High Pesticide Exposure Events (HPEE): Lessons learned from the Agricultural Health Study

The Agricultural Health Study (AHS) is a prospective epidemiologic study of some 60,000 private and commercial licensed pesticide applicators, and their spouses, in Iowa and North Carolina. Applicators complete several questionnaires over time that report their pesticide application history including acreage, crops, pesticides applied, use of personal protective equipment (PPE), and health parameters. The frequencies of High Pesticide Exposure Events (HPEE) defined as “an incident or experience while using any pesticide which caused an unusually high exposure” are also reported. These HPEE have been analyzed in six published papers to understand the characteristics of those involved for the purpose of devising advice and strategies for preventing them. This paper reviews these findings. The characteristics of the 14% of the applicators reporting HPEE were studied in comparison with those not reporting HPEE. After correcting for education and numbers of applications, commercial applicators were more likely to have HPEE than private applicators, and both were more likely to report self-repair of equipment and a delay in changing clothing or washing after an application. A model of the rate of HPEE increasing with days of application predicted that an HPEE has three components: Failure to faithfully follow the Manufacturer's Label Requirements; Inexperience with applications characterized by a higher rate of HPEE early in their farming career; Random events (unavoidable accidents, i.e. breaking hose). We synthesize the results of the six AHS HPEE papers and present them together with recommendations for identifying and correcting activities that are at high risk of leading to HPEE.