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Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation
STOTEN-20424; No of Pages 7 Science of the Total Environment xxx (2016) xxx–xxx
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Science of the Total Environment journal homepage: www.elsevier.com/locate/scitotenv
Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation Christos A. Damalas a,⁎, Gholamhossein Abdollahzadeh b a b
Department of Agricultural Development, Democritus University of Thrace, GR 68200 Orestiada, Greece Department of Agricultural Extension and Education, Gorgan University of Agricultural Sciences and Natural Resources, Gorgan, Iran
H I G H L I G H T S
G R A P H I C A L
A B S T R A C T
• Factors related to PPE use during pesticide handling were explored in northern Greece. • Most farmers (49.3%) showed potentially unsafe behaviour with respect to PPE use. • An episode of pesticide intoxication in the past exerted positive influence on PPE use. • Perception of pesticide hazard (harmful) exerted positive influence on PPE use. • Old age exerted a significant negative influence on PPE use.
a r t i c l e
i n f o
Article history: Received 13 May 2016 Received in revised form 30 June 2016 Accepted 6 July 2016 Available online xxxx Editor: D. Barcelo Keywords: Behaviour Exposure Health hazards Pesticides PPE Risk perceptions Safety
a b s t r a c t Understanding factors affecting the use of personal protective equipment (PPE) during handling of plant protection products (PPPs) is of major importance for the design of tailored interventions to minimize exposure among farmers. However, data regarding this issue are highly limited. Factors related to the use of PPE during handling of PPPs were explored in a survey of cotton farmers in northern Greece. Data were collected through face-to-face interviews with the farmers based on a questionnaire with structured items on the frequency of use of various personal protective devices during handling of PPPs. New evidence on patterns of PPE use and potential exposure of farmers to PPPs is provided. Most farmers (49.3%) showed potentially unsafe behaviour with respect to PPE use. Hat and boots were the most commonly used protective items during PPPs use, but most of the farmers surveyed reported low frequency of use for gloves, goggles, face mask, coveralls, and respirator. Especially the respirator was reported to be the least used PPE item amongst farmers. Farmers who perceived PPPs as harmful substances or those who had an episode of intoxication in the past reported more frequent use of several PPE items. Stepwise multiple regression analysis revealed that the variable episode of intoxication in the past exerted the strongest positive influence on PPE use, followed by the perception of PPPs being hazardous substances, upper secondary education, previous training on PPPs (i.e., spraying equipment, application parameters, risks to human health and environment, safety issues) and farm size under cultivation. Old age exerted a significant negative influence on PPE use, namely, elderly farmers tended not to use PPE. Strategies to maximize the protection of applicators of PPPs from hazardous exposures still require innovation to achieve increased effectiveness.
⁎ Corresponding author. E-mail addresses: [email protected], [email protected] (C.A. Damalas).
http://dx.doi.org/10.1016/j.scitotenv.2016.07.042 0048-9697/© 2016 Elsevier B.V. All rights reserved.
Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
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C.A. Damalas, G. Abdollahzadeh / Science of the Total Environment xxx (2016) xxx–xxx
Emphasis on lifelong training and education of farmers about hazards and risks of PPPs is crucial for changing wrong behaviours in handling of PPPs. © 2016 Elsevier B.V. All rights reserved.
1. Introduction Plant protection products (PPPs) are widely used in agricultural production to control harmful pests, diseases, weeds, and other plant pathogens in an effort to reduce or eliminate yield losses and maintain high product quality (Damalas and Eleftherohorinos, 2011). However, as much as these chemicals are vital for ensuring safety in food production and thus also supporting economic growth, incorrect and indiscriminate use at all stages of handling can generate serious risks for human health and the environment (Calliera et al., 2013). Mishandling of PPPs poses serious health problems for farmers, especially, but not only, in developing countries. PPPs use could entail a high risk to human health while being beneficial to crops, depending on numerous factors that determine the levels to which exposure occurs (Damalas, 2009). The potential of having severe adverse effects on farmers' health is not due to intensive farming where PPPs are required to achieve a high yield, but due to the ignorance of farmers on the potential health effects implicated with the use of PPPs (Palis et al., 2006). Farmers are often unaware of the potential negative effects of PPPs on human health and may use excessive amounts of PPPs without adequate protective measures. Even farmers who are aware of the harmful effects of PPPs are often unable to translate this awareness into their practices (Damalas et al., 2006; Isin and Yildirim, 2007; Yuantari et al., 2015). Farmers are routinely exposed to high levels of PPPs mainly during the preparation and application of the PPPs spray solutions, but also during cleaning the spraying equipment (Damalas and Koutroubas, 2016). Substantial dermal exposure of the operator during mixing and loading of PPPs, mostly in hands or the lower part of the body has been documented (Tsakirakis et al., 2010; Baldi et al., 2012; Gao et al., 2014; Cao et al., 2015). The use of PPE during PPPs handling should be a necessary part of working with agrochemicals. Various types of PPE can be used in PPPs handling to minimize dermal exposure. Although studies varied with regard to the types of chemicals investigated, the types of PPE examined, and the types of exposure measured, they clearly indicated that PPE is effective in reducing farmers' exposure to PPPs (Tsakirakis et al., 2010). Chemical-resistant gloves, boots, hats, long sleeve shirts, and certified coveralls are among the most common types of PPE (Damalas and Koutroubas, 2016). Reduction of farmers' exposure to PPPs may lead to lowering the incidence and severity of the adverse health effects related to their use. Therefore, it is vital to use reliable devices for personal protection. The level of protection provided by a specific PPE item depends on the protective features of that particular PPE type, the means of PPPs application, and the level of proper fitting and maintenance by the farmers (Damalas and Koutroubas, 2016). Thus, the intended maximum levels of protection are seldom achieved in routine use of PPE and the actual level of personal protection is often difficult to assess. Studies concerning several PPE materials and designs lend further support to the effectiveness of PPE, although some of these studies also indicated variations due to fabrics and clothing design (Espanhol-Soares et al., 2013; Abirami and Selvakumar, 2014). Despite the fact that PPE use minimizes exposure to PPPs, several operator and worker exposure studies have shown that PPE is frequently not used (Damalas et al., 2006; MacFarlane et al., 2008; Damalas and Hashemi, 2010; Feola and Binder, 2010; Hashemi et al., 2012) or is used incorrectly (Singh and Gupta, 2009; Blanco-Muñoz and Lacasaña, 2011; Yuantari et al., 2015). Improvement of infrastructure and workplace conditions was found to be crucial for promoting safety practices and PPE use (Levesque et al., 2012).
When PPPs are the chosen method for pest control, it is important that the products are used properly to ensure efficacy in the field, personal and environmental safety, and also legal compliance. Poor knowledge and understanding of safety practices during PPPs use and erroneous beliefs about the necessity of PPE can seriously impair farmers' abilities to protect themselves against risks from PPPs use (Jørs et al., 2006; Zhang and Lu, 2007). Decisions on the use of PPE present a challenge for PPPs users. Many PPPs users are unaware of the potential hazards of PPPs use and often they are uninformed about the type of PPE that should be worn during PPPs handling. The use of personal protective devices depends much on individual decisions and these decisions can be influenced by various factors: risk perception, awareness of belonging to a risk group, awareness of the seriousness of potential hazards, belief that prevention is effective in reducing potential risk and also that prevention is possible (Damalas et al., 2006; Damalas and Hashemi, 2010). Although much research has been carried out to describe safety practices with PPPs use, little is known about the use of PPE among end users. The need for further research into the relationship between risk perceptions and attitudes, and adoption of self-protective behaviours is often stressed (Remoundou et al., 2014). Such information is essential to know how farmers behave in PPPs handling in an effort to establish and assess prevention strategies that increase knowledge and aptitudes in this occupational group. To this end, information about farmers' perceptions and behaviours regarding safety practices during PPPs handling is essential. Therefore, understanding factors affecting the use of PPE during PPPs handling is of major importance, firstly for analyzing what behavioural drivers are relevant in that context and secondly for designing tailored interventions to minimize exposure to PPPs among farmers. Regretfully, data regarding this issue are highly limited. Thus, the objective of this project was to study the current levels of PPE use and the factors related to the PPE use among cotton farmers from rural areas in northern Greece. 2. Methods 2.1. Study area and sample selection The study was carried out with 148 randomly selected farmers from rural areas of northern Pieria (Eginio and Methoni) in northern Greece. The survey consisted of interviews with farmers from areas where cotton is mainly cultivated. The selection of farmers was totally random based on the fact that prospective participants in the study included conventional cotton cropping over the last years in their farming activities and on the willingness of each farmer to participate in the study. Participants were individuals who were actively engaged in agriculture and directly involved in PPPs spraying. This was a necessary prerequisite for participation in the study. In general, the aim was to interview those who were most likely to identify the real situation in the field. This was achieved with the close cooperation and the assistance of the leaders of farmers' groups. Cluster sampling (municipalities) with small subsets (villages) was used to collect data. Members of the subset can be more easily identified, contributing to lower costs of the survey (Green et al., 2006). Overall, 278 farmers were enlisted from lists of farmers obtained from the local farm supplies stores in each studied area. Potential participants were approached independently considering their availability and their willingness to participate in the study. The farmers gave oral consent to participate in the study after hearing a brief explanation of the
Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
C.A. Damalas, G. Abdollahzadeh / Science of the Total Environment xxx (2016) xxx–xxx
study's objective. To avoid any potential bias, it was made clear to the farmers that the study was for academic research. Totally, 148 interviews were fully completed. Of the remaining names drawn, some farmers were unavailable at the time of the interview and were not included in the study. Based on the total number of farmers on the lists used, the sample of the study provided an error of 5.5% at 95% level of significance, which was considered acceptable. 2.2. Data collection A questionnaire with structured items was designed based on published literature on relative subjects including also previous experience in the field from past projects (Damalas et al., 2006; Damalas and Hashemi, 2010). The questionnaire included questions about the frequency of use of various personal protective devices used in PPPs handling, which was measured on a 3-point Likert-type scale as follows: 1 = almost never, 2 = occasionally, and 3 = almost always. The use of PPE mainly referred to PPPs application to the target, not excluding other handling stages (e.g. mixing and loading, disposing of, cleaning, etc). Moreover, information relating to age, education, farm size under cultivation, membership in local associations, previous training on PPPs use (in the form of an organized seminar with classroom lectures or field demonstrations or both that required registration of participants and are organized by an official organization), perception of PPPs hazards and risks, and an episode of PPPs intoxication in the past (if a farmer felt any kind of sickness by the use of PPPs) was collected. Data were collected through face-to-face interviews with the farmers in a way of friendly discussion and with some field observations during PPPs handling and spraying activities, when possible. The questionnaire was initially pre-tested using small samples of farmers in the same areas in the form of a pilot study. 2.3. Data analysis Descriptive statistics (relative frequencies and means) were calculated for each variable. Cross-tabulation was used to summarize the most important categories such as perception of PPPs hazard (not harmful, harmful) and an episode of PPPs intoxication in the past (no, yes) with regard to PPE use (almost never, occasionally, almost always). The Chi-square test was performed on percentages of PPE use classified into a two-way frequency (contingency) table with two attributes (no, yes) for each of the variables: perception of PPPs hazard and an episode of PPPs intoxication in the past. This classification is used to determine whether the distributions in each variable are the same or differ. The Chi-square test is therefore useful to determine significant differences between the two independent attributes. However, this test has certain limitations, i.e., no category may have an expected frequency of less than five. Therefore, in this study, the Chi-square test was not applied to the protective item ‘respirator’. The average use score of the seven PPE items (i.e., hat, boots, gloves, mask, goggles, coveralls, respirator) was used to discriminate safety behaviour of the farmers regarding PPE use. Farmers' performance was expressed as a value ranging between 0 and 1 by applying the following formula (Singh and Hiremath, 2010): Performance ¼ ½actual value−minimum value=½maximum value−minimum value
where: actual value = the average use score of the seven items of protective equipment for each farmer, minimum value = the lowest use score of the seven items of protective equipment for each farmer, and maximum value = the greatest use score of the seven items of protective equipment for each farmer. Then, safety behaviour of farmers was divided into five levels of 0.20 points each, totaling 1, following the five-point scale model of Ko (2005), as below:
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Safe behaviour (excellent): 0.81–1.00; Potentially safe behaviour (good): 0.61–0.80; Intermediate behaviour (medium): 0.41–0.60; Potentially unsafe behaviour (poor): 0.21–0.40; Unsafe behaviour (bad): 0.00–0.20. 2.4. Multiple regression analysis Empirical examination of the determinants of PPE use was analyzed using stepwise multiple regression analysis with the ordinary least squares (OLS) method. Stepwise regression was chosen to address the research hypothesis because of its ability to assess the relationship between several independent variables and a single dependent variable. This analysis is designed to select from a group of independent variables, those which make the largest contribution to R-squared (Cohen, 1988). For this analysis, the stepwise criteria for F to enter were P ≤ 0.05 and to remove was P ≥ 0.01. The initial regression model is implicitly specified as follows: Y ¼ f ðX1; X2; X3; X4; X5; X6; X7; X8; UÞ where Y = level of use of PPE (number of protective devices used), X1 = Perception of PPPs hazard (dummy variables: 1 = harmful, 0 = otherwise), X2 = Episode of PPPs intoxication in the past (dummy variables: 1 = yes, 0 = otherwise), X3 = Age (years), X4 = Farm size (hectares), X5 = Lower secondary education (dummy variables: 1 = lower secondary, 0 = otherwise), X6 = Upper secondary education (dummy variables: 1 = upper secondary, 0 = otherwise), X7 = Previous training on PPPs (dummy variables: 1 = yes, 0 = otherwise), X8 = Membership in local associations (dummy variables: 1 = yes, 0 = otherwise), and U = Error term. The average score of the seven protective items (hat, boots, gloves, mask, goggles, coveralls, respirator) measured on a 3-point Liker-type scale (1 = almost never, 2 = occasionally, 3 = almost always) was used as the dependent variable (Cronbach's alpha = 0.672). The assumptions of constant variance, no influential outliers, and normality were verified using plots (Neter et al., 1990). The one-sample Kolmogorov-Smirnov statistic was used to test for normality. Neither the plots nor Kolmogorov-Smirnov test indicated any potentially significant departures from the assumptions. Appropriate statistical analysis was performed using SPSS18. A level of significance at P b 0.05 was used for all statistical tests. 3. Results Mean age of the farmers was 42.89 years with a tendency towards the category ‘above 46 years’ (Table 1). Concerning education, most farmers (89.9%) were in the category up to ‘secondary education’, whereas a sizeable proportion (11.5%) reported no education at all (Table 1). It must be noted that the reported education levels refer only to the specific sample of the participants surveyed. Weighting across education levels was not performed and the sample does not reflect education level of farmers at a national level. The average land size of farmers of the sample was 9.73 ha, but most farmers (39.2%) were in the category up to 6 ha. Most farmers (75.7%) did not receive any training on PPPs use (in the form of a seminar with classroom lectures or field demonstrations or both that required registration of participants and are organized by an official organization) and most (72.3%) were members in local associations. Farmers appeared divided into almost equal groups regarding perception of PPPs hazard (52.7% perceived PPPs as harmful substances) and an episode of PPPs intoxication in the past (46.6% reported that they had an episode of PPPs intoxication in the past). The use of PPE varied considerably depending on the item examined (Fig. 1). Hat and boots were the most commonly used protective items,
Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
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C.A. Damalas, G. Abdollahzadeh / Science of the Total Environment xxx (2016) xxx–xxx
Table 1 Socio-demographic profile of farmers. Variable Age (mean = 42.89 years) ≤30 31–45 ≥46 Education No education Primary education Lower secondary Upper secondary Tertiary Farm size (mean = 9.73 ha) 3–6 6–12 12–18 ≥18 Previous training on pesticides No Yes Membership in local associations No Yes Perception of pesticide hazard Not harmful Harmful Episode of pesticide intoxication in the past No Yes
Frequency
%
48 28 72
32.4 18.9 48.7
17 50 46 20 15
11.5 33.8 31.1 13.5 10.1
58 47 27 16
39.2 31.8 18.2 10.8
112 36
75.7 24.3
41 107
27.7 72.3
70 78
47.3 52.7
79 69
53.4 46.6
whereas respirator was the least used. Overall, systematic use of PPE was reported by 23.6% of farmers (Fig. 1). Almost half of the farmers (49.3%) showed potentially unsafe behaviour in the use of PPE (Table 2). Farmers who perceived PPPs as harmful substances were found to use more frequently (P b 0.01) gloves, mask, goggles, and coveralls than farmers who perceived PPPs as not harmful substances (Table 3). Also, farmers who had experienced an episode of PPPs intoxication in the past were found to use more frequently (P b 0.01) hat, boots, gloves, goggles than farmers who had not any episode of PPPs intoxication in the past (Table 4). The results of the stepwise regression analysis are presented in Table 5. The stepwise regression was run up to a sixth step and included six variables: perception of PPPs hazard (harmful), age, an episode of PPPs intoxication in the past (yes), upper secondary education, previous training on PPPs (yes), and farm size under cultivation. Five of the six independent variables included in the step six exerted a positive influence on the use of PPE, while only age showed a negative influence on the
dependent variable. The R2 of 0.800 indicates that 80.0% of the variance in the dependent variable is explained by the variance in the six independent variables. Calculating the empirical F-value (94.12) reveals that the model is highly significant. The influence of four independent variables on the dependent variable is significant at P b 0.01 and two of them are significant at P b 0.05. The variable: episode of PPPs intoxication in the past exerted the strongest positive influence with a standardized beta coefficient of 0.430, followed by perception of PPPs hazard (harmful) with 0.369, upper secondary education with 0.222, previous training on PPPs with 0.117 and farm size under cultivation with 0.080. This indicates that all these variables have a positive and significant contribution in increasing farmers' use of PPE. By contrast, age exerted a significant negative influence of − 0.726 on the measuring value of the dependent variable for every unit of increase in its own measuring value. This indicates that older farmers have a negative and significant contribution in increasing PPE use. Following these analyses, membership in local associations and lower secondary education had a non-significant modifying effect on farmers' use of PPE and were excluded from the final model. 4. Discussion This study provides insights to the current levels of PPE use and the factors related to the PPE use among cotton farmers from a rural area in northern Greece. The use of PPE varied considerably depending on the item examined with the hat and boots being the most commonly used protective items. Systematic use of PPE was reported by 23.6% of the farmers. On the other hand, almost half of the farmers showed potentially unsafe behaviour in the use of PPE, as defined by the five-point scale model of Ko (2005) that was used in this study. However, the use of PPE ought not to be considered as a default, but as a possible risk mitigation measure arising from the risk assessment carried out for the PPPs registration. Based on the risk assessment, the risk for operators might be acceptable even without PPE in some cases. Therefore, the non-use of PPE could not be definitively considered as an unsafe behaviour, unless the use of PPE is actually required. In this study, the use of PPE was not linked to the prescriptions included on the labels of PPPs, but it was studied as a common practice when handling most PPPs. This issue could be considered as a limitation of this study, but exceptional cases of PPPs that do not require PPE use cannot affect dramatically the general trends of this study. Understanding risk perceptions and risk attitudes of farmers' regarding exposure to PPPs is important for effective risk communication programs and policy responses that aim at reducing exposure to PPPs through adoption of self-protective behaviours. It appears that the public health objective of protecting farmers
Fig. 1. Use of PPE among farmers.
Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
C.A. Damalas, G. Abdollahzadeh / Science of the Total Environment xxx (2016) xxx–xxx
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Table 2 Behaviour of farmers regarding PPE use. Category a
Frequency
Percentage
Cumulative percentage
Safe behaviour (0.81–1.00) Potentially safe behaviour (0.61–0.80) Intermediate behaviour (0.41–0.60) Potentially unsafe behaviour (0.21–0.40) Unsafe behaviour (0.00–0.20)
3 16 51 73 5
2.0 10.8 34.5 49.3 3.4
2.0 12.8 47.3 96.6 100.0
a
On a scale from 0.00 to 1.00 (following Ko, 2005).
from hazardous chemical exposures is not being met by the current approach of PPE use. Thus, strategies to maximize the protection of PPPs users from hazardous exposures still require innovation to achieve increased effectiveness. In this context, the collected evidence could be a valuable benchmark for future comparisons in Greece and possibly for comparisons with other areas of southern Europe. An episode of PPPs intoxication in the past showed a significant positive effect on PPE use. This finding is in line with previous research (Feola and Binder, 2010) and indicates that farmers who experienced adverse health effects from PPPs use in the past were more likely to use PPE, suggesting that farmers learn from previous personal experiences. It is possible, however, that farmers might tend to underestimate the health effects from PPPs for cultural reasons or may want to maintain a high self-concept in order to avoid showing weakness, as pointed out elsewhere (Palis et al., 2006). The perception of PPPs hazard (perceived harmfulness) also showed a highly positive effect on PPE use. Operators who perceive that their health has been negatively affected by the use of PPPs were found to be more likely to adopt self-protective behaviours (Remoundou et al., 2015). High levels of risk perceptions of unsafe use of PPPs were associated with high farming experience among farmers and experience of adverse health effects from PPPs in the past rather than with age (Hashemi et al., 2012). In other words, farmers who have experienced health problems from PPPs use show heightened concern about the health effects from PPPs than those who have not experienced such problems (Lichtenberg and Zimmerman, 1999; Hashemi et al., 2012). In a related research from Pakistan, neither the experience of health effects, nor the levels of risk perception affected PPPs use among cotton farmers (Khan et al., 2015). Old age showed a significant negative effect on PPE use, namely, elderly farmers tended not to use PPE. This finding is in line with previous studies (Schenker et al., 2002; MacFarlane et al., 2008; Feola and Binder,
2010; Damalas and Hashemi, 2010) where PPE use appeared to be more strongly associated with young farmers rather than farmers of advanced age. It is possible that familiarity with PPPs may lead to complacency and greater risk taking in PPPs handling; therefore, the elderly farmers may feel that after many years in farming new efforts to protect their health are unnecessary (Damalas et al., 2006). Individuals who perceive that their health has already been affected by exposure to PPPs may also perceive that, because the damage has already been done, any further attempts to limit exposure to PPPs through adoption of self-protective behaviours would have limited health benefit (Remoundou et al., 2015). Similarly, the perception that resistance to PPPs risks will occur after years of exposure or that farmers' ability to control their own exposure to PPPs is limited, is likely to result in lower adoption levels of protective measures among farmers (Arcury et al., 2002; Cabrera and Leckie, 2009). Upper secondary education and previous training on PPPs use showed a significant positive effect on PPE use. The importance of education with regard to PPE use is no surprise, given that education status has been reported as a strong determinant of PPE use (Blanco-Muñoz and Lacasaña, 2011; Al Zadjali et al., 2015). Also, educational programs are often proposed to trigger more sustainable PPE use among smallholder farmers and PPPs applicators. Besides, there is a legal requirement across European Union (EU) Member States to establish National Action Plans (Directive 2009/128/EC), thereby setting quantitative objectives, targets, measures, timetables and indicators to reduce risks and impacts of PPPs use on human health and the environment. In this context, sufficient training would ensure that PPPs users, distributors, and advisors acquire sufficient knowledge on how to identify and control hazards and risks to humans associated with PPPs. However, education might not always be the most appropriate intervention policy to
Table 4 Effect of episode of pesticide intoxication in the past on farmers' use of PPE.
Table 3 Effect of perception of pesticide hazard on farmers' use of PPE.
Episode of pesticide intoxication
Perception of pesticide hazard PPE item
Frequency of use
Not harmful
Harmful
PPE item
Frequency of use
No
Hat
Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always
9 26 35 7 23 40 47 21 2 55 12 3 52 18 0 65 5 0 70 0 0
10 28 40 10 18 50 24 36 18 33 29 16 37 26 15 44 11 23 70 5 3
Hat
Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always
12 39 28 14 36 29 31 40 8 44 26 9 40 34 5 60 11 8 75 3 1
χ2 = 0.028, P = 0.986 Boots χ2 = 1.823, P = 0.402 Gloves χ2 = 23.835, P = 0.000 Mask χ2 = 21.073, P = 0.000 Goggles χ2 = 18.605, P = 0.000 Coveralls χ2 = 28.948, P = 0.000 Respirator χ2 = N/A
(9.0) (25.5) (35.5) (8.0) (19.4) (42.6) (33.6) (27.0) (9.5) (41.6) (19.4) (9.0) (42.1) (20.8) (7.1) (51.6) (7.6) (10.9) (66.2) (2.4) (1.4)
Values in parentheses show expected frequencies. N/A: not applicable.
(10.0) (28.5) (39.5) (9.0) (21.6) (47.4) (37.4) (30.0) (10.5) (46.4) (21.6) (10.0) (46.9) (23.2) (7.9) (57.4) (8.4) (12.1) (73.8) (2.6) (1.6)
χ2 = 16.194, P = 0.000 Boots χ2 = 41.448, P = 0.000 Gloves χ2 = 10.594, P = 0.005 Mask χ2 = 2.339, P = 0.311 Goggles χ2 = 15.061, P = 0.001 Coveralls χ2 = 4.837, P = 0.089 Respirator χ2 = N/A
Yes (10.1) (28.8) (40.0) (9.1) (21.9) (48.0) (37.9) (30.4) (10.7) (47.0) (21.9) (10.1) (47.5) (23.5) (8.0) (58.2) (8.5) (12.3) (74.7) (2.7) (1.6)
7 15 47 3 5 61 40 17 12 44 15 10 49 10 10 49 5 15 65 2 2
(8.9) (25.2) (35.0) (7.9) (19.1) (42.0) (33.1) (26.6) (9.3) (41.0) (19.1) (8.9) (41.5) (20.5) (7.0) (50.8) (7.5) (10.7) (65.3) (2.3) (1.4)
Values in parentheses show expected frequencies. N/A: not applicable.
Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
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C.A. Damalas, G. Abdollahzadeh / Science of the Total Environment xxx (2016) xxx–xxx
Table 5 Stepwise regression analysis of factors influencing farmers' use of PPE. Independent variable
B
Std. error
Constant Perception of pesticide hazard (harmful) Age Episode of pesticide intoxication (yes) Upper secondary education Previous training on pesticides (yes) Farm size under cultivation
1.789 0.108 −0.010 0.186 0.118 0.058 0.003
0.033 0.012 0.001 0.021 0.025 0.023 0.001
Std. beta
t-ratio
Sig.
VIF
0.369 −0.726 0.430 0.222 0.117 0.080
54.070** 8.710** −14.435** 8.978** 4.628** 2.489* 1.995*
0.000 0.000 0.000 0.000 0.000 0.014 0.048
1.268 1.784 1.618 1.618 1.554 1.133
R = 0.895, R2 = 0.800, Adjusted R2 = 0.792, F = 94.12**. VIF tests revealed no significant levels of multicollinearity between the independent variables. * Significance at 0.05 level, ** Significance at 0.01 level.
address PPE misuse (Feola et al., 2012). For example, such programs may not be appropriate in the case of farmers who already show a relatively high level of awareness of the risks involved and the potential adverse health effects. Instead, more articulated intervention strategies at multiple levels may be needed to promote safe PPPs use among farmers, particularly in developing countries (Feola and Binder, 2010). Given that farmers tend to learn from their direct negative experiences, the learning-by-experience approach could be targeted to trigger the transition of farmers towards more sustainable PPE use. This could be achieved through experience groups, involving farmers and an advisor who share experience of extreme situations with PPPs use and of the negative health effects linked to PPPs use and then use this experience for shaping specific training schemes. Identifying active social networks of farmers and involving farmers who are highly influential in the social community, also might prove to be an effective strategy. Training has been reported to be an important intervention for increasing PPE uptake and reducing farmers' exposure to PPPs (MacFarlane et al., 2008). Lastly, farm size showed a significant positive effect on PPE use. This trend means that large farmers were more willing to use PPE than small-scale farmers. This finding is in line with recent research (Okoffo et al., 2016). A possible explanation could be the fact that farmers with large farm size normally spend more time to apply PPPs and therefore it is expected that these farmers are more exposed to the harmful effects of the chemicals when spraying without PPE than small-scale farmers. Also, the significant cost of some PPE items may easily limit small-scale farmers' access to the equipment. Knowledge of the reasons for non-use of PPE is critical for directing programs towards the prevention of exposure to PPPs. However, the possible reasons of participants for not using PPE during PPPs use were not a part of the objectives of this study. A previous relevant study with tobacco farmers in the area showed that the main reason of farmers for not using protective equipment was that protective items are uncomfortable (Damalas et al., 2006). Possibly, a similar belief could be applicable also for the farmers of this study, although further investigation to verify this common belief was not carried out. Previous research reported that specific PPE instructions for each chemical may be too complicated or PPE requirements may be too troublesome for applicators to practice (Perry et al., 2002). In the United States, the frequency of PPE use was increased when business owners provided PPE (Strong et al., 2008). However, this result can be considered valid only for large businesses, probably because employers are required by law to protect workers from exposure to PPPs. In small businesses, however, the individual farmers or workers are the ones who take the protective measures and the decision to use the PPE depends on their knowledge, attitudes, and beliefs (Carpenter et al., 2002). In some communities, use of PPE was interpreted as a sign of weakness or fear (Tinoco-Ojanguren and Halperin, 1998; Rendón-Von Osten et al., 2004). This project relied mainly on self-reports of farmers' PPE use and these behaviours were only partly validated against actual use. This might be considered as an inherent limitation of this study. Self-report studies may suffer limitations of this kind as people frequently want to report socially desirable behaviours. However, the interviews in this
study were conducted in a friendly way and there was good cooperation with the growers without any refusals. Thus, the possibility of misreporting was assumed negligible. Also, the sample surveyed was completely random and sufficient to be considered representative for the average farmer in the area. Moreover, the study focused on PPE use, but using PPE is one component of safety behaviour. Future studies could also integrate other components of safety behaviour such as: ‘avoiding risks that endanger the user's health’ (e.g. smoking, drinking, eating, and disposing PPPs containers) and ‘considering common principles of safety’ (e.g. spraying recommended PPPs, reading the label instructions, changing clothes and showering after spraying) to formulate an acceptable index of safety behaviour. 5. Conclusions Data of this study provide a snapshot of farmers' behaviour in the use of PPE when handling PPPs. A substantial percentage of farmers in this study did not recognize the need to wear PPE on a regular basis. It appears that the public health objective of protecting farmers from hazardous chemical exposures is not being met by the current approach of PPE use and thus strategies to maximize the protection of PPPs users from hazardous exposures still require innovation to achieve increased effectiveness. Based on these trends, education and training are vital to promote farmers' knowledge of potential health hazards of PPPs. It is also essential to enhance farmers' awareness on the use of suitable and effective PPE, to facilitate access to PPE, and to ensure regulatory compliance. A pesticide label lists the minimum PPE that a person must wear while performing handling or early-entry activities. However, changing farmers' behaviour with respect to PPE use might require considerable effort. Emphasis on lifelong training and education of farmers about PPPs hazards is crucial for changing wrong behaviours in PPPs handling. This is in line with the European legislation (Directive 2009/128/EC) which requires that all professional users, distributors and advisors of PPPs have access to appropriate training, consisting of both initial and additional training to acquire and update knowledge as appropriate. Alternative approaches to the implementation of intervention strategies with exploring behavioural dynamics together with the local experts and implementing a participative process might prove to be effective. In this context, data of this study could be useful by filling the gap between science and policy making. Future research can compare farmers' safety behaviour among different farming systems and different crop producers, according to the model of this study. References Abirami, R., Selvakumar, N., 2014. Development of a test equipment for pesticide protective fabric evaluation and studies on simple cotton woven fabrics. J. Ind. Text. 43, 549–564. Al Zadjali, S., Morse, S., Chenoweth, J., Deadman, M., 2015. Personal safety issues related to the use of pesticides in agricultural production in the Al-Batinah region of northern Oman. Sci. Total Environ. 502, 457–461. Arcury, T.A., Quandt, S.A., Russell, G.B., 2002. Pesticide safety among farm workers: perceived risk and perceived control as factors reflecting environmental justice. Environ. Health Perspect. 110, 233–240.
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Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
Contents lists available at ScienceDirect
Science of the Total Environment journal homepage: www.elsevier.com/locate/scitotenv
Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation Christos A. Damalas a,⁎, Gholamhossein Abdollahzadeh b a b
Department of Agricultural Development, Democritus University of Thrace, GR 68200 Orestiada, Greece Department of Agricultural Extension and Education, Gorgan University of Agricultural Sciences and Natural Resources, Gorgan, Iran
H I G H L I G H T S
G R A P H I C A L
A B S T R A C T
• Factors related to PPE use during pesticide handling were explored in northern Greece. • Most farmers (49.3%) showed potentially unsafe behaviour with respect to PPE use. • An episode of pesticide intoxication in the past exerted positive influence on PPE use. • Perception of pesticide hazard (harmful) exerted positive influence on PPE use. • Old age exerted a significant negative influence on PPE use.
a r t i c l e
i n f o
Article history: Received 13 May 2016 Received in revised form 30 June 2016 Accepted 6 July 2016 Available online xxxx Editor: D. Barcelo Keywords: Behaviour Exposure Health hazards Pesticides PPE Risk perceptions Safety
a b s t r a c t Understanding factors affecting the use of personal protective equipment (PPE) during handling of plant protection products (PPPs) is of major importance for the design of tailored interventions to minimize exposure among farmers. However, data regarding this issue are highly limited. Factors related to the use of PPE during handling of PPPs were explored in a survey of cotton farmers in northern Greece. Data were collected through face-to-face interviews with the farmers based on a questionnaire with structured items on the frequency of use of various personal protective devices during handling of PPPs. New evidence on patterns of PPE use and potential exposure of farmers to PPPs is provided. Most farmers (49.3%) showed potentially unsafe behaviour with respect to PPE use. Hat and boots were the most commonly used protective items during PPPs use, but most of the farmers surveyed reported low frequency of use for gloves, goggles, face mask, coveralls, and respirator. Especially the respirator was reported to be the least used PPE item amongst farmers. Farmers who perceived PPPs as harmful substances or those who had an episode of intoxication in the past reported more frequent use of several PPE items. Stepwise multiple regression analysis revealed that the variable episode of intoxication in the past exerted the strongest positive influence on PPE use, followed by the perception of PPPs being hazardous substances, upper secondary education, previous training on PPPs (i.e., spraying equipment, application parameters, risks to human health and environment, safety issues) and farm size under cultivation. Old age exerted a significant negative influence on PPE use, namely, elderly farmers tended not to use PPE. Strategies to maximize the protection of applicators of PPPs from hazardous exposures still require innovation to achieve increased effectiveness.
⁎ Corresponding author. E-mail addresses: [email protected], [email protected] (C.A. Damalas).
http://dx.doi.org/10.1016/j.scitotenv.2016.07.042 0048-9697/© 2016 Elsevier B.V. All rights reserved.
Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
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C.A. Damalas, G. Abdollahzadeh / Science of the Total Environment xxx (2016) xxx–xxx
Emphasis on lifelong training and education of farmers about hazards and risks of PPPs is crucial for changing wrong behaviours in handling of PPPs. © 2016 Elsevier B.V. All rights reserved.
1. Introduction Plant protection products (PPPs) are widely used in agricultural production to control harmful pests, diseases, weeds, and other plant pathogens in an effort to reduce or eliminate yield losses and maintain high product quality (Damalas and Eleftherohorinos, 2011). However, as much as these chemicals are vital for ensuring safety in food production and thus also supporting economic growth, incorrect and indiscriminate use at all stages of handling can generate serious risks for human health and the environment (Calliera et al., 2013). Mishandling of PPPs poses serious health problems for farmers, especially, but not only, in developing countries. PPPs use could entail a high risk to human health while being beneficial to crops, depending on numerous factors that determine the levels to which exposure occurs (Damalas, 2009). The potential of having severe adverse effects on farmers' health is not due to intensive farming where PPPs are required to achieve a high yield, but due to the ignorance of farmers on the potential health effects implicated with the use of PPPs (Palis et al., 2006). Farmers are often unaware of the potential negative effects of PPPs on human health and may use excessive amounts of PPPs without adequate protective measures. Even farmers who are aware of the harmful effects of PPPs are often unable to translate this awareness into their practices (Damalas et al., 2006; Isin and Yildirim, 2007; Yuantari et al., 2015). Farmers are routinely exposed to high levels of PPPs mainly during the preparation and application of the PPPs spray solutions, but also during cleaning the spraying equipment (Damalas and Koutroubas, 2016). Substantial dermal exposure of the operator during mixing and loading of PPPs, mostly in hands or the lower part of the body has been documented (Tsakirakis et al., 2010; Baldi et al., 2012; Gao et al., 2014; Cao et al., 2015). The use of PPE during PPPs handling should be a necessary part of working with agrochemicals. Various types of PPE can be used in PPPs handling to minimize dermal exposure. Although studies varied with regard to the types of chemicals investigated, the types of PPE examined, and the types of exposure measured, they clearly indicated that PPE is effective in reducing farmers' exposure to PPPs (Tsakirakis et al., 2010). Chemical-resistant gloves, boots, hats, long sleeve shirts, and certified coveralls are among the most common types of PPE (Damalas and Koutroubas, 2016). Reduction of farmers' exposure to PPPs may lead to lowering the incidence and severity of the adverse health effects related to their use. Therefore, it is vital to use reliable devices for personal protection. The level of protection provided by a specific PPE item depends on the protective features of that particular PPE type, the means of PPPs application, and the level of proper fitting and maintenance by the farmers (Damalas and Koutroubas, 2016). Thus, the intended maximum levels of protection are seldom achieved in routine use of PPE and the actual level of personal protection is often difficult to assess. Studies concerning several PPE materials and designs lend further support to the effectiveness of PPE, although some of these studies also indicated variations due to fabrics and clothing design (Espanhol-Soares et al., 2013; Abirami and Selvakumar, 2014). Despite the fact that PPE use minimizes exposure to PPPs, several operator and worker exposure studies have shown that PPE is frequently not used (Damalas et al., 2006; MacFarlane et al., 2008; Damalas and Hashemi, 2010; Feola and Binder, 2010; Hashemi et al., 2012) or is used incorrectly (Singh and Gupta, 2009; Blanco-Muñoz and Lacasaña, 2011; Yuantari et al., 2015). Improvement of infrastructure and workplace conditions was found to be crucial for promoting safety practices and PPE use (Levesque et al., 2012).
When PPPs are the chosen method for pest control, it is important that the products are used properly to ensure efficacy in the field, personal and environmental safety, and also legal compliance. Poor knowledge and understanding of safety practices during PPPs use and erroneous beliefs about the necessity of PPE can seriously impair farmers' abilities to protect themselves against risks from PPPs use (Jørs et al., 2006; Zhang and Lu, 2007). Decisions on the use of PPE present a challenge for PPPs users. Many PPPs users are unaware of the potential hazards of PPPs use and often they are uninformed about the type of PPE that should be worn during PPPs handling. The use of personal protective devices depends much on individual decisions and these decisions can be influenced by various factors: risk perception, awareness of belonging to a risk group, awareness of the seriousness of potential hazards, belief that prevention is effective in reducing potential risk and also that prevention is possible (Damalas et al., 2006; Damalas and Hashemi, 2010). Although much research has been carried out to describe safety practices with PPPs use, little is known about the use of PPE among end users. The need for further research into the relationship between risk perceptions and attitudes, and adoption of self-protective behaviours is often stressed (Remoundou et al., 2014). Such information is essential to know how farmers behave in PPPs handling in an effort to establish and assess prevention strategies that increase knowledge and aptitudes in this occupational group. To this end, information about farmers' perceptions and behaviours regarding safety practices during PPPs handling is essential. Therefore, understanding factors affecting the use of PPE during PPPs handling is of major importance, firstly for analyzing what behavioural drivers are relevant in that context and secondly for designing tailored interventions to minimize exposure to PPPs among farmers. Regretfully, data regarding this issue are highly limited. Thus, the objective of this project was to study the current levels of PPE use and the factors related to the PPE use among cotton farmers from rural areas in northern Greece. 2. Methods 2.1. Study area and sample selection The study was carried out with 148 randomly selected farmers from rural areas of northern Pieria (Eginio and Methoni) in northern Greece. The survey consisted of interviews with farmers from areas where cotton is mainly cultivated. The selection of farmers was totally random based on the fact that prospective participants in the study included conventional cotton cropping over the last years in their farming activities and on the willingness of each farmer to participate in the study. Participants were individuals who were actively engaged in agriculture and directly involved in PPPs spraying. This was a necessary prerequisite for participation in the study. In general, the aim was to interview those who were most likely to identify the real situation in the field. This was achieved with the close cooperation and the assistance of the leaders of farmers' groups. Cluster sampling (municipalities) with small subsets (villages) was used to collect data. Members of the subset can be more easily identified, contributing to lower costs of the survey (Green et al., 2006). Overall, 278 farmers were enlisted from lists of farmers obtained from the local farm supplies stores in each studied area. Potential participants were approached independently considering their availability and their willingness to participate in the study. The farmers gave oral consent to participate in the study after hearing a brief explanation of the
Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
C.A. Damalas, G. Abdollahzadeh / Science of the Total Environment xxx (2016) xxx–xxx
study's objective. To avoid any potential bias, it was made clear to the farmers that the study was for academic research. Totally, 148 interviews were fully completed. Of the remaining names drawn, some farmers were unavailable at the time of the interview and were not included in the study. Based on the total number of farmers on the lists used, the sample of the study provided an error of 5.5% at 95% level of significance, which was considered acceptable. 2.2. Data collection A questionnaire with structured items was designed based on published literature on relative subjects including also previous experience in the field from past projects (Damalas et al., 2006; Damalas and Hashemi, 2010). The questionnaire included questions about the frequency of use of various personal protective devices used in PPPs handling, which was measured on a 3-point Likert-type scale as follows: 1 = almost never, 2 = occasionally, and 3 = almost always. The use of PPE mainly referred to PPPs application to the target, not excluding other handling stages (e.g. mixing and loading, disposing of, cleaning, etc). Moreover, information relating to age, education, farm size under cultivation, membership in local associations, previous training on PPPs use (in the form of an organized seminar with classroom lectures or field demonstrations or both that required registration of participants and are organized by an official organization), perception of PPPs hazards and risks, and an episode of PPPs intoxication in the past (if a farmer felt any kind of sickness by the use of PPPs) was collected. Data were collected through face-to-face interviews with the farmers in a way of friendly discussion and with some field observations during PPPs handling and spraying activities, when possible. The questionnaire was initially pre-tested using small samples of farmers in the same areas in the form of a pilot study. 2.3. Data analysis Descriptive statistics (relative frequencies and means) were calculated for each variable. Cross-tabulation was used to summarize the most important categories such as perception of PPPs hazard (not harmful, harmful) and an episode of PPPs intoxication in the past (no, yes) with regard to PPE use (almost never, occasionally, almost always). The Chi-square test was performed on percentages of PPE use classified into a two-way frequency (contingency) table with two attributes (no, yes) for each of the variables: perception of PPPs hazard and an episode of PPPs intoxication in the past. This classification is used to determine whether the distributions in each variable are the same or differ. The Chi-square test is therefore useful to determine significant differences between the two independent attributes. However, this test has certain limitations, i.e., no category may have an expected frequency of less than five. Therefore, in this study, the Chi-square test was not applied to the protective item ‘respirator’. The average use score of the seven PPE items (i.e., hat, boots, gloves, mask, goggles, coveralls, respirator) was used to discriminate safety behaviour of the farmers regarding PPE use. Farmers' performance was expressed as a value ranging between 0 and 1 by applying the following formula (Singh and Hiremath, 2010): Performance ¼ ½actual value−minimum value=½maximum value−minimum value
where: actual value = the average use score of the seven items of protective equipment for each farmer, minimum value = the lowest use score of the seven items of protective equipment for each farmer, and maximum value = the greatest use score of the seven items of protective equipment for each farmer. Then, safety behaviour of farmers was divided into five levels of 0.20 points each, totaling 1, following the five-point scale model of Ko (2005), as below:
3
Safe behaviour (excellent): 0.81–1.00; Potentially safe behaviour (good): 0.61–0.80; Intermediate behaviour (medium): 0.41–0.60; Potentially unsafe behaviour (poor): 0.21–0.40; Unsafe behaviour (bad): 0.00–0.20. 2.4. Multiple regression analysis Empirical examination of the determinants of PPE use was analyzed using stepwise multiple regression analysis with the ordinary least squares (OLS) method. Stepwise regression was chosen to address the research hypothesis because of its ability to assess the relationship between several independent variables and a single dependent variable. This analysis is designed to select from a group of independent variables, those which make the largest contribution to R-squared (Cohen, 1988). For this analysis, the stepwise criteria for F to enter were P ≤ 0.05 and to remove was P ≥ 0.01. The initial regression model is implicitly specified as follows: Y ¼ f ðX1; X2; X3; X4; X5; X6; X7; X8; UÞ where Y = level of use of PPE (number of protective devices used), X1 = Perception of PPPs hazard (dummy variables: 1 = harmful, 0 = otherwise), X2 = Episode of PPPs intoxication in the past (dummy variables: 1 = yes, 0 = otherwise), X3 = Age (years), X4 = Farm size (hectares), X5 = Lower secondary education (dummy variables: 1 = lower secondary, 0 = otherwise), X6 = Upper secondary education (dummy variables: 1 = upper secondary, 0 = otherwise), X7 = Previous training on PPPs (dummy variables: 1 = yes, 0 = otherwise), X8 = Membership in local associations (dummy variables: 1 = yes, 0 = otherwise), and U = Error term. The average score of the seven protective items (hat, boots, gloves, mask, goggles, coveralls, respirator) measured on a 3-point Liker-type scale (1 = almost never, 2 = occasionally, 3 = almost always) was used as the dependent variable (Cronbach's alpha = 0.672). The assumptions of constant variance, no influential outliers, and normality were verified using plots (Neter et al., 1990). The one-sample Kolmogorov-Smirnov statistic was used to test for normality. Neither the plots nor Kolmogorov-Smirnov test indicated any potentially significant departures from the assumptions. Appropriate statistical analysis was performed using SPSS18. A level of significance at P b 0.05 was used for all statistical tests. 3. Results Mean age of the farmers was 42.89 years with a tendency towards the category ‘above 46 years’ (Table 1). Concerning education, most farmers (89.9%) were in the category up to ‘secondary education’, whereas a sizeable proportion (11.5%) reported no education at all (Table 1). It must be noted that the reported education levels refer only to the specific sample of the participants surveyed. Weighting across education levels was not performed and the sample does not reflect education level of farmers at a national level. The average land size of farmers of the sample was 9.73 ha, but most farmers (39.2%) were in the category up to 6 ha. Most farmers (75.7%) did not receive any training on PPPs use (in the form of a seminar with classroom lectures or field demonstrations or both that required registration of participants and are organized by an official organization) and most (72.3%) were members in local associations. Farmers appeared divided into almost equal groups regarding perception of PPPs hazard (52.7% perceived PPPs as harmful substances) and an episode of PPPs intoxication in the past (46.6% reported that they had an episode of PPPs intoxication in the past). The use of PPE varied considerably depending on the item examined (Fig. 1). Hat and boots were the most commonly used protective items,
Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
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C.A. Damalas, G. Abdollahzadeh / Science of the Total Environment xxx (2016) xxx–xxx
Table 1 Socio-demographic profile of farmers. Variable Age (mean = 42.89 years) ≤30 31–45 ≥46 Education No education Primary education Lower secondary Upper secondary Tertiary Farm size (mean = 9.73 ha) 3–6 6–12 12–18 ≥18 Previous training on pesticides No Yes Membership in local associations No Yes Perception of pesticide hazard Not harmful Harmful Episode of pesticide intoxication in the past No Yes
Frequency
%
48 28 72
32.4 18.9 48.7
17 50 46 20 15
11.5 33.8 31.1 13.5 10.1
58 47 27 16
39.2 31.8 18.2 10.8
112 36
75.7 24.3
41 107
27.7 72.3
70 78
47.3 52.7
79 69
53.4 46.6
whereas respirator was the least used. Overall, systematic use of PPE was reported by 23.6% of farmers (Fig. 1). Almost half of the farmers (49.3%) showed potentially unsafe behaviour in the use of PPE (Table 2). Farmers who perceived PPPs as harmful substances were found to use more frequently (P b 0.01) gloves, mask, goggles, and coveralls than farmers who perceived PPPs as not harmful substances (Table 3). Also, farmers who had experienced an episode of PPPs intoxication in the past were found to use more frequently (P b 0.01) hat, boots, gloves, goggles than farmers who had not any episode of PPPs intoxication in the past (Table 4). The results of the stepwise regression analysis are presented in Table 5. The stepwise regression was run up to a sixth step and included six variables: perception of PPPs hazard (harmful), age, an episode of PPPs intoxication in the past (yes), upper secondary education, previous training on PPPs (yes), and farm size under cultivation. Five of the six independent variables included in the step six exerted a positive influence on the use of PPE, while only age showed a negative influence on the
dependent variable. The R2 of 0.800 indicates that 80.0% of the variance in the dependent variable is explained by the variance in the six independent variables. Calculating the empirical F-value (94.12) reveals that the model is highly significant. The influence of four independent variables on the dependent variable is significant at P b 0.01 and two of them are significant at P b 0.05. The variable: episode of PPPs intoxication in the past exerted the strongest positive influence with a standardized beta coefficient of 0.430, followed by perception of PPPs hazard (harmful) with 0.369, upper secondary education with 0.222, previous training on PPPs with 0.117 and farm size under cultivation with 0.080. This indicates that all these variables have a positive and significant contribution in increasing farmers' use of PPE. By contrast, age exerted a significant negative influence of − 0.726 on the measuring value of the dependent variable for every unit of increase in its own measuring value. This indicates that older farmers have a negative and significant contribution in increasing PPE use. Following these analyses, membership in local associations and lower secondary education had a non-significant modifying effect on farmers' use of PPE and were excluded from the final model. 4. Discussion This study provides insights to the current levels of PPE use and the factors related to the PPE use among cotton farmers from a rural area in northern Greece. The use of PPE varied considerably depending on the item examined with the hat and boots being the most commonly used protective items. Systematic use of PPE was reported by 23.6% of the farmers. On the other hand, almost half of the farmers showed potentially unsafe behaviour in the use of PPE, as defined by the five-point scale model of Ko (2005) that was used in this study. However, the use of PPE ought not to be considered as a default, but as a possible risk mitigation measure arising from the risk assessment carried out for the PPPs registration. Based on the risk assessment, the risk for operators might be acceptable even without PPE in some cases. Therefore, the non-use of PPE could not be definitively considered as an unsafe behaviour, unless the use of PPE is actually required. In this study, the use of PPE was not linked to the prescriptions included on the labels of PPPs, but it was studied as a common practice when handling most PPPs. This issue could be considered as a limitation of this study, but exceptional cases of PPPs that do not require PPE use cannot affect dramatically the general trends of this study. Understanding risk perceptions and risk attitudes of farmers' regarding exposure to PPPs is important for effective risk communication programs and policy responses that aim at reducing exposure to PPPs through adoption of self-protective behaviours. It appears that the public health objective of protecting farmers
Fig. 1. Use of PPE among farmers.
Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
C.A. Damalas, G. Abdollahzadeh / Science of the Total Environment xxx (2016) xxx–xxx
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Table 2 Behaviour of farmers regarding PPE use. Category a
Frequency
Percentage
Cumulative percentage
Safe behaviour (0.81–1.00) Potentially safe behaviour (0.61–0.80) Intermediate behaviour (0.41–0.60) Potentially unsafe behaviour (0.21–0.40) Unsafe behaviour (0.00–0.20)
3 16 51 73 5
2.0 10.8 34.5 49.3 3.4
2.0 12.8 47.3 96.6 100.0
a
On a scale from 0.00 to 1.00 (following Ko, 2005).
from hazardous chemical exposures is not being met by the current approach of PPE use. Thus, strategies to maximize the protection of PPPs users from hazardous exposures still require innovation to achieve increased effectiveness. In this context, the collected evidence could be a valuable benchmark for future comparisons in Greece and possibly for comparisons with other areas of southern Europe. An episode of PPPs intoxication in the past showed a significant positive effect on PPE use. This finding is in line with previous research (Feola and Binder, 2010) and indicates that farmers who experienced adverse health effects from PPPs use in the past were more likely to use PPE, suggesting that farmers learn from previous personal experiences. It is possible, however, that farmers might tend to underestimate the health effects from PPPs for cultural reasons or may want to maintain a high self-concept in order to avoid showing weakness, as pointed out elsewhere (Palis et al., 2006). The perception of PPPs hazard (perceived harmfulness) also showed a highly positive effect on PPE use. Operators who perceive that their health has been negatively affected by the use of PPPs were found to be more likely to adopt self-protective behaviours (Remoundou et al., 2015). High levels of risk perceptions of unsafe use of PPPs were associated with high farming experience among farmers and experience of adverse health effects from PPPs in the past rather than with age (Hashemi et al., 2012). In other words, farmers who have experienced health problems from PPPs use show heightened concern about the health effects from PPPs than those who have not experienced such problems (Lichtenberg and Zimmerman, 1999; Hashemi et al., 2012). In a related research from Pakistan, neither the experience of health effects, nor the levels of risk perception affected PPPs use among cotton farmers (Khan et al., 2015). Old age showed a significant negative effect on PPE use, namely, elderly farmers tended not to use PPE. This finding is in line with previous studies (Schenker et al., 2002; MacFarlane et al., 2008; Feola and Binder,
2010; Damalas and Hashemi, 2010) where PPE use appeared to be more strongly associated with young farmers rather than farmers of advanced age. It is possible that familiarity with PPPs may lead to complacency and greater risk taking in PPPs handling; therefore, the elderly farmers may feel that after many years in farming new efforts to protect their health are unnecessary (Damalas et al., 2006). Individuals who perceive that their health has already been affected by exposure to PPPs may also perceive that, because the damage has already been done, any further attempts to limit exposure to PPPs through adoption of self-protective behaviours would have limited health benefit (Remoundou et al., 2015). Similarly, the perception that resistance to PPPs risks will occur after years of exposure or that farmers' ability to control their own exposure to PPPs is limited, is likely to result in lower adoption levels of protective measures among farmers (Arcury et al., 2002; Cabrera and Leckie, 2009). Upper secondary education and previous training on PPPs use showed a significant positive effect on PPE use. The importance of education with regard to PPE use is no surprise, given that education status has been reported as a strong determinant of PPE use (Blanco-Muñoz and Lacasaña, 2011; Al Zadjali et al., 2015). Also, educational programs are often proposed to trigger more sustainable PPE use among smallholder farmers and PPPs applicators. Besides, there is a legal requirement across European Union (EU) Member States to establish National Action Plans (Directive 2009/128/EC), thereby setting quantitative objectives, targets, measures, timetables and indicators to reduce risks and impacts of PPPs use on human health and the environment. In this context, sufficient training would ensure that PPPs users, distributors, and advisors acquire sufficient knowledge on how to identify and control hazards and risks to humans associated with PPPs. However, education might not always be the most appropriate intervention policy to
Table 4 Effect of episode of pesticide intoxication in the past on farmers' use of PPE.
Table 3 Effect of perception of pesticide hazard on farmers' use of PPE.
Episode of pesticide intoxication
Perception of pesticide hazard PPE item
Frequency of use
Not harmful
Harmful
PPE item
Frequency of use
No
Hat
Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always
9 26 35 7 23 40 47 21 2 55 12 3 52 18 0 65 5 0 70 0 0
10 28 40 10 18 50 24 36 18 33 29 16 37 26 15 44 11 23 70 5 3
Hat
Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always Almost never Occasionally Almost always
12 39 28 14 36 29 31 40 8 44 26 9 40 34 5 60 11 8 75 3 1
χ2 = 0.028, P = 0.986 Boots χ2 = 1.823, P = 0.402 Gloves χ2 = 23.835, P = 0.000 Mask χ2 = 21.073, P = 0.000 Goggles χ2 = 18.605, P = 0.000 Coveralls χ2 = 28.948, P = 0.000 Respirator χ2 = N/A
(9.0) (25.5) (35.5) (8.0) (19.4) (42.6) (33.6) (27.0) (9.5) (41.6) (19.4) (9.0) (42.1) (20.8) (7.1) (51.6) (7.6) (10.9) (66.2) (2.4) (1.4)
Values in parentheses show expected frequencies. N/A: not applicable.
(10.0) (28.5) (39.5) (9.0) (21.6) (47.4) (37.4) (30.0) (10.5) (46.4) (21.6) (10.0) (46.9) (23.2) (7.9) (57.4) (8.4) (12.1) (73.8) (2.6) (1.6)
χ2 = 16.194, P = 0.000 Boots χ2 = 41.448, P = 0.000 Gloves χ2 = 10.594, P = 0.005 Mask χ2 = 2.339, P = 0.311 Goggles χ2 = 15.061, P = 0.001 Coveralls χ2 = 4.837, P = 0.089 Respirator χ2 = N/A
Yes (10.1) (28.8) (40.0) (9.1) (21.9) (48.0) (37.9) (30.4) (10.7) (47.0) (21.9) (10.1) (47.5) (23.5) (8.0) (58.2) (8.5) (12.3) (74.7) (2.7) (1.6)
7 15 47 3 5 61 40 17 12 44 15 10 49 10 10 49 5 15 65 2 2
(8.9) (25.2) (35.0) (7.9) (19.1) (42.0) (33.1) (26.6) (9.3) (41.0) (19.1) (8.9) (41.5) (20.5) (7.0) (50.8) (7.5) (10.7) (65.3) (2.3) (1.4)
Values in parentheses show expected frequencies. N/A: not applicable.
Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042
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C.A. Damalas, G. Abdollahzadeh / Science of the Total Environment xxx (2016) xxx–xxx
Table 5 Stepwise regression analysis of factors influencing farmers' use of PPE. Independent variable
B
Std. error
Constant Perception of pesticide hazard (harmful) Age Episode of pesticide intoxication (yes) Upper secondary education Previous training on pesticides (yes) Farm size under cultivation
1.789 0.108 −0.010 0.186 0.118 0.058 0.003
0.033 0.012 0.001 0.021 0.025 0.023 0.001
Std. beta
t-ratio
Sig.
VIF
0.369 −0.726 0.430 0.222 0.117 0.080
54.070** 8.710** −14.435** 8.978** 4.628** 2.489* 1.995*
0.000 0.000 0.000 0.000 0.000 0.014 0.048
1.268 1.784 1.618 1.618 1.554 1.133
R = 0.895, R2 = 0.800, Adjusted R2 = 0.792, F = 94.12**. VIF tests revealed no significant levels of multicollinearity between the independent variables. * Significance at 0.05 level, ** Significance at 0.01 level.
address PPE misuse (Feola et al., 2012). For example, such programs may not be appropriate in the case of farmers who already show a relatively high level of awareness of the risks involved and the potential adverse health effects. Instead, more articulated intervention strategies at multiple levels may be needed to promote safe PPPs use among farmers, particularly in developing countries (Feola and Binder, 2010). Given that farmers tend to learn from their direct negative experiences, the learning-by-experience approach could be targeted to trigger the transition of farmers towards more sustainable PPE use. This could be achieved through experience groups, involving farmers and an advisor who share experience of extreme situations with PPPs use and of the negative health effects linked to PPPs use and then use this experience for shaping specific training schemes. Identifying active social networks of farmers and involving farmers who are highly influential in the social community, also might prove to be an effective strategy. Training has been reported to be an important intervention for increasing PPE uptake and reducing farmers' exposure to PPPs (MacFarlane et al., 2008). Lastly, farm size showed a significant positive effect on PPE use. This trend means that large farmers were more willing to use PPE than small-scale farmers. This finding is in line with recent research (Okoffo et al., 2016). A possible explanation could be the fact that farmers with large farm size normally spend more time to apply PPPs and therefore it is expected that these farmers are more exposed to the harmful effects of the chemicals when spraying without PPE than small-scale farmers. Also, the significant cost of some PPE items may easily limit small-scale farmers' access to the equipment. Knowledge of the reasons for non-use of PPE is critical for directing programs towards the prevention of exposure to PPPs. However, the possible reasons of participants for not using PPE during PPPs use were not a part of the objectives of this study. A previous relevant study with tobacco farmers in the area showed that the main reason of farmers for not using protective equipment was that protective items are uncomfortable (Damalas et al., 2006). Possibly, a similar belief could be applicable also for the farmers of this study, although further investigation to verify this common belief was not carried out. Previous research reported that specific PPE instructions for each chemical may be too complicated or PPE requirements may be too troublesome for applicators to practice (Perry et al., 2002). In the United States, the frequency of PPE use was increased when business owners provided PPE (Strong et al., 2008). However, this result can be considered valid only for large businesses, probably because employers are required by law to protect workers from exposure to PPPs. In small businesses, however, the individual farmers or workers are the ones who take the protective measures and the decision to use the PPE depends on their knowledge, attitudes, and beliefs (Carpenter et al., 2002). In some communities, use of PPE was interpreted as a sign of weakness or fear (Tinoco-Ojanguren and Halperin, 1998; Rendón-Von Osten et al., 2004). This project relied mainly on self-reports of farmers' PPE use and these behaviours were only partly validated against actual use. This might be considered as an inherent limitation of this study. Self-report studies may suffer limitations of this kind as people frequently want to report socially desirable behaviours. However, the interviews in this
study were conducted in a friendly way and there was good cooperation with the growers without any refusals. Thus, the possibility of misreporting was assumed negligible. Also, the sample surveyed was completely random and sufficient to be considered representative for the average farmer in the area. Moreover, the study focused on PPE use, but using PPE is one component of safety behaviour. Future studies could also integrate other components of safety behaviour such as: ‘avoiding risks that endanger the user's health’ (e.g. smoking, drinking, eating, and disposing PPPs containers) and ‘considering common principles of safety’ (e.g. spraying recommended PPPs, reading the label instructions, changing clothes and showering after spraying) to formulate an acceptable index of safety behaviour. 5. Conclusions Data of this study provide a snapshot of farmers' behaviour in the use of PPE when handling PPPs. A substantial percentage of farmers in this study did not recognize the need to wear PPE on a regular basis. It appears that the public health objective of protecting farmers from hazardous chemical exposures is not being met by the current approach of PPE use and thus strategies to maximize the protection of PPPs users from hazardous exposures still require innovation to achieve increased effectiveness. Based on these trends, education and training are vital to promote farmers' knowledge of potential health hazards of PPPs. It is also essential to enhance farmers' awareness on the use of suitable and effective PPE, to facilitate access to PPE, and to ensure regulatory compliance. A pesticide label lists the minimum PPE that a person must wear while performing handling or early-entry activities. However, changing farmers' behaviour with respect to PPE use might require considerable effort. Emphasis on lifelong training and education of farmers about PPPs hazards is crucial for changing wrong behaviours in PPPs handling. This is in line with the European legislation (Directive 2009/128/EC) which requires that all professional users, distributors and advisors of PPPs have access to appropriate training, consisting of both initial and additional training to acquire and update knowledge as appropriate. Alternative approaches to the implementation of intervention strategies with exploring behavioural dynamics together with the local experts and implementing a participative process might prove to be effective. In this context, data of this study could be useful by filling the gap between science and policy making. Future research can compare farmers' safety behaviour among different farming systems and different crop producers, according to the model of this study. References Abirami, R., Selvakumar, N., 2014. Development of a test equipment for pesticide protective fabric evaluation and studies on simple cotton woven fabrics. J. Ind. Text. 43, 549–564. Al Zadjali, S., Morse, S., Chenoweth, J., Deadman, M., 2015. Personal safety issues related to the use of pesticides in agricultural production in the Al-Batinah region of northern Oman. Sci. Total Environ. 502, 457–461. Arcury, T.A., Quandt, S.A., Russell, G.B., 2002. Pesticide safety among farm workers: perceived risk and perceived control as factors reflecting environmental justice. Environ. Health Perspect. 110, 233–240.
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Please cite this article as: Damalas, C.A., Abdollahzadeh, G., Farmers' use of personal protective equipment during handling of plant protection products: Determinants of implementation, Sci Total Environ (2016), http://dx.doi.org/10.1016/j.scitotenv.2016.07.042