• could provide an essential peer-review function to lend greater scientific credibility to the investigations. An example is the advisory committee that was established to oversee the conduct of the Ranch Hand Study (IOM 2006).

  • A pilot study should be conducted to ensure adequate statistical power, ability to adjust for potential confounders, to identify data availability and limitations, and develop testable research questions and specific objectives. The objectives should be used to motivate essential study design features. Examples of these features include: subject eligibility criteria, size and demographic characteristics of the cohort, length of follow-up required, health outcomes to be studied, critical time periods of exposure, and potential confounding and modifying factors that would need to be measured. Careful consideration should be given to defining sensitive and useful exposure measures.
  • Assessment of health outcomes is best done collaboratively using the clinical informatics systems of the DoD and the VA, in addition to the non-military methods of follow-up (for example, National Death Index, state cancer registries) that can be used to identify the incidence and prevalence of health effects over time. Integration of current programs, such as the MCS, would increase feasibility and ease of study initiation. Multiple health assessments in the form of questionnaires and specific medical assessments could be administered periodically to better address intermediate and non-fatal health outcomes.
  • An exposure assessment for better source attribution and identification of chemicals associated with waste burning and other pollution sources at JBB should be conducted prior to beginning a new epidemiologic study to help the VA determine those health outcomes most likely to be associated with burn pit exposures. The committee’s analysis of available data from the environmental monitoring conducted at JBB suggests that exposure to PM emitted from sources such as diesel and jet engines, upwind Iraqi urban areas, and soil, may be of greater concern than exposure to burn pit emissions.
  • Exposure assessment should include detailed deployment information including distance and direction individuals lived and worked from the JBB burn pit, duration of deployment, and job duties. Multiple methods of estimating exposure have been discussed; however, the most applicable method should be defined by the study questions, data availability and limitations, and study design. Study of troops currently deployed at bases with operating burn pits, in addition to JBB, would allow for prospective exposure assessment of those troops and provide information useful to interpretation of results from JBB.

In conclusion, a study of health effects resulting from exposure to burn pits is feasible but its ability to produce useful and actionable results depends on a well thought-out design, thorough exposure assessment and careful follow-up. The IOM and NRC have recommended several methodologies for investigating and monitoring the health of military service members to the VA and the DoD over the years that, in addition to this report, can provide further guidance on study design and feasibility (IOM 1999, 2000b, 2008b; NRC 2000a,b).


AFHSC (U.S. Armed Forces Health Surveillance Center), the Naval Health Research Center, and the U.S. Army Public Health Command. 2010. Epidemiological studies of health outcomes among troops deployed to burn pit sites. Silver Spring, MD: Defense Technical Information Center.

CHPPM (U.S. Army Center for Health Promotion and Preventive Medicine) and AFIOH (U.S. Air Force Institute for Operational Health). 2009. Addendum 2. Screening health risk assessment burn pit exposures Balad Air Base, Iraq, May 2008. USACHPPM Report No. 47-MA-08PV-08/AFIOH Report No. IOH-RS-BR-TR-2008-0001. Aberdeen Proving Ground, MD: U.S. Army Center for Health Promotion and Preventive Medicine. August.

DoD (U.S. Department of Defense). 2010. Report to Congress on the use of open-air burn pits by the United States armed forces. Washington, DC: U.S. Department of Defense.

Gonzalez, C. A., M. Kogevinas, E. Gadea, A. Huici, A. Bosch, M. J. Bleda, and O. Papke. 2000. Biomonitoring study of people living near or working at a municipal solid-waste incinerator before and after two years of operation. Archives of Environmental Health 55(4):259-267.

Henriksen, G. L., N. S. Ketchum, J. E. Michalek, and J. A. Swaby. 1997. Serum dioxin and diabetes mellitus in veterans of Operation Ranch Hand. Epidemiology 8(3):252-258.

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