We used a combination of subjective (questionnaire) and objective (urinary metabolites) measurements to evaluate factors that can predict the exposure of farm workers in Qatar to organophosphate pesticides and to assess whether the levels of exposure are associated with any self-reported health outcomes. The results show that pesticides were being extensively mishandled in the farms. Very few (< 2%) of the farm workers knew the names of the pesticide they were using, and about one-third of the participants did not know the amount of pesticides to be applied to the crops. Nearly all (96%) of the participants had participated in mixing pesticides together before use and few (29%) used protective clothing while engaged in this operation. A significant number of participants (18%) had no knowledge that pesticides are a health hazard. At least one dialkyllphosphate (DAP) metabolite was detected in every worker. The geometric mean (GM) concentration of the dimethylalkylphosphates (DMAP) was 108 nM (range, from below the limit of detection (LOD) to 351 nM), and the GM for the diethylalkylphosphates (DEAP) was 43 nM (range, LOD-180 nM). The GM for total concentration of the metabolites (DAP) of 146 nM (maximum value estimated to be 531 nM) is below the values that have been reported for farmers in some countries, but higher than the levels in the general populations of many countries. We explored the influence of metal exposure and found consistent and negative relationships between the DAP metabolites and the concentrations of most of the trace elements in the urine of the farm workers; the negative associations were statistically significant for Cr, Mn, Fe, Ni, As, and Pb. We suspect that the negative associations are not source-dependent but may be reflective of antagonistic relationships in human metabolism of OPPs and trace metals; hence we recommend that metals should be included as co-factors in assessing the health effects of OPP exposure. (C) 2014 Elsevier Inc. All rights reserved.