Pulse
Briefs
Picture This
In one photograph, a toddler’s Big Wheel tricycle sits in a driveway in front of a “cloud” left by a mosquito-control truck. In another, a crop duster flies over a field, leaving a trail of spray behind. In a third, a preteen boy wears shorts, a T-shirt, and no mask as he stands amid the swirling mist emitted from the mosquito fogger in his hand.
These images were captured by women participating in a University of Minnesota research project on children’s pesticide exposure and health in the Red River Valley, a flat, fertile plain that is one of the nation’s largest growing regions for wheat, sugar beets, and potatoes, and a place where pesticide application is big
business.
Researchers in the School of Public Health had set out to assess the concerns of women in the northwestern Minnesota towns of Moorhead and Roseau, and on the White Earth Reservation, hypothesizing that people living in a part of the state where chemicals are routinely used to fend off bugs and other critters that can devastate crops were likely exposed in a variety of ways.
Rather than administer a survey, though, they employed a methodology known as “photovoice.” The approach puts cameras into the hands of ordinary people in order to define a problem as they see it—through a camera lens. The photographers then select the images that are the most meaningful to them and share their reasons for their choices. The idea is to help those who normally do not engage in discussions with decision makers about community problems share their viewpoint, says Pat McGovern, Ph.D., M.P.H., R.N. a principle investigator in the project.
In this case, the researchers gave 16 women digital cameras and charged them with snapping pictures of the ways they and their children are exposed to pesticides. Most women took between four and 15 photos. One woman took 100, according to McGovern, who explained that the researchers were more interested in the women’s reasons for taking a particular photograph than the image itself. The researchers then identified themes and concerns, and recommended changes based on the conversations about the pictures.
The overarching finding was that the women wanted more information on the health effects of pesticides and access to more organically grown foods. “It was interesting how little folks knew, particularly at the Immigrant Development Center,” McGovern says, noting that pesticides that are used here for agriculture and on lawns and gardens may not have been used in the women’s home countries. But, she says, all the women indicated they were not as aware of pesticide exposures as they should have been.
Three recommendations emerged from discussions with the participants. The first, to develop a pesticide education and outreach program for public health nurses, whom the women said they trusted for such information. The second, to increase the supply of and access to locally produced pesticide-free foods. And the third, to encourage farmers and public authorities to give notice prior to spraying and fogging.
McGovern and colleagues are working on the first two. A curriculum for public health nurses with up-to-date information about the health issues related to pesticide exposure is in the works. McGovern points to a growing body of research that shows links between measurable amounts of pesticide in children and such problems as low birth weights and neurologic abnormalities. But the third recommendation—asking farmers and pesticide applicators to work with public authorities to give notice before spraying—remains on the drawing board. Not because it isn’t important, McGovern says, but because it is “complex politically. It is not a message that’s well-received yet by agriculture and we need to focus on more feasible projects.”
McGovern insists that the photovoice project, although small, was valuable for researchers and the women who live in a corner of the state where conventional agriculture remains the dominant industry. “It gave them a voice about community problems that they may not be used to having.”—Carmen Peota
New Life for Left-Over Drugs?
Not all unused medications end up in the trash heap. Since 2005, the Minnesota AIDS Project has been collecting unused, unexpired medications and shipping them to countries in Africa, the Caribbean, and Latin America. The medications are given, under the supervision of a physician, to people who are HIV-positive and otherwise couldn’t afford them. The drugs collected in Minnesota are distributed by Aid for AIDS International, a New York nonprofit.
According to Darin Rowles, who coordinates the collection effort in Minnesota, the Minnesota AIDS Project took in 265 bottles of medication in 2007, the vast majority of which were antiretroviral and prophylaxis drugs.
Currently, 35 states have enacted laws allowing for the collection of certain unused medications from individuals, nursing homes, hospitals, and state institutions to be redistributed to the needy, according to National Association of Boards of Pharmacy data. Not all of those states have recycling programs up and running yet. And the laws vary considerably as to what can be collected and redistributed and how.
In 2005, the Minnesota Legislature created a cancer drug repository program, through which individuals can drop off unused, unexpired drugs and supplies at participating pharmacies. The drugs can then be given to cancer patients who don’t have health insurance or whose policies don’t include drug coverage.
The program has gotten off to a slow start, according to Cody Wiberg, Pharm.D, R.Ph., executive director of the Minnesota Board of Pharmacy, which approves pharmacies for participation. After the law was enacted, he says, the pharmacies at Hennepin County Medical Center and Park Nicollet’s Methodist Hospital applied to become repositories. However, neither is collecting drugs.
Wiberg believes the reason the program hasn’t gained much traction is because so many people in Minnesota have health insurance policies with drug coverage. “Even before Medicare Part D was enacted, 86 percent of the citizens of Minnesota had insurance coverage for drugs,” Wiberg says. “Since the advent of Medicare Part D, it’s over 90 percent.”
Also, the law requires the drugs to be in unopened unit-dose containers that show no evidence of tampering in order to be accepted. “The problem is, there aren’t many cancer drugs like that,” he explains. Most chemotherapy drugs are compounded before they are administered and are given to patients in a clinic, rather than at home. Also, federal law prohibits the return and redistribution of controlled substances such as morphine and fentanyl patches, which are used to control pain.
“It’s a noble idea,” Wiberg says of the law. “If drugs could be reused, it could save the system money. But in this state, at this time, the vast majority of people have drug coverage, and unless they pay really high deductibles or copays, what’s their incentive to receive ‘used drugs’ when they can get new ones?”—Kim Kiser
Level of Concern
Senator Katie Sieben’s constituents were worried. The residents of her east metro district, which stretches from Afton and South St. Paul to Hastings, had learned that their drinking water was contaminated with perfluorochemicals (PFCs) used at 3M’s Cottage Grove plant to make everything from film to firefighting foam. They wanted to know what effect the chemicals might have on their health.
“As a policymaker, it was frustrating to know that the Department of Health didn’t have any answers as to what the long-term effect of exposure is,” says the Newport Democrat.
Voter concern prompted Sieben and Rep. Julie Bunn (DFL- Lake Elmo) to convince lawmakers to fund a biomonitoring pilot program in 2007 that will test people living in affected communities for the presence of those and other chemicals in their bodies.
The two-year program will involve four separate pilot projects: One will measure the levels of three PFCs (perfluorooctane sulfonate, perfluorooctanic acid, and perfluorobutanoic acid) in 100 adults who live in areas served by the Oakdale municipal water supply and 100 who live in Lake Elmo and Cottage Grove and get their water from private wells. The second will measure arsenic levels in 100 children from a south Minneapolis neighborhood near a site where pesticides that contained arsenic were once manufactured and stored. A third will test newborns for exposure to mercury. The fourth has yet to be determined.
The Minnesota Department of Health has begun collecting urine samples from the south Minneapolis children and is selecting participants for the PFC study.
By winter, families of the children in the arsenic study should have results, and members of the community should know the average level of arsenic found in the children, as well as the highest and lowest readings, and how they compare with national data.
But what will such numbers, which simply indicate the presence of a chemical in the body, tell people who are living in areas of concern? “In the case of arsenic, we have a lot of good clinical information,” says Jean Johnson, Ph.D., the Minnesota Department of Health’s environmental health tracking and biomonitoring program director. For example, 50 micrograms or less of total arsenic per liter in urine is considered normal, and studies have found high levels of exposure over years to be associated with skin problems and an increased risk for certain cancers and heart disease.
Understanding the results of the PFC study will pose more of a challenge. “For PFCs, we have no clinical comparison value. There isn’t a test or a number we know of for a concentration in the body that indicates a health concern,” Johnson says. “The health effects that have been observed were seen in studies of animals and not humans.” And the doses in animal studies are much higher than human exposure levels.
Although the study won’t answer questions about the long-term health effects of these exposures, Johnson and her staff are working with area physicians to help them address the concerns of patients who are found to have either arsenic or PFCs in their bodies. “There’s no doubt that when we go looking for these chemicals in the body, that we will find them,” she says. “All people will get from us is a number. The physician is the key to helping individuals interpret those numbers.”—Kim Kiser