Down comes the mountain : coal mining and health in central Appalachia from 2000 to 2010.

69 Pages·2016·0.81 MB·English

UUnniivveerrssiittyy ooff LLoouuiissvviillllee
TThhiinnkkIIRR:: TThhee UUnniivveerrssiittyy ooff LLoouuiissvviillllee''ss IInnssttiittuuttiioonnaall RReeppoossiittoorryy
Electronic Theses and Dissertations
5-2014
DDoowwnn ccoommeess tthhee mmoouunnttaaiinn :: ccooaall mmiinniinngg aanndd hheeaalltthh iinn cceennttrraall
AAppppaallaacchhiiaa ffrroomm 22000000 ttoo 22001100..
James Kent Pugh
University of Louisville
Follow this and additional works at: https://ir.library.louisville.edu/etd
Part of the Sociology Commons
RReeccoommmmeennddeedd CCiittaattiioonn
Pugh, James Kent, "Down comes the mountain : coal mining and health in central Appalachia from 2000
to 2010." (2014). Electronic Theses and Dissertations. Paper 1162.
https://doi.org/10.18297/etd/1162
This Master's Thesis is brought to you for free and open access by ThinkIR: The University of Louisville's
Institutional Repository. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized
administrator of ThinkIR: The University of Louisville's Institutional Repository. This title appears here courtesy of
the author, who has retained all other copyrights. For more information, please contact [email protected].
DOWN COMES THE MOUNTAIN: COAL MINING AND HEALTH IN CENTRAL
APPALACHIA FROM 2000 TO 2010

By

James Kent Pugh
B.A., Berea College, 2012

A Thesis
Submitted to the Faculty of the
College of Arts and Sciences of the University of Louisville
in Partial Fulfillment of the Requirements
for the Degree of

Masters of Arts

Department of Sociology
University of Louisville
Louisville, Kentucky

May 2014

DOWN COMES THE MOUNTAIN: COAL MINING AND HEALTH IN CENTRAL
APPALACHIA FROM 2000 TO 2010
By
James Kent Pugh
B.A., Berea College, 2012

A Thesis Approved on

April 7, 2014

by the following Thesis Committee:

_______________________________
Robin S. Högnäs, Chair
Assistant Professor of Sociology

____________________________

Cynthia Negrey, Member
Professor of Sociology

____________________________

Kristina M. Zierold, Member
Associate Professor of Epidemiology & Population Health
ii
DEDICATION
This thesis is dedicated to my parents,
Mrs. Jeanie Denise Pugh
and
Mr. James Scott Pugh (R.I.P.).
Thorough their hard work and dedication I am here today.

iii
ABSTRACT
DOWN COMES THE MOUNTAIN: COAL MINING AND HEALTH IN CENTRAL
APPALACHIA FROM 2000 TO 2010
James Kent Pugh
April 7, 2014
Appalachia is one of the unhealthiest and most economically disadvantaged regions in
America. It has higher rates of diseases (including heart disease and cancer) than the rest
of the United States. Past research posits that low socioeconomic conditions in
Appalachia are the main determinants of health disparities, and a burgeoning body of
literature is examines the relationship between coal mining and health. The latter shows
that, when controlling for socioeconomic status, health status remains significantly lower
in coal-producing, Appalachian counties compared to non-coal producing Appalachian
counties. While previous studies examine coal production over one or two years, they do
not consider change in coal production and health over a longer period of time. This work
focuses on the relationship between coal production and health over an 11 year period in
counties in Eastern Kentucky and West Virginia. The results suggest that regional
changes in coal production are associated with changes in average county-level health.

iv
TABLE OF CONTENTS
PAGE
DEDICATION…………………………………………………………………………iii
ABSTRACT……………………………………………………………………………iv
LIST OF TABLES……………………………………………………………………..vi
LIST OF FIGURES…………………………………………………………………....vii
INTRODUCTION……………………………………………………………………....1
History of Coal in Appalachia…………………………………………………..1
Changes in Coal Mining Technology…………………………………………...2
Appalachian Health Trends……………………………………………………..4
Coal Mining and Health in Appalachia…………………………………………5
LITERATURE REVIEW……………………………………………………………….7
Conceptual Model of Socioeconomic Status, Environmental Exposure
and Health………………………………………………………………………7
Socioeconomic Status and Health………………………………………………8
Physical Environment and Health………………………………………………12
Physical Environment Health Risks in Appalachia……………………………..15
METHODS……………………………………………………………………………...21
Data……………………………………………………………………………...21
Dependent Variable……………………………………………………………..23
Independent Variables……..……………………………………………………24
Covariates……………………………………………………………………….25
Analytic Strategy………………………………………………………………..25
RESULTS……………………………………………………………………………….27
Descriptive Statistics……………………………………………………………27
Figures…………………………………………………………………………..31
Multivariate Statistics…………………………………………………………...33
DISCUSSION………………………………………………………………………......37
CONCLUSION…………………………………………………………………………42
REFERENCES………………………………………………………………………….47
APPENDICES…………………………………………………………………………..53
CURRICULUM VITA………………………………………………………………….60

v
LIST OF TABLES
TABLE PAGE
1. Sample County Characteristics for Eastern Kentucky and West
Virginia, 2000-2010…………………………………………………………..53
2. County-Level Health in Eastern Kentucky and West Virginia,
2000-2010: OLS, Random, and Fixed Effects Models……………………….54

vi
LIST OF FIGURES
FIGURE PAGE
1. Environmental Health Pathway……………………………………………….55
2. Proposed Study Area – Eastern Kentucky and West Virginia………………..56
3. Average County-Level MTR Coal Production in Central Appalachia,
2000-2010…………………………………………………………………….57
4. Average County-Level Coal Production in Central Appalachia, 2000-2010...58
5. Average County-Level Self-Reported Health Status in Central Appalachia,
2000-2010…………………………………………………………………….59

vii
INTRODUCTION
Appalachia has long been an unhealthy and poor region in the United States.
Central Appalachia, i.e., Eastern Kentucky and West Virginia, has higher rates of heart
disease, cancer, particularly breast cancer, stroke, and chronic obstructive pulmonary
disease (COPD) compared to the United States as a whole (Halverson, Ma , and Harner
2004). In 2009, approximately 6.5% of the adult population in West Virginia had
experienced a heart attack (Shanholtzer 2012). In 2011, 6.6% of adults in Kentucky had
experienced a heart attack compared to the overall national average, which was 4.4% of
adults (Kentucky BRFSS Data 2011).
While the overall rates of disease in Kentucky are concerning, these rates increase
dramatically across communities in Eastern Kentucky, where between 8-10% of the
population has experienced a heart attack, which is nearly double the national rates
(Kentucky BRFSS Data 2011). One characteristic associated with differences in chronic
illness both within Appalachia and between the region and other parts of the United
States is coal mining. The extent to which coal mining influences health adversely in
Appalachia is of increasing interest in the extant literature (and beyond) and is the
primary focus of this study.
History of Coal in Appalachia
Since the mid-19th century, coal mining and production in Central Appalachia has
been a primary energy source for many Americans. Coal mining started in earnest in the
1