Bibliography Tag: heartland region

Alexander et al., 2007

Alexander, B. H., Mandel, J. S., Baker, B. A., Burns, C. J., Bartels, M. J., Acquavella, J. F., & Gustin, C.; “Biomonitoring of 2,4-dichlorophenoxyacetic acid exposure and dose in farm families;” Environmental Health Perspectives, 2007, 115(3), 370-376; DOI: 10.1289/ehp.8869.


OBJECTIVE: We estimated 2,4-dichlorophenoxyacetic acid (2,4-D) exposure and systemic dose in farm family members following an application of 2,4-D on their farm.

METHODS: Farm families were recruited from licensed applicators in Minnesota and South Carolina. Eligible family members collected all urine during five 24-hr intervals, 1 day before through 3 days after an application of 2,4-D. Exposure profiles were characterized with 24-hr urine 2,4-D concentrations, which then were related to potential predictors of exposure. Systemic dose was estimated using the urine collections from the application day through the third day after application.

RESULTS: Median urine 2,4-D concentrations at baseline and day after application were 2.1 and 73.1 microg/L for applicators, below the limit of detection, and 1.2 microg/L for spouses, and 1.5 and 2.9 microg/L for children. The younger children (4-11 years of age) had higher median post-application concentrations than the older children (> or = 12 years of age) (6.5 vs. 1.9 microg/L). The geometric mean systemic doses (micrograms per kilogram body weight) were 2.46 (applicators), 0.8 (spouses), 0.22 (all children), 0.32 (children 4-11 years of age), and 0.12 (children > or = 12 years of age). Exposure to the spouses and children was primarily determined by direct contact with the application process and the number of acres treated. Multivariate models identified glove use, repairing equipment, and number of acres treated as predictors of exposure in the applicators.

CONCLUSIONS: We observed considerable heterogeneity of 2,4-D exposure among farm family members, primarily attributable to level of contact with the application process. Awareness of this variability and the actual magnitude of exposures are important for developing exposure and risk characterizations in 2,4-D-exposed agricultural populations.


Hart et al., 2005

Hart, L. G., Larson, E. H., & Lishner, D. M.; “Rural definitions for health policy and research;” American Journal of Public Health, 2005, 95(7), 1149-1155; DOI: 10.2105/AJPH.2004.042432.


The term “rural” suggests many things to many people, such as agricultural landscapes, isolation, small towns, and low population density. However, defining “rural” for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and economic differences across rural places-differences that have major implications for policy and research. Factors such as geographic scale and region also must be considered. Several useful rural taxonomies are discussed and compared in this article. Careful attention to the definition of “rural” is required for effectively targeting policy and research aimed at improving the health of rural Americans. FULL TEXT

Diepietro Mager, 2020

DiPietro Mager, Natalie Ann. (2020). Preconception and Interconception Health and Routine Health Service Use Among Women in a Rural Midwestern County (Doctor of Philosophy), Indiana University.


Advancement of preconception and interconception health is a key element to improve women’s health as well as pregnancy outcomes. Little is known about the preconception and interconception health status of rural Midwestern populations in the United States. The primary objective of this study was to determine the preconception and interconception health status as well as behaviors of reproductive age women living in a rural Midwestern area. Secondary objectives were to quantify process measures of health care access and barriers to care, as well as determine disparities in preconception and interconception health status among women in this rural area as compared to statewide estimates. As existing national or state secondary data sources often have limitations in data derived from areas with low population densities or insufficient sample sizes to generate reliable estimates, a cross-sectional study was performed using a 34item survey. Data were collected from February to May 2019 from 315 non-pregnant women ages 18-45 years in a rural county in northwestern Ohio. Nearly all women surveyed had at least one risk factor associated with poor pregnancy outcomes, many of which were modifiable. Nearly half of all respondents reported at least one barrier to receipt of health care services. Women in this rural county fared worse for several preconception and interconception health measures when compared to statewide estimates derived from Behavioral Risk Factor Surveillance System and Ohio Pregnancy Assessment Survey data. These findings illustrate the need for continued development of interventions to improve preconception and interconception health for rural women as well as improved methods to capture and analyze data on important subpopulations at risk.

Blewett et al., 2004

Blewett, Lynn A., Casey, Michelle M., & Call, Kathleen T.; “Improving Access to Primary Care for a Growing Latino Population: The Role of Safety Net Providers in the Rural Midwest;” Health Services Safety Net, 2004, Summer 2004.


Context: Many rural Midwestern communities are experiencing rapid growth in Latino populations with low rates of health insurance coverage, limited financial resources, language and cultural differences, and special health care needs. Purpose: We report on 2-day site visits conducted in 2001 and 2002 in 3 communities (Marshalltown, Iowa; Great Bend, Kansas; and Norfolk, Nebraska) to document successful strategies to meet Latino health care needs. Methods: We interviewed key informants to identify successful community strategies for dealing with health care access challenges facing the growing Latino population in the Midwest. Findings: Interventions have been developed to meet new demands including (1) use of free clinics, (2) school health programs, (3) outreach by public health, social services and religious organizations, and (4) health care providers’ efforts to communicate with patients in Spanish. Strain on safety net services for Latinos is due in part to a complicated and unstable mix of public and private funds, a large but overtaxed volunteer provider base, the dependence on a limited number of community leaders, and limited time for coordination and documentation of activities. Conclusions: We suggest the development of a Rural Safety Net Support System to provide targeted funding to rural areas with growing immigrant populations. Federal community health center support could be redirected to new and existing safety net providers to support the development of a safety net monitoring system.

Casey et al., 2004

Casey, Michelle M., Blewett, Lynn A., & Call, Kathleen T.; “Providing Health Care to Latino Immigrants: Community-Based Efforts in the Rural Midwest;” American Journal of Public Health, 2004, 94(10), 1709-1711; DOI: 10.2105/AJPH.94.10.1709.


We examined case studies of 3 rural Midwestern communities to assess local health care systems response to rapidly growing Latino populations. Currently, clinics provide free or low-cost care, and schools, public health, social services, and religious organizations connect Latinos to the health care system. However, many unmet health care needs result from lack of health insurance, limited income, and linguistic and cultural barriers. Targeted safety net funding would help meet Latino health care needs in rural communities with limited resources.  FULL TEXT

Askelson et al., 2020

Askelson, N., Ryan, G., Pieper, F., Bash-Brooks, W., Rasmusson, A., Greene, M., & Buckert, A.; “Perspectives on Implementation: Challenges and Successes of a Program Designed to Support Expectant and Parenting Community College Students in Rural, Midwestern State;” Maternal Child Health Journal, 2020, 24(Suppl 2), 152-162; DOI: 10.1007/s10995-020-02879-6.


OBJECTIVES: Expectant and parenting students (EPS) at community colleges are an underserved and often under-resourced group. In a rural, Midwestern state, the department of public health was awarded the Pregnancy Assistance Fund (PAF) grant to assist this population. This paper outlines the results of the implementation evaluation and offers suggestions for programs and evaluators working with this population in the community college setting.

METHODS: We conducted a multicomponent evaluation utilizing quantitative and qualitative methods. Evaluation activities included tracking activities/services, surveys and interviews with participants, and interviews with community college staff implementing grant activities. The research team calculated frequencies for quantitative data and coded qualitative data for themes.

RESULTS: Data from the community colleges and students’ self-reports revealed that EPS most commonly received concrete support from the program, often in the form of stipends or gift cards. Students reported that concrete support was beneficial and helped to relieve financial stress during the semester. Students’ major barriers to participation were lack of knowledge about the program and busy schedules that prevented them from accessing PAF services. Staff reported that difficulty identifying EPS and the short one-year project period were major implementation challenges.

CONCLUSIONS FOR PRACTICE: We recommend that community colleges work to identify EPS, use fellow EPS to recruit program participants, and implement programming that works with the students’ schedules.


Berens et al., 2020

Berens, Matthew B., Capel, Paul D., & Arnold, William A.; “Neonicotinoid Insecticides in Surface Water, Groundwater, and Wastewater across Land Use Gradients and Potential Effects;” Environmental Toxicology and Chemistry, 2020, In Press; DOI: 10.1002/etc.4959.


Neonicotinoid insecticides cause adverse effects on non-target organisms, but more information about their occurrence in surface and groundwater is needed across a range of land use. Sixty-five sites in Minnesota U.S., representing rivers, streams, lakes, groundwater, and treated wastewater, were monitored via collection of 157 water samples to determine variability in spatiotemporal neonicotinoid concentrations. The data were used to assess relations to land use, hydrogeologic condition, and potential effects on aquatic life. Results showed total neonicotinoid concentrations were highest in agricultural watersheds (median=12 ng/L) followed by urban (2.9 ng/L) and undeveloped watersheds (1.9 ng/L). Clothianidin was most frequently detected in agricultural areas (detection frequency = 100%) and imidacloprid most often in urban waters (detection frequency = 97%). The seasonal trend of neonicotinoid concentrations in rivers, streams, and lakes showed that their highest concentrations coincided with spring planting and elevated streamflow. Consistently low neonicotinoid concentrations were found in shallow groundwater in agricultural regions (<1.2-16 ng/L, median = 1.4 ng/L). Treated municipal wastewater had the highest concentrations across all hydrologic compartments (12-48 ng/L, median = 19 ng/L), but neonicotinoid loads from rivers and streams (median = 4100 mg/d) were greater than in treated wastewater (700 mg/d). No samples exceeded acute aquatic-life benchmarks for individual neonicotinoids, whereas 10% of samples exceeded a chronic benchmark for neonicotinoid mixtures. Although 62% of samples contained two or more neonicotinoids, the observed concentrations suggest there were low acute and potential chronic risks to aquatic life. This the first study of its size in Minnesota and is critical to better understanding the drivers of widescale environmental contamination by neonicotinoids where urban, agricultural, and undeveloped lands are present. FULL TEXT

Christensen et al., 2016

Christensen, C. H., Barry, K. H., Andreotti, G., Alavanja, M. C., Cook, M. B., Kelly, S. P., Burdett, L. A., Yeager, M., Beane Freeman, L. E., Berndt, S. I., & Koutros, S.; “Sex Steroid Hormone Single-Nucleotide Polymorphisms, Pesticide Use, and the Risk of Prostate Cancer: A Nested Case-Control Study within the Agricultural Health Study;” Frontiers in Oncology, 2016, 6, 237; DOI: 10.3389/fonc.2016.00237.


Experimental and epidemiologic investigations suggest that certain pesticides may alter sex steroid hormone synthesis, metabolism or regulation, and the risk of hormone-related cancers. Here, we evaluated whether single-nucleotide polymorphisms (SNPs) involved in hormone homeostasis alter the effect of pesticide exposure on prostate cancer risk. We evaluated pesticide-SNP interactions between 39 pesticides and SNPs with respect to prostate cancer among 776 cases and 1,444 controls nested in the Agricultural Health Study cohort. In these interactions, we included candidate SNPs involved in hormone synthesis, metabolism or regulation (N = 1,100), as well as SNPs associated with circulating sex steroid concentrations, as identified by genome-wide association studies (N = 17). Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Multiplicative SNP-pesticide interactions were calculated using a likelihood ratio test. We translated p-values for interaction into q-values, which reflected the false discovery rate, to account for multiple comparisons. We observed a significant interaction, which was robust to multiple comparison testing, between the herbicide dicamba and rs8192166 in the testosterone metabolizing gene SRD5A1 (p-interaction = 4.0 x 10(-5); q-value = 0.03), such that men with two copies of the wild-type genotype CC had a reduced risk of prostate cancer associated with low use of dicamba (OR = 0.62 95% CI: 0.41, 0.93) and high use of dicamba (OR = 0.44, 95% CI: 0.29, 0.68), compared to those who reported no use of dicamba; in contrast, there was no significant association between dicamba and prostate cancer among those carrying one or two copies of the variant T allele at rs8192166. In addition, interactions between two organophosphate insecticides and SNPs related to estradiol metabolism were observed to result in an increased risk of prostate cancer. While replication is needed, these data suggest both agonistic and antagonistic effects on circulating hormones, due to the combination of exposure to pesticides and genetic susceptibility, may impact prostate cancer risk. FULL TEXT

Thomas et al., 2010b

Thomas, K. W., Dosemeci, M., Coble, J. B., Hoppin, J. A., Sheldon, L. S., Chapa, G., Croghan, C. W., Jones, P. A., Knott, C. E., Lynch, C. F., Sandler, D. P., Blair, A. E., & Alavanja, M. C.; “Assessment of a pesticide exposure intensity algorithm in the agricultural health study;” Journal of Exposure Analysis and Environmental Epidemiology, 2010, 20(6), 559-569; DOI: 10.1038/jes.2009.54.


The accuracy of the exposure assessment is a critical factor in epidemiological investigations of pesticide exposures and health in agricultural populations. However, few studies have been conducted to evaluate questionnaire-based exposure metrics. The Agricultural Health Study (AHS) is a prospective cohort study of pesticide applicators who provided detailed questionnaire information on their use of specific pesticides. A field study was conducted for a subset of the applicators enrolled in the AHS to assess a pesticide exposure algorithm through comparison of algorithm intensity scores with measured exposures. Pre- and post-application urinary biomarker measurements were made for 2,4-D (n=69) and chlorpyrifos (n=17) applicators. Dermal patch, hand wipe, and personal air samples were also collected. Intensity scores were calculated using information from technician observations and an interviewer-administered questionnaire. Correlations between observer and questionnaire intensity scores were high (Spearman’s r=0.92 and 0.84 for 2,4-D and chlorpyrifos, respectively). Intensity scores from questionnaires for individual applications were significantly correlated with post-application urinary concentrations for both 2,4-D (r=0.42, P<0.001) and chlorpyrifos (r=0.53, P=0.035) applicators. Significant correlations were also found between intensity scores and estimated hand loading, estimated body loading, and air concentrations for 2,4-D applicators (r-values 0.28-0.50, P-values<0.025). Correlations between intensity scores and dermal and air measures were generally lower for chlorpyrifos applicators using granular products. A linear regression model indicated that the algorithm factors for individual applications explained 24% of the variability in post-application urinary 2,4-D concentration, which increased to 60% when the pre-application urine concentration was included. The results of the measurements support the use of the algorithm for estimating questionnaire-based exposure intensities in the AHS for liquid pesticide products. Refinement of the algorithm may be possible using the results from this and other measurement studies. FULL TEXT

Hoppin et al., 2002

Hoppin, J. A., Yucel, F., Dosemeci, M., & Sandler, D. P.; “Accuracy of self-reported pesticide use duration information from licensed pesticide applicators in the Agricultural Health Study;” Journal of Exposure Analysis and Environmental Epidemiology, 2002, 12(5), 313-318; DOI: 10.1038/sj.jea.7500232.


Epidemiologists frequently rely on self-reported information regarding a variety of exposures including smoking history, medication use, and occupational exposure because other sources of information are either unavailable or difficult to obtain. One way to evaluate the accuracy of self-reported information is through logic checks using other sources. To assess the quality of the self-reported pesticide product use history of 57,311 licensed pesticide applicators in the Agricultural Health Study (AHS), we compared the self-reported decade of first use and total years of use to the year the pesticide active ingredient was first registered for use. We obtained pesticide active ingredient registration information from the United States Environmental Protection Agency (USEPA) and other publicly available sources for the 52 pesticides on the AHS initial questionnaires administered from 1994 to 1997. Based on the registration year, we assessed 19 pesticides for potential inaccuracies regarding duration of use or decade of first use. When calculating potential total years of use, we did not consider the impact of chemicals being removed from the market, since the possibility for continued use existed. The majority of respondents provided plausible responses for both decade of first use and total duration of use. On average, 1% of the subjects overestimated total possible duration of use, ranging from less than 1% for carbofuran and chlorpyrifos to 5% for imazethapyr. Decade of first use was also reasonably reported, although more subjects did not report decade of first use than duration of use, with an average of 6% of subjects missing decade information for an individual chemical. For subjects who reported a decade of first use, 98% gave plausible responses on average, with overestimates highest for cyanazine, introduced in 1971 (6% reported earlier use), and chlorimuron ethyl, introduced in 1985 (7% reported earlier use). This analysis provided the opportunity to consider only one source of potential overreporting of exposure, and while underreporting may have also occurred, we cannot evaluate its role nor the balance between these potential inaccuracies. While we are unable to validate directly the accuracy of a respondent’s use of pesticides, this analysis suggests that participants provide plausible information regarding their pesticide use. FULL TEXT