To assess whether a specific agent impacts on human health, it is necessary to make a complex evaluation that includes exposure, association, and effect indexes. To investigate relationships occurring between military health and warfare theater environment, it is necessary to use an integrated approach based on both analytical and molecular epidemiology.

Environmental samplings can be used to provide information regarding the presence of hazardous substances, while it is ineffective to determine individual exposure and response. However, individual response to occupational hazards is extremely variable due to complex interplay among several factors, such as individual health, genetics, and time of exposure. Military personnel are exposed to environmental hazardous substances that can be very different from those for industry workers and for the general population ( Figure 1). Conclusions: This review indicates that only studies which analyzed epidemiological and molecular biomarkers in both exposed and control groups would provide evidence-based conclusions on exposure and disease risk in military personnel.

Another observation from this review is a major problem from the lack of suitable control groups. Biomarkers of exposures and effects are tools to explore relationships between exposures and diseases in military personnel. Assessment of environmental and individual exposures to pollutants is crucial, although often omitted, because soldiers have often been evaluated based on reported health problems rather than on excessive exposure to pollutants. Important factors to be considered are the lengths and intensities of exposures, its proximity to the sources of environmental pollutants, as well as confounding factors (cigarette smoke, diet, photo-type, healthy warrior effect, etc.). Results: The exposures include sulfur mustard, organ chlorines, combustion products, fuel vapors, and ionizing and exciting radiations. Methods: This review analyzed publications regarding epidemiological and biomonitoring studies on occupationally-exposed military personnel. Background: Military personnel are frequently exposed to environmental pollutants that can cause a variety of diseases.

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