VA Medical Center, War Related Illness & Injury Study Center (WRIISC) and VA Complex Exposure Threat Center (CETC), Washington, DC 20422 USA.
Uniformed Services University, Bethesda, MD 20814, USA.
Mil Med. 2024 Aug 19;189(Suppl 3):314-322. doi: 10.1093/milmed/usae114.
Military exposures may present a cumulative load and increased individual susceptibility to negative health outcomes. Currently, there are no comprehensive and validated environmental exposure assessment tools covering the full spectrum of occupational and environmental exposures for Veterans. The Veterans Affairs (VA) War Related Illness and Injury Study Center in Washington, DC, developed the Veteran Military Occupational and Environmental Exposure Assessment Tool (VMOAT) to establish a structured, comprehensive self-report tool that captures military and non-military occupational and environmental exposures. The VMOAT is clinically insightful, modular, and flexible for adding novel exposures, meeting the needs of modern evolving threats and exposures in both clinical and research settings. This manuscript reviews the ongoing development and validation plans for the VMOAT.
The VMOAT is a self-reported structured questionnaire, and VMOAT 1.0 was developed to cover an individual's 3 life phases (pre, during, post-military service); 5 exposure domains (chemical, physical, biological, injuries including ergonomic, and psychological stress exposures, plus military preventive health measures); and 64 specific exposures nested within exposure categories. VMOAT 1.0 addresses exposure dose (frequency, duration, proximity, route), and can be administered online via VA approved Qualtrics survey software. VMOAT 1.0 to 2.0 updates began in December 2022 with changes focused on readability, streamlining the exposure history, refining the exposure metrics, and improving the skip logic embedded within the survey design.
The initial VMOAT 1.0 development included face and construct validation with expert internal and external academic and military collaborators, undergoing an iterative 5-cycle review as well as sample testing among a small group of Veterans. The VMOAT 1.0 was used in Institutional Review Board (IRB)-approved longitudinal study, which has been examined preliminarily to compare the VMOAT 1.0 with other exposure assessments and to compare responses of Explosive Ordnance Disposal Veterans, a high occupational exposure cohort, to non-Explosive Ordnance Disposal Veterans. Ongoing VMOAT 2.0 updates will include integration of experiences from piloting the VMOAT 1.0 as well as additional face and content validation and survey cognitive testing with Veterans. VMOAT 2.0 data will improve the development of exposure-informed models using composite survey data to create scored- and scale-based exposure metrics for specific exposures and exposure domains. These data will highlight the effectiveness of the VMOAT as a structured comprehensive occupational and environmental exposure assessment instrument.
VMOAT development supports the 2022 Promise to Address Comprehensive Toxics Act and fits into the existing VA exposure assessment approach as a standardized, comprehensive self-reported exposure assessment tool. It can be utilized as a stand-alone instrument or supplemented by clinician interviews in research or specialty evaluation programs. The collected VMOAT self-report information on military occupational and environmental exposures will allow direct evaluation with objective measures of exposure and health outcomes. These data outcomes have a high potential to guide the DoD and VA environmental exposure risk mitigation and risk communication efforts.
军事暴露可能会对健康产生累积影响，并增加个人对负面健康结果的易感性。目前，还没有全面和经过验证的环境暴露评估工具可以涵盖退伍军人职业和环境暴露的全部范围。位于华盛顿特区的退伍军人事务部（VA）战争相关疾病和伤害研究中心开发了退伍军人军事职业和环境暴露评估工具（VMOAT），以建立一种结构化、全面的自我报告工具，用于捕获军事和非军事职业和环境暴露。VMOAT 具有临床洞察力、模块化和灵活性，可用于添加新的暴露，满足临床和研究环境中现代不断变化的威胁和暴露的需求。本文回顾了 VMOAT 的正在进行的开发和验证计划。
VMOAT 是一种自我报告的结构化问卷，VMOAT 1.0 旨在涵盖个人的 3 个生命阶段（兵役前、兵役期间和兵役后）；5 个暴露领域（化学、物理、生物、包括工效学在内的伤害和心理压力暴露，以及军事预防保健措施）；以及嵌套在暴露类别中的 64 种特定暴露。VMOAT 1.0 可以评估暴露剂量（频率、持续时间、接近度、途径），并可以通过 VA 批准的 Qualtrics 调查软件在线进行管理。VMOAT 1.0 到 2.0 的更新始于 2022 年 12 月，重点是提高可读性、简化暴露史、改进暴露指标，并改进调查设计中嵌入的跳转逻辑。
最初的 VMOAT 1.0 开发包括与内部和外部学术和军事专家进行的面部和结构验证，并经历了 5 个循环的迭代审查，以及一小部分退伍军人的样本测试。VMOAT 1.0 用于机构审查委员会（IRB）批准的纵向研究，该研究已初步进行了检查，以比较 VMOAT 1.0 与其他暴露评估的差异，并比较爆炸物处理专家（高职业暴露队列）与非爆炸物处理专家的反应。正在进行的 VMOAT 2.0 更新将包括整合 VMOAT 1.0 试点经验以及与退伍军人进行更多的面部和内容验证以及调查认知测试。VMOAT 2.0 数据将通过使用综合调查数据来创建特定暴露和暴露领域的评分和量表暴露指标，从而改进基于暴露的模型的开发。这些数据将突出 VMOAT 作为一种结构化全面职业和环境暴露评估工具的有效性。
VMOAT 的开发支持 2022 年《全面毒物法案承诺》，并符合 VA 现有的暴露评估方法，作为一种标准化、全面的自我报告暴露评估工具。它可以单独使用，也可以在研究或专业评估计划中通过临床医生访谈进行补充。收集的关于军事职业和环境暴露的 VMOAT 自我报告信息将允许直接评估与暴露和健康结果的客观测量。这些数据结果很有可能指导国防部和 VA 进行环境暴露风险缓解和风险沟通工作。
