Public Health
Military Exposures & Your Health - 2023 - Issue 9
In this issue:
- The Gulf War Era Cohort Study
- Airborne Hazards and Burn Pits Center of Excellence updates
- Military exposures and reproductive health
The Gulf War Era Cohort Study
Very soon after the 1990-1991 Gulf War, both Veterans and service members who had deployed began to report a variety of persistent symptoms that included pain, fatigue, difficulty concentrating, upset stomach, headaches, and a variety of other issues. There was concern among Gulf War Veterans that all the symptoms and illnesses that they were facing were related to exposures that were present during the Gulf War. Service members who served in the 1990-1991 Gulf War were exposed to many hazards, including chemical weapons, nerve agents, oil well fire smoke, pesticides, pyridostigmine bromide, sand, extreme heat, burning waste, multiple vaccines, depleted uranium, and chemical agent resistant coating (CARC) paint. To study the relationship between deployment to the 1990-1991 Gulf War and health, the VA’s Health Outcomes Military Exposures (HOME) created the Gulf War Era Cohort Study (GWECS) in 1995.
The GWECS is the largest study of Veterans who served in 1990-1991 Gulf War, and Veterans who served in the military during the time of the 1990-1991 Gulf War but did not deploy to the war (Gulf War Era). Fifteen thousand 1990-1991 Gulf War Veterans and 15,000 1990-1991 Gulf War Era Veterans (30,000 Veterans total) were invited to participate in the study to determine if the heath of 1990-1991 Gulf War Veterans was better, worse, or the same as 1990-1991 Gulf War Era Veterans. Veterans who agreed to participate were asked to complete a survey that included questions about deployment exposures, health care utilization, physical heath, mental health, reproductive health, persistent symptoms, and functional limitations. Results from this large study demonstrated that Gulf War Veterans were more likely to report worse health than Gulf War Era Veterans, more likely to have medical diagnoses, and more likely to have chronic symptoms. Veterans in this study were recontacted in 2005 and 2012 and asked to take additional surveys about their health and wellness and Gulf War Veterans continued to report more disease and limitations than Gulf War Era Veterans in the study.
At the end of 2023, HOME will conduct another round of data collection, over 30 years after the 1990-1991 Gulf War, to gather more information about how Gulf War Veterans and Gulf War Era Veterans are doing as they age. The survey that will be used in the 2023 data collection will include questions about COVID-19 infection and long COVID, cancer diagnoses, chronic disease, health care utilization, mental health, sleep quality, Gulf War illness (also known as chronic multisymptom illness), and health risk behaviors. A set of questions on women’s health and menopause experience will also be included for the women Veterans in the study.
The results from this study have helped develop health care and benefits policies for 1990-1991 Gulf War Veterans. In addition, over 30 scientific papers have been published from this data. HOME is grateful to all the Veterans who have taken part in this study over the last three decades.
Airborne Hazards and Burn Pits Center of Excellence updates
The Airborne Hazards and Burn Pits Center of Excellence (AHBPCE), located at the New Jersey War Related Illness and Injury Study Center, focuses on airborne hazards and burn pits-related research, education, clinical assessments, and evaluation of data from the Airborne Hazards and Open Burn Pit Registry. Below are recent accomplishments by the AHBPCE:
Addition of a sixth Post-Deployment Cardiopulmonary Evaluation Network (PDCEN) site
The Nashville VA Medical Center officially joined the PDCEN in October 2022. This location marks the sixth PDCEN site offering clinical evaluations for Veterans with concerns about their post-deployment health, including unexplained shortness of breath or difficulty breathing. The Nashville site also works with VA and Vanderbilt University Medical Center investigators to perform basic, translational, and clinical research to better understand how respiratory disease develops after deployment, how it affects the health of affected Veterans over time, and how it can be non-invasively diagnosed.
Reaching an agreement on diagnostic criteria for constrictive bronchiolitis
AHBPCE published the ”Consensus Statements on Deployment-Related Respiratory Disease, Inclusive of Constrictive Bronchiolitis: A Modified Delphi Study” in the journal CHEST in early 2023. This publication includes the definition of constrictive bronchiolitis as a histologic pattern of lung injury in previously deployed individuals.
Development of a new diagnostic toolkit for providers who treat Veterans with exposure concerns
AHBPCE collaborated with experts in Veteran care to develop a health care providers’ toolkit. This toolkit contains new clinical decision guidelines for deployment-related respiratory disease; its goal is to ensure that providers who see Veteran patients with airborne hazard-related exposure concerns have the knowledge necessary to best support and care for their patients.
Evaluating exposures and health
In collaboration with VA’s Health Outcomes Military Exposure (HOME) and Dr. James Parrott (Rutgers University), AHBPCE developed a robust and agile platform to evaluate current research on military environmental exposures and associated health risks. In the first six months of the project, the team examined over 1,000 research citations. Results from the initial review of interstitial lung diseases are expected by August 2023. The team plans to evaluate the association between airborne hazard exposure and autoimmune conditions before 2024.
Showcasing VA Efforts on Respiratory Health
In May 2023, more than 15,000 pulmonary, critical care, and sleep professionals attended the American Thoracic Society's International Conference in Washington, DC. A special VA session was held at the conference entitled, “VA's Approach to Post-Deployment Respiratory Health: Research, Clinical Care and Education.” HOME's Chief Consultant discussed the PACT Act, Co-Directors of the AHBPCE presented information regarding clinical evaluations and the Airborne Hazards and Open Burn Pit Registry, and the study chairs of VA's Cooperative Studies Program "Service and Health Among Deployed Veterans" (CSP#595) provided progress updates.
Military exposures and reproductive health
Military personnel may unintentionally be exposed to toxins and other hazards during their time in service. These exposures can enter the body through inhalation (breathing), consumption (drinking or eating), or absorption into the skin.1 Regardless of the pathway by which the toxic substance enters the body, these exposures can impact an individual’s health.
Few studies presently exist on the relationship between exposures and women Veterans’ reproductive health. Research on civilian individuals and animal species exposed to air pollutants have shown a decline in reproductive function.2 Environmental toxins may potentially impact the female reproductive system by impairing organ and hormonal systems, as well as creating molecular alterations and oxidative stress.3 Some prior environmental studies in civilian and military populations show that airborne hazards and open burn pit exposures could be associated with adverse reproductive outcomes. 4,5,6,7 A systematic research review conducted in 2017 found a relationship between air pollution and the prevalence of infertility in the civilian population.8
Rigorous research is needed to better understand military exposures and reproductive health outcomes, especially in women Veterans. The Women's Operational Military Exposure Network (WOMEN) was formed at the War-Related Illness and Injury Study Center in Palo Alto, CA. Its mission is to combine a comprehensive clinical care program with pioneering research to learn about military exposure effects on women who served. The WOMEN program will enhance, educate and promote women Veterans’ health by reviewing the science, conducting surveillance, studying possibilities with proven research techniques, and disseminating findings to scientific and Veteran communities.
References
1. Osinubi O. Conducting an Exposure Assessment Evaluation Issues Relevant to the Military and Veteran Population. 2013.
2. Carré, J., Gatimel, N., Moreau, J. et al. Does air pollution play a role in infertility?: a systematic review. Environ Health 2017; 16: 82.
3. Kumar S, Sharma A, Kshetrimayum C. Environmental & occupational exposure & female reproductive dysfunction. Indian J Med Res. 2019;150:532-545.
4. Bassig BA, Dai Y, Vermeulen R, et al. Occupational exposure to diesel engine exhaust and alterations in immune/inflammatory markers: a cross-sectional molecular epidemiology study in China. Carcinogenesis. 2017;38:1104-1111.
5. Brohi RD, Wang L, Talpur HS, et al. Toxicity of Nanoparticles on the Reproductive System in Animal Models: A Review. Front Pharmacol. 2017;8:606.
6. Shan M, Yang X, Ezzati M, et al. A feasibility study of the association of exposure to biomass smoke with vascular function, inflammation, and cellular aging. Environ Res. 2014;135:165-172.
7. Zhang J, Chen G, Liang S, et al. PM2.5 exposure exaggerates the risk of adverse birth outcomes in pregnant women with pre-existing hyperlipidemia: Modulation role of adipokines and lipidome. Sci Total Environ. 2021;787:147604.
8. Mancuso, A. C., Mengeling, M. A., Holcombe, A., & Ryan, G. L. (2022). Lifetime infertility and environmental, chemical, and hazardous exposures among female and male US Veterans. Am J Obstet Gynecol. 2022.
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