Student Research: Kenneth Kuhn

Evaluation of Exposure to Jet-Propellant-8 (JP-8) and Health Care Utilization in United States Army Soldiers Returning from Deployment to Operation Iraqi Freedom



BACKGROUND: The human health effects of many fuel oils are well known. The scientific literature shows numerous studies regarding the effects of JP-8 in animal models, but studies concerning its effect on humans are limited. JP-8 is the primary fuel of the United States Armed Forces. It represented approximately 50% of total Department of Defense (DoD) fuel purchases in FY 2007. In the Operation Iraqi Freedom theatre, for the year 2007, of 1.1 billion gallons of fuel used, 81.5% was jet fuel. Due to its wide use in the military, exposure to JP-8 can occur by numerous means. Acute exposure causes symptoms such as burning eyes and skin rash. Chronic exposure may adversely affect the pulmonary, cardiovascular, neurological, and auditory systems among others.

MATERIALS AND METHODS: This study is a retrospective cohort study. The cohort will be Soldiers who completed a Soldier Wellness Assessment Program (SWAP) questionnaire (a questionnaire completed by every Soldier who returns from a longer than 30 day deployment outside of the United States) between the dates of 09 Jan 2006 to 23 May 2006 who deployed to and returned from Operation Iraqi or Enduring Freedom. This will involve approximately 6200 Soldiers.

Exposure will be based on the SWAP questions, Do you have any persistent major concerns regarding the health effects of something you believe you may have been exposed to or encountered while deployed: JP-8 or other fuels, smoke from oil fire, smoke from burning trash/feces, vehicle/truck exhaust fumes, tent heater smoke, fog oils/smoke screens, and solvents? Those answering yes to JP-8 exposure will be considered exposed and will be graded based on number of exposures (e.g. 0= no to all, 1= yes to JP-8 only, 2=yes to JP-8 and one other variable, 3=yes to JP-8 and two other variables etc).

The outcome assessed will be healthcare utilization covering one year post-deployment. Logistic regression will compare Soldiers in the exposed groups to those in the unexposed group regarding the degree of healthcare utilization. Soldiers considered exposed will then be compared by looking at likelihood of exposure based on job classification. We will then analyze healthcare utilization by organ system (pulmonary, neurological, auditory) in the exposed versus unexposed groups. This study is powered to detect an odds ratio of 1.5 considering 80% power and a 0.05 significance level.

RESULTS: Upon completion of data analysis, the anticipated results are that exposure to JP-8 is a risk factor for increased healthcare utilization and this risk increases with increasing exposure.

CONCLUSIONS: The findings of this study will bear out the fact that exposure to JP-8 leads to increased utilization of healthcare. Its findings support increasing industrial hygiene assets in the deployed environment and including biological monitoring, which will allow for a quantifiable exposure and increase risk mitigation.