Farming and Pesticide Exposure Survey

Transcription

1 Farming and Exposure Survey Survey Research Center

2 1-7 Clinic Number: - - INSTRUCTIONS: PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANK AS INDICATED Today s Date: / / Month Day Year 16_ 1. Have you ever worked on a farm at least half time for more than 1 year? 1 " No Go to PESTICIDE USE SECTION on top page 4. 2 " Yes How many years did you work as a farmer in each the following decades? (Put 0 if none or not applicable.) Check here Percent if you lived time on a farm Number How large was worked during this Decade years the farm (acres)? on a farm time Before 1930 Years Acres % 1 " s Years Acres % 1 " s Years Acres % 1 " s Years Acres % 1 " s Years Acres % 1 " s Years Acres % 1 " s Years Acres % 1 " s Years Acres % 1 " and after Years Acres % 1 " 107_ 1 " Please check this box if you are currently a farmer. 2 " Please check this box if you are currently retired from farming. Page 1

3 2. At any time you worked on a farm, what were the major income-producing crops and animals that you raised? " No crops or animals 1 " Christmas trees 1 " Potatoes " Beef cattle 1 " Corn, popcorn 1 " Snapbeans " Dairy cattle 1 " Corn, field corn 1 " Sorghum " Hogs/swine 1 " Corn, seed corn 1 " Soybeans " Poultry 1 " Corn, sweet corn 1 " Strawberries " Sheep 1 " Cotton 1 " Sweet potatoes " Eggs 1 " Cucumbers 1 " Tomatoes " Other farm animals 1 " Grapes 1 " Tobacco " Apples 1 " Green peppers 1 " Watermelon " Alfalfa 1 " Hay 1 " Wheat " Blueberries 1 " Oats 1 " Other fruit " Cabbage 1 " Peaches 1 " Other vegetables " Peanuts 1 " Other small grains 146_ 3. Did a veterinarian ever tell you that any livestock on any farm you may have worked on, had leukemia or lymphoma caused by a virus? 1 " No 2 " Yes If yes, Was it dairy cattle that were diagnosed with leukemia or lymphoma? 147_ 1 " No 2 " Yes If yes, how many years ago did this first happen? 148_ 1 " Last 2 " 6 to 10 3 " 11 to 20 4 " 21 or more 5 years years years years Was it beef cattle that were diagnosed with leukemia or lymphoma? 149_ 1 " No 2 " Yes If yes, how many years ago did this first happen? 150_ 1 " Last 2 " 6 to 10 3 " 11 to 20 4 " 21 or more 5 years years years years Was it chickens that were diagnosed with leukemia or lymphoma? 151_ 1 " No 2 " Yes If yes, how many years ago did this first happen? 152_ 1 " Last 2 " 6 to 10 3 " 11 to 20 4 " 21 or more 5 years years years years During which decade were you most active in working on a farm? Decade For that decade, please answer the following questions: How many days per year did you do the following activities? ##### Till the soil (plow, disk, 157_ cultivate) " 2 " 3 " 4 " 5 " Drive combines or other 158_ crop harvesters " 2 " 3 " 4 " 5 " ##### 159_ Plant " 2 " 3 " 4 " 5 " Apply natural fertilizer 160_ (manure) " 2 " 3 " 4 " 5 " 161_ Apply chemical fertilizer " 2 " 3 " 4 " 5 " 162_ Hand pick crops " 2 " 3 " 4 " 5 " How many acres were planted on the farm(s) where you worked (whether or not you owned the farm)? 163_ 1 " None 4 " 50 to 199 acres 7 " 1,000 acres or more 2 " Less than 5 acres 5 " 200 to 499 acres 3 " 5 to 49 acres 6 " 500 to 999 acres How many poultry were there on the farm(s)? 164_ 1 " None 4 " 100 to " 10,000 or more 2 " Less than 50 5 " 500 to " 50 to 99 6 " 1,000 to 9,999 How many livestock (other than poultry) were there on the farm(s)? 165_ 1 " None 4 " 100 to " Less than 50 5 " 500 to " 50 to 99 6 " 1,000 or more 1 to to to 100 More than Never days days days 100 days 1 to 5 6 to to 50 More than Never days days days 50 days Page 2 Page 3

4 166_ 5. Have you ever personally mixed or applied any pesticides as part your job? (Include crop, livestock, and structural insecticides, herbicides, fungicides, and fumigants. Include pesticides used for farm use, commercial application, and personal use in your home or garden.) 1 " No 2 " Yes If yes, Please stop here. Survey is complete. How many years did you personally mix or apply pesticides? 167_ 1 " 1 year or less 2 " 2 to 5 years 3 " 6 to 10 years 4 " 11 to 20 years 5 " 21 to 30 years 6 " 31 years or more During the years marked above, how many days per year did you personally mix or apply pesticides? 168_ 1 " 4 days or less 2 " 5 to 9 days 3 " 10 to 19 days 4 " 20 to 39 days 5 " 40 to 59 days 6 " 60 to 149 days PESTICIDE USE SECTION FOR THIS SECTION, PLEASE GIVE US YOUR BEST ESTIMATE FOR EACH RESPONSE. When pesticides require mixing, what percent the time did you personally do the mixing? 169_ 1 " Never 2 " Less than 50 % the time 3 " 50% or more the time What percent the application did you personally do? 170_ 1 " Never 2 " Less than 50 % the time 3 " 50% or more the time 6. Please complete the following questions about your personal use the specific pesticides listed below. We realize this is not a complete list pesticides. We are interested in learning about those you are currently using as well as those you have personally used in the past. (Please answer yes or no to the use each pesticide. If you answer yes, continue across the page with the other questions. If you answer no, please continue on with the next pesticide on the list.) Name mixed or mix or apply this, this Herbicides (pesticides used to kill weeds) AAtrex, Atranex, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other atrazine 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 175_ 1 " Mark here if you Banvel, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Metambane, or 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s other dicamba products 180_ 1 " Mark here if you Bladex, Match, or 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 other cyanazine 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 185_ 1 " Mark here if you Dual, Cycle, or 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 other metolachlor 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 190_ 1 " Mark here if you Page 4 Page 5

5 Name mixed or mix or apply this, this Name mixed or mix or apply this, this Eradicane, Eptam, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other EPTC 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 195_ 1 " Mark here if you Lasso, Chimiclor, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other alachlor 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 200_ 1 " Mark here if you Pursuit or other 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 imazethapyr 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 205_ 1 " Mark here if you Roundup, Jury, or 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 other glyphosate 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 210_ 1 " Mark here if you Treflan, Trilin, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Commence, or 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s other trifluralin products 215_ 1 " Mark here if you Page ,4-D 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 220_ 1 " Mark here if you Classic or other 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 chlorimuron ethyl 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 225_ 1 " Mark here if you Lexone, Sencor, or 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 other metribuzin 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 230_ 1 " Mark here if you Paraquat 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 235_ 1 " Mark here if you Prowl or other 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 pendimethalin 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 240_ 1 " Mark here if you Page 7

6 Name mixed or mix or apply this, this Name mixed or mix or apply this, this Silvex or other 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before ,4,5 T P products 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s (No longer on the market.) ,4,5 T 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Crop, Nursery, Lawn, and Garden Insecticides Ambush, Pounce, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Asana, or other 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s permethrin or pyrethroid products 253_ 1 " Mark here if you Counter or other 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 terbufos products 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 258_ 1 " Mark here if you Dyfonate or other 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 fonos products 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 263_ 1 " Mark here if you Page Dylox or other 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 trichlorfon 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 268_ 1 " Mark here if you Furadan, Curaterr, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other carburan 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 273_ 1 " Mark here if you Crop/Poultry/Livestock/Animal Confinement Area Insecticides Lorsban, Dursban, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s chlorpyrifos products 278_ 1 " Mark here if you Co-Ral or other 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 coumaphos 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 283_ 1 " Mark here if you Ectiban, Atroban, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Permetrina or 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s other permethrin products 288_ 1 " Mark here if you Page 9

7 Name mixed or mix or apply this, this Name mixed or mix or apply this, this Vapona, Duravos, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other dichlorvos 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s or DDVP 293_ 1 " Mark here if you Forlin, Gamaphex, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other lindane 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 298_ 1 " Mark here if you Malathion 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 303_ 1 " Mark here if you Parathion (ethyl 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or methyl) 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 308_ 1 " Mark here if you Sevin, Carbamine, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other carbaryl 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 313_ 1 " Mark here if you Spectricide, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Dianon, or other 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s diazinon 318_ 1 " Mark here if you Temik or other 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 aldicarb products 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 323_ 1 " Mark here if you Thimet, Rampart, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other phorate 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 328_ 1 " Mark here if you Aldrin 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before Chlordane 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Page 10 Page 11

8 Name mixed or mix or apply this, this Name mixed or mix or apply this, this Dieldrin 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before DDT 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before Heptachlor 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before Toxaphene 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Fumigants (gases or liquids that turn to gas when released, used in enclosed spaces, or to treat soil) Brom-O-Gas, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Brom-O-Sol, or 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s other methyl bromide products 357_ 1 " Mark here if you Phostoxin, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Gastoxin, or 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s other aluminum phosphide products 362_ 1 " Mark here if you Carbon tetra- 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 chloride/carbon 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s disulfide (80/20 mix) 4 " 11 to 20 years 4 " 20 to 39 days 4 " In the 980s (No longer on the market.) EDB, E-D-Bee, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Bromume, or 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s other ethylene dibromide products (No longer on the market.) Fungicides (chemicals for controlling disease on crops and seed; may be pre-applied to seed) Bravo, Evade, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Daconil 2787, 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s or other chlorothalonil products 375_ 1 " Mark here if you Orthocide, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Clomitane, or 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s other captan products 380_ 1 " Mark here if you Page 12 Page 13

9 Name mixed or mix or apply this, this Benlate, Tersan, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other benomyl 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 60s 385_ 1 " Mark here if you Manex, Manzate, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 Dithane Z-78, or 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s other maneb or mancozeb products 390_ 1 " Mark here if you Ridomil, Subdue, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other metalaxyl 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 395_ 1 " Mark here if you Zirex, Corozate, 1 " No 1 " 1 year or less 1 " Less than 5 days 1 " Before 1960 or other ziram 2 " 2 to 5 years 2 " 5 to 9 days 2 " In the 1960s 400_ 1 " Mark here if you 401_ Please list any other significant pesticide exposures you would like to tell us about. Page What application methods do you generally use when you apply crop insecticides? 402:406 1 " Don t usually apply 1 " Backpack sprayer :407 crop insecticides 1 " Aerial (aircraft application) 403:408 1 " Airblast 1 " In furrow or banded 404:409 1 " Boom or tractor, truck, or trailer 1 " Mist blower/fogger 405:410 1 " Hand spray gun 1 " Other, please specify: 8. What application methods do you generally use when you apply poultry/livestock/ animal confinement area insecticides? 411:417 1 " Don t usually apply poultry/livestock/ 1 " Spray animals :418 animal confinement area insecticides 1 " Spray buildings 412:419 1 " Ear tag 1 " Rope wick 413:420 1 " Hang pest strips in barn 1 " Pour on animals 414:421 1 " Dust animals 1 " Other, please specify: 415: 1 " Fog/mist animals 416: 1 " Dip animals in pesticide solution 9. What application methods do you generally use when you apply fungicides? 422:426 1 " Don t usually apply 1 " Backpack sprayer :427 fungicides 1 " Aerial (aircraft application) 423:428 1 " Airblast 1 " Pre-applied to seed 424:429 1 " Boom or tractor, truck, or trailer 1 " Mist blower/fogger 425:430 1 " Hand spray gun 1 " Other, please specify: 10. What application methods do you generally use when you apply fumigants? 431:433 1 " Don t usually apply fumigants 1 " Row fumigation 432:434 1 " Gas canister 1 " Other, please specify: 11. When you personally mix herbicides, what additives do you generally use? 435:438 1 " Don t mix herbicides 1 " Fertilizer 436:439 1 " Don t usually use additives 1 " Other pesticides 437:440 1 " Solvents (like diesel fuel) 1 " Surfactants, crop oil concentrates :441 1 " Other, please specify: 12. When you personally mix crop insecticides, what additives do you generally use? 442:445 1 " Don t mix crop insecticides 1 " Fertilizer 443:446 1 " Don t usually use additives 1 " Other pesticides 444:447 1 " Solvents (like diesel fuel) 1 " Surfactants, crop oil concentrates :448 1 " Other, please specify: Page 15

10 13. When you personally mix animal/livestock/animal confinement area insecticides, what additives do you generally use? 449_ 1 " Don t mix animal/livestock/animal confinement area insecticides 450_ 1 " Don t usually use additives 451_ 1 " Solvents (like diesel fuel) 452_ 1 " Other pesticides 14. When you personally mix fungicides, what additives do you generally use? 453:456 1 " Don t mix fungicides 1 " Fertilizer 454:457 1 " Don t usually use additives 1 " Other pesticides 455:458 1 " Solvents (like diesel fuel) 1 " Surfactants, crop oil concentrates 15. How ten, if ever, have you had the following symptoms that you think may be related to your using pesticides? Never or Sometimes Always Frequently/ Almost rarely ### 459_ Been excessively tired " 2 " 3 " 460_ Had headaches/dizziness " 2 " 3 " 461_ Had nausea or vomiting " 2 " 3 " 462_ Had skin irritation " 2 " 3 " 463_ Had eye irritation " 2 " 3 " 464_ Had chest discomfort " 2 " 3 " 465_ Felt nervous or depressed " 2 " 3 " 16. As a result using pesticides, how ten have you: 3 or more Never Once Twice times #### 466_ seen a doctor? " 2 " 3 " 4 " 467_ been hospitalized? " 2 " 3 " 4 " 468_ We welcome any comments you may wish to provide. Thank you for taking time to participate in this survey! Page 16

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