INDEX
A
Abortion, spontaneous, from exposure to fuels, 292–293
ACGIH. See American Conference of Governmental Industrial Hygienists
ACS. See American Cancer Society
Acute nonlymphocytic leukemia, from exposure to fuels, 290
Agency for Toxic Substances and Disease Registry (ATSDR), 29, 34, 41, 45, 49–50, 100, 348, 351, 355, 403
Agents
identification of, 21
specified in PL 105–368 and PL 105–277, 13
Air-pollution studies
ambient exposures, 89
and exposure to combustion products and cardiovascular disease, 280–281
and lung cancer, 88
Alberta Health Care Insurance Plan, 99
Ambient air-pollution studies, 89
and exposure to combustion products, 89–91
American Academy of Dermatology, 335
American Cancer Society (ACS), 60, 90, 92, 129, 138, 256
on the consequences of smoking, 6
CPS-II Study, 89, 129, 135, 138, 279–280, 282
American Conference of Governmental Industrial Hygienists (ACGIH), 29, 351, 358
American Heart Association, 278
American Thoracic Society (ATS), 252, 256
Epidemiological Standardization project, 256
Amoco Oil Company, 72, 74, 76, 94, 97–98
Amyloidosis, experimental studies of the toxicology of hydrazines in, 355
Animal models, 405–406
Argentina, studies from cited, 92
Arizona, studies from cited, 289
Arteriosclerotic heart disease, mortality from, and exposure to nitric acid, 388–389
Assessing the strength of the evidence, 22–25
bias, 24–25
biologic plausibility, 2–4, 16, 24
chance, 25
specificity of association, 4, 23–24
strength of evidence of an association, 4, 22–23
categories used to evaluate indoor pollutants related to, 25
conclusions about, 264–266
from exposure to fuels, 242, 244
key studies of, 265–266
“physician-diagnosed,” 246
ATS. See American Thoracic Society
ATSDR. See Agency for Toxic Substances and Disease Registry
Australia, studies from cited, 241, 243, 255, 257, 260, 320
B
Bias, 24–25
in assessing the strength of the evidence, 24–25
confounding, 25
information bias, 24–25
selection bias, 24
Bioassays, chronic, 47
Biologic plausibility, in assessing the strength of the evidence, 3, 16, 24
Biological monitoring data, 26n
Biomass-fuel combustion, 261–262
population-based studies of, 261–262
Biomass studies, 262–264
Birth defects, 310–311
conclusions about, 311
in Gulf War Veterans, 288–290
Bladder cancer, 111–119
conclusions about, 118–119
and exposure to combustion products, 114–118
additional studies on cancers of the renal pelvis, 118
case-control studies, 115–118
cohort studies, 114–115
selected epidemiologic studies, 200–206
and exposure to fuels, 111–114
case-control studies, 111–114
selected epidemiologic studies, 198–200
Blinding, 406
Bolivia, studies from cited, 262, 268
Bosnia veterans, 257–258
Brain/CNS cancers
and exposure to combustion products, selected epidemiologic studies, 197
and exposure to fuels, selected epidemiologic studies, 195–196
Breast cancer
female, 101–102
male, 102–104
British Medical Research Council, 260, 262, 268
C
California, studies from cited, 73, 89, 92, 289, 301, 309, 310, 311
California Office of Statewide Health Planning and Development, 250
Cambridge Neuropsychological Test Automated Battery, 320
Canada, studies from cited, 69–70, 72, 75–77, 79–80, 86, 95, 97–101, 106, 108, 121–122, 124–126, 128–130, 133, 140, 259, 283, 295, 301, 308, 310, 361
bladder cancer, 111–119
brain/CNS cancers, 195–197
cancers of the nasal cavity and nasopharynx, 66–70
cancers of the oral cavity and oropharynx, 61–66
colon cancer, 74–76
developmental insults from, 359
esophageal cancer, 70–72
and exposure to hydrazines, toxicology of, 355
and exposure to nitric acid, toxicology of, 358–359
and exposure to uncombusted fuels, 35
female breast cancer, 101–102
female genital cancers (cervical, endometrial, uterine, and ovarian), 104–105
genotoxicity, 359
hepatic cancer. See Liver cancer
Hodgkin’s disease, 130–132
inadequate/insufficient evidence to determine whether an association exists, 8–9, 400–401
kidney cancer, 119–127
laryngeal cancer, 80–85
leukemias, 137–140
limited/suggestive evidence of an association, 7–8, 399
liver cancer, 78–79
lung cancer, 85–93
male breast cancer, 102–104
male genital cancers (prostatic and testicular), 105–107
malignant melanoma of the skin, 94–98
multiple myeloma, 132–137
myelodysplastic syndromes, 140–142
nervous system cancers, 107–110
non-Hodgkin’s lymphoma, 127–130
non-melanoma skin cancers, 98–101
ocular melanoma, 110–111
pancreatic cancer, 79–80
prostatic cancer. See Male genital cancers
rectal cancer, 76–78
stomach cancer, 72–74
summary of conclusions, 142–143
susceptibility to infection, 359
tables, 144–222
Cancers of the nasal cavity and nasopharynx, 66–70
conclusions about, 69–70
and exposure to combustion products, 67–69
case-control studies, 67–69
selected epidemiologic studies, 147–148
and exposure to fuels, 66–67
case-control studies, 67
selected epidemiologic studies, 147
Cancers of the oral cavity and oropharynx, 61–66
conclusions about, 65–66
and exposure to combustion products, 63–65
case-control studies, 63–65
selected epidemiologic studies, 145–146
and exposure to fuels, 62–63
case-control studies, 63
cohort studies, 62–63
selected epidemiologic studies, 144
Cancers of the renal pelvis, in bladder cancer, and exposure to combustion products, 118
Carbon monoxide and carbon dioxide
from combustion, 41–42
toxicity of, 48
Carcinogenicity, of various agents and categories used by other IOM committees, 15
Cardiovascular effects, 277–287
and exposure to combustion products, 278–284
and exposure to fuels, 278
and exposure to nitric acid, 384
and exposure to uncombusted fuels, experimental studies, 37
inadequate/insufficient evidence to determine whether an association exists, 10
Case-control studies, 408–409
of bladder cancer
and exposure to combustion products, 115–118
and exposure to fuels, 111–114
of cancers of the nasal cavity and nasopharynx
and exposure to combustion products, 67–69
and exposure to fuels, 67
of cancers of the oral cavity and oropharynx
and exposure to combustion products, 63–65
and exposure to fuels, 63
of colon cancer
and exposure to combustion products, 75–76
and exposure to fuels, 75
of esophageal cancer, and exposure to combustion products, 71
of female breast cancer, and exposure to combustion products, 102
of female genital cancers (cervical, endometrial, uterine, and ovarian), and exposure to combustion products, 105
of Hodgkin’s disease
and exposure to combustion products, 132
and exposure to fuels, 131
of kidney cancer
and exposure to combustion products, 124–127
and exposure to fuels, 121–124
of laryngeal cancer
and exposure to combustion products, 82–84
and exposure to fuels, 81–82
of leukemias, and exposure to combustion products, 138–139
of liver cancer
and exposure to combustion products, 78–79
and exposure to fuels, 78
of male breast cancer
and exposure to combustion products, 103
and exposure to fuels, 103
of male genital cancers (prostatic and testicular)
and exposure to combustion products, 106–107
and exposure to fuels, 106
of malignant melanoma of the skin
and exposure to combustion products, 96–97
and exposure to fuels, 95
of multiple myeloma
and exposure to combustion products, 135–136
and exposure to fuels, 134
of myelodysplastic syndromes
and exposure to combustion products, 141
and exposure to fuels, 140–141
of nervous system cancers
and exposure to combustion products, 109
and exposure to fuels, 109
of nitric acid exposure, 383–384
laryngeal cancer, 383
multiple myeloma, 384
of non-Hodgkin’s lymphoma
and exposure to combustion products, 129–130
and exposure to fuels, 128–129
of non-melanoma skin cancers
and exposure to combustion products, 100
and exposure to fuels, 99
of ocular melanoma, and exposure to combustion products, 110
of outdoor air pollution, 254–255
of pancreatic cancer, and exposure to combustion products, 80
of rectal cancer
and exposure to combustion products, 77–78
and exposure to fuels, 77
of sarcoidosis, and exposure to combustion products, 337–341
of stomach cancer
and exposure to combustion products, 73
and exposure to fuels, 72
tables of, 425–456
Case reports and case series, 409–410
Categories of association, 4–6, 25–27
inadequate/insufficient evidence to determine whether an association exists, 5, 8–10, 26, 142–143
limited/suggestive evidence
of no association, 6, 11, 26–27
sufficient evidence of a causal association, 5, 7, 25, 142
sufficient evidence of an association, 5, 7, 26, 142
Causal relationships, evidence of, 3, 15–16
CDC. See Centers for Disease Control and Prevention
Centers for Disease Control and Prevention (CDC), 361–362
Central nervous system (CNS) cancers, 294–296
Cervical cancer. See Female genital cancers
Cervical intraepithelial neoplasia (CIN), 105
CFS. See Chronic fatigue syndrome
Chemical identity and selected physical and chemical properties
of combustion products, 41–42
gases, 41–42
particulate matter, 42
of hydrazine, 349–350
of nitric acid, 349–350
of selected uncombusted fuels, 30–31
Chemical Industry Institute of Toxicology (CIIT), 45
Chevron Corporation, 241
Childhood cancers, 293–296, 311–313
central nervous system cancers, 294–296
conclusions about, 313
leukemia, 293–294
China, studies from cited, 63–64, 66–67, 73, 90–94, 256–257, 294, 301, 308, 335
Chlamydia pneumoniae, 340–341
Chronic bioassays, 47
Chronic bronchitis, 240
conclusions about, 267–269
and exposure to fuels, 242, 245
key studies of, 268
Chronic fatigue syndrome (CFS), 361
Chronic obstructive pulmonary disease (COPD), conclusions about, 269–270
CIIT. See Chemical Industry Institute of Toxicology
CIN. See Cervical intraepithelial neoplasia
Civilian populations, epidemiology of MCS symptoms in, 326–327
CNS. See Central nervous system cancers
Cohort studies, 20, 407–408, 413
of bladder cancer, and exposure to combustion products, 114–115
of cancers of the oral cavity and oropharynx, and exposure to fuels, 62–63
of colon cancer, and exposure to fuels, 74–75
of esophageal cancer
and exposure to combustion products, 71
and exposure to fuels, 70
of exposure to hydrazine, 363–369
in Italian power plant cohort, 368–369
in UK hydrazine production cohort, 367–368
in US aerospace cohort, 363–367
of exposure to nitric acid, 381–383
in Italian chemical plant workers, 382
in nitric acid production cohort, 382–383
occupational studies, 381–383
in Pennsylvania sheet and tin mill, 381
in US mid western metal pickling cohort, 381–382
of female breast cancer, and exposure to fuels, 101
of female genital cancers (cervical, endometrial, uterine, and ovarian), and exposure to fuels, 104
of Hodgkin’s disease
and exposure to combustion products, 132
and exposure to fuels, 131
of kidney cancer
and exposure to combustion products, 124
and exposure to fuels, 120–121
of laryngeal cancer, and exposure to fuels, 81
of leukemias, and exposure to combustion products, 138
of male genital cancers (prostatic and testicular), and exposure to fuels, 106
of malignant melanoma of the skin
and exposure to combustion products, 96
and exposure to fuels, 94–95
of multiple myeloma, and exposure to fuels, 133–134
of nervous system cancers, and exposure to fuels, 108–109
of non-Hodgkin’s lymphoma
and exposure to combustion products, 129
and exposure to fuels, 128
of non-melanoma skin cancers, and exposure to fuels, 98–99
of pancreatic cancer, and exposure to fuels, 79
prospective and retrospective, 407
of rectal cancer, and exposure to fuels, 76–77
of stomach cancer
and exposure to combustion products, 73
and exposure to fuels, 72
tables of, 414–425
Colon cancer, 74–76
conclusions about, 76
and exposure to combustion products, 75–76
case-control studies, 75–76
selected epidemiologic studies, 153–154
and exposure to fuels, 74–75
case-control studies, 75
cohort studies, 74–75
selected epidemiologic studies, 152–153
Columbia, studies from cited, 263
Combustion products, 39–49
bladder cancer, and exposure to, 114–118
cancers of the nasal cavity and nasopharynx, and exposure to, 67–69
cancers of the oral cavity and oropharynx, and exposure to, 63–65
cardiovascular disease, and exposure to, 278–284
air-pollution studies, 280–281
conclusions about, 284
Gulf War Veteran studies, 279–280
occupational studies, 282–284
colon cancer, and exposure to, 75–76
esophageal cancer, and exposure to, 70–71
female breast cancer, and exposure to, 102
female genital cancers (cervical, endometrial, uterine, and ovarian), and exposure to, 105
hepatic cancer, and exposure to, 156
Hodgkin’s disease, and exposure to, 131–132
kidney cancer, and exposure to, 124–127
laryngeal cancer, and exposure to, 82–84
leukemias, and exposure to, 138–139
liver cancer, and exposure to, 78–79
lung cancer, and exposure to, 86–93
male breast cancer, and exposure to, 103
male genital cancers (prostatic and testicular), and exposure to, 106–107
malignant melanoma of the skin, and exposure to, 95–97
multiple myeloma, and exposure to, 135–136
myelodysplastic syndromes, and exposure to, 141
nervous system cancers, and exposure to, 109
neurologic outcomes, and exposure to, 321–325
non-Hodgkin’s lymphoma, and exposure to, 129–130
non-melanoma skin cancers, and exposure to, 99–100
ocular melanoma, and exposure to, 110
pancreatic cancer, and exposure to, 80
physical and chemical properties of, 41–42
potential exposures in the Gulf War, 40–41
prostatic cancer, and exposure to. See Male genital cancers
rectal cancer, and exposure to, 77–78
reproductive and developmental outcomes, and exposure to, 297–313
adverse pregnancy outcomes, 298–311
respiratory outcomes, and exposure to, 243–270
asthma, key studies of, 265–266
biomass-fuel combustion, 261–262
chronic bronchitis, key studies of, 268
conclusions, 264–269
exposure statistics, 251
Gulf War studies, 246–251
occupational studies, 259–261
other biomass studies, 262–264
outdoor air pollution, 252–258
stomach cancer, and exposure to, 72–73
toxicity studies of, 43–49
toxicokinetics of, 42–43
and uncombusted fuels, 28–59
Computed-tomographic (CT) scans, 323
Conclusions, 264–269
about asthma, 264–266
about birth defects, 311
about bladder cancer, 118–119
about cancers of the nasal cavity and nasopharynx, 69–70
about cancers of the oral cavity and oropharynx, 65–66
about childhood cancers, 313
about chronic bronchitis, 267–269
about chronic obstructive pulmonary disease, 269–270
about colon cancer, 76
about combustion products and cardiovascular disease, 284
about dermatologic outcomes, 336
about emphysema, 269
about esophageal cancer, 71–72
about female breast cancer, 102
about female genital cancers (cervical, endometrial, uterine, and ovarian), 105
from Gulf War and Health, Volumes 1 and 2, 17, 398–402
about Hodgkin’s disease, 132
about kidney cancer, 127
about laryngeal cancer, 84–85
about leukemias, 139–140
about liver cancer, 79
about low birthweight and intrauterine growth retardation, 310
about lung cancer, 93
about male breast cancer, 103–104
about male genital cancers (prostatic and testicular), 107
about malignant melanoma of the skin, 98
about multiple chemical sensitivity, 331
about multiple myeloma, 137
about myelodysplastic syndromes, 141–142
about nervous system cancers, 110
about neurobehavioral effects, 321, 324
about non-Hodgkin’s lymphoma, 130
about non-melanoma skin cancers, 100–101
about ocular melanoma, 111
about pancreatic cancer, 80
about peripheral neuropathy, 319
about posttraumatic stress disorder, 323
about rectal cancer, 78
about reproductive and developmental outcomes, 297
about respiratory outcomes, 242–243, 264, 269
about sarcoidosis, 341
about stomach cancer, 74
summary of, 142–143
Consistency of association, in assessing the strength of the evidence, 4, 23
Contact dermatitis, experimental studies of the toxicology of hydrazines in, 356
Controlled epidemiologic studies (observational), 406–410
case-control studies, 408–409
case reports and case series, 409–410
cohort studies, 407–408
cross-sectional studies, 409
information from death certificates, 410
Controlled trials, randomized, 20
in humans, 406
COPD. See Chronic obstructive pulmonary disease
Cross-sectional studies, 20, 409, 410
of hydrazine exposure, 369–370
Japanese hydrazine hydrate workers, 369–370
missile-propellant handlers at Vandenberg Air Force Base, California, 369
rocket-propellant workers in Danish Air Force, 369
of outdoor air pollution, 254–255
CT. See Computed-tomographic scans
Czech Republic, studies from cited, 302, 307, 309
D
Danish Air Force, rocket-propellant workers in, 369
Danish Cancer Registry, 134, 136, 311
Danish Gulf War Study, 361
Danish Supplemental Pension Fund, 134, 136
Death certificates, information from, 410
Denmark, studies from cited, 91, 103
Dermatologic outcomes, 331–336
absorption of fuels by Gulf War personnel, 28
conclusions about, 336
dermatitis, and fuel exposure, 333–334
experimental studies in exposure to uncombusted fuels, 39
inadequate/insufficient evidence to determine whether an association exists, 10
Determinants of disease, epidemiology dealing with, 20
Developmental insults, from exposure to nitric acid, 359
Developmental outcomes. See Reproductive and developmental outcomes
Diabetes mellitus, mortality from, and exposure to nitric acid, 389
Diagnostic and Statistical Manual of Mental Disorders-IV, 320
Diesel heater fumes
exposure to, 19
Disease induction, exposure preceding the onset of disease by the duration of, 23
Diseases
epidemiology dealing with determinants of, distribution of, and frequency of, 20
not specified in legislation, 18
DOD. See US Department of Defense
Dose-response relationship, in assessing the strength of the evidence, 4–5, 23
E
Ear nose and throat (ENT) conditions, 262
Ecologic studies, given less weight, 22
Ecuador, studies from cited, 292
EMBASE, 403
EMBCS. See European Merged Bladder Cancer Study
Emphysema, conclusions about, 269
Endometrial cancer. See Female genital cancers
ENT. See Ear nose and throat conditions
Environmental studies, 14
EPA. See US Environmental Protection Agency
Epidemiologic studies, 3, 16, 19–21, 290–291, 360–389, 405–412
of acute nonlymphocytic leukemia, 290
of bladder cancer
and exposure to combustion products, 200–206
and exposure to fuels, 198–200
of brain/CNS cancers
and exposure to combustion products, 197
and exposure to fuels, 195–196
of cancers of the nasal cavity and nasopharynx
and exposure to combustion products, 147–148
and exposure to fuels, 147
of cancers of the oral cavity and oropharynx
and exposure to combustion products, 145–146
and exposure to fuels, 144
of colon cancer
and exposure to combustion products, 153–154
and exposure to fuels, 152–153
controlled epidemiologic studies, 406–410
of esophageal cancer
and exposure to combustion products, 149
and exposure to fuels, 148
experimental studies, 405–406
of female breast cancer
and exposure to combustion products, 189
and exposure to fuels, 188–189
of female genital cancers (cervical, endometrial, uterine, and ovarian)
and exposure to combustion products, 192–193
and exposure to fuels, 191
of hepatic cancer
and exposure to combustion products, 156
and exposure to fuels, 156
of Hodgkin’s disease
and exposure to combustion products, 216
and exposure to fuels, 215–216
of hydrazine exposure, occupational studies, 362–370
of kidney cancer
and exposure to combustion products, 210–212
and exposure to fuels, 207–210
of laryngeal cancer
and exposure to combustion products, 159–163
and exposure to fuels, 158
of leukemias, 290
and exposure to combustion products, 220–221
of lung cancer
and exposure to combustion products, 164–184
and exposure to fuels, 163–164
of male breast cancer
and exposure to combustion products, 190–191
and exposure to fuels, 190
of MCS symptoms in veteran and civilian populations, 326–327
of melanoma skin cancer, and exposure to fuels, 184–185
of multiple myeloma
and exposure to combustion products, 218–220
and exposure to fuels, 216–218
of myelodysplastic syndromes
and exposure to combustion products, 222
and exposure to fuels, 221–222
nature of the Gulf War studies, 410–411
of neuroblastoma, 291
of nitric acid exposure, occupational studies, 371–384
of non-Hodgkin’s lymphoma
and exposure to combustion products, 214–215
and exposure to fuels, 212–213
of non-melanoma skin cancers
and exposure to combustion products, 187–188
and exposure to fuels, 187
of ocular melanoma, and exposure to combustion products, 197–198
of pancreatic cancer
and exposure to combustion products, 157–158
and exposure to fuels, 157
of Prader-Willi syndrome, 291
of prostatic cancer
and exposure to combustion products, 194–195
and exposure to fuels, 193
of rectal cancer
and exposure to combustion products, 155–156
and exposure to fuels, 154–155
of reproductive outcomes from exposure to fuel, 290–291
of respiratory outcomes, and fuel exposure, 243–246
of Scud missile debris, exposure by Gulf War veterans to, 360–362
of stomach cancer
and exposure to combustion products, 151–152
and exposure to fuels, 150
Epidemiological Standardization project, 256
Error, reducing common sources of, 6, 22
Esophageal cancer, 70–72
conclusions about, 71–72
and exposure to combustion products, 70–71
case-control studies, 71
cohort studies, 71
selected epidemiologic studies, 149
and exposure to fuels, 70
cohort studies, 70
selected epidemiologic studies, 148
and exposure to nitric acid, 387–388
Ethiopia, studies from cited, 335
European Merged Bladder Cancer Study (EMBCS), 113–114, 117–119
European Prospective Study into Cancer and Nutrition, 254
Evaluation of the literature, 3–4, 18–27
categories of association, 25–27
considerations in assessing the strength of the evidence, 22–25
epidemiologic studies, 20–21
identification of the literature, 19
Evidence
of a causal relationship, 3, 16
of a statistical association, 2, 15
Excerpta Medica database, 403
Experimental studies, 405–406
animal models, 405–406
of exposure to nitric acid, 357–358
randomized controlled trials in humans, 406
of the toxicology of hydrazines, 354–356
amyloidosis, 355
cancer, 355
contact dermatitis, 356
genotoxicity, 355
hepatic effects, 354
nervous system effects, 354
reproductive and developmental effects, 354–355
respiratory effects, 354
systemic lupus erythematosus, 355
of the toxicology of nitric acid, 357–358
residual effects of corrosive action and irritation, 357–358
of uncombusted fuels, 34–39
cancer, 35
cardiovascular effects, 37
dermal effects, 39
gastrointestinal effects, 37
hepatic effects, 36–37
immunologic effects, 37–38
neurologic effects, 35–36
renal effects, 38
reproductive and developmental effects, 38–39
respiratory effects, 36
Exposure.
See also Combustion products;
Fuels;
Hydrazines;
Nitric acid
to compounds in exhaust fumes, 92–93
to environmental or wartime hazards, 1
and exposure-free interval for reversible effects, 21–22
to preventive medicines or vaccines associated with Gulf War service, 1
to toxic agents, 1
Exposure limits, for uncombusted fuels, 29
Exxon Corporation, 121, 128, 131–133
F
FAB. See French-American-British system
Factor analysis, 411
Fatigue, reported by Gulf War Veterans, 14
Female breast cancer, 101–102
conclusions about, 102
and exposure to combustion products, 102
case-control studies, 102
selected epidemiologic studies, 189
and exposure to fuels, 101
cohort studies, 101
selected epidemiologic studies, 188–189
Female genital cancers (cervical, endometrial, uterine, and ovarian), 104–105
conclusions about, 105
and exposure to combustion products, 105
case-control studies, 105
selected epidemiologic studies, 192–193
and exposure to fuels, 104
cohort studies, 104
selected epidemiologic studies, 191
Finland, studies from cited, 64, 80, 100, 105, 125, 264
Finnish Cancer Registry, 100, 123
Forced vital capacity (FVC), 251, 259
France, studies from cited, 80, 83, 117, 127, 141, 254
French-American-British (FAB) system, 139–140
Frequency of disease, epidemiology dealing with, 20
See also Uncombusted fuels
bladder cancer, and exposure to, 111–114
cancers of the nasal cavity and nasopharynx, and exposure to, 66–67
cancers of the oral cavity and oropharynx, and exposure to, 62–63
and cardiovascular disease, 278
colon cancer, and exposure to, 74–75
dermatitis, and exposure to, 333–334
esophageal cancer, and exposure to, 70
female breast cancer, and exposure to, 101
female genital cancers (cervical, endometrial, uterine, and ovarian), and exposure to, 104
hepatic cancer, and exposure to. See Liver cancer
Hodgkin’s disease, and exposure to, 131
kidney cancer, and exposure to, 120–124
laryngeal cancer, and exposure to, 81–82
leukemias, and exposure to, 138
liver cancer, and exposure to, 78
lung cancer, and exposure to, 86
male breast cancer, and exposure to, 103
male genital cancers (prostatic and testicular), and exposure to, 106
malignant melanoma of the skin, and exposure to, 94–95
multiple myeloma, and exposure to, 133–134
myelodysplastic syndromes, and exposure to, 140–141
nervous system cancers, and exposure to, 108–109
neurologic outcomes, and exposure to, 318–321
non-Hodgkin’s lymphoma, and exposure to, 128–129
non-melanoma skin cancers, and exposure to, 98–99
ocular melanoma, and exposure to, 110
pancreatic cancer, and exposure to, 79
prostatic cancer, and exposure to. See Male genital cancer
rectal cancer, and exposure to, 76–77
reproductive and developmental outcomes, and exposure to, 290–297
childhood cancers, 293–296
conclusions about, 297
infertility, 291–292
selected epidemiologic studies, 290–291
spontaneous abortion, 292–293
respiratory outcomes, and exposure to, 241–243
chronic bronchitis and emphysema, 242, 245
conclusions about, 242–243
nonmalignant respiratory disease, 241–244
pneumonia and influenza, 245–246
selected epidemiologic studies, 243–246
stomach cancer, and exposure to, 72
toxicokinetics of, 34
FVC. See Forced vital capacity
G
Gases from combustion, 41–42, 45–48
carbon monoxide and carbon dioxide, 41–42, 48
ozone, 47–48
physical and chemical properties, 41–42
toxicity studies of, 43–49
toxicokinetics of, 42–43
Gasoline sniffing, 36, 320–321
Gastrointestinal effects, experimental studies of exposure to uncombusted fuels, 37
Gene-Tox database, 359
General exposure, to engine exhaust, 91–92
General Health Questionnaire, 322
Genetic susceptibility
and exposure to nitric acid, 359
and hydrazine, 356
Genital cancers
female, 104–105
male, 105–107
Genotoxicity
experimental studies of the toxicology of hydrazines in, 355
from exposure to nitric acid, 359
Georgia, studies from cited, 289, 302
Germany, studies from cited, 64, 66, 81, 83–84, 91–92, 106, 113, 123, 125
Global Initiative for Chronic Obstructive Lung Disease (GOLD), 240, 269
GOLD. See Global Initiative for Chronic Obstructive Lung Disease
Greece, studies from cited, 90, 254
Gulf War and Health: Updated Literature Review of Sarin, 1
Gulf War and Health, Volume 1: Depleted Uranium, Pyridostigmine Bromine, Sarin, and Vaccines, 1, 12, 18
conclusions from, 398–402
Gulf War and Health, Volume 2: Insecticides and Solvents, 1, 12, 18, 29
conclusions from, 398–402
H
Harvard Six Cities Study, 90, 256, 280
Hawaii, studies from cited, 289
HCFA. See Health Care Financing Administration
HCs. See Hydrocarbons
Headaches, reported by Gulf War Veterans, 14
Health Care Financing Administration (HCFA), 82
“Healthy-worker” effect, 407–408
Hepatic cancer. See Liver cancer
and exposure to combustion products, selected epidemiologic studies, 156
and exposure to fuels, selected epidemiologic studies, 156
Hepatic effects, experimental studies
of exposure to uncombusted fuels, 36–37
of the toxicology of hydrazines in, 354
Herbicides used in Vietnam, categories used to evaluate, 25
Hodgkin’s disease, 130–132
conclusions about, 132
and exposure to combustion products, 131–132
case-control studies, 132
cohort studies, 132
selected epidemiologic studies, 216
and exposure to fuels, 131
case-control studies, 131
cohort studies, 131
selected epidemiologic studies, 215–216
Human health outcomes, 6
summary of findings regarding the association between exposure to fuels,
combustion products, hydrazines, and nitric acid and specific health outcomes, 7–11
Humans, randomized controlled trials in, 406
Hydrazines, 348–356
chemical identity and selected physical and chemical properties of, 349–351
experimental studies, 354–356
genetic susceptibility, 356
interactions, 356
occupational studies of, 362–370
recommended exposure limits for, 352–353
toxicokinetics, 351–353
Hydrocarbons (HCs), 120–121, 133, 135
Hydrogen sulfide
from combustion, 41
respiratory diseases, from outdoor air pollution, 258
toxicity of, 45
Hypertensive heart disease, mortality from, and exposure to nitric acid, 389
I
IARC. See International Agency for Research on Cancer
ICD. See International Classification of Disease codes
Iceland, studies from cited, 91
Identification
of class or agent, 21
of the relevant literature, 19
Idiopathic environmental intolerance. See Multiple chemical sensitivity
IES. See Impact of Events Scale
IHD. See Ischemic-heart-disease
Immunologic effects, experimental studies in exposure to uncombusted fuels, 37–38
Impact of Events Scale (IES), 322
Imperial Oil Limited, 70, 74–76, 79, 86, 93, 95, 98, 101, 104, 106, 108, 121, 128, 130–131, 133
Inadequate/insufficient evidence to determine whether an association exists, 5, 8–10, 26, 142–143, 400–402
cardiovascular effects, 10
conclusions from Gulf War and Health, Volumes 1 and 2, 400–402
dermal effects, 10
respiratory effects, 10
Inclusion criteria for literature used, 4, 21–22
exposure assessment, and exposure-free interval for reversible effects, 21–22
identification of class or agent, 21
methodological rigor, 21
specificity of outcome, 21
support studies, 22
Increased risk in Gulf War Veterans, determining, 2–3, 15–16
India, studies from cited, 261, 263, 384
Individual susceptibility, to uncombusted fuels and combustion products, 49–50
Indoor air pollution, from combustion of fuels, 88
Indoor pollutants related to asthma, categories used to evaluate, 25
Infection, susceptibility to, from exposure to nitric acid, 359
Infertility, from exposure to fuels, 291–292
Influenza, from exposure to fuels, 245–246
Information
bias in, 24–25
from death certificates, 410
Inhalation of fuels, by Gulf War personnel, 28
Inhibited red fuming nitric acid (IRFNA), 347–348
Institute of Medicine (IOM), 1–2, 12, 14–15, 288
previous studies by, 5–6, 15, 25, 141, 288
Institute of Oncology (Poland), 383
Interactions
with hydrazine, 356
with nitric acid, 359
with uncombusted fuels and combustion products, 50
International Agency for Research on Cancer (IARC), 2, 15, 20, 29, 61, 82, 100, 348, 351, 357, 359, 385, 403
International Classification of Disease
seventh revision (ICD-7), 381
eighth revision (ICD-8), 133
ninth revision (ICD-9), 10, 61–64, 68, 70, 74, 76, 78–79, 83, 85, 94, 101–102, 104–105, 110–111, 119, 127–128, 130, 132, 137–138, 246, 251, 280, 283
Clinical Modification, 279
tenth revision (ICD-10), 326
International Classification of Disease (ICD) codes, 22, 24, 277, 281, 324, 363
International Renal-Cell Cancer Study (IRCCS), 118, 123, 125
International Standard Classification of Occupation and Industry (ISCOI), 68, 125–126
Intrauterine growth retardation, 6, 302–310
IOM. See Institute of Medicine
Iowa, studies from cited, 113, 115, 128–129, 289, 328, 336
Iowa Farm Family Health and Hazard Survey, 336
Iowa Persian Gulf Study Group, 411
IRCCS. See International Renal-Cell Cancer Study
IRFNA. See Inhibited red fuming nitric acid
Ischemic-heart-disease (IHD), 368, 371
ISCOI. See International Standard Classification of Occupation and Industry
Israel, studies from cited, 332
Italian chemical plant workers, cohort studies of nitric acid exposure, 382
Italian power plant cohort, 368–369
Italy, studies from cited, 65, 70, 72–73, 90–91, 101–102, 107, 109, 113, 116, 128, 130–132, 136, 139, 368, 382
J
Japan, studies from cited, 255
Japanese hydrazine hydrate workers, 369–370
K
Kaiser Permanente Medical Care Program, 92
Kashmir, studies from cited, 263
Kidney cancer, 119–127
conclusions about, 127
and exposure to combustion products, 124–127
case-control studies, 124–127
cohort studies, 124
selected epidemiologic studies, 210–212
and exposure to fuels, 120–124
case-control studies, 121–124
cohort studies, 120–121
selected epidemiologic studies, 207–210
Kuwait, oil-fires in, 40, 43, 93, 269, 322
L
Laryngeal cancer, 80–85
conclusions about, 84–85
and exposure to combustion products, 82–84
case-control studies, 82–84
selected epidemiologic studies, 159–163
and exposure to fuels, 81–82
case-control studies, 81–82
cohort study, 81
selected epidemiologic studies, 158
and exposure to nitric acid, 387
case-control studies, 383
LBW. See Low birthweight
agents specified in PL 105–368 and PL 105–277, 13
diseases or illnesses not specified, 18
conclusions about, 139–140
and exposure to combustion products, 138–139
case-control studies, 138–139
cohort studies, 138
nested case-control studies, 138
selected epidemiologic studies, 220–221
and exposure to fuels, 138, 290
Limited/suggestive evidence
of an association, 5, 7–8, 26, 399
conclusions from Gulf War and Health, Volumes 1 and 2, 399
neurologic effects, 399
other health effects, 399
reproductive effects, 8
respiratory effects, 8
of no association, 6, 11, 26–27, 402
conclusions from Gulf War and Health, Volumes 1 and 2, 402
Literature
evaluation of, 3–4
peer-reviewed published, 19
Liver cancer, 78–79
conclusions about, 79
and exposure to combustion products, 78–79
case-control studies, 79
and exposure to fuels, 78
case-control studies, 78
Lombardy Cancer Registry for Varese Province, 368
Louisiana, studies from cited, 121, 128, 131, 133, 279–280, 360
Low birthweight (LBW), 6, 302–310
conclusions about, 310
and exposure to combustion products, 303–306
Lung cancer, 85–93
conclusions about, 93
and exposure to combustion products, 6, 86–93
and ambient air pollution from combustion of fuels, 89
ambient air-pollution studies, 89–91
and indoor air pollution from combustion of fuels, 88
occupational exposure to engine exhaust, 91–93
and occupations with exposure to combustion products, 87
selected epidemiologic studies, 164–184
and exposure to fuels, 86
selected epidemiologic studies, 163–164
and exposure to nitric acid, 386–387
Lupus. See Systemic lupus erythematosus
Lymphomas. See Non-Hodgkin’s lymphoma
Lymphopoietic cancer, and exposure to nitric acid, 388
M
Malaysia, studies from cited, 67–68
Male breast cancer, 102–104
conclusions about, 103–104
and exposure to combustion products, 103
case-control studies, 103
selected epidemiologic studies, 190–191
and exposure to fuels, 103
case-control studies, 103
selected epidemiologic studies, 190
Male genital cancers (prostatic and testicular), 105–107
conclusions about, 107
and exposure to combustion products, 106–107
case-control studies, 106–107
and exposure to fuels, 106
case-control studies, 106
cohort studies, 106
Malignant melanoma skin cancer, 94–98.
See also Non-melanoma skin cancers
conclusions about, 98
and exposure to combustion products, 95–97
case-control studies, 96–97
cohort studies, 96
selected epidemiologic studies, 185–187
and exposure to fuels, 94–95
case-control studies, 95
cohort studies, 94–95
selected epidemiologic studies, 184–185
Mantel-Haenzel test, 141
Maryland, studies from cited, 134
Massachusetts, studies from cited, 279–280, 360
MCS. See Multiple chemical sensitivity
MDFs. See Middle-distillate fuels
MDSs. See Myelodysplastic syndromes
MEDLINE, 403
Melanomas.
See also Malignant melanoma skin cancer;
Ocular melanoma
Mexico, studies from cited, 262
Michigan, studies from cited, 91, 112
Middle-distillate fuels (MDFs), 35, 37
Minnesota, studies from cited, 121, 126, 128
Missile-propellant handlers, at Vandenberg Air Force Base, California, 369
Mississippi, studies from cited, 288
Missouri, studies from cited, 43–44, 126
Mixtures of combustion products, toxicity studies of, 43–44
Mortality studies
of combustion products and respiratory outcomes, 259–260
of outdoor air pollution, 255–256
Multiple chemical sensitivity (MCS), 325–331, 361
background, 326–327
common triggers and original causes reported by people with, 331
conclusions about, 331
epidemiology of symptoms in veteran and civilian populations, 326–327
evaluation of the evidence and inclusion criteria, 327–328
Gulf War studies, 328–329
hypotheses about etiology, 327
prevalence of symptoms in Gulf War and US population-based samples, 326–327
studies in non-Gulf War Veteran populations, 329–331
Multiple myeloma, 132–137
conclusions about, 137
and exposure to combustion products, 135–136
case-control studies, 135–136
nested case-control studies, 135
selected epidemiologic studies, 218–220
and exposure to fuels, 133–134
case-control studies, 134
cohort studies, 133–134
selected epidemiologic studies, 216–218
and exposure to nitric acid, 388
case-control studies of, 384
Mutagenicity, 35
Myelodysplastic syndromes (MDSs), 140–142
conclusions about, 141–142
and exposure to combustion products, 141
case-control studies, 141
selected epidemiologic studies, 222
and exposure to fuels, 140–141
case-control studies, 140–141
selected epidemiologic studies, 221–222
Myelomas, multiple. See Multiple melanoma
N
Naphtha, 29
NAS. See National Academy of Sciences
Nasal cavity and nasopharynx, cancers of, 66–70
conclusions about, 69–70
and exposure to combustion products, 67–69
case-control studies, 67–69
selected epidemiologic studies, 147–148
and exposure to fuels, 66–67
case-control studies, 67
selected epidemiologic studies, 147
Nasopharyngeal carcinoma (NPC), 66–68
National Academy of Sciences (NAS), 1, 12
National Bladder Cancer Study (NBCS), 112–113, 115, 118
National Cancer Institute (NCI), 74, 112
National Cancer Survey database, 75, 77
National Enhanced Cancer Surveillance System (NECSS), 126, 129
National Family Health Survey (India), 261
National Guard units, 288, 360
National Health Interview Survey, 336
National Institute for Occupational Safety and Health (NIOSH), 29, 348, 356–357, 381
National Library of Medicine (NLM), 403–404
National Occupational Hazard Survey, 75, 77
National Oceanic and Atmospheric Administration (NOAA), 247, 251, 279
National Prader-Willi Syndrome Association, 296
National Priorities List, 336
National Research Council (NRC), 29, 34–39, 46, 48, 347–348, 351, 355–356, 369
National Taiwan University Hospital, 335
National Toxicology Program (NTP), 47
NBCS. See National Bladder Cancer Study
NCI. See National Cancer Institute
NECSS. See National Enhanced Cancer Surveillance System
Nepal, studies from cited, 262
Nervous system cancers, 107–110
conclusions about, 110
and exposure to combustion products, 109
case-control studies, 109
and exposure to fuels, 108–109
case-control studies, 109
cohort studies, 108–109
Nervous system effects, experimental studies of the toxicology of hydrazines in, 354
Nested case-control studies
in leukemias, and exposure to combustion products, 138
in multiple myeloma, and exposure to combustion products, 135
The Netherlands, studies from cited, 89–90, 92, 97, 114, 256, 280–281
The Netherlands Cohort Study on Diet and Cancer, 114, 256, 280–281
Neuroblastoma, and exposure to fuels, 291
Neurologic outcomes, 317–325
conclusions about, 319, 321, 323–325
and exposure to combustion products, 321–325
neurobehavioral effects, 323–324
neurologic diseases, 324–325
posttraumatic stress disorder, 322–323
and exposure to uncombusted fuels, 318–321
experimental studies in, 35–36
peripheral neuropathy, 319
neurobehavioral effects, 320–321
inadequate/insufficient evidence to determine whether an association exists, 10, 401
limited/suggestive evidence of an association, 399
New Caledonia, studies from cited, 91
New Jersey, studies from cited, 78, 112, 121
New York, studies from cited, 65, 73, 84, 90, 96, 102, 129, 132, 138, 257, 283, 295, 340
New Zealand, studies from cited, 127, 258, 310, 324
New Zealand Cancer Registry, 127
NHL. See Non-Hodgkin’s lymphoma
NHLBI, 253
NIOSH. See National Institute for Occupational Safety and Health
Nitric acid, 356–359
and cancer, 358–359
chemical identity and selected physical and chemical properties of, 349–350
experimental studies of, 357–358
and genetic susceptibility, 359
interactions, 359
occupational studies of exposure to, 371–384
recommended exposure limits for, 352–353
residual effects of corrosive action and irritation, 357–358
toxicokinetics of, 356–357
white fuming, 356
Nitrogen oxides
from combustion, 41
toxicity of, 46–47
NLM. See National Library of Medicine
No-observed-effect level (NOEL), 358
NOAA. See National Oceanic and Atmospheric Administration
NOEL. See No-observed-effect level
Non-cancer health outcomes, and exposure to nitric acid, 384, 388–390
arteriosclerotic heart disease (mortality), 388–389
cardiovascular effects, 384
diabetes mellitus (mortality), 389
hypertensive heart disease (mortality), 389
respiratory effects, 384
vascular lesions of CNS (mortality), 389
Non-Hodgkin’s lymphoma (NHL), 127–130
conclusions about, 130
and exposure to combustion products, 129–130
case-control studies, 129–130
cohort studies, 129
selected epidemiologic studies, 214–215
and exposure to fuels, 128–129
case-control studies, 128–129
cohort studies, 128
selected epidemiologic studies, 212–213
Non-melanoma skin cancers, 98–101
conclusions about, 100–101
and exposure to combustion products, 99–100
case-control studies, 100
selected epidemiologic studies, 187–188
and exposure to fuels, 98–99
case-control studies, 99
cohort studies, 98–99
selected epidemiologic studies, 187
Nonmalignant respiratory disease, and exposure to fuels, 241, 244
Normative Aging Study, 284
Norway, studies from cited, 89–90, 260, 382–383
Norwegian Cancer Registry, 383
NPC. See Nasopharyngeal carcinoma
NRC. See National Research Council
NTP. See National Toxicology Program
O
Observational studies, 406–410
case-control studies, 408–409
case reports and case series, 409–410
cohort studies, 407–408
cross-sectional studies, 409
types of epidemiologic studies, 406–410
Occupational Safety and Health Administration (OSHA), 29, 351, 356
Occupational studies, 2, 14–15, 16, 87
of exposure to combustion products, 91–93
and cardiovascular disease, 282–284
and respiratory outcomes, 259–261
of exposure to engine exhaust, 91–93
estimated exposure to compounds in exhaust fumes, 92–93
general exposure to exhaust, 91–92
Gulf War Veteran study, 93
of hydrazine exposure, 362–371
cohort studies, 363–369
conclusions from, 371
cross-sectional studies, 369–370
health outcomes, 372–374
of nitric acid exposure, 371, 375–385
case-control studies, 383–384
cohort studies, 381–383
conclusions from, 385
health outcomes and exposure to nitric acid, 386–390
Occupations, with exposure to combustion products, 87
Ocular melanoma, 110–111
conclusions about, 111
and exposure to combustion products, 110
case-control studies, 110
selected epidemiologic studies, 197–198
and exposure to fuels, 110
Oil-well fire by-products
exposure to, 14, 19, 28, 40, 43, 93, 267, 269
Gulf War studies of smoke, 248–249
Oklahoma, studies from cited, 122, 126
Oral cavity and oropharynx, cancers of, 61–66
conclusions about, 69–70
and exposure to combustion products, 67–69
case-control studies, 67–69
selected epidemiologic studies, 147–148
and exposure to fuels, 66–67
case-control studies, 67
selected epidemiologic studies, 147
Oregon, studies from cited, 362
Oropharynx, cancers of, 61–66
conclusions about, 69–70
and exposure to combustion products, 67–69
case-control studies, 67–69
selected epidemiologic studies, 147–148
and exposure to fuels, 66–67
case-control studies, 67
selected epidemiologic studies, 147
ORs. See Odds ratios
OSHA. See Occupational Safety and Health Administration
Outdoor air pollution, 252–258
cross-sectional or case-control studies, 254–255
hydrogen sulfide and respiratory diseases, 258
mortality studies, 255–256
prospective studies, 252–254
support studies, 256–258
Ovarian cancer. See Female genital cancers
Ozone, toxicity of, 47–48
P
PAHs. See Polycyclic aromatic hydrocarbons
Pancreatic cancer, 79–80
conclusions about, 80
and exposure to combustion products, 80
case-control studies, 80
selected epidemiologic studies, 157–158
and exposure to fuels, 79
cohort studies, 79
selected epidemiologic studies, 157
Particulate matter (PM) from combustion, 39, 40, 42–43, 48–50, 90
physical and chemical properties of, 42
toxicity studies of, 48–49
toxicokinetics of, 42–43
PEL. See Permissible exposure limit
Pennsylvania, studies from cited, 381–382, 384
Pennsylvania sheet and tin mill cohorts, cohort studies of nitric acid exposure, 381
Peripheral neuropathy
conclusions about, 319
from exposure to fuels, 319
Permissible exposure limit (PEL), 356
Persian Gulf War Veterans Act (PL 105–277), 1, 12–13
Physical and chemical properties
of combustion products, 41–42
gases, 41–42
participate matter, 42
of uncombusted fuels, 29
PL 105–368 and PL 105–277, agents specified in, 13
PM. See Participate matter from combustion
PMRs. See Proportional morbidity ratios
Pneumonia, from exposure to fuels, 245–246
Poland, studies from cited, 90, 99, 383
Polycyclic aromatic hydrocarbons (PAHs), 39–40, 42–43, 49, 61, 63–66, 71, 80, 82–83, 85, 91–93, 97, 99–103, 105–107, 114–116, 117–119, 123, 125–126, 141, 307, 309, 312, 368, 370
Population-based studies, of biomass-fuel combustion, 261–262
Posttraumatic stress disorder (PTSD), 280, 321–323, 360–361
conclusions about, 323
from exposure to combustion products, 322–323
Prader-Willi syndrome (PWS), 296–297
from exposure to fuels, 291
and combustion-product exposure, 299–300
Primary studies, 21
ProCite database, 403
Profile of Mood States, 323
Proportional morbidity ratios (PMRs), 250
Prospective studies
design of, 406–407
of outdoor air pollution, 252–254
Prostatic cancer, 193–195.
See also Male genital cancers
and exposure to combustion products, selected epidemiologic studies, 194–195
and exposure to fuels, selected epidemiologic studies, 193
PTSD. See Posttraumatic stress disorder
PubMed, 404
PWS. See Prader-Willi syndrome
R
Randomized controlled trials, 20, 406
in humans, 406
RCCs. See Renal-cell carcinomas
Recommended exposure limits
for exposure to hydrazine, 352–353
for exposure to nitric acid, 352–353
for fuels, 32–33
Rectal cancer, 76–78
conclusions about, 78
and exposure to combustion products, 77–78
case-control studies, 77–78
selected epidemiologic studies, 155–156
and exposure to fuels, 76–77
case-control studies, 77
cohort studies, 76–77
selected epidemiologic studies, 154–155
Red fuming nitric acid (RFNA), 348, 356, 358–360
Relative risk, 22
Renal-cell carcinomas (RCCs). See Kidney cancer
Renal effects, and exposure to uncombusted fuels, experimental studies of, 38
Reproductive and developmental outcomes, 288–313
and combustion products, 297–313
experimental studies
in exposure to uncombusted fuels, 38–39
of the toxicology of hydrazines in, 354–355
and fuels, 290–297
inadequate/insufficient evidence to determine whether an association exists, 9–10, 401
limited/suggestive evidence of an association, 8
studies of birth defects in Gulf War Veterans, 288–290
Respiratory cancer, and exposure to nitric acid, 386
Respiratory outcomes, 240–270
and combustion products, 243–270
and exposure to fuel, 241–243
and exposure to nitric acid, 384
and exposure to uncombusted fuels, experimental studies, 36
and the toxicology of hydrazines, experimental studies, 354
Retrospective design, of studies, 407
Reversible effects, exposure-free interval for, 21–22
RFNA. See Red fuming nitric acid
Rhode Island, studies from cited, 340
Risks of illness among Gulf War Veterans
determining increased, 2–3, 15–16
human or animal populations exposed to an agent, 2, 15–16
Rocket-propellant workers, in Danish Air Force, 369
Roswell Park Memorial Institute, 65, 73, 84, 96, 129, 132, 138
S
Sarcoidosis, 337–341
conclusions about, 341
and exposure to combustion products, case-control studies of, 338–339
Saudi Arabia, studies from cited, 263
Scientific evidence, strength of, 1–2
SCLC. See Small cell lung cancer
Scud missiles
debris from, 14, 347, 357, 360–362, 385
propellant components of, 7, 347
SDA. See Seventh-Day Adventist Study
Searching the literature, 403–404
SEER. See Surveillance, Epidemiology, and End Results registry
Selection bias, 24
Self-reported symptoms, 410
Seventh-Day Adventist (SDA) Study, 89–90, 252, 264, 280
Short-term exposure limit (STEL), 356
SIRs. See Standardized incidence ratios
Six Cities Study, 90, 256, 280
Skin burns, 347
Skin cancers. See Dermatologic outcomes;
Malignant melanoma skin cancer;
Nonmelanoma skin cancers
Small cell lung cancer (SCLC), 85
Social Security Administration, 381
South Carolina, studies from cited, 337
South Korea, studies from cited, 302, 307, 323
Spain, studies from cited, 80–83, 113
Specificity
of association, in assessing the strength of the evidence, 4, 23–24
of outcome, 21
Spontaneous abortion, from exposure to fuels, 292–293
Standard Industrial Classification of Economic Activities, 311.
See also International Standard Classification of Occupation and Industry
Standard Occupational Classification, 311
Standardized incidence ratios (SIRs), 63, 71, 73, 281
State Health Registry of Iowa, 113, 129
Statistical association
stability of, 5n
Statistical significance, measures of, 22
Statistics Canada, 301
STEL. See Short-term exposure limit
Stomach cancer, 72–74
conclusions about, 74
and exposure to combustion products, 72–73
case-control studies, 73
cohort studies, 73
selected epidemiologic studies, 151–152
and exposure to fuels, 72
case-control studies, 72
cohort studies, 72
selected epidemiologic studies, 150
Strength of evidence of an association, 4, 22–23
Study designs, 20
cohort or case-control studies, 20
cross-sectional studies, 20
randomized controlled trials, 20
Sulfur oxides
from combustion, 41
toxicity of, 45–46
Surveillance, Epidemiology, and End Results (SEER) registry, 81, 134–135, 137, 384
Susceptibility
to infection, from exposure to nitric acid, 359
to uncombusted fuels and combustion products, individual, 49–50
Sweden, studies from cited, 63–66, 71, 73, 77, 90–92, 97–98, 113–114, 124, 128, 130–131, 137, 139, 257, 261, 310, 383
Swedish Cancer Environmental Registry, 96–97, 113–114, 116, 124, 381
Switzerland, studies from cited, 91
Systemic lupus erythematosus, experimental studies of the toxicology of hydrazines in, 355
T
Tables of cancer studies related to exposure to fuels and combustion products, 144–222, 413–456
case-control studies, 425–456
cohort studies, 414–425
Taiwan, studies from cited, 91, 335
Temporal relationships, in assessing the strength of the evidence, 23
Testicular cancer. See Male genital cancers
Texas, studies from cited, 82–84, 86, 93, 121
Toxicity studies of combustion products, 43–49
gases, 45–48
mixtures of combustion products, 43–44
particulate matter, 48–49
Toxicokinetics
of combustion products, 42–43
of exposure to nitric acid, 356–357
of fuels, 29
of hydrazine, 351–353
of uncombusted fuels, 34
Toxicologic Assessment of Jet Propulsion Fuel, 8, 34
of hydrazines, 348–356
of nitric acid, 356–359
recommended exposure limits, 352–353
ToxNet, 404
Gene-Tox database, 359
Tucson Veterans Affairs Medical Center, 329
U
UDMH. See Unsymmetrical dimethylhydrazine
UK hydrazine production cohort, 367–368
Uncombusted fuels, 28–39
and combustion products, 28–59
experimental studies, 34–39
exposure limits, 29
physical and chemical properties of selected fuels, 29–31
recommended exposure limits for fuels, 32–33
toxicokinetics, 34
United Kingdom, studies from cited, 283, 289, 311, 367
United Kingdom Childhood Cancer Study, 311
University Hospital of Lille, 140
Unsymmetrical dimethylhydrazine (UDMH), 347–348, 351–352, 354–355, 360, 369–370
Uruguay, studies from cited, 81, 83
US, studies from cited. See individual states
US aerospace cohort, 363–367
US Army
Environmental Health Agency, 40
Environmental Hygiene Agency, 321
US Department of Agriculture, Forest Service, 261
US Department of Defense (DOD), 246–247, 250–251, 279, 290, 410
military treatment facilities, 93
US Department of Veterans Affairs (VA), 7, 19, 250, 289, 409
US Environmental Protection Agency (EPA), 40, 46, 336, 351
National Priorities List, 336
US Forest Service, 261
US mid western metal pickling cohort, cohort studies of nitric acid exposure, 381–382
US Surgeon General, 20
Utah, studies from cited, 112, 134
Uterine cancer. See Female genital cancers
V
VA. See US Department of Veterans Affairs
Vaccine safety, categories used to evaluate, 25
Vandenberg Air Force Base, California, missile-propellant handlers at, 369
Vascular lesions of CNS, mortality from, and exposure to nitric acid, 389
Veteran populations, epidemiology of MCS symptoms in, 326–327
Veterans Programs Enhancement Act (PL 105–277), 1, 12–13
Vietnam War, 322
categories used to evaluate herbicides used in, 25
VOCs. See volatile organic compounds
Volatile organic compounds (VOCs), 39
W
Washington, studies from cited, 69, 81, 84, 362
WFNA. See White fuming nitric acid
White fuming nitric acid (WFNA), 356, 358–359
WHO. See World Health Organization
World Health Organization (WHO), 46–47, 60, 140
Global Initiative for Chronic Obstructive Lung Disease, 240
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