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Seattle Epidemiologic Research and Information Center (ERIC)

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CSP 595 Study

Welcome to the Service and Health Among Deployed Veterans (SHADE) Website

The study is sponsored by the VA Office of Research and Development (ORD) Cooperative Studies Program (CSP) and Military Exposures Research Program (MERP).

The primary objective of the study is to characterize the impact of deployment to Central Asia (Afghanistan and Kyrgyzstan), Southwest Asia (Iraq, Kuwait, Qatar, and United Arab Emirates) and Africa (Djibouti) on the respiratory health of Veterans. The study is intended to complement and expand current epidemiologic resources to better understand the long-term influences of military service, deployment, and environmental exposures on the health status of Veterans. The study supports the CSP mission to advance the health and care of Veterans through cooperative research studies that produce innovative and effective solutions to Veteran and national healthcare problems.

Recruitment

The study is selecting its participants from a population, or group of people, decided on by the researchers in advance. The study is not open to everyone who meets the eligibility criteria. Only those Veterans who are selected at random from those who were deployed will be invited to participate.

The study population is identified from the U.S. Department of Defense master personnel roster of all military personnel who deployed after October 1, 2001 in support of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), Operation New Dawn (OND), and other military operations during the Post-9/11 Gulf War Era and have separated from active military service. Veterans who served in the U.S. Army, Marine Corps, or Air Force are eligible to participate without regard to current or past user status in the Veterans Health Administration. From among those Veterans who meet study eligibility, a random sample of Veterans living in the catchment area of the participating VA medical centers are selected for recruitment into the study. Again, not everyone who is eligible to participate will be asked to participate. 

The study has 6 sites:

Additional resource: SHADE study details from ClinicalTrials.gov

Status

3,266 participants have enrolled in SHADE as of January 31, 2025. 

Publications

Thanks to the Veterans who have participated in the SHADE study, researchers are making important discoveries. These are scientific publications using study data.

  • Henkle BE, Gravely A, Redlich CA, et al. Blast exposure and associations with respiratory symptoms among deployed military Veterans to Southwest Asia and Afghanistan (abstract). Am Thorac Soc. 2025.

  • Mohazzab-Hosseinian S, Redlich CA, Timmons A, et al. Civilian occupational exposures and current respiratory symptoms in Veterans previously deployed to Southwest Asia and Afghanistan (abstract). Am Thorac Soc. 2025.

  • Maccarone J, Redlich CA, Timmons A, et al. Sinusitis and rhinitis among US Veterans deployed to Southwest Asia and Afghanistan after September 11, 2001. J Allergy Clin Immunol Glob. 2024;4(1):100367. doi: 10.1016/j.jacig.2024.100367

  • Maccarone JR, Sterns OR, Timmons A, et al. Deployment-related cigarette smoking behaviors and pulmonary function among U.S. Veterans. Mil Med. 2024;189(9-10):2030-2038. doi: 10.1093/milmed/usae049

  • Hosseini R, Blanc PD, Garshick E, et al. Characterization of non-deployment-related military occupational and environmental inhalational exposures and their association with chronic respiratory health outcomes among US Veterans (abstract). Am J Respir Crit Care Med. 2024;209:A2881. doi: 10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A2881

  • Maccarone J, Blanc PD, Timmons A, et al. Associations between rhinitis and lower respiratory tract symptoms following deployment-related occupational and environmental exposures among US Veterans (abstract). Am J Respir Crit Care Med. 2024;209:A3099. doi: 10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A3099

  • Garshick E, Redlich CA, Korpak A, et al. Chronic respiratory symptoms following deployment-related occupational and environmental exposures among US Veterans. Occup Environ Med. 2024;81(2):59-65. doi: 10.1136/oemed-2023-109146

  • Garshick E, Blanc PD. Military deployment-related respiratory problems: an update. Curr Opin Pulm Med. 2023;29(2):83-89. doi: 10.1097/MCP.0000000000000946

  • Falvo MJ, Sotolongo AM, Osterholzer JJ, et al. Consensus statements on deployment-related respiratory disease, inclusive of constrictive bronchiolitis: A modified Delphi study. Chest. 2023;163(3):599-609. doi: 10.1016/j.chest.2022.10.031

Study data is deposited into a subject registry and data repository for future research about the health of Veterans who served during the Post-9/11 Gulf War Era. These are scientific publications from our secondary studies.

  • Anderson E, Johnston D, Kheradmand F, et al. Association between diffusing capacity and small airway abnormalities and symptoms in deployed US military Veterans (abstract). Am Coll Occup Environ Med. 2025.

  • Leopardi C, Kheradmand F, Wendt C, et al. Asthma and small airway dysfunction in post-deployment Veterans (abstract). Am Coll Occup Environ Med. 2025.

  • Alexander T, Ndirangu D, Toczylowski R, et al. Evaluation of a structured deployment exposure questionnaire designed for epidemiological study in a Veteran cohort undergoing clinical evaluation (abstract). Am Thorac Soc. 2025.

  • Fan VS, Kheradmand F, Wendt CH, et al. Associations between the lung clearance index with pulmonary function and symptoms in post-deployment US Veterans (abstract). Am Thorac Soc. 2025.

  • Fan VS, Kheradmand F, Wendt CH, et al. Quantitative chest CT-defined structure and diffusion capacity in post-deployment US Veterans (abstract). Am Thorac Soc. 2025.

  • Marrufo A, Stewart M, Wendt CH, et al. Assessment of deployment-related particulate matter 2.5 exposure in immune and pulmonary dysfunction in Veterans (abstract). Am Thorac Soc. 2025.

  • Schmit H, Garshick E, Fan VS, et al. Modifying eligibility criteria: A protocol shift to promote inclusion for female participants in pulmonary research (abstract). Am Thorac Soc. 2025.

  • Gurijala N, Garshick E, Johnston D, et al. Associations between peripheral white blood cells and pulmonary function in US Veterans following deployment exposures (abstract). Ann Allergy Asthma Immunol. 2024;133(6):S55-S56. doi: 10.1016/j.anai.2024.08.190

  • Garshick E, Fan VS, Kheradmand F, et al. Quantitative chest CT-defined structure and pulmonary function among US Veterans deployed to Afghanistan and Iraq (abstract). Am J Respir Crit Care Med. 2024;209:A6780. doi: 10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A6780

  • Fan VS, Kheradmand F, Wendt CH, et al. Association between chronic respiratory symptoms and pulmonary function following deployment to Afghanistan and Iraq among United States Veterans (abstract). Am J Respir Crit Care Med. 2024;209:A3871. doi: 10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A3871

Veterans who deployed during the Post-9/11 Gulf War Era may have been exposed to high levels of particulate air pollution from numerous sources, including desert dust and sand and industrial and military combustion sources. These are scientific publications from our collaborators at the Harvard T.H. Chan School of Public Health who are quantifying deployment-related pollution exposures.

  • LaPiere TR, Bolduc TD, Yin X, et al. Identification of combustion sources during deployment to Iraq and Afghanistan using historical imagery (abstract). Am J Respir Crit Care Med. 2024;209:A3093. doi: 10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A3093

  • Li J, Kang CM, Wolfson JM, et al. Estimation of fine particulate matter in an arid area from visibility based on machine learning. J Expo Sci Environ Epidemiol. 2022;32(6):926-931. doi: 10.1038/s41370-022-00480-3

  • Wang M, Franklin M, Li L. Generating fine-scale aerosol data through downscaling with an artificial neural network enhanced with transfer learning. Atmosphere. 2022;13(2):255. doi: 10.3390/atmos13020255

  • Alahmad B, Al-Hemoud A, Kang CM, et al. A two-year assessment of particulate air pollution and sources in Kuwait. Environ Pollut. 2021;282:117016. doi: 10.1016/j.envpol.2021.117016

  • Li J, Garshick E, Hart JE, et al. Estimation of ambient PM2.5 in Iraq and Kuwait from 2001 to 2018 using machine learning and remote sensing. Environ Int. 2021;151:106445. doi: 10.1016/j.envint.2021.106445

  • Li J, Garshick E, Huang S, Koutrakis P. Impacts of El Niño-Southern Oscillation on surface dust levels across the world during 1982-2019. Sci Total Environ. 2021;769:144566. doi: 10.1016/j.scitotenv.2020.144566

  • Li J, Garshick E, Al-Hemoud A, Huang S, Koutrakis P. Impacts of meteorology and vegetation on surface dust concentrations in Middle Eastern countries. Sci Total Environ. 2020;712:136597. doi: 10.1016/j.scitotenv.2020.136597

  • Achilleos S, Al-Ozairi E, Alahmad B, et al. Acute effects of air pollution on mortality: A 17-year analysis in Kuwait. Environ Int. 2019;126:476-483. doi: 10.1016/j.envint.2019.01.072

  • Chudnovsky AA, Koutrakis P, Kostinski A, Proctor SP, Garshick E. Spatial and temporal variability in desert dust and anthropogenic pollution in Iraq, 1997-2010. J Air Waste Manag Assoc. 2017;67(1):17-26. doi: 10.1080/10962247.2016.1153528

  • Masri S, Garshick E, Hart J, Bouhamra W, Koutrakis P. Use of visual range measurements to predict fine particulate matter exposures in Southwest Asia and Afghanistan. J Air Waste Manag Assoc. 2017;67(1):75-85. doi: 10.1080/10962247.2016.1243169

  • Masri S, Garshick E, Coull BA, Koutrakis P. A novel calibration approach using satellite and visibility observations to estimate fine particulate matter exposures in Southwest Asia and Afghanistan. J Air Waste Manag Assoc. 2017;67(1):86-95. doi: 10.1080/10962247.2016.1230079
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