The Environmental Epidemiology Service (EES) conducts original research studies on the health of Veterans, including research on potential exposures to environmental hazards during military service.
EES also maintains databases and registries of Veterans’ exposures and health care utilization, which provide unique data for much of the research.
Learn about upcoming and ongoing research studies on:
- Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans
- Gulf War Era Veterans
- Vietnam Veterans
Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans
The MIND Study (Markers for the Identification, Norming, and Differentiation of TBI and PTSD)
The MIND Study will be an in-depth follow-up of a sample of participants from the National Health Study for a New Generation of U.S. Veterans who have experienced a TBI, symptoms of TBI, or post-traumatic stress disorder (PTSD). Researchers plan to identify sub-groups who have symptoms of TBI and/or PTSD and a comparison group of veterans. These veterans will be invited to one of the three VA War Related Illness and Injury Study Centers (WRIISCs) beginning in summer 2010 to be a part of the MIND Study. Participants will receive further physical evaluation and diagnostic testing that will explore differential diagnoses between TBI and PTSD and build objective and consistent diagnostic criteria.
More information about the MIND Study is available on the flyer Introducing Two New VA Initiatives on Traumatic Brain Injury in Veterans (560 KB, PDF).
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National Health Study for a New Generation of U.S. Veterans
Investigators: Han Kang, Dr.P.H.; Clare Mahan, Ph.D.; Steven Coughlin, Ph.D.; Aaron Schneiderman, Ph.D., M.P.H., R.N.; Stephanie Eber, M.P.H.; Shannon Boyer, M.P.H.; Jessica Maillard, M.P.H.
This 10-year follow-up study is one of the largest scientific research studies ever undertaken on the health of recent veterans. Thirty thousand OEF/OIF Veterans and 30,000 Veterans who served elsewhere during the same time period will be contacted and invited to participate.
Researchers will compare chronic medical conditions, PTSD and other psychological conditions, general health perceptions, reproductive health, pregnancy outcomes, functional status, mortality, health care utilization, behavioral risk factors and VA disability compensation between the Veterans who served in OEF/OIF and the Veterans who served elsewhere. This study will provide the basis to begin answering questions on the long-term effects of deployment to OEF/OIF and provide important knowledge for improving the health of recent Veterans and future military personnel deployed in combat theaters. Learn more about the National Health Study for a New Generation of U.S. veterans.
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Gulf War Era Veterans
Longitudinal Health Study of Gulf War Era Veterans
Investigators: Han Kang, Dr.P.H.; Clare Mahan, Ph.D.; Seth Eisen, M.D.; Charles Engel, Jr., M.D., M.P.H.
This is a follow-up study of 30,000 Veterans (15,000 Gulf War Veterans and 15,000 non-Gulf War military personnel) who were in service during 1990-1991. It is one of the largest scientific research studies ever undertaken on the health of Veterans. The goal is to find out how the health 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. To achieve this goal, researchers mailed survey questionnaires, conducted telephone interviews, and reviewed medical records.
Specific areas under study are chronic medical conditions, PTSD and other psychological conditions, functional status, mortality, general health perceptions, health care utilization, and VA disability compensation between the two Veteran groups. Research findings from this study are currently being compiled and published in scientific journals, and presented to the scientific community.
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Estimates of Cancer Prevalence in Gulf Veterans Using State Registries
Han Kang, Dr.P.H.; Clare Mahan, Ph.D.; Paul Levine, M.D.; Samuel Simmens, Ph.D.; Heather Young, Ph.D.; Jessica Maillard, M.P.H.
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, Congress asked VA to address the question of 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
- to assess and compare the prevalence, distribution, and characteristics of cancer among approximately 620,000 Gulf War Veterans to 750,000 non-Gulf War Veterans; and
- to assess demographic, military, and in-theater exposure characteristics associated with the cancer.
Gulf War and non-Gulf War Veterans with a diagnosis of cancer from 1991 to 2003 are being identified 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.
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Post War Mortality from Neurologic Diseases in Gulf War Veterans
Investigators: Han Kang, Dr.P.H.; Shannon Boyer, M.P.H.; Tim Bullman, M.S.; Mitchell Wallin, M.D., M.P.H.
We investigated the risk of post-war mortality from neurological disease among 620,000 Gulf War Veterans and 750,000 non-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, multiple sclerosis, Parkinson’s disease, or brain cancer. These risks may be related to potentially hazardous environmental exposures during the war, such as oil well fire smoke, chemical and biological warfare agents, prophylactic agents against chemical and biological warfare, multiple vaccinations, depleted uranium, pesticides, and endemic infectious diseases.
Since our last follow-up in 1997, there have been few changes in mortality rates among Gulf War and non-Gulf Veterans. Controlling for oil well fire smoke exposure, Army Gulf War Veterans who were potentially exposed to nerve agents at Khamisiyah had a higher mortality rate from brain cancer compared to Army Veterans who were not considered exposed. The risk of death due to motor vehicle accidents is still higher among female Gulf War Veterans compared to female non-Gulf War Veterans, though no longer statistically significant among male Gulf War Veterans.
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Vietnam Veterans
Long Term Health Outcomes of Women’s Service During the Vietnam Era
Han Kang, Dr.P.H.; Amy Kilbourne, Ph.D.; Kathryn Magruder, M.P.H., Ph.D.; Rachel Kimerling, Ph.D.; Susan Frayne, M.D., M.P.H.; Avron Spiro III, Ph.D.; Joan Furey, R.N., M.A.; Yasmin Cypel, Ph.D.; Clare Mahan, Ph.D.; Matt Reinhard, Psy.D.; Kathy Swanson, C.S.P., R.Ph., M.S.; Ciaran Phibbs, Ph.D.; Tracey Serpi, Ph.D.
This is the most comprehensive study to date of the mental and physical health of women Vietnam Veterans. It will estimate the prevalence of post-traumatic stress disorder (PTSD) and other mental and physical health conditions in these women, and examine the relationship between PTSD and other conditions. Researchers will study approximately 10,000 women who served in the military during the Vietnam War, including those who served in Vietnam, those who served near Vietnam, and those who served in the United States. This study will include four research phases conducted over a 5-year period: one year of cohort development, two years of mail survey and telephone interview administration, one year of medical record abstraction, and one year of data analysis.
The study will be used to shape future research on women Veterans, and to plan for appropriate services for women Veterans and the aging Veteran population. It is being coordinated by VA’s Cooperative Studies Program and involves researchers from across the country. More information about this study is available on the Vietnam-Era Women Veterans Study Web page and on the press release Secretary Shinseki Announces Study of Vietnam-Era Women Veterans.
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A Study of the Long-term Health Consequences of PTSD among Vietnam Veterans on the VA Agent Orange Registry
Han Kang, Dr.P.H.; Kelly McCoy, Psy.D.; Jessica Maillard, M.P.H.
This study will examine the long-term health consequences of PTSD among Vietnam Veterans on the VA Agent Orange Registry (AOR). Vietnam Veterans who received a diagnosis of PTSD during their AOR exam will be compared to Vietnam Veterans on the registry without a diagnosis of PTSD during the AOR exam. A group of Veterans will be selected from among those who had an AOR medical exam before January 1, 1990 and also had at least one visit to a VA facility. The selection will include AOR Veterans with an ICD-9 code of 309.81, indicating a diagnosis of PTSD, and other individuals without a PTSD diagnosis. Comparisons will be made based on the presence or absence of a PTSD diagnosis at the time of the original AOR exam. Vital status for all study Veterans will be obtained from various data files.
Morbidity data will be extracted from diagnosis data in the VA inpatient and outpatient databases. A sample of 500 Veterans with PTSD will be selected for validation of PTSD diagnosis. For these Veterans, all VA medical records will be reviewed by a qualified mental health specialist to determine the validity of the diagnosis. Mortality data will be analyzed to determine the effects of a set of Vietnam service variables on the risk of dying from a specific cause. Morbidity data will be analyzed to evaluate the risk of specific health outcomes suspected of being associated with PTSD. Analyses will also be performed to investigate health care utilization patterns, examining the frequency of visits, whether visits were inpatient or outpatient, the duration of inpatient visits, and the types of clinics or providers seen.
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Evaluation of Dr. Stellman’s Herbicide Exposure Reconstruction Model
Han Kang, Dr.P.H.; Yasmin Cypel, Ph.D.; Clare Mahan, Ph.D.; Tim Bullman, M.S.; Shannon Boyer, M.P.H.
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:
- 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.
- 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.
- 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.
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