The report first discusses the individual elements of the committee’s review of the drinking-water contamination at Camp Lejeune (Chapters 2-7) and then considers the elements together to draw conclusions about whether particular health outcomes can be linked to the exposures that occurred. Chapter 2 evaluates what is known about the possible exposures of the populations that lived or worked in areas served by the contaminated water systems. On the basis of what is known about the primary contaminants of concern, Chapter 3 discusses some of the biochemical changes that occur after the contaminants enter the body and how they or their metabolic products are transported in the body; it also considers populations that might be more susceptible to effects of the contaminants, lifestyle factors that affect how the contaminants interact in the body, and how the contaminants interact with each other and with other chemicals in the body. In reviewing what adverse health effects might result from exposure to the contaminants, the committee first reviews the toxicology literature in Chapter 4, which involves primarily studying effects in animals given the contaminants under experimental conditions. Chapter 5 reviews studies of human subjects who were exposed to the same chemicals that contaminated the Camp Lejeune drinking-water system, mainly studies of occupational exposure. Chapter 6 evaluates studies of populations exposed to similar contaminants via drinking water to see whether any inferences that would be applicable to the Camp Lejeune situation can be drawn. The toxicologic and epidemiologic evidence is considered together in Chapter 7 to determine the strength of the available evidence on particular health outcomes. Chapter 8 deals specifically with studies of exposure and health effects in former residents of Camp Lejeune, including completed, current, and proposed studies by ATSDR.

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