“It Should All Be Out There”: Communicating with Veterans About Airborne Hazard Exposures

Veterans’ Perspectives highlights research conducted by HSR and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the July - August 2026 Issue:

• Introduction: Approximately 45% of the more than 6 million Veterans screened by VA report concerns about toxic exposures, particularly airborne hazards like burn pits, oil well fires, and dust. While VA has developed tools and training to help providers treat and communicate about airborne hazard exposures, Veteran-facing materials about these exposures often do not address Veterans’ specific concerns.
• The Research: VA researchers conducted five focus groups with Veterans who had airborne hazard exposure concerns to understand how VA should communicate about these exposures, especially when scientific evidence is still emerging. The study explored Veterans’ information needs, communication preferences, and trusted sources of health information.
• Findings: Veterans want personalized, transparent communication that acknowledges their exposure concerns without dismissing them. They also want providers to treat them as individuals: to ask about their unique military experiences and geographic contexts, not just check boxes. Veterans understand that research is ongoing and want both honest information about what is and isn’t known, as well as concrete next steps for health management.
• Implications for Program Improvement: To reach all Veterans with airborne hazard concerns, VA must move toward a Veteran-centered approach involving diverse communication strategies, from websites and patient portals to direct mail, social media, and community outreach. Communication of airborne hazard risks must validate Veterans’ experiences with service-related health concerns while providing actionable information about symptoms to watch for, available treatments, and research opportunities.

Introduction

For decades, millions of U.S. service members were exposed to a variety of airborne hazards while deployed to the Middle East, Southwest Asia, and other global theaters. These included emissions from open-air burn pits—where everything from plastics and medical waste to jet fuel was incinerated—as well as desert sand and dust, industrial pollutants, particulate matter, and oil well fire smoke. While the immediate respiratory effects of these exposures, such as cough and shortness of breath, were often documented, the long-term trajectory of these exposures remains a subject of intense scientific study and, for many Veterans, deep anxiety.

Communicating with Veterans about how these exposures may impact their health is both important and challenging. There is typically no individual data to quantify the type or scope of environmental exposures, and even when data exist, it is often difficult to determine if an environmental exposure has contributed, or will contribute, to disease or disability. This uncertainty can leave both Veterans and healthcare providers unsure about the relationship between a Veteran’s health condition and their exposure history.

While VA has developed extensive tools to help healthcare professionals navigate the treatment of airborne hazard-related conditions, materials that communicate directly to Veterans about their concerns have been lacking. To guide the development of Veteran-facing communication tools, VA researchers sought to understand what information Veterans with airborne hazard concerns need, and how they want to receive this information.

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The Research

Between May and June 2024, a team led by researchers from VA’s Center for Health Optimization and Implementation Research (CHOIR) and War-Related Illness and Injury Study Center (WRIISC) conducted five focus groups with 13 Veterans who had reported airborne hazard exposure concerns in the Veterans Signals (VSignals) digital survey, which collects Veteran feedback on VA healthcare and benefits.

These Veterans were geographically and demographically diverse, and represented a cross-section of the Veteran community, including men and women from the Gulf War era and the post-9/11 conflicts.

The virtual focus groups explored four main topics:

1. What information Veterans need about airborne hazards;
2. How VA should communicate when scientific evidence is unclear;
3. Where and how Veterans prefer to receive this information; and
4. Where to find trusted health information.

The discussions generated many insights into how Veterans think about their exposures and what would help them navigate their concerns. Researchers used a "rapid qualitative analysis" framework to ensure the findings could be translated into communication tools quickly.

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Findings

Researchers identified three key findings important to communicating with Veterans about their airborne hazard exposure concerns:

1. Veterans want personalized, transparent, and comprehensive communication.

Researchers asked, “What information would be helpful, in this situation where doctors don’t always have immediate answers?” Veterans wanted information that was honest, transparent, and thorough. One participant responded, “It should all be out there.”

Veterans said they wanted information about how exposures might manifest in their own bodies, and about how they might be affected as individuals.

“I would be concerned with what kind of signs should I be looking for in my body. I’m not going to be paranoid, but let me know what kind of things people are experiencing so I can be paying a little more attention to it.”

While Veterans understood that research on airborne hazards is ongoing and that VA doesn’t yet have all the answers, they wanted to be informed about what research VA is conducting:

“Just put out, ‘This is what we’re researching,’ not necessarily results if there’s not accurate data. But just to say, ‘This is what we’re doing, what we’re researching.’”

They also wanted to know about studies they could participate in, when appropriate, so they could contribute to advancing knowledge about airborne hazard exposures.

One of the most significant, and consistent, insights shared by Veterans was that they think about their health in the context of their lives and histories. While providers and systems may focus on specific hazards or conditions, Veterans are making broader connections. Participants consistently expressed a desire to receive information that wasn’t from a stale pamphlet, brochure, or checklist; they wanted to hear from people who acknowledged their individual experiences, military service, and concerns:

“The most important thing is that... you’re not getting read right from a book...I want somebody to personalize a response to me where they sit here and they take me as a person...”

One Veteran said, “I only got asked if I was exposed to burn pits—that’s it.” Another suggested that providers specifically ask: “What locations, what cities were you in? What did you handle?”

One Veteran in her 50s recalled her provider attributing her health complaints to her age rather than to her exposure history. As another (male) Veteran pointed out, military culture often discourages the sharing of health concerns, and minimizing these concerns can be especially counterproductive:

“Veterans are a very proud people, and we don’t want to be labeled... I didn’t like for people to know my business... I’m learning how to be open about my illness, about my condition. Beforehand, I was ashamed, and I didn’t want anybody to know that I would battle through those things, especially as a male.”

2. Veterans want to be able to act on information with tangible next steps.

Without knowing a clear path forward, participants viewed just-the-facts communication as counterproductive or even anxiety-inducing. Veterans wanted to know what to do with those facts. They wanted to understand the clinical pathway—exactly what a toxic exposure means for their future care, what tests follow a positive screening, and who the specialist will be. They also wanted tangible and actionable “to-do” lists with guidance on monitoring their own symptoms, lifestyle changes that could mitigate risk, and advocating for themselves during primary care visits:

“I registered in the registry. I had the testing done. Now what? Am I just supposed to sit around and wait for symptoms to manifest?”

For many participants, the challenges and complexities of navigating healthcare and benefits systems made them want an advocate or support person to help guide them through these steps:

“I’d like to get a professional involved and have them help direct me as to where they think I should go.”

Veterans also described wanting their healthcare to address their whole health and counterbalance the effects of their military exposures, rather than attempt to address symptoms in isolation:

“Normally, you get a doctor at the VA and they tell you, OK, you have to take… anxiety pills. You have to take all these medications. Painkiller for aches and pains. But they have really come a long way and now they have holistic approaches with meditation, yoga. There are several other things. Acupuncture, which they didn’t have originally and chiropractic treatment.

3. Varied, multimodal communication strategies are needed to reach the range of Veterans with concerns about airborne hazard exposures.

When asked where they get health information, Veterans described using a wide range of sources: VA websites, listservs and digital tools like VA’s patient portal, as well as non-VA sources like PubMed, the Mayo Clinic, and WebMD. Participants noted that VA communications typically reach limited audiences—and aren’t always easy to navigate:

“I can’t remember ever seeing an advertisement for the VA, to be honest with you.”

“I get frustrated, because [the website is] not very intuitive. So, if you don’t make it, if it’s more than 3 clicks, people don’t want to have to go digging too far.” 

Veterans in the focus groups suggested multiple strategies to reach Veterans with airborne exposure concerns: VA websites, patient portals, direct mail, email, social media, local VA offices, Veterans Service Organizations like the VFW and the American Legion, community spaces like churches and town halls, and places with higher concentrations of Veterans like shooting ranges and military retail establishments.

Participants also emphasized that different age groups preferred different communication methods, and that at least one Veteran Service Organization had integrated this into their communication strategies:

“You’ve gotta do social media campaigns, television advertisements, radio. [You] can’t expect people to come to you. You’ve gotta find them and let them know what’s going on…”

“I don’t know if you guys have seen them yet, but the American Legion has been doing Facebook ads and they have completely rebranded themselves. They’re really focusing towards the youth. They’re doing like skits and what not.”

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Implications

These three critical components affirm the importance of patient-centered communication that validates Veterans’ experiences and concerns while providing accurate evidence-based information. Many Veterans have felt betrayed by past government responses to exposures, from Agent Orange to Gulf War Illness, and they understand their exposures through the lens of their military service and life experiences—not just as isolated clinical events. Honest, respectful communication that acknowledges this history while moving forward with transparency—and offering a rigorous plan for monitoring and follow-up—can help rebuild trust.

The insights shared by Veterans in this study informed the co-design of the Deployment Related Respiratory Disease Toolkit, which was created with Veteran consultants and VA clinicians. Providers should use this resource as a starting point for a personalized dialogue, rather than as a script to be followed.

For policy makers and other VA leadership, this study highlights the need for investment in diverse communication methods and styles. This may include developing high-quality video content, enhancing the toxic exposure portals on the VA website (the Environmental Health Registry Evaluation, the Airborne Hazards and Open Burn Pit Registry, VET-HOME, and others), and using peer health navigators with specialized training in environmental exposure concerns.

The research team also used these Veteran focus group insights to develop a series of Veteran-facing materials including a poster, burn pit communication booklet, and interactive digital tools. It was recently awarded a VA funded grant to develop and then test a bundle of VA services to better meet the needs of Veterans with concerns about their airborne hazard exposures.

Gemmae Fix, PhD, is an Investigator and Acting Associate Director of VA’s Center for Health Optimization and Implementation Research (CHOIR) at the VA Bedford Healthcare System.

Study Publication

Fix GM, Jordan JA, McDannold S, et al. Ask the experts: Veterans' perspectives on communicating about airborne hazard exposures. Medical Care. December 12, 2025;64(2):S124–S129.

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The views expressed in this publication are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.