{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:58:12Z","timestamp":1790834292176,"version":"4.1.0"},"reference-count":25,"publisher":"American Chemical Society (ACS)","issue":"1","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":2293,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background: At least one-fourth of U.S. veterans who served in the 1990\u20131991 Gulf War are affected by the chronic symptomatic illness known as Gulf War illness (GWI). Clear determination of the causes of GWI has been hindered by many factors, including limitations in how epidemiologic studies have assessed the impact of the complex deployment environment on veterans\u2019 health.<\/jats:p>\n                  <jats:p>Objective: We sought to address GWI etiologic questions by evaluating the association of symptomatic illness with characteristics of veterans\u2019 deployment.<\/jats:p>\n                  <jats:p>Methods: We compared veteran-reported wartime experiences in a population-based sample of 304 Gulf War veterans: 144 cases who met preestablished criteria for GWI and 160 controls. Veteran subgroups and confounding among deployment variables were considered in the analyses.<\/jats:p>\n                  <jats:p>Results: Deployment experiences and the prevalence of GWI differed significantly by veterans\u2019 location in theater. Among personnel who were in Iraq or Kuwait, where all battles took place, GWI was most strongly associated with using pyridostigmine bromide pills [odds ratio (OR) = 3.5; 95% confidence interval (CI): 1.7, 7.4] and being within 1 mile of an exploding SCUD missile (OR = 3.1; 95% CI: 1.5, 6.1). For veterans who remained in support areas, GWI was significantly associated only with personal pesticide use, with increased prevalence (OR = 12.7; 95% CI: 2.6, 61.5) in the relatively small subgroup that wore pesticide-treated uniforms, nearly all of whom also used skin pesticides. Combat service was not significantly associated with GWI.<\/jats:p>\n                  <jats:p>Conclusions: Findings support a role for a limited number of wartime exposures in the etiology of GWI, which differed in importance with the deployment milieu in which veterans served.<\/jats:p>","DOI":"10.1289\/ehp.1003399","type":"journal-article","created":{"date-parts":[[2011,9,19]],"date-time":"2011-09-19T00:18:29Z","timestamp":1316391509000},"page":"112-118","source":"Crossref","is-referenced-by-count":151,"title":["Complex Factors in the Etiology of Gulf War Illness: Wartime Exposures and Risk Factors in Veteran Subgroups"],"prefix":"10.1021","volume":"120","author":[{"given":"Lea","family":"Steele","sequence":"first","affiliation":[{"name":"Institute of Biomedical Studies, Baylor University, Waco, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Sastre","sequence":"additional","affiliation":[{"name":"Midwest Research Institute, Kansas City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary M.","family":"Gerkovich","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Health Informatics, University of Missouri\u2013Kansas City School of Medicine, Kansas City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary R.","family":"Cook","sequence":"additional","affiliation":[{"name":"Midwest Research Institute, Kansas City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2011,9,19]]},"reference":[{"key":"2026080610062222000_micit1","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.pbb.2003.10.018","article-title":"Co-exposure to pyridostigmine bromide, DEET, and\/or permethrin causes sensorimotor deficit and alterations in brain acetylcholinesterase activity.","volume":"77","author":"Abou-Donia","year":"2004","journal-title":"Pharmacol Biochem Behav"},{"key":"2026080610062222000_micit2","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1093\/epirev\/mxf003","article-title":"Prevalence of symptoms and symptom-based conditions among Gulf War veterans: current status of research findings.","volume":"24","author":"Barrett","year":"2002","journal-title":"Epidemiol Rev"},{"key":"2026080610062222000_micit3","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1006\/taap.2002.9412","article-title":"Pyridostigmine bromide modulates the dermal disposition of [14C] permethrin.","volume":"181","author":"Baynes","year":"2002","journal-title":"Toxicol Appl Pharmacol"},{"key":"2026080610062222000_micit4","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.neuro.2010.05.006","article-title":"Effects of low-level exposure to sarin and cyclosarin during the 1991 Gulf War on brain function and brain structure in US veterans.","volume":"31","author":"Chao","year":"2010","journal-title":"Neurotoxicology"},{"key":"2026080610062222000_micit5","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1136\/oem.58.5.299","article-title":"Health and exposures of United Kingdom Gulf War veterans. Part II: the relation of health to exposure.","volume":"58","author":"Cherry","year":"2001","journal-title":"Occup Environ Med"},{"key":"2026080610062222000_micit6","unstructured":"DOD (U.S. Department of Defense)\n          . 2000. Information Paper: Vaccine Use During the Gulf War. Washington, DC:Office of the Special Assistant for Gulf War Illnesses.Available: http:\/\/www.gulflink.osd.mil\/va\/ [accessed 1 September 2011]."},{"key":"2026080610062222000_micit7","unstructured":"DOD (U.S. Department of Defense)\n          . 2002. Case Narrative: U.S. Demolition Operations at Khamasiyah, Final Report. Washington, DC:Office of the Special Assistant to the Undersecretary of Defense for Gulf War Illnesses, Medical Readiness, and Military Deployments.Available: http:\/\/www.gulflink.osd.mil\/khamisiyah_iii\/ [accessed 1 September 2011]."},{"key":"2026080610062222000_micit8","unstructured":"DOD (U.S. Department of Defense)\n          . 2003. Environmental Exposure Report: Pesticides, Final Report. Washington, DC:Office of the Special Assistant to the Undersecretary of Defense for Gulf War Illnesses, Medical Readiness, and Military Deployments.Available: http:\/\/www.gulflink.osd.mil\/pest_final\/index.html [accessed 1 September 2011]."},{"key":"2026080610062222000_micit9","article-title":"Pesticide Use During the Gulf War: A Survey of Gulf War Veterans","author":"Fricker RD, Reardon E, Spektor DM, Cotton SK, Hawes-Dawson J, Pace JE, et al","year":"2000"},{"key":"2026080610062222000_micit10","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1001\/jama.280.11.981","article-title":"Chronic multisymptom illness affecting Air Force veterans of the Gulf War.","volume":"280","author":"Fukuda","year":"1998","journal-title":"JAMA"},{"key":"2026080610062222000_micit11","author":"Goss Gilroy Inc","year":"1998"},{"key":"2026080610062222000_micit12","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1001\/jama.1997.03540270057027","article-title":"Self-reported exposure to neurotoxic chemical combinations in the Gulf War. A cross-sectional epidemiologic study.","volume":"277","author":"Haley","year":"1997","journal-title":"JAMA"},{"key":"2026080610062222000_micit13","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.neuro.2007.03.006","article-title":"Quantitative magnetic resonance brain imaging in U.S. Army veterans of the 1991 Gulf War potentially exposed to sarin and cyclosarin.","volume":"28","author":"Heaton","year":"2007","journal-title":"Neurotoxicology"},{"key":"2026080610062222000_micit14","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1093\/ije\/dyi102","article-title":"Can epidemiology clear the fog of war? Lessons from the 1990\u201391 Gulf War.","volume":"34","author":"Hotopf","year":"2005","journal-title":"Int J Epidemiol"},{"key":"2026080610062222000_micit15","article-title":"Gulf War and Health: Volume 8\u2014Health Effects of Serving in the Gulf War","author":"Institute of Medicine","year":"2010"},{"key":"2026080610062222000_micit16","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1001\/jama.1997.03540270064028","article-title":"Self-reported illness and health status among Gulf War veterans. A population-based study.","volume":"277","author":"Iowa Persian Gulf Study Group","year":"1997","journal-title":"JAMA"},{"key":"2026080610062222000_micit17","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1136\/bmj.325.7364.576","article-title":"The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study.","volume":"325","author":"Ismail","year":"2002","journal-title":"BMJ"},{"key":"2026080610062222000_micit18","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1097\/JOM.0b013e3181a2feeb","article-title":"Health of US veterans of 1991 Gulf War: a follow-up survey in 10 years.","volume":"51","author":"Kang","year":"2009","journal-title":"J Occup Environ Med"},{"key":"2026080610062222000_micit19","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/00043764-200005000-00006","article-title":"Illnesses among United States veterans of the Gulf War: a population-based survey of 30,000 veterans.","volume":"42","author":"Kang","year":"2000","journal-title":"J Occup Environ Med"},{"key":"2026080610062222000_micit20","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/00005053-200005000-00002","article-title":"Deployment stressors and a chronic multisymptom illness among Gulf War veterans.","volume":"188","author":"Nisenbaum","year":"2000","journal-title":"J Nerv Ment Dis"},{"key":"2026080610062222000_micit21","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1289\/ehp.9251","article-title":"Persistence of symptoms in veterans of the first Gulf War: 5-year follow-up.","volume":"114","author":"Ozakinci","year":"2006","journal-title":"Environ Health Perspect"},{"key":"2026080610062222000_micit22","article-title":"Gulf War Illness and the Health of Gulf War Veterans","author":"RAC-GWVI (Research Advisory Committee on Gulf War Veterans\u2019 Illnesses)","year":"2008"},{"key":"2026080610062222000_micit23","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1093\/aje\/152.10.992","article-title":"Prevalence and patterns of Gulf War illness in Kansas veterans: association of symptoms with characteristics of person, place, and time of military service.","volume":"152","author":"Steele","year":"2000","journal-title":"Am J Epidemiol"},{"key":"2026080610062222000_micit24","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/S0140-6736(98)11338-7","article-title":"Health of UK servicemen who served in Persian Gulf War.","volume":"353","author":"Unwin","year":"1999","journal-title":"Lancet"},{"key":"2026080610062222000_micit25","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/00043764-200203000-00015","article-title":"Risk factors for multisymptom illness in US Army veterans of the Gulf War.","volume":"44","author":"Wolfe","year":"2002","journal-title":"J Occup Environ Med"}],"container-title":["Environmental Health Perspectives"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-pdf\/120\/1\/112\/66445232\/ehp.1003399.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-pdf\/120\/1\/112\/66445232\/ehp.1003399.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:49:48Z","timestamp":1786628988000},"score":1,"resource":{"primary":{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-lookup\/doi\/10.1289\/ehp.1003399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,9,19]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2011,9,19]]},"published-print":{"date-parts":[[2012,1,1]]}},"URL":"https:\/\/doi.org\/10.1289\/ehp.1003399","relation":{},"ISSN":["0091-6765","1552-9924"],"issn-type":[{"value":"0091-6765","type":"print"},{"value":"1552-9924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,9,19]]}}}