Wives of Farm Pesticide Applicators at Risk for Incident RA
Among female spouses of licensed pesticide applicators, the personal use of organochlorine insecticides was associated with an increased risk for rheumatoid arthritis (RA). Among women who did not use specific pesticides personally, the applicator's use of specific pesticides was associated with incident RA.
METHODOLOGY:
Researchers investigated whether the use of pesticides influenced the risk for RA in a cohort of female spouses of licensed pesticide applicators from North Carolina and Iowa (1993-1997).
They included 32,126 female spouses and collected data on their direct pesticide use or indirect exposure, regular farming tasks, and other demographic and lifestyle factors.
Cases of incident RA were identified using follow-up questionnaires, medical records, medication use, and claims data.
The analysis included 410 participants with probable RA (median age, 51 years) and 21,850 without RA (median age, 45 years), with a median survey follow-up duration of 10 and 19 years and a median of 0.5 and 8 fee-for-service years among those with Medicare data, respectively.
A total of 32 specific pesticides were included in the final analysis, and their associations with RA were estimated.
TAKEAWAY:
Almost half of the participants never used agricultural pesticides. Most reported using them for 20 days or less each year (adjusted odds ratio [aOR], 1.26; 95% CI, 1.01-1.57 vs never use) and for 20 years or less, with no higher odds being observed among those who used them more.
The personal use of organochlorine insecticides was associated with a higher likelihood for incident RA (aOR, 1.54; 95% CI, 1.14-2.07), especially with the use of dichlorodiphenyltrichloroethane (aOR, 1.89; 95% CI, 1.30-2.75) and lindane (aOR, 1.97; 95% CI, 1.12-3.47); among the organophosphate insecticides, coumaphos use showed a stronger association (aOR, 2.32; 95% CI, 1.29-4.19).
Among spouses who never used specific pesticides themselves, the applicator's use of metribuzin was associated with increased odds of RA (aOR, 1.66; 95% CI, 1.10-2.52).
The use of any fungicide was associated with increased odds of RA (aOR, 1.72; 95% CI, 1.24-2.38). Several farming activities, such as cleaning with solvents, driving a gas tractor, grinding feed, painting, applying chemical fertilizer, and planting, were significantly associated with RA.
IN PRACTICE:
'[The study] findings provide robust evidence that some insecticides may contribute to risk of developing RA in women. While insecticides are an important tool in controlling threats to crops and human health, our results provide evidence of potential risks,' the authors wrote.
SOURCE:
This study was led by Christine G. Parks, PhD, Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina. It was published online on July 16, 2025, in Arthritis & Rheumatology.
LIMITATIONS:
Some cases of RA may have been missed by the algorithm, and clinical data and details such as serology of RA were missing. The study had insufficient statistical power to examine differences by risk factors linked to seropositive and seronegative RA. The exposure to pesticides was self-reported, and the frequency or duration of pesticide use in spouses was lacking.
DISCLOSURES:
This study received support in part from the intramural research program of the National Institutes of Health, the National Institute of Environmental Health Sciences, and the National Cancer Institute. The authors reported having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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Chewable or dissolvable tablets: Chewable and dissolvable tablets are typically lower in added sugar than gummies and tend to have more comprehensive formulations. The downsides? They're often chalky and not always a hit with kids. Liquid: Liquid kids' multivitamins are typically either flavored and administered via a measuring spoon or cup, or unflavored and stirred into a cool food or beverage. They may be a better choice for younger kids or those who dislike taking other supplement forms. However, many liquid products have a shorter shelf-life and can have a strong taste or thick, syrupy texture that kids might not like. Powder: Powder multivitamins are similar to liquid ones in that they can be stirred into a cool food or beverage, making them handy for picky eaters or younger kids. However, depending on the powder, it may alter the taste of the food or beverage you add it to. These products also tend to be pricier and harder to find. 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Gummy vitamins are quite popular, but it is important to use caution with these and store them out of reach as they look and taste like candy," says Ellis. Ultimately, the best form is the one your child can take safely. Sweeteners: Ideally, look for products with no more than 2 grams of added sugar per serving. Some products use natural sugar substitutes, like monk fruit, or artificial sweeteners, like xylitol, to add sweetness without added sugar. While generally well-tolerated, some artificial sweeteners can cause digestive side effects, like bloating, and kids may not always like the taste or aftertaste of sweeteners like monk fruit or stevia. Colors and flavors: When possible, opt for products that are naturally colored and sweetened using ingredients like fruit or vegetable juice. Allergies: If your child has a food allergy, it's important to choose a supplement that's free of the allergen and ideally made in an allergen-free facility. 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With 8 grams of added sugar per 4-gummy serving, it's one of the highest-sugar options out there, which may be a deal breaker for some families. OLLY Kids Multi Gummy Worms: These gummy worm-shaped gummies were a close contender for our "best gummy" pick. These gummies are naturally flavored and colored, third-party tested for purity and potency, contain just 2 grams of added sugar and offer a good variety of vitamins and minerals. The biggest difference between it and SmartyPants is OLLY's kids' vitamin doesn't include omega-3s. However, for kids who eat fish regularly, these gummy worms may be a better pick. Flintstones Complete Chewable: Considered the OG kids' multivitamin by many parents, Flintstones Vitamins are still going strong and now come in both gummy and chewable options. Since I had already tested several gummies, I went with the Complete Chewable. The classic chalky texture from my own childhood is still there, though the taste was a bit more sour than I remembered. My son didn't seem to mind, but the flavor might be off-putting for some kids. Nutritionally, it's a comprehensive formula, with many vitamins present at 100% of the DV, making it a better fit for kids with very limited diets or those needing extra support. However, it does contain artificial ingredients, including food dyes, which may be a dealbreaker for some families. Li'l Critters Gummy Vites: It's clear why this multivitamin is so popular on Amazon: It's affordable, and the gummy bear shape and sweet taste is sure to be a hit with kids — though my toddler found them too sticky for his taste. As with many other gummy vitamins, it doesn't contain many minerals and isn't suitable for vegan diets. Unlike Nature Made Kids' multivitamin, Li'l Critters doesn't contain omega-3s and isn't third-party tested for purity and potency. Zarbee's Complete Kids Multivitamin Gummies + Immune Support: This honey-sweetened multivitamin is unique in that it contains black elderberry extract, which may help support your child's immune system and prevent or shorten the duration of respiratory illnesses, though more research is needed. Suitable for kids ages 2 to 12, it provides a good range of vitamins, though doesn't contain many minerals. It's free of artificial dyes, flavors and sweeteners and contains 1 gram of added sugar per gummy. It's also third-party tested for label accuracy. The biggest drawback is the taste, which my son said was too tart. (back to top) FAQs Are kids' multivitamins worth it? It depends. Most healthy kids who generally eat a balanced diet don't need to take a multivitamin daily. Instead, they might benefit from a multivitamin on days when their appetite is low or during periods of extreme pickiness. Some multivitamins contain smaller amounts of key nutrients and could be helpful for simply bridging gaps in your child's diet. That said, multivitamins can be helpful for ensuring adequate nutrient intake in kids who are at risk for nutrient inadequacies or deficiencies. "Some signs that suggest a child may benefit from a multivitamin include noticeable changes in energy or focus, ongoing fatigue, growth concerns or frequent illness. Additionally, if a child has a very limited diet or is consistently excluding entire food groups over a long period of time, a multivitamin may be helpful. If there are any concerns about nutrient gaps or growth, it's always best to consult with your child's healthcare provider to determine the root cause and appropriate supplementation," says Ellis. Can kids' multivitamins cause constipation? Yes, some nutrients, especially iron and calcium, can be constipating in some kids. If your child has fewer than three bowel movements in a week, it's best to talk with a pediatrician or registered dietitian to determine the root cause. Are kids multivitamin HSA/FSA eligible? Most over-the-counter kids' supplements are not HSA or FSA eligible, unless prescribed by a pediatrician. That said, eligibility requirements vary, so it's worth double checking with your HSA or FSA plan provider What is the best multivitamin for kids with ADHD? The best multivitamin for kids with ADHD depends on your child's diet. Research on supplements to help manage ADHD symptoms in kids is limited. That said, being low in certain nutrients, including vitamin D, zinc and iron may worsen or contribute to ADHD symptoms. Avoiding products that are high in added sugar or that contain artificial food dyes may also help, though larger, higher-quality studies are needed. Hiya may be a good option for kids with ADHD as it contains zinc and vitamin D, plus it's free of artificial dyes and added sugar. For an iron-containing supplement, Renzo's Picky Eater may be worth considering. Ultimately, it's best to talk with your pediatrician to determine the right supplement for your kid. (back to top) Meet our experts Brittany Brown, RD, CDE, a pediatric dietitian and lactation consultant in Nova Scotia, Canada Alicia Miller, MS, RD, LDN, maternal and pediatric nutrition specialist Yvette Hill, RDN, board-certified lactation consultant and pediatric food allergy specialist Ali Ellis, MS, RD, pediatric dietitian and founder of the Toddler Kitchen (back to top) Our health content is for informational purposes only and is not intended as professional medical advice. Consult a medical professional on questions about your health.
