This study, which involves 30,000 veterans, is one of the largest scientific research studies ever undertaken on the health of veterans. The goal is to find out how the health status of Gulf War veterans changes over time and if it is better, worse, or the same as non-Gulf War veterans ten or more years after the war. Specific areas under study are chronic medical conditions, post-traumatic stress disorder and other psychological conditions, functional status, mortality, general health perceptions, health care utilization, and VA disability compensation between these two veteran groups.

To achieve this goal, researchers are collecting information from 15,000 Gulf War veterans and 15,000 non-Gulf War military personnel who were in service during 1990-1991. They are presently collecting information from these veterans through postal questionnaire surveys and telephone interviews.

Mortality Follow-Up of U.S. Navy Veterans Who Were Potentially Exposed to Biologic and Chemical Warfare Agents
Investigators: Han Kang, DrPH; Clare Mahan, PhD; Tim Bullman, MS

From 1962 to 1968, the Department of Defense conducted numerous tests on board US Naval ships. This effort, known as Project SHAD (Shipboard Hazard and Defense), exposed Navy personnel to a variety of chemical and biological warfare agents or simulations of these agents.

This study is designed to determine if there are any long-term adverse health effects associated with having participated in Project SHAD. Specifically, this study will determine if veterans who participated in the Project SHAD tests are at an increased risk for overall or cause-specific mortality when their mortality is compared to that of non-SHAD participants

Mortality Follow-Up Study of U.S. Veterans Who Participated in Operations Enduring Freedom and Iraqi Freedom
Investigators: Han Kang, DrPH; Tim Bullman, MS

The purpose of this study is to evaluate the post-service mortality risk of US Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans. Specifically, this study will determine if either OEF or OIF veterans are at an increased risk for overall mortality or any cause-specific mortality following separation from military service. This study should also provide important information on the risk of deaths due to injuries and suicide among OIF and OEF veterans.

This research project will assess the overall and cause specific mortality risk of 50,000 OEF and 150,000 OIF veterans. The cause-specific mortality of these veterans will be compared to that of 150,000 veterans who served in the military during OEF and OIF, but did not serve in either the Afghanistan or Iraq theaters. This study is the first to assess the post-military service mortality risks associated with having participated in OEF and/or OIF, and it is an important first step in monitoring the health of these groups of veterans in the future.

Clinical Surveillance Program for Operations Iraqi Freedom and Enduring Freedom Veterans
Investigators: Han Kang, DrPH; Aaron Schneiderman, PhD, MPH, RN; Mian Li, MD, PhD; Mitchell Wallin, MD, MPH

The aim of this research study is to find out the health status and health concerns of veterans returning from Operation Iraqi Freedom and Operation Enduring Freedom. Researchers hope that this study will shed light on the health needs that this group of veterans may have in the future, and help health professionals prepare to meet these needs. To achieve this, the WRIISC is providing a comprehensive evaluation of veterans who have recently returned from these conflicts. This evaluation includes:

A thorough medical history and physical examination
A targeted neurological evaluation
A neuropsychological test
Laboratory tests
An introduction to VA benefits

Antecedents of Fatal Motor Vehicle Crashes in Gulf War and Non-Deployed Veterans
Investigators: Han Kang, DrPH; Andrew Lincoln, ScD, MS; Marina Dobrovitsky, MA

The aim of this study is to examine risk factors for fatal motor vehicle crashes among Gulf War veterans and veterans who were not deployed to a theater of conflict during the same time period as the Gulf War. This study takes advantage of a unique capability to identify and link individuals in the military across many independent databases. It looks at demographic and military characteristics, DoD and VA hospitalization diagnoses, self- reported risk behaviors, and potential Gulf War exposures.

Health and Communications Study of Veterans
Investigators: Aaron Scheiderman, PhD, MPH, RN; Han Kang, DrPH; Barbara Curbow, PhD, MA; Mubashra Raza, MPH

This needs assessment is intended to help the WRIISC develop a strategy for a dynamic and focused risk communication program, and help it develop supportive materials for veterans, clinicians, and others. Researchers are using a mailed questionnaire survey to assess:

The variety and prevalence of health conditions experienced by veterans from the Vietnam War, the Persian Gulf War (1991), and the Bosnia-Kosovo peace-keeping effort
Veterans’ perceptions about whether health conditions are related to military service
The most frequently mentioned environmental exposures and medical countermeasures by region of deployment, and the level of concern that veterans have about the perceived health impact of these exposures
Which health problems, symptoms, and exposures veterans want to receive information on
How veterans would prefer to receive risk communication messages, and who they feel are the most appropriate and trustworthy people to give these messages

Study of Health Outcomes & Environmental Surveillance in Bosnia/Kosovo (SHOES)
Investigators: Andrew Lincoln, ScD, MS; Han Kang, DrPH; Aaron Scheiderman, PhD, MPH, RN; Marina Dobrovitsky, MA; Clare Mahan, PhD; Matthew McAtee; Jack Heller, PhD, MS; Brad Hutchens, MS; Coleen Weese, MD, MPH, FACOEM; Peter Lees, PhD, CIH

The long-term goal of this project is to acquire and merge personnel, healthcare, and other important records from the DoD and VA to develop a database of personnel who were deployed to recent peace-keeping operations in Europe. This database will capture environmental exposures data, troop location data, military service records, and DoD and VA healthcare utilization records.

The purpose of this database is to help researchers answer questions about the health effects of recent peacekeeping operations on Bosnia/Kosovo veterans. This database will allow researchers to explore topical health issues and validate the consistency of health effects experienced by Bosnia/Kosovo veterans compared with veterans from other recent military campaigns. This research project will also assess the health risks of having participated in Operations Joint Endeavor and Joint Guardian by comparing cause-specific morbidity and mortality of Bosnia/Kosovo participants to non-deployed veteran controls.

Post War Mortality from Neurologic Diseases in Gulf War Veterans
Investigators: Han Kang, DrPH; Clare Mahan, PhD; Tim Bullman, MS; Mitchell Wallin, MD, MPH; Shannon Boyer, MPH

The Washington, D.C. War-Related Illness and Injury Study Center of the Department of Veterans Affairs is investigating post-war mortality from neurological disease in Gulf War veterans. Gulf War veterans may be at increased risk for adverse health outcomes, including neurological disorders, as a result of their Gulf War service. Specifically, there is concern that Gulf War veterans may be at increased risk for amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson’s disease, or brain cancer. These risks are related to potentially hazardous environmental exposures during the war, such as oil well fire smoke, chemical and biological warfare (CBW) agents, prophylactic agents against CBW, multiple vaccinations, depleted uranium, pesticides, and endemic infectious diseases. Two recent studies reported that Gulf War veterans may be at increased risk for ALS (Horner et al, 2003; Haley, 2003). An association between ALS and Gulf War service became of concern when ALS cases began to occur in young servicemen at an age when it is not common (Karsarskis et al, 1999). Haley and colleagues also reported evidence of basal ganglia injury and other abnormalities with detailed neurologic assessments in several case control studies (Haley et al, 1997; Haley et al, 2000). Concerning the risk of brain cancer among Gulf War veterans, there is one study suggesting an association of brain cancer mortality with possible nerve-agent exposure (Bullman et al, 2005). One method of assessing health consequences of the 1991 Gulf War for the risk of rare disease is to compare the cause-specific post-war mortality of Gulf War veterans to non-Gulf War veterans. This study will compare risk of mortality due to ALS, MS, Parkinson’s, or brain cancer between 620,000 Gulf War veterans and 750,000 non-Gulf War veterans.

Estimates of Cancer Prevalence in Gulf Veterans Using State Registries
Han Kang, DrPH; Clare Mahan, PhD; Paul Levine, MD; Samuel Simmens, PhD; Heather Young, PhD; Jessica Bocek, MPH

Although there were relatively few combat casualties in the 1990-1991 Gulf War, many veterans were subjected to a wide variety of natural and man-made environmental exposures, some of which are considered potential human carcinogens. Because of concerns about increased cancer risks among these veterans, Department of Veterans Affairs officials were asked during Congressional hearings to address the potential cancer risk among Gulf War veterans.

Researchers are evaluating the hypothesis that 1990-1991 Gulf War veterans are at an increased risk of developing specific cancers compared to non-Gulf War veterans. The objectives of the study are (a) to assess and compare the prevalence, distribution, and characteristics of cancer among 621,902 Gulf War veterans to 746,248 non-Gulf War veterans; and (b) to assess demographic, military, and in-theater exposure characteristics associated with the cancer. They are identifying Gulf War and non-Gulf War veterans with a diagnosis of cancer from 1991 to 2003 through record linkage of the veterans’ database with files supplied by state cancer registries. This study will produce information with adequate statistical power to address the question on whether or not there is an excess cancer risk associated with the 1990-1991 Gulf War.

Evaluation of Dr. Stellman’s Herbicide Exposure Reconstruction Model
Han Kang, DrPH; Clare Mahan, PhD; Andrew Lincoln, ScD, MS; Nancy Dalager, MS; Tim Bullman, MS; Yasmin Cypel, PhD

This study will evaluate a method developed by Columbia University researcher Jeanne Stellman, PhD and her team to estimate Vietnam veterans’ opportunity for exposure to various herbicides, based on historical reconstruction of relevant military records and a geographic information system. This study aims to evaluate the validity and utility of this model with the following three objectives, using the databases already collected from previous health studies on Vietnam veterans:

1) Does the model generate internally consistent index exposure scores consistent with variation in military mission? To test this, five military units stationed in Vietnam during the height of Agent Orange spraying in 1968 will be tracked for geographic location in Vietnam for one year, using the databases already collected by Dr. Stellman and her team.

2) Does the model demonstrate a positive association between the index exposure scores and the prevalence or incidence of health outcomes that are considered truly associated with herbicides, such as soft tissue sarcoma, non-Hodgkin’s lymphoma, and Hodgkin’s disease? To test this, veteran study subjects from three existing case-control study databases and three Vietnam veterans mortality study databases will be used. Geographic locations and time of service in Vietnam of the cancer cases and controls will be tracked and applied to the model.

3) Does application of the model to existing epidemiologic study databases generate additional information on the health effects of exposure to herbicide in Vietnam beyond what is already known? How much time and resources are required to conduct a health study of Vietnam veterans using the model? The model will be applied to three existing databases: the Agent Orange Registry of 240,000 Vietnam veterans, Marine Corps Vietnam Veterans, and Women Vietnam Veterans.

Environmental Exposures Assessment Tool (EE-Tool) for OIF/OEF Veterans
Investigators: Aaron Schneiderman, PhD, MPH, RN; Michelle Prisco, MSN, ANP-C; Helena Chandler, PhD; Mubashra Raza, MPH

This project will use qualitative and quantitative methods to develop an instrument to measure the environmental exposure experience and related concerns among combat veterans of OEF /OIF. Multiple data sources will be used during development, including historical focus group data, clinical data, published DOD Post Deployment Health Assessment findings, and literature review. A formal review of the draft instrument will be conducted by a panel of Subject Matter Experts in environmental health and survey research. A secondary review will include a series of cognitive interviews with OEF /OIF veterans to further refine the instrument.

Reviewed/Updated Date: May 7, 2008