Chemical Weapons Exposures in Iraq: Challenges of a Public Health Response a Decade Later.

An October 14, 2014 article in The New York Times reported that the US Department of Defense (DoD) concealed, for nearly a decade, circumstances surrounding service members' exposure to chemical warfare agents (CWA) while deployed to Iraq in support of Operations Iraqi Freedom and New Dawn from March 13, 2003, to December 31, 2011, and alleged failure of the DoD to provide expedient and adequate medical care. This report prompted the DoD to devise a public health investigation, with the Army Public Health Center (Provisional) as the lead agency to identify, evaluate, document, and track CWA casualties of the Iraq war. Further, the DoD revisited and revised clinical guidelines and health policies concerning CWA exposure based on current evidence-based guidelines and best practices.

Health hazards of exposures during deployment to war.

OBJECTIVE: This article serves as an introduction to the history of military environmental exposures, both man-made and naturally occurring. It also discusses exposure hazards of concern to US military members who have served in armed conflict in the past 40+ years. METHODS: A review of the literature of the historic exposure concerns as well as those of the recent and current conflicts. RESULTS: In recognition that there have been no significant compilations of articles regarding exposure hazards and concerns faced by US Service members returning from the recent and current conflicts in Afghanistan and Iraq, this dedicated issue of the Journal contains 14 such papers. This articles provides a brief overview of these reports. CONCLUSIONS: Environmental exposure hazards during deployment to conflict are not new. Concerns about these exposures are not new. Many conflicts have similar, if not identical exposures of concern, but also often have some that are unique to the particular conflict. In 2001 the Department of Veterans Affairs established a new program to address some of these concerns of Veterans.

Exposures of concern to veterans returning from Afghanistan and Iraq.

There is a long history of Veterans returning from war with concerns regarding environmental hazards that they may have experienced while in theater. The author describes some of the tools in place within the Department of Defense to capture the frequency and nature of exposure concerns of returning troops. This article then reviews the exposures of concern to Service members returning from military service in the current and recent conflicts in Afghanistan and Iraq. The author then presents some of the recent published literature on these concerns. To address these exposure concerns of Veterans, there is then a brief discussion of a new program being put in place at the Department of Veterans Affairs.

Risk communication in deployment-related exposure concerns.

OBJECTIVE: Veterans Affairs and Department of Defense health care providers and educators serve as primary channels of communication with veterans but may not understand the importance and benefits of risk communication to inform and empower veterans about actions to take or not take to improve the quality of their health. This article describes the importance of understanding and applying risk communication principles in communicating to veterans about the potential for health concerns/impacts from deployment-related exposures. RESULTS: The principles of risk communication as relevant to clinical encounters are presented, focusing on a review of risk perception factors influencing deployment-related exposure concerns. Results show that risk communication can impact how veterans will take in and process information about deployment-related exposures. CONCLUSION: This article illustrates how providers can effectively use risk communication to structure better clinical encounters and communication with veterans.

Environmental exposure and health of Operation Enduring Freedom/Operation Iraqi Freedom veterans.

OBJECTIVE: We characterized the prevalence of self-reported environmental exposures, concerns about exposures, and their relationships with somatic symptoms in Operation Enduring Freedom (Afghanistan) (OEF) and Operation Iraqi Freedom (Iraq) (OIF) veterans seeking treatment at a specialty Veterans Affairs (VA) clinic. Concerns about environmental exposures were expected to lead to more reporting of somatic symptom burden. METHODS: We conducted a chart review of 469 OEF/OIF veterans seen at a VA tertiary care clinic. RESULTS: OEF/OIF veterans reported a high level of environmental exposures and concerns about environmental exposures. Greater reported environmental exposures (ß = 0.13) and environmental exposure concerns (ß = 0.39) were associated with a greater somatic symptom burden. Exposure concerns accounted for some of the relationship of exposures on somatic symptom burden (confidence interval, 0.33-0.60). CONCLUSIONS: OEF/OIF veterans seeking treatment at a VA clinic reported a high prevalence of environmental exposures and exposure concerns. Both negatively impacted health outcomes.

Organizational psychosocial factors and deployment-related exposure concerns in Afghanistan/Iraq War veterans.

OBJECTIVE: Environmental exposure concerns are associated with adverse health outcomes in soldiers deployed to South West Asia. There is little data on factors associated with the reporting of exposure concerns. We explored the relationship between deployment-related preparedness/support and exposure concerns. METHODS: Retrospective chart review of 489 Afghanistan/Iraq veterans evaluated at a Veterans Affairs tertiary center for postdeployment health. RESULTS: Virtually all subjects were concerned about environmental exposure(s). There were no significant demographic differences in exposure concerns, preparedness/support variables, or both. Preparedness/support correlated inversely with exposure concerns. Mental health function mediated the relationship between preparedness/support and exposure concerns. CONCLUSIONS: Deployment-related preparedness/support is associated with exposure concerns and mental health functioning. Definitive studies will provide data and insight on how the military may better prepare/support soldiers to optimize their resilience and reduce deployment-related exposure concerns.