INFORMATION TO USERS The most advanced technology has been used to photograph and reproduce this manuscript from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copiesare in typewriter face, while others may be from any type of computerprinter. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthruugh, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand corner and continuing from left to right in equal sections withsmall overlaps. Each original is also photographed in one exposure and is included in reduced format the back of the book. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6" x 9" black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. U-M-I University Microfilms International A Bell & Howell Information Company 300 North Zeeb Road. Ann Arbor. MI 48106-1346USA 313;761-4700 800/521-0600 Order Number 9101033 An assessment of the knowledge, attitudes, and behavior regarding pesticide application of Thai orchid nursery workers Kamlang-ek, Venika, Ph.D. University of Hawaii, 1990 U·M·I 300 N. Zeeb Rd AnnArbor, MI 48106 NOTE TO USERS THE ORIGINAL DOCUMENT RECEIVED BY V.M.I. CONTAINED PAGES WITH POOR PRINT. PAGES WERE FILMED AS RECEIVED. THIS REPRODUCTION IS THE BEST AVAILABLE COPY. AN ASSESSMENT OF THE KNOWLEDGE, ATTITUDES, AND BEHAVIOR REGARDING PESTICIDE APPLICATION OF THAI ORCHID NURSERY WORKERS A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAII IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PUBLIC HEALTH AUGUST 1990 Venika Kam1ang-ek Dissertation Committee: D. William Wood, Chairperson Jerrold M. Michael Arthur M. Kodama Walter K. Patrick Richard A. Dubanoski iii e Copyright 1990 by Venika Kam1ang-ek iv ACKNOWLEDGMENTS The completion of this dissertationwould not have been possible without the guidance and encouragement of a great number of people. Although it is not possible to list all the individuals here at this time, I would like to express my deepest gratitude to the Thai Military for continuing financial support both for my academic training and for this research project. I also gratefully acknowledge the special assistance of all the members of my doctoral studies committee for their kind guidance and support which made this dissertation possible. Special appreciation is extended to Associate Professor D. William Wood, my chairperson, for his most valued comments on my research proposal, for kindly providing me with relevant literature necessary to my research, and for giving invaluable advice regarding the interpretation of the data in this research project. I would like to express my most sincere gratitude to Dean Jerrold M. Michael, Associate Professor Arthur M. Kodama, Associate Professor Walter K. Patrick and Dean Richard A. Dubanoski for their helpful guidance and assistance in editing the final draft of this dissertation. At the Mahidol University School of Public Health in Bangkok, I would like to express my sincere appreciation to Dean Debhanom Muangman, Associate Professor Chompusakdi Pulket, Associate Professor Thonglaw Dejthai and Mrs. Sumalee Singhaniyom for their most valuable comments on my research proposal and for kindly providing me with their v individual points of view on my research study. I wish to thank my tutor, Mr. William T. Carlon III, for his continuous assistance in the editing of this paper. Sincere appreciation is also offered to the Shell Oil Company and the Extension Agricultural Officers in Phasi Charoen, Ta1ing Chan, Nong Khaem in Bangkok and Krathum Baen, Ban Phaeo in Samut Sakhon province and Sam Ph ran in Nakhon Pathom province and all the orchid workers in this study for their cooperation throughout the process of data collection. Finally, immeasurable indebtedness is expressed to my father for his unfailing encourpgement during my studies and his outstanding support. I wish to express my deepest gratitude to my mother who passed away with cancer in 1983. I always kept in mind that I should try to help anyone who was touched by cancer. That is how I first became interested in pesticide research and why I have tried to help the agricultural workers who are at risk of this disease. In closing, it is my fond hope that this research will be beneficial to the Thai workers using pesticide in Thailand. vi ABSTRACT This investigation examines the knowledge, attitudes, practices and behavioral observation in the use of protective equipment among pesticide users at orchid nurseries in Thailand. An experimental group of 270 people and a control group of 250 were selected by random assignment from two separate orchid-growing areas near Bangkok. An experimental survey questionnaire, field observation and blood cholinesterase testing for toxic effects were the methods used to collect data. Data collection included: baseline data on pesticide exposure, obtained by the Tintometric and the Cholinesterase B test to search for blood cholinesterase activity; the performance of an intervention trial, wherein the experimental group was given health and safety training regarding pesticide use while the control group was given training in pest control; and field observation of all participants as well as a post-test of knowledge retention using the original questionnaire in order to evaluate the learning of contents of the health and safety training. Final blood testing of cholinesterase activity was done in order to determine the differences in results between those workers who had used protective equipment and those who had not. Through demonstrations and pictures, the experimental group was given training in the correct ways to apply pesticides and how to use protective equipment. The control group training consisted only of vii various methods of pest control. Overall, the health and safety training intervention was moderately successful in raising the knowledge and correct practice levels regarding the use of protective equipment in the experimental group. In the final observation of their behavior when spraying pesticide, the control group also showed improvement in the use of protective equipment. This indicates that most nursery workers are aware of the need to wear various articles of protective apparel but are reluctant to do so because of discomfort caused mostly by hot and humid weather. The blood testing proved that both the Tintometric and Cholin­ esterase Bmethods are effective in checking cholinesterase activity in a field situation. However, toxic effects from pesticides accumulate slowly and major changes in blood chemistry are difficult to detect in the short term. v;;; TABLE OF CONTENTS ACKNOWLEDGMENTS .. ..... iv ABSTRACT ••• ........ vi LIST OF TABLES ...... x LIST OF ILLUSTRATIONS .. ......... x;; CHAPTER I INTRODUCTION • 1 Development of Pesticide Use • 1 Pesticides and the Environment. 3 Pesticide Use in Thailand 5 Statement of Prob1em ••••••• 10 Pesticide Problems in Other Countries 17 Research Questions • • • • ••••. 19 Hypotheses •••••••••••.• 20 CHAPTER II REVIEW OF THE LITERATURE • 22 Literature on the Problem 22 Unsafe Use ••••• 22 Occupational Exposure ••••••. 24 Hazards to People • • • • • • • • • . • 28 Prevention of Hazards •••••..•• 29 Literature on Methodology of Cholinesterase Activity . 30 Literature on Application of Research ...• 35 Cultural Problems and the Transfer of Pesticide Technology •••.•..•.. 35 Health Behaviors and Pesticide Awareness •• 37 Implication for the Thai Farmers 42 CHAPTER III RESEARCH METHODOLOGY •••••• 45 Research Des ign • • • • • • . • • • . 45 Field Survey Administration 46 Sample and Sampling Techniques. 51 Deve1opment of Scales ••••••••.• 52 Data Collection •••••••••. 55 Biological Monitoring of Agricultural Workers Exposed to Pesticides; Cholinesterase Activity in Other Countries • . • • .• .••• 60 Cholinesterase Activity •..•.. 62 ix Health and Safety Program in the Experimental Group •••••• 63 Pest Controlling Program in the Control Group ••••• 63 CHAPTER IV RESEARCH FINDINGS •••••••• 65 Study Focus •••••••••••••• 65 Description of the Management of Data •. 67 Missing Case Analysis (Lost Cases Analysis) ••••••••• 67 Coding of the Data ••••• 72 Description of Study Population ••••• 72 CHAPTER V ANALYSIS II ••••••.•.•• 114 Discriminant Function Analyses 129 Discriminant Function Variables • 130 CHAPTER VI DISCUSSION AND CONCLUSION •••• 148 Interpretation of Chapters IV and V• 148 Results of Hypotheses Testing •• 152 Limitations of the Study •••• 157 Suggestions for Further Research 160 Conclusion ••••••••••• 162 APPENDICES .• .. .. .. 170 A. Interview Schedule 170 B. Results of Preliminary Interview Questionnaires for Persons Engaged in Agriculture •.•••• 178 C. The Tintometric Test and the Cholinesterase B Test . ... 181 D. Operational Definitions • 191 E. Location and Mapping 193 F. Health and Safety Program and Pest Control