Coal Tattoo

Coal River Mountain as seen from nearby Kayford Mountain. Photo courtesy of Coal River Mountain Watch.

There’s another new study out from West Virginia University’s Michael Hendryx, this one reporting, based on a community survey in the Coal River area of Boone and Raleigh counties:

Self-reported cancer rates were significantly higher in the mining versus non-mining areas after control for respondent age, sex, smoking, occupational history and family history.

Mountaintop mining is linked to increased community cancer risk. Efforts to reduce cancer and other health disparities in Appalachia must focus on mountaintop mining portions of the region.

The study, “Self-Reported Cancer Rates in Two Rural Areas of West Virginia with and without Mountaintop Coal Mining,” (subscription required)  was published online in the Journal of Community Health.

Hendryx co-authored the paper with Leah Wolfe and Juhua Luo of the WVU Department of Community Medicine. Also listed as a co-author is Bo Webb, a Coal River resident and activist who has long been concerned about the health impacts of mountaintop removal.

The new study is based on 773 interviews with local residents, in a community survey that the researchers designed, in part to try to investigate the health concerns that Bo and other residents have been raising for years. As the paper explains:

Local residents in mountaintop mining areas of West Virginia identified the problem based on their personal experiences and the experiences of their neighbors. They witnessed, for example, the explosions at the mining sites and the dust that subsequently settled over their porches, windows and gardens. They collected bottles of well water from their kitchen taps that were black with impurities from coal treatment settling ponds. Concerns about the health impacts from these conditions led them to contact a university researcher for assistance. The researcher and community members worked together to identify the study focus, develop the approach, plan the logistics, recruit interviewers for a door–door survey, conduct the survey, collect and analyze the data, and report the results. Throughout the process, the importance of maintaining objectivity and using the best possible survey instruments and methods was emphasized by all parties.

The actual interviews were done in March and were conducted by undergraduate students from several local colleges and universities who volunteered to conduct the work as a service project during their spring break week. Interviews were conducted along the Coal River Valley in an area roughly stretching from the Seth-Prenter communities down to Rock Creek. Separate interviews were conducted in Pocahontas County, which was used as a comparison community.

The interviews revealed a cancer rate in the Coal River communities of 14 percent, compared to a rate of 9 percent in Pocahontas County. Researchers controlled for various other potential factors, including age, sex, smoking, occupational exposure and family cancer history (but not for obesity) — and found “Coal River subjects reported significantly higher odds of cancer”:

The odds for reporting cancer were twice as high in the mountaintop mining environment compared to the non-mining environment in ways not explained by age, sex, smoking, occupational exposure, or family cancer history.

While this study does not include data for exposure to any mining pollution, it does outline possible impacts:

Environmental pollution contributes to cancer risk, and many chemicals that are present in coal, coal strata and coal processing activities are established or possible carcinogens.

Arsenic, for example, is an impurity present in coal that is implicated in many forms of cancer including that of skin, bladder and kidney. Cadmium is linked to renal cancer. Diesel engines are widely used at mining sites, and diesel fuel is used for surface mining explosives, coal transportation and coal processing; diesel exhaust has been identified as a major environmental contributor to cancer risk.

The paper continues:

Previous research on Appalachian health disparities has tended to focus on health care access problems, or behavioral risks such as poor diet and smoking, as the causal factors driving poor health outcomes. A recent study in Virginia, for example, identified higher cancer rates among Appalachian compared to non-Appalachian residents, and discussed the need for better health care in Appalachia. However, Appalachian Virginia also has mountaintop coal mining, and the environmental, social and economic impacts of coal mining are often overlooked in Appalachian health research. Mountaintop coal mining is damaging to the environment, and contributes to the area’s chronic economic problems; these areas have the highest poverty rates and highest unemployment rates in the region. Poor economic conditions are one of the most powerful predictors of poor public health outcomes.

Map of study areas. Cross-hatched areas indicate the approximate locations of survey activities

The paper is not without its limitations. The authors explained:

Study limitations include those relating to survey sampling procedures and the extent of questions asked. Contact attempts at most households occurred only once, and survey times did not include late evenings and weekends because of the logistical and cost difficulties involved in transporting and housing the student volunteers. This could result in survey respondents in both locations that are not necessarily representative of the entire populations. Survey procedures, however, were comparable in both communities and so would not be expected to result in an overestimate of cancer in Coal River relative to Pocahontas. Asking people if they have ever had cancer limits the cancer experience to survivors. Information on persons who died from cancer was not collected, which may explain why some cancer types such as lung cancer were observed rarely in the sample. In other research, higher lung cancer mortality in coal mining portions of Appalachia has been documented.

In addition:

The survey included limited information on covariates. The preference among the community research partners was to keep the survey brief so that as many surveys as possible could be collected in a short time. There were concerns expressed by community partners that if the time spent per survey was prolonged, such that fewer surveys could be completed/day and more time had to be spent in Coal River to collect an adequate sample size, word about the survey taking place would reach the coal industry, and community residents would be instructed or pressured by industry representatives not to take part. Limited covariate data precluded investigating the possible impacts of such variables as obesity or health care access on cancer.

After data collection the research partners convened to discuss how the study process could be improved for possible replication in other communities. There was agreement that future efforts should attend to data collection during weekend and evening times, and how some additional data would have been worth the extra survey time to collect. In addition to extra covariates such as obesity, community partners expressed the importance in future studies of collecting cancer data not just on biologically-related family members but on spouses, as they knew of cases where a husband or wife had recently died of cancer, but these data were not collected in the survey. These discussions illustrate the utility of the community-based participatory model in helping both parties (academic researchers and community residents) learn from each other to make research efforts more practical and effective.

The paper concludes:

There are 1.2 million people who live in mountaintop coal mining counties in central Appalachia based on 2010 US Census data. If the rates found in this study represent the region, a 5% higher cancer rate (14.4% vs. 9.4%) translates to an additional 60,000 people with cancer in central Appalachian mountaintop mining counties. On a national level, the difference between 11.2 and 3.9% (the rates in the Coal River sample and the US, respectively, not including non-melanoma skin cancers) translates to an additional 87,600 people with cancer in central Appalachian mountaintop mining areas compared to national rates. Although, these projections are uncertain, they illustrate the large numbers of people who are potentially impacted by mountaintop mining environments.

The people of Appalachia constitute a nationally recognized priority population for the elimination of health disparities. The results of this study and others previously cited on coal mining populations demonstrate that health disparities are concentrated in mountaintop mining areas of the region; clearly, the national goal to eliminate Appalachian health disparities will not be achieved unless disparities are eliminated in mountaintop mining areas.