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Strategies to Protect the Health of DEPLOYED U.S. FORCES Assessing Health Risks to Deployed U.S. Forces Workshop Proceedings Board on Environmental Studies and Toxicology Commission on Life Sciences National Research Council NATIONAL ACADEMY PRESS Washington, D.C.

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NATIONAL ACADEMY PRESS 2101 Constitution Ave., N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This project was supported by Contract No. DASW01-97-C-0078 between the National Academy of Sciences and the Department of Defense. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authoress and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-06876-2 Additional copies of this report are available from: National Academy Press 2101 Constitution Ave., NW Box 285 Washington, DC 20055 800-624-6242 202-334-3313 (in the Washington metropolitan area) http://www.nap.edu Copyright 2000 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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National Acaclemy of Sciences National Acaclemy of Engineering Institute of Meclicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad commu- nity of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Acad- emies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY GORDON ORIANS (Chair), University of Washington, SeahIe, Washington DONALD MATTISON (vice Chair), March of Dimes, White Plains, New York DAVID ALLEN, University of Texas, Austin, Texas INGRID C. BURKE, Colorado State University, Fort Collins, Colorado WILLIAM L. CHAMEIDES, Georgia Institute of Technology, Atlanta, Georgia JOHN DOULL, The University of Kansas Medical Center, Kansas City, Kansas CHRISTOPHER B. FIELD, Carnegie Institute of Washington, Stanford, California JOHN GERHART, University of California, Berkeley, California J. PAUL OILMAN, Celera Genomics, Rockville, Maryland BRUCE D. HAMMOCK, University of California, Davis, California MARK HARWELL, University of Miami, Miami, Florida ROGENE HENDERSON, Lovelace Respiratory Research Institute, Albuquerque, New Mexico CAROL HENRY, Chemical Manufacturers Association, Arlington, Virginia BARBARA HULKA, University of North Carolina, Chapel Hill, North Carolina JAMES F. KITCHELL, University of Wisconsin, Madison, Wisconsin DANIEL KREWSKI, University of Ottawa, Ottawa, Ontario JAMES A. MAcMAHoN, Utah State University, Logan, Utah MARIO J. MOUNA, Massachusetts Institute of Technology, Cambridge, Massachusetts CHARLES O'MELIA, Johns Hopkins University, Baltimore, Maryland WILLEM F. PASSCHIER, Health Council of the Netherlands KIRK SMITH, University of California, Berkeley, California MARGARET STRAND, Oppenheimer Wolff Donnelly & Bayh, LLP, Washington, D.C. TERRY F. YOSIE, Chemical Manufacturers Association, Arlington, Virginia Senior Staff JAMES J. REISA, Director DAVID J. POLICANSKY, Associate Director and Senior Program Director for Applied Ecology CAROL A. MACZKA, Senior Program Director for Toxicology and Risk Assessment RAYMOND A. WASSEL, Senior Program Director for Environmental Sciences and _ . , -nglneerlng KULBIR S. BAKSHI, Program Director for the Committee on Toxicology LEE R. PAULSON, Program Director for Resource Management IV

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PRINCIPAL INVESTIGATOR Lorenz Rhomberg, Gradient Corporation, Cambridge, Massachusetts (formerly of the Harvard School of Public Health, Boston, Massachusetts) ADVISORY GROUP FOR STRATEGIES TO PROTECT THE HEALTH OF U.S. FORCES Arthur ,l. Barsky, Brigham and Women's Hospital, Boston, Massachusetts Germaine M. Buck, State University of New York at Buffalo, Buffalo, New York William S. Cain, University of California, San Diego, California John Doull, The University of Kansas Medical Center, Kansas City, Kansas Ernest Hodgson, North Carolina State University, Raleigh, North Carolina David H. Moore, Battelle Memorial Institute, Bel Air, Maryland Roy Renter, Life Systems, Inc., Cleveland, Ohio Ken W. Sexton, University of Minnesota, Minneapolis, Minnesota Robert E. Shope, University of Texas, Medical Branch, Galveston, Texas Ainsley Weston, National Institute of Occupational Safety and Health, Morgantown, West Virginia Staff Carol A. Maczka, Project Director Raymond A. Wassel, Program Director Susan N.,l. Pang, Staff Officer Robert Crossgrove, Technical Editor Catherine M. Kubik, Senior Project Assistant Leah L. Probst, Project Assistant Mirsada Karalic-Loncarevic, Information Specialist Sponsor U.S. Department of Defense v

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BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY Gordon Orians (Chair), University of Washington, Seattle, Washington Donald Mattison (Vice Chair), March of Dimes, White Plains, New York David Allen, University of Texas, Austin, Texas Ingrid C. Burke, Colorado State University, Fort Collins, Colorado William L. Chameides, Georgia Institute of Technology, Atlanta, Georgia John Doull, The University of Kansas Medical Center, Kansas City, Kansas Christopher B. Field, Carnegie Institute of Washington, Stanford, California John Gerhart, University of California, Berkeley, California ,l. Paul Gilman, Celera Genomics, Rockville, Maryland Bruce D. Hammock, University of California, Davis, California Mark Harwell, University of Miami, Miami, Florida Rogene Henderson, Lovelace Respiratory Research Institute, Albuquerque, New Mexico Carol Henry, Chemical Manufacturers Association, Arlington, Virginia Barbara Hulka, University of North Carolina, Chapel Hill, North Carolina flames F. Kitchell, University of Wisconsin, Madison, Wisconsin Daniel Krewski, University of Ottawa, Ottawa, Ontario James A. MacMahon, Utah State University, Logan, Utah Mario ,l. Molina, Massachusetts Institute of Technology, Cambridge, Massachusetts Charles O'Melia, Johns Hopkins University, Baltimore, Maryland Willem F. Passchier, Health Council of the Netherlands Kirk Smith, University of California, Berkeley, California Margaret Strand, Oppenheimer Wolff Donnelly & Bayh, LLP, Washington, D.C. Terry F. Yosie, Chemical Manufacturers Association, Arlington, Virginia Senior Stay ,lames,l. Reisa, Director David ,l. Policansky, Associate Director and Senior Program Director for Applied Ecology Carol A. Maczka, Senior Program Director for Toxicology and Risk Assessment Raymond A. Wassel, Senior Program Director for Environmental Sciences and Engineering Kulbir S. Bakshi, Program Director for the Committee on Toxicology Lee R. Paulson, Program Director for Resource Management Al

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COMMISSION ON LIFE SCIENCES Michael T. Clegg (Chair), University of California, Riverside, California Paul Berg (Vice Chair), Stanford University, Stanford, California Frederick R. Anderson, Cadwalader, Wickersham & Taft, Washington, D.C. Joanna Burger, Rutgers University, Piscataway, New Jersey James E. Cleaver, University of California, San Francisco, California David Eisenberg, University of California, Los Angeles, California John Emmerson, Fishers, Indiana Neal First, University of Wisconsin, Madison, Wisconsin David ,l. Galas, Keck Graduate Institute of Applied Life Science, Claremont, California David V. Goeddel, Tularik, Inc., South San Francisco, California Arturo Gomez-Pompa, University of California, Riverside, California Corey S. Goodman, University of California, Berkeley, California Jon W. Gordon, Mount Sinai School of Medicine, New York, New York David G. Hoel, Medical University of South Carolina, Charleston, South Carolina Barbara S. Hulka, University of North Carolina, Chapel Hill, North Carolina Cynthia Kenyon, University of California, San Francisco, California Bruce R. Levin, Emory University, Atlanta, Georgia David Livingston, Dana-Farber Cancer Institute, Boston, Massachusetts Donald R. Mattison, March of Dimes, White Plains, New York Elliot M. Meyerowitz, California Institute of Technology, Pasadena, California Robert T. Paine, University of Washington, Seattle, Washington Ronald R. Sederoff, North Carolina State University, Raleigh, North Carolina Robert R. Sokal, State University of New York, Stony Brook, New York Charles F. Stevens, The Salk Institute, La Jolla, California Shirley M. Tilghman, Princeton University, Princeton, New Jersey Raymond L. White, University of Utah, Salt Lake City, Utah Staff Warren R. Muir, Executive Director Jacqueline K. Prince, Financial Officer Barbara B. Smith, Administrative Associate Kit W. Lee, Administrative Assistant v,,

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OTHER REPORTS OF THE BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY Waste Incineration and Public Health (1999) Hormonally Active Agents in the Environment (1999) Research Priorities for Airborne Particulate Matter: II. Evaluating Research Progress and Updating the Portfolio (1999) Ozone-Forming Potential of Reformulated Gasoline (1999) Risk-Based Waste Classification in California (1999) Arsenic in Drinking Water (1999) Research Priorities for Airborne Particulate Matter: I. Immediate Priorities and a Long-Range Research Portfolio (1998) Brucellosis in the Greater Yellowstone Area (1998) The National Research Council's Committee on Toxicology: The First 50 Years (1997) Toxicologic Assessment of the Army's Zinc Cadmium Sulfide Dispersion Tests (1997) Carcinogens and Anticarcinogens in the Human Diet (1996) Upstream: Salmon and Society in the Pacific Northwest (1996) Science and the Endangered Species Act (1995) Wetlands: Characteristics and Boundaries (1995) Biologic Markers (5 reports, 1989-1995) Review of EPA's Environmental Monitoring and Assessment Program (3 reports, 1994-1995) Science and Judgment in Risk Assessment (1994) Ranking Hazardous Waste Sites for Remedial Action (1994) Pesticides in the Diets of Infants and Children (1993) Issues in Risk Assessment (1993) Setting Priorities for Land Conservation (1993) Protecting Visibility in National Parks and Wilderness Areas (1993) Dolphins and the Tuna Industry (1992) Hazardous Materials on the Public Lands (1992) Science and the National Parks (1992) Animals as Sentinels of Environmental Health Hazards (1991) Assessment of the U.S. Outer Continental Shelf Environmental Studies Program, Volumes I-IV (1991-1993) Human Exposure Assessment for Airborne Pollutants (1991) Monitoring Human Tissues for Toxic Substances (1991) Rethinking the Ozone Problem in Urban and Regional Air Pollution (1991) Decline of the Sea Turtles (1990) Copies of these reports may be ordered from the National Academy Press (800) 624-6242 (202) 334-3313 www.nap. edu . . . v,,,

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Contents Background Collection and Use of Personal Exposure and Human Biological-Marker Information for Assessing Risks to Deployed U.S. Forces in Hostile Environments Morton Lippmann Characteristics of the Future Battlefield and Deployment Edward D. Martin The Nature of Risk Assessment and Its Application to Deployed U.S. Forces Joseph V. Rodricks Future Health Assessment and Risk-Management Integration for Infectious Diseases and Biological Weapons for Deployed U.S. Forces Joan B. Rose Approaches for Using Toxicokinetic Information in Assessing Risk to Deployed U.S. Forces Karl K. Rozman Health Risks and Preventive Research Strategy for Deployed U.S. Forces from Toxicological Interactions Among Potentially Harmful Agents Raymond S.H. Yang Appendix: Biographical Information on Commissioned Authors IX 2 24 35 59 113 150 183

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