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Sordillo JE, Dey A, Ho YL, Kosik N, Harrington K, Costa L, Muralidhar S, Hauser E, Gaziano JM, Cho K, Whitbourne S. Military and occupational exposures among Veterans in the Million Veteran Program by survey self-report: a descriptive study. Occup Environ Med 2024:oemed-2024-109544. [PMID: 39327043 DOI: 10.1136/oemed-2024-109544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/16/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVE We aimed to characterise self-reported military and occupational exposures including Agent Orange, chemical/biological warfare agents, solvents, fuels, pesticides, metals and burn pits among Veterans in the Department of Veterans Affairs Million Veteran Program (MVP). METHODS MVP is an ongoing longitudinal cohort and mega-biobank of over one million US Veterans. Over 500 000 MVP participants reported military exposures on the baseline survey, and over 300 000 reported occupational exposures on the lifestyle survey. We determined frequencies of selected self-reported occupational exposures by service era, specific deployment operation (1990-1991 Gulf War, Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF)), service in a combat zone and occupational categories. We also explored differences in self-reported exposures by sex and race. RESULTS Agent Orange exposure was mainly reported by Vietnam-era Veterans. Gulf War and OEF/OIF Veterans deployed to a combat zone were more likely to report exposures to burn pits, chemical/biological weapons, anthrax vaccination and pyridostigmine bromide pill intake as compared with non-combat deployers and those not deployed. Occupational categories related to combat (infantry, combat engineer and helicopter pilot) often had the highest percentages of self-reported exposures, whereas those in healthcare-related occupations (dentists, physicians and occupational therapists) tended to report exposures much less often. Self-reported exposures also varied by race and sex. CONCLUSIONS Our results demonstrate that the distribution of self-reported exposures varied by service era, demographics, deployment, combat experience and military occupation in MVP. Overall, the pattern of findings was consistent with previous population-based studies of US military Veterans.
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Affiliation(s)
- Joanne E Sordillo
- Million Veteran Program (MVP) Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA
| | - Andrew Dey
- Million Veteran Program (MVP) Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA
| | - Yuk-Lam Ho
- Million Veteran Program (MVP) Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA
| | - Nicole Kosik
- Million Veteran Program (MVP) Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA
| | - Kelly Harrington
- Million Veteran Program (MVP) Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA
| | - Lauren Costa
- Million Veteran Program (MVP) Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia, USA
| | - Elizabeth Hauser
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
| | - John Michael Gaziano
- Million Veteran Program (MVP) Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kelly Cho
- Million Veteran Program (MVP) Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stacey Whitbourne
- Million Veteran Program (MVP) Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Hall AL, Demers PA, VanTil L, MacLean MB, Dalton ME, Batchelor T, Rushton L, Driscoll TR. Lessons Learned From Presumptive Condition Lists in Veteran Compensation Systems. Front Public Health 2022; 10:739746. [PMID: 35619818 PMCID: PMC9127463 DOI: 10.3389/fpubh.2022.739746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 04/04/2022] [Indexed: 12/01/2022] Open
Abstract
Presumptive condition lists formally accept connections between military factors and veteran health conditions. An environmental scan of such lists and their evidentiary basis was conducted across four veterans' administrations to inform other administrations considering the development of such lists. Information on included conditions, qualifying military factors, and scientific processes was obtained through targeted internet searches and correspondence with veterans' administrations. The content of presumptive condition lists across jurisdictions varied by conditions included, as well as military eligibility requirements (e.g., service in particular conflict, context, or time period). Scientific review processes to develop lists also varied across jurisdictions. Findings indicate that evidence and experience may be leveraged across compensation systems (veteran and civilian). Ongoing research to understand links between military exposures and veteran health is recommended.
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Affiliation(s)
- Amy L Hall
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, PE, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada
| | - Linda VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, PE, Canada
| | - Mary Beth MacLean
- Faculty of Health Sciences School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | - Maria E Dalton
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Lesley Rushton
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Tim R Driscoll
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Miggantz EL, Materna K, Herbert MS, Golshan S, Hernandez J, Peters J, Delaney E, Webb-Murphy J, Wisbach G, Afari N. Characteristics of Active Duty Service Members Referred to the Navy's Weight-Management Program. Mil Med 2021; 188:e174-e181. [PMID: 34910186 PMCID: PMC9825239 DOI: 10.1093/milmed/usab523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Rates of overweight and obesity have increased in the military, particularly in the U.S. Navy. While the Navy has implemented weight-management programs like ShipShape, findings on the effectiveness of these programs are mixed. Further knowledge on the characteristics of service members (SMs) who participate in these programs may help inform course curricula and improve outcomes. This study aimed to (1) examine characteristics of SMs referred to the Navy's ShipShape program at a large military treatment facility, (2) compare these characteristics among SMs who did and did not enroll in a randomized clinical trial of ShipShape (ShipShape study participants), and (3) compare demographic and health characteristics of ShipShape study participants to that of a random and similarly sized sample of Navy SMs who responded to the 2015 DoD Health-Related Behaviors Survey (HRBS). MATERIALS AND METHODS Data from active duty Navy SMs referred to the ShipShape program at a large military treatment facility were evaluated (n = 225). A subset of these SMs enrolled in the ShipShape study (n = 187). Among enrolled SMs, data from 147 who completed all measures were compared to that of HRBS respondents. Univariate ANOVA and chi-square analyses were used to examine (1) demographic and motivational differences between SMs who did and did not enroll in the ShipShape study and (2) differences in demographics and medical and mental health conditions between ShipShape study participants and Navy HRBS respondents. RESULTS The majority of SMs referred to ShipShape were female with an average age of 28.3 years. Compared to SMs who did not enroll in the ShipShape study (n = 38), ShipShape study participants were more likely to be female, less likely to be Hispanic, and had higher motivation and emotional eating scores. Compared to Navy HRBS respondents (n = 164), ShipShape study participants (n = 147) were younger, more likely to be female, non-Hispanic, enlisted, and obese. Further, ShipShape study participants reported significantly fewer medical health conditions but higher rates of probable depression, anxiety, and PTSD and were more likely to report receiving current mental health treatment than HRBS respondents. CONCLUSION Overweight or obese SMs seeking weight loss in the ShipShape study were relatively young, female, non-Hispanic, motivated, but with greater emotional eating. ShipShape study participants endorsed few medical health conditions but had higher rates of probable mental health conditions compared to the HRBS sample. These findings suggest that SMs referred to Navy weight-management programs are likely experiencing comorbid mental health conditions which may interfere with the effectiveness of their weight loss efforts. The descriptive nature of this study and the focus on Navy SMs in only one ShipShape program may decrease the generalizability of our findings to participants at other locations. Nonetheless, these findings demonstrate the potential need for Navy weight-management programs that incorporate mental health treatment and address the specific needs of female and diverse SMs. A more comprehensive curriculum could improve the results of weight-management efforts, increase SM quality of life and fitness and thereby operational readiness.
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Affiliation(s)
| | - Karla Materna
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California, La Jolla, CA 92093, USA,VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Shahrokh Golshan
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California, La Jolla, CA 92093, USA
| | | | - Joshua Peters
- Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Eileen Delaney
- Naval Center for Combat & Operational Stress Control, San Diego, CA 92134, USA
| | | | - Gordon Wisbach
- Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California, La Jolla, CA 92093, USA,VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
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Ying D, Schmajuk G, Trupin L, Blanc PD. Inorganic Dust Exposure During Military Service as a Predictor of Rheumatoid Arthritis and Other Autoimmune Conditions. ACR Open Rheumatol 2021; 3:466-474. [PMID: 34085777 PMCID: PMC8281049 DOI: 10.1002/acr2.11273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) and other autoimmune (AI) conditions are associated with inorganic dust exposure. Many military activities are likely to entail inorganic dust exposures. We wished to identify associations between prior military dust exposure and RA and other AI conditions. METHODS We studied persons from a roster of Army, Navy, Air Force, or Marine Corps personnel who had served in Operation Enduring Freedom and Operations Iraqi Freedom and New Dawn. We linked military occupational codes to a job exposure matrix assigning dust exposure likelihood. We used the Veterans Affairs Health Care System (VAHCS) electronic health care records to identify cases of RA, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), vasculitis, and inflammatory myositis. Generalized estimating equations modeled risk of RA and other AI conditions associated with dust exposure, taking into account military service branch, age at first VAHCS encounter, sex, race/ethnicity, smoking status, and years of military service. RESULTS Of 438 086 veterans (68% ever-smokers), 44% were classified with likely or somewhat likely dust exposure. Cases included 1139 cases with RA, 467 cases with SLE, and 180 cases with other AI diseases (SSc, vasculitis, or inflammatory myositis). Military dust exposure was associated with increased odds of RA (odds ratio [OR] = 1.10; 95% confidence interval [CI] = 1.003-1.20) and increased odds of SSc, vasculitis, or inflammatory myositis (OR = 1.23; 95% CI = 1.14-1.34) but was protective for SLE (OR = 0.81; 95% CI = 0.76-0.88). CONCLUSION Dust exposure during past military service comprises an occupational and environmental risk factor for RA and other AI diseases. This is potentially relevant for prevention activities.
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Affiliation(s)
- David Ying
- San Francisco Veterans Affairs Health Care System, San Francisco, California, John Muir Health, Walnut Creek, California, and University of California at San Francisco
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
| | | | - Paul D. Blanc
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
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