Abstract Several pesticides are widely used in agriculture, yet many farmers lack adequate knowledge and protective practices, increasing risk of exposure and related health effects. This study aimed to screen health risks and analyze the factors affecting pesticide exposure among farmers in Chachoengsao Province, Thailand. Cross-sectional study was performed. Data were collected from 177 farmers who volunteered to participate.

For pesticide exposure, 81.92% of farmers currently use pesticides, 57.25% sprayed pesticides themselves, 39.31% were present in the spraying area, and 3.45% were employed to spray for others. The average duration of pesticide exposure was 16.41 ± 13.37 years. A health risk assessment revealed that 33.79% of farmers were at high risk. Voluntary blood testing showed that 11.72% of exposed farmers had inhibited cholinesterase activity, indicating a potential health risk. Stepwise multiple regression indicated that wearing a mask or other respiratory protection while spraying pesticides had a statistically significant effect on cholinesterase activity (β = 374.569, P = 0.046), Forecasting the effect of pesticide exposure, wearing a mask could affect on cholinesterase activity for 3.6% (Adjusted R² = 0.036, P < 0.05). This study suggesting that protecting against inhalation exposure substantially reduces the risk of pesticide absorption.

Therefore, preventing pesticide exposure, especially protecting against inhalation, is a crucial step in safeguarding farmers in Chachoengsao Province, Thailand. Strengthening protective practices, especially the consistent use of effective respiratory equipment during pesticide application, represents a decisive measure to reduce toxic absorption, preserve occupational well-being, and sustain the long-term viability of local agricultural communities.

Keywords: Cholinesterase enzyme, Pesticides, Pesticide exposure, Risk factors

Funding: This research was supported by the Research and Development Institute, Rajabhat Rajanagarindra University, Thailand Science Research and Innovation (TSRI), and the National Science, Research and Innovation Fund (NSRF) [Grant No. 193740].

Citation:  Kanjanasingh, P., Ngamsang, T., and Tajai, P. 2026. Occupational health risks from pesticide exposure: Evidence from Thai farmers. Natural and Life Sciences Communications. 25(4): e2026096.

Graphical Abstract:

INTRODUCTION

Due to technological advances, synthetic chemicals are increasingly used to facilitate agricultural production (Tudi et al., 2021; Manggala et al., 2023; Mance et al., 2025). Extensive evidence over several decades has demonstrated the adverse effects of pesticide exposure, including both acute and chronic toxicity (Cevik et al., 2020; Kaur et al., 2024; Shekhar et al., 2024). Moreover, several countries have begun to prohibit the use of certain pesticides due to the increasing number of health reports indicating long-term health hazards (Abou Zeid et al., 2020). Therefore, the potential negative health effects of prolonged pesticide exposure warrant serious concern (Shekhar et al., 2024).

Most farmers in Chachoengsao Province are engaged in pesticide-based farming, partly because pesticides are easy to obtain, convenient to use, and familiar practices that have been passed down through generations. Farmers in the study area typically apply pesticides in response to pest occurrence rather than following a fixed schedule, resulting in variable exposure patterns. In addition, commonly used pesticides in this region include organophosphates (e.g., malathion), carbamates (e.g., carbaryl), and pyrethroids (e.g., cypermethrin), reflecting typical agricultural practices in vegetable farming systems. However, the evidence indicates that many farmers do not follow adequate safety standards for pesticide protection. As a result, they are directly exposed to pesticides, making it essential to monitor the health impact of exposure. Limited access to up-to-date health information, insufficient knowledge about pesticide safety, and a lack of caution when handling pesticides contribute to this risk (Bagheri et al., 2021). Importantly, not using proper personal protective equipment allows high amounts of pesticides to enter the body, causing harmful health effects (Panuwet et al., 2004; Nguyen and Tsai, 2024). Furthermore, long-term pesticide use often results in a diminished perception of risk among farmers, leading to a significant reduction in the use of protective measures (Meunier et al., 2024). Interestingly, long-standing local practices have led to variations in pesticide application patterns across different areas (Kafle et al., 2021; Begum et al., 2025). Therefore, screening for health risks related to pesticide exposure is an important step toward preventing adverse health effects among reginal agricultural workers. 

This research aims to screen pesticide-exposed farmers in Sanam Chai Khet District, Chachoengsao Province, and analyze the risk factors associated with pesticide exposure to increase awareness of health risks from pesticide exposure in agricultural occupations. Due to the prevalent use of carbaryl and cypermethrin in the region, cholinesterase activity served as the primary biomarker for assessing pesticide exposure (Wielgomas and Krechniak, 2007; Herr et al., 2010). Identifying risk factors that associated with pesticide exposure in Sanam Chai Khet District, Chachoengsao Province, is beneficial to monitoring occupational pesticide use and increasing the awareness of adverse health effects arising from pesticide exposure in farmers.

MATERIALS AND METHODS

Ethical approval and informed consent

The study was conducted in accordance with the Declaration of Helsinki and received approval from the Institutional Review Board (Human Research Ethics Committee) of Naresuan University, Thailand (Ethics Approval Reference: 0029/2567). Written informed consent was obtained from all participants before enrollment, and the study results were reported anonymously.

Study design and population

This cross-sectional study assessed pesticide exposure and its determinants among farmers in Sanam Chai Khet District, Chachoengsao Province, Thailand. The research was conducted in rural farming communities where vegetable cultivation is the primary occupation.

The target population was the farmers who grew vegetables in Sanam Chai Khet District, Chachoengsao Province. Data from the District Agricultural Extension Office indicated 326 farmers in the area. A sample size was calculated using the Krejcie and Morgan formula (Krejcie and Morgan, 1970), yielding a sample of 177 farmers based on a 5% margin of error, a 95% confidence level, and an assumed population proportion of 0.5 in the absence of prior prevalence data. The sample size was determined for prevalence estimation of pesticide exposure characteristics in the study population. The recruitment of farmers into the study was conducted in cooperation with the District Agricultural Extension Office to establish credibility and build confidence among participants. The sample group of farmers who recruited in the study met four inclusion criteria: 1) performing vegetable cultivation in Sanam Chai Khet District, 2) age above 20-years-old, 3) no history of serious illness, 4) voluntary participation in the study. The exclusion criteria were 1) farmers who did not reside in Sanam Chai Khet District, 2) age below 20-years-old, 3) having history of serious illness, 4) Participation in the study was not voluntary. The study outline is presented in Figure 1.

Risk assessment of pesticide exposure in farmers

Farmers who met inclusion criteria were enrolled in the study. The study were evaluated for pesticide exposure risk using the Pesticide Exposure Risk Assessment tool developed by the Department of Disease Control, Thailand. Risk levels were determined through structured interviews conducted by trained researchers.

The pesticide exposure risk was quantified using a standardized Risk Assessment tool, which categorizes participants into five distinct tiers: low, moderate, quite high, high, and very high risk. This classification is based on a composite score derived from the questionnaire accounting for frequency and duration of use integrated with the presence and severity of self-reported clinical symptoms (supplementary material). Participants identified as having quite high or very high risk were invited to provide voluntary blood samples for measurement of cholinesterase activity, a biomarker of exposure to organophosphate and carbamate pesticides. For participants in the low or moderate risk categories, cholinesterase levels were also measured on a voluntary basis to enable comparison with those in the higher-risk groups.

Questionnaire

Researchers interviewed participating farmers using a questionnaire that was reviewed by experts to identify factors influencing occupationnal pesticide exposure. The questionnaire addressed pesticide use, usage history, application characteristics, and related behaviors. PPE use was assessed as a binary variable (use/non-use) based on self-reported practices during pesticide application; compliance and correctness of use were not evaluated in this study. Questionnaire validity was evaluated by three experts. Each item was rated on a scale of -1 to +1. An average IOC score > 0.9 was retained, resulting in a final questionnaire in the study.

The trained research assistants followed standardized protocols designed to minimize interviewer and recall bias. Additionally, the risk of social desirability bias was mitigated by ensuring respondent privacy during interviews and reinforcing the anonymity of the collected information.

Cholinesterase activity detection

Blood samples were collected from participants classified as quite high risk, high risk, and very high risk; however, three individuals in the high-risk group declined to have their blood drawn. Serum cholinesterase activity was measured using a kinetic spectrophotometric assay. All reagents were equilibrated to room temperature for 15 minutes before the assay. For each measurement, 3 mL of reagent 1 (0.25 mM dithiobisnitrobenzoic acid in phosphate buffer, pH 7.7) was added to a cuvette. After blanking the spectrophotometer, 20 µL of the serum sample was added and mixed gently, followed by the addition of 50 µL of reagent 2 (5% butyrylthiocholine iodide). The reaction was monitored by measuring absorbance at 405 nm in 30-second intervals over two minutes. Cholinesterase activity was calculated using a conversion factor of 23,400. Reference intervals were ≥ 4,900 U/L for males and ≥ 4,300 U/L for females. All chemicals and reagents were purchased from Sigma-Aldrich (St. Louis, MO, USA) and were of analytical grade unless otherwise stated.

Statistical analysis

Demographic data of the farmers were analyzed using descriptive statistics. Results were presented as numbers, percentages (%), and means ± standard deviations (SD). Cholinesterase activity was expressed as mean ± SD, and differences between the normal and at-risk groups were evaluated using Student’s t-test. Potential factors associated with cholinesterase inhibition were examined through Stepwise multiple regression using SPSS software version 28.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was set at P < 0.05.

RESULTS

Demographic data of farmers in Sanam Chai Khet District, Chachoengsao Province, Thailand

Farmers in Sanam Chai Khet District, Chachoengsao Province, Thailand, were voluntarily recruited for the study. Data were collected using both a researcher-designed questionnaire and the Pesticide Exposure Risk Assessment from the Department of Disease Control. Blood samples were collected from participants classified as quite high risk, high risk, and very high risk; however, three individuals in the high-risk group declined to have their blood drawn. For participants in the low- and medium-risk groups, blood screening was conducted voluntarily to compare cholinesterase activity with that of the high-risk groups. The study outline is presented in Figure 1.

Figure 1. Outline of data collection in the study. * three participants declined a blood draw.

The demographic characteristics of the 177 farmers in Sanam Chai Khet District, Chachoengsao Province, Thailand, are presented in Table 1.

Table 1. Demographic characteristics of farmers.

The study population consisted of 57 males (32.20%) and 120 females (67.80%), with an average age of 56 years. Most participants had completed primary school (124; 70.06%), followed by secondary school (40; 22.60%); 12 (6.78%) were illiterate, and one (0.56%) held a bachelor’s degree. Regarding health status, 108 participants (61.02%) reported at least one underlying disease, while 69 (38.98%) reported none. Most respondents owned farmland (172; 97.18%), whereas only five (2.82%) were hired as agricultural workers. The average cultivated area was 8.97 rai, with an average agricultural experience of 19.55 years and 4.70 hours of farming per day.

Among the 177 respondents, 145 (81.92%) were current pesticide users, 15 (8.47%) had used pesticides in the past but no longer did, and 17 (9.60%) had never used pesticides.

Pesticide exposure of farmers in Sanam Chai Khet District, Chachoengsao Province, Thailand 

A total of 145 farmers were currently using pesticides for pest control. The primary pesticides reported in this area were malathion (organophosphate), carbaryl (carbamate), and cypermethrin (pyrethroid). Data on pesticide use are presented in Table 2.

Table 2. Pesticide exposure of farmers.

Among the 145 farmers who used pesticides, 83 (57.24%) mixed and sprayed them, while 57 (39.31%) were present in the spraying area. Additionally, five farmers (3.45%) were hired to spray pesticides. Pesticide use in the study area is typically reactive and varies in frequency and duration depending on pest occurrence. Farmers in this study reported an average duration of pesticide use of 16.41 ± 13.37 years, with an average application frequency of approximately 9.97 times per year.

Regarding training in pesticide use, 92 farmers (63.45%) had never attended any training on pesticide safety, while 53 (36.55%) had received such training. Most participants obtained information about pesticides from government agricultural staff (41.38%), followed by television, radio, or newspapers (40.69%).

Regarding opinions about pesticide use, most farmers were confident in the effectiveness of pesticides for controlling pests (71.03%), followed by their convenient availability and ease of use (62.07%). More than half (53.79%) reported long-standing familiarity with pesticide use. Concerning the disadvantages of discontinuing pesticides, 66.90% believed they pose health risks, and 32.41% considered them too expensive - an identical proportion to those who reported no intention of stopping pesticide use (32.41%).

Practices in the use of pesticides by farmers in Sanam Chai Khet District, Chachoengsao Province, Thailand

Data collected from 145 pesticide-using farmers identified 83 who sprayed pesticides on their own land, while five were hired to spray pesticides, for 88 individuals. Information on pesticide use practices is presented in Table 3.

Table 3. Practices in the use of pesticides by farmers.

According to Table 3, most farmers reported reading pesticide labels before each use (89.77%), while 7.95% never read labels and 2.27% read them only occasionally. Regarding the use of protective gloves during pesticide mixing, 75.00% reported always wearing gloves, 15.91% wore them sometimes, and 9.09% never did. When spraying pesticides, 97.73% wore long-sleeved shirts every time, and 2.27% wore them only occasionally. Similarly, 98.86% consistently wore long pants, with 1.14% wearing them only sometimes. For the use of rubber gloves during spraying, 80.68% reported always wearing them, 10.23% wore them sometimes, and 9.09% never wore them. 

Farmers reported wearing rubber shoes while spraying pesticides, with 95.45% wearing them every time, 1.14% wearing them occasionally, and 3.41% never wearing them. Regarding the use of masks or respirators, 84.09% wore them every time, 11.36% wore them sometimes, and 4.55% never used them. Checking wind direction before spraying was common: 92.05% did so every time, 5.68% checked only sometimes, and 2.27% never checked. After spraying, 92.05% of participants showered immediately, 6.82% did so occasionally, and 1.14% did not shower right after spraying. Concerning meal breaks during spraying, 62.50% never took a break, 25.00% took breaks occasionally, and 12.50% paused every time. Finally, when pesticide splashes occurred, 88.64% washed their bodies immediately, 4.55% did so sometimes, and 6.82% did not cleanse pesticide splashes right away.

Overall, most farmers reported using appropriate protective measures when handling pesticides, indicating generally good compliance with recommended safety practices. Nevertheless, a minority of farmers failed to follow these guidelines consistently, particularly in areas such as wearing protective equipment and observing safe spraying procedures. Strengthening education and regular training on pesticide handling could further improve adherence and reduce potential health risks.

Serum cholinesterase levels among farmers

From 145 farmers who were currently using pesticides, 96 were classified as having low or medium risk, while 49 were categorized as quite high, high, or very high risk (Figure 1). Blood samples were collected from participants in the quite high-, high-, and very high-risk groups to measure cholinesterase enzyme activity and evaluate their exposure risk. In the high-risk group, 46 farmers agreed to have blood drawn, whereas three declined. In addition, blood samples were voluntarily collected from the low- and medium-risk groups to compare their cholinesterase activity with that of the high-risk group; 38 of the 96 farmers in these categories provided samples. The data-collection flowchart is presented in Figure 1.

Cholinesterase activity in blood samples from farmers was measured using spectrophotometry. Normal cholinesterase activity was defined as ≥ 4,900 U/L for men and ≥ 4,300 U/L for women. Among the 84 farmers tested, 32 were men and 52 were women in the relatively high-, high-, and very high-risk groups. Cholinesterase levels were evaluated separately for men and women, given the different reference values.

Measurement of cholinesterase activity in male farmers showed that, among 32 participants, 22 had normal activity with a mean value of 6,559.80 ± 1,111.27 U/L, while ten had abnormally low activity (4,261.10 ± 515.07 U/L), a statistically significant difference (P < 0.05; P = 7.9 × 10^-7) (Table 4). Among females, of 52 participants, 45 had normal cholinesterase activity (6,224.91 ± 1,367.85 U/L), whereas seven had abnormal levels (3,658.75 ± 381.48 U/L); this difference was also statistically significant (P < 0.05; P = 1.1 × 10^-5) (Table 4). Overall, 17 of the 145 pesticide-exposed farmers (11.72%) exhibited low cholinesterase activity, indicating an increased risk of pesticide exposure.

Table 4. Serum cholinesterase levels in farmers with high pesticide-exposure risk and those in the low-risk group.

Note: ChE = cholinesterase; U/L = units per liter; Data were presented as mean ± SD; ***P-values < 0.001.

Factors affecting pesticide exposure among farmers in Sanam Chai Khet District, Chachoengsao Province, Thailand

The relationship between pesticide-use behaviors and pesticide exposure determined by cholinesterase activity among farmers was examined using stepwise multiple regression. The results of the analysis are presented in Table 5.

Table 5.  Stepwise multiple regression analysis of cholinesterase activity and pesticide-use behaviors.

Note: Dependent variable: ChE; Predictor variable: pesticide-use behaviors. R² = 0.048, Adjust R² = 0.036, F = 4.105, *P < 0.05

Stepwise multiple regression analysis showed that wearing a mask while spraying pesticides had a statistically significant effect on blood cholinesterase activity at the 0.05 level (β = 374.569, P = 0.046). While other factors did not show any influence on blood cholinesterase activity. Additionally, wearing mask could affect on cholinesterase activity for 3.6% (Adjusted R² = 0.036, P < 0.05). Thus, forecasting equation for cholinesterase activity related pesticide exposure in agriculturist as indicated below, where as Y was a cholinesterase activity

                          Y = 4,509.398 + 0.218 (Wearing mask)

A predictive equation was developed to estimate cholinesterase activity in relation to pesticide exposure, where Y represents cholinesterase activity: Y = 4,509.398 + 0.218 (Wearing mask). In application, this model indicates that the use of respiratory protection (mask wearing) is positively associated with higher cholinesterase activity, suggesting better preservation of enzymatic function. These findings support the potential role of respiratory protection in reducing pesticide inhalation exposure among farmers in the study area. Therefore, this study suggests that protection against pesticide inhalation is strongly associated with health risk status from occupational pesticide exposure in Sanam Chai Khet District, Chachoengsao Province, Thailand.

DISCUSSION

Strong scientific evidence indicates a relationship between occupational pesticide exposure and adverse health outcomes. The deleterious effects of pesticide exposure include immediate toxicity, long-term health impacts (Cevik et al., 2020; Zainuddin et al., 2020; Shekhar et al., 2024) as well as a range of diseases with unclear etiology but suspected links to pesticide exposure, such as Parkinson’s disease, Alzheimer’s disease, and others (Kiani et al., 2023; Wu et al., 2023; Kaur et al., 2024; Akhter et al., 2025).

Despite increasing campaigns promoting a shift from pesticide use to chemical-free farming (Finger and Möhring, 2024, Nitzko et al., 2024), most farmers continue to favor pesticides. Long-standing familiarity, the high effectiveness of pesticides for pest control, and their role in improving yields and product quality remain key factors sustaining pesticide use (Tudi et al., 2021; Martín-García et al., 2024). Consistent with our findings, 71.03% of farmers in Sanam Chai Khet District, Chachoengsao Province, Thailand, expressed confidence in the effectiveness of pesticides for pest management. Convenience further reinforces their preference, making pesticides the first choice in local farming practices. Although farmers in the study area are aware of the potential health risks associated with occupational pesticide exposure, they have not adopted alternative approaches. Discontinuing pesticide use remains challenging because of their proven effectiveness, ability to control pests, and positive impact on yields and quality (Huang et al., 2021; Tudi et al., 2021; Mance et al., 2025). Nevertheless, considering the potential health consequences of pesticide exposure (Ahmad et al., 2024; Hailu et al., 2025), these advantages may not outweigh the associated risks.

Therefore, preventing pesticide exposure is crucial for reducing adverse health effects. In our study, screening with the Exposure Risk Assessment Form indicated that 30% of farmers were at risk. Blood cholinesterase activity was then examined in volunteers to confirm their health status in relation to pesticide exposure. Cholinesterase inhibition is a primary indicator of health risk from pesticide exposure, particularly from organophosphates and carbamates (Amin et al., 2023) and reflects both acute and chronic effects (Sombatsawat et al., 2023; Kumar and Sinha, 2024). Our data showed 11.72% of volunteers with evidence of cholinesterase inhibition, although some farmers declined blood testing.

Analysis of the correlation between cholinesterase activity and pesticide-use behaviors revealed that wearing respiratory protection while spraying pesticides was significantly associated with higher cholinesterase activity (P < 0.05), suggesting that inhalation exposure strongly affects this enzyme. This finding is consistent with evidence that inhalation is a particularly toxic route of exposure: doses as small as 0.2-2.0 mg/g can produce moderate toxicity (Damalas and Koutroubas, 2016; Boonupara et al., 2023; Shekhar et al., 2024). Rapid absorption through the respiratory tract, combined with the vapor and particle characteristics of pesticides during spraying, further increases inhalation risk (Tudi et al., 2022). Although diluted pesticides applied with conventional sprayers generate large droplets and pose minimal inhalation risk, equipment that produces fine droplets markedly increases exposure (Damalas and Koutroubas, 2016; Msibi et al., 2021). These findings underscore that spraying methods are closely linked to pesticide inhalation risk. Appropriate respiratory protection should therefore be worn to guard against aerosols produced during spraying, and the type of respirator must follow the label instructions to ensure complete protection from inhaled pesticides.

Consistent with the empirical evidence, this study highlights the importance of respiratory protection among individuals exposed to pesticides (Sapbamrer et al., 2021; Nguyen and Tsai, 2024). Although no significant association was observed between certain PPE-related behaviors and acetylcholinesterase activity in this study, the effectiveness of PPE in reducing occupational exposure is well supported by previous studies (Lari et al., 2023; Pengpan et al., 2024; Chagkornburee and Chaiklieng, 2025). Furthermore, the findings suggest a potential protective association between consistent footwear use and a reduced incidence of visual impairment, particularly blurred vision (Chagkornburee and Chaiklieng, 2025).

The effectiveness of respiratory protective equipment also warrants careful consideration. While the current study observed a high degree of uniformity in pesticide mask selection, this pattern is likely influenced by localized distribution and standardized usage practices in the study area. However, protective equipment specifications and usage protocols may vary substantially across regions. Previous studies indicate that PPE utilization is shaped by a complex interplay of geographic factors, agricultural practices, psychosocial perceptions, and environmental conditions (Sapbamrer and Thammachai, 2020). Several limitations should be acknowledged. As a cross-sectional study, causal relationships cannot be established, and temporal ambiguity remains a key limitation. In addition, voluntary participation may introduce selection bias, and self-reported data are subject to recall bias. Furthermore, the observed association between acetylcholinesterase activity and PPE use may be influenced by unmeasured confounding factors, including age, duration of exposure, and behavioral variability, which were not controlled in the present analysis.

Most farmers are aware of the health impacts of pesticides; nevertheless, prolonged use can diminish their perception of risk. In addition, limited knowledge about preventive measures, lack of quality protective equipment, and failure to use such equipment while mixing or spraying pesticides, often due to familiarity with the task (Cevik et al., 2020; Afata et al., 2022; Kangavari et al., 2024), placing agricultural workers at increased risk of occupational pesticide exposure.

CONCLUSION

Farmers in Sanam Chai Khet District, Chachoengsao Province, Thailand, showed clear evidence of health risks, including cholinesterase inhibition, associated with pesticide exposure, particularly through inhalation. The consistent use of appropriate respiratory protective equipment is essential for the reduction of exposure during occupational pesticide application. Strengthening education on safe pesticide handling, improving access to high-quality protective gear, and encouraging the adoption of safer spraying techniques are critical to minimizing health hazards. Continuous monitoring of cholinesterase activity, combined with regular training and policy support, can further safeguard workers and promote more sustainable pest-management practices. Additionally, empirical evidence indicates that mask usage significantly reduces pesticide inhalation through the respiratory system. As a result, the use of respiratory protection is essential. It is therefore recommended that farmers receive education regarding the importance of mask usage and the selection of appropriate mask types to minimize pesticide exposure.

ACKNOWLEDGEMENTS

The authors are sincerely grateful to all farmers who participated in the study for their valuable time and cooperation.

AUTHOR CONTRIBUTIONS

Pronrumpa Kanjanasingh: Conceptualization (Lead), Methodology (Lead), Formal Analysis (Lead), Investigation (Lead), Data Curation (Lead), Software (Lead), Writing – Original Draft (Lead), Project Administration (Lead), Funding Acquisition (Lead); Thittaya   Ngamsang: Data Curation (Supporting). Preechaya Tajai: Conceptualization (Equal), Methodology (Equal), Data Curation (Equal), Formal Analysis (Equal), Writing Original Draf (Equal), Writing – Review & Editing (Equal), Project Administration (Equal).

CONFLICT OF INTEREST

The authors declare that they have no conflicts of interest.

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