Health Effects Of Exposures In Agriculture

农业健康研究（AHS）是一项长期的前瞻性研究，研究与农药和其他农业接触相关的潜在健康影响。这项研究是国家癌症研究所，国家环境健康科学研究所和美国环境保护局的合作，以及国家职业安全与健康研究所的合作。我们正在对来自北卡罗来纳州（NC）和爱荷华州（IA）的持牌农药施用者、配偶和子女进行前瞻性研究，以检查癌症发病率和其他健康终点。在3年的时间里（1993- 1997年），我们招募了57，000多名持牌施药员，占IA和NC合格私人施药员（主要是农民）的82%，占爱荷华州商业施药员的43%。大约40%的私人施用者还完成了一份更详细的带回家的调查问卷，内容涉及农业实践和健康。近32 000名农民申请者的配偶参加了登记，其中三分之二还提供了生殖健康数据，包括所有21岁以下儿童的信息。 自入组以来，70%的参与者完成了五年的随访电话访谈（1999-2003），该研究有望在我们目前的随访电话访谈中达到类似的应答率。 每年，申请人、配偶和子女的癌症发病率通过与IA和NC基于人群的癌症登记处联系确定。随访计算机辅助电话访谈用于更新暴露信息，识别非恶性疾病病例，并收集自入组研究以来健康状况变化的信息。 我们目前正在完成对队列成员的第二轮随访。从参与者中收集颊细胞样本，以提取DNA用于未来基因和环境相互作用的分析。此外，饮食评估（食物频率问卷）是自我完成的，并通过邮件返回。对一小部分农民及其家庭进行了农业接触的深入评估，以验证调查问卷并促进接触分类。收集了环境和生物样本。 在这一随访期内特别关注的非癌症结局包括神经系统疾病和症状（帕金森病、听力损失、抑郁和神经行为功能）、呼吸和过敏结局（哮喘、鼻炎、慢性支气管炎、呼吸道死亡率）、心脏病发作（发病率和死亡率）、糖尿病除癌症外，这些疾病还包括妊娠期和成人）、自身免疫性疾病（类风湿性关节炎）、年龄相关性黄斑变性和生殖结果（生育力、出生体重、先兆子痫、自然流产）。 我们目前正在进行一些子研究，以收集有关农药潜在健康后果的更详细信息。 生长和青春期（GAP）研究是一项内部资助的试点研究，旨在评估在AHS的农场儿童中测量青春期早期标志物（尿液和唾液中的激素水平、身高增长速度、坦纳分期）的可行性。 这项研究招募了大约60名儿童，三次家访中的最后一次将于2008年12月完成。 基因和年龄相关性黄斑变性（GENARM）研究正在获得医疗记录，眼科照片和唾液作为在后续采访中报告黄斑变性事件的个人的DNA来源。 实地工作已经完成，数据分析正在进行。 在与爱荷华大学的Frederic Gerr的合作中，我们使用许多标准化测试进行了一项神经行为功能的研究。 超过700名农民参与了研究，我们目前正在分析样本中的对氧磷酶活性和与有机磷代谢相关的基因。 另外两个（帕金森病和肺部健康）在单独的年度报告中描述。 农业健康研究的最新结果包括：1）成人过敏性哮喘与农药使用的显著相关性，特别是在动物模型中显示可增加过敏性气道反应性的有机磷杀虫剂，2）与使用特定农药相关的偶发性糖尿病（有机氯：艾氏剂、氯代农药和七氯;有机磷：敌敌畏和敌百虫;除草剂：甲草胺和氰草津），以剂量依赖的方式，和3）听力损失与长期使用农药。 我们继续分析农场暴露和特定呼吸道疾病的横断面数据，包括成人哮喘和呼吸道死亡率。其他工作重点是先兆子痫和怀孕期间使用农药以及其他不良妊娠和分娩结果，子宫肌瘤，黄斑变性，心血管死亡率和II型糖尿病（成人发病）的风险。正在进行后续电话访谈，并将于2010财政年度完成。

The Agricultural Health Study (AHS) is a long-term prospective study of potential health effects associated with exposure to pesticides and other agricultural exposures. The study is a collaboration of the National Cancer Institute, the National Institute of Environmental Health Sciences, and the US Environmental Protection Agency, with additional collaboration by the National Institute for Occupational Safety and Health. We are examining cancer incidence and other health endpoints in a prospective study of licensed pesticide applicators, spouses and children from North Carolina (NC) and Iowa (IA). Over a 3-year period (1993-7), we enrolled more than 57,000 licensed applicators, representing 82% of eligible private pesticide applicators (largely farmers) in IA and NC and 43% of commercial applicators from Iowa. About 40% of the private applicators also completed a more detailed take-home questionnaire covering farming practices and health. Nearly 32,000 spouses of farmer applicators enrolled and 2/3 of these also provided data on reproductive health, including information on all children under age 21. Since enrollment, 70% of participants completed the five-year followup phone interview (1999-2003) and the study is on track to achieve a similar response rate in our current followup phone interview. Annually, cancer incidence among the applicators, spouses, and children is determined through linkage with the population-based cancer registries in IA and NC. Follow-up computer-assisted telephone interviews are used to update exposure information, identify cases of non-malignant disease, and to collect information on changes in health status since enrollment in the study. We are currently completing the second round of followup with cohort members. Buccal-cell samples have been collected from participants in order to extract DNA for future analyses of gene and environment interactions. In addition, a dietary assessment (food frequency questionnaire) was self-completed and returned by mail. In-depth assessment of agricultural exposures has been done for a small sample of farmers and their families in order to validate the questionnaires and facilitate exposure classification. Both environmental and biological samples were collected. Non-cancer outcomes of particular interest in this follow-up period include neurological diseases and symptoms (Parkinson's Disease, hearing loss, depression, and neurobehavioral function), respiratory and allergic outcomes (asthma, rhinitis, chronic bronchitis, respiratory mortality), heart attacks (incidence and mortality), diabetes (both gestational and in adults), autoimmune diseases (rheumatoid arthritis), age-related macular degeneration, and reproductive outcomes (fertility, birthweight, pre-eclampsia, spontaneous abortion) in addition to cancer. We are currently involved in a number of substudies to collect more detailed information on potential health consequences of pesticides. The Growth and Puberty (GAP) Study is an intramurally-funded pilot study to assess the feasibility of measuring early puberty markers (hormone levels in urine and saliva, height velocity, Tanner staging) among farm children in the AHS. This study has enrolled approximately 60 children and the last of the three home visits will be completed by December 2008. The Genes and Age Related Macular Degeneration (GENARM) Study is obtaining medical records, opthamalogical photographs, and saliva as a source of DNA for individuals who reported incident macular degeneration at one of the followup interviews. Field work is completed and data analysis is ongoing. In a collaboration with Frederic Gerr at the University of IA, we conducted a study of neurobehavioral function using a number of standardized tests. Over 700 farmers participated and we are currently analyzing specimens for paraoxonase activity and genes related to organophosphate metabolism. Two more (parkinsons disease and lung health) are described in separate annual reports. Recent results from the Agricultural Health Study include: 1) Significant association of allergic asthma in adults with pesticide use, particularly organophosphate insecticides which have been shown in animal models to increase allergic airway responsiveness, 2) incident diabetes associated with use of specific pesticides (organochlorines: aldrin, chlordane, and heptachlor; organophosphates: dichlorvos and trichlorfon, and herbicides: alachlor and cyanazine), in a dose-dependent manner, and 3) hearing loss associated with long term pesticide use. We continue to analyze cross-sectional data on farm exposures and specific respiratory diseases, including adult onset asthma and respiratory mortality. Other work focuses on preeclampsia and use of pesticides during pregnancy as well as other adverse pregnancy and birth outcomes, uterine fibroids, macular degeneration, and risk for cardiovascular mortality and incident type II (adult onset) diabetes. Follow-up telephone interviews are being conducted and will be completed in FY2010.