(Beyond Pesticides, July 8, 2025) A commentary published in Science of The Total Environment showcases the occupational and environmental exposure pathways of fossil-fuel-based pesticide and fertilizer products that children across the globe face, particularly in rural areas of low- and middle-income countries. The authors underscore “the urgent need for multi-level systemic change, resilient health systems, and active stakeholder engagement,” which includes “support for safer and more sustainable agricultural practices.” This includes specific asks for governments “to offer technical assistance to producers and encourage organic and agroecological practices to ensure both environmental justice and food security.” Organic food systems, and criteria for land management systems more broadly, are critical to addressing the triple crises of biodiversity loss, public health collapse, and climate emergency. Organic law, as defined in the Organic Foods Production Act (OFPA) of 1991, is designed as a participatory process with accountability and transparency integral to the statutory language. The law creates the National Organic Standards Board (NOSB), comprised of farmers, consumers, and conservation organizations, a scientific expert, an organic certifier, and a retailer with the statutory authority to adopt binding recommendations to the Secretary of Agriculture on the National List of Allowed and Prohibited Substances. Simultaneously, the public […]

(Beyond Pesticides, June 17, 2025) Funding cuts in the current budget bill include drastic cuts in research essential to protect farmers, farmworkers, and their families. There are many federal agencies funding research, but among the most important of those funding research affecting farmers, farmworkers, and their families are the U.S. Environmental Protection Agency (EPA) and the National Institute for Occupational Safety and Health (NIOSH).   >> Tell Congress to restore funding that protects the health of farmers, farmworkers, and their families. EPA funding for the Bioecological Center for Research on Children’s Health (BeRCH) project was cut after almost two years. This project had the potential to address farmworker children’s health. Farmworker children can face many challenges–including poverty, language barriers, inadequate housing, discrimination, fear of family separation, exposure to agricultural chemicals, food insecurity, and migration. BeRCH was designed to identify, understand, and address the cumulative impacts on the health, development, and growth of farmworker children. The project goals were to examine farmworker children’s exposures to environmental toxins (pesticides, heavy metals, particulate matter) and non-chemical psychosocial stressors (poverty, food insecurity, trauma, discrimination, etc). Working in collaboration with the Florida State University (FSU) health clinic in Immokalee, the project would have examined threats, implemented strategies to improve health outcomes for farmworker children, and collaboratively established […]

(Beyond Pesticides, May 29, 2025) A study, published in Environmental Toxicology and Pharmacology, “investigates genotoxic effects on farmers in Paraíba, Brazil, analyzing buccal mucosa cells [cells from inside the cheek] for DNA and cellular damage,” the authors write. In comparing data from 33 pesticide-exposed agricultural workers to 29 unexposed people in a control group, the researchers report that the “findings revealed significantly higher frequencies of cellular alterations and DNA damage among exposed farmers relative to the control group, with no significant impact from factors such as smoking, alcohol consumption, or family cancer history.” They continue, “These results underscore the genotoxic risks linked to prolonged pesticide exposure and highlight the necessity for stricter regulatory measures.” As Beyond Pesticides documents in Disproportionate Pesticide Hazards to Farmworkers and People of Color Documented… Again, farmworkers have been excluded from labor and occupational safety protection laws since their inception. The Occupational Safety and Health Administration (OSHA) defers all policy on pesticide protections to the U.S. Environmental Protection Agency (EPA), which has been widely criticized for providing inadequate worker protection standards. This study focuses on workers in Brazil, but represents issues that impact communities worldwide. “The agricultural sector plays a pivotal role in Brazil’s economy, encompassing […]

(Beyond Pesticides, May 23-26, 2025) This Memorial Day, while honoring and mourning the U.S. military personnel who have died serving in the United States Armed Forces, Beyond Pesticides recognizes those who are still fighting the long-term impacts of exposure to toxic chemicals as a result of their use in warfare. A recent review in the Open Journal of Soil Science acts as a reminder of the effects that span multiple generations to both the environment and human health following the use of pesticides. The review analyzes the history and impacts of herbicide use during the Vietnam War, as well as emphasizes the importance and relevance for current and future generations. As the authors state, “The United States (U.S.) and other countries, including Russia and Ukraine, need to learn the historical lessons from the U.S. use of herbicides, containing dioxin TCDD and/or arsenic (As), as chemical weapons during the Vietnam War.” As previously reported by Beyond Pesticides, public attention generally focuses on the “rainbow herbicides,” particularly Agent Orange, used during the Vietnam War; meanwhile, it is the dioxin TCDD (2,3,7,8 tetrachlorodibenzodioxin), a byproduct of Agent Orange’s manufacturing process, that has caused the most lasting damage within the country. While the breakdown […]

(Beyond Pesticides, May 21, 2025) An assessment of the fire hazards of four herbicide products in Science of The Total Environment finds high fire and toxic gas emission risk, particularly in 2,4-D-based weed killer products. The authors note that “Inert [nondisclosed] ingredients significantly influence flammability and toxic gas generation in fires,” and the combustion of these products “releases hazardous gases and polycyclic aromatic hydrocarbons.” These results highlight the fire hazards associated with herbicides, as well as the emission of hazardous substances into the atmosphere, which can threaten environmental and public health.    The authors summarize: “[T]he aim of this work is to raise awareness of the fire hazards posed by the storage of pesticides and what effect the ‘inert’ substances in them have. In the past, large fires have occurred around the world, e.g., in Basel (1986), Arkansas (1998), and in Eastern Virginia at the Bayer CropScience plant (2008). It is important to note that in addition to large factories and warehouses, fires can affect small crop protection product stores and local wholesalers.” (See related coverage on the 2023 train derailment, fire, and subsequent release of chemicals here.) The U.S. Fire Administration estimates 344,600 residential building fires nationally, based on […]

(Beyond Pesticides, March 7, 2025) In honor of International Women’s Day on Saturday, March 8, 2025, Beyond Pesticides sheds light on the disproportionate risks to women from toxic chemicals that are often unaccounted for and even dismissed throughout pesticide regulatory review and the underlying statutes. In a roundup of Daily News coverage in 2024, as well as the most recent scientific studies in 2025, on the scientific links between pesticide exposure and adverse effects in women, this article highlights the growing inequities in pesticide threats to women’s health.  Women farmers and farmworkers are particularly excluded when assessing pesticide risks. As previously reported by Beyond Pesticides, a study published in Occupational and Environmental Medicine finds that pesticide exposure, especially during puberty, can play a role in ovarian cancer development among female farmers. Although there are many studies that evaluate the risk for cancers among farmers, very few scientific articles cover the risk of ovarian cancer from pesticide exposure.  Additionally, this study suggests the role of hormones in ovarian cancer prognosis and development, highlighting an association with endocrine disruption. Endocrine disruption can lead to numerous health problems in multiple organ systems, including hormone-related cancer development (e.g., thyroid, breast, ovarian, prostate, testicular), reproductive […]

(Beyond Pesticides, January 31, 2025) A recent cross-sectional study in Heliyon highlights the link between sleep disorders in Thai farmers and pesticide exposure. The authors find pesticide exposure as an important risk factor for sleep disorders after surveying 27,334 farmers over the age of 20 who had work experience for at least five years. The importance of sleep health is reflected both physically and mentally, as studies find “sleep deficiency increase[s] mortality and various health complications, including hypertension, obesity and type 2 diabetes, cardiovascular diseases, mood disorders, and neurodegenerative disorder.” Additional studies find that these issues are compounded when sleep health is affected by environmental factors such as pesticide exposure. (See previous Beyond Pesticides’ coverage here and here.) The researchers report: “The study found a positive association of 19 individual pesticides (twelve insecticides, two herbicides, and five fungicides). Some associations demonstrated a dose-response pattern. Additionally, the study revealed that women are at a higher risk of sleep-related issues with pesticide exposure compared to males. These results not only substantiate existing literature but also unveil several new individual pesticides that may impact sleep health.” Focusing on study participants in Thailand, which is “characterized by heavy pesticide use and minimal protective measures, […]

(Beyond Pesticides, January 14, 2025) Women with occupational pesticide exposure have elevated rates of breast cancer, according to a study in Immunopharmacology and Immunotoxicology. Based on an analysis of clinicopathological data from 188 affected women, the study authors demonstrate “that occupational exposure to pesticides modifies the clinical presentation of disease in breast cancer patients, depending on their age at disease onset, affecting cytokine production, especially in those exhibiting early age at diagnosis.”   “Breast cancer (BC) is the most common malignant neoplasm affecting women worldwide and the second leading cause of cancer-related death in this population,” the researchers report. They continue: “Aging is the primary risk factor associated with breast cancer development and mortality, resulting in a cumulative lifetime risk of 1 in 8 women developing the disease. Disease onset significantly impacts patient prognosis. While most cases are of late onset and occur in women over 50 years of age, early-onset BC is prevalent in certain populations and is associated with a poor prognosis and aggressive tumor behavior.”  Data was collected and analyzed from May 2015 to December 2022, with the study population in Brazil spanning “27 municipalities in the southwest of Paraná, a region characterized by extensive pesticide use, predominantly […]

(Beyond Pesticides, August 30, 2024) There is no more compelling reason to embrace a precautionary pesticide poisoning standard this Labor Day than the need to protect workers. In fact, the Occupational Safety and Health Administration (OSHA) says on its website, Transitioning to Safer Chemicals, that the best way to protect workers is to  “eliminate or reduce hazardous chemicals at the source.” While some try to employ product substitution with “safer” chemicals, Beyond Pesticides urges decision makers to embrace alternative systems, such as organic management systems, that embrace management techniques to meet disease and infestation management goals and use only organic compatible substances. According to OSHA: “In chemical management, [the industrial hygiene principle, known as the hierarchy of controls] guides employers and workers to eliminate or reduce hazardous chemicals at the source by substituting them with safer alternatives. Unlike traditional engineering controls, administrative controls, work practice controls, or personal protective equipment, these strategies can completely eliminate exposure to hazardous chemicals, reduce the potential for chemical accidents, reduce disposal costs, and remove concerns regarding worker compliance and equipment maintenance.” A look through the state and federal databases that track occupational pesticide poisoning for both acute (immediate short-term) and chronic (long-term) pesticide effects […]

(Beyond Pesticides, July 16, 2024) Yet another study in the August 2024 journal Ecotoxicology and Environmental Safety has found that exposure to organophosphorus pesticides (OPPs) is correlated with increased suicidal thoughts in some people. This study is just the latest in a long line of studies from around the world that have linked pesticide exposure to mental health conditions, including sleep disorders, depression, and suicidal ideation (SI). As the rate of suicide increased by 30% between 2000 and 2020, there is an urgent public health need to investigate and address all potential contributing factors. A 2019 study, covered in Daily News, found that teens and adolescents living in agricultural areas and exposed to organophosphate (OP) insecticides are at higher risk of depression, In July and January this year, other studies link farmer psychiatric episodes to pesticide exposure, adding to the body of science. Exposure to household pesticides is also linked to depression in a 2020 study.   Study and Methodology  The study entitled “Association between exposure to organophosphorus pesticide and suicidal ideation among U.S. adults: A population-based study,” analyzes information on the mental and physical health of over 5,000 individuals aged 20 and up in the United States. The study aims […]

(Beyond Pesticides, March 29, 2024) Last week during National Agriculture Week, U.S. Senator Ben Ray Luján (D-NM) introduced S.4038, the Children’s Act for Responsible Employment and Farm Safety (CARE), aiming to elevate labor standards for young workers in the agricultural sector, as protection from pesticides remains weak. Currently, agriculture stands as the sole industry that permits children—as young as 12 years old—to work without significant limits on their hours of employment outside of school time. This scenario is a reality for hundreds of thousands of children across the U.S., who undertake the demanding tasks of planting, harvesting, processing, and packaging the food produced nationwide. The CARE Act proposes to align the age and working hour criteria for underage workers in agriculture with those enforced in other sectors. Additionally, the legislation seeks to toughen both civil and criminal penalties for violations of child labor laws and to enhance safeguards for children against the risks of pesticide exposure. It is important to note, however, that the CARE Act would exempt farm-owning families, allowing their children to work on the family farm under the current guidelines. Exemptions to the Fair Labor Standards Act (FLSA) currently allow children to work unlimited hours, outside of school  hours, […]

(Beyond Pesticides, February 16, 2024) A report released in January, US pesticide regulation is failing the hardest-hit communities. It’s time to fix it, finds “people of color and low-income communities in the United States and around the world continue to shoulder the societal burden of harmful pollution.” More specifically, the authors state that “ongoing environmental injustice is the disproportionate impact these communities suffer from pesticides, among the most widespread environmental pollutants.” The report follows an earlier article by the same lead authors and others (see earlier coverage) on the long history of documented hazards and government failure to protect farmworkers from pesticide use in agriculture. In a piece posted by Beyond Pesticides earlier this week, the serious weaknesses in the worker protection standard for farmworkers are documented.   The latest report was led by Nathan Donley, environmental health science director at the Center for Biological Diversity and Robert Bullard, known as the “Father of Environmental Justice” and executive director of the Robert D. Bullard Center for Environmental and Climate Justice at Texas Southern University in Houston. In addition to these authors, the 2022 review was coauthored by Jeannie Economos of the Farmworker Association of Florida, Iris Figueroa of Farmworker Justice, Jovita […]

(Beyond Pesticides, February 14, 2024) The latest in a series of reports on the state of farmworker protection, released last December, highlights the long history of health threats, regulatory failures, and structural racism that is imbued in the chemical-intensive agricultural system that feeds the nation and world. The authors conclude that farmworkers “face a level of occupational risk unrivaled by most workers.” They continue: “From repeated exposure to pesticides and extreme heat, to injuries from machinery and repetitive motion, conditions on American farms involve myriad hazards. Meanwhile, a lack of access to healthcare and legal services, low wages, marginalization, language barriers, racism, and the threat of deportation among these largely immigrant communities compound their many challenges.” Describing the U.S. food system and the workers who serve as its foundation, Precarious Protection: Analyzing Compliance with Pesticide Regulations for Farmworker Safety is the third publication in a series of reports on farmworker health and safety, led by the Center for Agriculture and Food Systems (CAFS) at Vermont Law and Graduate School and written with the Harvard Law School Food Law and Policy Clinic and the nonprofit group Farmworker Justice. Johns Hopkins Center for a Livable Future and Farmworker Justice partnered on the […]

(Beyond Pesticides, January 4, 2024) A review published in the Journal of Neurosciences in Rural Practice finds an association between farmers’ pesticide exposure and cognitive impairment. Specifically, farmers suffer from attention deficit, lack of information processing, non-comprehension of verbal cues, slow processing speed, memory loss, sluggishness, speech difficulties, and impaired motor function. Additionally, the risk of adverse effects from exposure increases with time spent around pesticides, like in other occupational (work-related) settings. Although pesticide exposure may not be the only factor involved in cognitive impairment, exposure can work synergistically (together) with other factors, triggering neurotoxicity. Pesticides play various roles in causing or exacerbating adverse health outcomes like neurotoxic effects and chemical damage to the brain. Numerous pesticides impair neurological function, especially for chronically exposed individuals (e.g., farmworkers) or during critical windows of vulnerability and development (e.g., childhood, pregnancy). Mounting evidence over the past years shows that chronic exposure to sublethal (low) levels of pesticides adversely affects the central nervous system (CNS) and neural receptors, such as connections between nerves, the brain, enzymes, and DNA. Specifically, researchers identify agricultural chemical exposure as a cause of many adverse CNS impacts and neurological diseases, including Alzheimer’s, amyotrophic lateral sclerosis (ALS), and Parkinson’s disease. The researchers reviewed scientific articles published in […]

(Beyond Pesticides, January 3, 2024) A study published in Environmental Health Perspectives finds elevated, chronic exposure to glyphosate throughout one’s lifetime increases the risk of mosaic loss of chromosome Y (loss of chromosome Y occurs to many men in some cells due to aging [mLOY]) that impacts a noticeable fraction of cells. Although the loss of this sex chromosome does not cause cell death, like the loss of autosomal chromosomes, the risk of mLOY is a biomarker for genotoxicity (the damage of genetic information within a cell causing mutations from chemical exposure, which may lead to cancer) and expansion of cellular response to glyphosate, resulting in the precursor for hematological (blood) cancers. This study is one of the first to identify sex-specific chromosome degradation, with stark evidence demonstrating links to various cancers, including non-Hodgkin lymphoma. The International Agency for Research on Cancer (IARC) has classified the glyphosate as a probable carcinogen or cancer-causing chemical. However, the U.S. Environmental Protection Agency’s (EPA) allowance of widespread use of glyphosate allows for adverse impacts, especially among vulnerable individuals, like pregnant women, infants, children, and the elderly. Glyphosate exposure levels and resulting residues in urine has been documented with recent data showing that four out of five (81.6%) […]

(Beyond Pesticides, December 4, 2023) With a history of neglect of farmworker protection in the workplace, advocates are pointing to the need for ensuring stringent enforcement of regulations that are expected to take effect under the Pregnant Workers Fairness Act (PWFA) this month. In addition to weak laws and protections that typically exempt farmworkers, enforcement for farmworker protections that do exist has been lacking. A report on enforcement of wage and hour law under Wage and Hour Division of the U.S. Department of Labor (DOL) has documented diminished capacity to detect and enforce against violations. A report by the Economic Policy Institute (2020) shows the dramatic failures of DOL, which is underfunded and understaffed to enforce the law. As the agency charged with operationalizing the new law to protect farmworkers, the Equal Employment Opportunity Commission (EEOC) will be up against a federal pesticide law enforcement system that is dependent by agreements with state agencies, mostly departments of agriculture, that have a history of failing to enforce the limited protections provided for farmworkers. The EEOC is headquartered in Washington, D.C. and operates 53 field offices in every part of the country. Farmworkers have endured a long history of discrimination in the United […]

With the elevated adverse impacts associated with pesticides and reproductive health, the Pregnant Workers Fairness Act (PWFA) law may be used to improve protections for farmworkers and other high-risk employees.

(Beyond Pesticides, June 7, 2023) A systematic review of scientific literature published in Environmental Research on the development of mood disorders among pesticide applicators (farmers, landscapers, etc.) finds an increased risk of depression symptoms over the last decade. The evidence in the review highlights the presence of pesticide-specific biomarkers and biomarkers of depression that determine the positive association between pesticide exposure and the development of depressive symptoms. With more high-quality longitudinal studies to control sociocultural variables, researchers can directly pinpoint risks of developing depression, especially among agricultural workers and landscapers who use pesticides. Research on pesticide-induced diseases commonly investigates pesticide exposure concerning the development of various physical illnesses. However, previous studies show that occupational (work-related) risks of developing depression are high in agriculture, where pesticide use is rampant. Acute exposure to chemicals, including organophosphate, organochlorine, triazine, and carbamate pesticides, tends to put farmers at greater risk of suicide than the general population. There is a lack of information connecting pesticide exposure to the subsequent psychological (psychiatric) effects on the general population. Additionally, household pesticide exposure varies from occupational exposure via exposure frequency, duration, intensity, and type.   According to the World Health Organization (WHO), depression affects 322 million people globally, with the number of diagnosed patients increasing by 18.4% from 2005 to […]

(Beyond Pesticides, February 23, 2023) A father’s exposure to occupational (work-related) chemicals, including pesticides, around the time of his partner’s pregnancy, has an association with a higher risk of infant congenital heart defects (CHDs), according to a Japanese study published in Environmental Health and Preventive Medicine. The prevalence of infant CHDs is one of the most common genetic (congenital) diseases worldwide. However, the etiology of CHD includes both genetic and environmental factors. Heart diseases are among the leading causes of death worldwide, and heart conditions are one leading cause of disability in the U.S. Research, including this study, demonstrates environmental pollutant exposure can increase the risk of developing cardiovascular disease, including stroke, heart attack, heart failure, atrial fibrillation, and cardiac arrest. Considering chemical exposure exacerbates adverse disease effects, reviews like these highlight the significance of evaluating synergism between diseases and toxic chemicals to safeguard human health. Therefore, researchers are “suggesting the importance of the management of paternal occupational exposures for the prevention of infant CHDs. Further studies using biomarkers of occupational exposure are warranted.” To investigate the risk of CHDs in infants, researchers in this study examine fathers’ work-related exposure to toxic chemical compounds, frequency of pesticide use, and synergetic mixtures of chemical compounds. […]

(Beyond Pesticides, August 18, 2022) A study published in Environmental Research suggests occupational (work-related) exposure to pesticides among nonpregnant women and men may increase childhood cancer risk for offspring. Already, studies find low levels of pesticide exposure during pregnancy or childhood cause adverse health effects from metabolic disorders to mental and physical disabilities. However, few assess parental exposure’s impact on childhood disease risk outside critical development periods (e.g., pregnancy). Although medical advancements in disease survival are more prominent nowadays, childhood cancer remains the leading cause of death from disease among children. Furthermore, childhood cancer survivors can suffer from chronic or long-term health complications that may be life-threatening. The etiology or cause of childhood cancer involves the interaction of multiple components like lifestyle and genetics. However, emerging evidence indicates that environmental contaminants like pesticides (e.g., occupational exposures, air pollution, pesticides, solvents, diet, etc.) play a role in disease etiology. Pesticide contamination is widespread in all ecosystems, and chemical compounds can accumulate in human tissues resulting in chronic health effects. Children are particularly vulnerable to the impacts of pesticide exposure as their developing bodies cannot adequately combat exposure effects. Moreover, several studies demonstrate an association between environmental or occupational pesticide exposure and the risk of childhood cancer. Considering maternal pesticide […]

(Beyond Pesticides, May 19, 2022) A study published in the Journal of the American Heart Association finds a correlation between the number of fires fought annually and atrial fibrillation (AF), one of the most common medical arrhythmias that increases the risk of stroke, heart failure, and other cardiovascular health issues. In the firefighting occupation, firefighters can experience exposure to chemicals and particulate matter in smoke, pollutants, volatile organic compounds, and polycyclic aromatic hydrocarbons (PAHs) that increase cardiovascular (heart) and respiratory distress risk through oxidative stress and autonomic function disruption. However, firefighters encounter both personal and occupational (work-related) risk factors for cardiovascular diseases, making this subset of the population particularly vulnerable to heart-related fatalities. Considering firefighters live 10 to 15 years less than non-firefighters, studies like these are significant for understanding how chemical exposure contributes to health and wellness disparities. Lead author Paari Dominic, Ph.D., notes, “Clinicians who care for firefighters need to be aware of the increased cardiovascular risk, especially the increased risk of [AF], among this unique group of individuals… The conditions that elevate their risk further, such as high blood pressure, type 2 diabetes, lung disease and sleep apnea, should be treated aggressively. In addition, any symptoms of [AF], such as […]

(Beyond Pesticides, February 3, 2022) A study published in the journal Thorax finds lifetime occupational (work-related) exposure to pesticides increases incidents of chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis. Although research often attributes COPD risk to genetics or cigarette smoking, the increasing rate of COPD incidents indicates an external cause of disease development. Although an exact etiology (cause) of the increase in respiratory disease cases remains unknown, the connection between chronic respiratory diseases and exposure to pesticides continues to strengthen. Several circumstances, including smoking patterns, poverty, occupation, and diet, can influence disease prognosis. However, studies show that relative exposure to chemicals like pesticides can occur within each circumstance, making chemical exposure ubiquitous. Additionally, pesticide drift is an omnipresent issue impacting communities surrounding farming operations, and dust may harm humans, plants, and aquatic systems. Therefore, this review highlights the significance of evaluating the association between pesticide exposure and disease development, especially for diseases generally attributed to genetics or vices. Researchers in the study note, “[W]e found that cumulative exposure to pesticides is associated with an increased risk of COPD, with positive exposure-response trends. The unique large sample and the confirmation of our results in sensitivity analyses, in particular in never-smokers, support the validity […]

(Beyond Pesticide, November 4, 2021) A scientific literature analysis by the Federal University of Goias, Brazil, finds occupational (work-related) exposure to agricultural pesticides increases the risk for 45 different types of cancer. This analysis assesses studies from the last decade—2011 to 2020—to identify cancer risk associated with occupational exposure by country, pesticide type, and methods used to diagnose disease. Many pesticides are “known or probable” carcinogens (cancer-causing agents), and widespread uses only amplify chemical hazards, adversely affecting human health. However, research on cancer and pesticides lacks comprehensive information regarding human health effects associated with long-term chemical use. This study highlights the significant role that long-term research plays in identifying potential health concerns surrounding registered pesticides. The use of these xenobiotics (foreign chemical compounds) substances in agriculture are increasing. Thus, it is important those working with and around these toxicants have protection. The analysis notes, “Overall, then, the results of the present study emphasize the need to evaluate overuse of pesticides and the concomitant increase in the number of cancer cases. Future research should thus include active intervention in the correct use of pesticides by farmworkers and encourage adequate training and the use of PPEs [personal protective equipment], as well as routine periodic medical […]