Relations between health indicators and residential proximity to coal mining in West Virginia

Association of Environmental Injustice and Cardiovascular Diseases and Risk Factors in the United States

BACKGROUND

While the impacts of social and environmental exposure on cardiovascular risks are often reported individually, the combined effect is poorly understood.

METHODS AND RESULTS

Using the 2022 Environmental Justice Index, socio-environmental justice index and environmental burden module ranks of census tracts were divided into quartiles (quartile 1, the least vulnerable census tracts; quartile 4, the most vulnerable census tracts). Age-adjusted rate ratios (RRs) of coronary artery disease, strokes, and various health measures reported in the Prevention Population-Level Analysis and Community Estimates data were compared between quartiles using multivariable Poisson regression. The quartile 4 Environmental Justice Index was associated with a higher rate of coronary artery disease (RR, 1.684 [95% CI, 1.660-1.708]) and stroke (RR, 2.112 [95% CI, 2.078-2.147]) compared with the quartile 1 Environmental Justice Index. Similarly, coronary artery disease 1.057 [95% CI,1.043-1.0716] and stroke (RR, 1.118 [95% CI, 1.102-1.135]) were significantly higher in the quartile 4 than in the quartile 1 environmental burden module. Similar results were observed for chronic kidney disease, hypertension, diabetes, obesity, high cholesterol, lack of health insurance, sleep <7 hours per night, no leisure time physical activity, and impaired mental and physical health >14 days.

CONCLUSIONS

The prevalence of CVD and its risk factors is highly associated with increased social and environmental adversities, and environmental exposure plays an important role independent of social factors.

Characterization of water-soluble ions in PM10 over an industrial area in northern Colombia: Temporal variations and correlation with satellite data

This study was designed to assess the concentrations of nine water-soluble ions in PM10 mass at two sites of an open-pit coal mine and to analyze the correlation and variation of the spatial distribution of sulfate ions with the PM10 sulfate aerosol optical depth at 550 nm (suaod550) in two (North and South) stations of the study area. The daily average of PM10 concentrations ranged from 20.48 to 53.10 μg/m3 and thus did not exceed the daily average maximum permissible level of PM10 (100 μg/m3) established in the Colombia standard at any station. The concentrations of nine water-soluble ions in PM10 (Cl-, NO3-, PO43-, SO42- Na+, NH4+, K+, Mg2+, and Ca2+) were determined. The ions under analysis, SO42-, Na+, and NH4+ had the highest concentrations. Combined, they accounted for 75% of the mass of water-soluble ions in a total of 210 samples. The SO42- concentrations in PM10 significantly correlated with suaod550 (r ranging from 0.57 to 0.66), emphasizing the strong effect of suaod550 from Venezuela (Lake Maracaibo) on central and northern Colombia. These results demonstrate that the effects of local sulfate emissions near monitoring sites can be predicted and assessed using satellite data.

Micronuclei frequency and exposure to chemical mixtures in three Colombian mining populations

The Colombian mining industry has witnessed significant growth. Depending on the scale and mineral extracted, complex chemical mixtures are generated, impacting the health of occupationally exposed populations and communities near mining projects. Increasing evidence suggests that chromosomal instability (CIN) is an important link between the development of certain diseases and exposure to complex mixtures. To better understand the effects of exposure to complex mixtures we performed a biomonitoring study on 407 healthy individuals from four areas: three located in municipalities exploiting different-scale mining systems and a reference area with no mining activity. Large, medium, and small-scale mining systems were analyzed in Montelibano (Córdoba), artisanal and small-scale mining (ASGM) in Nechí (Antioquia), and a closed mining system in Aranzazu (Caldas). The reference area with no mining activity was established in Montería (Córdoba). ICP-MS measured multi-elemental exposure in hair, and CIN was evaluated using the cytokinesis-block micronucleus technique (MNBN). Exposure to mixtures of chemical elements was comparable in workers and residents of the mining areas but significantly higher compared to reference individuals. In Montelibano, increased MNBN frequencies were associated with combined exposure to Se, Hg, Mn, Pb, and Mg. This distinct pattern significantly differed from other areas. Specifically, in Nechí, Cr, Ni, Hg, Se, and Mg emerged as the primary contributors to elevated frequencies of MNBN. In contrast, a combination of Hg and Ni played a role in increasing MNBN in Aranzazu. Interestingly, Se consistently correlated with increased MNBN frequencies across all active mining areas. Chemical elements in Montelibano exhibit a broader range compared to other mining zones, reflecting the characteristics of the high-impact and large-scale mining in the area. This research provides valuable insights into the effects of exposure to chemical mixtures, underscoring the importance of employing this approach in the risk assessment of communities, especially those from residential areas.

Effect of Coal Mining on Health Outcomes Between Male and Female Miners in Southern West Virginia: A Brief Report

PURPOSE

There is evidence of an association between coal mining and an increased prevalence of respiratory and cardiovascular disease (CVD). Mining is significantly associated with elevated chronic CVD mortality rates. Research is limited and looks at the differences between specific health outcomes between male and female coal miners. The aim of this study was to compare the long-term health outcomes of male and female coal miners in southern West Virginia.

METHODS

We used the Charleston Area Medical Center (CAMC) data registry to look at specific health outcomes of coal miners. We queried the data warehouse from September 1, 2016, to January 1, 2023, to identify any coal miners coming to CAMC for any treatment. We identified adult patients aged 18-90 years with at least one visit to a clinic in the CAMC system.

FINDINGS

We identified (n=2,460) cases of coal miners, comprising of 2,280 males and 180 females. Overall, we found higher mortality rates as well as higher rates of ischemic heart disease, heart failure, cancer, and mental health disorders among male coal miners.

CONCLUSIONS

Additional research is needed to further examine possible contributing factors that explain the differences in health outcomes between male and female coal miners. Clinicians and policymakers need to address health disparities and occupational hazards that impact the health outcomes of coal miners living in southern West Virginia.

Short-term exposure to some heavy metals carried with PM10 and cardiovascular system biomarkers during dust storm

This study aimed to evaluate the effect of short-term exposure to heavy metals (HM) extracted from PM10 on CB in workers' population in an outdoor space located in southern Iran during a dust storm. At first, 44 healthy and non-smoking workers were selected. Then PM10 and Blood samples were collected before and after the dust storm. Finally, HMs associated with PM10 measured by ICP-MS and its effect on the CB, including fibrinogen, CRP, TNF-α, and BP were estimated by ANOVA, Pearson correlation, and Odd Ratio (OR) in SPSS23. Based on the results, the concentration of PM10 and extracted HM such as Cr, As, and Cd was higher than the WHO/EPA standards in dust storms they increased the CB and BP remarkably. Moreover, the level of fibrinogen, blood pressure (BP) and TNF-α in dust storms were higher than in normal conditions (p < 0.05, OR > 3). In addition, As and Cd decreased fibrinogen concentration and systolic BP, respectively. Whereas, TNF-α was associated with concentration of Pb (R = - 0.85) on normal days. Consequently, the HM on PM10 such as As, interferes with the level of investigated CB. These results considered a potential risk for the residents in the southern regions of Iran.

Adult asthma associated with roadway density and housing in rural Appalachia: the Mountain Air Project (MAP)

BACKGROUND

Appalachian Kentucky is a rural area with a high prevalence of asthma among adults. The relative contribution of environmental exposures in the etiology of adult asthma in these populations has been understudied.

OBJECTIVE

This manuscript describes the aims, study design, methods, and characteristics of participants for the Mountain Air Project (MAP), and focuses on associations between small area environmental exposures, including roadways and mining operations, and lifetime and current asthma in adults.

METHODS

A cohort of residents, aged 21 and older, in two Kentucky counties, was enrolled in a community-based, cross-sectional study. Stratified cluster sampling was used to select small geographic areas denoted as 14-digit USGS hydrologic units (HUCs). Households were enumerated within selected HUCs. Community health workers collected in-person interviews. The proximity of nearby active and inactive coal mining operations, density of oil and gas operations, and density of roadways were characterized for all HUCs. Poisson regression analyses were used to estimate adjusted prevalence ratios.

RESULTS

From 1,459 eligible households contacted, 1,190 individuals were recruited, and 972 persons completed the interviews. The prevalence of lifetime asthma was 22.8%; current asthma was 16.3%. Adjusting for covariates, roadway density was positively associated with current asthma in the second (aPR = 1.61; 95% CI 1.04-2.48) and third tertiles (aPR = 2.00; 95% CI 1.32-3.03). Increased risk of current asthma was associated with residence in public, multi-unit housing (aPR = 2.01; 95% CI 1.27-3.18) compared to a residence in a single-family home. There were no notable associations between proximity to coal mining and oil and gas operations and asthma prevalence.

CONCLUSIONS

This study suggests that residents in rural areas with higher roadway density and those residing in public housing units may be at increased risk for current asthma after accounting for other known risk factors. Confirming the role of traffic-related particulates in producing high asthma risk among adults in this study contributes to the understanding of the multiple environmental exposures that influence respiratory health in the Appalachia region.

Factors associated with genetic damage - an analysis integrating human populations from Southern Brazil

Socioeconomic and demographic factors, lifestyle and cultural characteristics may play an important role in the development of genetic damage. This damage represents a potential health risk to an individual and increases the risk of developing negative outcomes. The aim of this study was to investigate the association of a set of factors and genetic damage by gathering data from previously studied populations in southern Brazil. This study analyzed data related to genetic damage and socioeconomic, demographic, and lifestyle variables of 514 individuals aged 18 to 64 years, residing in 8 cities located in the extreme south of the Brazil. A total of twelve factors were considered in the analysis, and of these seven had some association with the frequency of micronucleus or some parameter of the comet assay. Interestingly, age was a factor weakly associated with genetic damage, while skin color, occupational exposure, drug use, exposure to radiation, and the cultural habit of consuming chimarrão were shown to be associated with genetic damage when analyzed using multivariate regression. Therefore, we suggest that yerba mate consumption is a confounding factor and should be considered in cytogenetic studies in the southern region of South America. These results reinforce the need for human biomonitoring studies to include consideration of a broad range of population and cultural characteristics when seeking to identify relevant associations.

Mortality during Resource Booms and Busts

Using national data on county-level mortality, coal mining, and shale development, we examine the effects of resource booms and busts on mortality in the United States. We find evidence that decreases in operating coal mines increased total all-cause mortality, non-drug mortality, and opioid overdose mortality, especially for counties with greater than 10 operating coal mines in 2000. Our model results for drug overdose mortality and opioid overdose mortality are sensitive to the panel's start year. For shale development, the shale boom is associated with increases in non-drug suicides but otherwise had little impact on mortality. Our findings suggest a potential role for job-training programs and the cultivation of local healthcare resources in regions suffering coal busts and suicide prevention in areas with shale development.

Maternal proximity to mountain-top removal mining and birth defects in Appalachian Kentucky, 1997-2003

Extraction of coal through mountaintop removal mining (MTR) alters many dimensions of the landscape. Explosive blasts, exposed rock, and coal washing have the potential to pollute air and water. Previous research suggests that infants born to mothers living in areas with MTR have a higher prevalence of birth defects. In this cross-sectional study, we further examine the relationship between MTR activity and several types of birth defects. Maternal exposure to MTR was assessed using remote sensing data from Skytruth, which captures MTR activity in the Central Appalachian region of the United States. Active MTR area was quantified within a five-kilometer buffer surrounding geocoded maternal address captured on birth records for live births to Appalachian Kentucky mothers between 1997 and 2003 (N = 95,581). We assigned high, medium, and low exposure based on the tertile of total MTR area within 5-km, and births with no MTR within this buffer were assigned zero exposure. The presence or absence of a birth defect grouped into six major organ systems was identified using birth records alone. Finally, we applied conditional multiple imputation for variables with missing values before conducting separate multivariable log-binomial regression models for each birth defect group. Prevalence ratio (PR) estimates were adjusted for individual level covariates from birth records. The prevalence of gastro-intestinal defects was significantly higher in birth records with high and low active MTR exposure compared to records with no exposure. (High exposure: PR = 1.99, 95% CI = 1.14-3.47; low exposure PR = 1.88, 95% CI = 1.06-3.31). This study supports some of the existing findings of previous ecological studies. Research addressing the relationship between gastro-intestinal birth defects and MTR coal mining is warranted but should carefully consider temporal dimensions of exposure.

Impact on mental health and wellbeing in Indigenous communities due to land loss resulting from industrial resource development: protocol for a systematic review

BACKGROUND

Indigenous Peoples are impacted by industrial resource development that takes place on, or near, their communities. Existing literature on impacts of industrial resource development on Indigenous Peoples primarily focus on physical health outcomes and rarely focus on the mental health impacts. To understand the full range of long-term and anticipated health impacts of industrial resource development on Indigenous communities, mental health impacts must be examined. It is well-established that there is a connection between the environment and Indigenous wellbeing, across interrelated dimensions of mental, physical, emotional, and spiritual health.

METHODS

This paper identifies how the Community Advisory Team and a team of Indigenous and settler scholars will conduct the review. The literature search will use the OVID interface to search Medline, Embase, PsycINFO, and Global Health databases. Non-indexed peer-reviewed journals related to Indigenous health or research will be scanned. Books and book chapters will be identified in the Scopus and PsycINFO databases. The grey literature search will also include Google and be limited to reports published by government, academic, and non-profit organizations. Reference lists of key publications will be checked for additional relevant publications, including theses, dissertations, reports, and other articles not retrieved in the online searches. Additional sources may be recommended by team members. Included documents will focus on Indigenous Peoples in North America, South America, Australia, Aotearoa New Zealand, and Circumpolar regions, research that reports on mental health, and research that is based on land loss connected to dams, mines, agriculture, or petroleum development. Literature that meets the inclusion criteria will be screened at the title/abstract and full-text stages by two team members in Covidence. The included literature will be rated with a quality appraisal tool and information will be extracted by two team members; a consensus of information will be reached and be submitted for analysis.

DISCUSSION

The synthesized evidence from this review is relevant for land use policy, health impact assessments, economic development, mental health service planning, and communities engaging in development projects.

SYSTEMATIC REVIEW REGISTRATION

Registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration number CRD42021253720 ).

Identifying exposure pathways mediating adverse birth outcomes near active surface mines in Central Appalachia

Background

Previous work has determined an association between proximity to active surface mining within Central Appalachia and an increased risk of preterm birth (PTB) and low birthweight (LBW). Multiple potential exposure pathways may exist; however, including inhalation of particulate matter (airshed exposure), or exposure to impacted surface waters (watershed exposure). We hypothesize that this relationship is mediated by exposure to contaminants along one or both of these pathways.

Methods

We geolocated 194,084 birth records through health departments in WV, KY, VA, and TN between 1990 and 2015. We performed a mediation analysis, iteratively including within our models: (a) the percent of active surface mining within 5 km of maternal residence during gestation; (b) the cumulative surface mining airshed trajectories experienced during gestation; and (c) the percent of active surface mining occurring within the watershed of residency during gestation.

Results

Our baseline models found that active surface mining was associated with an increased odds of PTB (1.09, 1.05-1.13) and LBW (1.06, 1.02-1.11), controlling for individual-level predictors. When mediators were added to the baseline model, the association between active mining and birth outcomes became nonsignificant (PTB: 0.48, 0.14-1.58; LBW 0.78, 0.19-3.00), whereas the association between PTB and LBW remained significant by airshed exposure (PTB: 1.14, 1.11-1.18; LBW: 1.06, 1.03-1.10).

Conclusions

Our results found that surface mining airsheds at least partially explained the association between active mining and adverse birth outcomes, consistent with a hypothesis of mediation, while mediation via the watershed pathway was less evident.

Assessing the effects of mining projects on child health in sub-Saharan Africa: a multi-country analysis

Background

The African continent hosts many industrial mining projects, and many more are planned due to recent prospecting discoveries and increasing demand for various minerals to promote a low-carbon future. The extraction of natural resources in sub-Saharan Africa (SSA) represents an opportunity for economic development but also poses a threat to population health through rapid urbanisation and environmental degradation. Children could benefit from improved economic growth through various channels such as access to high-quality food, better sanitation, and clean water. However, mining can increase food insecurity and trigger local competition over safe drinking water. Child health can be threatened by exposure to mining-related air, noise, and water pollution. To assess the impact of mines on child health, we analyse socio-demographic, health, and mining data before and after several mining projects were commissioned in SSA.

Results

Data of 90,951 children living around 81 mining sites in 23 countries in SSA were analysed for child mortality indicators, and 79,962 children from 59 mining areas in 18 SSA countries were analysed for diarrhoea, cough, and anthropometric indicators. No effects of the launch of new mining projects on overall under-five mortality were found (adjusted Odds Ratio (aOR): 0.88; 95% Confidence Interval (CI): 0.68–1.14). However, activation of mining projects reduced the mortality risk among neonates (0–30 days) by 45% (aOR: 0.55; 95% CI: 0.37–0.83) and risk for a child to develop diarrhoeal diseases by 32% (aOR: 0.68; 95% CI: 0,51–0.90). The timing analysis of observed changes showed that there is a significant decline in the risk for childhood diarrhoea (aOR: 0.69; 95% CI: 0.49–0.97), and the mean height-for-age z-scores by 28 percentage points, during the prospection and construction phase; i.e., within four years to the initiation of extraction activity. No effects were found for cough and weight-for-height.

Conclusion

The results presented suggest that the impacts of mining on child health vary throughout the mine’s life cycle. Mining development likely contributes positively to the income and livelihoods of the impacted communities in the initial years of mining operations, particularly the prospection and construction phase; these potential benefits are likely to be at least partially offset by food insecurity and environmental pollution during early and later mining stages, respectively. Further research is warranted to better understand these health impacts and to identify policies that can help sustain the positive initial health impacts of mining projects in the long term.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-022-00797-6.

High Thyroid Cancer Incidence Rate in a Community near a Landfill: A Descriptive Epidemiological Assessment

Background: to investigate the high thyroid cancer incidence rate of Staten Island and to disentangle the effects of potential environmental exposure from a landfill from screening. Methods: age-adjusted thyroid cancer incidence rates obtained from the New York State Public Access Cancer Epidemiology Data for New York State (NYS) excluding New York City (NYC) and the five NYC boroughs, including Staten Island, were mapped over time (1995–2018), investigated per age group and by percentage of localized thyroid cancer. Changes in trends were assessed using joinpoint. Contaminants of concern on Staten Island were assessed for carcinogenic and endocrine disruptive properties. Results: a more pronounced thyroid cancer incidence rate increase, without a difference in age distribution and similar percentages of localized thyroid cancer, was found in Staten Island compared to its demographic equivalent (NYS excluding NYC). Multiple contaminants of concern with carcinogenic and endocrine disrupting properties (e.g., cadmium, lead) were identified in air, water and sediment samples. Conclusion: investigations into the effects of increased/sustained environmental exposures are needed in chronically exposed populations to identify potential mechanisms of action of certain pollutants.

In Their Own Words: How Opioids Have Impacted the Lives of "Everyday" People Living in Appalachia

Introduction

The opioid epidemic is ravaging people, families, and communities in Appalachia. However, limited research has examined how "everyday" people (e.g., not chronic pain patients, not medical professionals) living in these communities how opioids have impacted their lives.

Objective

Identify the perception of the opioid epidemic on individuals, families, and communities from people living in region most impacted regions.

Methods

Patients were recruited at Remote Area Medical clinics throughout Central and Southern Appalachia to complete interviews online (N = 169) or over the phone (N = 26), including one open-ended question about how opioids have impacted their lives.

Results

Using the qualitative method content analysis, several themes were identified, including both the positive and negative impact of opioids from the online interviews. Additionally, resiliency was found to be a common theme and a theme not often emphasized by scholars and the media. These themes also highlight the importance of social support in these communities. Further, in the phone interviews, we were able to replicate the themes, and an additional theme was identified: Systemic Cause of Opioids.

Conclusion

Opioid intervention must be comprehensive and include the cultural context that recognizes community ties, family and kinship support, resilience, and systemic barriers to addressing the opioid epidemic. Future interventions must harness the existing resiliency and social support in these communities to effectively combat the opioid crisis in Appalachia. Otherwise, opioids will remain the insider and further insulate Appalachian communities from systemic recovery.

Decomposing Differences in Poor Self-rated Health between Those in Agriculture and Natural Resource Occupations and the Rest of the Labor Force

Objective: Occupations in agriculture and natural resources persistently have some of the highest rates of injury and illness. Additionally, these fields are dominated by segments of the population known to demonstrate poorer health, such as those with less education, lower family income, and more irregular labor force participation. Thus, it is unclear if health disparities between those in these sectors and the rest of the labor force are unique to these occupations, or a reflection of their demographic composition. The objective of this study was to determine how much of the difference in self-rated health between those who work agriculture and natural resource occupations - meaning farming, forestry, fishing, hunting, and resource extraction - and the rest of the labor force was due to demographic characteristics versus unexplained factors unique to the occupations.Methods: Using the National Health Interview Survey from 2008 to 2017, a two-way Oaxaca-Blinder decomposition of linear probability models predicting poor self-rated health between those reporting agriculture and natural resource occupations and other working adults with sociodemographic characteristics was performed.Results: Results show more than the total difference in the probability of poor self-rated health between the two groups (0.0173) can be explained by demographic composition (0.0303). If the agriculture and natural resource workforce had the average demographic composition between them and the rest of the labor force, they would have lower rates of poor self-rated health than the broader labor force.Conclusion: While agriculture and natural resource occupations are hazardous, the prevalence of poor self-rated health in the labor force is not unique to these occupations, but appears common among all occupations dominated by those with low income and education.

Impacts of Coal Use on Health

This article reviews evidence for the public health impacts of coal across the extraction, processing, use, and waste disposal continuum. Surface coal mining and processing impose public health risks on residential communities through air and water pollution. Burning coal in power plants emits more nitrogen oxides, sulfur dioxide, particulate matter, and heavy metals per unit of energy than any other fuel source and impairs global public health. Coal ash disposal exposes communities to heavy metals and particulate matter waste. Use of coal in domestic households causes public health harm concentrated in developing nations. Across the coal continuum, adverse impacts are disproportionately felt by persons of poor socioeconomic status, contributing to health inequities. Despite efforts to develop renewable energy sources, coal use has not declined on a global scale. Concentrated efforts to eliminate coal as an energy source are imperative to improve public health and avert serious climate change consequences.

Associations between dietary patterns and 10-year cardiovascular disease risk score levels among Chinese coal miners--a cross-sectional study

Background

Diet-related cardiovascular diseases have produced a large health burden in China. Coal miners are a high-risk population for cardiovascular disease, but there is little evidence concerning associations between coal miners’ dietary patterns and their 10-year cardiovascular disease risk score levels.

Methods

The study included 2632 participants and focused on dietary patterns associated with higher 10-year cardiovascular disease risk score levels. A valid semi-quantitative food frequency questionnaire was used to collect data regarding dietary intake, and dietary patterns were identified using factor analysis combined with cluster analysis. Logistic regression was used to assess associations between dietary patterns and 10-year cardiovascular disease risk score levels.

Results

For ground workers, compared with the ‘Healthy’ pattern, the ‘High-salt’ and ‘Refined grains’ patterns were significantly associated with higher 10-year atherosclerotic cardiovascular disease risk score level (OR: 1.50, 95% CI: 1.02–2.21; OR: 1.92, 95% CI: 1.26–2.93) and 10-year ischemic cardiovascular disease risk score level (OR: 2.18, 95% CI: 1.25–3.80; OR: 2.64, 95% CI: 1.48–4.72) adjusted for gender, and behavioural and socioeconomic factors. The ‘High-fat and salt’ pattern was significantly associated with higher 10-year ischemic cardiovascular disease risk score level (OR: 1.97, 95% CI: 1.13–3.42). For underground workers, the ‘High-salt’ pattern was significantly associated with higher 10-year atherosclerotic cardiovascular disease risk score level (OR: 1.65, 95% CI: 1.16–2.36) and 10-year ischemic cardiovascular disease risk score level (OR: 1.76, 95% CI: 1.09–2.84).

Conclusions

This study provides evidence for dietary patterns associated with higher 10-year cardiovascular disease risk score levels in Chinese miners, and facilitates relevant departments in designing effective dietary guidelines to ameliorate dietary structures.

Suppression of coal dust by microbially induced carbonate precipitation usingStaphylococcus succinus

Coal dust from open-cast mines is a significant air pollutant; thus, dust particles and toxins contained in the dust are a severe threat to human health and ecosystems. Microbially induced carbonate precipitation (MICP) is a low-cost and environmentally friendly way to suppress coal dust. With high urease activity and tolerance to coal dust, a bacterial strain, Staphylococcus succinus J3, was isolated from soil in a mine area. Thus, in dust suppression experiments, we used coal dust dominated by fine granule particles (100-250 μm) from an open-cast mine. Consequently, four factors were identified: initial bacterial biomass, calcium concentration, urea concentration, and spraying frequency; we investigated their effects on MICP as a dust suppression technique using one-factor-at-a-time experiments. Maximum threshold broken wind speed (45.5 m s^-1) and pressure (912 kPa) were obtained under the following condition: OD₆₀₀ = 0.7, 40 mmol calcium, 6% (w/w) urea in the bonding solution which was sprayed five times in 35 days. Pearson correlation analysis described that urea concentration and spraying frequency both significantly positive correlations with the threshold broken wind speed and pressure via Pearson analysis. When the coal dust suppression process was complete, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy showed that a solidified layer of calcareous precipitate had formed on the surface of the dust. These results indicate that Staphylococcus succinus J3 has considerable potential for use in MICP as a coal dust suppression technique.

Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study

BACKGROUND

Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as "coal-county effect." We also investigated what factors may accentuate or attenuate the coal-county effect.

METHODS

An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented.

RESULTS

The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed.

CONCLUSIONS

This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.

Model-Based Clustering of Nonparametric Weighted Networks with Application to Water Pollution Analysis

Water pollution is a major global environmental problem, and it poses a great environmental risk to public health and biological diversity. This work is motivated by assessing the potential environmental threat of coal mining through increased sulfate concentrations in river networks, which do not belong to any simple parametric distribution. However, existing network models mainly focus on binary or discrete networks and weighted networks with known parametric weight distributions. We propose a principled nonparametric weighted network model based on exponential-family random graph models and local likelihood estimation, and study its model-based clustering with application to large-scale water pollution network analysis. We do not require any parametric distribution assumption on network weights. The proposed method greatly extends the methodology and applicability of statistical network models. Furthermore, it is scalable to large and complex networks in large-scale environmental studies. The power of our proposed methods is demonstrated in simulation studies and a real application to sulfate pollution network analysis in Ohio watershed located in Pennsylvania, United States.

Toxic effects of a methanolic coal dust extract on fish early life stage

Coal dust is a contaminant that impacts the terrestrial and aquatic environment with a complex mixture of chemicals, including PAHs and metals. This study aims to evaluate the toxic effect of a methanolic coal dust extract on a fish early life stage by analyzing phenotypic alterations, transcriptome changes, and mortality in zebrafish (ZF) embryos. ZF embryos were exposed to methanolic coal dust extract at 1-5000 mg·L-1 and monitored using bright field microscopy 24 and 48 hpf to determine malformations and mortality. In situ hybridization, RNA sequencing, and qRT-PCR were employed to identify transcriptome changes in malformed embryos. Three malformed phenotypes were generated in a dose-dependent manner. In situ hybridization analysis revealed brain, somite, dorsal cord, and heart tube development biomarker alterations. Gene expression profile analysis identified changes in genes related to structural constituent of muscle, calcium ion binding, actin binding, melanin metabolic process, muscle contraction, sarcomere organization, cardiac myofibril assembly, oxidation-reduction process, pore complex, supramolecular fiber, striated muscle thin filament, Z disc, and intermediate filament. This study shows, for the first time, the malformations generated by a mixture of pollutants from a methanolic coal dust extract on a fish early life stage, constituting a potential risk for normal embryonic development of other aquatic vertebrate organisms. Furthermore, we establish that phenotypes and changes in gene expression induced by the extract constitute a target for future studies about mechanical toxicity and their utility as sensitive tools in environmental risk assessments for biota and humans exposed to coal mining activities.

Research Advances of Prevention and Control of Hydrogen Sulfide in Coal Mines

Sudden emission and casualty accidents caused by abnormal enrichment of hydrogen sulfide (H₂S) in coal mines are becoming frequent increasingly, causing major casualties and environmental pollution. Scholars in various countries have developed various measuring devices for hydrogen sulfide content in coal and rock formations and their calculation methods. The existing prevention and control technologies of H₂S in coal mines were summarized in various countries. According to the distribution characteristics, occurrence modes, and emission forms of H₂S in coal mines, the prevention and control technologies of H₂S in coal-bearing strata, airflow in tunnel, and underground water body are mainly introduced. Analyzed the effects of different ventilation systems on prevention and control of H₂S, which include conventional ventilation system, partial homotropal ventilation system, and full homotropal ventilation system. The methods used mainly include neutralization by injecting alkalizer through drilling in coal seams with high pressure, spraying alkalizer in tunnel, attenuation by increasing wind amount, changing the ventilation method, pumping, dredging, and blocking the water that contains H₂S as well as comprehensive prevention and control method. The basic agents adopted mainly include sodium carbonate (the mass percentage concentration is about 0.5% ~ 3.0%) and sodium bicarbonate solution, and some basic solution is added by an additive, such as surfactant, Fenton reagent, sodium dodecyl benzene sulfonate, sodium hypochlorite, or chloramine-T. The treatment effect and the main problems of each prevention and control technology are analyzed, and a comprehensive method of prevention and control techniques of H₂S in coal mines is proposed. According to current technological level as well as the cost, the effective prevention and control techniques of H₂S should take the occurrence, distribution, and emission forms of H₂S in coal mines as well as the content into consideration.

Association between DNA damage, dietary patterns, nutritional status, and non-communicable diseases in coal miners

Several negative health effects have been associated with environmental pollution. Coal mining activities are related to DNA damage. However, the impact of lifestyle as well as environmental exposure must be considered when evaluating the extent of DNA damage. The aim of this cross-sectional study was to analyze nutritional status, dietary patterns, and the prevalence of non-communicable diseases (CNCDs) among coal miners as well as to investigate the correlation of these variables with DNA damage. We used a questionnaire to assess demographics, health, and dietary habits. The nutritional status was measured in terms of BMI (body mass index) and DNA damage was assessed by the comet assay. The sample population was composed of 158 coal miners from the largest coal mining company in South of Brazil, and majority of them were classified as overweight (51.3%) or obese (28.5%). Hypertension was the most common CNCD (50.6%) and a majority of these workers consumed all groups of foods three or more times a week. There was a significant positive correlation between BMI and DNA damage (r = 0.1646, p = 0.04) and this association was stronger (r = 0.2556, p = 0.04) in coal miners with some CNCD. There was no significant correlation between dietary patterns and DNA damage in coal miners. These results suggest that the nutritional status and CNCD increase the extent of DNA damage in coal miners. Since this population is at high occupational risk, specific strategies should be designed to improve the health of these workers, aiming to achieve health equity.

Mountaintop removal mining and multiple illness symptoms: A latent class analysis

BACKGROUND

Mountaintop removal mining has been associated with multiple types of disease outcomes for populations living nearby. The current study tested whether latent classes identifying people with symptoms from multiple organ systems were associated with residence in mountaintop mining communities.

METHODS

We used data from three cross-sectional household community surveys conducted in three Appalachian states (N = 2756). The surveys contained information on 29 recent illness symptoms grouped into eight organ systems (respiratory, cardiovascular, gastrointestinal, musculoskeletal, skin, eye-ear-nose-throat, neurological, and other.) We identified latent classes, and then tested whether classes with higher probabilities of multiple symptoms would be associated with residence in mountaintop removal areas after control for covariates.

RESULTS

Three latent classes were identified, including a low-symptom referent class, an intermediate class, and a class with high symptom probability across organ systems. Controlling for covariates, latent classes characterized by intermediate and high multi-symptom probabilities were significantly associated with residence near mountaintop removal mining, with the highest odds ratio for the MTR versus control condition for the high multi-symptom group (OR = 2.17, 95% CI = 1.80-2.61).

CONCLUSIONS

Symptoms across multiple organ systems were related to residential proximity to mountaintop removal mining. Prior research has established multiple environmental contaminants related to mining that may contribute to poor population health through more than one exposure route or chemical of concern.

Intake Fraction of PM10 from Coal Mine Emissions in the North of Colombia

Intake fraction was determined in this study to provide insight into population exposures to PM₁₀ that is effectively inhaled due to emissions of an opencast coal mine. We applied the CALPUFF model to a coal mine in Northern Colombia, which has 6 active pits with an annual production of 33.7 million tons. We estimated the intake fractions for 7 towns through the integration of dispersion model results over the population data. The resulting average intake fractions were between 6.13 × 10⁻⁹ and 3.66 × 10⁻⁸ for PM₁₀. 62.4% of the intake fractions in the domain were calculated within a 23 km radius from the coal mine and coved 44.3% of the total population in this area. We calculated an estimate point for morbidity impacts using standard epidemiological assumptions. It is estimated that there were annually 105835 restricted activity days and 336832 respiratory symptom cases due to the direct impact of the opencast coal mining. These data also provide a framework for improved understanding of the effect of coal mining in Colombia.

Cytogenetic instability in populations with residential proximity to open-pit coal mine in Northern Colombia in relation to PM10 and PM2.5 levels

Epidemiological studies indicate that living in proximity to coal mines is correlated with numerous diseases including cancer, and that exposure to PM₁₀ and PM_2.5 components could be associated with this phenomenon. However, the understanding of the mechanisms by which PM exerts its adverse effects is still incomplete and comes mainly from studies in occupationally exposed populations. The aims of this study were to: (1) evaluate DNA damage in lymphocytes assessing the cytokinesis-block micronucleus cytome assay (CBMN-cyt) parameters; (2) identify aneugenic or clastogenic effects in lymphocytes of exposed populations using CREST immunostaining for micronuclei; (3) evaluate multi-elemental composition of atmospheric particulate matter; and (4) verify relation between the DNA damage and PM_2.5 and PM₁₀ levels around the mining area. Analysis revealed a significant increase in micronuclei frequency in binucleated (MNBN) and mononucleated (MNMONO) cells of individuals with residential proximity to open-pit coal mines compared to residents from non-mining areas. Correlation analysis demonstrated a highly significant association between PM_2.5 levels, MNBN frequencies and CREST+ micronuclei induction in exposed residents. These results suggest that PM_2.5 fraction generated in coal mining activities may induce whole chromosome loss (aneuploidy) preferentially, although there are also chromosome breaks. Analysis of the chemical composition of PM_2.5 by PIXE demonstrated that Si, S, K and Cr concentrations varied significantly between coal mining and reference areas. Enrichment factor values (EF) showed that S, Cr and Cu were highly enriched in the coal mining areas. Compared to reference area, mining regions had also higher concentrations of extractable organic matter (EOM) related to nonpolar and polar compounds. Our results demonstrate that PM_2.5 fraction represents the most important health risk for residents living near open-pit mines, underscoring the need for incorporation of ambient air standards based on PM_2.5 measures in coal mining areas.

Systematic review of community health impacts of mountaintop removal mining

BACKGROUND

The objective of this evaluation is to understand the human health impacts of mountaintop removal (MTR) mining, the major method of coal mining in and around Central Appalachia. MTR mining impacts the air, water, and soil and raises concerns about potential adverse health effects in neighboring communities; exposures associated with MTR mining include particulate matter (PM), polycyclic aromatic hydrocarbons (PAHs), metals, hydrogen sulfide, and other recognized harmful substances.

METHODS

A systematic review was conducted of published studies of MTR mining and community health, occupational studies of MTR mining, and any available animal and in vitro experimental studies investigating the effects of exposures to MTR-mining-related chemical mixtures. Six databases (Embase, PsycINFO, PubMed, Scopus, Toxline, and Web of Science) were searched with customized terms, and no restrictions on publication year or language, through October 27, 2016. The eligibility criteria included all human population studies and animal models of human health, direct and indirect measures of MTR-mining exposure, any health-related effect or change in physiological response, and any study design type. Risk of bias was assessed for observational and experimental studies using an approach developed by the National Toxicology Program (NTP) Office of Health Assessment and Translation (OHAT). To provide context for these health effects, a summary of the exposure literature is included that focuses on describing findings for outdoor air, indoor air, and drinking water.

RESULTS

From a literature search capturing 3088 studies, 33 human studies (29 community, four occupational), four experimental studies (two in rat, one in vitro and in mice, one in C. elegans), and 58 MTR mining exposure studies were identified. A number of health findings were reported in observational human studies, including cardiopulmonary effects, mortality, and birth defects. However, concerns for risk of bias were identified, especially with respect to exposure characterization, accounting for confounding variables (such as socioeconomic status), and methods used to assess health outcomes. Typically, exposure was assessed by proximity of residence or hospital to coal mining or production level at the county level. In addition, assessing the consistency of findings was challenging because separate publications likely included overlapping case and comparison groups. For example, 11 studies of mortality were conducted with most reporting higher rates associated with coal mining, but many of these relied on the same national datasets and were unable to consider individual-level contributors to mortality such as poor socioeconomic status or smoking. Two studies of adult rats reported impaired microvascular and cardiac mitochondrial function after intratracheal exposure to PM from MTR-mining sites. Exposures associated with MTR mining included reports of PM levels that sometimes exceeded Environmental Protection Agency (EPA) standards; higher levels of dust, trace metals, hydrogen sulfide gas; and a report of increased public drinking water violations.

DISCUSSION

This systematic review could not reach conclusions on community health effects of MTR mining because of the strong potential for bias in the current body of human literature. Improved characterization of exposures by future community health studies and further study of the effects of MTR mining chemical mixtures in experimental models will be critical to determining health risks of MTR mining to communities. Without such work, uncertainty will remain regarding the impact of these practices on the health of the people who breathe the air and drink the water affected by MTR mining.

Atmospheric particulate matter in proximity to mountaintop coal mines: sources and potential environmental and human health impacts

Mountaintop removal mining (MTM) is a widely used approach to surface coal mining in the US Appalachian region whereby large volumes of coal overburden are excavated using explosives, removed, and transferred to nearby drainages below MTM operations. To investigate the air quality impact of MTM, the geochemical characteristics of atmospheric particulate matter (PM) from five surface mining sites in south central West Virginia, USA, and five in-state study control sites having only underground coal mining or no coal mining whatsoever were determined and compared. Epidemiologic studies show increased rates of cancer, respiratory disease, cardiovascular disease, and overall mortality in Appalachian surface mining areas compared to Appalachian non-mining areas. In the present study, 24-h coarse (>2.5 µm) and fine (≤2.5 µm) PM samples were collected from two surface mining sites in June 2011 showed pronounced enrichment in elements having a crustal affinity (Ga, Al, Ge, Rb, La, Ce) contributed by local sources, relative to controls. Follow-up sampling in August 2011 lacked this enrichment, suggesting that PM input from local sources is intermittent. Using passive samplers, dry deposition total PM elemental fluxes calculated for three surface mining sites over multi-day intervals between May and August 2012 were 5.8 ± 1.5 times higher for crustal elements than at controls. Scanning microscopy of 2,249 particles showed that primary aluminosilicate PM was prevalent at surface mining sites compared to secondary PM at controls. Additional testing is needed to establish any link between input of lithogenic PM and disease rates in the study area.

Altered gene expression in HepG2 cells exposed to a methanolic coal dust extract

Exposure to coal dust has been associated with different chronic diseases and mortality risk. This airborne pollutant is produced during coal mining and transport activities, generating environmental and human toxicity. The aim of this study was to determine the effects of a coal dust methanolic extract on HepG2, a human liver hepatocellular carcinoma cell line. Cells were exposed to 5-100ppm methanolic coal extract for 12h, using DMSO as control. MTT and comet assays were used for the evaluation of cytotoxicity and genotoxicity, respectively. Real time PCR was utilized to quantify relative expression of genes related to oxidative stress, xenobiotic metabolism and DNA damage. Coal extract concentrations did not induce significant changes in HepG2 cell viability after 12h exposure; however, 50 and 100ppm of the coal extract produced a significant increase in genetic damage index with respect to negative control. Compared to vehicle control, mRNA CYP1A1 (up to 163-fold), NQO1 (up to 4.7-fold), and GADD45B (up to 4.7-fold) were up regulated, whereas PRDX1, SOD, CAT, GPX1, XPA, ERCC1 and APEX1 remained unaltered. This expression profile suggests that cells exposed to coal dust extract shows aryl hydrocarbon receptor-mediated alterations, changes in cellular oxidative status, and genotoxic effects. These findings share some similarities with those observed in liver of mice captured near coal mining areas, and add evidence that living around these industrial operations may be negatively impacting the biota and human health.

Atmospheric particulate matter size distribution and concentration in West Virginia coal mining and non-mining areas

People who live in Appalachian areas where coal mining is prominent have increased health problems compared with people in non-mining areas of Appalachia. Coal mines and related mining activities result in the production of atmospheric particulate matter (PM) that is associated with human health effects. There is a gap in research regarding particle size concentration and distribution to determine respiratory dose around coal mining and non-mining areas. Mass- and number-based size distributions were determined with an Aerodynamic Particle Size and Scanning Mobility Particle Sizer to calculate lung deposition around mining and non-mining areas of West Virginia. Particle number concentrations and deposited lung dose were significantly greater around mining areas compared with non-mining areas, demonstrating elevated risks to humans. The greater dose was correlated with elevated disease rates in the West Virginia mining areas. Number concentrations in the mining areas were comparable to a previously documented urban area where number concentration was associated with respiratory and cardiovascular disease.

The contextual influence of coal abandoned mine lands in communities and type 2 diabetes in Pennsylvania

Coal abandoned mine lands (AMLs), persistent and prevalent across Pennsylvania, offer an instructive evaluation of potential contextual influences of chronic environmental contamination (CEC) on individual health. We evaluated associations between the burden of AMLs, represented by 10 contextual metrics at the community level, and individual-level type 2 diabetes using hemoglobin A1c (HbA1c) as a biomarker. Cross-sectional and longitudinal multilevel analyses were conducted with over 28,000 diabetic primary care patients of the Geisinger Clinic. Adjusted models revealed five AML burden measures were associated (p<0.05), and three additional were borderline associated (0.05≤p≤0.10), with higher and/or change in HbA1c levels. This study provides key empirical evidence of adverse impacts of CEC in communities on an important chronic disease, illustrating the contextual effects of living in long-term degraded landscapes and communities.

Personal and family health in rural areas of Kentucky with and without mountaintop coal mining

PURPOSE

This study investigates health disparities for adults residing in a mountaintop coal mining area of Appalachian Kentucky. Mountaintop mining areas are characterized by severe economic disadvantage and by mining-related environmental hazards.

METHODS

A community-based participatory research study was implemented to collect information from residents on health conditions and symptoms for themselves and other household members in a rural mountaintop mining area compared to a rural nonmining area of eastern Kentucky. A door-to-door health interview collected data from 952 adults. Data were analyzed using prevalence rate ratio models.

FINDINGS

Adjusting for covariates, significantly poorer health conditions were observed in the mountaintop mining community on: self-rated health status, illness symptoms across multiple organ systems, lifetime and current asthma, chronic obstructive pulmonary disease, and hypertension. Respondents in mountaintop mining communities were also significantly more likely to report that household members had experienced serious illness, or had died from cancer in the past 5 years. Significant differences were not observed for self-reported cancer, angina, or stroke, although differences in cardiovascular symptoms and household cancer were reported.

CONCLUSIONS

Efforts to reduce longstanding health problems in Appalachia must focus on mountaintop mining portions of the region, and should seek to eliminate socioeconomic and environmental disparities.

A case-based toxicology module on agricultural- and mining-related occupational exposures

OBJECTIVE

To develop and assess a toxicology module to teach pharmacy students about farming- and mining-related occupational exposures in the context of an existing toxicology elective course.

DESIGN

A teaching unit that included lectures and case studies was developed to address the unique occupational exposures of patients working in agricultural and mining environments. Upon completion of this 4-hour (2 class periods) module, students were expected to recognize the clinical signs and symptoms associated with these occupational exposures and propose acceptable therapeutic plans.

ASSESSMENT

After completing the module, students scored significantly higher on a patient case involving suicide resulting from pesticide consumption. Seventy-three percent of the students scored higher than 90% on a 33-item multiple-choice examination. Eighty-two percent of students were able to correctly read a product label to determine the type of pesticide involved in an occupational exposure.

CONCLUSION

Pharmacy students who completed a module on occupation exposure demonstrated competence in distinguishing occupational exposures from each other and from exposure to prescription and nonprescription drugs. This module can be used to educate future pharmacists about occupational health issues, some of which may be more prevalent in a rural setting.

Residence in coal-mining areas and low-birth-weight outcomes

The objective of this study was to estimate the association between residence in coal mining environments and low birth weight. We conducted a cross-sectional, retrospective analysis of the association between low birth weight and mother's residence in coal mining areas in West Virginia. Birth data were obtained from the West Virginia Birthscore Dataset, 2005-2007 (n = 42,770). Data on coal mining were from the US Department of Energy. Covariates regarding mothers' demographics, behaviors, and insurance coverage were included. We used nested logistic regression (SUDAAN Proc Multilog) to conduct the study. Mothers who were older, unmarried, less educated, smoked, did not receive prenatal care, were on Medicaid, and had recorded medical risks had a greater risk of low birth weight. After controlling for covariates, residence in coal mining areas of West Virginia posed an independent risk of low birth weight. Odds ratios for both unadjusted and adjusted findings suggest a dose-response effect. Adjusted findings show that living in areas with high levels of coal mining elevates the odds of a low-birth-weight infant by 16%, and by 14% in areas with lower mining levels, relative to counties with no coal mining. After covariate adjustment, the persistence of a mining effect on low-birth-weight outcomes suggests an environmental effect resulting from pollution from mining activities. Air and water quality assessments have been largely missing from mining communities, but the need for them is indicated by these findings.

The mining and burning of coal: effects on health and the environment

Australia's coal conundrum is that all political parties say they are concerned about climate change while sanctioning an unprecedented expansion of coalmining and coal seam gas extraction in Australia. Australia's coal contributes to climate change and its global health impacts. Each phase of coal's lifecycle (mining, disposal of contaminated water and tailings, transportation, washing, combustion, and disposing of postcombustion wastes) produces pollutants that affect human health. Communities in which coalmining or burning occurs have been shown to suffer significant health impacts. The health and climate costs of coal are unseen, and when costs to health systems are included, coal is an expensive fuel.

The association between mountaintop mining and birth defects among live births in central Appalachia, 1996-2003

Birth defects are examined in mountaintop coal mining areas compared to other coal mining areas and non-mining areas of central Appalachia. The study hypothesis is that higher birth-defect rates are present in mountaintop mining areas. National Center for Health Statistics natality files were used to analyze 1996-2003 live births in four Central Appalachian states (N=1,889,071). Poisson regression models that control for covariates compare birth defect prevalence rates associated with maternal residence in county mining type: mountaintop mining areas, other mining areas, or non-mining areas. The prevalence rate ratio (PRR) for any birth defect was significantly higher in mountaintop mining areas compared to non-mining areas (PRR=1.26, 95% CI=1.21, 1.32), after controlling for covariates. Rates were significantly higher in mountaintop mining areas for six of seven types of defects: circulatory/respiratory, central nervous system, musculoskeletal, gastrointestinal, urogenital, and 'other'. There was evidence that mountaintop mining effects became more pronounced in the latter years (2000-2003) versus earlier years (1996-1999.) Spatial correlation between mountaintop mining and birth defects was also present, suggesting effects of mountaintop mining in a focal county on birth defects in neighboring counties. Elevated birth defect rates are partly a function of socioeconomic disadvantage, but remain elevated after controlling for those risks. Both socioeconomic and environmental influences in mountaintop mining areas may be contributing factors.

Health disparities of coal miners and coal mining communities: the role of occupational health nurses

This article investigates how the health disparities of Appalachian coal miners and coal mining communities could be decreased through a partnership with occupational health nurses. On-site health clinics managed by occupational health nurses working in the coal mining industry are proposed as a means to improve health care outcomes. Health effects, economic considerations, environmental impacts, and U.S. coal mining legislation and regulation are examined. An epidemiological approach is presented to the unique health effects experienced by Appalachian coal miners and coal mining communities within the context of existent socioeconomic disparities. The long-standing health crisis in Appalachian coal mining communities requires a multidisciplinary approach led by occupational health nurses.