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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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GULF WAR and HEALTH

VOLUME 11

Generational Health Effects
of Serving in the Gulf War

Committee on Gulf War and Health, Volume 11:
Generational Health Effects of Serving in the Gulf War

Board on Population Health and Public Health Practice

Health and Medicine Division

A Consensus Study Report of

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THE NATIONAL ACADEMIES PRESS
Washington, DC
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
×

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This activity was supported by Contract Number VA701-16-C-0029 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-47823-6
International Standard Book Number-10: 0-309-47823-5
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and health, volume 11: Generational health effects of serving in the Gulf War. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25162.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
×

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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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COMMITTEE ON GULF WAR AND HEALTH, VOLUME 11: GENERATIONAL HEALTH EFFECTS OF SERVING IN THE GULF WAR

KENNETH S. RAMOS (Chair), Associate Vice President for Precision Health Sciences, Professor of Medicine and Director, Center for Applied Genetics and Genomic Medicine, University of Arizona Health Sciences

TRACY L. BALE, Professor and Director, Center for Epigenetic Research in Child Health and Brain Development, University of Maryland School of Medicine

JOHN R. BALMES, Professor of Medicine, University of California, San Francisco

BRENDA ESKENAZI, Jennifer and Brian Maxwell Professor of Maternal and Child Health and Epidemiology, Director, Center for Environmental Research and Children’s Health, University of California, Berkeley

ELAINE M. FAUSTMAN, Professor and Director, Institute for Risk Analysis and Risk Communication, Department of Environmental and Occupational Health Sciences, University of Washington

MARI S. GOLUB, California National Primate Research Center, University of California, Davis

RAFAEL A. IRIZARRY, Professor of Biostatistics, Dana-Farber Cancer Institute, Harvard University

TAMARRA JAMES-TODD, Mark and Catherine Winkler Assistant Professor of Environmental Reproductive and Perinatal Epidemiology, Harvard T.H. Chan School of Public Health

STEPHEN A. KRAWETZ, Associate Director, C.S. Mott Center for Human Growth and Development, Charlotte B. Failing Professor of Fetal Therapy and Diagnosis, Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University

LINDA A. McCAULEY, Dean, Nell Hodgson Woodruff School of Nursing, Emory University

JACOB D. McDONALD, Senior Scientist, Vice President, Chief Science Officer, Lovelace Respiratory Research Institute

DYLAN S. SMALL, Professor, Department of Statistics, The Wharton School, University of Pennsylvania

JACQUETTA TRASLER, Senior Scientist, Research Institute of the McGill University Health Centre, James McGill Professor in Pediatrics, Human Genetics, and Pharmacology and Therapeutics, McGill University

CHERYL LYN WALKER, Director, Center for Precision Environmental Health, Professor, Department of Molecular and Cell Biology and Medicine, Baylor College of Medicine

CAROL S. WOOD, Staff Scientist, Toxicology and Hazard Assessment Group, Environmental Sciences Division, Oak Ridge National Laboratory

ROBERT O. WRIGHT, Ethel H. Wise Professor of Pediatrics, Chair, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai

Study Staff

ROBERTA WEDGE, Study Director

CARY HAVER, Program Officer

T. CHERI BANKS, Associate Program Officer

PAMELA RAMEY-McCRAY, Senior Program Assistant

ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Bruce A. Barron, University of Rochester Medical Center

Joseph Braun, Brown University

Dana C. Dolinoy, University of Michigan School of Public Health

Seth Eisen, Washington University School of Medicine

David Korn, Harvard Medical School

Nancy E. Lane, University of California, Davis, School of Medicine

Germaine Buck Louis, George Mason University

Donald R. Mattison, Risk Sciences International, Ottawa

Reza J. Rasoulpour, Dow AgroSciences

Laura N. Vandenberg, University of Massachusetts

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Nancy F. Woods, University of Washington, and Maryellen L. Giger, The University of Chicago. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
×

Preface

Veterans of the 1990–1991 Gulf War and the Post-9/11 conflicts in Iraq and Afghanistan were exposed to a variety of biological, chemical, radiological, psychosocial, and physical stressors during their deployments. Over the past 20 years the National Academies of Sciences, Engineering, and Medicine (the National Academies) has convened more than 10 committees of experts to assess the health effects that might be linked to those exposures. Some of the health effects identified by past committees include post-traumatic stress disorder, other mental health disorders, Gulf War illness, respiratory effects, and self-reported sexual dysfunction. Veterans’ concerns regarding the impacts of deployment-related exposures on their health have grown to include potential adverse effects on the health of their children and grandchildren. These concerns now increasingly involve female veterans, as more women join the military and are deployed to war zones and areas that pose potential hazards. The committee notes that veterans’ harmful exposures are not restricted to deployment; such exposures may occur during military service in general or even outside of active duty (for example, exposure to trichloroethylene in contaminated drinking water at Camp Lejeune). As such, the need for data and knowledge to protect the health of the children and grandchildren of veterans who may have experienced harmful exposures during deployment has become urgent.

The exposure of male and female veterans to toxicants during their deployments may pose unknown risks to their future children, whether conceived during or after deployment. Harmful exposures may affect germ cells in both men and women and compromise the reproductive health of veterans and the future health of their children. For female veterans who may be deployed before they are aware they are pregnant, there may also be a risk to the developing fetus. The impact of exposures experienced during these periods on the developing embryo is largely unknown. Given these inherent risks, and in light of several public reports linking a parent’s or even a grandparent’s exposure to a toxicant to negative health outcomes in their descendants, veterans’ concerns about generational effects continue to escalate. While the public reporting of generational effects has garnered considerable attention, the scientific evidence to support those links is not compelling at this time.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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To address these gaps in data and knowledge, the Department of Veterans Affairs (VA) requested this eleventh update of the Gulf War and Health series of reports. This volume addresses two major tasks: evaluating the scientific and medical literature on reproductive and developmental effects and health outcomes associated with Gulf War and Post-9/11 exposures, and determining those research areas requiring further scientific study on potential health effects in the descendants of veterans of any era.

To accomplish these tasks, the National Academies established a committee of 16 members representing a broad range of areas of scientific and medical expertise. Its work was informed by two public meetings at which the committee heard from key stakeholders, including veterans, veterans’ service organizations, research scientists, and representatives from VA, the Department of Defense, and other governmental organizations that are also attempting to determine what, if any, generational health effects may result from a veteran’s exposures prior to or during pregnancy. The committee completed a comprehensive evaluation of relevant literature and integrated its findings with the large amounts of data on reproductive and developmental health outcomes reviewed in previous updates. The synthesis of the evidence was then used to craft a path forward for VA to address veteran concerns related to multigenerational health effects, particularly as they relate to veterans’ children conceived during and after deployment, their grandchildren, and even future generations.

The Volume 11 committee thanks those who presented valuable information to the committee, including Fred Tyson, National Institute of Environmental Health Sciences; Vicki Walker, National Toxicology Program; Antonia Calafat, Centers for Disease Control and Prevention; John Greally, Albert Einstein School of Medicine; Colleen Baird, U.S. Army Public Health Command; R. Loren Erickson, Peter Rumm, and Aaron Schneiderman, Department of Veterans Affairs; and the many veterans who shared their deployment experiences with the committee. The committee is most grateful to Roberta Wedge, our outstanding study director, who helped us navigate through the report process and ensured that progress was made at all times. The committee is also indebted to Cary Haver and Cheri Banks for their hard work in support of committee functions and to Pam Ramey-McCray for her graceful administrative support of our activities. The committee acknowledges the expert assistance provided by Daniel Bearss of the National Academies Research Center helping to create and execute a detailed literature search strategy and for fact-checking the lengthy and sometimes complicated chapters included in the volume. A heartfelt thank-you to my fellow committee members for their collegiality, insights, hard work, thoughtfulness, and outstanding service over the past 2 years.

The committee is optimistic that the recommendations contained in this report will help answer many of the critical questions facing VA and the nation as a whole regarding the complex interactions between genes, environment, and lifestyle that may influence health outcomes across multiple generations. The report also provides specific guidance on the development of a health monitoring research program that can help gather the data required to evaluate generational effects and to establish a path forward in continuing to meet our responsibility to veterans of all conflicts.

Kenneth S. Ramos, Chair

Committee on Gulf War and Health, Volume 11: Generational Health Effects of Serving in the Gulf War

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Acronyms and Abbreviations

αGSU glycoprotein hormone α-subunit
γ-HCH gamma-hexachlorocyclohexane (lindane)
ΣDAP sum of DAP
1-N 1-naphthol
1-OHNa 1-hydroxynaphthalene
1-OHP 1-hydroxypyrene
2-MMA 2-methoxyacetic acid
2-OHF 2-hydroxyfluorene
2-OHNa 2-hydroxynapthalene
4-OHPh 4-hydroxyphenanthrene
9-OHFlu 9-hydroxyfluorene
9-OHPh 9-hydroxyphenanthrene
AChE acetylcholinesterase
ADHD attention deficit–hyperactivity disorder
AHLTA Armed Forces Health Longitudinal Technology Application system (of DoD)
AhR aryl hydrocarbon receptor
ALL acute lymphoblastic leukemia
AMH anti-Müllerian hormone
AML acute myeloid leukemia
APC adenomatous polyposis coli
aPR adjusted prevalence ratio
ASD autism spectrum disorder
ATSDR Agency for Toxic Substances and Disease Registry
AVA anthrax vaccine absorbed
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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BaP benzo[a]pyrene
BASC Behavior Assessment System for Children
BDNF brain-derived neurotrophic factor
BMI body mass index
BN-1MN binucleated cells with one micronucleus
BNBAS Brazelton Neonatal Behavioral Assessment Scale
BPA 3-phenoxybenzoic acid
BRIEF Behavior Rating Inventory of Executive Functioning
BSID-II Bayley Scales of Infant Development II
BTEX benzene-toluene-ethylbenzene-xylene
BuChE butyrylcholinesterase
CARC chemical agent-resistant coating
CBCL Child Behavior Checklist
CCCEH Columbia Center for Children’s Environmental Health (study)
CD3+ cluster of differentiation 3
CD4+ cluster of differentiation 4
CD19+ cluster of differentiation 19
CDCCA cis-3-(2,2- dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid
CHAMACOS Center for the Health Assessment of Mothers and Children of Salinas (study)
CHARGE Childhood Autism Risks from Genetics and Environment (study)
ChE cholinesterase
CHEAR Children’s Health Exposure Analysis Resource (of NIEHS)
CI confidence interval
CIA Central Intelligence Agency
CO carbon monoxide
CO2 carbon dioxide
CPF chlorpyrifos
CpG cytosine-adjacent-to-guanine (sites in the human genome)
CPT-II Conners’ Continuous Performance Test-II
Cr6 hexavalent chromium
CYP1A1 cytochrome P450 1A1
CYP2E1 cytochrome P450 2E1
DAG directed acyclic graph
DAP dialkylphosphate
DBCA cis-2,2-dibromovinyl-2,2-dimethylcyclopropane-carboxylic acid
DCA dichloroacetate
DEDTP diethyldithiophosphate
DEP diethylphosphate
DETP diethylthiophosphate
DFI DNA fragmentation index
DLA Defense Logistics Agency
DLC dioxin-like chemical
DMDC Defense Manpower Data Center
DMDTP dimethyldithiophosphate
DMP dimethylphosphate
Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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DMSS Defense Medical Surveillance System
DMTP dimethylthiophosphate
DNA deoxyribonucleic acid
DNAm DNA methylation
DNMT DNA methyltransferase
DNMT3B DNA methyltransferase 3 beta
DoD Department of Defense
DOEHRS Defense Occupational and Environmental Health Readiness System
DOHaD developmental origins of health and disease
DSM-IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
DU depleted uranium
E2 estradiol
EAA ethoxyacetic acid
ECHA European Chemicals Agency
EGBE ethylene glycol monobutyl ether (2-butoxyethanol)
EGEE ethylene glycol monoethyl ether (2-ethoxythanol)
EGMBE ethylene glycol monobutyl ether (2-butoxyethanol)
EGME ethylene glycol monomethyl ether (2-methoxyethanol)
EHR electronic health record
ELEMENT Early Life Exposures in Mexico to Environmental Toxicants (study)
EPA U.S. Environmental Protection Agency
EU enriched uranium
FAI free androgen index
FDA Food and Drug Administration
FeNO fractional exhaled nitric oxide
FSH follicle-stimulating hormone
FT4/FT3 free thyroxin/triiodothyronine ratio
FT4 free thyroxine
FVC forced vital capacity
GD gestational day
GnRH gonadotropin-releasing hormone
GSTM1 glutathione S-transferase mu 1 (M1)
GSTT1 glutathione S-transferase theta 1 (T1)
GWAS genome-wide association study
H2S hydrogen sulfide
Hmlh1 human mutL homolog 1
HMRP health monitoring and research program
HOME Health Outcomes and Measures of the Environment (study)
HR hazard ratio
HRMS high-resolution mass spectrometry
HSD11B2 11β-hydroxysteroid dehydrogenase type 2
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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IARC International Agency for Research on Cancer
ICM inner cellular mass
IDR incidence density ratio
IFNγ interferon gamma
IGC immature germ cell
IgE immunoglobulin E
ILER individual longitudinal exposure record
IOM Institute of Medicine
iPSC induced pluripotent stem cell
IQR interquartile range
IRIS Integrated Risk Information System
IRR incidence rate ratio
JBB Joint Base Balad
JP-4 jet fuel 4
JP-5 jet fuel 5
JP-8 jet fuel 8
KIDS Kinder Infant Development Scale
LBW low birth weight
LEP leptin
LH luteinizing hormone
md mean difference
MDA malathion dicarboxylic acid
MDI mental development index
MGMT methyl guanine methyl transferase
MHS Military Health System
MilCo Millennium Cohort (DoD study)
miRNA microribonucleic acid
MLH1 mutL homolog 1
mRNA messenger ribonucleic acid
Mt. Sinai Mount Sinai Children’s Environmental Health Cohort Study
mtDNA mitochondrial DNA
MVP Million Veteran Program (VA study)
NAS National Academy of Sciences
NBDPS National Birth Defects Prevention Study
NBNA Neonatal Behavioral Neurological Assessment
ncRNA noncoding RNA
NHL non-Hodgkin’s lymphoma
NIEHS National Institute of Environmental Health Sciences
NIH National Institutes of Health
NK natural killer (cell)
NMDA N-methyl-D-aspartate
NO nitrogen oxide
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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NO2 nitrogen dioxide
NRC National Research Council
NTD neural tube defect
O3 ozone
OEF Operation Enduring Freedom
OIF Operation Iraqi Freedom
OND Operation New Dawn
OP organophosphate
OR odds ratio
OSAGWI Office of the Special Assistant for Gulf War Illnesses
PAH polycyclic aromatic hydrocarbon
PB pyridostigmine bromide
PBA 3-phenoxybenzoic acid
PCDD polychlorinated dibenzo-p-dioxin
PCDF polychlorinated dibenzofuran
PCE tetrachloroethylene (perchloroethylene)
PCOS polycystic ovary syndrome
PDI psychomotor development index
PGC primordial germ cell
piRNA Piwi-interacting RNA
PM particulate matter
PND postnatal day
PNET pancreatic neuroendocrine tumor
PON1 paraoxonase 1
PR progesterone receptor
PROGRESS Programming Research in Obesity, Growth, Environment and Social Stressors
PTB preterm birth
RNA ribonucleic acid
ROS reactive oxygen species
RR relative risk
SDQ Strengths and Difficulties Questionnaire
SES socioeconomic status
SGA small for gestational age
SHBG sex hormone binding globulin
SIR standardized incidence ratio
SM sulfur mustard
SO2 sulfur dioxide
sRR summary relative risk
SRS Social Responsiveness Scale
SSVS stochastic search variable selection
TBDD 2,3,7,8-tetrabromodibenzo-p-dioxin
TBG thyroxin-binding globulin
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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TCA trichloroacetate
TCDD 2,3,7,8-tetrachlorodibenzodioxin
TCE trichloroethylene
TCPy trichloro-2-pyridinol
TDCCA trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid
TDG thymine DNA glycosylase
TDM tail distributed moment
TET2 Tet methylcytosine dioxygenase 2
TGCT testicular germ cell tumor
THREE Tracking Health Related to Environmental Exposures
tRNA transfer RNA fragment
TSH thyroid-stimulating hormone
TTP time to pregnancy
VA Department of Veterans Affairs
VAERS Vaccine Adverse Event Reporting System
VAO Veterans and Agent Orange
VHEMBE Venda Health Examination of Mothers, Babies and Their Environment
VISTA Veterans Information Systems and Technology Architecture (of VA)
VOC volatile organic compound
VSO veterans service organization
WBC white blood cell
WHO World Health Organization
WISC-IV Weschler Intelligence Scale for Children, 4th edition
WPPSI-III Weschler Preschool and Primary Scales of Intelligence-III
XIST X-inactive specific transcript
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War Get This Book
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For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the National Academies of Sciences, Engineering, and Medicine has been conducting an ongoing review of the evidence to determine veterans' long-term health problems and potential causes.

Some of the health effects identified by past reports include post-traumatic stress disorders, other mental health disorders, Gulf War illness, respiratory effects, and self-reported sexual dysfunction. Veterans’ concerns regarding the impacts of deployment-related exposures on their health have grown to include potential adverse effects on the health of their children and grandchildren. These concerns now increasingly involve female veterans, as more women join the military and are deployed to war zones and areas that pose potential hazards.

Gulf War and Health: Volume 11 evaluates the scientific and medical literature on reproductive and developmental effects and health outcomes associated with Gulf War and Post-9/11 exposures, and designates research areas requiring further scientific study on potential health effects in the descendants of veterans of any era.

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