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Sara A. Quandt,¹ María A. Hernández-Valero,² Joseph G. Grzywacz,¹ Joseph D. Hovey,³ Melissa Gonzales,⁴ and Thomas A. Arcury¹

¹Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; ²University of Texas, M.D. Anderson Cancer Center, Houston, Texas, USA; ³University of Toledo, Toledo, Ohio, USA; ⁴University of New Mexico, Albuquerque, New Mexico, USA

Abstract
In this article we identify factors potentially associated with pesticide exposure among farmworkers, grade the evidence in the peer-reviewed literature for such associations, and propose a minimum set of measures necessary to understand farmworker risk for pesticide exposure. Data sources we reviewed included Medline, Science Citation Index, Social Science Citation Index, PsycINFO, and AGRICOLA databases. Data extraction was restricted to those articles that reported primary data collection and analysis published in 1990 or later. We read and summarized evidence for pesticide exposure associations. For data synthesis, articles were graded by type of evidence for association of risk factor with pesticide exposure as follows: 1 = association demonstrated in farmworkers ; 2 = association demonstrated in nonfarmworker sample ; 3 = plausible association proposed for farmworkers ; or 4 = association plausible but not published for farmworkers. Of more than 80 studies we identified, only a third used environmental or biomarker evidence to document farmworker exposure to pesticides. Summaries of articles were compiled by level of evidence and presented in tabular form. A minimum list of data to be collected in farmworker pesticide studies was derived from these evidence tables. Despite ongoing concern about pesticide exposure of farmworkers and their families, relatively few studies have tried to test directly the association of behavioral and environmental factors with pesticide exposure in this population. Future studies should attempt to use similar behavioral, environmental, and psychosocial measures to build a body of evidence with which to better understand the risk factors for pesticide exposure among farmworkers. Key words: agricultural workers, folk belief, personal protective equipment, psychosocial stressors, safety behavior. Environ Health Perspect 114:943–952 (2006) . doi:10.1289/ehp.8529 available via http://dx.doi.org/ [Online 16 February 2006]

This article is part of the mini-monograph "Farmworker Exposure to Pesticides: Methodological Issues for the Collection of Comparable Data."

Address correspondence to S.A. Quandt, Division of Public Health Sciences, Dept. of Epidemiology and Prevention, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063 USA. Telephone: (336) 716-6015. Fax: (336) 713-4157. E-mail: squandt@wfubmc.edu

This article was produced as part of the Farmworker Environmental Health Research Comparable Data Conference held in Winston-Salem, NC, on 30 September–1 October 2004.

Financial support was provided by the Pesticide Environmental Trust Fund, N.C. Department of Agriculture and Consumer Services ; the National Institute of Environmental Health Sciences (NIEHS) and the National Institute for Occupational Safety and Health (R13 ES/OH013378) ; and CropLife America, Inc. This work was supported in part by the intramural research program of the NIEHS, National Institutes of Health.

The authors declare they have no competing financial interests.

Received 11 July 2005 ; accepted 3 November 2005.