Helen Murphy – FNP, MHSHelen Murphy – FNP, MHSPacific Northwest Agricultural Safety and Health Center Pacific Northwest Agricultural Safety and Health Center

(PNASH)(PNASH)School of Public Health School of Public Health

University of WashingtonUniversity of Washington

Women’s and Children’s Women’s and Children’s Vulnerability to PesticidesVulnerability to Pesticides

ToddlersToddlers

GREATER EXPOSUREGREATER EXPOSURE Hand to mouth behaviorsHand to mouth behaviors SKIN contact with floors and lawns SKIN contact with floors and lawns Lighter less clothingLighter less clothing Eats (12x) and drinks (2x) more per weight than adultsEats (12x) and drinks (2x) more per weight than adults

GREATER ABSORPTION GREATER ABSORPTION Breathing rates Breathing rates (1.7x more)(1.7x more) Heart ratesHeart rates Skin surface/weight Skin surface/weight (2.7 x more)(2.7 x more)

GREATER SENSITIVITY GREATER SENSITIVITY Sensitive developing organs Sensitive developing organs (reproductive, neurological)(reproductive, neurological) Less ability to detoxify Less ability to detoxify (immature hepatic cells)(immature hepatic cells)

Selevan SG, Kimmel CA, Mendola P. 2000

Children and AdolescentsChildren and Adolescents

Physically still developing –biologic risksPhysically still developing –biologic risks Dependency – Parental role in preventing Dependency – Parental role in preventing

exposuresexposures Sources of food and water Sources of food and water Home and school proximity to agriculture sitesHome and school proximity to agriculture sites Para-occupational exposures Para-occupational exposures Household and school use of pesticides Household and school use of pesticides

(structural, garden and pet pest control (structural, garden and pet pest control measures) measures)

Children and AdolescentsChildren and Adolescents

Risk taking behaviorsRisk taking behaviors* * Learning by experimentation (e.g. Indonesia Learning by experimentation (e.g. Indonesia

making rockets out of old pesticide containers) making rockets out of old pesticide containers) Perceptual development – overestimate Perceptual development – overestimate

physical abilities physical abilities Social development – peers and sibling rolesSocial development – peers and sibling roles Impulse control – still developing by early 20’sImpulse control – still developing by early 20’s Cognitive Development – affects following Cognitive Development – affects following

directions, doing what the rules say, directions, doing what the rules say, remembering understanding rules, sense of remembering understanding rules, sense of invulnerability, planning and organizing, invulnerability, planning and organizing, consequences of decisions. consequences of decisions.

*Source: David C. Schwebel, Ph.D. Department of Psychology, University of Alabama at Birmingham

Health Impacts on ChildrenHealth Impacts on Children

Asthma Asthma Cancers Cancers Neuro-developmental problems Neuro-developmental problems

Small for age at birth Small for age at birth Congenital defects Congenital defects

Cancers in Children: Cancers in Children: The Agriculture Health Study The Agriculture Health Study

All cancer incidence: a third higher than rates in All cancer incidence: a third higher than rates in general populationgeneral population

All lymphomas 2 x higher - Hodgkin's 2.5 x higherAll lymphomas 2 x higher - Hodgkin's 2.5 x higher Exposure risks Exposure risks

risk if father NOT use chemically resistant glovesrisk if father NOT use chemically resistant gloves NOT associated to parental application frequency NOT associated to parental application frequency risk with aldrin (2.66) but not a known carcinogenrisk with aldrin (2.66) but not a known carcinogen

• Limitations: only 5 year follow up and small numbersLimitations: only 5 year follow up and small numbers

Source: Flower KB, Hoppin JA, Lynch CF, Blair A, Knott C, Shore DL, Sandler DP. Cancer risk and parental pesticide application in children of Agricultural Health Study participants. Environ Health Perspect. 2004 Apr;112(5):631-5.

Congenital AnomaliesCongenital Anomalies

Consistent findings with Consistent findings with Limb reductions - Uro-genital defectsLimb reductions - Uro-genital defects Central nervous systemCentral nervous system Cleft palates/lips: marginal significant Cleft palates/lips: marginal significant

w/maternal exposure w/maternal exposure Eye – heart defectsEye – heart defects

Not definitive until better exposure Not definitive until better exposure analysis with the US Children’s Health analysis with the US Children’s Health StudyStudySource: Sanborn M, Cole D, Kerr K, Vakil C, Sanin LH, Bassil K. Pesticides Literature Review.

Ontario College of Family Physicians. Toronto 2004.

Probable linkProbable link Fetal and maternal blood samples Fetal and maternal blood samples

for OP by-products and newborn for OP by-products and newborn lengthslengths

Chlorpyrifos and diazinon Chlorpyrifos and diazinon [by-products measured in fetal [by-products measured in fetal and maternal blood] associated to and maternal blood] associated to lower birth weight and length*lower birth weight and length*

Small for Age at BirthSmall for Age at Birth

* Whyatt RM et al. Biomarkers in assessing residential insecticide exposures during pregnancy and effects on fetal growth.Tox Applied Pharm 206 (2): 246-254 AUG 7 2005

Periods of Vulnerability Periods of Vulnerability for Womenfor Women

AdolescenceAdolescence Childbearing Childbearing YearsYears

Pregnancy Pregnancy

The Adolescent FemaleThe Adolescent Female

Jobs or hobbies involving Jobs or hobbies involving chemical exposureschemical exposures

Onset of puberty: still Onset of puberty: still developing reproductive developing reproductive organs are sensitive to organs are sensitive to hormonally active pesticideshormonally active pesticides

Women of Child Bearing Women of Child Bearing YearsYears

Menstrual cycle disorders: Menstrual cycle disorders: Women using hormonally active pesticides Women using hormonally active pesticides

(lindane, atrazine, mancozeb or maneb) have (lindane, atrazine, mancozeb or maneb) have 1.5 x increased odds of longer cycles, missing 1.5 x increased odds of longer cycles, missing a period, mid cycle bleeding (Farr SL et al 2004 a period, mid cycle bleeding (Farr SL et al 2004 ))

Time to pregnancy delay: Time to pregnancy delay: Studies Studies suggestsuggest that occupational exposure to that occupational exposure to

certain herbicides (dicamba, glyphosate, 2,4-D) certain herbicides (dicamba, glyphosate, 2,4-D) fungicide-insecticides (thiocarbamates) fungicide-insecticides (thiocarbamates) increase by 20% time needed to become increase by 20% time needed to become pregnant (Curtis et al 1999)pregnant (Curtis et al 1999)

Women of Child Bearing Women of Child Bearing YearsYears

Pre-conceptual risks: Pre-conceptual risks: May not know they will become pregnant at May not know they will become pregnant at

the pre conception critical window of exposure the pre conception critical window of exposure relative to risks for birth defects (Sanborn et al relative to risks for birth defects (Sanborn et al 2007) 2007)

Work to home pesticide exposures:Work to home pesticide exposures: Risks exposing families through work clothes, Risks exposing families through work clothes,

skin, and vehicles. (see Work to Home skin, and vehicles. (see Work to Home Exposure Pathway slides)Exposure Pathway slides)

Pre-Natal ExposuresPre-Natal Exposures

Neurodevelopmental risks to child:Neurodevelopmental risks to child:Prenatal exposure to chlorpyrifos, an Prenatal exposure to chlorpyrifos, an organophosphate, is associated with: organophosphate, is associated with:

Increased odds of abnormal reflexes in neonatesIncreased odds of abnormal reflexes in neonates Poorer verbal IQ in 3½ and 5 year oldsPoorer verbal IQ in 3½ and 5 year olds Increased odds of pervasive developmental Increased odds of pervasive developmental

disorderdisorder

Whyatt RM et al. 2005, Ruah VA. et al, 2006, Young JG et al 2005,

Roberts EM 2007