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Safe Handling of AgriculturalPesticides in Minnesota:

Results of a County-wideEducational Intervention

Jeffrey H. Mandel, M.D, M.?H, M Peter Catr, M.PH., T er m Hillmer, M.I?H.,Pamela R. Leonard, M. D, M.?H., Julia U Halberg, M.D., M.PH.,Wayne 1: Sand erson, Ph.D, C.I.H., and Jack S. Mandel Ph.D, M I H .

ABSTRACT: afe pesticide handling in a g roup of Minnesota farmers, aged 40 years andom WIS inj7uenced thro ugh the use of a multifaceted, countyunde educational i n t m t w n .T w i n t m t i o n counties a nd tuu control counties m e m l u e d i n this effort. The i n t m -tw n consisted of mailed pesticide injinmation t o fa rm households educational programs onpesticides f i r cou nty physicians, elemolta ry school training modules on pesticides and the useof safe pesticide handling displays in key business areas by agricultural extension agents. Fiwhundred eight f armers m e dent ipd as pesticide users (186 in the i n t m t w n co un ties and322 in the control counties). The use of gloues and other protectiw clothing while handlingpesticides increased in the in tm ti on group. I r n p r m t UMS greater in those who had usedprotectiw equipment the least b e p e the int erm tio n. From these results, it appears that abroad-based educational intenmtwn might haw a modest impact in hau armers protect themselws when usin g pesticides.

he prevention of pesticide exposure amongfarmers has the obvious benefit of avoidinghealth problems from acute or chronic in-toxication. Even though controversy existsT s to the relationship of pesticide exposurein the development of certain cancers such as lympho-ma, leukemia, myeloma and others Blair and Zahm,1991), proper pesticide handling is obviously prudent.Unfortunately, safe pesticide handling by farmers ingeneral has been shown to be less than optimum(Avory and Coggon, 1994; Elkind and Coty-Salter,1994; Hayes, 1980; Rucker, 1994; Winstead, 1993). This

appears to be true despite the fact that farmers under-stand both the potential harmful effects of pesticidesand the benefits of protective equipment (Elkind andCody-Salter, 1994; Mandel, et al., 1996; Rucker, 1994).Previous assessments have shown that with increas-

ing demands on their time, farmers are less likely topractice safe handling techniques; that a farmeis atti-tude toward safety in other situations is related to safepesticide use (Avory and Coggon, 1994; Ogdvie, 1990);that labeling plays a role in proper pesticide use(Hayes, 1980); that administrative control alone mightnot effectively enhance safe pesticide use (Runyan,

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1994); that educational programs designed to affectfarmers' knowledge are difficult to implement andmeasure Rucker, 1994); that farmers self-report theneed for further education in pesticide protection(Stone, et al., 1994); and that time urgency plays a rolein preventing farmers from using safe techniques Elk-ind and Cody-salter, 1994; Walker, 1988; Weigel, 1980).

Prior attempts to improve safe handling practices inthe United States have focused primarily on legisla-tion, machinery engineering, protective equipment andhealth provider education (Cordes and Rea, 1991).Im-provements in farmers' other preventive health behav-iors through education have been demonstrated (Mul-lan, et al., 1996; Reding, et al., 1996; Goldsmith andSisneros, 1996).This intervention study was initiated to gain furtherinsights into enhancing safe pesticide handling amongMinnesota farmers through an educational approad.This effort was part of a countywide intervention pro-gram designed not only to enhance safe pesticide han-dling but also to increase breast cancer screening andto increase awareness of skin cancer prevention. Thisreport provides the results of the safe pesticide han-dling educational intervention.

MethodsThe study was a community intervention trial con-ducted in 1992. Four counties were selected on the ba-

sis of similar demographic and agricultural produc-tion characteristics.Of these, two nonadjacent countieswere randomly selected to receive interventions.Uni-versity of Minnesota Institutional Review Board a pp r o d was obtained prior to the intervention effort.

The intervention included both a physician compo-nent and a community component. The physician in-tervention consisted of a seminar that was held inboth counties and provided information on exposureto pesticides. The seminars were cosponsored by thecounty medical societies and earned 2.0 category IAmerican Medical Association continuing educationcredits. County medical society lists were used as thebasis for inviting physicians to attend the seminars.More than 80 percent of the 72 primary care physi-cians on these lists attended the seminars.

The community interventions consisted of an ele-mentary school curriculum, educational materialsmailed to all farm households in the interventioncounties and panel displays utilized by County Exten-sion Service staff. The school curriculum was designed

to educate children about the presence of pesticides inand around the rural home, and it suggested ways toprevent exposure to pesticides. Separate curriculawere developed for kindergarten through secondgrade and for thitd grade through sixth grade Materi-als were developed to serve as a free-standing schoolunit intended to be presented as a special project.Ea public and private elementary school in the twointervention countieswas provided the curricula,w hih were implemented with help from MinnesotaExtension Service representatives.vention included an educational brochure with infor-mation on safe pesticide handling practices, an emer-gency action card for managing acute pesticide expo-sures, poison center information and a washing ma-chine magnet with instructions for launderingpesticide-contaminated clothing. Materials weremailed to each farm household in the interventioncounties; addresses were compiled from the list offarm operators maintained by the Minnesota Agricul-tural Statistics Service MASS).

The panel display was developed by County Exten-sion Service personnel to provide information on pes-ticide exposure prevention and safe handling of pesti-cides. The display was designed for use at sites suchas health fairs, training programs, government andprofessional building lobbies and shopping malls inthese counties.

Intervention effectiveness was evaluated using pre-and postintervention telephone surveys. Participantswere chosen randomly in a two-stage process. In thefirst stage, a random sample of farm operations wasselected from the list of farms maintained by theMASS. A farm was defined as any place from which1,OOO or more of agricultural products were pro-duced and sold in a given year. A farm operation was

eligible for participation if there was at least one mem-ber of the household age 40 years or older who hadlived on a farm for the last five years. IS age was

The materials mailed out on pesticide exposure pre-

This study uzzs supported by the National In stitu tefor Occupafional Safetyand Health Demon stration Cancer Control Projects for Farmers G o p a -fiv e Agreement UO3ICCU 506 136 . The M in ne so ta C a m ontrol i nFarmers Study Group comprises Eugene L Anderson Ph.D. Timothy R .Church Ph.D Bryan D m d Ph.D. Sherry A . Gahring M .S Dean Herr-feld M.S \ohn I: Kelley, M.D. George Maldonado, Ph.D Anne McGearyB.A. Kiypen Macgregos B.S., Wanda W Olson M.S. and J k i nVance M.D . Forfurther information contact: Jefie y H. Madel, M . DMedical Department 3M Center Building 220-3W-05, S t. P a d M N551441000.

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selected to maximize participants for the breast cancerscreening part of the study.) The second stage in-volved selecting at random one eligible person fromthe household, age 40 years or older, who had livedon a farm for five years, to serve as the study respon-dent. To ensure a balanced number of subjectsby ageand gender, an approximately equal number of sub-jects was sampled from each of six age-gender stratausing a weighted random sampling scheme. Pre- andpostintervention interviews were conducted with thesame respondents within the same households a pproximately 18 months apart.The s u r v e y contained items on demographic charac-teristics, health insurance coverage, access to and useof preventive health services, use of agricultural pesti-cides, perceived adverse health effects related to pesti-cide exposure, perceived effectiveness of protectivegloves, perceived effectiveness of other protectiveclothing and percentage of time spent using protectiveequipment (Mandel, et al., 1996). Pesticide users weredefined as those farmers who had personally mixed,loaded or applied pesticides while farming.

A comparison of pre- and postintervention use ofchemically resistant gloves and other protective cloth-ing was conducted among those who used pesticides.A relative change statisticwas used as an indication ofthe interventions effectiveness.This was calculated bycomparing the pre- and postintervention difference inthe use of protective equipment 75 percent of the timeor more in the intervention and control counties. (Aratio of the relative change was calculated by compar-ing percentage of change in intervention counties vs.control counties.)A relative-use statistic was also cal-culated, which indicated the prevalence of postinter-vention use of protective equipment 75 percent of thetime or more in the intervention counties, comparedto prevalence of use in the control counties. This post-intervention prevalence of use was also calculated bypreintervention use strata (0 to 74 percent and 75 per-cent to 100 percent). Seventy-five percent was thepoint that was judged best to represent consistent pro-tective equipment usage.

ResultsEighty-one percent (1,613) of the farms listed byMASS were determined eligible on the initial meen-ing. Of these, 1,049 individuals (65 percent) completedboth pre- and postintervention interviews. In thisgroup, there were 186 farmers in the intervention

counties who used pesticides and 322 in the controlcounties who used pesticides.Table 1 lists demographic characteristics of pesticideusers who participated in the surveys in the interven-tion and control Counties. There were small differencesbetween the two groups.Ten women in the interven-tion counties indicated that h y had personallymixed, loaded or applied pesticides vs. 29 in the con-trol group. A greater percentage of the interventiongroup were high school graduates 50 percent vs. 42percent), whereas 33 percent had postsecondary edu-cation, compared with 47 percent in the control group.Table 2 contains information on the use of protec-tive equipment (gloves and other protective clothingsu as boots, bibs and hats) for pesticide users in theintervention and control populations, before and afterthe intervention. For use of chemically resistant gloves,there was an increase in those using gloves 75 percentor more of the time in the intervention counties (59percent before vs. 71 percent after the intervention)and in the control counties (56 percent vs. 65 percent).After the intervention there was a modest shift to us-ing other protective clothing 75 percent or more of thetime in the intervention group (21 percent vs. 34 per-cent) and to a lesser degree in the control group (21percent vs. 25 percent). Controlling for farm size 480acres or less and greater than 480 acres) did notchange this general relationship. Belief in the harmful-ness of long-term exposure and in the effectiveness ofprotective equipment as well as pesticide applicatorcertification status did not change following theintervention.The overall relative change ratio (intervention tocontrol counties) was 1.4 (confidence interval [CI]=O.9to 1.8) for glove use and 2.9 CI=1.8 to 3.3) or otherprotective equipment use.It was difficult to assess the effect of the interven-tion in women because 8 of 10 in the interventiongroup and 23 of 29 in the control group said theyused protective equipment 75 percent of the time ormore Similarly, it was difficult to assess the interven-tion effect by type of pesticide used. Most farmers in-dicated that they used several pesticide types. The ef-fect of the intervention by age was assessed withintwo categories 40 o 49 years and 50 to 64years). Rel-ative change in intervention and control counties wasminimal (both CIs included 1.0). Relative change inintervention and control countieswas assessed by ed-ucational level (up to and including high school andpostsecondary school). In those with a high school ed-ucation or less, the change ratio was greater in the in-tervention counties than n the control counties (rela-

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Table 1. Characteristics of Pesticide Users by Intervention Status.

Intervention Control

Number Total = Number Total =1 ) Percentage 322) Percentage

Women age in years)45 950 to 6465+45 to 4950 to 6465Never graduated from high SmoolHigh &I graduatePostsecondary educationMarital statusMarried or living as marriedNot married

Employed for wages or salaryYesNoIncome ( )=10,00010,000 to


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Table 2. Re nd Postintervention Pesticide Exposure Beliefs and Practicesby Intervention Status AmongPesticide Users.

Preintervention Postintervention

Intervention Control Intervention ControlNumber

(Percentage) (Percentage) (Percentage) (Percentage)Numberumber Number

Percent time use hemically resistant gloves0 to 74750 o 7475YesNoNot sure

Percent time use other protective clothing

Believe that long-term exposure to pesticides is harmful

Effectiveness of protective clothing in preventing pesticide exposureverySomewhatNot effectiveNot sureCurrently certifiedCertification lapsedNever certifiedNot sure

Pesticide applicator certification status

76 (40.9)110 (59.1)147 (79.0)39 (21.1)177 (95.2)7 3.8)78 (41.9)97 (52.2)7 3.8)

154 (82.8)9 (4.8)22 (11.8)1 (0.5)

2 1.1)

4 (2.2)

140 (43.5)182 (56.5)54 (78.9)68(21.1)294 (91.3)10(3.1)18(5.6)151 (46.9)157 48.8)3 (0.9)

11 (3.4)259 (80.4)12 (3.7)50 (15.5)1 (0.3)

53 (28.5)133 (71.5)123 (66.1)82 (33.9)

178 (95.7)3 (1.6)5 2.6)88 (47.3)3 (1.6)1 (0.5)

156 (83.9)7 (3.8)23 (12.4)0 0.0)

94 (50.5)

111 (34.5)211 (65.5)240 (74.5)82 (25.5)98 (92.5)15 (4.7)9 (2.8)149 (46.3)166 (51.6)4 (1.2)3 (0.9)

252 (78.0)12 (3.7)59 (18.3)0 0.0)

Table 3. Intervention Effectiveness Among Pesticides Users.

Preintervention Utilization Status

75 Percentero to 74 Percent

Chemically resistant glove useOther protective clothing use

Relative use and 95 CIRelative use and 95 CI

1.2(0.9o 1.7)1.5

(1.0 o 2.2)

1 o(0.9o 1.1)1.1

(0.8 to 1.6)

1. Postintervention relative use of chemically resistant gloves and other protective clothing (75 ercent of the time postintenrention[intervention vs. control counties] stratified by preintervention utilization status).

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ers in the control county (relative use=1.2). The inter-vention county farmers who had used other protectiveequipment less than 75 percent of the time prior tothe intervention also had a higher postinterventionuse of such equipment than did the control countyfarmers (relative use=1.5).

The intervention county farmers showed an increasein their safe handling of pesticides with these educa-tional efforts. This was true for the use of both glovesand other protective clothing. For intervention farmersthere was a larger effect among those who, prior tothe intervention, used protective equipment the least.Although the magnitude of this effect is modest, thesefarmers represent the desired group in terms of en-hancing pestiade exposure protection.The educational intervention used had the advan-tage of reaching farmers from a variety of demograph-ic backgrounds. In previous studies the specific a pproach of labeling was thought to be the single mostimportant factor in how farmers handle pesticidessafely (Hayes, 1980). Education has been identified asan important conceptual component of safe pestiadeuse (Abrams, et al., 1991; Marwick, 1989; McQuiston,et al., 1994; Rosival, 1985), but it has focused on thespeafic use of protective equipment instead of on cre-ating an awareness, as this intervention attempted todo. The benefits of the former approach have been dif-ficult to demonstrate (Rucker, 1994).

Results from the study as a whole, where the inter-vention was broader based, indicate that educationmight be more helpful than previously thought. Therelative simplicity of conducting an educational inter-vention like the one reported here makes it an attrac-tive option compared with administrative and legisla-tive efforts. The intervention omitted other approach-es, such radio and television, which could enhanceand su s ta in desired effects. Even a modest result suchas the one demonstrated suggests that additional re-search on educational interventions could benefitfarmers. It is not known whether the observed effectswill be long-lasting because only one follow-up evalu-ation was conducted. Interestingly, beliefs in the harm-fulnessof long-term pesticide exposure did notchange before or after the intervention (95.2 percentvs. 95.7 percent).The intervention involved four primary areas: ef-forts through the school systems; direct mailing of

pesticide information to all defined farms in the coun-ties; use of County Extension Service agents to in-crease awareness of safe pestiade use; and attempts toinform community physicians about pesticides. Therole of each of these efforts was not ascertained sepa-rately in the analyses. However, the latter two effortsinvolved the smallest amounts of time and might,with greater emphasis, be areas that could further en-hance safe pesticide useThere were several potential problems with t h i sstudy. The results of the analyses are based on phoneinterviews. Information on pesticide handling was notvalidated in either the intervention county or the con-trol county. Because participating farmers were overage 40 years, results are not generalizable to youngergroups. Also, these results might not represent otherparts of the country, where different pesticides anddifferent pesticide handling practices might be used.

In summary more broad-based educational inter-ventions could be important in creating an awarenessof potential problems related to pesticide exposureand in increasing farmers' use of protective equipment. More attention needs to be paid to enhancingand sustaining the results of such education. Thereappears to be a potential for improving the safety ofpesticide handling with a relatively simple educationalinput. This could have important public health impli-cations for t i s occupational group.

ReferencesAbrams, K Hogan,D, & Maibach, H. 1991). Pesticide-related der-

matoses in agricultural workers. Occupational Medicine: State ofthe Art Reviews, 6,4 492.Avory, G, & Coggon, D. 1994).Determinants of safebehavior infarmers when working with pesticides. Occupatwnnl Medicine44,236-238.

Blair, A, Q Zahm, SH. 1991a). Cancer among farmers. OccupationalMedicine: State of the Art Reviews, 6 415-428.Cordes, D, & Rea, D. 1991). Preventive measures in agricultural set-

tings. Occupatwnal Medicine: State of the Art Reviews, 6 541-550.Elkind, P,& Cody-salter,H. 1994). Farm stressors: The hazards of

agrarian l i f Annals of Agricultural and Environmental Medicine 1,2S27

among California fannworkers: Preliminary findings.Journal ofRural h l f h , 12, 343-348.Environmental Science Hialth 15, 100S1021.W, & Mandel, JS.(19 ). Factors associated with safe use of ag-ricultural pesticides in Minnesota. Journal of Rural Health 12,301-309.

Goldsmith, D, & Sineros, G . (1996). Cancer prevention strategies

Hayes, W. 1980). Factors limiting injury from pesticides.JournalofMandel, JH, Cam, P, Hillmer, T, Leonard, P, Halberg, I Sanderson,

Marwick, C. 1989). Educating farmers, physicians who treat them,

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about rural lifes potential health hazards. Journal f the A m -can Medical Association, 261, 343.

McQuiston, T, Coleman, N, Wallerstein, A Marcus, I Morawetz, I &Ortlieb D. (1994). Hazardous waste worker education: h g -term effects. Journal of OccupufionnlMedicine 36,1310-1323.

Mullen, P, Gardiner,J Rosenman, K. Zhw Z, & Swanson. M. 1996).Skin cancer prevention and detection practices in a Michiganfann population following an educational intervention.h r n a lof Rural Health 12, 311-320.grain fmmers. Unpublished doctoral dissertation. University ofIowa,A m , A.

Reding, D, Fisdter, V,Gunderson, P, Lappe, K, Anderson, H, & Cal-vert, G 1996). Teens eam skin cancer prevention JournaI of

Ogilvie, L. 1990).Agricultural safety equzpment usage: A surupy of owa

Rurnl Hearth iz, 265-272.

Rosival, L. 1985). Pestiades [Review]. Scandinavian Journal of MbrkEnoironment and Health 11, 189-197.Rucker, M. 1994). Attitudes and clothing practices of pesticide a pplicators. P ro tec fk CIothing Systems and h4aterials 55,79-94.Runyan, J. 1994). arm safety: ay mles on pesticides. AgriculturalOutlook 210,24-26.Stone,Greenhouse applicators perceptions and use of personal pro-tective equipment.J o u d of Em hm nm ta l Hea lth 57 1622.Walker, J. 1988).elf reported stress symptoms in farmers. Journal ofClinical Psychology 1 10-16.Weigel, R. 1980, May/-). Helping farmers handle stress. JournalWinstead,C. 1993). How pesticides are handled in a rural NorthCarolina county:A survey of farmers.AmeticPn AssoCintirm ofccupationalHealth Nursing,41, 24-32.

Padgett, S,Witersteen,W, Shelley, M, & Chisholm. S. 1994).

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