is recognized as a major cause of pesticide poisoning.

METHODS

A literature review of mortality and morbidity studies related to suicide among pesticide-exposed populations, and of human and animal studies of central nervous system toxicity related to organophosphate (OP) pesticides was performed.

RESULTS

Suicide rates are high in farming populations. Animal studies link OP exposure to serotonin disturbances in the central nervous system, which are implicated in depression and suicide in humans. Epidemiological studies conclude that acute and chronic OP exposure is associated with affective disorders. Case series and ecological studies also support a causal association between OP use and suicide.

CONCLUSIONS

OPs are not only agents for suicide. They may be part of the causal pathway. Emphasizing OPs solely as agents for suicide shifts responsibility for prevention to the individual, reducing corporate responsibility and limiting policy options available for control.

Physical Exposures in Work Commonly Done by Women

The North American workforce is still highly sex-segregated, with most members of each sex in jobs composed primarily of workers of the same sex. This division is accentuated when jobs involve physical demands. Women have traditionally been assigned to tasks whose physical demands are considered to be light. Nevertheless, these tasks can have biological effects, sometimes serious. Phenomena related to physical demands of women's work can be considered in three categories: (a) musculoskeletal and cardiovascular demands of tasks often assigned to women in factories and service work; (b) sex- and gender-specific effects of toxic substances found in the workplace; and (c) interactions between work and the domestic responsibilities of many women. These phenomena are described, using examples recently gathered from workplaces. Effects of biological sex are distinguished, as far as possible, from effects of gender (social roles). Keywords: ergonomics, gender, occupation, anthropometry, toxicity, repetitive movements, static effort

Association of pesticide exposure with neurologic dysfunction and disease

Poisoning by acute high-level exposure to certain pesticides has well-known neurotoxic effects, but whether chronic exposure to moderate levels of pesticides is also neurotoxic is more controversial. Most studies of moderate pesticide exposure have found increased prevalence of neurologic symptoms and changes in neurobehavioral performance, reflecting cognitive and psychomotor dysfunction. There is less evidence that moderate exposure is related to deficits in sensory or motor function or peripheral nerve conduction, but fewer studies have considered these outcomes. It is possible that the most sensitive manifestation of pesticide neurotoxicity is a general malaise lacking in specificity and related to mild cognitive dysfunction, similar to that described for Gulf War syndrome. Most studies have focused on organophosphate insecticides, but some found neurotoxic effects from other pesticides, including fungicides, fumigants, and organochlorine and carbamate insecticides. Pesticide exposure may also be associated with increased risk of Parkinson disease; several classes of pesticides, including insecticides, herbicides, and fungicides, have been implicated. Studies of other neurodegenerative diseases are limited and inconclusive. Future studies will need to improve assessment of pesticide exposure in individuals and consider the role of genetic susceptibility. More studies of pesticides other than organophosphates are needed. Major unresolved issues include the relative importance of acute and chronic exposure, the effect of moderate exposure in the absence of poisoning, and the relationship of pesticide-related neurotoxicity to neurodegenerative disease.

Occupational cancer among women: where have we been and where are we going?

Studies of occupational exposures have been a fruitful area of research for identifying carcinogens. Some of the early observations, such as increased risk of breast cancer among nuns and bone cancer among radium dial workers, were made among women. Recent research on cancer among women has shown increased risks of cancer in many industries and occupations. Estimates that 1% of cancer among women is attributable to occupation are based on research conducted mainly in the 1970s among men in developed countries. These studies do not reflect the dramatic changes in the participation of women in the workplace or the patterns of employment of women in developing countries. The proportion of women in the paid workforce, the amounts and types of unpaid labor, the distribution of women by economy sector, the scale of the workplaces, the allowable exposure levels in the workplace, and implementation of controls have changed over time and vary internationally. Occupational cancer researchers need to expand their focus on women, increase activities in developing countries, include newly created industries, use sophisticated exposure assessment methods, and, where appropriate, incorporate molecular epidemiologic techniques to discover new occupational carcinogens and to identify where better control measures are needed.

Pesticide exposure and women's health

BACKGROUND

Research on pesticide-related health effects has been mostly focused in industrialized countries and in men. This paper discusses critical issues related to women's pesticide exposure and its effects on women's health.

METHODS

The literature on pesticides was reviewed with emphasis on data related to women. Attention was focused on research suggesting different conditions of exposure or different response to pesticides by sex. Studies on cancer and reproductive effects were used as illustrative examples.

RESULTS

Women are increasingly exposed to pesticides in developing countries, where women's poisoning and other pesticide-related injuries seem to be greatly underestimated. Many of the effects of pesticides in human health will be the same for men and women, but not always. Some organochlorine pesticides have been related to breast cancer in post-menopausal women. However, knowledge about other pesticides is much more limited. Epidemiological studies assessing maternal exposure to individual pesticides and abortion, fetal death, or congenital defects are not conclusive, although some suggestive associations have been observed.

CONCLUSIONS

Gender-sensitive research is needed to properly address the study of women's pesticide exposures and related adverse outcomes. A better understanding of potential gender-environment and sex-environment interactions related to pesticide exposure and health effects in women is needed.

Be the fairest of them all: challenges and recommendations for the treatment of gender in occupational health research

BACKGROUND

Both women's and men's occupational health problems merit scientific attention. Researchers need to consider the effect of gender on how occupational health issues are experienced, expressed, defined, and addressed. More serious consideration of gender-related factors will help identify risk factors for both women and men.

METHODS

The authors, who come from a number of disciplines (ergonomics, epidemiology, public health, social medicine, community psychology, economics, sociology) pooled their critiques in order to arrive at the most common and significant problems faced by occupational health researchers who wish to consider gender appropriately.

RESULTS

This paper describes some ways that gender can be and has been handled in studies of occupational health, as well as some of the consequences. The paper also suggests specific research practices that avoid errors. Obstacles to gender-sensitive practices are considered.

CONCLUSIONS

Although gender-sensitive practices may be difficult to operationalize in some cases, they enrich the scientific quality of research and should lead to better data and ultimately to well-targeted prevention programs.