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Many veterans and their advocates are concerned that military service may cause impaired respiratory function resulting from occupational exposures to environmental hazards (e.g., Agent Orange in the Vietnam War, burn pits in the Global War on Terror) or infectious diseases (e.g., pneumonia). Such exposures occurring in service members' young adulthoods may not have immediately discernible effects on lung health; some symptoms may emerge in the immediate months or years after separation from the military, and diagnosable conditions may not manifest until decades later. Health care providers serving veteran populations must consider both the unique combat circumstances surrounding the time of veterans' service and the age-graded nature of health conditions that might result from military service.

To characterize lung health across a broad age range of veterans, the authors analyzed data from two nationally representative surveys of health and well-being that include samples of veterans and their civilian peers. With these data, the authors compared respiratory health outcomes observed for the veteran and civilian populations who were of prime age for military service during different periods of national conflict: the Korean War, the Vietnam War, Operation Desert Shield/Storm, and the Global War on Terror.

The authors estimated that differences in smoking behaviors — including differences prior to enlistment — account for at least half of the veteran–civilian disparities in respiratory outcomes. This suggests the need for military-based and post-transition smoking cessation efforts and further research into other factors that might contribute to these veteran and civilian disparities, such as environmental exposures during military service.

Key Findings

  • Veterans and civilians had similar respiratory health profiles during their 20s and 30s, and key symptoms were generally not present at these younger ages.
  • At older ages, veterans had worse respiratory health profiles than civilians did. For instance, veterans over the age of 60 had higher rates of chronic obstructive pulmonary disease, lung cancer, functional limitations caused by poor lung health, and activity limitations caused by poor lung health than did civilians over the age of 60.
  • Veterans who served during periods of peace had a similar prevalence of respiratory disease diagnoses and symptoms as veterans who served during wartime.
  • Cigarette smoking may be a major reason why veterans have poor respiratory health. Differences in adult smoking behaviors were estimated to account for 20 percent to 25 percent of the differences in respiratory health outcomes between veterans and civilians. Overall differences in smoking behaviors, both prior to age 19 and during adulthood, were estimated to account for at least half of veteran–civilian disparities in respiratory outcomes.

Research conducted by

Funding for this publication was made possible by a generous gift from Daniel J. Epstein through the Epstein Family Foundation. The research was conducted by the RAND Epstein Family Veterans Policy Research Institute within RAND Education and Labor.

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