Publications on Chronic Disease in Coal Dependent Communities in Central Appalachia

CONTEXT: Agency and nonprofit reports have traditionally been the source of health information in Appalachia. Recently, publications have appeared in the literature associating coal mining, specifically mountain top mining, with numerous chronic health conditions spurring debate among environmental and industry interest groups. Publication quantity and quality were objectively assessed. This article reports on a literature review and analysis of publications on chronic disease in coal dependent communities in Appalachia. OBJECTIVE: To conduct a review and analysis of original, peer reviewed research publications on chronic health conditions in communities dependent on coal mining with a focus on central Appalachia and report on publication and research quantity and quality. DATA SOURCES: Thorough searches were conducted using PubMed, EBSCO, and CiNAHL computerized databases to identify original, peer-reviewed research articles addressing ‘Appalachia’, ‘health’ and ‘coal’. STUDY SELECTION: The computerized database search identified original research publications relevant to chronic health conditions (heart disease, lung disease, kidney disease, cancers, diabetes, obesity, etc.) and coal mining in central Appalachia. DATA EXTRACTION: Quantitative measures of the literature review provided information on author collaborations, year of publication, frequency of publication by contributing authors, etc. Journal impact factors were noted and other objective qualitative criteria were considered. DATA SYNTHESIS: Over 60 publications relevant to mining with 38 publications specific to Appalachia and health were identified. The publications were reviewed relative to relevance and article quality i.e., current, original research, application to central Appalachia and discussions of chronic human health and coal mining. Over the past five years most of the publications relevant to chronic disease and coal mining in central Appalachia resulted from a research group with a single common author. CONCLUSIONS: Science based evidence is needed and data must be provided by independent researchers from various disciplines of study to share different perspectives on how to alleviate the longstanding health disparities in central Appalachia. Studies will require the application of sound methodologies to validate the findings and support future interventions

Amenities and Rural Appalachia Economic Growth

Patterns of economic growth in rural Appalachia are examined with a focus on natural and built amenities. While the literature is clear that rural areas endowed with scenic beauty, lakes, forests, and wildlife, among other natural amenities, and coupled with built amenities such as golf courses, are experiencing robust economic growth. It is not clear if these patterns extend to rural Appalachia. In this applied research study we use data for rural U.S. counties. We estimate an augmented Carlino-Mills growth model with specific attention to growth patterns of Appalachia. We also build on the empirical modeling by adopting a Bayesian Modeling Average (BMA) approach to address the problem of model specification. We find that while there are some commonalities across the whole of the United States, the country is sufficiently heterogeneous that impact of amenities or other policy variables may be significantly different depending on where one is within the country. Our results suggest that while non-metropolitan Appalachia tends to follow national trends, there are sufficient differences that warrant special attention.amenities, quality of life, rural economic growth, Bayesian, Community/Rural/Urban Development,

[Review of] William H. Turner and Edward J. Cabell, eds. Blacks in Appalachia

The editors are a civil rights worker (Cabell) and an academician (Turner) who evidence a longstanding interest in the Appalachian region and especially in the place and history of black people there. The articles are grouped into eight parts: Basic Approaches, Historical Perspectives, Community Studies, Race Relations, Black Coal Miners, Blacks and Local Politics, Personal Anecdotal Accounts of Black Life, and Selected Demographic Aspects. According to Turner\u27s article on the demography of Black Appalachia, he defines Appalachia as the Appalachian Regional Commission counties in Alabama, Georgia, Kentucky, North Carolina, South Carolina, Tennessee, Virginia and West Virginia

Natural Resource Curse and Poverty in Appalachian America

The Appalachian mountain region has long been characterized by deep poverty which led to the formation of the Appalachian Regional Commission (ARC) in 1965. The ARC region covers West Virginia and parts of 12 other states, running from New York to Mississippi (Ziliak 2012). The ARC region had an average county poverty rate of over 40 percent in 1960, about double the national average (Deaton and Niman 2012; Ziliak 2012). While the poverty gap between the ARC region and the rest of the nation closed significantly by 1990, it remained nearly twice as large in Central Appalachia. There are many reasons for higher poverty in Appalachia in general and Central Appalachia in particular. Possible causes include a low-paying industry structure, below average education, low household mobility, and remoteness from to cities (Weber et al. 2005; Partridge and Rickman 2005; Lobao 2004). A key distinction between Central Appalachia and the rest of the ARC region is its historic dependence on coal mining. There is long literature arguing that the area’s dependence on coal mining has contributed to its deep poverty through weaker local governance, entrepreneurship, and educational attainment, as well as degrading the environment, poor health outcomes, and limitations on other economic opportunities (Deaton and Niman 2012; James and Aadland 2011). These factors are broadly associated with the natural resources curse in the international development literature. More recently, the process of mountain top mining (MTM) has expanded coal mining’s environmental footprint in the region, possibly increasing health risks and further reducing the chances for long-term amenity-led growth that can alleviate poverty (Deller 2010; Woods and Gordon 2011). This study reinvestigates the causes of county poverty rates in Appalachia with a special focus on coal mining’s role. Using data over the 1990-2010 period we assess whether coal mining continues to have a positive association with poverty rates, even as the industry’s relative size has declined. We also appraise whether MTM is associated with higher poverty. We do this by comparing the ARC region to the rest of the U.S. and by using more disaggregated employment data that allows us to differentiate the effects of coal mining from other mining (versus aggregating all mining together as in past research). The results suggest that any potential adverse effects of coal mining on poverty have declined over time. Below, we first develop an empirical model followed by the empirical results. The final section provides our concluding thoughts

Persistence with Mammography Screening and Stage at Breast Cancer Diagnosis among Elderly Appalachia-West Virginia Women

The objective of this study is to evaluate the association between persistence with mammography screening and stage at breast cancer diagnosis in elderly Appalachia-West Virginia women diagnosed with first incident breast cancer. The study utilized West Virginia Cancer Registry-Medicare linked database to identify women age 70 and above diagnosed with first incident breast cancer in 2007. Persistence to mammography screening was defined as having had at least three mammography screenings before breast cancer diagnosis. A multiple logistic regression was conducted to assess the association between persistence with mammography screening and stage at breast cancer diagnosis in these women. Of the 221 elderly Appalachia-West Virginia women included in the analysis, 113 women (51.1%) were persistent to mammography screening before their diagnosis with breast cancer. In a multiple logistic regression after adjusting for all the variables, as compared to elderly women who were not persistent with mammography screening, women who were persistent with mammography screening were significantly more likely to be diagnosed with early stage breast cancer (adjusted odds ratio=4.25, 95% confidence interval=1.96-9.19). Persistence with mammography screening is significantly associated with earlier stages of breast cancer in the rural and underserved Appalachia-West Virginia women. The study findings suggest targeting interventions to encourage regular mammography in these women for whom there are no clear guidelines

Poverty and Mortality Disparities in Central Appalachia: Mountaintop Mining and Environmental Justice

Objectives. This study investigated the associations between poverty rates, Appalachian mountaintop coal mining, and age-adjusted total mortality rates to determine if persons exposed to this form of mining experience greater poverty and higher death rates compared to other types of mining or other areas of Appalachia. Methods. Mortality rates, poverty rates, Appalachian designation and mining activity were examined for counties in Kentucky, Tennessee, Virginia and West Virginia (N=403). Linear least squares models tested for annual group differences from 2000-2007 in total and child poverty, and total mortality, based on mining type and Appalachian location. Nested linear models accounting for state-level effects were used to determine whether mountaintop mining and poverty were associated with mortality rates controlling for other risks. Results. Mountaintop mining areas had significantly higher mortality rates, total poverty rates and child poverty rates every year compared to other referent counties of these states. Both poverty and mountaintop mining were independently associated with age-adjusted mortality rates in nested models. Conclusions. Persons living in MTM areas experience persistently elevated poverty and mortality rates. Higher mortality is independently associated with both poverty and MTM, the latter effect suggestive of a possible environmental contribution from mining activities. Efforts to reduce longstanding health disparities in Appalachia must focus on those areas where disparities are concentrated: the Appalachian coalfields

Environmental and Health Disparities in Appalachian Ohio: Perceptions and Realities

Background. Appalachia is a region of the United States that faces significant environmental and health disparities. Understanding these disparities and the social determinants that contribute to them will help public health practitioners make better decisions. The purpose of this research is two-fold. First, through secondary data analysis, we document environmental and health disparities as well as demographic and economic conditions that may contribute to these disparities between Appalachian and non-Appalachian Ohio. Second, we examine perceptions of environmental health practitioners about the differences in environmental conditions between Appalachian and non-Appalachian Ohio. Methods. We gathered secondary data about economics, health, and the environment from the Ohio Department of Health, Healthy Ohio Community Profiles, the U.S. Environmental Protection Agency, and the U.S. Census. In addition, we conducted an online survey of 76 environmental health professionals across Ohio. Results. The secondary data indicates that there are significant differences between Appalachian and non-Appalachian Ohio in terms of socioeconomic, health, and environmental indicators. In addition, environmental health professionals perceive worse environmental conditions in the Appalachian region and indicate that there are environmental and health disparities found in this part of the state that do not exist elsewhere. Conclusions. The results contribute to understanding environmental and health conditions that contribute to health disparities in the Appalachian region as well as suggest approaches for public health practitioners to reduce these disparities

AMERICA'S FORGOTTEN PEOPLE AND PLACES: ENDING THE LEGACY OF POVERTY IN THE RURAL SOUTH

This study focuses on the longstanding impoverishment of the rural South and three of its subregions-Appalachia, the Mississippi Delta, and the Black Belt. The poor quality of life in rural Appalachia and along the Mississippi Delta has been publically acknowledged by programs and commissions for improving conditions. However, the more comprehensive Black Belt subregion that links parts of Southern Appalachia and the Southern Delta has not received such regional policy attention. While the South as a whole is more rural and impoverished than other U.S. regions, this is largely due to the poor conditions in the Black Belt. In addition to region and rurality, a third feature of the pattern is race. It is in the Black Belt that the South's poor socioeconomic conditions are most concentrated. Policy and program attention are needed for regional solutions that take rurality and race into account along with demographic and other subregional characteristics.Appalachia, Black Belt, Mississippi Delta, policy, poverty, quality of life, rural, South, Community/Rural/Urban Development,