Poison Center Surveillance of Agricultural Poisonings
Although all Americans are exposed to pesticides, agricultural workers and their families have the potential for additional exposures because of their work, place of residence, and recreation sites, which often adjoin one another or overlap (Arcury 2000, Arcury 2001, Kirkhorn 2002). Agriculture accounts for 75% of the 1.2 billion pounds of conventional pesticides applied annually in the United States (EPA 1998, Donaldson 2002, Calvert 2004). Thus, populations in agricultural regions need to be more thoroughly monitored for exposure (Ward 2000).
The Southeast Center collaborated with poison control centers in four states to increase awareness of the links between hazardous chemical exposures and production agriculture (2006--2009). In an earlier, retrospective study involving 240 counties in the lower Mississippi River Delta (McKnight, 2004; Bryden, 2005), researchers found that poison control center records contained limited information that could be used to identify chemical exposures related to production agriculture. However, few records included information on the circumstances of exposure – information needed to design and target effective prevention efforts.
In the more recent study, the Southeast Center partnered with six poison control centers serving Kentucky, Alabama, Virginia, and West Virginia. All six centers use the Toxicall® data collection system to enter reports of exposures into the Toxic Exposure Surveillance System (TESS©) database maintained by the American Association of Poison Control Centers (AAPCC). This makes possible harmonized data collection and data sharing. The system as originally designed does not have a pre-formatted "variable" to distinguish production agriculture pesticide exposures from non-agricultural exposures; thus, for this six-site study, the Toxicall® data collection software was modified to capture these facts.
The study integrated the Toxicall® software modification in a voluntary, non-intrusive manner, keeping in mind the overall mission of poison control centers to eliminate or reduce morbidity and mortality from toxic exposures by providing information on poisoning and telephone consultations for emergencies (Simpson 2002). During a 24-month period (2007-2008), three additional questions assessing an exposure’s link to production agriculture were asked of callers who reported an exposure implicating at least one insecticide, herbicide, fungicide or fumigant from a list of 39 poison control center product codes.
Analysis indicates that the software modification increased the precision of and details recorded for pesticide exposures. Of 7522 calls received involving study pesticides, the enhanced protocol solicited additional information in 270 cases. Of those cases that asked the three additional study questions, 14.5% (n=30) had exposures linked to agricultural activities.
Awareness of agriculture issues may increase documentation for differentiation of agricultural versus non-agricultural exposures in poison control center records. This study suggests that the Toxicall® software modification could be used by other centers to document agricultural involvement in reported exposures, as well as to improve surveillance for other exposure categories of interest.
This project was supported by CDC/NIOSH Cooperative Agreement U50 OH007547. Approval of research involving human subjects was approved under University of Kentucky IRB Protocol 06-0555-P2G.
For more information contact Phyllis A. Bryden, DrPH, MSPH, RN, Assistant Professor Department of Health Promotion and Administration, Eastern Kentucky University, Begley 428, 521 Lancaster Ave. Richmond, KY 40475-3102. Phone: 859-622-1147