B
Air Force Health Study Data

Section 602(c) of Pub. L. 108-183 called for this committee to evaluate “[t]he scientific merit of retaining and maintaining the medical records, other study data, and laboratory specimens collected in the course of the Air Force Health Study after its currently scheduled termination date in 2006” and to determine “[w]hether or not any obstacles exist to retaining and maintaining the medical records, other study data, and laboratory specimens.”

Pursuant to this charge, the committee reviewed data and specimen collection as reported in the original study protocol (AFHS, 1982), official AFHS morbidity cycle reports (AFHS, 1984, 1987, 1990, 1995, 2000, 2005), the Serum Dioxin Analysis of 1987 Examination Results (AFHS, 1991), AFHS mortality (AFHS, 1983, 1984, 1985, 1986, 1989, 1991, 1993, 1994, 1996) and reproductive outcomes reports (AFHS, 1992, 1998), as well as various AFHS analyses reported in scientific journals as cited in preceding chapters. AFHS data dictionaries and clinical collection and laboratory processing protocols were also reviewed where available.

The purpose of this appendix is to provide a sense of the scope and magnitude of the data collected and analyzed throughout the course of the AFHS. The following tables are not intended to serve as an exhaustive accounting of data collected or archived. Data collected in the mortality arm of the study are not represented in this appendix. The information contained in Tables B-1 through B-13 was derived primarily from analyses reported in AFHS morbidity cycle reports (cited above). Hence, they generally represent those outcomes included in morbidity analyses for a particular cycle and not necessarily all outcomes re-



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Disposition of the Air Force Health Study B Air Force Health Study Data Section 602(c) of Pub. L. 108-183 called for this committee to evaluate “[t]he scientific merit of retaining and maintaining the medical records, other study data, and laboratory specimens collected in the course of the Air Force Health Study after its currently scheduled termination date in 2006” and to determine “[w]hether or not any obstacles exist to retaining and maintaining the medical records, other study data, and laboratory specimens.” Pursuant to this charge, the committee reviewed data and specimen collection as reported in the original study protocol (AFHS, 1982), official AFHS morbidity cycle reports (AFHS, 1984, 1987, 1990, 1995, 2000, 2005), the Serum Dioxin Analysis of 1987 Examination Results (AFHS, 1991), AFHS mortality (AFHS, 1983, 1984, 1985, 1986, 1989, 1991, 1993, 1994, 1996) and reproductive outcomes reports (AFHS, 1992, 1998), as well as various AFHS analyses reported in scientific journals as cited in preceding chapters. AFHS data dictionaries and clinical collection and laboratory processing protocols were also reviewed where available. The purpose of this appendix is to provide a sense of the scope and magnitude of the data collected and analyzed throughout the course of the AFHS. The following tables are not intended to serve as an exhaustive accounting of data collected or archived. Data collected in the mortality arm of the study are not represented in this appendix. The information contained in Tables B-1 through B-13 was derived primarily from analyses reported in AFHS morbidity cycle reports (cited above). Hence, they generally represent those outcomes included in morbidity analyses for a particular cycle and not necessarily all outcomes re-

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Disposition of the Air Force Health Study corded or measured in AFHS clinical and laboratory evaluations or those obtained from private medical and dental records or military records. The myriad laboratory tests performed (by the Kelsey-Seybold Clinic for Cycle 1 and Scripps Clinic for Cycles 2–6) on subject blood, urine, and semen were provided by AFHS investigators by committee request and are listed in Table B-14. Dioxin assays are not included in this list as they were performed separately at the Centers for Disease Control and Prevention. A summary of covariates used in various analyses throughout the AFHS is provided in Table B-15 to further characterize available subject data. Table B-16 provides a brief overview of the types of data gathered through questionnaire administration as well as the major changes made to questionnaire (baseline and interval) content over time. Additional details relating AFHS data resources and analyses are can be found in Chapters 2–4.

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Disposition of the Air Force Health Study TABLE B-1 General Health Assessment Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Analyzed Endpoints   Self-perception of health (Q) X X X X X X Appearance of illness or distress as assessed by physician (PE) X X X X X X Relative age appearance as assessed by physician (PE) X X X X X X Calculated body fat (percentage) (PE) X X X X X   BMI (PE)   X Erythrocyte sedimentation (mm/hour) (LAB) X X X X X X Covariates   Age (years) (MIL) X X X X X X Race (MIL) X X X X     Military occupation (MIL) X X X X X X Current cigarette smoking (cigarettes/day) (Q)   X X Lifetime cigarette smoking history (pack-years) (Q)   X X Current alcohol use (2 weeks prior to physical exam) (drinks/day) (Q)   X Current alcohol use (drinks/day) (Q)   X   Lifetime alcohol history (drink-years) (Q)   X X Personality type (PE)   X X X X   Caloric intake (Q)   X   NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified; (MIL) military records. Areas in gray indicate that either an endpoint was not analyzed for a particular cycle or that it was unclear from the cycle report if an endpoint was analyzed. Gray areas do not indicate that an endpoint was not measured or recorded for a particular cycle. Shaded boxes with an X indicate that the endpoint was measured but not included in section analyses.

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Disposition of the Air Force Health Study TABLE B-2 Neurological Assessment Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Analyzed Endpoints   Inflammatory diseases (MVR) X X X X X X Hereditary and degenerative diseases (MRV) X X X X X X Peripheral disorders (MRV) X X X X X X Disorders of eye (MRV) X X X   Disorders of ear (MRV) X X X   Other neurological disorders (MRV)   X X X X X Smell (PE) X X X X X X Visual fields (PE) X X X X X X Light reaction (PE) X X X X X X Ocular movement (PE) X X X X X X Facial sensation (PE) X X X X X X Corneal reflex (PE) X X X X X X Jaw clench (PE) X X X X X X Smile (PE) X X X X X X Palpebral fissure (PE) X X X X X X Balance/Romberg sign (PE) X X X X X X Gag reflex (PE) X X X X X X Speech (PE) X X X X X X Tongue position relative to midline (PE) X X X X X X Palate and uvula movement (PE) X X X X X X Shoulder shrug (PE)   X Cranial nerve index without range of motion (PE)   X X X     Cranial nerve index (PE)   X X X X X

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Disposition of the Air Force Health Study Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Neck range of motion (PE) X X X X X   Pinprick (PE) X X X X X X Light touch (PE) X X X X X X Muscle status (PE) X X X X X X Vibratory sensation (PE) X X X   Patellar reflex (PE) X X X X X X Achilles reflex (PE) X X X X X X Biceps reflex (PE) X X X X X X Babinski reflex (PE) X X X X X X Any symmetrical peripheral abnormality (PE)   X Possible peripheral neuropathy (PE)   X Probable peripheral neuropathy (PE)   X Polyneuropathy severity index (PE)   X   Polyneuropathy prevalence index (PE)   X   Multiple polyneuropathy index (PE)   X   Confirmed polyneuropathy index (PE)   X   Vibrotactile threshold great toes (PE)   X   Tremor (PE) X X X X X X Coordination (PE) X X X X X X Romberg sign (PE) X X X X X X Gait (PE) X X X X X X CNS index (PE)   X X X X X Nerve conduction velocity (PE) X   NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified; (MIL) military records. Areas in gray indicate that either an endpoint was not analyzed for a particular cycle or that it was unclear from the cycle report if an endpoint was analyzed. Gray areas do not indicate that an endpoint was not measured or recorded for a particular cycle.

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Disposition of the Air Force Health Study TABLE B-3 Psychology Assessment Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Analyzed Endpoints   Psychoses (MRV) X X X X X X Alcohol dependence (MRV) X X X X X X Drug dependence (MRV)   X X X X Anxiety (MRV) X X X X X X Other neuroses (MRV) X X X X X X Fatigue (Q) X   Depression (Q) X Anxiety (Q) X Erosion of skills (Q) X Social isolation (Q) X Aggressive or impulsive behavior (Q) X Trouble falling asleep (Q)   X   Waking up during the night (Q) X Waking up too early and can’t go back to sleep (Q) X Waking up unrefreshed (Q) X Involuntarily falling asleep during the day (Q) X Great disabling fatigue during the day (Q) X Frightening dreams (Q) X Talking in sleep (Q) X Sleepwalking (Q) X Abnormal movement/activity during the night (Q) X Sleep problems requiring medication (Q) X Snore loudly in all sleeping positions (Q) X

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Disposition of the Air Force Health Study Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Insomnia (Q)   X   Overall sleep disorder index (Q)   X   Average sleep each night (hours) (Q)   X   SCL-90-R: Symptom Checklist-90—Revised (PE)   X X X X WMS-R: Wechsler Memory Scale—Revised (PE)   X MCMI: Millon Clinical Multiaxial Inventory (PE)   X   MMPI: Minnesota Multiphasic Personality Inventory (PE) X X   CMI: Cornell Medical Index (PE)   X   HRB: Halstead-Reitan Neuropsychological Test Battery (PE) X X   CI: Cornell Index (PE) X   WAIS: Wechsler Adult Intelligence Scale (PE) X   NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified; (MIL) military records. Areas in gray indicate that either an endpoint was not analyzed for a particular cycle or that it was unclear from the cycle report if an endpoint was analyzed. Gray areas do not indicate that an endpoint was not measured or recorded for a particular cycle. Shaded boxes with an X indicate that the endpoint was measured but not included in section analyses.

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Disposition of the Air Force Health Study TABLE B-4 Gastrointestinal Assessment Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Analyzed Endpoints   Uncharacterized hepatitis (Q/MRV) X X Xa X X X Jaundice (unspecified) (Q/MRV) X X X X X X Acute and subacute necrosis of the liver (Q/MRV)   X X X X Chronic liver disease and cirrhosis (alcohol related) (Q/MRV) X X X X X X Chronic liver disease and cirrhosis (nonalcohol related) (Q/MRV) X X X X X X Liver abscess and sequelae of chronic liver disease (Q/MRV)   X X X X Enlarged liver (hepatomegaly) (Q/MRV)   X X X X X Skin bruises, patches, or sensitivity (Q/MRV) X X X   Reported/verified ulcer (Q/MRV)   X X   Other disorders of the liver (Q/MRV) Xb X X X X X Liver disease (lifetime history) (Q/MRV)   X   Current hepatomegaly (PE) X X X X X X AST (U/L) (LAB) X X X X X X ALT (U/L) (LAB) X X X X X X GGT (U/L) (LAB) X X X X X X Alkaline phosphatase (U/L) (LAB) X X X X X X Total bilirubin (mg/dl) (LAB) X X X X X X Direct bilirubin (mg/dl) (LAB) X X X X X X LDH (U/L) (LAB) X X X X X X Cholesterol (mg/dl) (LAB) X X X X X X HDL cholesterol (mg/dl) (LAB)   X X X X Cholesterol-HDL ratio (LAB)   X X X X Triglycerides (mg/dl) (LAB) X X X X X X

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Disposition of the Air Force Health Study Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Creatine phosphokinase (U/L) (LAB)   X X X X Serum amylase (U/L) (LAB)   X X X Evidence of prior hepatitis A (LAB) X X X Evidence of prior hepatitis B (LAB) X X X Current hepatitis B (LAB) X X   Evidence of prior hepatitis C (LAB) X X X Evidence of prior hepatitis D (LAB)   X   Stool occult blood test (LAB) X X X Protein profile: prealbumin (mg/dl) (LAB) X X X Protein profile: albumin (mg/dl) (LAB) X X X Protein profile: α-1-acid glycoprotein (mg/dl) (LAB) X X X Protein profile: α-1-antitrypsin (mg/dl) (LAB) X X X Protein profile: α-2-macroglobulin (mg/dl) (LAB) X X X Protein profile: apolipoprotein B (mg/dl) (LAB) X X X Protein profile: C3 complement (mg/dl) (LAB) X X X Protein profile: C4 complement (mg/dl) (LAB) X X X Protein profile: haptoglobin (mg/dl) (LAB) X X X Protein profile: transferrin (mg/dl) (LAB) X X X Prothrombin time (seconds) (LAB)   X Fasting glucose (LAB)   X   Uroporphyrin (LAB) X X  

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Disposition of the Air Force Health Study Coproporphyrin (LAB) X X   Aminolevulinic acid (LAB) X   NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified; (MIL) military records. Areas in gray indicate that either an endpoint was not analyzed for a particular cycle or that it was unclear from the cycle report if an endpoint was analyzed. Gray areas do not indicate that an endpoint was not measured or recorded for a particular cycle. Shaded boxes with an X indicate that the endpoint was measured but not included in section analyses. aIn Cycle 3 viral hepatitis is reported versus uncharacterized hepatitis in other cycles. bLiver necrosis and enzyme elevation included in the other liver conditions category.

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Disposition of the Air Force Health Study TABLE B-5 Dermatological Assessment Cycle 1 2 3 4 5a 6 Examination Year 1982 1985 1987 1992 1997 2002 Analyzed Endpoints   Acne (lifetime) (Q/MRV) X X X X   X Post-SEA acne (Q/MRV/MIL) X X X X X Post-SEA acne (no pre-SEA acne) (Q/MRV/MIL) X X X X X Post-SEA acne (with pre-SEA acne) (Q/MRV/MIL) X X X X X Location of post-SEA acne (pre-SEA acne cases excluded) (Q/MRV)   X X X X Location of post-SEA acne (all post-SEA occurrences) (Q/MRV) X X X X X Duration of post-SEA acne (pre-SEA acne cases excluded) (months) (Q) X X X   X Duration of post-SEA acne (all post-SEA occurrences) (months) (Q) X X X X Acneiform lesions (PE) X X X X Acneiform scars (PE) X X X X Comedones (PE) X X X X Depigmentation (PE)   X X X Hyperpigmentation (PE) X X X X Inclusion cysts (PE) X X X X Dermatology index (PE)b X X X X X Other abnormalities (PE)c X X X X   NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified; (MIL) military records. Areas in gray indicate that either an endpoint was not analyzed for a particular cycle or that it was unclear from the cycle report if an endpoint was analyzed. Gray areas do not indicate that an endpoint was not measured or recorded for a particular cycle. Shaded boxes with an X indicate that the endpoint was measured but not included in section analyses. aDermatologic assessment not reported in the Cycle 5 follow-up examination results. bThe dermatology index comprised counts for comedones, acneiform lesions, acneiform scars, and inclusion cysts (AFHS, 1990). cConditions comprising the other abnormalities category were jaundice, spider angiomata, palmar erythema, suspected melanoma, palmar keratoses, petechiae, ecchymoses, conjunctival abnormality, oral mucosal abnormality, fingernail abnormality, toenail abnormality, dermatographia, cutis rhomboidalis, suspected basal cell carcinoma, suspected squamous cell carcinoma, nevus, or other abnormalities (AFHS, 1990). Vitiligo was added to the list in Cycle 5 (AFHS, 1997).

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Disposition of the Air Force Health Study Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Skin and systemic neoplasms (MRV/PE)   All   All sites combined   X X X X X Malignant   All sites combined   X PSA (LAB)   X X X NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified; (MIL) military records. Areas in gray indicate that either an endpoint was not analyzed for a particular cycle or that it was unclear from the cycle report if an endpoint was analyzed. Gray areas do not indicate that an endpoint was not measured or recorded for a particular cycle. Overlap in site-specific analyses occurs as in some cycles broad ICD-9 classes are used versus the specific site or organ codes used in other cycles. aSite-specific analyses were conducted in Cycles 1–3 for the majority of cell types (AFHS, 1982, 1987, 1990). bSun exposure-related cases included (AFHS, 1990). cDigestive organ/peritoneum is one category (AFHS, 1994). dEsophagus only (AFHS, 2005). eGenitourinary is one category (ICD 9 codes 179-189—excludes carcinoma in situ) (AFHS, 1984). fKidney and Bladder is the category reference (AFHS, 1987, 1990, 1995). gCarcinoma in situ of penis and other sites listed separately (AFHS, 1990). hThe only site-specific reference for carcinoma in situ is penis (AFHS, 2000).

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Disposition of the Air Force Health Study TABLE B-13 Reproductive Assessment Year of Report 1984a 1992b 1998 Analyzed Endpoints   Number of marriages (Q) X   X Duration of marital and nonmarital relationships (Q) X X Number of couples with the desired number of children (Q) X X Sperm count (LAB) X X Sperm morphology (LAB) X X Number of conceptions (Q) X X X Conception outcomes: miscarriage (Q/MRV) X X X Conception outcomes: induced abortion (Q/MRV) X X X Conception outcomes: tubal pregnancy (QMRV)   X   Conception outcomes: stillbirth (Q/MRV) X X X Conception outcomes: live birth (Q/MRV) X X X Live birth outcomes: learning disabilities (Q/MRV) X   X Live birth outcomes: physical handicaps (Q/MRV) X X Live birth outcomes: neonatal mortality (Q/MRV) X X Live birth outcomes: infant mortality (Q/MRV) X X Live birth outcomes: birth defectsc (ICD 9 coded) (Q/MRV) X X X CDC birth defect category: total congenital anomalies (Q/MRV)   X   CDC birth defect category: nervous system anomalies (Q/MRV) X CDC birth defect category: eye anomalies (Q/MRV) X CDC birth defect category: ear, face, and neck anomalies (Q/MRV) X CDC birth defect category: circulatory system and heart anomalies (Q/MRV) X CDC birth defect category: respiratory anomalies (Q/MRV) X CDC birth defect category: digestive system anomalies (Q/MRV) X CDC birth defect category: genital anomalies (Q/MRV) X Birth defects: urinary system anomalies (Q/MRV) X CDC birth defect category: musculoskeletal deformities (Q/MRV) X CDC birth defect category: anomalies of the skin (Q/MRV) X CDC birth defect category: chromosomal anomalies (Q/MRV) X CDC birth defect category: other and unspecified anomalies (Q/MRV) X Birth defect severity (Q/MRV) X X X Birth weight (MRV)   X   NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified. Analyzed endpoints in 1992 study were chosen for ease of comparison with the results from the 1989 CDC Vietnam Experience Study reproductive outcome results. Many of the outcomes in the 1992 report were included under broader variables analyzed for the 1984 and 1998 reports. Areas in gray indicate that either an endpoint was not analyzed for a particular cycle or that it was unclear from the cycle report if an endpoint was analyzed. Gray areas do not indicate that an endpoint was not measured or recorded for a particular cycle. aData collected at Cycle 1 (1982). No outcomes verified. bData collected in 1982, 1985, and 1987. cBirth defect had to match description on predetermined list to be included in analyses at the baseline.

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Disposition of the Air Force Health Study TABLE B-14 Laboratory Analyses Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Hematology   Cell Count/Indices X X X X X X WBC X X X X X X RBC X X X X X X RDW X X X X   HGB X X X X X X Hematocrit X X X X X X MCV X X X X X X MCH X X X X X X MCHC X X X X X X PLT X X X X X X Differential X X X X X X Neutrophils X X X X X X LYMPH X X X X X X MONO X X X X X X EOS X X X X X X BANDS X X X X X X BASO X X X X X X BLAST X X X X X X RBC morphology   X X X X X Platelet observation   X X X X X Cells counted X X X X X X Absolute differential   ABS SEGS   X X X X X ABS BANDS X X X X X ABS LYMPHS X X X X X ABS MONOS X X X X X ABS EOS X X X X X ABS BASOS X X X X X RPR/VDRL/FTA X X X X X X ESR X X X X X X Glucose, 2HR PP X X X X X X Prothrombin time X X X X X X Chemistry Routine   BUN X X X X X X Glucose fasting X X X X X X Cholesterol X X X X X X HDL cholesterol X X X X X X Triglycerides X X X X X X SGOT/AST X X X X X X SGPT/ALT X X X X X X

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Disposition of the Air Force Health Study Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Gamma GT X X X X X X Alkaline phosphatase X X X X X X Total LDH X X X X X X Creatinine serum X   X X X Creatine kinase X X X X X X Amylase   X X X X X Total bilirubin X X X X X X Direct bilirubin X X X X X X Chemistry Miscellaneous   FSH X X X X X X LH X X X X X X Testosterone, free   X X X Testosterone, total X X X X X X Sex hormone binding globulin   X   Estradiol   X X X T4, free   X T4, RIA X X X X X   T3, free   X T3, uptake X X X   TSH X X X X X X FTI X   PSA   X X X Insulin, fasting   X Glucagon @ 2 hr   X   X Insulin, serum @ 2 hr   X X X Glycated hemoglobin   X X X C Peptide, serum   X   X ACTH, serum   X   Uric acid   X Urinalysis Routine   Color X X X X X X Character X X X X X X Glucose X X X X X X pH X X X X X X Ketone X X X X X X Protein X X X X X X Bile X X X X X X Occult blood X   X Urobilinogen X X X X X X Specific gravity X X X X X X Epithelial cells X X X X X X

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Disposition of the Air Force Health Study Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Urinalysis Routine   Bacteria X X X X X X Mucus X X X X X X WBC/HPF X X X X X X Casts   X X X X X Crystals X X X X X RBC X X X X X Nitrites X X X X X Leukocyte esterase   X X Other   X X X Comments X X X X X X Glucose, urine 2 hr X X X X X X Urine 24 hr   Coproporphyrin X X   Uroporphyrin X X Porphobilinogen X X Heptacarboxyporphyrins   X Hexacarboxyporphyrins X Pentacarboxyporphyrins X Creatinine X   Aminolevulinic Acid X Comments X X Cortisol Differential   Cortisol 1 X X   Cortisol 2 X X Protein Electrophoresis   Total protein X X X   Prealbumin   X X X Albumin X X X X X X Alpha 1 globulin X X X X X X Alpha 2 globulin X X X X X X Beta globulin X X X X X X Gamma globulin X X X X X X IGA X X X X X X IGG X X X X X X IGM X X X X X X Protein Profile   Alpha 1 acid glycoprotein   X X X X Alpha 1 antitrypsin X X X X

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Disposition of the Air Force Health Study Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Alpha 2 macroglobulin   X X X X Apolipoprotein B X X X X C3 complement X X X X C4 complement X X X X Haptoglobin X X X X Transferrin X X X X HI-RES Electrophoresis   High-resolution bands   IGG-Kappa   X   IGG-Lambda X IGG-No light chain X IGA-Kappa X IGA-Lambda X IGA-No light chain X IGM-Kappa X IGM-Lambda X IGM-No light chain X KAPPA-No heavy chain X LAMBDA-No heavy chain X Hepatitis Panel   HA Antibody X   X X X X HBs Antigen X X X X X X HBc Antibody X   X X X X HBs Antibody X X X X X X HC Antibody   X X X HD Antibody   X X HIV-1 ELISA Screen   X X X X Semen Analysis   Total count X   Volume X Abnormal forms X Immunology   Mixed lymphocyte RX   X X   Cell surface markers X X Killer cell no interferon X X Killer cell interferon X X Mitogen PHA stimulate X X Mitogen pokweed stimulation X X

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Disposition of the Air Force Health Study Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Lymphocyte Phenotyping Panel   WBC count   X X X % Lymphocytes X X X Absolute lymphocytes X X X C45 total lymph (CD14–) X X X CD14 monocytes X X X Absolute CD14 X   CD20 B cells X Absolute CD20 X X X CD5 T cells X X X Absolute CD5 X   Absolute CD20 and CD5+ X CD4 helper T cells X Absolute CD4 X X X CD4+CD3 X X X Absolute CD4+CD3   X X CD8 suppressor T cells X X Absolute CD8 X X X CD4+ & CD8+ X X X Absolute CD4+ & CD8+ X   Ratio CD4/CD8 X CD8+CD3 X Absolute CD8+CD3   X X CD3 T cells   X X Absolute CD3 X X X CD16/56 NK cells X X X Absolute CD16/56 X X X CD3+ & CD16/56+NK-like T cells X X X Absolute CD3+ & CD16/56+ X   CD25 IL-2 receptor cells X Absolute CD25 X CD25+ & CD3+ activated T cells X Absolute CD25+ & CD3+ X (CD4 + CD8)/CD3 X (CD3 + CD20 + CD16)/CD45 X Occult Blood Panel—Fecal   Occult blood 1   X   Occult blood 2 X Occult blood 3 X

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Disposition of the Air Force Health Study Cycle 1 2 3 4 5 6 Examination Year 1982 1985 1987 1992 1997 2002 Mouse Stomach/Kidney Lupus Panel   Antinuclear AB   X X Antimitochondrial AB   X X X Antismooth Muscle AB X X X Antiparietal Cell AB X X X MSK other X   Thyroid microsomal AB X X X Rheumatoid factor latex X X X ANA on HEP-2 Cells   Hep-2 cells   X   Speckled X Homogenous X Nucleolar X Centromere X ANA Hep-2 other X DNA antibodies (IFA) X Anti Sm X Anti RNP X SSA antibody X SSB antibody X Lymphocyte phenotyping panel X X X Islet cell antibody X X X T-Cell clone   X Anti-thyroid antibody X   X Fibrinogen   X X Microalbumin   Microalbumin screen   X Urine creatinine X Microalbumin quantity X Ratio X Diabetes Panel   Hemoglobin A1c   X Islet Cell AB X GAD Ab X C-Peptide X Proinsulin X

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Disposition of the Air Force Health Study TABLE B-15 Covariate Data Collected (Nonexhaustive List) Age (years) (MIL) Aminodiphenyl exposure (Q) Anthracene exposure (Q) Arsenic exposure (Q) Asbestos exposure (Q) Average lifetime residential history (Q) Benzene exposure (Q) Benzidene exposure (Q) Body fat (percentage) (PE) Body mass index (kg/m2) (PE) Chloromethylether exposure (Q) Cholesterol (mg/dl) (LAB) Chromate exposure (Q) Coal tar exposure (Q) Combat service (MIL) Compliance to dietary restrictions (PE) Composite carcinogen exposure (Q) Composite exposure to heavy metals (Q) Composite skin-reaction index (Q) Creosote exposure (Q) Cumulative degreasing chemical exposure (Q) Cumulative herbicide exposure (Q) Cumulative industrial chemical exposure (Q) Cumulative insecticide exposure (Q) Cumulative ionizing radiation exposure (Q) Current alcohol use (drinks/day) (Q) Current cigarette smoking (cigarettes/day) (Q) Current employment Current marital status (Q) Current occupation (Q) Current parental status (Q) Current total household income (dollars) (Q) Current wine consumption (drinks of wine/day) (Q) Cutting oil exposure (Q) Diabetes status (Q/LAB/MRV) Diabetic severity (MRV) Duration of diabetes (years) (LAB/MRV) Ethnic background (Q) Eye color (PE) Family history of diabetes (Q) Family history of heart disease (Q) Family history of heart disease before age 45 (Q) Hair color (PE) Lifetime alcohol history (drink-years) (Q) Lifetime cigarette smoking history (pack-years) (Q) Lifetime wine history (drink-years of wine) (Q) Maternal age (refers to partner in reproductive evaluation) (Q) Maternal drinking habits (refers to partner in reproductive evaluation) (Q) Maternal smoking (refers to partner in reproductive evaluation) (Q) Military occupation (MIL) Mustard gas exposure (Q) Naphthyamine exposure (Q) Nonmedical X ray (Q) Personality type (PE) Physical activity index (kcal/kg/day) (Q) Presence of pre-SEA acne (Q) Presence of PTSD (Q) Race (MIL) Skin color (PE) Skin reaction to sun after first exposure (Q) Skin reaction to sun after repeated exposure (Q) Taking blood pressure medication (Q) Time of conception relative to SEA tour (refers to reproductive evaluation) (Q/MRV) Trichloroethylene exposure (Q) UV light exposure (nonsolar) (Q) Vinyl chloride exposure (Q) Waist-to-hip ratio (PE) NOTES: Data sources: (Q) questionnaires; (PE) physical examination; (LAB) laboratory tests; (MRV) medical records verified; (MIL) military records.

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Disposition of the Air Force Health Study TABLE B-16 AFHS Questionnaire Data Cycle Subject Areas 1 Subject Demographic Employment history Marital/reproductive history Medical history Substance abuse history Psychological history Exposure to toxic substances Income Spouse Demographic Reproductive history Substance abuse history Next of Kin (Proxy) Demographic Employment history Marital/reproductive history Medical history Substance abuse history Leisure activities Mortality data Additions to Interval Questionnaires 2 Subject Skin cancer Personality type Birth marks Smoking habits Drinking habits 3 Subject Detailed drinking history Sleep disorders Interviewer remarks section addeda 4 Subject Occupational exposures (heavy metals and vibrating power tools) Family health history (with particular reference to diabetes, heart trouble, and heart disease) Diabetes history (type, treatment received, and medications taken) Hepatitis B vaccination history Intermittent claudication and vascular insufficiency history Normal physical activity level Dietary surveyb 5 Subject Percentage of herbicide spraying missions flown Intentional herbicide ingestion 6 Subject Drinking history 2 weeks prior to physical exam Current personal relationships Employment history 1 week prior to physical exam Children under 18 living at home (including children, grandchildren, stepchildren, foster or adopted children) History of mission volunteerism in SEA aThis section was added to the baseline questionnaire. bThe dietary survey was developed by Walter Willett at Harvard University and administered at the Cycle 4 follow-up only.

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Disposition of the Air Force Health Study REFERENCES AFHS. 1984. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Baseline Morbidity Study Results. Brooks AFB, TX: USAF School of Aerospace Medicine. NTIS AD-A-138-340. AFHS. 1987. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. First Follow-up Examination Results. 2 vols. Brooks AFB, TX: USAF School of Aerospace Medicine. USAFSAM-TR-87-27. AFHS. 1990. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. 2 vols. Brooks AFB, TX: USAF School of Aerospace Medicine. USAFSAM-TR-90-2. AFHS. 1992. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Reproductive Outcomes. Brooks AFB, TX: Armstrong Laboratory. AL-TR-1992-0090. AFHS. 1993. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Mortality Update: 1993. Brooks AFB, TX: Armstrong Laboratory. AL/ AO-TR-1993-0161. AFHS. 1995. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. 1992 Followup Examination Results. Brooks AFB, TX: Epidemiologic Research Division. Armstrong Laboratory. AL-TR-920107. AFHS. 1998. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Reproductive Outcome Update. Brooks AFB, TX: Epidemiologic Research Division. Armstrong Laboratory. AFRL-HE-BR-TR-1998-0073. AFHS. 2000. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. 1997 Follow-up Examination Results. Brooks AFB, TX: Human Systems Program Office. Armstrong Laboratory. AFRL-HE-BR-TR-2000-02. AFHS. 2005. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. 2002 Followup Examination Results. Brooks AFB, TX: Epidemiologic Research Division. Armstrong Laboratory. AFRL-HE-BR-SR-2005-0003.