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An unattended finding: associations of agricultural airborne pesticide vapors attaining inhabited areas with respiratory An unattended finding: associations of agricultural airborne pesticide vapors attaining inhabited areas with respiratory symptoms of 7– 11 years old children in Heves county, Hungary M. J. Varró 1, Z. Virágh 1, Gy. Gombkötõ 2, M. Szeremi 2, P. Rudnai 1 1 Fodor József National Center for Public Health, National Institute of Environmental Health; Budapest, Hungary; 2 National Public Health and Medical Officer Service, Institute of Heves County; Eger, Hungary NCPH NIEH NPHMOS

INTRODUCTION 1. Nat. Inst. Environ. Health Fodor József Nat. Center Publ. Health, (formerly: Nat. INTRODUCTION 1. Nat. Inst. Environ. Health Fodor József Nat. Center Publ. Health, (formerly: Nat. Inst. Hyg. , ) Budapest, Hungary Nat. Publ. Health & Med. Officer Service series of highly uniform environmental epidemiologic surveys among 7– 11 y children NCPH NIEH NPHMOS

INTRODUCTION 2. 1995/96 CESAR - international survey - 5 towns, N=3720 - questionnaire - INTRODUCTION 2. 1995/96 CESAR - international survey - 5 towns, N=3720 - questionnaire - physical examination - spirometry - measures of outdoor air pollutants NCPH NIEH NPHMOS

INTRODUCTION 2. Questionnaire - health endpoints - indoor environmental factors - other influencing factors INTRODUCTION 2. Questionnaire - health endpoints - indoor environmental factors - other influencing factors Main finding - respiratory symptoms & yearly average cc PM NCPH NIEH NPHMOS

INTRODUCTION 3. 1997 12 towns, N=6221 1998 6 towns, N=1768 1999 3 towns, N=1579 INTRODUCTION 3. 1997 12 towns, N=6221 1998 6 towns, N=1768 1999 3 towns, N=1579 2000 6 counties, N=2354 2001 Heves county, N=2540 2002 Budapest 2 distr. +1 suburban, N=567 NCPH NIEH NPHMOS

INTRODUCTION 4. . arised: agricultural airborne pesticide sprays do attain inhabited areas (no report) INTRODUCTION 4. . arised: agricultural airborne pesticide sprays do attain inhabited areas (no report) Highly significant associations with health endpoints NCPH NIEH NPHMOS

OBJECTIVE To evaluate the associations of pesticide sprays with respiratory symptoms - of 7– OBJECTIVE To evaluate the associations of pesticide sprays with respiratory symptoms - of 7– 11 year old children - in 40 villages of an area of Heves county - in 2001 NCPH NIEH NPHMOS

METHODS 1. Allergic symptoms - house dust - pollen - animal hair, feather - METHODS 1. Allergic symptoms - house dust - pollen - animal hair, feather - food - medicine - other - diagnosis: by a doctor? NCPH NIEH NPHMOS

METHODS 2. Neurotic symptoms: at least two of - lack of appetite - fatigue METHODS 2. Neurotic symptoms: at least two of - lack of appetite - fatigue - headache - irritability - anxiety NCPH NIEH NPHMOS

METHODS 3. Head mucosal symptoms: at least one of - conjunctivitis - blocked nose METHODS 3. Head mucosal symptoms: at least one of - conjunctivitis - blocked nose - sinusitic complaints - earache NCPH NIEH NPHMOS

METHODS 4. Bronchitic symptoms regular cough - in autumn-winter - mornings - days/nights - METHODS 4. Bronchitic symptoms regular cough - in autumn-winter - mornings - days/nights - daily, >3 months - with sputum NCPH NIEH NPHMOS

METHODS 5. Asthmatic symptoms - in the last 12 months - wheezing - dry METHODS 5. Asthmatic symptoms - in the last 12 months - wheezing - dry cough at night - asthma - ever diagnosed by a doctor NCPH NIEH NPHMOS

METHODS 6. Data entry, - procession - Epi Info 6. 04 d Analysis - METHODS 6. Data entry, - procession - Epi Info 6. 04 d Analysis - STATA 7. 0 - bivariate tabulation - backward logistic models NCPH NIEH NPHMOS

N 0=2437 N=1819 74. 6% % 50 25 0 Reported symptoms 1. 7– 11 N 0=2437 N=1819 74. 6% % 50 25 0 Reported symptoms 1. 7– 11 years old children, Villages, Heves county, Hungary, 2001 21. 8 20. 3 Allergic symptoms Min. 2 neur. sy. -s N=1718 N=1647 NCPH NIEH NPHMOS

Reported symptoms 2. 7– 11 years old children, Villages, Heves county, Hungary, 2001 % Reported symptoms 2. 7– 11 years old children, Villages, Heves county, Hungary, 2001 % 50 46. 3 25 0 15. 5 14. 1 Head mucosal Bronchitic Asthmatic N=1647 N=1623 N=1471 NCPH NIEH NPHMOS

Agricultural airborne pesticide sprays attaining inhabited areas Villages, Heves county, Hungary, 2001 % 100 Agricultural airborne pesticide sprays attaining inhabited areas Villages, Heves county, Hungary, 2001 % 100 75 90. 8 82. 5% of the villages (n=40) 50 25 9. 2 0 No sprays N=1666 Sprays NCPH NIEH NPHMOS

Agricultural airborne pesticide sprays attaining inhabited areas % % 100 75 50 Villages, Heves Agricultural airborne pesticide sprays attaining inhabited areas % % 100 75 50 Villages, Heves county, Hungary, 2001 93. 9 OR=2. 48*** (95% CI= 1. 76– 3. 44) 13. 9 25 0 86. 1 Vineyard territories General agricultural N=1013 N=653 No sprays Sprays NCPH NIEH NPHMOS

Agricultural airborne pesticide sprays/ inhabited areas and allergic symptoms 7– 11 years old children, Agricultural airborne pesticide sprays/ inhabited areas and allergic symptoms 7– 11 years old children, Villages, Heves county, Hungary, 2001 % 75 OR=2. 13*** (95% CI=1. 48– 3. 07) m. OR=2. 23*** (95% CI=1. 48– 3. 37) 50 goodness-of-fit: p=0. 69 34. 9 25 20. 1 0 No sprays Sprays N=1451 N=146 NCPH NIEH NPHMOS

Agricultural airborne pesticide sprays/ inhabited areas and neurotic symptoms 7– 11 years old children, Agricultural airborne pesticide sprays/ inhabited areas and neurotic symptoms 7– 11 years old children, Villages, Heves county, Hungary, 2001 % 75 OR=2. 19*** (95% CI=1. 51– 3. 17) m. OR=2. 33*** (95% CI=1. 55– 3. 51) 50 goodness-of-fit: p=0. 18 33. 3 25 18. 6 0 No sprays Sprays N=1391 N=144 NCPH NIEH NPHMOS

Agricultural airborne pesticide sprays/ inhabited areas and head mucosal sy. -s 7– 11 years Agricultural airborne pesticide sprays/ inhabited areas and head mucosal sy. -s 7– 11 years old children, Villages, Heves county, Hungary, 2001 % 75 OR=1. 51* (95% CI=1. 08– 2. 14) 50 55. 6 45. 1 25 0 No sprays Sprays N=1391 N=144 NCPH NIEH NPHMOS

Agricultural airborne pesticide sprays/ inhabited areas and bronchitic sy. -s 7– 11 years old Agricultural airborne pesticide sprays/ inhabited areas and bronchitic sy. -s 7– 11 years old children, Villages, Heves county, Hungary, 2001 % 75 OR=1. 93** (95% CI=1. 28– 2. 92) 50 25 0 24. 6 14. 5 No sprays Sprays N=1382 N=138 NCPH NIEH NPHMOS

Agricultural airborne pesticide sprays/ inhabited areas and asthmatic sy. -s 7– 11 years old Agricultural airborne pesticide sprays/ inhabited areas and asthmatic sy. -s 7– 11 years old children, Villages, Heves county, Hungary, 2001 % 75 OR=1. 82** (95% CI=1. 20– 2. 78) 50 25 0 21. 9 13. 3 No sprays Sprays N=1450 N=146 NCPH NIEH NPHMOS

DISCUSSION 1. Whether it is really possible? - to check retrospectively - flight documentations DISCUSSION 1. Whether it is really possible? - to check retrospectively - flight documentations - to check prospectively - biological monitoring NCPH NIEH NPHMOS

DISCUSSION 2. Chance - high p-values! Bias - recall bias? Confounding - not probable DISCUSSION 2. Chance - high p-values! Bias - recall bias? Confounding - not probable NCPH NIEH NPHMOS

SUMMARY 1. - Pesticide sprays do attain inhabited areas - Respiratory symptoms - 7– SUMMARY 1. - Pesticide sprays do attain inhabited areas - Respiratory symptoms - 7– 11 y children - N=1819 survey questionnaires NCPH NIEH NPHMOS

SUMMARY 2. - allergic and neurotic symptoms - prevalences: 21. 8%, 20. 3% - SUMMARY 2. - allergic and neurotic symptoms - prevalences: 21. 8%, 20. 3% - pesticide sprays attaining inhabited areas: 9% - odds ratios: 2. 13*** (2. 23***), 2. 19*** (2. 33***) NCPH NIEH NPHMOS

SUMMARY 3. - head mucosal, bronchitic, asthmatic sy. -s - prevalences: 46. 3%, 15. SUMMARY 3. - head mucosal, bronchitic, asthmatic sy. -s - prevalences: 46. 3%, 15. 5%, 14. 1% - odds ratios: 1. 51*, 1. 93**, 1. 82* NCPH NIEH NPHMOS

CONCLUSION Specially designed investigations - environmental health impact - pesticide spraying Official measures NCPH CONCLUSION Specially designed investigations - environmental health impact - pesticide spraying Official measures NCPH NIEH NPHMOS

THANKS HUNGARIAN NEHAP SECRETARY Dr. Anna Páldy „Fodor József” NCPH NIEH DEPT. COMMUNITY HEALTH THANKS HUNGARIAN NEHAP SECRETARY Dr. Anna Páldy „Fodor József” NCPH NIEH DEPT. COMMUNITY HEALTH Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Renáta Szentmihályi, Györgyi Tóth SCHOOLS, MUNICIPALITIES, HEALTH SERVICES directorship of schools, class leaders, maires, youth and district nurses FAMILIES parents, children NCPH NIEH NPHMOS

Thanks for the attention NCPH NIEH NPHMOS Thanks for the attention NCPH NIEH NPHMOS