. 2022 Sep 29;130(9):096002. doi: 10.1289/EHP9934

Table 3.

Characteristics of Latin American and the Caribbean studies on pesticide exposure and neurobehavioral outcomes published between 2007 and 2021 ( $lowercase italic n equals 54$ ).

Study	Year of publication/country	Population and sample size	Study design	Pesticides assessed	Exposure assessment method	Pesticide or metabolite concentrations	Health effect and assessment method/instrument	Results
Studies on OCs
Studies in children
1. Torres-Sánchez et al.¹⁰⁷	2007/Mexico	244 mother–child (0–12 months of age) pairs from malaria-endemic zone	Prospective cohort	OCs	Maternal serum DDE before and during each trimester of pregnancy	$Geometric mean \pm geometric SD (GSD)$ ( $ng / mL$ ): $p, p'$ -DDE: $first trimester = 6.4 \pm 2.8$ ; $second trimester = 6.8 \pm 2.9$ ; $third trimester = 7.8 \pm 2.8$	Neurodevelopment: mental and psychomotor development (BSID-II)	Higher DDE during first trimester of pregnancy was associated with lower PDI scores in first year of life ( $β$ per 2-fold increase in $DDE = - 0.5$ ; 95% CI: $negative 1.0$ , $negative 0.1$ ). Null associations between DDE and MDI scores.
2. Torres-Sánchez et al.¹⁰⁸	2009/Mexico	270 mother–child (12–30 months of age) pairs	Prospective cohort	OCs	Maternal serum DDE during each trimester of pregnancy	$Mean \pm SD$ ( $ng / mL$ ): $p, p'$ -DDE: $first trimester = 6.3 \pm 3.1$ ; $second trimester = 6.5 \pm 3.0$ ; $third trimester = 7.9 \pm 2.8$ ; $p, p'$ -DDT: $first trimester = 0.008 \pm 2.7$ ; $second trimester = 0.006 \pm 2.0$ ; $third trimester = 0.006 \pm 2.3$	Neurodevelopment: mental and psychomotor development (BSID-II)	Null associations of prenatal DDE with PDI and MDI scores.
3. Bahena-Medina et al.¹⁰⁹	2011/Mexico	265 mother–child (1 month of age) pairs	Prospective cohort	OCs	Maternal serum DDE during each trimester of pregnancy	$Geometric mean \pm geometric SD (GSD)$ DDE ( $ng / mL$ ): First trimester: $normal reflexes = 6.2 \pm 3.1$ ; $one abnormal reflex = 7.1 \pm 2.6$ ; $greater than or equal to 2$ ; $abnormal reflexes = 5.4 \pm 3.2$ ; $non-neurological soft signs = 6.0 \pm 3.0$ ; $one neurological soft sign = 7.0 \pm 2.9$ ; $greater than or equal to 2$ $neurological soft signs = 5.2 \pm 2.2$ Second trimester: $normal reflexes = 7.5 \pm 2.8$ ; $one abnormal reflex = 7.3 \pm 3.1$ ; $greater than or equal to 2$ $abnormal reflexes = 4.2 \pm 2.9$ ; $non-neurological soft signs = 6.4 \pm 3.1$ ; $one neurological soft sign = 7.8 \pm 2.9$ ; $greater than or equal to 2$ $neurological soft signs = 5.4 \pm 2.0$ Third trimester: $normal reflexes = 7.5 \pm 2.7$ ; $one abnormal reflex = 8.1 \pm 2.9$ ; $greater than or equal to 2$ $abnormal reflexes = 5.1 \pm 3.3$ ; $non-neurological soft signs = 7.7 \pm 2.8$ ; $one neurological soft sign = 7.0 \pm 3.1$ ; $greater than or equal to 2$ $neurological soft signs = 4.3 \pm 2.2$	Neurodevelopment: neonatal reflexes (NBAS), neurological soft signs (Graham-Rosenblith scale), mental and psychomotor development (BSID)	Null associations between prenatal DDE exposure and neonatal neurodevelopment.
4. Dallaire et al.¹¹⁰	2012/Guadeloupe	153 mother–child (7 months of age) pairs living near banana plantations	Prospective cohort	OCs (chlordecone)	Questionnaire (infant dietary intake history) Cord blood chlordecone Breast milk chlordecone at 3 months	$Mean \pm SD$ chlordecone ( $μ g / L$ ): $Cord blood = 0.53 \pm 1.97$ ; $breast milk = 1.09 \pm 1.15$	Neurodevelopment: visual recognition, memory, and processing speed (FTII, TAC, Brunet-Lezine scale)	Those in the highest tertile of cord blood chlordecone concentrations (classified as $concentrations > median$ ) scored lower on the novelty preference test ( $β = - 0.2$ ; 95% CI: $negative 0.4$ , 0) than those in the second tertile of cord chlordecone concentrations (classified as $concentrations > LOD$ and $\leq median$ ) ( $lowercase beta equals 0.1$ ; 95% CI: $negative 0.3$ , 0.1). Detectable concentrations of chlordecone in cord blood were associated with increased odds of low fine motor scores ( $odds ratio equals 1.3$ ; 95% CI: 1.1, 1.5).
5. Boucher et al.¹¹¹	2013/Guadeloupe	141 mother–child (18 months of age) pairs living near banana plantations	Prospective cohort	OCs (chlordecone)	Questionnaire (infant dietary intake history) Cord blood chlordecone Breast milk chlordecone at 3 months	$Mean \pm SD$ chlordecone ( $μ g / L$ ): $Cord blood = 0.41 \pm 0.6$ ; $breast milk = 0.93 \pm 0.90$	Neurodevelopment: personal–social, communication, problem-solving, fine motor, and gross motor (ASQ-19)	Higher chlordecone concentrations in cord blood were associated with lower fine motor scores among boys ( $β = - 0.32$ ; $lowercase italic p equals 0.03$ ).
6. Torres-Sánchez et al.¹¹²	2013/Mexico	203 mother–child (42–60 months of age) pairs	Prospective cohort	OCs	Maternal serum DDE during each trimester of pregnancy	Median (P10–P90) ( $ng / g$ lipid): DDE: $first trimester equals 1,255.40 open parenthesis 259.26 to 4,964.21 close parenthesis$ ; $second trimester equals 1138.16 open parenthesis 154.39 to 2,857.14 close parenthesis$ ; $third trimester equals 812.75 open parenthesis 153.23 to 2,919.00 close parenthesis$ ; DDT: $first trimester equals 0.0123 open parenthesis 0.0123 to 31.48 close parenthesis$ ; $second trimester equals 0.0123 open parenthesis 0.0123 to 2.54 close parenthesis$ ; $third trimester equals 0.0123 open parenthesis 0.0123 to 4.21 close parenthesis$	Neurodevelopment: verbal, perceptual performance, quantitative, memory, motor skills, and general cognitive index (MSCA)	Higher DDE during third trimester of pregnancy was associated with poorer verbal ( $β$ per 2-fold increase in $DDE = - 1.1$ ; 95% CI: $negative 2.2$ , $negative 0.1$ ), quantitative ( $β = - 2.1$ ; 95% CI: $negative 3.2$ , $negative 1.0$ ), and memory ( $β = - 1.3$ ; 95% CI: $negative 2.2$ , $negative 0.3$ ) skills and a poorer general cognitive index ( $β = - 2.0$ ; 95% CI: $negative 3.6$ , $negative 0.4$ ) at 42–60 months of age.
7. Osorio-Valencia et al.¹¹³	2015/Mexico	167 mother–child (60 months of age) pairs	Prospective cohort	OCs	Maternal serum DDE during each trimester of pregnancy	$Mean \pm SD$ $p, p'$ -DDE ( $ng / g$ lipid): First trimester: $female = 1,624 \pm 1,376$ ; $male = 1,997 \pm 2,266$ ; second trimester: $female = 1,297 \pm 1,194$ ; $male = 1,424 \pm 1,494$ ; third trimester: $female = 1,434 \pm 1,457$ ; $male = 1,121 \pm 1,280$	Neurodevelopment: lateralization and spatial orientation (MSCA)	Higher DDE during second trimester of pregnancy was associated with poorer spatial orientation ( $β$ per 2-fold increase in $DDE = - 0.2$ ; 95% CI: $negative 0.4$ , 0.04).
8. Campos et al.¹¹⁸	2015/Brazil	46 children (6–16 years of age)	Cross-sectional	OCs	Child serum HCH, HCB, DDE, DDT, endosulfan, aldrin, endrin, dieldrin, methoxychlor, and mirex	Median (range) ( $ng / mL$ ): $lowercase alpha uppercase h c h equals 3.75 open parenthesis less than uppercase l o d to 20,558.86 close parenthesis$ ; $lowercase beta uppercase h c h equals 7.09 open parenthesis less than uppercase l o d to 33,088.2 close parenthesis$ ; $lowercase gamma uppercase h c h equals 2.03 open parenthesis less than uppercase l o d to 5,160.83 close parenthesis$ ; $lowercase italic p, lowercase italic p prime uppercase d d t equals 3.98 open parenthesis less than uppercase l o d to 5,300.06 close parenthesis$ ; $lowercase italic o, lowercase italic p prime uppercase d d t equals 0.50 open parenthesis less than uppercase l o d to 2,145.75 close parenthesis$ ; $lowercase italic p, lowercase italic p prime uppercase d d t equals 6.63 open parenthesis less than uppercase l o d to 33,556.54 close parenthesis$ ; $lowercase italic p, lowercase italic p prime uppercase d d t equals 1.06 open parenthesis less than uppercase l o d to 803.79 close parenthesis$ ; $aldrin equals 3.17 open parenthesis less than uppercase l o d to 2,090.23 close parenthesis$ ; $endrin equals 1.71 open parenthesis less than uppercase l o d to1,476.47 close parenthesis$ ; $dieldrin equals 0.89 open parenthesis uppercase l o d to 4,161.32 close parenthesis$ ; $endosulfan 1 equals 0.57 open parenthesis less than uppercase l o d to 2.49 close parenthesis$ ; $endosulfan 2 equals 0.29 open parenthesis less than uppercase l o d to 2.53 close parenthesis$ ; $mirex equals 0.51 open parenthesis less than uppercase l o d to 879.11 close parenthesis$ ; $methoxychlor less than or equal to than uppercase l o d open parenthesis less than uppercase l o d to 1.43 close parenthesis$	Neurodevelopment: cognitive function (WISC-III)	Higher $α -HCH$ was associated with poorer performance IQ ( $β$ per $1 nanogram per milliliter$ increase $= - 0.5$ ; 95% CI: $negative 0.9$ , 0), resistance to distraction ( $β = - 0.3$ ; 95% CI: $negative 0.6$ , 0), and processing speed ( $β = - 0.5$ ; 95% $CI = - 0.9$ , $negative 0.1$ ). Higher $γ -HCH$ was associated with poorer resistance to distraction ( $β = - 1.7$ ; 95% $CI = - 3.1$ , $negative 0.4$ ) and processing speed ( $β = - 1.8$ ; 95% $CI = - 3.6$ , 0). Higher $p, p'$ -DDT was associated with poorer processing speed ( $β = - 0.8$ ; 95% $CI = - 1.4$ , $negative 0.3$ ).
9. Cordier et al.¹¹⁷	2015/Guadeloupe^a	75 mother–child (18 months of age) pairs	Prospective cohort	OCs	Cord blood and breast milk chlordecone, cord blood DDE	Median (P25–P75) ( $μ g / L$ ) in entire study population (111 mother–child pairs): $cord blood chlordecone equals 0.13 open parenthesis less than uppercase l o d to 0.31 close parenthesis$ ; cord blood $lowercase italic p lowercase italic p prime uppercase d d e equals 0.30 open parenthesis 0.09 to 1.05 close parenthesis$ ; $breast milk chlordecone equals 0.60 open parenthesis less than uppercase l o d to 1.16 close parenthesis$	Neurodevelopment: personal–social, communication, problem-solving, fine motor, and gross motor (ASQ-19)	Association between cord chlordecone and fine motor scores among boys (reported by Boucher et al.¹¹¹) was not mediated by TSH.
10. Ogaz-Gonzales et al.¹¹⁴	2018/Mexico	142 mother–child (42–60 months of age) pairs	Prospective cohort	OCs	Questionnaire (pesticide use history) Maternal serum DDE during first and third trimester of pregnancy	Mean (P10–P90) DDE ( $ng / mL$ ): $first trimester equals 7.6 open parenthesis 1.8 to 23.1 close parenthesis$ $second trimester equals 8.1 open parenthesis 1.3 to 23.5 close parenthesis$ $third trimester equals 9.0 open parenthesis 1.7 to 29.2 close parenthesis$	Neurodevelopment: verbal, perceptual performance, quantitative, memory, motor skills, and general cognitive index (MSCA)	Higher third-trimester maternal DDE was associated with lower motor development in children whose mothers had lower intake of DHA (an omega-3 fatty acid) ( $β$ per 2-fold increase in $DDE = - 1.3$ ; 95% CI: $negative 2.6$ , 0.1), but not in children whose mothers had a higher DHA intake. Higher maternal DDE was associated with poorer memory skills in children whose mothers had lower ARA (an omega-6 fatty acid) intake ( $β$ per 2-fold increase in $DDE = - 1.3$ ; 95% CI: $negative 2.3$ , $negative 0.3$ ) but not in children whose mothers had a higher ARA intake.
11. Saint-Amour et al.¹¹⁵	2020/Guadeloupe	285 mother–child (7–8 years of age) pairs	Prospective cohort	OCs (chlordecone)	Cord blood and child (7 years of age) blood chlordecone	Median (range) chlordecone ( $μ g / L$ ): $cord blood equals 0.80 open parenthesis 0.06 to 29.78 close parenthesis$ ; $child blood equals 0.17 open parenthesis 0.02 to 7.01 close parenthesis$	Neurodevelopment: visual contrast sensitivity (FrACT)	Higher cord plasma chlordecone (continuous) was associated with lower scores ( $β = - 0.1$ ; 95% CI: $negative 0.1$ , 0). Child chlordecone (continuous) was associated with lower scores among boys ( $β = - 0.1$ ; 95% CI: $negative 0.2$ , 0).
12. Cordier et al.¹¹⁶	2020/Guadeloupe	116 mother–child (7 years of age) pairs	Prospective cohort	OCs (chlordecone)	Cord blood and child (7 years of age) blood chlordecone	Median (range) chlordecone ( $μ g / L$ ): $cord blood equals 0.17 open parenthesis less than uppercase l o d to 7.4 close parenthesis$ ; $child blood equals 0.04 open parenthesis less than uppercase l o d to 1.0 close parenthesis$	Neurodevelopment: sex-typed play behavior (feminine, masculine, or neutral play reported as a proportion of the complete playing time)	Null associations of cord blood and child chlordecone with sex-typed play behavior.
Studies in adults
13. Steenland et al.¹¹⁹	2014/Costa Rica	89 adults from historically (and now partially) agricultural area	Cross-sectional	OCs	Questionnaire (occupational exposure history) Serum HCH, DDE, DDT, and dieldrin	$Mean \pm SD$ ( $ng / mL$ ): Past occupational pesticides exposure: $p, p' -DDE = 0.7 \pm 0.55$ ; $p, p' -DDT = 0.14 \pm 0.08$ ; $dieldrin = 7.58 \pm 19.63$ ; $β -HCH = 0.78 \pm 0.30$ No past occupational pesticides exposure: $p, p' -DDE = 1.20 \pm 1.46$ ; $p, p' -DDT = 0.12 \pm 0.12$ ; $dieldrin = 3.40 \pm 6.48$ ; $β -HCH = 0.73 \pm 0.19$	Neurodegeneration: spatial and temporal orientation, short-term memory, attention, calculation, language, praxis (MMSE); tremor-at-rest (UPDRS)	Null associations of serum OC (parent compounds or metabolites) with MMSE and tremor-at-rest.
Studies on OPs or CBs
Studies in children
14. Handal et al.¹³⁰	2007/Ecuador	142 children (24–61 months of age) from 2 communities with industrial flower farms and from a community with local agriculture and crops for food	Cross-sectional	CBs, OPs	Questionnaire (parental occupational and residential exposure history, child outdoor activities)	Not applicable	Neurodevelopment: communication, fine motor, gross motor, problem-solving, personal–social (ASQ), visual–motor skills (Beery-Buktenica VMI developmental test)	Maternal employment in the flower industry at time of child assessment was associated with improved communication ( $percentage change equals 6.9$ ; 95% CI: $negative 0.3$ , 8.5) and problem-solving ( $percentage change equals 8.4$ ; 95% CI: 0.7, 9.4) skills. Pesticide use on domestic crops was also associated with better gross motor ( $percentage change equals 8.1$ ; 95% CI: 0.6, 9.2) and personal–social ( $percentage change equals 7.0$ ; 95% CI: $negative 0.7$ , 9.0) scores, whereas pesticide use within the home was associated with lower communication scores ( $% change = - 7.5$ ; 95% CI: $negative 8.8$ , $negative 0.3$ ). Children who played with irrigation water had lower fine motor ( $% change = - 8.2$ ; 95% CI: $negative 9.3$ , $negative 0.5$ ) and problem-solving ( $% change = - 7.3$ ; 95% CI: $negative 8.4$ , $negative 0.4$ ) scores.
15. Handal et al.¹²¹	2007/Ecuador	154 children (3–61 months of age) from 2 communities with industrial flower farms/129 children from a community with local agriculture and crops for food	Cross-sectional	CBs, OPs	Questionnaire (parental occupational and residential exposure history)	Not applicable	Neurodevelopment: communication, fine motor, gross motor, problem solving, personal–social (ASQ)	Children 3–23 months of age from industrial flower farms communities had lower gross motor ( $β = - 8.8$ , $lowercase italic p equals 0.002$ ), fine motor ( $β = - 5.0$ , $lowercase italic p equals 0.06$ ), and socioindividual ( $β = - 5.8$ , $lowercase italic p equals 0.02$ ) scores compared with children from a local agriculture community. Children 24–61 months of age from industrial flower farms communities had lower gross motor scores compared with children of similar ages from a local agriculture community ( $β = - 3.8$ , $lowercase italic p equals 0.06$ ).
16. Handal et al.¹²⁰	2008/Ecuador	121 children (3–23 months of age) from 2 communities with industrial flower farms and from a community with local agriculture and crops for food	Cross-sectional	CBs, OPs	Questionnaire (maternal occupational exposure history during pregnancy)	Not applicable	Neurodevelopment: communication, fine motor, gross motor, problem solving, personal–social (ASQ), prehension and visual acuity (targeted development tests)	Children whose mothers worked as floriculturists during pregnancy had lower communication ( $lowercase beta equals 4.6$ ; 95% CI: $negative 9.6$ , 0.3) and fine motor $β = - 8.0$ ; 95% CI: $negative 13.0$ , $negative 3.1$ ) scores and had an increased risk of poor visual acuity ( $odds ratio equals 4.7$ ; 95% CI: 1.1, 20) than children whose mothers did not.
17. Harari et al.¹²³	2010/Ecuador	84 children (6–8 years of age) living in a floricultural area	Cross-sectional	OPs	Questionnaire (parental occupational and residential exposure history) Urinary DAPs^b Blood AChE^b	Not applicable	Neurodevelopment: simple motor speed (finger tapping task), motor coordination (Santa Ana Form Board), attention (CPT), short-term auditory memory (WISC and Stanford-Binet), visual performance (Raven’s test and Stanford-Binet copying test), visual memory (Stanford-Binet copying recall test)	Children whose mothers were exposed to pesticides during pregnancy showed poorer motor speed ( $β = - 7.1$ ; 95% CI: $negative 12.5$ , $negative 1.6$ ), motor coordination ( $odds ratio equals 5.3$ ; 95% CI: 1.03, 27.6), visual performance (Raven’s test: $lowercase beta equals 0.5$ ; 95% CI: 0.2, 1.0), and visual memory ( $odds ratio equals 6.6$ ; 95% CI: 1.02, 42.9) compared with children of unexposed mothers. Children whose fathers were exposed to pesticides during pregnancy showed poorer visual memory ( $odds ratio equals 13.4$ ; 95% CI: 1.8, 101.9) than children of unexposed fathers. Children with current exposure (i.e., at least one detectable urinary DAP metabolite) had longer reaction times compared with children with no exposure ( $lowercase beta equals 64.7$ ; 95% CI: $negative 12.4$ , 141.7).
18. Muñoz-Quesada et al.¹²⁷	2011/Chile	25 children (6–11 years of age) from rural communities	Cross-sectional	OPs	Child urinary DAPs	Geometric mean (range) ( $μ g / L$ ): $uppercase d m p equals 7.3 open parenthesis 2.5 to 63.6 close parenthesis$ ; $uppercase d m t p equals 7.0 open parenthesis 2.5 to 51.4 close parenthesis$ ; $uppercase d e p equals 17.3 open parenthesis 2.5 to 49.9 close parenthesis$	Neurodevelopment: cognitive function (WISC-III)	Negative association between urinary DMTP and processing speed ( $r = - 0.44$ , $lowercase italic p equals 0.01$ ). Null associations of other DAP metabolites and WISC-III outcomes.
19. Martos-Mula et al.¹²⁹	2013/Argentina	42 children (7–10 years of age) living in an agricultural area/29 children living in a nonagricultural area	Cross-sectional	OPs, CBs	Questionnaire Blood AChE, BChE	Not applicable	Neurodevelopment: associative memory (Digit and Symbol subtest), short-term memory (Digit Memory test), maze test (motor, visuospatial processing), cognitive function (WISC-III), gross motor and balance tests	Children living in an agricultural area had poorer motor function and visuospatial processing than children living in a nonagricultural area ( $lowercase italic p less than 0.01$ ). Null associations between enzyme activities and neurodevelopmental outcomes.
20. Suarez-Lopez et al.¹²²	2013/Ecuador	307 children (4–9 years of age) living in floricultural communities	Cross-sectional	OPs	Questionnaire (parental occupational and residential exposure history) Blood AChE	Not applicable	Neurodevelopment: attention and inhibitory control, language, memory and learning, sensorimotor, visuospatial processing (NEPSY-II)	Boys, but not girls, in the highest tertile of AChE activity had increased odds of poor neurodevelopment ( $<$ 9th percentile) than boys in the lowest tertile (total neurodevelopment $odds ratio equals 5.1$ ; 95% CI: 0.8, 31.5; attention/executive functioning $odds ratio equals 4.6$ ; 95% CI: 1.2, 17.4); memory/learning $odds ratio equals 6.0$ ; 95% CI: 1.2, 31.1).
21. Fortenberry et al.¹²⁸	2014/Mexico	187 mother–child (6–11 years of age) pairs	Prospective cohort	OPs (chlorpyrifos)	Maternal urinary TCPy during third trimester of pregnancy	Geometric mean (P10–P90) TCPy ( $ng / mL$ ): 1.76 (0.45–6.40)	Neurodevelopment: attention and hyperactivity (CRS-R, CPT, BASC-2)	Increased ADHD index for the highest TCPy tertile compared with the lowest tertile for boys ( $lowercase beta equals 5.6$ ; 95% CI: $negative 0.2$ , 11.3). Increased attention problems for the middle TCPy tertile compared with the lowest tertile for girls ( $lowercase beta equals 5. 8$ ; 95% CI: $negative 0.8$ , 12.4).
22. Suarez-Lopez et al.¹²⁶	2017/Ecuador	308 children (4–9 years of age) living in floricultural communities	Cross-sectional	OPs	Questionnaire (parental occupational and residential exposure history) Blood AChE	Not applicable	Neurodevelopment: attention and inhibitory control, language, memory and learning, sensorimotor, visuospatial processing (NEPSY-II)	Children examined sooner after Mother’s Day had lower attention/inhibitory control (score difference per 10.8 d $equals 0.4$ ; 95% CI. 0.10, 0.7), visuospatial processing (0.6; 95% CI: 0.3, 0.9), and sensorimotor (0.4; 95% CI: 0.1, 0.8) scores than children examined later. Further adjustment for AChE activity had overall a small effect on most associations but strengthened associations in the attention and inhibitory control domain by about 16%.
23. Suarez-Lopez et al.¹²⁴	2019/Ecuador	529 adolescents (11–17 years of age) living in floricultural communities	Cross-sectional	OPs	Blood AChE	Not applicable	Mental health disorders: anxiety (MASC-2) and depression symptoms (CDI-2)	Lower AChE activity was associated with more depression symptoms ( $β$ per SD decrease in AChE $activity equals 1.1$ ; 95% CI: 0, 2.2). Associations were stronger among girls ( $lowercase beta 1.6$ ; 95% CI: 0.1, 3.1) than boys ( $lowercase beta 0.7$ ; 95% CI: $negative 0.9$ , 2.3) and among younger ( $lowercase beta 1.6$ ; 95% CI: $negative 0.2$ , 3.4) than older children ( $lowercase beta 0.6$ ; 95% CI: $negative 0.8$ , 2.0). No associations were observed with anxiety scores.
24. Suarez-Lopez et al.¹²⁵	2021/Ecuador	300 adolescents (11–17 years of age) living in floricultural communities	Cross-sectional	OPs	Blood AChE	Not applicable	Mental health disorders: anxiety (MASC-2) and depression symptoms (CDI-2)	Lower AChE activity was associated with more depression symptoms ( $β$ per 10% decrease in AChE $activity equals 1.0$ ; 95% CI: 0, 1.9) and increased odds of an elevated depression score ( $odds ratio equals 1.7$ ; 95% CI: 1.0, 2.7). These associations were stronger among girls than boys. Adjustment for cortisol, testosterone and dehydroepiandrosterone reduced gender differences by 18%–62%.
Studies in adults
25. Wesseling et al.¹³⁶	2010/Costa Rica	78 male banana farmworkers with poisoning/130 non-poisoned workers from company payrolls	Cross-sectional	OPs, CBs	Questionnaire (occupational exposure history, history of OP pesticide poisoning) Blood AChE^b	Not applicable	Mental health disorders: psychological distress and suicidal ideation (BSI)	Farmworkers with history of OP pesticide poisonings had increased odds of somatization ( $odds ratio equals 3.1$ ; 95% CI:1.6, 6.0), obsessive-compulsiveness ( $odds ratio equals 3.2$ ; 95% CI:1.6, 6.2), interpersonal sensitivity ( $odds ratio equals 2.9$ ; 95% CI:1.5, 5.8), depression ( $odds ratio equals 2.4$ ; 95% CI: 1.3, 4.7), hostility ( $odds ratio equals 2.3$ ; 95% CI: 1.1, 4.6), anxiety ( $odds ratio equals 2.3$ ; 95% CI:1 1.4, 4.4), phobia ( $odds ratio equals 1.9$ ; 95% CI: 1.0, 3.6), and psychoticism ( $odds ratio equals 2.2$ ; 95% CI: 1.1, 4.3). Individuals with history of OP pesticide poisonings had increased odds of having suicidal thoughts in the previous month ( $odds ratio equals 3.6$ ; 95% CI: 1.5, 8.8), with increasing risk for those with more poisonings ( $prevalence ratio equals 5.0$ ; 95% CI: 1.7, 14.5). Farmworkers with history of CB pesticide poisonings had increased odds of somatization ( $odds ratio equals 2.6$ ; 95% CI: 1.1, 6.2).
26. Muñoz-Quezada et al.¹³²	2016/Chile	93 farmworkers/84 controls	Cross-sectional	OPs	Questionnaire (occupational exposure history)	Not applicable	Neurobehavioral performance: cognitive function (WAIS-IV), visuospatial memory and visual perception (ROCF), visual memory and visuoconstruction skills (BVRT), neurological alterations with frontal involvement (MMSE), and motor performance	Farmworkers had lower WAIS-IV verbal comprehension ( $β = - 3.2$ ; 95% CI: $negative 6.1$ , $negative 0.2$ ), processing speed ( $β = - 4.4$ ; 95% CI: $negative 8.6$ , $negative 0.3$ ), and total IQ ( $β = - 4.0$ ; 95% CI: $negative 6.8$ , $negative 0.7$ ) scores than controls. Farmworkers also had lower MMSE scores ( $β = - 1.0$ ; 95% CI: $negative 1.7$ , $negative 0.1$ ) and poorer discrimination sensitivity ( $lowercase beta equals 1.0$ ; 95% CI: 0.2, 1.2) and deep reflexes ( $lowercase beta equals 1.1$ ; 95% CI: 0.0, 2.2) than controls.
27. Corral et al.¹³¹	2017/Chile	32 farmworkers/32 individuals living in agricultural communities/38 controls	Cross-sectional	OPs	Questionnaire (occupational exposure history)	Not applicable	Neurobehavioral performance: spatial and temporal orientation, short-term memory, attention, calculation, language, praxis (MMSE), memory and attention (WAIS-R DST), visuoconstruction skills and visual memory (ROCF), divided attention and resistance to interference (Stroop), attention (d2), executive function (FAB), and verbal fluency (Barcelona for Animals and Letter P)	Both farmworkers and people living in agricultural communities had increased odds of poorer (i.e., below cutoff value) executive function ( $odds ratio equals 44.9$ ; 95% CI: 5.6, 359.7 and $odds ratio equals 7.3$ ; 95% CI: 1.7, 32.4, respectively), memory and attention (DST forward: $odds ratio equals 4.9$ ; 95% CI: 1.6, 14.9, and DST backward: $odds ratio equals 7.4$ ; 95% CI: 2.4, 22.4; DST forward: $odds ratio equals 4.5$ ; 95% CI: 1.4, 13.8, and DST backward: $odds ratio equals 2.9$ ; 95% CI: 1.02, 8.3, respectively), and verbal fluency (animals: $odds ratio equals 5.7$ ; 95% CI: 1.3, 25.6, and Letter P: $odds ratio equals 16.7$ ; 95% CI: 4.3, 64.6; animals: $odds ratio equals 4.5$ ; 95% CI: 1.04, 19.4, and Letter P: $odds ratio equals 8.1$ ; 95% CI: 2.1, 31.3, respectively) than the unexposed group.
28. Grillo Pizarro et al.¹³⁵	2018/Chile	55 farmworkers/58 unexposed controls	Cross-sectional	OPs	Questionnaire (occupational and residential exposure history)	Not applicable	Peripheric polyneuropathy	Farmworkers exposed to OP pesticides had increased odds of peripheric polyneuropathy compared with controls ( $odds ratio equals 3.6$ ; 95% CI: 1.2, 10.5)
29. Serrano-Medina et al.¹³⁷	2019/Mexico	140 farmworkers/100 controls	Cross-sectional	OPs	Questionnaire (occupational exposure history) Blood AChE	Not applicable	Mental health disorders: neuropsychiatric disorders (MINI based on DSM-IV)	Farm work was associated with increased odds of suicide ( $odds ratio equals 5.3$ ; 95% CI: 2.4, 11.9), whereas higher AChE activity levels were associated with decreased odds of suicide ( $odds ratio equals 0.5$ , $lowercase italic p less than 0.01$ ).
30. Buralli et al.¹³⁸	2020/Brazil^c	42 pesticide applicators/36 farmworkers who did not apply pesticides	Cross-sectional	OPs	Questionnaire (occupational exposure history) Blood AChE, BChE^b	Not applicable	CMD (SRQ-20)	Farmworkers who did not spray pesticides had a higher probability of feeling easily tired ( $prevalence ratio equals 3.2$ ; 95% CI: 1.3, 7.7) and worthless ( $prevalence ratio equals 7.2$ ; 95% CI: 1.7, 31.0) compared with pesticide applicators.
31. Ramírez-Santana et al.¹³⁴	2020/Chile	87 adults occupationally exposed (OE)/81 environmentally exposed (EE)/100 unexposed controls (RG)	Cross-sectional	OPs, CBs	Questionnaire (occupational and residential exposure history) Blood AChE, BChE, APEH	Not applicable	Neurobehavioral performance at one (RG) or two (OE and EE) time points: general mental status (MMSE), memory (WMS III, Digit span forward, ROCF memory, 1036 A-B and A-B recall), language (WAIS subtest vocabulary), constructive praxis (ROCF copy, WAIS subtest block design), executive function (Tower of London movements and time resolution tests, WCST perseverative errors, Barcelona test categorical evocation animals and words), attention (WAIS digit span backward, d2 test, Stroop word–color and inhibitory control tests, Trail Making Test A, WAIS symbols), Psychomotricity (Purdue pegboard test, MOART reaction time, MOART finger tapping test), Mood (BDI-II depression inventory, Hamilton anxiety scale)	Both exposure groups (OE and EE) had poorer executive function (Tower of London time, WCST perseverative errors), psychomotricity [MOART reaction time (right and left hand)], and mood (BDI-II depression inventory, Hamilton anxiety scale) than the RG. Seasonal exposure impaired performance in both exposure groups on all tests except those related to attention and mood. During the spray season, BChE activity was associated with decreased scores on tests of logical, auditory, and visual memory; inhibitory control of cognitive interference; constructional and planning abilities; executive function; and motor speed and coordination among those in the EE group. Weaker associations were observed for AChE levels and tests of logical memory, constructional abilities, and fine motor coordination in the EE group. In the OE group, levels of the three biomarkers were associated with worse performance on tests of inhibitory control of cognitive interference (2 tests with AChE, 2 tests with BChE, and 1 test for APEH); results were only significant for AChE.
32. Ramírez-Santana et al.¹³³	2020/Chile	78 adults occupationally exposed (OE)/78 environmentally exposed (EE)	Cross-sectional	OPs, CBs	Questionnaire (occupational and residential exposure history) Blood AChE, BChE	Not applicable	Changes in neurobehavioral performance from prespray to spraying season in OE and EE: General mental status (MMSE), memory (WMS III, Digit span forward, ROCF memory, 10/36 SRT A-B and A-B recall), language (WAIS subtest vocabulary), constructive praxis (ROCF copy, WAIS subtest block design), executive function (Tower of London movements and time resolution tests, WCST perseverative errors, Barcelona test categorical evocation animals and words), attention (WAIS digit span backward, d2 test, Stroop word–color and inhibitory control tests, Trail Making Test A, WAIS symbols), Psychomotricity (Purdue pegboard test, MOART reaction time, MOART finger tapping test), Mood (BDI-II depression inventory, Hamilton anxiety scale)	AChE inhibition was associated with worse performance on tests of attention (Stroop word–color and inhibitory control test, Trail Making A test) in the EE group and worse performance on tests of memory (WMS) and attention (Trail Making A test) in the OE group. BChE inhibition was associated with worse performance on tests of general mental status (MMSE), memory (WMS III-I, WMS III-II, Digit span forward, 10/36 SRT-A, 10/36 SRT-B, 10/36 SRT-A recall, 10/36 SRT-B recall), language (WAIS), attention (Stroop word–color and inhibitory control tests), executive function (Tower of London movements, WCST perseverative errors, Barcelona tests animals) in the EE group and worse performance on a test of attention (Stroop word–color test) in the OE group.
Studies on other pesticides or multiple pesticide classes
Studies in children
33. Eckerman et al.¹⁴³	2007/Brazil	38 adolescents (10–18 years of age) from rural areas/28 adolescents from urban areas	Cross-sectional	Multiple pesticide classes	Questionnaire (exposure index based on 86 occupational history questions plus number of hours worked per day applying chemical plus number of years worked)	Not applicable	Neurobehavioral: BARS (CPT, MTS, DST, PRT, RTT, SAT, SDL, SDT, TAP)	Compared with adolescents from rural areas, adolescents from urban areas performed better on tests of response speed and coordination (TAP_NP), attention and working memory (DS-F), and complex function (SD_LAT), but worse on a cognition test (SDL) ( $lowercase italic p less than 0.1$ ). Among the youngest age group (10–11 y), rural participants had poorer mean scores in tests of response time and coordination (TAP_P, TAP_NP, TAP_ALT), motivation (PRT), attention and working memory (DS-F; CPT_HLAT; SAT_LAT), reaction time (RT_ALL), complex function (SDT_LAT), and visual memory and delay (MTS_LAT) ( $lowercase italic p less than 0.1$ for each) than urban participants.
34. Lu et al.¹³⁹	2009/Costa Rica	18 children (4–10 years of age) of conventional coffee farmworkers/17 children of organic coffee farmworkers	Cross-sectional	OPs, herbicides, pyrethroids	Child urinary 2,4-D, TCPy, 3-PBA, and IMPY	$Mean \pm SD$ ( $μ g / L$ ): La Amistad: 2, $4 -D = 0.21 \pm 0.22$ ; $3 -PBA = 0.75 \pm 1.61$ ; $CIT = 0.27 \pm 0.41$ ; $IMPY = 0.92 \pm 2.15$ ; $TCPy = 0.31 \pm 0.91$ Las Mellizas: $2,4 -D = 0.41 \pm 0.49$ ; $3 uppercase p b a equals 0.4 0.22$ ; $CIT = 0.14 \pm 0.26$ ; $IMPY = 0.52 \pm 1.05$ ; $TCPy = 1.45 \pm 2.29$	Neurodevelopment: cognition (BARS, figure-drawing task, long-term memory test)	Null associations between urinary pesticide metabolites and neurodevelopmental outcomes.
35. van Wendel et al.¹⁴⁰	2016/Costa Rica	140 rural children (6–9 years of age) living near banana and plantain plantations	Cross-sectional	Mn-containing fungicides, OPs, pyrethroids	Questionnaire (parental occupational exposure history) Child urinary TCPy, ETU, and 3-PBA	Median (P25–P75) ( $μ g / L$ ): $uppercase t c p lowercase y equals 1.4 open parenthesis 0.7 to 3.1 close parenthesis$ ; $uppercase e t u equals 1.2 open parenthesis 0.7 to 3.0 close parenthesis$ ; $3 uppercase p b a equals 0.8 open parenthesis 0.5 to 1.5 close parenthesis$	Neurodevelopment: cognitive function (WISC-IV), behavioral problems (CPRS-R), visual sensory function (LDD-15), visuospatial construction and visual memory (ROCF), verbal memory and learning abilities (CAVLT-2), visual–motor coordination (DTVP-2), fine motor function (WRAVMA), and attention (RTT)	Higher TCPy was associated with poorer working memory in boys ( $β$ per 10-fold increase in $TCPy = - 7.5$ ; 95% CI: $negative 14.4$ , $negative 0.7$ ) and poorer visual–motor coordination ( $β = - 1.4$ ; 95% CI: $negative 2.7$ , $negative 0.1$ ); oppositional disorders ( $odds ratio equals 6.8$ ; 95% CI: 1.8, 28.6) and decreased ability to discriminate colors ( $odds ratio equals 6.6$ ; 95% CI: 1.6, 30.3) in boys and girls combined. Higher was associated with poorer verbal learning outcomes ( $β = - 7.0$ ; 95% CI: $negative 12.7$ , $negative 1.3$ ). Higher 3-PBA was associated with poorer processing speed scores, particularly in girls ( $β = - 8.8$ ; 95% CI: $negative 16.1$ , $negative 1.4$ ).
36. Watkins et al.¹⁴²	2016/Mexico	187 mother–child (2–3 years of age) pairs	Prospective cohort	Pyrethroids	Maternal urinary 3-PBA during third trimester of pregnancy	$Geometric mean \pm GSD$ 3-PBA ( $ng / mL$ ): 0.26 $\pm 1.80$	Neurodevelopment: cognitive, language, personal–social, fine and gross motor development (BSID-II)	Children whose mothers had medium and high 3-PBA during pregnancy had lower MDI scores at 24 months than children whose mothers had low 3-PBA ( $β = - 3.5$ ; 95% CI: $negative 7.9$ , 0.8 and $β = - 3.8$ ; 95% CI: $negative 8.4$ , 0.8, respectively). Null associations of prenatal 3-PBA with PDI scores at 24 or 36 months.
37. Mora et al.¹⁴¹	2018/Costa Rica	355 mother–child (1 year of age) pairs living near banana plantations aerially sprayed	Prospective cohort	Mn-containing fungicides	Maternal urinary ETU, blood Mn, and hair Mn during pregnancy	$Mean \pm SD$ ( $μ g / L$ ): $ETU = 4.4 \pm 7.1$ ; $hair manganese open parenthesis microgram per gram close parenthesis equals 3.7 open parenthesis 5.4 close parenthesis$ ; $blood Mn = 24.4 \pm 6.2$	Neurodevelopment: cognition, motor function, language, and social–emotional development (BSID-III)	Girls whose mothers had higher urinary ETU during pregnancy had lower social–emotional scores ( $β$ per 10-fold $increase = - 7.4$ points; 95% CI: $negative 15.2$ , 0.4), whereas those whose mothers had higher hair Mn during pregnancy had lower cognitive scores ( $β$ per 10-fold $increase = - 3.0$ points; 95% CI: $negative 6.1$ , 0.1). Among boys, higher hair Mn during pregnancy was associated with lower social–emotional scores ( $β$ per 10-fold $increase = - 4.6$ points; 95% CI: $negative 8.5$ , $negative 0.8$ ). Null associations for blood Mn, language, and motor outcomes.
38. Christian et al.¹⁴⁵	2018/Jamaica	298 children (2–8 years of age) with ASD/298 controls without ASD	Case–control	Multiple pesticide classes	Questionnaire (maternal exposure history)	Not applicable	ASD (ADOS, ADI-R)	Maternal exposure to pesticides from 3 months before pregnancy to end of breastfeeding was associated with increased risk of ASD ( $odds ratio equals 1.7$ ; 95% CI: 1.1, 2.6), with some evidence of effect modification by exposure to oil-based paints and paint solvents.
39. Friedman et al.¹⁴⁴	2020/Ecuador	307 children (4–9 years of age) living in floricultural communities	Cross-sectional	Multiple pesticide classes	Proximity to floricultural crops	Not applicable	Neurodevelopment: attention and inhibitory control, language, memory and learning, sensorimotor, visuospatial processing (NEPSY-II)	For every 100 m closer in proximity to treated floricultural crops, participants had increased odds of low memory/learning ( $odds ratio equals 1.2$ ; 95% CI: 1.1, 1.5) and language ( $odds ratio equals 1.1$ ; 95% CI: 1.0, 1.2) scores. Compared with those living $greater than 500 meters$ from crops, those living within $50 meters$ of crops had lower language ( $β = - 1.3$ ; 95% CI: $negative 2.5$ , $negative 0.1$ ), attention/inhibitory control ( $β = - 1.2$ , 95% CI: $negative 2.5$ , $negative 0.0$ ), and memory/learning ( $β = - 0.9$ ; 95% CI: $negative 2.0$ , 0.2) scores.
Studies in adults
40. Araújo et al.¹⁵⁹	2007/Brazil^c	102 farmworkers	Cross-sectional	Multiple pesticide classes	Questionnaire (occupational exposure history) Blood AChE	Not applicable	Neurological symptoms (neurological examination and perception of neurological symptoms)	Null association between inhibition of AChE activity and intoxication symptoms.
41. Steenland et al.¹⁴⁶	2013/Costa Rica	400 adults $greater than 60$ years of age from historically (and now partially) agricultural area	Cross-sectional	Multiple pesticide classes	Questionnaire (occupational exposure history)	Not applicable	Neurodegeneration: spatial and temporal orientation, short-term memory, attention, calculation, language, praxis (MMSE); PD risk (UPDRS)	Exposed subjects performed worse on the MMSE than the nonexposed ( $lowercase italic p equals 0.01$ ), had increased odds of abnormal scores on two UPDRS items (tremor-at-rest $odds ratio equals 2.3$ ; 95% CI: 1.3–5.2 and finger tapping $odds ratio equals 2.9$ ; 95% CI: 1.03, 8.4), and had an increased risk of PD ( $odds ratio equals 2.6$ ; 95% CI: 0.9, 7.3).
42. Faria et al.¹⁵²	2014/Brazil	2,400 tobacco farmworkers	Cross-sectional	Fungicides, herbicides, neonicotinoids, OPs, pyrethroids	Questionnaire (occupational exposure history)	Not applicable	Mental health disorders: MPD (SRQ-20)	Increased risk of MPD among those who entered the treated area following application ( $prevalence ratio equals 1.7$ ; 95% CI: 1.3, 2.2) and those who had contact through clothes wet from pesticides ( $prevalence ratio equals 1.4$ ; 95% CI: 1.1, 1.7). Workers from farms in which OPs were used had an increased risk of MPD compared with those who were not exposed ( $prevalence ratio equals 1.5$ ; 95% CI: 1.2, 1.9). Number of poisonings was positively associated with risk of MDP (PR for 1 $episode equals 1.6$ ; 95% CI: 1.1, 2.2; PR for 2 $episodes equals 2.5$ ; 95% CI: 1.8, 3.4).
43. Portilla-Portilla et al.¹⁵⁵	2014/Colombia	49 adults from a rural area	Cross-sectional	Multiple pesticide classes	Questionnaire (occupational and environmental history of exposure to neurotoxic pesticides)	Not applicable	Neurological symptoms (self-reported)	Participants with pesticide exposure had increased odds of irritability ( $prevalence ratio equals 1.8$ ; 95% CI: 1.1, 2.8), dizziness ( $prevalence ratio equals 2.3$ ; 95% CI: 1.1, 4.9), phosphenes ( $prevalence ratio equals 2.6$ ; 95% CI: 1.0, 6.6), epistaxis ( $prevalence ratio equals 2.9$ ; 95% CI: 1.0, 8.3), and fasciculations ( $prevalence ratio equals 8.7$ ; 95% CI: 1.1, 66.9).
44. Campos et al.¹⁴⁹	2016/Brazil	869 adults from a rural population	Cross-sectional	Herbicides, natural pesticides, OPs, OCs, pyrethroids	Questionnaire (occupational exposure history)	Not applicable	Mental health disorders: MPD (SRQ-20) and depression (self-reported)	Ever feeling ill after a pesticide application was associated with common mental disorders ( $odds ratio equals 2.6$ ; 95% CI: 1.6, 4.3) and self-reported depression ( $odds ratio equals 2.6$ ; 95% CI: 1.6, 4.2). Age at onset of pesticide exposure $less than or equal to 15$ y ( $odds ratio equals 1.7$ ; 95% CI: 1.7, 2.8), exposure to pyrethroids ( $odds ratio equals 1.8$ ; 95% CI: 1.0, 3.2) and aliphatic alcohol ( $odds ratio equals 2.0$ ; 95% CI: 1.04, 3.8), and greater period of exposure to dinitroaniline ( $odds ratio equals 2.2$ ; 95% CI: 1.0, 4.7) and sulfonyl urea ( $odds ratio equals 5.0$ ; 95% CI: 1.1, 23.0) were associated with self-reported depression.
45. Azevedo and Meyer¹⁵⁸	2017/Brazil	51 endemic disease control agents with essential tremor/204 endemic disease control agents with no tremor (controls)	Case–control	Larvicides, OCs, OPs, pyrethroids	Questionnaire (occupational exposure history)	Not applicable	Neurodegeneration: essential tremor	Null association of cumulative pesticide exposure load (calculated by multiplying years of application, frequency of application, and hours worked per day) with essential tremor. Workers who had applied pesticides for 16–16.9 y had increased odds of essential tremor compared with workers who had applied pesticides for $less than or equal to 13$ y ( $odds ratio equals 4.9$ ; 95% CI: 1.3, 18.0).
46. Hansen et al.¹⁴⁷	2017/Bolivia	120 male endemic disease control agents	Cross-sectional	Pyrethroids	Questionnaire (occupational exposure history)	Not applicable	Neurobehavioral performance: hand tremor, postural balance, vocabulary (BNT), audiovisual reaction (RTT), cognition (BARS), visual attention (CPT), complex cognitive function (SDT), attention and memory (DST, SDL), and visual memory (MTS)	Higher pesticide spraying intensity was associated with increased odds of poor postural balance among those exposed to pyrethroids (OR per 1-quintile increase in $intensity equals 3.83$ ; 95% CI: 1.1, 13.6). Higher spraying intensity was also associated with worse neurocognitive performance ( $β$ per 1-quintile increase for all $workers = - 0.4$ ; 95% CI: $negative 0.7$ , $negative 0.2$ and $β$ for workers exposed to pyrethroids $only = - 1.3$ ; 95% CI: $negative 2.2$ , $negative 0.5$ ). Cumulative pesticide exposure was associated with worse neurocognitive performance ( $β$ per 1-quintile increase for all $workers = - 0.4$ ; 95% CI: $negative 0.6$ , $negative 0.1$ and $β$ for workers exposed to pyrethroids $only = - 1.4$ ; 95% CI: $negative 2.3$ , $negative 0.4$ ).
47. Conti et al.¹⁴⁸	2018/Brazil	220 male farmworkers	Cross-sectional	Glyphosate, fungicides, neonicotinoids	Questionnaire (occupational exposure history)	Not applicable	Mental health disorders: depression (BDI-II)	Pesticide exposure was associated with increased odds of more severe depressive symptoms ( $odds ratio equals 5.5$ ; 95% CI: 1.2, 25.9).
48. Palzes et al.¹⁶⁰	2019/Costa Rica	48 farmworkers	Cross-sectional	Mn-containing fungicides	Hair and toenail Mn	$Mean \pm SD$ ( $μ g / g$ ) Mn: $Hair = 0.40 \pm 3.53$ ; $toenail = 0.24 \pm 3.54$	Cortical brain activity (fNIRS)	Null association of hair and toenail Mn concentrations with brain activity during working memory task.
49. Conti et al.¹⁵⁰	2020/Brazil	288 adults from a rural area	Cross-sectional	Multiple pesticide classes	Questionnaire (pesticide exposure in general, did not distinguish between residential and occupational)	Not applicable	Mental health disorders: depression (BDI-II)	Pesticide use was associated with increased odds of depression ( $odds ratio equals 4.2$ , $lowercase italic p less than 0.001$ ).
50. Vasconcellos et al.¹⁵⁶	2020/Brazil	32 participants with PD	Cross-sectional	Multiple pesticide classes	Questionnaire (occupational exposure history)	Not applicable	PD	78% of patients with PD had worked in agriculture and 75% had contact with pesticides.
51. Silvestre et al.¹⁵⁷	2020/Brazil	88 PD cases/264 controls	Case–control	Multiple pesticide classes	Questionnaire (occupational and environmental exposure history)	Not applicable	PD	Pesticide use at work was associated with increased odds of PD ( $odds ratio equals 3.4$ ; 95% CI: 1.6, 7.6).
52. Cruzeiro Szortyka et al.¹⁵³	2021/Brazil	2,469 tobacco growers	Cross-sectional	Multiple pesticide classes	Questionnaire (occupational exposure history, history of APP, pesticide-related work tasks)	Not applicable	Mental health disorders: suicidal ideation (SRQ), suicide attempts (self-reported)	Performing between 6 and 9 pesticide-related tasks ( $prevalence ratio equals 1.8$ ; 95% CI: 1.0, 3.3) and history of APP ( $prevalence ratio equals 2.4$ ; 95% CI: 1.2, 4.7) were associated with increased prevalence of suicidal ideation.
53. Gonzaga et al.¹⁵⁴	2021/Brazil	547 farmworkers (311 occupationally exposed/236 following agroecological practices)	Cross-sectional	Multiple pesticide classes	Questionnaire (occupational exposure history, history of APP)	Not applicable	Mental health disorders: suicidal ideation (SRQ-20)	Occupational pesticide exposure ( $odds ratio equals 2.3$ ; 95% CI: 1.2, 4.6) and history of APP ( $odds ratio equals 8.6$ ; 95% CI: 3.0, 24.7) were associated with increased odds of suicidal ideation.
54. Farnham et al.¹⁵¹	2021/Costa Rica	300 farmworkers	Cross-sectional	Multiple pesticide classes	Questionnaire (occupational exposure history, history of APP)	Not applicable	Neurological symptoms Mental health disorders: psychological distress and suicidal ideation (BSI)	Self-reported APP was associated with fainting ( $odds ratio equals 7.5$ ; 95% CI: 1.8, 30.7), shaking hands ( $odds ratio equals 3.5$ ; 95% CI: 1.6, 7.6), numbness/tingling in hands or feed ( $odds ratio equals 3.2$ ; 95% CI: 1.7, 6.3), insomnia ( $odds ratio equals 2.5$ , 95 % CI: 1.3, 4.8), accelerated heartrate ( $odds ratio equals 2.4$ ; 95% CI: 1.0, 5.5), dizziness ( $odds ratio equals 2.4$ ; 95% CI: 1.2, 4.7), increased irritability/anger ( $odds ratio equals 2.4$ ; 95% CI: 1.2, 4.6), low energy ( $odds ratio equals 2.3$ ; 95% CI: 1.2, 4.5), and difficulty concentrating ( $odds ratio equals 2.0$ ; 95% CI: 1.1, 3.9) during the 12 months prior to the interview. Farmworkers who reported an APP in the 10 y prior to the interview experienced increased odds of hostility ( $odds ratio equals 4.5$ ; 95% CI: 1.2, 17.7) and paranoid ideation ( $odds ratio equals 3.8$ ; 95% CI: 1.0, 18.2).

Note: %change, percentage change; 2,4-D, 2,4-dichlorophenoxyacetate; 3-PBA, 3-phenoxybenzoic acid; AChE, acetylcholinesterase; ADHD, attention deficit hyperactivity disorder; ADI-R, Autism Diagnostic Interview–Revised; ADOS, Autism Diagnostic Observation Schedule; APEH, acyl peptide hydrolase; APP, acute pesticide poisoning; ARA, arachidonic acid; ASD, autism spectrum disorder; ASQ, Ages and Stages Questionnaire; BARS, BChE, butyrylcholinesterase; Behavioral Assessment and Research System; BASC-2, Behavior Assessment System for Children-2; BDI-II, Beck’s Depressive Inventory, 2nd edition; BNT, Boston Naming Test; BSI, Brief Symptom Inventory; BSID, Bayley Scales of Infant Development; BSID-II, Bayley Scales of Infant Development, 2nd edition; BVRT, Benton Visual Retention Test; CAVLT-2, Children’s Auditory Verbal Learning Test, 2nd edition; CB, carbamate; CDI-2, Children’s Depression inventory, 2nd edition; CI, confidence interval; CIT, 5-chloro-1,2-dihydro-1-isopropyl-[3H]-1; CMD, common mental disorders; CRS-R, Conners’ Parental Rating Scales–Revised; CPT, Continuous Performance Test; CPRS-R, Conner’s Parent Rating Scale–Revised Short Version; CPT, Continuous Performance Test; CPT_HLAT, Continuous Performance Latency for Hits; DAP, dialkylphosphate; DDE, dichlorodiphenyldichloroethylene; DDT, dichlorodiphenyltrichloroethane; DEP, diethylphosphate; DHA, docosahexaenoic acid; DMP, dimethylphosphate; DMTP, dimethylthiophosphate; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders; DS-F, DST, Digit Span Test; DTVP-2, Frostig Developmental Test of Visual Perception, 2nd edition; EE, environmentally exposed; ETU, ethylenethiourea; FAB, Frontal Assessment Battery; fNIRS, functional near-infrared spectroscopy; FrACT, functional acuity contrast test; FTII, Fagan Tests of Infant Intelligence; GSD, geometric standard deviation; HCH, hexachlorocyclohexane; IMPY, 2-isopropyl-4-methyl-6-hydroxypyrimidinol; IQ, intelligence quotient; LOD, limit of detection; LDD-15, Lanthony Desaturated D-15 Test; MASC-2, Multidimensional Anxiety Scale for Children, 2nd edition; MDI, Mental Development Index; MINI, Mini International Neuropsychiatric Interview Diagnostic Test; MMSE, Mini-Mental State Exam; Mn, manganese; MOART, multi-operational apparatus for reaction time; MPD, minor psychiatric disorders; MSCA, McCarthy Scales of Children’s Abilities; MTS, matching to sample; MTS_LAT, matching to sample latency; NESPY-II, A Developmental Neuropsychological Assessment, 2nd edition; NBAS, Brazelton Neonatal Behavioral Assessment; OC, organochlorine; OE, occupationally exposed; OP, organophosphate; OR, odds ratio; PD, Parkinson’s disease; PDI, Psychomotor Development Index; PR, probability ratio; PRT, Progressive Ratio test; RG, rural group; RGDT, Random Gap Digit test; ROCF, Rey-Osterrieth complex figure test; RT_ALL, reaction time; RTT, reaction time test; SAT, selective attention test; SAT_LAT, selective attention test latency; SD, standard deviation; SDL, serial digit learning; SDT, Symbol Digit test; SDT_LAT, Symbol Digit test latency; SRQ-20, Self-Reporting Questionnaire 20-Item; SRT, spatial recall test; TAC, total abnormal cells; TAP, tapping test; TAP_ALT, tapping with alternate hands; TAP_NP, tapping with non-preferred hand; TAP_P tapping with preferred hand; TCPy, 3,5,6-trichloro-2-pyridinol; TSH, thyroid-stimulating hormone; UPDRS, United Parkinson’s Disease Rating Motor Subscale; VMI, visual motor integration test; WAIS; Weschler Adult Intelligence Scale; WAIS-R; Weschler Adult Intelligence Scale–Revised Version; WCST, Wisconsin Card Sorting test; WISC, Weschler Intelligence Scale for Children; WMS, Wechsler Memory Scale; WRAVMA; Wide Range Assessment of Visual Motor Ability.

^{^a}

Also included in Table 6 (thyroid function).

^{^b}

Investigators did not use exposure biomarker concentrations in multivariate analyses.

^{^c}

Also included in Table 9 (other health outcomes).