The Impact of Toxicant Exposure on Camp Lejeune Veteran Trust

October 13, 2026
By Bianca Dinkha

New research exploring trust in the Veterans Health Administration (VHA) among Camp Lejeune (CL) veterans exposed to military environmental toxins suggests that several factors shaping veterans’ trust, including their VHA healthcare experiences, are potentially modifiable and may be acted upon to increase trust.

The study, conducted by Salva Balbale, PhD, associate professor of medicine, and Master of Public Health alumni Stephanie Hayes, ’25 MPH, further highlights potential strategies to address these factors by actively engaging veterans and leveraging peer-level veteran camaraderie.

The big picture

Over 1 million veterans and civilians were exposed to contaminated water at Camp Lejeune from 1953 - 1987. Harms from environmental toxicant exposures can last far longer than the exposure itself and reduce trust in institutions, including relevant healthcare systems and government agencies.

Addressing military toxin exposures and fostering trust are top priorities for the VHA. However, there is limited understanding of veterans’ trust in the VHA following the events at CL. Because trust directly affects whether veterans seek and stay engaged with healthcare, understanding what has helped or hurt trust in this population offers new avenues to support them.

How the study was done

In this qualitative study, researchers conducted 22 semi-structured interviews to capture the perceptions and experiences of veterans who served at CL during the contamination period. During analysis, researchers mapped emerging themes onto the Health Systems Trust Content Area (HSTCA) Framework to organize their findings by core domains, such as honesty, communication, and competence.

The finer details

In this group of CL veterans, trust in the VHA was shaped by complex and potentially modifiable factors:

• Reasons for trust included veterans’ positive experiences with VHA healthcare;
• Reasons for lack of trust included poor experiences with healthcare, lack of transparency, and complicated claims processes;
• Additionally, veterans’ trust in the VHA was complicated by external factors, including delays by the United States Marine Corps and federal government in acknowledging the contamination and addressing its effects on Veteran health.

What’s next?

With continued collaboration with CL veterans, future directions include developing feasible, standardized methods to measure and rebuild trust among CL veterans.

Thoughts from the author

“Engaging Veterans with lived experiences from Camp Lejeune is essential to understanding factors that shape trust and potential opportunities to improve it,” Hayes said. “We see this as a foundational effort that begins to fill a known gap in scientific knowledge and may inform VHA’s ongoing initiatives to serve Veterans with military environmental exposures in a way that centers on Veterans.”