Pilot Study of Pesticide Knowledge, Attitudes, and Practices among Pregnant Women in Northern Thailand

An estimated 200,000 children born in Thailand each year are at risk of prenatal exposure to pesticides and associated neurodevelopmental outcomes because of their mothers’ agricultural occupations. Children born to non-agricultural workers may also be at risk of exposure from other pathways of maternal pesticide exposure, including exposure through home use, diet, and other environmental media. Pesticide exposure in Thailand has been linked to unsafe practices and beliefs about pesticides. However, limited information exists on pesticide knowledge, attitudes, and practices among pregnant women in Thailand or elsewhere. Obtaining this information is essential to understand the factors associated with prenatal pesticide exposure, identify populations potentially at risk, and ultimately protect pregnant women and their children. We administered surveys to 76 pregnant women in northern Thailand and used multivariable logistic regression to evaluate associations among pesticide-related knowledge, pregnancy trimester, and pesticide use behavior. In this pilot study, lower knowledge score and earliest trimester of pregnancy were marginally (p < 0.1) associated with unsafe practices in the home, but not at work. Women who worked in agriculture or applied pesticides before becoming pregnant, or who had a previous child were significantly (p < 0.05) more likely to engage in unsafe behaviors in the home during their current pregnancy. We preliminarily conclude that increasing pesticide-related knowledge among pregnant women may help promote safe practices and reduce prenatal exposure. Knowledge-based interventions may be most effective when implemented early in pregnancy and targeted to agricultural workers and other sub-populations at risk of pesticide exposure.

Agree [8] Do all the pesticides have the same adverse health effect on the human body? No [8] Pesticides can be harmful to the health of: The general population Yes [9] The agricultural workers who apply them Yes [10] Other agricultural workers Yes [11]

Source
Pesticides protect people from pest-related diseases Agree [16] Pesticides are poisonous Agree [11] Pesticide hazard can cause death Agree [17] You can smoke, drink, and eat during pesticide spraying Disagree [11] If I eat and drink near areas where pesticides have been sprayed I will not be exposed to pesticides Disagree [18] Which of the following are potential health impacts of pesticides? to dichlorodiphenyl-dichloroethane (DDE) and measures of obesity in childhood, the toxicological evidence is limited and there is a lack of general consensus regarding the potential relationship between pesticide exposure and obesity. Table A2. Personal susceptibility attitude score calculation.
Attitudes on personal susceptibility to health effects from pesticides *

Response indicating higher belief in susceptibility ^
Using a large amount of pesticides for only a short time is not harmful to my health Disagree Using a small amount of pesticides for a long time is not harmful to my health Disagree * Score ranges from 0-4 with higher scores indicating a higher belief in personal susceptibility to health effects from pesticides. ^ These responses were awarded 2 points, while the opposite response was awarded 0 points. Responses of "not sure" or "don't know" (indicating beliefs in between the extremes) were awarded 1 point. Attitudes on future or current children's susceptibility to health effects from pesticides *

Response indicating higher belief in susceptibility ^
Using a large amount of pesticides for only a short time is not harmful to the health of my fetus Disagree Using a small amount of pesticides for a long time is not harmful to the health of my fetus Disagree Adults are more resistant to pesticides than children Agree Adults are more resistant to pesticides than babies Agree * Score ranges from 0-8 with higher scores indicating a higher belief in the participant's child's susceptibility to health effects from pesticides. ^ These responses were awarded 2 points, while the opposite response was awarded 0 points. Responses of "not sure" or "don't know" (indicating beliefs in between the extremes) were awarded 1 point. Table A4. Responsibility attitude score calculation.

Attitudes on responsibility for safe use based on Sam et al.
[23] *

Response indicating acceptance of responsibility ^
It is necessary to read or understand the label of a pesticide bottle or container Agree

If a pesticide is sold in the market it means it is safe no matter how or by whom it is used Disagree
A pesticide is effective only if its effect can be seen immediately after spraying Disagree A pesticide is more effective if it is sprayed according to personal experience and not necessarily according to the recommended amount Disagree Every person who uses a pesticide is responsible for its safe use Agree After using pesticides for a number of years, a person can develop an immunity to pesticides Disagree * Score ranges from 0-12 with higher scores indicating a higher acceptance of personal responsibility for the safe use of pesticides. ^ These responses were awarded 2 points, while the opposite response was awarded 0 points. Responses of "not sure" or "don't know" (indicating beliefs in between the extremes) were awarded 1 point. Yes * Score ranges from 0-13 with higher scores indicating a higher belief in the usefulness of pesticides (scored as missing if the participant did not personally apply pesticides). ^ Affirmative responses to questions with a "yes" in this category were awarded 1 point each, while all other responses were awarded 0 points. Table A6. Risky behaviors defined by Goldman et al. [24].

Risky behaviors defined by Goldman et al. [24]
Corresponding KAP survey question(s) Sometimes or never washing hands in the field before smoking or eating A20 Not bathing immediately after work A21 Not wearing adequate clothing to protect against pesticide exposure (long-sleeved shirt, something to cover the head, and gloves)

A18, D5, K3
Storing or washing farm-worker clothes together with family clothes J8, J12 Cleaning the house less than a few times per week C2 Eating fruits and vegetables directly from the field B11A Household member(s)wearing work shoes from the field into the home J4 Household member(s)wearing work clothes from the field into the home for more than 30 minutes J6 Table A7. Risky behaviors at work score calculation.

Corresponding KAP survey question(s)
Sometimes or never washing hands in the field before smoking or eating A20 Not bathing immediately after work A21 Not wearing adequate clothing to protect against pesticide exposure (long-sleeved shirt, something to cover the head, and gloves) A18 * These scores were only calculated for participants who worked in agriculture while pregnant. Table A8. Risky behaviors at home score calculation.

Corresponding KAP survey question(s)
Not wearing personal protective equipment when using pesticides in the home D5, K3 Storing or washing farm-worker clothes together with family clothes * J8, J12 Cleaning the house less than a few times per week C2 Eating fruits and vegetables directly from the field B11A Household member(s) wearing work shoes from the field into the home * J4 Household member(s) wearing work clothes from the field into the home for more than 30 minutes * J6 Household member(s) storing pesticides from work in or around the home J13 * Only considered risky when participants had household members who worked in agriculture.