Abstract

This paper discusses the knowledge, attitudes, and practices (KAP) of the Brazilian family farmers regarding the impact of pesticides on health and the environment. This mixed cross-sectional study was conducted in 2014 in São José de Ubá, Rio de Janeiro. It encompasses two stages: a qualitative one, based on field observations and interviews with 25 participants on KAP about the use of pesticides; and a quantitative one, assessing sociodemographic data and exposure to pesticides among 78 farmers. Despite partially recognizing the danger of pesticides, farmers face the risks of exposure and usually adopt inappropriate work practices. Lack of technical support and occupational training, low schooling, difficulty in understanding the instructions on pesticides labels and package inserts, high price and discomfort caused by the use of Personal Protective Equipment (PPE), and the belief in the need for using pesticides, partially explain the unsafe attitudes. Effective and immediate prevention of pesticides-related injuries and diseases requires promoting more sustainable agricultural practices, strengthening technical support and occupational training, improving communication and pesticides risk management, and reducing gender inequalities among the Brazilian farmers.

Keywords:
Pesticides; Farm Workers; Family Farming; Knowledge, Attitudes, and Practices; Risk Perception

Introduction

In Brazil, the agricultural sector is one of the main economic bases, both because of agribusiness in the production of commodities for export, and of family farming in food production, both with growth potential. This agricultural expansion has occurred through the significant increase in the use of pesticides and the relaxation of legislation, which made Brazil one of the largest consumers in the world (Almeida et al., 2017ALMEIDA, M. D., CAVENDISH, T. A., BUENO, P. C. et al. A flexibilização da legislação brasileira de agrotóxicos e os riscos à saúde humana: análise do Projeto de Lei nº 3.200/2015. Cadernos de Saude Pública, Rio de Janeiro, v. 33, n. 7, p. 1-11, 2017. DOI: 10.1590/0102-311X00181016
https://doi.org/10.1590/0102-311X0018101... ). Among farmers, exposure to pesticides can engender several acute and chronic health effects including weakness; spasms and muscle tremors; gastrointestinal, cardiovascular, respiratory, neurological, mental, cognitive, endocrine outcomes; and cancer (Mostafalou; Abdollahi, 2017MOSTAFALOU, S.; ABDOLLAHI, M. Pesticides: an update of human exposure and toxicity. Archives of Toxicology, Rockville, v. 91, n. 2, p. 549-599, 2017. DOI: 10.1007/s00204-016-1849-x
https://doi.org/10.1007/s00204-016-1849-... ). In Brazil, studies with farmers exposed to pesticides suggest respiratory (Faria et al., 2005FARIA, N. M. X., FACCHINI, L. A., FASSA, A. G. et al. Pesticides and respiratory symptoms among farmers. Revista de Saúde Pública, São Paulo, v. 39, n. 6, p. 973-981, 2005. DOI: 10.1590/S0034-89102005000600016
https://doi.org/10.1590/S0034-8910200500... ) effects, mentaleffects (Campos et al., 2016CAMPOS, Y., SILVA, V. S. P., MELLO, M. S. C. et al. Exposure to pesticides and mental disorders in a rural population in Southern Brazil. Neurotoxicology, Rockville, v. 56, p. 7-16, 2016. DOI: 10.1016/j.neuro.2016.06.002
https://doi.org/10.1016/j.neuro.2016.06.... ), suicide (Faria; Fassa; Meucci, 2014FARIA, N. M. X.; FASSA, A. G.; MEUCCI, R. D. Association between pesticide exposure and suicide rates in Brazil. Neurotoxicology, Amsterdam, v. 45, p. 355-362, 2014. DOI: 10.1016/j.neuro.2014.05.003
https://doi.org/10.1016/j.neuro.2014.05.... ) , and cancer (Boccolini et al., 2014BOCCOLINI, P. M. M., ASMUS, C. I. R. F., CHRISMAN, J. R. et al. Stomach cancer mortality among agricultural workers: results from a death certificate-based case-control study. Cadernos de Saúde Coletiva, Rio de Janeiro, v. 22, n. 1, p. 86-92, 2014. DOI: 10.1590/1414-462X201400010013
https://doi.org/10.1590/1414-462X2014000... ), among others.

Poisonings have been significantly increasing in Brazil in line with the trading of pesticides. In the period from 2010 to 2019, the Sistema de Informação de Agravos de Notificação (Sinan) recorded 10,745 work-related poisonings from pesticides. The incidence coefficient had a threefold increase in that period, from 4.0 to 12.5 cases per 100,000 workers (Brazil, 2020BRASIL. Ministério da Saúde. Perfil sociodemográfico e epidemiológico dos trabalhadores agropecuários do Brasil, 2010 a 2019. Boletim Epidemiológico, Brasília, DF, v. 51, n 39, 2020. Disponível em: <Disponível em: https://www.gov.br/saude/pt-br/media/pdf/2020/outubro/23/boletim_epidemiologico_svs_39.pdf >. Acesso em: 8 jul. 2021.
https://www.gov.br/saude/pt-br/media/pdf... ). Moreover, underreporting is estimated in approximately 50 cases for each poisoning notification (Carneiro et al., 2015CARNEIRO, F. F., AUGUSTO, L. G. S., RIGOTTO, R. M. et al. (Org.). Dossiê ABRASCO: um alerta sobre os impactos dos agrotóxicos na saúde. São Paulo: Expressão Popular, 2015.). Underreporting may be even greater for records of the relationship between work and chronic diseases, hardly related to pesticides.

Especially in lower-income countries, where regulation and surveillance in health and environment are more lenient or precarious, and resources are limited, reckless and excessive use of pesticides may increase exposure and damages to health (Staudacher et al., 2020STAUDACHER, P., FUHRIMANN, S., FARNHAM, A. et al. Comparative Analysis of Pesticide Use Determinants Among Smallholder Farmers From Costa Rica and Uganda. Environmental Health Insights, Rockville, v. 14, p. 1-15, 2020. DOI: 10.1177/1178630220972417
https://doi.org/10.1177/1178630220972417... ). In those countries, including Brazil, studies conducted with farmers have pointed out several factors that favor exposure to pesticides, such as low education and income, use of highly-toxic chemicals, living close to crops, insufficient technical support and training to manage hazardous substances, lack of knowledge about the exposure routes, inappropriate use of personal protective equipment (PPE), and inadequate disposal of pesticide containers (Manyilizu et al., 2017MANYILIZU, W. B., MDEGELA, R. H., HELLEVE, A. et al. Self-Reported Symptoms and Pesticide Use among Farm Workers in Arusha, Northern Tanzania: A Cross Sectional Study. Toxics, Rockville, v. 5, n. 4, p. 1-13, 2017. DOI: 10.3390/toxics5040024
https://doi.org/10.3390/toxics5040024... ; Negatu et al., 2016NEGATU, B., KROMHOUT, H., MEKONNEN, Y. et al. Use of chemical pesticides in Ethiopia: A cross-sectional comparative study Onknowledge, attitude and practice of farmers and farm workers in three farming systems. Annals of Occupational Hygiene, Rockville, v. 60, n. 5, p. 551-566, 2016. DOI: 10.1093/annhyg/mew004
https://doi.org/10.1093/annhyg/mew004... ; Pasiani et al., 2012PASIANI, J. O., TORRES, P., SILVA, J. R. et al. Knowledge, attitudes, practices and biomonitoring of farmers and residents exposed to pesticides in Brazil. International Journal of Environmental Research and Public Health, Rockville, v. 9, n. 9, p. 3051-3068, 2012. DOI: 10.3390/ijerph9093051
https://doi.org/10.3390/ijerph9093051... ; Petarli et al., 2019PETARLI, G. B., CATTAFESTA, M., LUZ, T. C. et al. Exposição ocupacional a agrotóxicos, riscos e práticas de segurança na agricultura familiar em município do estado do Espírito Santo, Brasil. Revista Brasileira de Saúde Ocupacional, São Paulo, v. 44, p. 1-13, 2019. DOI: 10.1590/2317-6369000030418
https://doi.org/10.1590/2317-63690000304... ; Staudacher et al., 2020STAUDACHER, P., FUHRIMANN, S., FARNHAM, A. et al. Comparative Analysis of Pesticide Use Determinants Among Smallholder Farmers From Costa Rica and Uganda. Environmental Health Insights, Rockville, v. 14, p. 1-15, 2020. DOI: 10.1177/1178630220972417
https://doi.org/10.1177/1178630220972417... ).

However, good agriculture practices are not fully effective to prevent exposure to pesticides, notably in the context of family farming. Therefore, studies on knowledge, attitudes and practices (KAP) have recognized agroecological practices as complementary to sanitary and environmental controls (Petarli et al., 2019PETARLI, G. B., CATTAFESTA, M., LUZ, T. C. et al. Exposição ocupacional a agrotóxicos, riscos e práticas de segurança na agricultura familiar em município do estado do Espírito Santo, Brasil. Revista Brasileira de Saúde Ocupacional, São Paulo, v. 44, p. 1-13, 2019. DOI: 10.1590/2317-6369000030418
https://doi.org/10.1590/2317-63690000304... ; Reus et al., 2017).

Attitudes and practices regarding the use of pesticides and the resulting level of human exposure are directly influenced by the farmers’ knowledge and perception of risk. Therefore, understanding the farmers’ KAP is key to the development and improvement of public policies, as well as to recommend safer, sustainable and responsive alternatives to the communities’ demands. In this context, this article discusses the KAPs on health and environmental impacts ensuing from the use of pesticides, based on the findings of a risk assessment study. This research also provides complementary data on the perception and exposure to chemicals, and their potential health effects.

Methods

The study was carried out in São José de Ubá (SJU), in the northwest of the state of Rio de Janeiro, Brazil. In this municipality of approximately 7,000 inhabitants, about 56% of the population live in rural areas, only 16% have formal jobs, and 40% have a monthly per capita income of up to 1/2 minimum wage. The average Municipal Human Development Index (MHDI) is 0.652 (IBGE, 2010IBGE - INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTATÍSTICA. Censo Demográfico. 2010. Disponível em: <Disponível em: https://cidades.ibge.gov.br/brasil/rj/sao-jose-de-uba/panorama >. Acesso em: 15 mar. 2019.
https://cidades.ibge.gov.br/brasil/rj/sa... ).

The economy of SJU is based on agriculture, mainly tomato-growing. The municipality is one of the largest tomato growers in Brazil, with annual harvests ranging from 21,000 to 32,000 tons between 2007 and 2017 (IBGE, 2017IBGE - INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTATÍSTICA. Censo Agropecuário. 2017. Disponível em: <Disponível em: https://censos.ibge.gov.br/agro/2017/ >. Acesso em: 6 abr. 2020.
https://censos.ibge.gov.br/agro/2017/... ). The mountainous terrain has few areas of natural vegetation cover, and severe processes of soil erosion and silting of rivers and streams, whose waters also suffer with the disposal of domestic sewage and pesticides, resulting in eutrophication and contamination (Leão et al., 2018LEÃO, R. S., MARQUES, R. C., BURALLI, R. J. et al. Avaliação de saúde pública por exposição a agroquímicos: uma experiência com a agricultura familiar no noroeste do Rio de Janeiro. Sustentabilidade em Debate, Brasília, DF, v. 9, n. 1, p. 81-94, 2018. DOI: 10.18472/SustDeb.v9n1.2018.26956
https://doi.org/10.18472/SustDeb.v9n1.20... ).

This cross-sectional research used mixed methodology, and comprised two stages: (1) qualitative, approaching community’s perceptions about the impacts of pesticides on health and the environment; and (2) quantitative, gathering the results of the assessment of exposure to pesticides and effects on farmers’ health in SJU. Based on the results, information pertinent to the KAP of family farmers in SJU was integrated and discussed.

The qualitative stage was composed of semi-structured interviews with residents of the SJU rural area selected by non-probabilistic convenience in January 2014. Twenty-five individuals (E1 - E25) were interviewed, including farmers, family members, and community stakeholders. The most relevant sentences were transcribed by two observers and, at the end, reviewed and compared thus generating a single record. We decided not to record interviews, so that the participants would feel more comfortable. Interviews were conducted in the homes of the volunteers, and the number of participants was determined by the saturation point of responses, reached when patterns could be identified and some level of generalization could be set (Duarte, 2002DUARTE, R. Pesquisa qualitativa: reflexões sobre o trabalho de campo. Cadernos de Pesquisa, São Paulo, n. 115, p. 139-154, 2002. DOI: 10.1590/S0100-15742002000100005
https://doi.org/10.1590/S0100-1574200200... ). This article describes the respondents’ profile, discloses their main statements, and discusses the statements in light of the scientific literature.

The quantitative stage included interviews with family farmers. Interviews were based on questionnaires about exposure to pesticides during the 2014 harvest (July and August), the period of more intensive contact with the product. Additionally, field observations, conversations with farmers, and image and audio records were used to discuss exposure to pesticides. In this stage, 78 farmers selected by convenience (“snowball” sampling) were assessed, whether or not they had participated in the qualitative stage. The sample size was limited by the project’s time and budget constraints, and represented about 11% of the farmers involved in tomato growing in SJU.

Information was collected regarding use of pesticides; knowledge, attitudes and practices that may influence exposure, such as: current or past contact; length of exposure; age when responded started farming; activities performed; household exposure (e.g. for domestic pest control or gardening, or by having contact with contaminated clothing or equipment); previous poisoning; pesticides used; use of agronomic prescription; subject responsible for the prescription and dosage of pesticides; previous training and labor guidance; proximity between homes and cultivation areas; use of PPE (cloth mask or respirator, visor, hat, gloves, boots and overalls); hand washing and showering after work; consumption of food and water in cropping areas; respect for the preharvest interval; place of storage of agricultural inputs; and, handling and disposal of used pesticide containers.

This article presents absolute and relative frequencies to support the discussion of knowledge, experiences, attitudes, and practices. Further details on the study methodology (Leão et al., 2018LEÃO, R. S., MARQUES, R. C., BURALLI, R. J. et al. Avaliação de saúde pública por exposição a agroquímicos: uma experiência com a agricultura familiar no noroeste do Rio de Janeiro. Sustentabilidade em Debate, Brasília, DF, v. 9, n. 1, p. 81-94, 2018. DOI: 10.18472/SustDeb.v9n1.2018.26956
https://doi.org/10.18472/SustDeb.v9n1.20... ), respiratory effects (Buralli et al., 2018BURALLI, R. J., RIBEIRO, H., MAUAD, T. et al. Respiratory condition of family farmers exposed to pesticides in the state of Rio de Janeiro, Brazil. International Journal of Environmental Research and Public Health, Rockville, v. 15, n. 1203, p. 1-14, 2018. DOI: 10.3390/ijerph15061203
https://doi.org/10.3390/ijerph15061203... ), and mental and poisoning symptoms (Buralli et al., 2020BURALLI, R. J., RIBEIRO, H., IGLESIAS, V. et al. Occupational exposure to pesticides and health symptoms among family farmers in Brazil. Revista de Saúde Pública, São Paulo, v. 54, n. 133, p. 1-12, 2020. DOI: 10.11606/s1518-8787.2020054002263
https://doi.org/10.11606/s1518-8787.2020... ) are presented in previous studies.

Only individuals who agreed to participate voluntarily in the research and signed the consent form were included. This study was approved by the ethics committee of the Hospital Universitário Clementino Fraga Filho of the Universidade Federal do Rio de Janeiro (CAAE: 30459814.5.0000.5257).

Results

Perceptions about the impacts of the use of pesticides on health and the environment

Farmers, family members, and community stakeholders interviewed in SJU (n=25) responded about the use of pesticides and possible effects on human health and the environment. The participants resided in the region for an average of 33.2 ± 15.4 years. The volunteer group was composed of 17 men (68%) and 8 women (32%), aged between 21 and 75 years, with a mean age of 56 and 51 years, respectively. Most of them had a low level of education, having only incomplete elementary school education (64%).

Approximately 70% of them worked in pesticides-based agriculture by the time of assessment; however, all of them claimed to have worked previously. Most respondents reported to have learned the agricultural work from relatives, mainly parents, grandparents, brothers, cousins, and uncles, while only two learned from other farmers and one from specialized technicians.

Some respondents showed satisfaction in agricultural work, especially for the quality of life on the farm, autonomy and flexibility in working hours, pleasure in producing food, being considered by one of them as an advance for the country.

However, most farmers showed dissatisfaction with rural work, mainly due to work overload, difficulty in selling production, sale value of the products, exploitation by middlemen, lack of technical assistance, difficulty in acquiring/loaning machinery, and the use of pesticides. Some respondents pointed out the low level of education as one of the main conditioning factors for the lack of opportunities beyond rural work.

Most respondents do not acknowledge - or accept - the risks of pesticides, or consider them indispensable to the agricultural production, downplaying the problem of exposure, minimizing or even denying its dangers. Some farmers take on the risks associated with the use of the products because they need them or depend on the work.

Some respondents said that “the medicine [pesticides] no longer have any effect”, “they became weaker” and that “it seems we haven’t even used it”, while others reported an increase in pest resistance leading to the need to apply stronger and larger quantities of pesticides, stating that “Pests are more resistant” and “[pests] got used to the poison”. Three participants considered pesticides as indispensable for agricultural production.

When asked about the dangers of agricultural work, 14 respondents (56%) mentioned pesticides, and two mentioned accidents with animals (8%) and risk of falls (8%). The majority of respondents recognized the acute and chronic effects of pesticides on human health; 24% reported having been intoxicated at least once, and 52% reported cases of poisoning with relatives and pals. Different terms were used to refer to the chemicals, such as “pesticides,” “poison,” “pesticide,” “medicine,” and “crop protection products”.

Some volunteers highlighted the lack of care in handling and spraying pesticides, the non-use of PPE, and the lack of technical support as important risk factors for getting sick in the rural work.

Regarding diseasing and the link with rural work, some respondents claimed to have no illnesses (n=10; 40%), some claimed to have health problems, while others claimed to be in good health after having ceased working with pesticides. The health conditions most commonly mentioned were: cancer, hypertension and diabetes, by 15 (60%), 12 (48%) and 10 (40%) participants respectively, followed by respiratory diseases and “viruses” (n=3; 12%), headaches and orthopedic problems (n=2; 8%). One key informant and one farmer spontaneously related “viral” conditions to poisoning from pesticides.

When asked about the health of children in the region, most participants (n=20; 80%) reported good health and “smartness”, attributing it to the good nutrition offered in schools, prohibition of child labor, and construction of daycare centers as a way to prevent parents from taking their children to the crops. Among the aforementioned respondents, four (16%) contradicted themselves by stating that there are “lots of special children” and “with learning disorders”. This information was restated by three other participants, including a teacher (female, 55 years old) who reported many cases of children with learning disabilities, whose special needs are ignored by their parents.

When asked about the environmental impacts caused by pesticides, 10 respondents (40%) reported concern about water, soil, and air contamination from the improper disposal of pesticides containers and residues. Some reported that habits have improved, and that farmers are more conscious about how to manage used containers.

When asked who should be held responsible for the reported problems, some respondents (n=8; 32%) named the government (not referring to a specific sphere or manager), the farmers themselves, the mayor, technicians and secretary of the environment, to a lesser extent.

Attitudes and practices as risk factors for exposure to pesticides

Among the 78 participants in the quantitative stage, the mean age was 44.1 ± 13.2 years (SD) and the mean time of engagement in agricultural work was 27.0 ± 14.3 years. Half of the respondents (50%) started working or helping with crops at less than 12 years of age, and another 30% started between 13 and 17 years (Table 1).

Most participants were married, had low education and family income, lived up to 1 km away from cropping areas, never received technical support or training, and were domestically exposed to pesticides, either by using these for pest control in and around homes, or through contact with contaminated clothing and equipment (Table 1). Women were the main ones in charge of washing the clothes used in farming, and some stated to even wash clothes together with the family’s clothes.

About 58% of the respondents were men who were mainly engaged in pesticides handling and application activities, while women (42%) usually performed other activities such as sowing, fertilizing, harvesting, and “pulling the hose” during irrigation and spraying of pesticides. Respondents reported using 49 pesticides from 31 different chemical groups, most of which were classified as extremely and highly toxic, and some even prohibited for tomato growing in Brazil. These pesticides were sprayed in mixtures formulated with multiple pesticides 1-3 times (85.7%) or 4-7 times (11.9%) weekly during the harvest period.

Approximately 68% of participants reported using some type of PPE, with boots, gloves, and mask being the most commonly used, while visors was the PPE least cited (Table 1). However, during field visits, it was found that workers were wearing cloth masks, rather than the recommended respirator. In addition, no workers were seen using full PPE. Some respondents said they did not use PPE because they considered them “expensive,” “hot,” and “uncomfortable”. Regarding other attitudes and practices that may increase exposure to pesticides, 91% of the farmers said they consume water and food on the cropping sites, including on days when pesticides are applied. Respectively, about 80% and 60% of them said they wash their hands and shower after working in crops (Table 1), although these practices are more common after the workday and not between cropping activities.

Some study participants did not answer some questions for their own decision, because they were unaware of the answer, or because they did not perform the activity asked. Regarding the use of agronomic prescriptions, 48% of the respondents said they never use it or do not know how to use it. When asked whether they read (or asked someone to read) the labels and instructions of pesticides, 44% said they frequently read, 42% reported never reading, and 14% said they read them sometimes, usually when it was a new product.

Regarding who recommended which pesticides to use, 30 farmers (39%) said it was the salespersons or agronomists, 15 (19%) said it was themselves, other farmers or crop owners and eight respondents (10%) said they did not know. About 30% of those who applied pesticides did not know which products they used, because they sprayed the mixture prepared by others (Buralli et al., 2020BURALLI, R. J., RIBEIRO, H., IGLESIAS, V. et al. Occupational exposure to pesticides and health symptoms among family farmers in Brazil. Revista de Saúde Pública, São Paulo, v. 54, n. 133, p. 1-12, 2020. DOI: 10.11606/s1518-8787.2020054002263
https://doi.org/10.11606/s1518-8787.2020... ). Regarding who recommended the doses and frequency of application, of the participants (n=58), 29 respondents (50%) mentioned salesperson and agronomists, 15 (26%) said they did it by themselves, other farmers or owners and 14 (24%) said they followed what was recommended in the product labels and leaflets. When asked about the preharvest interval between the last pesticides application and harvest, among those who answered the question, only five (11%) claimed to always respect it, while 22 (50%) said they obeyed it frequently and 17 (39%), occasionally.

About 58% of the farmers claimed to store pesticides in specific areas for inputs on the crop sites, 37% in a reserved place externally to their homes, and 5% inside their homes. When asked about the place of disposal of used pesticide containers, 56% said they deliver or wait for the collection by the municipality for disposal in a municipal warehouse (built in 2013), while the remaining respondents declared they returned to the points of purchase. Regarding the procedures adopted with the containers prior to disposal, 42% said they washed it and kept it in plastic bags, 28% said they kept it in bags or in a reserved environment until disposal, and 19% assumed they washed it, punctured it and kept it in plastic bags. Only 11% claimed to perform triple washing, puncture the containers and store them in appropriate environments until disposal, as recommended by the Brazilian legislation.

Many symptoms compatible with poisoning from pesticides were self-reported (Buralli et al., 2020BURALLI, R. J., RIBEIRO, H., IGLESIAS, V. et al. Occupational exposure to pesticides and health symptoms among family farmers in Brazil. Revista de Saúde Pública, São Paulo, v. 54, n. 133, p. 1-12, 2020. DOI: 10.11606/s1518-8787.2020054002263
https://doi.org/10.11606/s1518-8787.2020... ), although only 18% of respondents claimed to have been intoxicated during rural work (Table 1).

Discussion

Most family farmers assessed in SJU recognized exposure to pesticides as a health risk, corroborating other studies approaching Brazilian farmers (Gregolis; Pinto; Peres, 2012GREGOLIS, T. B. L.; PINTO, W. J.; PERES, F. Percepção de riscos do uso de agrotóxicos por trabalhadores da agricultura familiar do município de Rio Branco, AC. Revista Brasileira de Saúde Ocupacional, São Paulo, v. 37, n. 125, p. 99-113, 2012. DOI: 10.1590/S0303-76572012000100013
https://doi.org/10.1590/S0303-7657201200... ; Pasiani et al., 2012PASIANI, J. O., TORRES, P., SILVA, J. R. et al. Knowledge, attitudes, practices and biomonitoring of farmers and residents exposed to pesticides in Brazil. International Journal of Environmental Research and Public Health, Rockville, v. 9, n. 9, p. 3051-3068, 2012. DOI: 10.3390/ijerph9093051
https://doi.org/10.3390/ijerph9093051... ; Petarli et al., 2019PETARLI, G. B., CATTAFESTA, M., LUZ, T. C. et al. Exposição ocupacional a agrotóxicos, riscos e práticas de segurança na agricultura familiar em município do estado do Espírito Santo, Brasil. Revista Brasileira de Saúde Ocupacional, São Paulo, v. 44, p. 1-13, 2019. DOI: 10.1590/2317-6369000030418
https://doi.org/10.1590/2317-63690000304... ). Despite that, many respondents considered the contact as inevitable and inherent to the agricultural work, in an attitude of minimization and denial of the risk. Self-attribution regarding environmental and health damages due to the use of pesticides was clearly identified in the participants’ reports, and none of them related the problem to the conventional agriculture system. The participants of this study live in a setting of high socio-environmental vulnerability, and presented several effects on respiratory health, including symptoms and changes in lung function (Buralli et al., 2018BURALLI, R. J., RIBEIRO, H., MAUAD, T. et al. Respiratory condition of family farmers exposed to pesticides in the state of Rio de Janeiro, Brazil. International Journal of Environmental Research and Public Health, Rockville, v. 15, n. 1203, p. 1-14, 2018. DOI: 10.3390/ijerph15061203
https://doi.org/10.3390/ijerph15061203... ), mentaloutcomes, and poisoning symptoms (Buralli et al., 2020BURALLI, R. J., RIBEIRO, H., IGLESIAS, V. et al. Occupational exposure to pesticides and health symptoms among family farmers in Brazil. Revista de Saúde Pública, São Paulo, v. 54, n. 133, p. 1-12, 2020. DOI: 10.11606/s1518-8787.2020054002263
https://doi.org/10.11606/s1518-8787.2020... ) associated with contact with the products. Farmers’ knowledge about the effects of pesticides on health and the environment does not necessarily influence their attitudes and practices, and does not ensure the prevention of exposure and deleterious effects. Contact with pesticides, especially in the dynamics of work approached, compromises the health and quality of life of farmers and their families, the agricultural workforce, food production, and gives rise to individual and collective damage, with huge social and economic costs to families, the health system and social security (Brazil, 2020BRASIL. Ministério da Saúde. Perfil sociodemográfico e epidemiológico dos trabalhadores agropecuários do Brasil, 2010 a 2019. Boletim Epidemiológico, Brasília, DF, v. 51, n 39, 2020. Disponível em: <Disponível em: https://www.gov.br/saude/pt-br/media/pdf/2020/outubro/23/boletim_epidemiologico_svs_39.pdf >. Acesso em: 8 jul. 2021.
https://www.gov.br/saude/pt-br/media/pdf... ).

In Brazil, other studies with family farmers point out some common aspects, such as low education and income, poor sanitation conditions, exposure to multiple highly toxic pesticides, little or no technical support and training (Carneiro et al., 2015CARNEIRO, F. F., AUGUSTO, L. G. S., RIGOTTO, R. M. et al. (Org.). Dossiê ABRASCO: um alerta sobre os impactos dos agrotóxicos na saúde. São Paulo: Expressão Popular, 2015.; Pedlowski et al., 2012PEDLOWSKI, M. A., CANELA, M. C., TERRA, M. A. C. et al. Modes of pesticides utilization by Brazilian smallholders and their implications for human health and the environment. Crop Protection, Amsterdam, v. 31, n. 1, p. 113-118, 2012. DOI: 10.1016/j.cropro.2011.10.002
https://doi.org/10.1016/j.cropro.2011.10... ; Petarli et al., 2019PETARLI, G. B., CATTAFESTA, M., LUZ, T. C. et al. Exposição ocupacional a agrotóxicos, riscos e práticas de segurança na agricultura familiar em município do estado do Espírito Santo, Brasil. Revista Brasileira de Saúde Ocupacional, São Paulo, v. 44, p. 1-13, 2019. DOI: 10.1590/2317-6369000030418
https://doi.org/10.1590/2317-63690000304... ). About 15% of the Brazilian farmers have never been to school, 24% have only primary schooling, and 19% have fundamental schooling (IBGE, 2017IBGE - INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTATÍSTICA. Censo Agropecuário. 2017. Disponível em: <Disponível em: https://censos.ibge.gov.br/agro/2017/ >. Acesso em: 6 abr. 2020.
https://censos.ibge.gov.br/agro/2017/... ). Education is a determinant of income and adherence to safety and health prevention measures (Brazil, 2020BRASIL. Ministério da Saúde. Perfil sociodemográfico e epidemiológico dos trabalhadores agropecuários do Brasil, 2010 a 2019. Boletim Epidemiológico, Brasília, DF, v. 51, n 39, 2020. Disponível em: <Disponível em: https://www.gov.br/saude/pt-br/media/pdf/2020/outubro/23/boletim_epidemiologico_svs_39.pdf >. Acesso em: 8 jul. 2021.
https://www.gov.br/saude/pt-br/media/pdf... ). Low education may hinder the reading and understanding of safety guidelines on the use of pesticides. Moreover, information on package leaflets and labels is ambiguous and difficult to understand, some of it unfeasible in the context of family farming (Pedlowski et al., 2012PEDLOWSKI, M. A., CANELA, M. C., TERRA, M. A. C. et al. Modes of pesticides utilization by Brazilian smallholders and their implications for human health and the environment. Crop Protection, Amsterdam, v. 31, n. 1, p. 113-118, 2012. DOI: 10.1016/j.cropro.2011.10.002
https://doi.org/10.1016/j.cropro.2011.10... ; Waichman; Eve; Nina, 2007WAICHMAN, A. V.; EVE, E.; NINA, N. C. S. Do farmers understand the information displayed on pesticide product labels? A key question to reduce pesticides exposure and risk of poisoning in the Brazilian Amazon. Crop Protection, Amsterdam, v. 26, n. 4, p. 576-583, 2007. DOI: 10.1016/j.cropro.2006.05.011
https://doi.org/10.1016/j.cropro.2006.05... ).

In another study, farmers complained that fonts are small, instructions are long, and the language is too technical. No participant could tell the toxicity of pesticides based on the colors on the labels, and few understood the informative images (Waichman; Eve; Nina, 2007WAICHMAN, A. V.; EVE, E.; NINA, N. C. S. Do farmers understand the information displayed on pesticide product labels? A key question to reduce pesticides exposure and risk of poisoning in the Brazilian Amazon. Crop Protection, Amsterdam, v. 26, n. 4, p. 576-583, 2007. DOI: 10.1016/j.cropro.2006.05.011
https://doi.org/10.1016/j.cropro.2006.05... ). This reinforces the relevance of improving the communication of pesticides-related risks among Brazilian farmers, and of providing training on how to use these chemicals. In SJU, most participants had low education, little or no technical support and training in occupational safety, and were unaware of the pesticides they used, thus limiting their perception of risk and adoption of protective measures.

Some habits, attitudes, and practices observed in SJU are of particular concern and may increase occupational and environmental exposure to pesticides, such as: use of mixtures of many pesticides of high toxicity, frequent and repeated exposure, domestic and peri-domestic use, partial use or absolute no use of PPE, consumption of food and drink on cropping areas, bathing only at the end of the workday, non-use of agronomic prescriptions, incompliance with the recommended preharvest interval, storage of products in inappropriate places, and residences near cropping areas. These attitudes have also been observed in other studies with Brazilian farmers (Carneiro et al., 2015CARNEIRO, F. F., AUGUSTO, L. G. S., RIGOTTO, R. M. et al. (Org.). Dossiê ABRASCO: um alerta sobre os impactos dos agrotóxicos na saúde. São Paulo: Expressão Popular, 2015.; Gregolis; Pinto; Peres, 2012GREGOLIS, T. B. L.; PINTO, W. J.; PERES, F. Percepção de riscos do uso de agrotóxicos por trabalhadores da agricultura familiar do município de Rio Branco, AC. Revista Brasileira de Saúde Ocupacional, São Paulo, v. 37, n. 125, p. 99-113, 2012. DOI: 10.1590/S0303-76572012000100013
https://doi.org/10.1590/S0303-7657201200... ; Pasiani et al., 2012PASIANI, J. O., TORRES, P., SILVA, J. R. et al. Knowledge, attitudes, practices and biomonitoring of farmers and residents exposed to pesticides in Brazil. International Journal of Environmental Research and Public Health, Rockville, v. 9, n. 9, p. 3051-3068, 2012. DOI: 10.3390/ijerph9093051
https://doi.org/10.3390/ijerph9093051... ; Pedlowski et al., 2012PEDLOWSKI, M. A., CANELA, M. C., TERRA, M. A. C. et al. Modes of pesticides utilization by Brazilian smallholders and their implications for human health and the environment. Crop Protection, Amsterdam, v. 31, n. 1, p. 113-118, 2012. DOI: 10.1016/j.cropro.2011.10.002
https://doi.org/10.1016/j.cropro.2011.10... ; Petarli et al., 2019PETARLI, G. B., CATTAFESTA, M., LUZ, T. C. et al. Exposição ocupacional a agrotóxicos, riscos e práticas de segurança na agricultura familiar em município do estado do Espírito Santo, Brasil. Revista Brasileira de Saúde Ocupacional, São Paulo, v. 44, p. 1-13, 2019. DOI: 10.1590/2317-6369000030418
https://doi.org/10.1590/2317-63690000304... ) and farmers from different lower-income countries (Manyilizu et al., 2017MANYILIZU, W. B., MDEGELA, R. H., HELLEVE, A. et al. Self-Reported Symptoms and Pesticide Use among Farm Workers in Arusha, Northern Tanzania: A Cross Sectional Study. Toxics, Rockville, v. 5, n. 4, p. 1-13, 2017. DOI: 10.3390/toxics5040024
https://doi.org/10.3390/toxics5040024... ; Negatu et al., 2016NEGATU, B., KROMHOUT, H., MEKONNEN, Y. et al. Use of chemical pesticides in Ethiopia: A cross-sectional comparative study Onknowledge, attitude and practice of farmers and farm workers in three farming systems. Annals of Occupational Hygiene, Rockville, v. 60, n. 5, p. 551-566, 2016. DOI: 10.1093/annhyg/mew004
https://doi.org/10.1093/annhyg/mew004... ; Staudacher et al., 2020STAUDACHER, P., FUHRIMANN, S., FARNHAM, A. et al. Comparative Analysis of Pesticide Use Determinants Among Smallholder Farmers From Costa Rica and Uganda. Environmental Health Insights, Rockville, v. 14, p. 1-15, 2020. DOI: 10.1177/1178630220972417
https://doi.org/10.1177/1178630220972417... ). In Costa Rica and Uganda, for example, although most pesticides used are highly toxic and 90% of farmers are aware of health effects, only 11% and 2% of them, in their respective countries, used PPE when handling pesticides (Staudacher et al., 2020STAUDACHER, P., FUHRIMANN, S., FARNHAM, A. et al. Comparative Analysis of Pesticide Use Determinants Among Smallholder Farmers From Costa Rica and Uganda. Environmental Health Insights, Rockville, v. 14, p. 1-15, 2020. DOI: 10.1177/1178630220972417
https://doi.org/10.1177/1178630220972417... ).

Rural work in Brazil, especially in small and medium farms, is passed from parents to children from an early age, determining the organization of families around the agricultural activity, and exposing all the core family’s members to the high risks of contact with pesticides (Gregolis; Pinto; Peres, 2012GREGOLIS, T. B. L.; PINTO, W. J.; PERES, F. Percepção de riscos do uso de agrotóxicos por trabalhadores da agricultura familiar do município de Rio Branco, AC. Revista Brasileira de Saúde Ocupacional, São Paulo, v. 37, n. 125, p. 99-113, 2012. DOI: 10.1590/S0303-76572012000100013
https://doi.org/10.1590/S0303-7657201200... ; Reis et al., 2017REIS, M. M., OLIVEIRA, A. P. N., TURCI, S. R. B. et al. Conhecimentos, atitudes e práticas de agricultoras sobre o processo de produção de tabaco em um município da Região Sul do Brasil. Cadernos de Saúde Pública, Rio de Janeiro, v. 33, p. 148-161, 2017. DOI: 10.1590/0102-311X00080516
https://doi.org/10.1590/0102-311X0008051... ). In SJU, while men handle and spray pesticides, women perform agricultural activities considered of “lesser exposure”, often concomitantly or on the same day as the application of pesticides, such as pulling the hose for spraying, tying the sprouts, harvesting fruit, among others. Additionally, they are responsible for washing the clothes and equipment used. In the same line, most of the female farmers assessed in SJU did not use PPE, had less training compared to male farmers, and reported more self-reported symptoms suggestive of acute and chronic poisoning from pesticides (Buralli et al., 2018BURALLI, R. J., RIBEIRO, H., MAUAD, T. et al. Respiratory condition of family farmers exposed to pesticides in the state of Rio de Janeiro, Brazil. International Journal of Environmental Research and Public Health, Rockville, v. 15, n. 1203, p. 1-14, 2018. DOI: 10.3390/ijerph15061203
https://doi.org/10.3390/ijerph15061203... , ²⁰²⁰BURALLI, R. J., RIBEIRO, H., IGLESIAS, V. et al. Occupational exposure to pesticides and health symptoms among family farmers in Brazil. Revista de Saúde Pública, São Paulo, v. 54, n. 133, p. 1-12, 2020. DOI: 10.11606/s1518-8787.2020054002263
https://doi.org/10.11606/s1518-8787.2020... ).

Compared to men, women in this study showed greater concern about the potential negative health effects of pesticides. This perception, however, was not translated into stronger protective actions, given the cultural conditioning of production in the gender light. Female family farmers are key in the organization and performance of agricultural work and, thus, are more exposed to pesticides. They become more vulnerable because they are also in charge of domestic chores that include application of pesticides at and in the home, and the washing of clothes and accessories used in the field. Female farmers also move more frequently between the cropping sites and the residence, having contact with a larger number of workers (London et al., 2002LONDON, L., WESSELING, C., KISTING, S. K. Pesticide usage and health consequences for women in Developing Countries: Out of sight, out of mind? International Journal Occupational Environmental Health, London, v. 8, n. 1, p. 46-59, 2002. DOI: 10.1179/oeh.2002.8.1.46
https://doi.org/10.1179/oeh.2002.8.1.46... ). Therefore, public policies aimed at female farmers could contribute toward safer production, echoing in the protection of families involved in agriculture.

In general, it is essential to improve the technical support and training of the Brazilian family farmers on the measures of protection against the dangers of agricultural work, especially related to the use of pesticides as the most effective and immediate way to prevent chemicals-related injuries. For that, it is necessary to strengthen the inter-institutional actions of surveillance and health care focused on farmers’ populations, such as the Política Nacional de Saúde Integral das Populações do Campo, Floresta e Águas (National Policy for the Integral Health of Farmers, Foresters, and Waters, PNSIPCF) and Vigilância em Saúde de Populações Expostas a Agrotóxicos (Surveillance in the Health of Populations Exposed to Pesticides, VSPEA).

More sustainable production models responsive to family farming should also be supported and encouraged for the reduction of environmental and social liabilities, especially in a setting of fast expansion of agricultural production and use of pesticides. A study found strong similarities between the trends of increasing productivity of agricultural commodities and poisonings from pesticides, especially since the 1990s (Porto; Soares, 2012PORTO, M. F.; SOARES, W. L. Modelo de desenvolvimento, agrotóxicos e saúde: um panorama da realidade agrícola brasileira e propostas para uma agenda de pesquisa inovadora. Revista Brasileira de Saúde Ocupacional, São Paulo, v. 37, n. 125, p. 17-31, 2012.). The research points out that the risks of acute poisoning would be even greater on small farms since risk factors, such as the use of knapsack sprayers, non-use of prescriptions and PPE, and lack of technical assistance, among others, are more present. The claim of SJU farmers that pesticides “became weaker” and “it seems that they were not even applied” also represents an important risk factor, considering the need to use more products and in larger quantities.

In Brazil, the notification of pesticides-related diseases is underestimated, and evaluations of contact and health effects on family farmers are still scarce, hindering the accurate quantification of acute and chronic effects arising from the complex exposure scenarios. In SJU, for example, there are no health surveillance mechanisms with professionals trained to identify and report poisonings. Therefore, it is also urgent to improve the recording of occupational diseases resulting from the use of these chemicals, and promote epidemiological studies to explain the exposure settings and health effects on farmers, especially with longitudinal monitoring and sensitive biomarkers, evaluating acute and chronic diseases, effects of mixing multiple pesticides, among others.

Final considerations

Despite partially recognizing the risks of exposure to pesticides, farmers historically adopt unsuitable work practices, considerably favoring their contact with chemicals. The belief that the use of pesticides is inherent to agricultural production, added with the condition of high socio-environmental vulnerability contribute to attitudes of risk minimization and resistance to adhere to more sustainable farming practices.

To prevent risks, promote health, well-being and sustainability in family farming, a key element is the access to quality education in rural areas, technical assistance and occupational training for Brazilian farmers to change knowledge, attitudes and practices about the impacts of pesticides on health and the environment. For that, surveillance, promotion, and health care actions should be strengthened, as well as specific policies and programs for those populations.

The grant or subsidies for purchasing PPE, and the design of models that provide more ergonomic and thermal comfort could increase the adherence of workers to good practices, and thus reduce human exposure. We should also acknowledge the gender inequity that stems from the traditional organization of agricultural work, and induces women to a higher risk of exposure to pesticides. The recognition that women’s “help” in agriculture is true work can be translated into greater health security and protection for family farming itself.

Finally, it should be emphasized that the promotion of more sustainable agricultural practices and the restriction of pesticides use (especially the most toxic ones) are the most effective ways to reduce exposure. Therefore, public and credit policies in this light are much needed.

References

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