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Exposure Opportunity Models for Agent Orange, Dioxin, and Other Military Herbicides Used in Vietnam, 1961–1971

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Exposure Opportunity Models for Agent Orange, Dioxin, and Other Military Herbicides Used in Vietnam, 1961–1971 Journal of Exposure Analysis and Environmental Epidemiology (2004) 14, 354–362 r 2004 Nature Publishing Group All rights reserved 1053-4245/04/$30.00 www.nature.com/jea Exposure opportunity models for Agent Orange, dioxin, and other military herbicides used in Vietnam, 1961–1971 STEVEN D. STELLMANa,b AND JEANNE M. STELLMANc aDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA bInstitute for Cancer Prevention, Valhalla, NY10595, USA cDepartment of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY 10032, USA Nearly 19.5 million gallons of herbicides were sprayed on the Republic of Vietnam between 1961 and 1971 for military purposes. Amounts of spray and patterns of applications are available in an electronic file called HERBS that contains records of 9141 defoliation missions, including detailed coordinates of US Air Force Ranch Hand aircraft flight paths, along with chemical agent and gallonage sprayed. Two classes of models for use in epidemiological and environmental studies that utilize the HERBS data for estimating relative exposure opportunity indices are presented: a discrete ‘‘hits’’ model that counts instances of proximity in time and space to known herbicide applications, and a continuous exposure opportunity index, E4, that takes into account type and amount of herbicide sprayed, distance from spray application, and time interval when exposure may have occurred. Both direct spraying and indirect exposure to herbicide (or dioxin) that may have remained in the local environment are considered, using a conservative first-order model for environmental disappearance. A correction factor for dermal versus respiratory routes of entry has been incorporated. E4 has a log-normal distribution that spans six orders of magnitude, thus providing a substantial amount of discrimination between sprayed and unsprayed areas. The models improve on earlier ones by making full use of the geometry of the HERBS spray flight paths of Ranch Hand aircraft. To the extent possible so many decades after the War, the models have been qualitatively validated by comparison with recent dioxin soil and biota samples from heavily contaminated areas of Vietnam, and quantitatively validated against adipose dioxin obtained in epidemiological studies of Vietnamese. These models are incorporated within a geographic information system (GIS) that may be used, as one would expect, to identify locations such as hamlets, villages, and military installations sprayed by herbicide. In a novel application, the GIS also facilitates quantitative risk assessment in epidemiological and ecological studies by applying the models within a framework of historical reconstruction of exposure history of individuals based upon their location histories. Journal of Exposure Analysis and Environmental Epidemiology (2004) 14, 354–362. doi:10.1038/sj.jea.7500331 Keywords: Agent Orange, dioxin, exposure modeling, herbicides, Vietnam. Introduction 0 and 100 p.p.m., and sprayed at concentrations far higher than those used for domestic agricultural defoliation Between 1961 and 1971, nearly 19.5 million gallons of purposes. (Stellman et al., 2003a). Little is known of the herbicides were used by the United States Armed Forces for long-term health or ecological consequences related to this tactical defoliation and crop destruction in Southeast Asia. massive, concentrated use of herbicides in the former The three mixtures most commonly used were Agent Orange Republic of Vietnam (RVN). (National Research Council, (esters of 2,4-dichlorophenoxyacetic acid and 2,4,5-trichlor- 1974; Institute of Medicine, 1994, 1996, 1998, 2001). ophenoxyacetic acid), Agent White (triisopropanolamine Persistently high levels of dioxins in Vietnam soil and biota, salts of 2,4-D and picloram), and an arsenical called Agent as well as in samples of Vietnamese serum, adipose tissue, Blue (cacodylic acid). (The colors refer to an identification and breast milk have been reported and so-called ‘‘hot spots’’ stripe painted on the storage drums.) The 2,4,5-T-containing identified (Dwernychuk et al., 2002). The military use of herbicides (at least 12.6 million gallons of the total) were herbicides in Vietnam thus represents one of the most contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin, concentrated environmental exposures to dioxin-contami- which we will refer to as dioxin, at levels estimated between nated herbicides for which few systematic investigations of health and ecological effects have been carried out. In 1994, the Institute of Medicine recommended that a 1. Address correspondence to: Dr. Steven D. Stellman, Department of methodology be developed for characterizing exposure to Epidemiology, Mailman School of Public Health, Columbia University, herbicides by historical reconstruction of military records 722 West 168th Street, NewYork, NY 10032, USA. (Institute of Medicine, 1997), recognizing that environmental Tel.: þ 1-212-305-4911. Fax: þ 1-212-305-9413. E-mail: [email protected]. sampling for estimating past exposures is of limited utility Received 10 January 2003; accepted 28 October 2003 because environmental transport mechanisms will have long Agent Orange exposure opportunity modeling Stellman et al. since reduced many, if not most, initially elevated levels to Methods background. The Department of Veterans Affairs contracted with the National Academy of Sciences (NAS) to do so. All exposure estimates produced by our EOI models are The present study, carried out under a subcontract to based on herbicide applications documented in the so-called the NAS for that effort, has led to the development HERBS file. This data file, originally created by the of a geographical information system (GIS) for use in Department of Defense, provides the flight paths taken by studies of Vietnam (Stellman et al., 2003b). More than Ranch Hand aircraft as they carried out their spray missions. simply a system for aggregating geocoded data, our GIS is a (Data Management Agency, 1970; US Army and Joint research tool that permits investigators to evaluate herbicide Services, 1985). The HERBS file uses alphanumeric indica- exposure for an individual, military unit, or fixed location in tors to mark turning points and activation/deactivation of Vietnam (such as a village). It does so through linkage of an spray apparatus. The date, number of gallons, and herbicide extensive herbicide application database to tables that agent used for each mission, the type of aircraft or other contain location histories of individuals or military units, equipment use, as well as other details of the mission, are also and, most importantly, to exposure estimates that are based included in the mission record. We have carried out extensive on models developed by the authors and presented here. The quality control on existing spray data and expanded the file GIS itself is not dependent on any particular model, and by analysis of additional primary sources (Stellman et al., alternative models to those described belowcould be 2003a). The file nowcontains data on 9141 missions, incorporated by a user willing to calculate the relevant primarily carried out by C-123 fixed-wing aircraft, but also exposure tables. by helicopter, truck, and in some cases backpacks worn by Exposure assessment is based on calculation of exposure soldier-sprayers. scores called exposure opportunity indexes (EOIs). EOI Since an EOI score is a measure of proximity in time and models that represent exposure as a function of proximity in space to herbicide spraying missions, it must always be time and space to a toxic agent are becoming increasingly referred to a specific location and a specific time interval common in epidemiological studies (Smith, 2002). An EOI is during which exposure may occur. The GIS provides a often used, for example, in occupational or environmental computational framework for the distance- and time- studies as a surrogate estimator of historical exposure where dependent calculations specified by our model. Two central current environmental or biomarker measurements are not features of the GIS are (1) geographical partitioning of good estimators of past exposures, and where measurements Vietnam into a grid system spaced at 0.011 intervals in were never made in the past or are unavailable (Schaeffner latitude and longitude, defining the southwest corner of cells 2 et al., 2001). The EOI concept is complementary to with average area E1.2 km , and (2) association of each cell traditional exposure methodologies based upon toxicological defined by this grid with several measures of proximity to models and measures. Exposure opportunity is not a every herbicide mission, which occurred inside or near it. We toxicological measure, but EOI scores can be incorporated use the centroid of each GIS cell as the reference location into toxicological models as ‘‘presentation’’ dosages. They when calculating the EOI for all locations within it, and the are meant to be used in large-scale studies in which a location residence period within the cell as the time interval during history is the principal source of information about an which exposure may have occurred at that location. individual or group such as a military unit. They are Our models provide two types of estimates of exposure especially applicable to studies in which body burden opportunity: measurements are impractical or unlikely to reflect exposures in the distant past. direct exposure that results from being within
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