New report calls for health monitoring and research program on Gulf War and post-9/11 veterans

A new report from NASEM recommends the creation of a health monitoring and research program (HMRP)

Nov. 28, 2018

WASHINGTON – To help determine if the descendants of Gulf War and post-9/11 veterans are at risk for health effects resulting from the service members’ exposure to toxicants during deployment, a new report from the National Academies of Sciences, Engineering, and Medicine recommends the creation of a health monitoring and research program (HMRP). The committee that carried out the study and wrote the report assessed the available evidence on the reproductive, developmental, and generational health effects related to exposures that may have occurred during the Gulf War and post-9/11 conflicts. While there is a growing base of human and animal evidence on the reproductive and developmental effects of many toxicants of concern, there is a dearth of information on the specific effects of veterans’ exposures on their children, grandchildren, and great-grandchildren.

Almost 700,000 U.S. troops were deployed to the Persian Gulf region during the height of Operation Desert Shield and Operation Desert Storm in 1990-1991. The U.S. military engaged in further conflicts in the Middle East following the terrorist attacks of Sept. 11, 2001, with troops stationed in and around Afghanistan and in Iraq. In any war, deployed service members may be exposed to potentially hazardous agents and situations — some intentionally and others unknowingly, the report says. These may include chemicals that are used in everyday civilian life, such as pesticides and solvents, as well as chemical and biological agents, mandatory vaccines, smoke from burn pits and oil-well fires, dust, high ambient temperatures and heat stress, and depleted uranium.

Because there was little or no information on specific effects in veterans for many of the toxicants, the committee relied on studies that examined occupational or residential cohorts, who were exposed to some of the same toxicants as Gulf War and post-9/11 veterans were. The committee was unable to determine how relevant the exposures in these non-veteran studies are to those experienced by deployed veterans in terms of the exposure magnitude, duration, frequency, mixtures, and co-exposures. The ability to generalize associations found in such studies to veterans is also limited by differences in population characteristics such as gender, age, ethnicity, and lifestyle. Therefore, such exposures should be studied specifically in active-duty service members and veterans in order to confirm that the associations are valid for those populations.

The committee came to more than 50 conclusions in five categories of association between the deployment exposures and reproductive effects, adverse pregnancy outcomes, or developmental effects. No toxicant had sufficient evidence of a causal association between exposure and reproductive or developmental effects, nor did any toxicant have limited/suggestive evidence of no association between exposure and reproductive or developmental effects. Among the conclusions, the committee found sufficient evidence of an association between prenatal exposure to organophosphate pesticides and neurodevelopmental effects; prenatal exposure to particulate matter and adverse pregnancy outcomes, such as low birth weight and preterm birth; and prenatal exposure to benzene and childhood leukemia. In addition, the committee found limited/suggestive evidence of an association between sulfur mustard and reproductive effects in men, and between prenatal exposure to particulate matter and pregnancy-induced hypertensive disorders, and respiratory or neurodevelopmental effects in children.

The HMRP would be a collaboration among a number of government and nongovernmental organizations. The report describes a recommended framework for development of an HMRP, including the following priorities, which will be critical to implementing a useful HMRP:

  • The collection, storage, and maintenance of comprehensive baseline and longitudinal data and biospecimens from veterans, their partners, and their descendants;
  • Detailed exposure characterization and assessment during and after deployment; and
  • The development, evaluation, standardization, and interoperability of biomarkers of exposure, susceptibility, and biological effects.

“Addressing the priorities outlined in this report will require substantial resources, long-term commitment by the departments of Defense and Veterans Affairs and other governmental organizations, and considerable engagement by past, current, and future veterans and their families,” said committee chair Kenneth S. Ramos, associate vice president for precision health sciences, professor of medicine, and executive director of the Center for Applied Genetics and Genomic Medicine at University of Arizona. “However, the results that arise from studying generational effects will ultimately be rewarded with new knowledge of veterans’ exposures, their reproductive health, and the health of their children and grandchildren. Importantly, the new understanding derived from these investments will be relevant to the health of all Americans now and for future generations.”

There are numerous considerations that must be addressed to implement a large-scale HMRP, such as financial and human resource costs, the availability and expertise of adequately trained personnel, the time required for project completion, ready access to well-curated data, the maintenance of confidential human health data, ethical considerations for investigations that include parents and children, and the implementation of appropriate health and risk communication strategies between and among organizations and veterans and their families. Given these considerations, a practical approach to exploring generational health effects should leverage ongoing veterans’ health research programs, such as the Million Veteran Program and the Millennium Cohort Study, the report says.

The costs of designing and conducting an HMRP for any veteran cohort will be considerable, as demonstrated by the cost of similar programs such as the National Institutes of Health’s National Children’s Study and the All of Us Research Program, the report says. However, the costs of some of the underlying technologies — for example, whole-genome sequencing — have declined dramatically, and research results from the health monitoring program may translate into significant cost savings for the nation.

The study was sponsored by the U.S. Department of Veterans Affairs. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit A committee roster follows.


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Report Highlights

Summary of Conclusions

Download the report at


Dana Korsen, Media Relations Officer

Andrew Robinson, Media Relations Assistant

Office of News and Public Information

202-334-2138; e-mail [email protected]


Copies of Gulf War and Health, Volume 11: Generational Health Effects of Serving in the Gulf War are available from the National Academies Press on the Internet at or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).


Health and Medicine Division

Board on Population Health and Public Health Practice

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; and

Professor of Medicine

Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, and

Executive Director

Center for Applied Genetics and Genomic Medicine

College of Medicine

University of Arizona


Tracy L. Bale

Professor of Pharmacology, and


Center for Epigenetic Research in Child Health and Brain Development

School of Medicine

University of Maryland


John R. Balmes

Professor of Medicine

Division of Occupational and Environmental Medicine

University of California

San Francisco

Brenda Eskenazi

Brian and Jennifer Maxwell Endowed Chair in Public Health and Professor of Epidemiology, and


Center for Environmental Research and Children’s Health

School of Public Health

University of California


Elaine M. Faustman

Professor of Environmental and Occupational Health Sciences

School of Public Health, and


Institute for Risk Analysis and Risk Communication

University of Washington


Mari Golub

Adjunct Professor Emerita

Department of Internal Medicine, and

Affiliate Scientist

California National Primate Research Center

University of California


Rafael A. Irizarry


Department of Biostatistics and Computational Biology

Dana Farber Cancer Institute, and

Professor of Biostatistics

Harvard T.H. Chan School of Public Health


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

Professor of Obstetrics and Gynecology and of Molecular Medicine and Genetics,

Charlotte B. Failing Professor of Fetal Therapy and Diagnosis, and

Associate Director

C.S. Mott Center for Human Growth and Development

Department of Obstetrics and Gynecology

School of Medicine

Wayne State University


Linda A. McCauley*

Professor and Dean

Nell Hodgson Woodruff School of Nursing

Emory University


Jacob D. McDonald

Vice President of Applied Sciences

Lovelace Respiratory Research Institute

Chief Scientific Officer

Lovelace Biomedical

Albuquerque, N.M.

Dylan Small

Class of 1965 Wharton Professor of Statistics

Department of Statistics

Wharton School of Business

University of Pennsylvania


Jacquetta Trasler

James McGill Professor in Pediatrics, Human Genetics and Pharmacology and Therapeutics, and

Director for Pediatric Research

Research Institute

McGill University Health Centre


Cheryl Lyn Walker*


Center for Precision Environmental Health, and

Alkek Presidential Chair

Departments of Molecular and Cell Biology and Medicine

Baylor College of Medicine


Carol S. Wood

Staff Scientist

Environmental Sciences Division

Oak Ridge National Laboratory

Oak Ridge, Tenn.

Robert O. Wright

Ethel H. Wise Professor of Pediatrics, and


Department of Environmental Medicine and Public Health

Icahn School of Medicine

Mount Sinai Hospital

New York City


Roberta Wedge

Staff Officer

*Member, National Academy of Medicine

Media Contact
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