A range of determinants at multiple socio-ecological levels operate in small farm households' use and handling of hazardous pesticides, suggesting the need for integrated health and agriculture promotion approaches. The aim is to assess changes in health promotion outcomes relevant to highly hazardous pesticide use associated with a multi-component community program. A longitudinal evaluation design using mixed methods was employed in 18 agricultural communities in Ecuador. Over a 7-month period, health education and agricultural interventions focused upon: health risks associated with hazardous pesticides, more adequate use and handling of pesticides, and better crop management techniques. Data collection included field forms, focus groups, structured observations and repeat surveys. In the qualitative analysis, communities were compared by extent of leadership and involvement with the interventions. For the quantitative analysis, hypothesized paths were constructed including factors relevant to pesticide-related practices and use. Testing involved gender-role stratified (household and crop manager) multivariable regression models. Information on pesticide health impacts and the pesticide use and handling, shared in focus groups, showed substantial improvement, as a result of health promotion activities though people were still observed to engage in risky practices in the field. In path models, community leadership and intervention intensity lead to changes in the household managers' pesticide-related knowledge and practices and to reduction in farm use of hazardous pesticides (both significant, p < 0.05). Integrated, community programs can promote pesticide-related risk reduction among small farm households. Changing practices in the use and management of pesticides among crop managers appears limited by deeper structural and cultural factors.

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The WHO has advocated monitoring adherence to the Food and Agriculture Organization's Code of Conduct to reduce use of highly hazardous pesticides in lower and middle income countries. We re-framed Code articles in terms of farmers' rights and drew on survey data, farmer focus group results, and direct observations of agrochemical stores in Ecuador and Peru to construct indicators reflecting respect for such rights. Use of highly (Ia and Ib) and moderately (II) hazardous pesticides was common. Worse indicators were observed in places with lower education, greater poverty, and more use of indigenous languages. Limited government enforcement capacity, social irresponsibility of the pesticide industry, and lack of farmers' knowledge of the Code were all factors impeding respect for farmers' rights. Addressing the power imbalance among social actors requires informed farmer and farmworker participation in monitoring adherence and active involvement of non-governmental organizations and municipal governments.

Transdisciplinary education on sustainability for health has been primarily developed in high-income countries, yet the need in countries with limited research and human resource investments remains urgent. Little empiric documentation of the facilitators and barriers to transdisciplinary learning in such countries has been described. We assessed transdisciplinary learning among students of different disciplines collaborating with an Ecuadorian sustainability for health research project. Six undergraduate students from four different disciplinary backgrounds were incorporated through work-study agreements with provincial university academic supervisors. Learning was fostered and monitored through participant observations by a field supervisor. Students' learning was evaluated through subsequent in-depth interviews and visualization methods. Academic supervisor key informant and co-investigator observations aided triangulation. Qualitative data were analyzed using indicators of transdisciplinary thinking. Principal factors facilitating transdisciplinary learning were interaction with social actors, the integration of work with other disciplines, the use of alternative research techniques and methods, and the constant support of the field supervisor. Inhibiting factors included the existence of rigid academic rules, lack of training of the academic supervisors in diverse research methods, and social pressures to implement unidisciplinary foci. At the end of their link with the project, students had developed both cognitive outcomes and attitudinal values relevant to sustainable development for health. In countries with limited investments in research and human resources development, transdisciplinary approaches with social actors and engaged researchers can sensitize new professionals training in traditional academic contexts to the ecological-social-health problems faced by poor majorities and encourage their subsequent work on sustainability for human health.

The use of nutritional labeling is low in both mestiza and indigenous Ecuadorians, although higher among the mestizas. Among the indigenous women, mostly likely owing to less education, limited nutrition-related health knowledge, and higher risk for food insecurity, the utility of the new traffic light food label is limited.

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BackgroundLongitudinal studies using multi-level models to examine health inequalities in lower and middle income countries (LMICs) are rare. We explored socio-economic gradients in health among small farm members participating in a pesticide-related health and agriculture program in highland Ecuador.MethodsWe profiled 24 communities through key informant interviews, secondary data (percent of population with unsatisfied basic needs), and intervention implementation indicators. Pre (2005) and post (2007) surveys of the primary household and crop managers included common questions (education, age, and the health outcome - digit span scaled 0-10)) and pesticide-related practice questions specific to each. Household assets and pesticide use variables were shared across managers. We constructed multi-level models predicting 2007 digit span for each manager type, with staged introduction of predictor variables.Results376 household managers (79% of 2005 participants) and 380 crop managers (76% of 2005 participants) had complete data for analysis. The most important predictor of 2007 digit span was 2005 digit span: β (Standard Error) of 0.31(0.05) per unit for household and 0.17(0.04) for crop managers. Household asset score was next most important: 0.14(0.06) per unit for household and 0.14(0.05) for crop managers. Community percent with unsatisfied basic needs was associated with reductions in 2007 digit span: -0.04(0.01) per percent for household and -0.03(0.01) for crop managers.ConclusionsThe important roles of life endowments and/or persistent neurotoxicity were exemplified by limited change in the health outcome. Gradients by household assets and community deprivation were indicative of ongoing, structural inequities within this LMIC.

The nutrition and physical activity transitions appear more evident in urban- compared to rural-dwelling women, and are associated with more obesity and higher BP.