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Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

LONG-TERM HEALTH EFFECTS OF PARTICIPATION IN PROJECT SHAD (SHIPBOARD HAZARD AND DEFENSE)

William F. Page, Heather A. Young, and Harriet M. Crawford, authors

with Oversight from the

Advisory Panel for the Study of Long-Term Health Effects of Participation in Project SHAD

Medical Follow-Up Agency

Board on Military and Veterans Health

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

THE NATIONAL ACADEMIES PRESS

500 Fifth Street, N.W. Washington, DC 20001

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 advisory panel that oversaw the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. V101(93)P-1637, T/0#26 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number-13: 978-0-309-10210-0

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Additional copies of this report are available from the

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For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2007 by the National Academy of Sciences. All rights reserved.

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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museum in Berlin.

Suggested citation: IOM (Institute of Medicine). 2007. Long-term health effects of participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES


Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


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. Ralph J. Cicerone 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. Charles M. Vest 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. Harvey V. Fineberg 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 community 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 Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.


www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

AUTHORS

WILLIAM F. PAGE (Study Director), Epidemiologist

HEATHER A. YOUNG, Statistician

HARRIET M. CRAWFORD, IT Project Manager

ADVISORY PANEL FOR THE STUDY OF LONG-TERM HEALTH EFFECTS OF PARTICIPATION IN PROJECT SHAD

DANIEL H. FREEMAN, Jr. (Chair), Professor,

University of Texas Medical Branch at Galveston, University of Texas

DAN G. BLAZER, J.P. Gibbons Professor of Psychiatry,

Duke University Medical Center

DONALD S. BURKE, Dean,

University of Pittsburgh Graduate School of Public Health

LINDA D. COWAN, George Lynn Cross Research Professor,

University of Oklahoma College of Public Health

GREGORY C. GRAY, Professor,

College of Public Health, University of Iowa

PETER S. SPENCER, Professor of Neurology and Director,

Center for Research on Occupational and Environmental Toxicology, Oregon Health and Science University

Project Staff

WILLIAM F. PAGE, Study Director

HEATHER A. YOUNG, Statistician

HARRIET M. CRAWFORD, IT Project Manager

NOREEN STEVENSON, Research Assistant

DWAYNE BELL, Programmer Analyst

JIHAD DAGHMASH, Programmer Analyst

JOHN LARSON, St. Louis Records Manager

ROBERT MATHES, Research Associate

ALVAR MATTEI, Senior Program Assistant

RICK ERDTMANN, Director,

Board on Military and Veterans Health/Medical Follow-Up Agency

PAMELA RAMEY-MCCRAY, Administrative Assistant

ANDREA COHEN, Financial Associate

JAMES QUINN, Consultant

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. 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:

Norman Breslow, School of Public Health and Community Medicine, University of Washington

Carlos A. Camargo, Jr., Emergency Medicine Network Coordinating Center, Massachusetts General Hospital

Robert Hoover, Epidemiology and Biostatistics Program, National Cancer Institute

Matthew L. Puglisi, Business Development, Aptima, Inc.

Kenneth R. Still, Occupational Toxicology Associates, Hillsboro, Oregon

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 Dr. Melvin Worth, Scholar-in-Residence, Institute of Medicine. Appointed by the Institute of Medicine, he was 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 authors and the Institute of Medicine.

Page viii Cite
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Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Preface

Our study of the long-term health effects of participation in Project SHAD (Shipboard Hazard and Defense) posed a number of challenges, including difficulties in identifying all the Project SHAD participants, assembling an appropriate control group, devising and administering a suitable survey instrument, and producing a sound analysis and accompanying report. We could not have achieved the results we did without a great deal of help.

Throughout this study, Institute of Medicine (IOM) staff have relied especially on the good guidance of our expert advisory panel. Its members included experts in biostatistics, epidemiology, survey research, infectious disease epidemiology, toxicology, and military veteran epidemiology. We could not have persevered through all of the difficult challenges we faced without their help and support. Nonetheless, although the expert panel provided sound guidance for which the study and this report are better, the authoring staff take full responsibility for the final product.

We are also grateful especially to the military veterans who provided us with information, support, and encouragement. Without their willingness to donate their time and effort in support of this project, this study would not have been possible.


William F. Page, Ph.D.

Heather A. Young, Ph.D.

Harriet M. Crawford, B.S.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Acknowledgments

The study of the health effects of participation in Project SHAD was a large enterprise, and the list of people who deserve recognition for their contribution is enormous. Members of the Medical Follow-Up Agency (MFUA) data operations staff who worked on this study include Dwayne Bell, Jihad Daghmash, John Larson, Robert Mathes, Al Mattei, and Noreen Stephenson. Richard Miller, former Director of MFUA, provided valuable guidance for this study.

The data collection efforts for the Project SHAD study involved many people outside of MFUA. We appreciate the efforts of Robert Bilgrad and staff at the National Death Index; Barbara Bauman and staff at the National Personnel Records Center in St. Louis, Missouri; the staff at the National Archives in College Park, MD (Archives II); and staff at many federal archives centers and Department of Veterans Affairs (VA) regional offices across the country, especially the VA regional office in the District of Columbia. We relied on a few consultants external to the staff for some technical work critical to the conduct of the study, including Victor Miller, James Quinn, and Ada Youk. We are particularly grateful to SRBI, Inc., who conducted the telephone interviews for our health survey, especially John Boyle, Stephen Dienstfrey, and Paul Schroeder.

The MFUA staff has benefited from the vigilance and enthusiasm of many interested veterans, including Jack Alderson, Robert Bates, Jim Druckemiller, Norman LaChapelle, and John Olsen. The latter two also served on the Project SHAD Task Force, chaired by Jack Devine, of the Vietnam Veterans of America (VVA), whom we also thank for their assistance. We are especially grateful to Rick Weidman and Bernard Edelman, VVA staff, for their help and support throughout the study.

The current members of the Advisory Panel for the Study of Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense)—chair Daniel H. Freeman, Jr., Dan G. Blazer, Donald S. Burke, Linda D. Cowan, Gregory C. Gray, and Peter S. Spencer—have helped to ensure the quality of the logic followed in the conduct of this study. We thank them and assume responsibility for whatever items of advice they offered that we did not take.

Mark Brown and Han Kang of the VA have provided us valuable help, and Michael Kilpatrick and his staff at the Department of Defense’s Force Health Protection and Readiness Program (formerly Deployment Health) have been particularly helpful to us. We wish to single out Dee Morris and Roy Finno for their special assistance on this project.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Lara Andersen, Sue Barron, Andrea Cohen, James Jensen, Linda Kilroy, Bronwyn Schrecker, Christine Stencel and the many other staff at the Institute of Medicine and the National Academies all helped along the way. Special thanks to Medical Follow-up Agency Director, Frederick (Rick) Erdtmann, and administrative assistant, Pamela Ramey-McCray, who provided much appreciated support to the project.

We—William Page, Harriet Crawford, and Heather Young Durick—thank everyone on this list (and perhaps a few whose names we have unintentionally omitted) for producing with us this report.

Page xiii Cite
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Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Tables and Figures

TABLES

3-1

 

List of Project SHAD Tests, Ships, or Military Units Involved, and Agents,

 

11

6-1

 

The Process of Selecting Control Ships,

 

20

6-2

 

List of Participant and Control Units Showing Selected Characteristics,

 

21

7-1

 

Number and Percent of FedEx-Delivered Mailings by Source of Address,

 

26

7-2

 

Number and Percent of FedEx-Delivered Mailings by Mailing Group,

 

27

7-3

 

Percent Distribution of Various Demographic Characteristics by Participation Status, for All Study Subjects and for Survey Respondents,

 

28

7-4

 

Percent of Study Subjects with Social Security Number, by Analysis Group,

 

28

7-5

 

Response Proportions by Analysis Group, Participation Status, and Presence of Social Security Number,

 

29

7-6

 

Comparison of Mail Questionnaire Versus Telephone Interview Respondents for Selected Characteristics by Percentage Distribution,

 

30

7-7

 

Percent Distribution of Subjects with a VA Outpatient Visit, by Participation and Response Status, for Various Characteristics,

 

31

8-1

 

Variables Considered for Analysis and Their Sources,

 

34

8-2

 

Primary, Secondary, and Tertiary Outcome Variables,

 

35

8-3

 

SHAD Exposure Groups,

 

36

9-1

 

Vital Status and Availability of Death Data by Project SHAD Participant Status and Exposure Group,

 

40

9-2

 

Percentage of Study Subjects with SSN and BIRLS Record, by Exposure Group and Project SHAD Participation Status,

 

40

9-3

 

Proportional Hazards Analysis of Total Mortality, by Exposure Group, Including All Subjects, Regardless of Completeness of Mortality Follow-Up,

 

41

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

9-4

 

Proportional Hazards Analysis of Total Mortality, by Exposure Group, Including Only Subjects with SSNs, Presumably with Virtually Complete Mortality Follow-Up,

 

42

9-5

 

Survival Analysis Using Proportional Hazards Regression: Cause-Specific Mortality Comparing Participants to Controls (Adjusted for Age, Race, Pay Grade, and Branch in Group B Only), Including Only Subjects with SSNs, Presumably with Virtually Complete Mortality Follow-Up,

 

43

9-6

 

Mortality Analysis Using Standardized Mortality Ratios (SMRs): Observed Number of Deaths and SMRs for Participants and Controls with SSNs for Selected Causes of Death, 1979–2004, by Analysis Group,

 

44

10-1

 

Availability of Mail Questionnaire and Telephone Interview Data by Analysis Group and Participation Status,

 

46

10-2

 

Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores, by Analysis Group and Participation Status (Sample Sizes in Parentheses), with Results of t-Test Comparisons,

 

46

10-3

 

Mean SF-36 Subscale Scores, by Analysis Group and Participation Status, with Results of t-Test Comparisons,

 

49

10-4

 

Mean SF-36 Summary Scores, by Analysis Group and Various Other Factors, with Results of F-Test Comparisons,

 

50

10-5

 

Adjusted Mean SF-36 Summary Scores, by Analysis Group, with Results of F-Test Comparisons,

 

52

10-6

 

Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores for Subjects in Group A (Standard Errors in Parentheses), by Agent, with Adjustment for Age, Race, Branch, Pay Grade, Smoking, Drinking, and Body Mass Index (Model 1) or These Factors Plus Number of Tests (Model 2),

 

54

10-7

 

Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores (Standard Errors in Parentheses) for Subjects in Group A, by “Dose” of Agent, with Adjustment for Age, Race, Pay Grade, and Branch,

 

55

10-8

 

Mean Somatization Scores, Unadjusted and Adjusted, for Participants and Controls, by Analysis Group,

 

56

10-9

 

Mean Memory and Attention Scores, Unadjusted and Adjusted, for Participants and Controls, by Analysis Group,

 

57

10-10

 

Number of Medical Conditions for Participants and Controls, with Adjusted Odds Ratios (ORs) and 95% Confidence Intervals (CIs), by Analysis Group,

 

57

10-11

 

Summary of Cancer Types by Group and Participant Status,

 

59

10-12

 

Ungrouped Medical Conditions by Analysis Group, Comparing Participants to Controls (Navy and Marine Only),

 

60

10-13

 

Reports of Other Neurodegenerative Diseases by Participant and Group Status,

 

64

10-14

 

Numbers of Symptoms by Group Comparing Participants to Controls, with Adjusted Odds Ratios (ORs),

 

65

10-15

 

Proportion of Subjects Hospitalized Since Discharge from Active Duty Comparing Participants to Controls, with Adjusted Odds Ratios (ORs),

 

67

10-16

 

Birth Defects Among Those Who Fathered a Child Comparing Participants to Controls, with Adjusted Odds Ratios (ORs),

 

67

FIGURES

7-1

 

Mean summary SF-36 scores by month of telephone interview,

 

30

10-1

 

Average SF-36 physical component scores (PCS) by study group and participation status,

 

47

10-2

 

Average SF-36 mental component scores (MCS) by study group and participation status,

 

48

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

Abbreviations and Acronyms

BIRLS Beneficiary Identification and Records Locator Subsystem

BUPERS Bureau of Personnel (Navy)

DoD Department of Defense

DTC Deseret Test Center

ICD International Classification of Diseases

IOM Institute of Medicine

IRB institutional review board

IRS Internal Revenue Service

MCS mental component summary score of the SF-36

MFUA Medical Follow-Up Agency

MSN military service number

NCHS National Center for Health Statistics

NDI National Death Index

NHIS National Health Interview Survey

NIOSH National Institute for Occupational Safety and Health

NIS Neuropsychological Impairment Score

OPT outpatient treatment file

PCS physical component summary score of the SF-36

PTF patient treatment file

SHAD Shipboard Hazard and Defense

SMR standardized mortality ratio

Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
×

SSA Social Security Administration

SSN Social Security number

TARGET online interface to BIRLS system

VA Department of Veterans Affairs

VSO veterans service organization

VVA Vietnam Veterans of America

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. doi: 10.17226/11900.
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More than 5,800 military personnel, mostly Navy personnel and Marines, participated in a series of tests of U.S. warship vulnerability to biological and chemical warfare agents, Project SHAD (Shipboard Hazard and Defense), in the period 1962-1973. Only some of the involved military personnel were aware of these tests at the time. Many of these tests used simulants, substances with the physical properties of a chemical or biological warfare agent, thought at the time to have been harmless. The existence of these tests did not come to light until many decades later.

In September 2002, the Institute of Medicine (IOM) agreed to undertake a scientific study, funded by the Veterans' Affairs, of potential long-term health effects of participation in Project SHAD. In general, there was no difference in all-cause mortality between Project SHAD participants and nonparticipant controls, although participants statistically had a significantly higher risk of death due to heart disease, had higher levels of neurodegenerative medical conditions and higher rates of symptoms with no medical basis.

Long-Term Health Effects of Participation in Project SHAD focuses on the potential health effects of participation in Project SHAD. It is a useful resource for government defense agencies, scientists and health professionals.

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