INDEX

A

Abortion, spontaneous, from exposure to fuels, 292–293

ACGIH. See American Conference of Governmental Industrial Hygienists

ACS. See American Cancer Society

Acute nonlymphocytic leukemia, from exposure to fuels, 290

Agency for Toxic Substances and Disease Registry (ATSDR), 29, 34, 41, 45, 49–50, 100, 348, 351, 355, 403

Agents

identification of, 21

specified in PL 105–368 and PL 105–277, 13

Air-pollution studies

ambient exposures, 89

and exposure to combustion products and cardiovascular disease, 280–281

and lung cancer, 88

Alberta Health Care Insurance Plan, 99

Ambient air-pollution studies, 89

and exposure to combustion products, 89–91

American Academy of Dermatology, 335

American Cancer Society (ACS), 60, 90, 92, 129, 138, 256

on the consequences of smoking, 6

CPS-II Study, 89, 129, 135, 138, 279–280, 282

American Conference of Governmental Industrial Hygienists (ACGIH), 29, 351, 358

American Heart Association, 278

American Thoracic Society (ATS), 252, 256

Epidemiological Standardization project, 256

Amoco Oil Company, 72, 74, 76, 94, 97–98

Amyloidosis, experimental studies of the toxicology of hydrazines in, 355

Animal models, 405–406

Argentina, studies from cited, 92

Arizona, studies from cited, 289

Arteriosclerotic heart disease, mortality from, and exposure to nitric acid, 388–389

Assessing the strength of the evidence, 22–25

bias, 24–25

biologic plausibility, 2–4, 16, 24

chance, 25

consistency of association, 4, 23

dose-response relationship, 4–5, 23



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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 INDEX A Abortion, spontaneous, from exposure to fuels, 292–293 ACGIH. See American Conference of Governmental Industrial Hygienists ACS. See American Cancer Society Acute nonlymphocytic leukemia, from exposure to fuels, 290 Agency for Toxic Substances and Disease Registry (ATSDR), 29, 34, 41, 45, 49–50, 100, 348, 351, 355, 403 Agents identification of, 21 specified in PL 105–368 and PL 105–277, 13 Air-pollution studies ambient exposures, 89 and exposure to combustion products and cardiovascular disease, 280–281 and lung cancer, 88 Alberta Health Care Insurance Plan, 99 Ambient air-pollution studies, 89 and exposure to combustion products, 89–91 American Academy of Dermatology, 335 American Cancer Society (ACS), 60, 90, 92, 129, 138, 256 on the consequences of smoking, 6 CPS-II Study, 89, 129, 135, 138, 279–280, 282 American Conference of Governmental Industrial Hygienists (ACGIH), 29, 351, 358 American Heart Association, 278 American Thoracic Society (ATS), 252, 256 Epidemiological Standardization project, 256 Amoco Oil Company, 72, 74, 76, 94, 97–98 Amyloidosis, experimental studies of the toxicology of hydrazines in, 355 Animal models, 405–406 Argentina, studies from cited, 92 Arizona, studies from cited, 289 Arteriosclerotic heart disease, mortality from, and exposure to nitric acid, 388–389 Assessing the strength of the evidence, 22–25 bias, 24–25 biologic plausibility, 2–4, 16, 24 chance, 25 consistency of association, 4, 23 dose-response relationship, 4–5, 23

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 specificity of association, 4, 23–24 strength of evidence of an association, 4, 22–23 temporal relationship, 4, 23 Asthma, 240, 242 categories used to evaluate indoor pollutants related to, 25 conclusions about, 264–266 from exposure to fuels, 242, 244 key studies of, 265–266 “physician-diagnosed,” 246 ATS. See American Thoracic Society ATSDR. See Agency for Toxic Substances and Disease Registry Australia, studies from cited, 241, 243, 255, 257, 260, 320 B Benzene, 6, 29, 102, 133 Bias, 24–25 in assessing the strength of the evidence, 24–25 confounding, 25 information bias, 24–25 reducing, 6, 22 selection bias, 24 Bioassays, chronic, 47 Biologic plausibility, in assessing the strength of the evidence, 3, 16, 24 Biological monitoring data, 26n Biomass-fuel combustion, 261–262 population-based studies of, 261–262 Biomass studies, 262–264 Birth defects, 310–311 conclusions about, 311 in Gulf War Veterans, 288–290 Bladder cancer, 111–119 conclusions about, 118–119 and exposure to combustion products, 114–118 additional studies on cancers of the renal pelvis, 118 case-control studies, 115–118 cohort studies, 114–115 selected epidemiologic studies, 200–206 and exposure to fuels, 111–114 case-control studies, 111–114 selected epidemiologic studies, 198–200 Blinding, 406 Bolivia, studies from cited, 262, 268 Bosnia veterans, 257–258

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Brain/CNS cancers and exposure to combustion products, selected epidemiologic studies, 197 and exposure to fuels, selected epidemiologic studies, 195–196 Breast cancer female, 101–102 male, 102–104 British Medical Research Council, 260, 262, 268 C California, studies from cited, 73, 89, 92, 289, 301, 309, 310, 311 California Office of Statewide Health Planning and Development, 250 Cambridge Neuropsychological Test Automated Battery, 320 Canada, studies from cited, 69–70, 72, 75–77, 79–80, 86, 95, 97–101, 106, 108, 121–122, 124–126, 128–130, 133, 140, 259, 283, 295, 301, 308, 310, 361 Cancers, 16, 60–239, 413–454 bladder cancer, 111–119 brain/CNS cancers, 195–197 cancers of the nasal cavity and nasopharynx, 66–70 cancers of the oral cavity and oropharynx, 61–66 colon cancer, 74–76 developmental insults from, 359 esophageal cancer, 70–72 and exposure to hydrazines, toxicology of, 355 and exposure to nitric acid, toxicology of, 358–359 and exposure to uncombusted fuels, 35 female breast cancer, 101–102 female genital cancers (cervical, endometrial, uterine, and ovarian), 104–105 genotoxicity, 359 hepatic cancer. See Liver cancer Hodgkin’s disease, 130–132 inadequate/insufficient evidence to determine whether an association exists, 8–9, 400–401 kidney cancer, 119–127 laryngeal cancer, 80–85 leukemias, 137–140 limited/suggestive evidence of an association, 7–8, 399 liver cancer, 78–79 lung cancer, 85–93 male breast cancer, 102–104 male genital cancers (prostatic and testicular), 105–107 malignant melanoma of the skin, 94–98 multiple myeloma, 132–137 myelodysplastic syndromes, 140–142

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 nervous system cancers, 107–110 non-Hodgkin’s lymphoma, 127–130 non-melanoma skin cancers, 98–101 ocular melanoma, 110–111 pancreatic cancer, 79–80 prostatic cancer. See Male genital cancers rectal cancer, 76–78 stomach cancer, 72–74 summary of conclusions, 142–143 susceptibility to infection, 359 tables, 144–222 Cancers of the nasal cavity and nasopharynx, 66–70 conclusions about, 69–70 and exposure to combustion products, 67–69 case-control studies, 67–69 selected epidemiologic studies, 147–148 and exposure to fuels, 66–67 case-control studies, 67 selected epidemiologic studies, 147 Cancers of the oral cavity and oropharynx, 61–66 conclusions about, 65–66 and exposure to combustion products, 63–65 case-control studies, 63–65 selected epidemiologic studies, 145–146 and exposure to fuels, 62–63 case-control studies, 63 cohort studies, 62–63 selected epidemiologic studies, 144 Cancers of the renal pelvis, in bladder cancer, and exposure to combustion products, 118 Carbon monoxide and carbon dioxide from combustion, 41–42 toxicity of, 48 Carcinogenicity, of various agents and categories used by other IOM committees, 15 Cardiovascular effects, 277–287 and exposure to combustion products, 278–284 and exposure to fuels, 278 and exposure to nitric acid, 384 and exposure to uncombusted fuels, experimental studies, 37 inadequate/insufficient evidence to determine whether an association exists, 10 Case-control studies, 408–409 of bladder cancer and exposure to combustion products, 115–118

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 and exposure to fuels, 111–114 of cancers of the nasal cavity and nasopharynx and exposure to combustion products, 67–69 and exposure to fuels, 67 of cancers of the oral cavity and oropharynx and exposure to combustion products, 63–65 and exposure to fuels, 63 of colon cancer and exposure to combustion products, 75–76 and exposure to fuels, 75 of esophageal cancer, and exposure to combustion products, 71 of female breast cancer, and exposure to combustion products, 102 of female genital cancers (cervical, endometrial, uterine, and ovarian), and exposure to combustion products, 105 of Hodgkin’s disease and exposure to combustion products, 132 and exposure to fuels, 131 of kidney cancer and exposure to combustion products, 124–127 and exposure to fuels, 121–124 of laryngeal cancer and exposure to combustion products, 82–84 and exposure to fuels, 81–82 of leukemias, and exposure to combustion products, 138–139 of liver cancer and exposure to combustion products, 78–79 and exposure to fuels, 78 of male breast cancer and exposure to combustion products, 103 and exposure to fuels, 103 of male genital cancers (prostatic and testicular) and exposure to combustion products, 106–107 and exposure to fuels, 106 of malignant melanoma of the skin and exposure to combustion products, 96–97 and exposure to fuels, 95 of multiple myeloma and exposure to combustion products, 135–136 and exposure to fuels, 134 of myelodysplastic syndromes and exposure to combustion products, 141 and exposure to fuels, 140–141

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 of nervous system cancers and exposure to combustion products, 109 and exposure to fuels, 109 of nitric acid exposure, 383–384 laryngeal cancer, 383 multiple myeloma, 384 of non-Hodgkin’s lymphoma and exposure to combustion products, 129–130 and exposure to fuels, 128–129 of non-melanoma skin cancers and exposure to combustion products, 100 and exposure to fuels, 99 of ocular melanoma, and exposure to combustion products, 110 of outdoor air pollution, 254–255 of pancreatic cancer, and exposure to combustion products, 80 of rectal cancer and exposure to combustion products, 77–78 and exposure to fuels, 77 of sarcoidosis, and exposure to combustion products, 337–341 of stomach cancer and exposure to combustion products, 73 and exposure to fuels, 72 tables of, 425–456 Case reports and case series, 409–410 Categories of association, 4–6, 25–27 inadequate/insufficient evidence to determine whether an association exists, 5, 8–10, 26, 142–143 limited/suggestive evidence of an association, 5, 7–8, 26 of no association, 6, 11, 26–27 sufficient evidence of a causal association, 5, 7, 25, 142 sufficient evidence of an association, 5, 7, 26, 142 Causal relationships, evidence of, 3, 15–16 CDC. See Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), 361–362 Central nervous system (CNS) cancers, 294–296 Cervical cancer. See Female genital cancers Cervical intraepithelial neoplasia (CIN), 105 CFS. See Chronic fatigue syndrome Chemical identity and selected physical and chemical properties of combustion products, 41–42 gases, 41–42 particulate matter, 42

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 of hydrazine, 349–350 of nitric acid, 349–350 of selected uncombusted fuels, 30–31 Chemical Industry Institute of Toxicology (CIIT), 45 Chevron Corporation, 241 Childhood cancers, 293–296, 311–313 central nervous system cancers, 294–296 conclusions about, 313 leukemia, 293–294 China, studies from cited, 63–64, 66–67, 73, 90–94, 256–257, 294, 301, 308, 335 Chlamydia pneumoniae, 340–341 Chronic bioassays, 47 Chronic bronchitis, 240 conclusions about, 267–269 and exposure to fuels, 242, 245 key studies of, 268 Chronic fatigue syndrome (CFS), 361 Chronic obstructive pulmonary disease (COPD), conclusions about, 269–270 CIIT. See Chemical Industry Institute of Toxicology CIN. See Cervical intraepithelial neoplasia Civilian populations, epidemiology of MCS symptoms in, 326–327 CNS. See Central nervous system cancers Cohort studies, 20, 407–408, 413 of bladder cancer, and exposure to combustion products, 114–115 of cancers of the oral cavity and oropharynx, and exposure to fuels, 62–63 of colon cancer, and exposure to fuels, 74–75 of esophageal cancer and exposure to combustion products, 71 and exposure to fuels, 70 of exposure to hydrazine, 363–369 in Italian power plant cohort, 368–369 in UK hydrazine production cohort, 367–368 in US aerospace cohort, 363–367 of exposure to nitric acid, 381–383 in Italian chemical plant workers, 382 in nitric acid production cohort, 382–383 occupational studies, 381–383 in Pennsylvania sheet and tin mill, 381 in US mid western metal pickling cohort, 381–382 of female breast cancer, and exposure to fuels, 101 of female genital cancers (cervical, endometrial, uterine, and ovarian), and exposure to fuels, 104 of Hodgkin’s disease

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 and exposure to combustion products, 132 and exposure to fuels, 131 of kidney cancer and exposure to combustion products, 124 and exposure to fuels, 120–121 of laryngeal cancer, and exposure to fuels, 81 of leukemias, and exposure to combustion products, 138 of male genital cancers (prostatic and testicular), and exposure to fuels, 106 of malignant melanoma of the skin and exposure to combustion products, 96 and exposure to fuels, 94–95 of multiple myeloma, and exposure to fuels, 133–134 of nervous system cancers, and exposure to fuels, 108–109 of non-Hodgkin’s lymphoma and exposure to combustion products, 129 and exposure to fuels, 128 of non-melanoma skin cancers, and exposure to fuels, 98–99 of pancreatic cancer, and exposure to fuels, 79 prospective and retrospective, 407 of rectal cancer, and exposure to fuels, 76–77 of stomach cancer and exposure to combustion products, 73 and exposure to fuels, 72 tables of, 414–425 Colon cancer, 74–76 conclusions about, 76 and exposure to combustion products, 75–76 case-control studies, 75–76 selected epidemiologic studies, 153–154 and exposure to fuels, 74–75 case-control studies, 75 cohort studies, 74–75 selected epidemiologic studies, 152–153 Columbia, studies from cited, 263 Combustion products, 39–49 bladder cancer, and exposure to, 114–118 cancers of the nasal cavity and nasopharynx, and exposure to, 67–69 cancers of the oral cavity and oropharynx, and exposure to, 63–65 cardiovascular disease, and exposure to, 278–284 air-pollution studies, 280–281 conclusions about, 284 Gulf War Veteran studies, 279–280 occupational studies, 282–284

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 colon cancer, and exposure to, 75–76 esophageal cancer, and exposure to, 70–71 female breast cancer, and exposure to, 102 female genital cancers (cervical, endometrial, uterine, and ovarian), and exposure to, 105 hepatic cancer, and exposure to, 156 Hodgkin’s disease, and exposure to, 131–132 kidney cancer, and exposure to, 124–127 laryngeal cancer, and exposure to, 82–84 leukemias, and exposure to, 138–139 liver cancer, and exposure to, 78–79 lung cancer, and exposure to, 86–93 male breast cancer, and exposure to, 103 male genital cancers (prostatic and testicular), and exposure to, 106–107 malignant melanoma of the skin, and exposure to, 95–97 multiple myeloma, and exposure to, 135–136 myelodysplastic syndromes, and exposure to, 141 nervous system cancers, and exposure to, 109 neurologic outcomes, and exposure to, 321–325 non-Hodgkin’s lymphoma, and exposure to, 129–130 non-melanoma skin cancers, and exposure to, 99–100 ocular melanoma, and exposure to, 110 pancreatic cancer, and exposure to, 80 physical and chemical properties of, 41–42 potential exposures in the Gulf War, 40–41 prostatic cancer, and exposure to. See Male genital cancers rectal cancer, and exposure to, 77–78 reproductive and developmental outcomes, and exposure to, 297–313 adverse pregnancy outcomes, 298–311 respiratory outcomes, and exposure to, 243–270 asthma, key studies of, 265–266 biomass-fuel combustion, 261–262 chronic bronchitis, key studies of, 268 conclusions, 264–269 exposure statistics, 251 Gulf War studies, 246–251 occupational studies, 259–261 other biomass studies, 262–264 outdoor air pollution, 252–258 stomach cancer, and exposure to, 72–73 toxicity studies of, 43–49 toxicokinetics of, 42–43 and uncombusted fuels, 28–59

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Computed-tomographic (CT) scans, 323 Conclusions, 264–269 about asthma, 264–266 about birth defects, 311 about bladder cancer, 118–119 about cancers of the nasal cavity and nasopharynx, 69–70 about cancers of the oral cavity and oropharynx, 65–66 about childhood cancers, 313 about chronic bronchitis, 267–269 about chronic obstructive pulmonary disease, 269–270 about colon cancer, 76 about combustion products and cardiovascular disease, 284 about dermatologic outcomes, 336 about emphysema, 269 about esophageal cancer, 71–72 about female breast cancer, 102 about female genital cancers (cervical, endometrial, uterine, and ovarian), 105 from Gulf War and Health, Volumes 1 and 2, 17, 398–402 about Hodgkin’s disease, 132 about kidney cancer, 127 about laryngeal cancer, 84–85 about leukemias, 139–140 about liver cancer, 79 about low birthweight and intrauterine growth retardation, 310 about lung cancer, 93 about male breast cancer, 103–104 about male genital cancers (prostatic and testicular), 107 about malignant melanoma of the skin, 98 about multiple chemical sensitivity, 331 about multiple myeloma, 137 about myelodysplastic syndromes, 141–142 about nervous system cancers, 110 about neurobehavioral effects, 321, 324 about non-Hodgkin’s lymphoma, 130 about non-melanoma skin cancers, 100–101 about ocular melanoma, 111 about pancreatic cancer, 80 about peripheral neuropathy, 319 about posttraumatic stress disorder, 323 about rectal cancer, 78 about reproductive and developmental outcomes, 297 about respiratory outcomes, 242–243, 264, 269 about sarcoidosis, 341

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 about stomach cancer, 74 summary of, 142–143 Consistency of association, in assessing the strength of the evidence, 4, 23 Contact dermatitis, experimental studies of the toxicology of hydrazines in, 356 Controlled epidemiologic studies (observational), 406–410 case-control studies, 408–409 case reports and case series, 409–410 cohort studies, 407–408 cross-sectional studies, 409 information from death certificates, 410 Controlled trials, randomized, 20 in humans, 406 COPD. See Chronic obstructive pulmonary disease Cross-sectional studies, 20, 409, 410 of hydrazine exposure, 369–370 Japanese hydrazine hydrate workers, 369–370 missile-propellant handlers at Vandenberg Air Force Base, California, 369 rocket-propellant workers in Danish Air Force, 369 of outdoor air pollution, 254–255 CT. See Computed-tomographic scans Czech Republic, studies from cited, 302, 307, 309 D Danish Air Force, rocket-propellant workers in, 369 Danish Cancer Registry, 134, 136, 311 Danish Gulf War Study, 361 Danish Supplemental Pension Fund, 134, 136 Death certificates, information from, 410 Denmark, studies from cited, 91, 103 Dermatologic outcomes, 331–336 absorption of fuels by Gulf War personnel, 28 conclusions about, 336 dermatitis, and fuel exposure, 333–334 experimental studies in exposure to uncombusted fuels, 39 inadequate/insufficient evidence to determine whether an association exists, 10 Determinants of disease, epidemiology dealing with, 20 Developmental insults, from exposure to nitric acid, 359 Developmental outcomes. See Reproductive and developmental outcomes Diabetes mellitus, mortality from, and exposure to nitric acid, 389 Diagnostic and Statistical Manual of Mental Disorders-IV, 320 Diesel heater fumes exposure to, 19 Disease induction, exposure preceding the onset of disease by the duration of, 23

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Nervous system effects, experimental studies of the toxicology of hydrazines in, 354 Nested case-control studies in leukemias, and exposure to combustion products, 138 in multiple myeloma, and exposure to combustion products, 135 The Netherlands, studies from cited, 89–90, 92, 97, 114, 256, 280–281 The Netherlands Cohort Study on Diet and Cancer, 114, 256, 280–281 Neuroblastoma, and exposure to fuels, 291 Neurologic outcomes, 317–325 conclusions about, 319, 321, 323–325 and exposure to combustion products, 321–325 neurobehavioral effects, 323–324 neurologic diseases, 324–325 posttraumatic stress disorder, 322–323 and exposure to uncombusted fuels, 318–321 experimental studies in, 35–36 peripheral neuropathy, 319 neurobehavioral effects, 320–321 inadequate/insufficient evidence to determine whether an association exists, 10, 401 limited/suggestive evidence of an association, 399 New Caledonia, studies from cited, 91 New Jersey, studies from cited, 78, 112, 121 New York, studies from cited, 65, 73, 84, 90, 96, 102, 129, 132, 138, 257, 283, 295, 340 New Zealand, studies from cited, 127, 258, 310, 324 New Zealand Cancer Registry, 127 NHL. See Non-Hodgkin’s lymphoma NHLBI, 253 NIOSH. See National Institute for Occupational Safety and Health Nitric acid, 356–359 and cancer, 358–359 chemical identity and selected physical and chemical properties of, 349–350 experimental studies of, 357–358 and genetic susceptibility, 359 interactions, 359 occupational studies of exposure to, 371–384 recommended exposure limits for, 352–353 red fuming, 16, 347, 348, 356 residual effects of corrosive action and irritation, 357–358 toxicokinetics of, 356–357 white fuming, 356 Nitrogen oxides from combustion, 41 toxicity of, 46–47 NLM. See National Library of Medicine

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 No-observed-effect level (NOEL), 358 NOAA. See National Oceanic and Atmospheric Administration NOEL. See No-observed-effect level Non-cancer health outcomes, and exposure to nitric acid, 384, 388–390 arteriosclerotic heart disease (mortality), 388–389 cardiovascular effects, 384 diabetes mellitus (mortality), 389 hypertensive heart disease (mortality), 389 respiratory effects, 384 vascular lesions of CNS (mortality), 389 Non-Hodgkin’s lymphoma (NHL), 127–130 conclusions about, 130 and exposure to combustion products, 129–130 case-control studies, 129–130 cohort studies, 129 selected epidemiologic studies, 214–215 and exposure to fuels, 128–129 case-control studies, 128–129 cohort studies, 128 selected epidemiologic studies, 212–213 Non-melanoma skin cancers, 98–101 conclusions about, 100–101 and exposure to combustion products, 99–100 case-control studies, 100 selected epidemiologic studies, 187–188 and exposure to fuels, 98–99 case-control studies, 99 cohort studies, 98–99 selected epidemiologic studies, 187 Nonmalignant respiratory disease, and exposure to fuels, 241, 244 Normative Aging Study, 284 Norway, studies from cited, 89–90, 260, 382–383 Norwegian Cancer Registry, 383 NPC. See Nasopharyngeal carcinoma NRC. See National Research Council NTP. See National Toxicology Program O Observational studies, 406–410 case-control studies, 408–409 case reports and case series, 409–410 cohort studies, 407–408 cross-sectional studies, 409

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 types of epidemiologic studies, 406–410 Occupational Safety and Health Administration (OSHA), 29, 351, 356 Occupational studies, 2, 14–15, 16, 87 of exposure to combustion products, 91–93 and cardiovascular disease, 282–284 and respiratory outcomes, 259–261 of exposure to engine exhaust, 91–93 estimated exposure to compounds in exhaust fumes, 92–93 general exposure to exhaust, 91–92 Gulf War Veteran study, 93 of hydrazine exposure, 362–371 cohort studies, 363–369 conclusions from, 371 cross-sectional studies, 369–370 health outcomes, 372–374 of nitric acid exposure, 371, 375–385 case-control studies, 383–384 cohort studies, 381–383 conclusions from, 385 health outcomes and exposure to nitric acid, 386–390 Occupations, with exposure to combustion products, 87 Ocular melanoma, 110–111 conclusions about, 111 and exposure to combustion products, 110 case-control studies, 110 selected epidemiologic studies, 197–198 and exposure to fuels, 110 Odds ratios (ORs), 20, 22, 63 Oil-well fire by-products exposure to, 14, 19, 28, 40, 43, 93, 267, 269 Gulf War studies of smoke, 248–249 Oklahoma, studies from cited, 122, 126 Oral cavity and oropharynx, cancers of, 61–66 conclusions about, 69–70 and exposure to combustion products, 67–69 case-control studies, 67–69 selected epidemiologic studies, 147–148 and exposure to fuels, 66–67 case-control studies, 67 selected epidemiologic studies, 147 Oregon, studies from cited, 362 Oropharynx, cancers of, 61–66 conclusions about, 69–70

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 and exposure to combustion products, 67–69 case-control studies, 67–69 selected epidemiologic studies, 147–148 and exposure to fuels, 66–67 case-control studies, 67 selected epidemiologic studies, 147 ORs. See Odds ratios OSHA. See Occupational Safety and Health Administration Outdoor air pollution, 252–258 cross-sectional or case-control studies, 254–255 hydrogen sulfide and respiratory diseases, 258 mortality studies, 255–256 prospective studies, 252–254 support studies, 256–258 Ovarian cancer. See Female genital cancers Ozone, toxicity of, 47–48 P PAHs. See Polycyclic aromatic hydrocarbons Pancreatic cancer, 79–80 conclusions about, 80 and exposure to combustion products, 80 case-control studies, 80 selected epidemiologic studies, 157–158 and exposure to fuels, 79 cohort studies, 79 selected epidemiologic studies, 157 Particulate matter (PM) from combustion, 39, 40, 42–43, 48–50, 90 physical and chemical properties of, 42 toxicity studies of, 48–49 toxicokinetics of, 42–43 PEL. See Permissible exposure limit Pennsylvania, studies from cited, 381–382, 384 Pennsylvania sheet and tin mill cohorts, cohort studies of nitric acid exposure, 381 Peripheral neuropathy conclusions about, 319 from exposure to fuels, 319 Permissible exposure limit (PEL), 356 Persian Gulf region, 2, 347 Persian Gulf War Veterans Act (PL 105–277), 1, 12–13 Physical and chemical properties of combustion products, 41–42 gases, 41–42

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 participate matter, 42 of uncombusted fuels, 29 PL 105–368 and PL 105–277, agents specified in, 13 PM. See Participate matter from combustion PMRs. See Proportional morbidity ratios Pneumonia, from exposure to fuels, 245–246 Poland, studies from cited, 90, 99, 383 Polycyclic aromatic hydrocarbons (PAHs), 39–40, 42–43, 49, 61, 63–66, 71, 80, 82–83, 85, 91–93, 97, 99–103, 105–107, 114–116, 117–119, 123, 125–126, 141, 307, 309, 312, 368, 370 Population-based studies, of biomass-fuel combustion, 261–262 Posttraumatic stress disorder (PTSD), 280, 321–323, 360–361 conclusions about, 323 from exposure to combustion products, 322–323 Prader-Willi syndrome (PWS), 296–297 from exposure to fuels, 291 Preterm births, 6, 298–302 and combustion-product exposure, 299–300 Primary studies, 21 ProCite database, 403 Profile of Mood States, 323 Proportional morbidity ratios (PMRs), 250 Prospective studies design of, 406–407 of outdoor air pollution, 252–254 Prostatic cancer, 193–195. See also Male genital cancers and exposure to combustion products, selected epidemiologic studies, 194–195 and exposure to fuels, selected epidemiologic studies, 193 PTSD. See Posttraumatic stress disorder PubMed, 404 PWS. See Prader-Willi syndrome R Randomized controlled trials, 20, 406 in humans, 406 RCCs. See Renal-cell carcinomas Recommended exposure limits for exposure to hydrazine, 352–353 for exposure to nitric acid, 352–353 for fuels, 32–33 Rectal cancer, 76–78 conclusions about, 78 and exposure to combustion products, 77–78

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 case-control studies, 77–78 selected epidemiologic studies, 155–156 and exposure to fuels, 76–77 case-control studies, 77 cohort studies, 76–77 selected epidemiologic studies, 154–155 Red fuming nitric acid (RFNA), 348, 356, 358–360 inhibited, 14, 347–348 Relative risk, 22 Renal-cell carcinomas (RCCs). See Kidney cancer Renal effects, and exposure to uncombusted fuels, experimental studies of, 38 Reproductive and developmental outcomes, 288–313 and combustion products, 297–313 experimental studies in exposure to uncombusted fuels, 38–39 of the toxicology of hydrazines in, 354–355 and fuels, 290–297 inadequate/insufficient evidence to determine whether an association exists, 9–10, 401 limited/suggestive evidence of an association, 8 studies of birth defects in Gulf War Veterans, 288–290 Respiratory cancer, and exposure to nitric acid, 386 Respiratory outcomes, 240–270 and combustion products, 243–270 and exposure to fuel, 241–243 and exposure to nitric acid, 384 and exposure to uncombusted fuels, experimental studies, 36 and the toxicology of hydrazines, experimental studies, 354 Retrospective design, of studies, 407 Reversible effects, exposure-free interval for, 21–22 RFNA. See Red fuming nitric acid Rhode Island, studies from cited, 340 Risks of illness among Gulf War Veterans determining increased, 2–3, 15–16 human or animal populations exposed to an agent, 2, 15–16 Rocket-propellant workers, in Danish Air Force, 369 Roswell Park Memorial Institute, 65, 73, 84, 96, 129, 132, 138 S Sarcoidosis, 337–341 conclusions about, 341 and exposure to combustion products, case-control studies of, 338–339 Saudi Arabia, studies from cited, 263

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Scientific evidence, strength of, 1–2 SCLC. See Small cell lung cancer Scud missiles debris from, 14, 347, 357, 360–362, 385 propellant components of, 7, 347 SDA. See Seventh-Day Adventist Study Searching the literature, 403–404 SEER. See Surveillance, Epidemiology, and End Results registry Selection bias, 24 Self-reported symptoms, 410 Seventh-Day Adventist (SDA) Study, 89–90, 252, 264, 280 Short-term exposure limit (STEL), 356 SIRs. See Standardized incidence ratios Six Cities Study, 90, 256, 280 Skin burns, 347 Skin cancers. See Dermatologic outcomes; Malignant melanoma skin cancer; Nonmelanoma skin cancers Small cell lung cancer (SCLC), 85 Smoking consequences, 6, 367 maternal, 298, 309 Social Security Administration, 381 South Carolina, studies from cited, 337 South Korea, studies from cited, 302, 307, 323 Spain, studies from cited, 80–83, 113 Specificity of association, in assessing the strength of the evidence, 4, 23–24 of outcome, 21 Spontaneous abortion, from exposure to fuels, 292–293 Standard Industrial Classification of Economic Activities, 311. See also International Standard Classification of Occupation and Industry Standard Occupational Classification, 311 Standardized incidence ratios (SIRs), 63, 71, 73, 281 State Health Registry of Iowa, 113, 129 Statistical association evidence of, 2, 15 stability of, 5n Statistical significance, measures of, 22 Statistics Canada, 301 STEL. See Short-term exposure limit Stomach cancer, 72–74 conclusions about, 74 and exposure to combustion products, 72–73 case-control studies, 73

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 cohort studies, 73 selected epidemiologic studies, 151–152 and exposure to fuels, 72 case-control studies, 72 cohort studies, 72 selected epidemiologic studies, 150 Strength of evidence of an association, 4, 22–23 Study designs, 20 cohort or case-control studies, 20 cross-sectional studies, 20 randomized controlled trials, 20 Sulfur oxides from combustion, 41 toxicity of, 45–46 Surveillance, Epidemiology, and End Results (SEER) registry, 81, 134–135, 137, 384 Susceptibility to infection, from exposure to nitric acid, 359 to uncombusted fuels and combustion products, individual, 49–50 Sweden, studies from cited, 63–66, 71, 73, 77, 90–92, 97–98, 113–114, 124, 128, 130–131, 137, 139, 257, 261, 310, 383 Swedish Cancer Environmental Registry, 96–97, 113–114, 116, 124, 381 Switzerland, studies from cited, 91 Systemic lupus erythematosus, experimental studies of the toxicology of hydrazines in, 355 T Tables of cancer studies related to exposure to fuels and combustion products, 144–222, 413–456 case-control studies, 425–456 cohort studies, 414–425 Taiwan, studies from cited, 91, 335 Temporal relationships, in assessing the strength of the evidence, 23 Testicular cancer. See Male genital cancers Texaco, 101, 104, 106, 108 Texas, studies from cited, 82–84, 86, 93, 121 Toluene, 28–29, 34 Toxicity studies of combustion products, 43–49 gases, 45–48 mixtures of combustion products, 43–44 particulate matter, 48–49 Toxicokinetics of combustion products, 42–43 of exposure to nitric acid, 356–357

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 of fuels, 29 of hydrazine, 351–353 of uncombusted fuels, 34 Toxicologic Assessment of Jet Propulsion Fuel, 8, 34 Toxicology, 16–17, 348–359 of hydrazines, 348–356 of nitric acid, 356–359 recommended exposure limits, 352–353 ToxNet, 404 Gene-Tox database, 359 Tucson Veterans Affairs Medical Center, 329 U UDMH. See Unsymmetrical dimethylhydrazine UK hydrazine production cohort, 367–368 Uncombusted fuels, 28–39 and combustion products, 28–59 experimental studies, 34–39 exposure limits, 29 physical and chemical properties of selected fuels, 29–31 recommended exposure limits for fuels, 32–33 toxicokinetics, 34 United Kingdom, studies from cited, 283, 289, 311, 367 United Kingdom Childhood Cancer Study, 311 University Hospital of Lille, 140 Unsymmetrical dimethylhydrazine (UDMH), 347–348, 351–352, 354–355, 360, 369–370 Uruguay, studies from cited, 81, 83 US, studies from cited. See individual states US aerospace cohort, 363–367 US Army Environmental Health Agency, 40 Environmental Hygiene Agency, 321 US Department of Agriculture, Forest Service, 261 US Department of Defense (DOD), 246–247, 250–251, 279, 290, 410 military treatment facilities, 93 US Department of Veterans Affairs (VA), 7, 19, 250, 289, 409 US Environmental Protection Agency (EPA), 40, 46, 336, 351 National Priorities List, 336 US Forest Service, 261 US mid western metal pickling cohort, cohort studies of nitric acid exposure, 381–382 US Surgeon General, 20 Utah, studies from cited, 112, 134 Uterine cancer. See Female genital cancers

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 V VA. See US Department of Veterans Affairs Vaccine safety, categories used to evaluate, 25 Validity of studies, 3, 6, 20 Vandenberg Air Force Base, California, missile-propellant handlers at, 369 Vascular lesions of CNS, mortality from, and exposure to nitric acid, 389 Veteran populations, epidemiology of MCS symptoms in, 326–327 Veterans Programs Enhancement Act (PL 105–277), 1, 12–13 Vietnam War, 322 categories used to evaluate herbicides used in, 25 VOCs. See volatile organic compounds Volatile organic compounds (VOCs), 39 W Washington, studies from cited, 69, 81, 84, 362 WFNA. See White fuming nitric acid White fuming nitric acid (WFNA), 356, 358–359 WHO. See World Health Organization World Health Organization (WHO), 46–47, 60, 140 Global Initiative for Chronic Obstructive Lung Disease, 240 X Xylenes, 29, 34

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3