Gulf War Veterans Measuring Health (1999) / Chapter Skim
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5 Gulf War Veterans Health Study
5 Gulf War Veterans Health Study
Pages 63-82
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From page 63... ...
We have called this the Gulf War Veterans Health Study (GWVHS)
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From page 64... ...
Additionally, the committee recommends that the prospective cohort study investigate the following four questions: played; 1. How healthy are Gulf War veterans?
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From page 65... ...
As noted earlier, the prospective cohort study is designated by the committee as the Gulf War Veterans Health Study (GWVHS)
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From page 66... ...
As this report is being written, however, 8 years have elapsed since the Gulf War. Given the anticipated deterioration of the address information in DoD and VA records, the committee anticipates that a substantial tracing and tracking effort will be necessary to locate, recruit, and follow a representative sample of Gulf War veterans in the prospective cohort study it recommends.
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From page 67... ...
Because members of the Gulf War veteran population and the comparison groups were not randomly assigned to those groups, the comparison will be subject to potential selection bias problems common to all observational studies: Gulf War veterans might be different from the comparison groups even in the absence of the Gulf War experience. To account for such differences, data are to be collected on potential confounding factors, such as sex, years of schooling, and other correlates of health status.
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From page 68... ...
Although some contextual data can be obtained with little effort for all geographical locales, some detailed contextual data require direct data collection in the specific locales being studied. Additionally, if face-to-face interviewing is used to administer questionnaires, a geographically clustered sample is more efficient than random distribution of the study population across the county.
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From page 69... ...
For example, if comparisons are to be made not just between Gulf War veterans and nonGulf War veterans, but also between male and female veterans of each group, the appropriate sample size will be larger than that required when comparing only Gulf War and non-Gulf War veterans overall. If a cluster-based sample design is used, the power analyses must take into account the design effect due to intracluster correlation, which usually increases the sample size required.
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From page 70... ...
Incentives can be offered to encourage the participants to provide this information. Baseline Data ~Analysis First Follow-Up Data Second Follow-Up Analysis Prep Time Year 1 FIGURE 5-1 Timing of the Gulf War Veterans Health Study.
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From page 71... ...
In various survey-based studies of Gulf War veterans conducted to date, response rates have ranged from a low of 31% in the study of active duty and reserve personnel based in Hawaii and Pennsylvania, conducted by Stretch et al.
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From page 72... ...
Research has shown that monetary incentives are effective at increasing response rates; are more effective when prepaid than when promised; may induce greater respondent commitment and, therefore, improve quality of data obtained; are most effective at increasing the response rates of individuals with lower income and less education; when combined with follow-up mailings, are signif~cantly more effective than one, two, or three follow-up mailings without incentives; and added costs are likely to be offset by savings in the costs of follow-up activities (Armstrong, 1975; Berk et al., 1987; Berlin et al., 1992; Cannell and Henson, 1974; Duffer et al., 1996; James and Bostein, 1990; Kulka, 1993; Linsky, 1975; and O'Keefe and Homer, 1987~. Because of the importance of achieving and maintaining representative participation in the study, the committee urges the principal investigators implementing the GWVHS to consider the use of monetary incentives.
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From page 73... ...
78.4% (of 2,949) Gulf War veterans: 78.3% (of 2,421)
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From page 74... ...
Gulf War veterans, 15,000 Gulf War-era veterans Questionnaires distributed during unit training weekends; for Unit C, during 10-day period Forces Personnel (Goss Gilroy, 1998) Unwin et al., 1999 VA National Health Survey of Gulf War-era veterans and their families (study ongoing)
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From page 75... ...
Mail-out, mail-back survey Study population: activated Air National Guard Unit Mail and telephone recruiting; questionnaires completed at one of five sessions Study population: 24th Reserve Naval Mobile Construction Battalion Questionnaires distributed through units Study population: Active duty, National Guard, alla reserve personnel from units in Hawaii and Pennsylvania Fukuda et al., 1998 (;continue~ Holmes et al., 1998 Haley, et al., 1997 Stretch et al., 1995, 1996 SOURCE: Compiled from published articles cited. PILOT STUDY Because the GWVHS recommended by this committee requires a major commi~nent of resources, a pilot study will be essential to determine its feasibility and its cost.
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From page 76... ...
Using Existing Instruments Generally, the committee advises that, wherever possible, proposed surveys and studies should attempt to use existing instruments, where such instruments have been documented (ideally in the peer-reviewed literature or through other authoritative avenues) to be reliable, valid, reasonably responsive, and reasonably practical to implement.
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From page 77... ...
to engage the services of evaluators knowledgeable in the assessment of a wide array of existing instruments for the purposes envisioned for this study, for example, the Medical Outcomes Trust. Modifying Existing Instruments Using existing instruments, more or less intact, may blur into modifying existing instruments.
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From page 78... ...
COST The committee recognizes that the cost of implementing the recommended prospective cohort study is not insignificant. Recent estimates of the cost of other large national panel surveys offer a range of reference points.
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From page 79... ...
and to those of as yet unforeseen conflicts, peacekeeping efforts, or wars as well as to the health problems of Gulf War veterans. Health-related factors likely to be of importance include well-known and predictable phenomena.
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From page 80... ...
To ensure high-quality research throughout the program the committee believes an independent advisory board should be established to set policies for and monitor the progress of the prospective cohort study and research portfolio of the health of Gulf War veterans and veterans of other military conflicts. Such an advisory board could include the following tasks among its functions: · provide scientific and public oversight of research on issues related to the health of Gulf War veterans and veterans of other conflicts; · establish policies regarding data protection and access, and review and award research grants or contracts; · ensure integration of new research findings to advance understanding and treatment of war-related illnesses; and · provide advice to federal agencies on research on the health of veterans.
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From page 81... ...
The advisory board should · be an independent, scientific, and policy-oriented body composed of experts in clinical medicine, epidemiology, health status and health outcomes assessment; veterans' health issues; health services research; social, behavioral, physical, and biomedical sciences; survey research; statistics; national health databases; and health policy, along with members of the public who represent Gulf War veterans. · review, in a timely manner, requests for proposals developed by the funding agencies to conduct the prospective cohort study recommended by the committee.
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