UK gets $3.7 million grant to find out why Appalachian Kentucky is so sleep-deprived, part of 'public-health epidemic' cited by CDC

By Elizabeth Chapin
University of Kentucky

The University of Kentucky has received a $3.7 million grant from the National Institutes of Health to find out why people in the Appalachian region of Kentucky have such consistently poor sleep outcomes.

Poor sleep is linked to a wide range of medical issues, including hypertension, diabetes, depression, obesity and cancer. With more than a third of U.S. adults reporting insufficient sleep, the Centers for Disease Control and Prevention calls a "public-health epidemic."

Kentuckians are some of the nation’s most sleep-deprived, particularly in the state's Appalachian counties, where 25% to 58% of adults report insufficient sleep, defined as less than six hours a day.

Over five years, the team will track the sleep of 400 adults from Appalachian Kentucky, along with health information such as heart rate, physical activity, blood sugar levels, and immune function. Participants will also report their daily experiences including stress and substance use.

Participants will come from 12 Appalachian counties: six coalfield counties that have been identified as insufficient sleep hotspots (Pike, Knott, Perry, Letcher, Bell and Whitley), and six non-coal counties that are not considered hotspots (Jackson, Lincoln, Russell, Adair, Rockcastle and Estill) even though they have comparable economic distress, rurality, and demographics.

Researchers will look for what drives sleep deficiencies and health outcomes over time, how factors linked to sleep deficiencies differ between hotspot and non-hotspot counties, and the degree to which daytime distress affects sleep.

Ph.D.s Christal Badour and Mariead Moloney

The study, titled "Researching Equitable Sleep Time in Kentucky Communities (REST-KY)," is led by Associate Professors Mairead Moloney and Christal Badour.

It aims to provide answers to longstanding questions about the causes and consequences of sleep deficiencies in rural populations, not just Appalachia. But the new knowledge will inform interventions to reduce sleep disparities among people in Appalachia, who also experience severe health inequities including higher mortality rates for many conditions including diabetes, heart disease and cancer.

“Sleep is the critical pivot point for understanding ways in which people in this region experience health disparities,” said Badour. “If we can understand why people are getting poor sleep, we can then identify interventions that can help them sleep better, which would have cascading benefits for many aspects of their health.”

The REST-KY team includes experts across four UK colleges: Badour, Moloney, Suzanne Segerstrom and Lauren Whitehurst from the College of Arts and Sciences, Daniela Moga from the College of Pharmacy, Nancy Schoenberg from the College of Medicine, and Emily Slade from the College of Public Health.

“This collaboration of experts across so many disciplines will enable us to get a holistic look at the biological, behavioral, emotional, and social contributions to sleep health,” Moloney said.

The REST-KY grant is one of NIH’s prestigious “R01” awards. It builds on the team’s previous interdisciplinary research, including a 2018 intervention study to address insomnia among women in Appalachian Kentucky.

UK Rural and Underserved Health Research Center symposium Nov. 12; topics include opioids, vaccines, hospitals, miners' health

The Rural and Underserved Health Research Center is holding a free half-day symposium to discuss research in a wide range of topics, including: rural opioid misuse and suicide, pneumonia-vaccine disparities, the impact of rural hospital closures on emergency services, and health-care utilization among coal miners with black lung and other respiratory diseases.

The symposium will be held at the University of Kentucky Gatton Student Center, Senate Chamber A268, from 9 a.m. to 11 a.m. Nov. 12. The event is free, but registration is required before Nov. 5. Click here to register. Click here to see the full agenda.

The RUHRC is a grant-funded program that focuses its research on access to healthcare and substance abuse treatment in underserved rural areas of the United States, including Appalachia. The research is meant to better inform health policy makers "with the ultimate goal of reducing inequities in care and improving population health in rural communities," says its website.

Interior Department official met with coal industry lobbyists before canceling study on health effects of surface mining in Appalachia

A top official in the Department of the Interior met repeatedly with coal-industry lobbyists shortly before canceling a study on the public health effects of surface mining, Jimmy Tobias reports for the Pacific Standard.

Katharine MacGregor

Katharine MacGregor, the principal deputy assistant secretary for land and minerals management, oversees the Office of Surface Mining Reclamation and Enforcement. OSM hired the National Academies of Science, Engineering and Medicine to do the study, but Interior abruptly suspended it last August, as researchers were about to hold their final public meetings on it. The meetings were held, and researchers said they expected to continue after a budget review that Interior had cited as the reason for the suspension, but then Ken Ward Jr. of the Charleston Gazette-Mail revealed that the study was the only one suspended. Later, the contract was canceled and the research committee disbanded.

Tobias writes: "Emails obtained through a FOIA request show that Katharine MacGregor had a hand in ensuring the health study's cancellation. Indeed, she appears to have been keenly interested in the matter." She wrote the OSM director Aug. 17: I thought you told me on the phone that this was postponed?" The next day, OSM suspended the work.

“This is the very essence of what we mean when we describe Appalachia as a sacrifice zone,” said Bob Kincaid, president of Coal River Mountain Watch, a group fighting mountaintop-removal mining. Bo Webb, coordinator of the Appalachian Community Health Emergency campaign, which helped prompt West Virginia officials to ask for the study, said in the same press release, "It’s clear now that canceling this study was a gift to the coal industry.."

Tobias reports that "in the months leading up to the cancellation," MacGregor's calendar "shows that she had no fewer than six meetings with the most powerful mining players in the country. In both April and May of 2017, she met with the National Mining Association. In March and June, meanwhile, she met with Arch Coal, a long-time practitioner of mountaintop removal mining in Appalachia."

The evidence is circumstantial, but Tobias sees a broader trend in MacGregor's calendars: "At the same time she held a mere handful of meetings—fewer than 10, according to my tally—with conservation organizations like The Wilderness Society and Sportsmen for the Boundary Waters." The calendar sshow that she "appears to have a habit of meeting repeatedly with industries and organizations that later receive favorable treatment from agencies she helps oversee," Tobias writes. An Interior spokesperson told him MacGregor is "happy to make time to meet with whomever requests a meeting," including conservation groups. "We have always welcomed input from all citizens and will continue to listen to ideas and concerns from anyone interested in sharing them."

As black lung surges in Appalachia, so do lung transplants

A new study published in the American Journal of Industrial Medicine shows that, as black-lung cases have surged in the Central Appalachian coalfield, so have lung transplants. The expensive surgery can be risky, and most transplant recipients die within five years. The study, conducted by researchers from the National Institute for Occupational Safety and Health, "found that 62 black lung patients had lung transplant surgery over the past two decades, and most of the miners lived in Kentucky, Virginia, and West Virginia," Benny Becker reports for Ohio Valley ReSource. "The study also found that more than two dozen patients were placed on a wait list for transplants. Of those, 11 died while waiting."

The study's lead author, David Blackley, said that the rate of lung transplants for black-lung patients increased nearly threefold in the last decade. "That suggested pretty strongly to us that this is a problem that's getting worse," he told Becker.

Insurance from coal companies and other private sources paid for about one third of the lung transplants. Nearly two-thirds were paid for with public insurance, including 26 percent paid for by Medicare and up to 24 percent paid for by the federal Black Lung Disability Trust Fund. "That fund has paid more than $45 billion to cover benefits for miners who can’t seek benefits from their employer, because the responsible company has either gone bankrupt or can’t be identified," Becker reports. A federal study is looking into how long the fund can stay solvent given the rise in cases.

The researchers who conducted the study had also recently discovered that the spike in late-stage black lung in Central Appalachia is the largest cluster of the disease ever recorded.

Denied federal funding, study on the health effects of mountaintop-removal coal mining has been abandoned

"After Trump administration officials ordered a halt to a study on the health effects of mountaintop removal last fall, the study’s committee has been released, effectively terminating the project," Kate Mishkin reports for the Charleston Gazette-Mail.

"The National Academies of Sciences, Engineering and Medicine’s study would have looked at the health effects on residents who live near mountaintop removal coal-mining sites. It was put on hold when the Department of the Interior’s Office of Surface Mining announced that it was reviewing grants and agreements that would cost more than $100,000."

An Interior spokesperson did not answer any questions about why the study was terminated and whether it might be revived in the future. Riya Anandwala, a spokesperson for the National Academies, would not speculate on the reason for the study's termination, but told Mishkin it was "not unprecedented, but it's very rare."

In county with 75% on Medicaid and 12.4% unemployed, Salyersville mayor ponders Medicaid's new work rules

Kentucky's new Medicaid plan requires some of its recipients to work or volunteer will be phased in, with poor areas last, but some are worried that finding work there won't be easy, and that enforcing the new requirement will cause some to lose their coverage.

"I would not be truthful if I didn't say it's a big challenge," Kristi Putnam, the Medicaid waiver program manager for the state, told Miranda Combs of Lexington's WKYT-TV.  "It's a big project. There are a lot of moving parts and lots of partnerships."

Kentucky was the first state the federal government allowed to require some of its Medicaid recipients to work, volunteer or get job training 80 hours a month to keep their health insurance. This requirement will largely affect those who gained coverage through the expansion of the program, under federal health reform, to those with incomes up to 138 percent of the federal poverty level.

Combs compared unemployment and Medicaid numbers and found that "the latest unemployment rate numbers were above the state average in each of the 10 counties with the highest percentages of Medicaid recipients," making many wonder where these people are going to work.

Screenshot of WKYT interactive map with percentage of population on Medicaid 

The top 10 Medicaid counties have between 58 percent to 82 percent of their population on the program, and have unemployment ranging from 5.2 percent to 12.4 percent. The statewide unemployment rate is 4.4 percent.

Combs talked to Salyersville Mayor Pete Shepherd about how 75 percent of the people in Magoffin County ended up on Medicaid.

"We got here because the federal government decided in the 1960s to give food stamps and welfare to everybody that was under a certain threshold," Shepherd said, adding that the loss of coal jobs added others to the rolls.

"We had a lot of people that went off good-paying jobs to nothing," Shepherd said. "It's not their fault, and a lot of them would work if there were jobs available."

Shepherd, who said he needed more guidance from the state on the program, also voiced his concern about the new work rules, saying, " You can't make jobs if there's nothing there to have for jobs."

Putnam told Combs that the state will help people meet the  new requirements, which won't be rolled out in Magoffin County until November.

Putnam estimated that about 239,000 people in Kentucky will have the "community engagement requirement," and that half of them already meet it. "It's really intended to help connect people to resources so that they aren't in the multi-generational poverty situation where they depend on benefits," she said.

Opponents of the plan are concerned that the lock-out periods for failure to meet work requirements, pay premiums, or report changes or renew coverage in a timely manner will result in Kentuckians losing their health coverage. The Bevin administration recognizes that many will lose their coverage, estimating that there will be 95,000 fewer Kentuckians on Medicaid in five years than without the program, partly because of "non-compliance."

Three nonprofit groups representing 16 Kentuckians have sued the federal government to block Kentucky's Medicaid waiver. The Trump administration and Gov. Matt Bevin want the case to be heard in federal court in Frankfort.

National Academies of Science say study of surface mining's link to health is only one Interior has suspended, refuting department

When the Interior Department suspended a National Academies of Science, Engineering and Medicine study on the possible health effects of large-scale surface coal mining in Central Appalachia, it said it was part of a review of all grants and partnerships costing more than $100,000. But the study "is the only one of eight current Interior-funded National Academies projects that has been put on even a temporary hold, according to Academies officials," Ken Ward Jr. reports for the Charleston Gazette-Mail.

"Seven other projects with funding of $100,000 or more are continuing without any such orders from the department or anyone else in the Trump administration," Ward reports. "The mountaintop-removal study, with a $1 million price tag, is the largest of the studies. The total Interior funding for the other seven is roughly $2.8 million, according to National Academies officials," who are part of a "private, non-profit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine," Ward notes.

Steve Gardner

The scientific journal Nature objected to the suspension of the study, calling it a rare event and noting that little research has been done in the area, partly due to opposition from the coal industry. "Among the coal industry critics of the research was J. Steven Gardner, a Kentucky mining engineer identified by Environment & Energy News as the front-runner" for director of the Office of Surface Mining Reclamation and Enforcement, which contracted for the study, Ward notes. Citing "multiple sources," reporter Dylan Brown wrote, "Gardner's name has been in the rumor mill since shortly after Election Day."

Gardner "was part of a multi-company team hired to analyze the potential economic impacts of the Stream Protection Rule, the Obama administration's seven-year quest to impose new restrictions on coal-mining pollution," Brown notes. "Gardner testified before Congress that he and other team members refused to change their assumptions for calculating the rule's impact under pressure from OSMRE and were subsequently fired. OSMRE, for its part, argued that work by Gardner and his colleagues was shoddy and both sides parted ways after not renewing their contract."

Study on strip mining and health suspended, but all sides were heard at meetings already scheduled in Hazard and Lexington

Historical map shows mountaintop-removal sites in red, other
strip mines in yellow. (For a larger version, click on the image.)

By Melissa Patrick
Kentucky Health News

A study of possible health risks of living near big strip mines in Central Appalachia held what may have been its final public meetings in Kentucky last week, following suspension of the study by the Trump administration.

On Aug. 18, the Office of Surface Mining Reclamation and Enforcement told the National Academies of Sciences, Engineering and Medicine to stop all work on the study, citing a budget review of the Interior Department, OSMRE's parent agency.

"The National Academies believes this is an important study and we stand ready to resume it as soon as the Department of the Interior review is completed," the academies said in a statement, but the spokeswoman for the agency said they didn't know when that might be.

The academies created an 11-member committee to review the available research on the health effects of mountaintop removal and other forms of surface coal mining, and identify gaps in the research for study.

A number of studies have shown that surface mining is associated with higher rates of cancer, heart disease, birth defects and other health conditions in Central Appalachia, but have not established a connection, and other studies have been inconclusive or not even found correlation.

Hazard and Lexington meetings

The committee's first Kentucky meeting, Aug. 21 in Hazard, included coal-mine visits and a public meeting. The second was Aug. 22 in Lexington, where the panel heard from Kentucky environmental officials, geologists and others.

Several who spoke at Hazard said they hoped the Trump administration would restart the study and also expressed concerns that "mountaintop mining hurts air and water quality, impairs human health and destroys mountains and streams," Bill Estep of the Lexington Herald-Leader reports.

"Science isn’t going to hurt us. What we don’t know very well could," said Dee Davis of Whitesburg, president of the Center for Rural Strategies.

Coal-industry representatives said "Coal companies do a good job of reclaiming land and monitoring water quality," Estep reports. Tyler White, president of the Kentucky Coal Association, said his organization supports the decision to halt the study and the tax dollars appropriated for it would have been better spent combating health problems or drug abuse in the coalfield.

Glynis Bourd of Ohio Valley Resource reports that the effects of surface mining on health have been a concern of people in Central Appalachia for a long time. Her story includes a detailed video timeline demonstrating them.

At the Lexington meeting, Larry C. Taylor, an environmental scientist for the state Department for Environmental Protection, told the panel that a state study found there was no correlation between two metals, arsenic and chromium, in drinking water and cancer incidence and deaths in Eastern Kentucky. The metals are released by mountaintop removal and other large-scale surface mining.

Richard Wahrer of the state Department of Natural Resources said state regulators perform extensive evaluations on the impact of mining on watersheds. "Remember, water can't leave the mining site unless it is in compliance with established standards," he said. "We have not had material damage occurring outside the cumulative impact area."

Viney Aneja, a professor at North Carolina State University, reported on his study that measured the environmental exposure of residents in southwest Virginia to coal dust generated by trucks hauling coal from a nearby surface coal mine.

The study found that coarse dust particles, called PM10, often exceeded the national standards in locations both near and about one mile away from the surface mine, and on some days were three times higher than the national standards. PM10 particulates, which can be as small as 2.5 micrometers across, can easily be inhaled and pose a risk of lung damage.

Charles Snavely, secretary of the Kentucky Cabinet for Energy and the Environment and a former coal executive, said he had never heard anyone in his Eastern Kentucky community attribute a health problem to coal mining.

"I don't see how you could tell it because the problems that we have in the coalfields of Kentucky are obesity, smoking, lack of exercise, poor medical care and drug abuse," he said. "I'm sorry, I tried to stay to data . . . but I and a bunch of people who work there, grew up there, lived there our entire adult lives and I never heard that complaint once." He is a native of Prestonsburg.

Others weigh in

Luke Popovich, a spokesman for the National Mining Association, told The New York Times that the decision to halt the study may have been justified: “The National Institute of Environmental and Health Sciences concluded in July that after examining available studies, it didn’t see evidence justifying a health hazard, noting that no conclusive evidence connected mountaintop mining with health effects and that studies often failed to account for extraneous health and lifestyle effects.”

Actually, the institute said it could not reach any conclusion because the existing research had a "strong potential for bias." It called for more research and concluded: "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."

The American Public Health Association said in a statement that the study's suspension shows the Trump administration's "disregard for science and evidence when it comes to the environment and safeguarding health."

U.S. Rep. John Yarmuth, D-Louisville, who has introduced legislation to block new surface-mining permits until the health risks have been determined, said in a statement: “The fact that mountaintop-removal permits have been approved when there has never been a federal study on the health effects of mountaintop-removal mining is shameful enough. To now prevent this study from being completed would be reprehensible."

National panel studying surface coal mining's effects on health sets meetings Mon. night in Hazard, Tue. afternoon in Lexington

In a study of possible health risks from large-scale strip mining, the National Academies of Sciences, Engineering and Medicine will hold two public meetings in Kentucky.

The first meeting will be held from 6:30 to 9 p.m. Monday, Aug. 21, at the Perry County Library, 289 Black Gold Blvd. in Hazard.

The second meeting will be held from 12:45 to 5 p.m. Tuesday at the Marriott Griffin Gate Resort, 1800 Newtown Pike in Lexington.

The study was commissioned by the Interior Department's Office of Surface Mining Reclamation and Enforcement, citing a “growing amount of academic research that relates to possible correlations between increased health risks as a result of living near surface coal mine operations.”

Bill Estep of the Lexington Herald-Leader notes, "Several studies have concluded that mountaintop mining in Central Appalachia is associated with higher rates of cancer, heart disease and other health problems among local residents." The leading researcher has pointed to dust containing rare-earth metals as a likely cause. However, a 2012 study by a Yale University researcher and others for coal interests "did not find that mining or mining-related pollution directly contributed to health problems in Central Appalachia," Estep notes. "Rather, the results pointed to 'substantial economic and cultural disadvantages that adversely impact the health of many area residents,' the study said." The leading researcher says his work has accounted for those issues.

Information about the study can be found here. For more information, or to register to attend, email rchappetta@nas.edu or call 202-334-2766.

Scenario for reviving Obamacare repeal: Name Manchin to head Energy Dept. and replace him with a Republican senator

Senate Majority Leader Mitch McConnell could get the 50th vote he needs to pass an Obamacare repeal bill through a political shuffle by President Trump, who has been sniping at McConnell about failure to pass one.

It would work this way: Trump would name Energy Secretary Rick Perry secretary of homeland security, replacing Gen. John Kelly, who recently became Trump's chief of staff. Then Trump would name Democratic Sen. Joe Manchin of West Virginia energy secretary, and GOP Gov. Jim Justice would appoint a Republican to fill Manchin's unexpired term.

"Some congressional Democrats think it's possible, even likely," reports Harris Meyer of Modern Healthcare. "If the 49 GOP senators who voted for McConnell's stripped-down repeal bill last month backed the new legislation, the McConnell wouldn't need the votes of the three Republicans—Susan Collins, Lisa Murkowski and John McCain—who voted no last time."

"Rep. Karen Bass (D-Calif.) said Monday morning at a health-care town hall in Chicago that she and other Democrats expect Manchin will be offered the job and he will accept it," Meyer reports. "Then, they expect McConnell to quickly launch a new drive to pass a repeal-and-replace bill. That's what Trump has been needling McConnell to do since the previous bill failed by one vote on July 28, when McCain dramatically turned his thumb down."

There is also the possibility that McCain could resign from the Senate if his brain cancer progresses, Christopher Condeluci, a health-care lobbyist and former Senate Republican staffer, told Meyer. Arizona also has a Republican governor.

"Ron Pollack, chairman-emeritus of Families USA, who helped build grassroots support for ACA's passage in 2010, said he is skeptical about the Manchin replacement scenario, but he cautioned that ACA supporters should remain vigilant," Meyer reports. "Even if Republicans succeed in executing this personnel switcheroo, McConnell wouldn't necessarily have 50 votes he needs to pass either the so-called skinny repeal bill or a broader repeal-and-replace package."

Tom Miller, a conservative health policy analyst at the American Enterprise Institute, told Meyer, "The next hurdle is finding 50 real votes for skinny repeal when McCain isn't available to bail out up to a half-dozen or more Republican senators who voted for it very reluctantly last time."

The Hill notes, "Manchin was reportedly considered for the job after Trump's election in November." Manchin, who faces a potentially tough re-election battle in 2018, represents a state that has swung sharply Republican, largely because of troubles of its signature industry, coal, during the Obama administration.

Federal study in Central Appalachia will try to see if living near a surface coal mine is bad for your health

Scientists from the National Academies of Sciences, Engineering and Medicine will study Eastern Kentucky, West Virginia and the coal regions of Virginia and Tennessee to determine if living near a surface mine increases the risk of health problems, Bill Estep reports for the Lexington Herald-Leader.

"A number of studies have shown that mountaintop mining is associated with higher rates of cancer, heart disease and other health problems in Central Appalachia," Estep writes. "Michael S. Hendryx, a professor who did several of the studies while formerly at West Virginia University, told the Herald-Leader last year that the studies were adjusted to account for factors such as higher rates of smoking and obesity in the region."

"However, the coal industry has fiercely disputed the studies, and a 2012 industry-funded study by a Yale University researcher and others concluded that 'coal mining is not per se the cause of increased mortality in rural Appalachia,'' Estep writes. "The study by the National Academies could identify gaps in existing research and help settle some of the uncertainties about the issue."

The U.S. Office of Surface Mining Reclamation and Enforcement, which commissioned the two-year study, "said the research agency would choose experts to examine a 'growing amount of academic research that relates to possible correlations between increased health risks as a result of living near surface coal mine operations,'" Estep writes. "The study will involve synthesizing existing research, not conducting new field studies." (Read more)

Eastern Kentucky has some of the nation's highest cancer mortality rates, study finds

Eastern Kentucky has some of the highest cancer rates in the U.S., says a study by researchers at the Institute for Health Metrics and Evaluation at the University of Washington published in the Journal of the American Medical Association. While cancer mortality rates declined 20.1 percent from 1980-2014, death rates in poor counties with high rates of obesity and smoking, such as Eastern Kentucky, rose by about 50 percent. (UW map: Mortality rate for cancer and other neoplasms for both sexes, by county, in 2014)

Researchers used data from the National Center for Health Statistics, the Census Bureau and the Human Mortality Database from 1980 to 2014 for 29 cancers. During that time, there were 19.5 million cancer deaths in the U.S.  From 1980 to 2014, the cancer mortality rate declined from 240.2 to 192 per 100,000.

"In counties with the highest 2014 cancer death rates, six of the top 10 were in Eastern Kentucky," Lindsey Tanner reports for The Associated Press. "Six of the 10 lowest rates were in the Colorado Rockies. For lung cancer deaths, four of the five counties with the highest 2014 rates were in Eastern Kentucky, with rates up to 80 percent higher than in 1980." (Map: Percent change in mortality rates for cancer and other neoplasms, 1980-2014)

"Three of the five counties with the lowest 2014 rates were in the Colorado Rockies, where rates dropped by up to 60 percent," Tanner writes. "Death rates for breast and colorectal cancers increased in Madison County, Mississippi, and in 2014 were at least five times higher there than in Summit County, Colorado, where the rates fell."

Researchers found that "for many cancers, there were distinct clusters of counties with especially high mortality. Clusters of breast cancer were present in the Southern belt and along the Mississippi River, while liver cancer was high along the Texas-Mexico border, and clusters of kidney cancer were observed in North and South Dakota and counties in West Virginia, Ohio, Indiana, Louisiana, Oklahoma, Texas, Alaska and Illinois."

As coal declines in Central Appalachia, what is its legacy in health, including mental health?

As the coal industry declines, rapidly in Central Appalachia, there are "clues suggesting that health and mental-health issues will pose enormous challenges to the affected coal communities, and will linger for decades," Georgia State University biology professor Roberta Attanasio writes for The Conversation US.

Appalachia's death rates are higher than in the nation as a whole, Attanasio notes: "A study that examined the elevated mortality rates in Appalachian coal mining areas for 1979-2005 linked coal mining to 'socioeconomic disadvantages' and concluded that the human cost of the Appalachian coal mining economy outweighed its economic benefits."

A retired coal miner looks at Kayford Mountain in West
Virginia in 2007. (Photo by Andrea Hopkins for Reuters)

Attanasio notes research showing correlations between mountaintop-removal mining and poor health: "They show that when mountaintop removal increases, well-being decreases. However, they do not show that mountaintop removal directly causes a decline in well-being because of the nature of the pollutants and the nature of the exposure to them. Despite the intricacy of studying this area, links to adverse outcomes such as birth defects, cancer, and lung, respiratory and kidney disease, are undeniable."

Mountaintop mining may also affect some people's mental health, Attanasio writes: "People who gain a strong sense of identity from the land are most likely to experience negative outcomes. Environmental philosopher Glenn Albrecht coined the term solastalgia as 'a feeling of chronic distress caused by negatively perceived changes to a home and its landscape,' which he observed in his native Australia due to the effects of coal mining. People who experience solastalgia lack the solace or comfort provided by their home; they long for the home environment to be the way it was before. In a study of Australia published in 2007, Albrecht and collaborators documented the dominant components of solastalgia linked to open-cut coal mining in the Upper Hunter region of New South Wales – the loss of sense of place, the feeling of threats to personal health and well-being, and a sense of injustice and/or powerlessness."

Attanasio notes a survey-based study in Central Appalachian areas with and without coal "indicated that individuals who experience environmental degradation caused by mountaintop-removal mining are at increased risk for depression. The study showed that the odds of a score indicative of risk for major depression are 40 percent higher in areas subjected to mountaintop-removal mining when compared to non-mining areas. Furthermore, the risk of major depression is statistically elevated only in mountaintop-removal areas, and not in areas subjected to other forms of mining, even after statistical control for income, education and other risks."

CDC doesn't deliver on reported promise to probe health effects of surface coal mining, but other federal agencies are tackling it

When Shaping Our Appalachian Region was formed to help improve and diversify the economy of Appalachian Kentucky, one of the 10 working groups on issues was about health, which is not good in the region.

As the working group held 16 meetings around the region, it heard repeated concerns about the health impacts of surface coal mining, which has evolved from small contour-strip mines around hillsides to huge mines that take the tops off of mountains.

At every meeting, someone brought up the West Virginia University research that showed a correlation between poor health and surface mining, such as increased rates of cancer and birth defects, according to Dr. Nikki Stone, a University of Kentucky dentist in Hazard.

Dr. Nikki Stone (Photo by Mimi Pickering, Appalshop)

“It was something that people were afraid to talk about, but it came up over and over, and it ended up at the top of our list,” along with a coordinated health program in schools, Stone told Benny Becker of West Virginia Public Broadcasting. "In its final report, the working group advised that SOAR should ask a federal agency for help studying the issue," Becker notes.

But when SOAR published the working groups' ideas a few weeks later, it listed only the "shortest-term recommendations" and did not include the mining study. At the health session of SOAR's "Strategy Summit" in May 2015, Dee Davis of the Whitesburg-based Center for Rural Strategies asked the moderator/presenter, Jennifer "Jenna" Seymour of the federal Centers for Disease Control and Prevention, what if anything was being done about the recommendation. Seymour replied that she wasn't aware of it. But when questioned about it, she said that she had heard about it.

Davis told Becker that CDC Director Thomas Frieden told the working group when it presented its recommendations that if they made a request the CDC would investigate. "Davis said that as far as he knows, that was the last time anybody from the CDC acknowledged the request. The CDC recently confirmed that the agency is not engaged in any such research," Becker reports. "It’s not clear where exactly things got stalled, but SOAR Executive Director Jared Arnett said there’s a reason why the group tends to steer clear of environmental issues."

“It’s about uniting, and a lot of things that may not be a part of SOAR that people want to be a part of SOAR are very divisive,” Arnett told Becker. He said earlier that the group would focus its health efforts on substance abuse, obesity and diabetes.

Davis told Becker, “If we want our talent to be part of what turns our region around, then it’s not really going to help us to sweep big questions about cancer and birth defects under the rug. . . . It’s about building an economy in a place,” Davis said, “and part of that is making sure that our communities are places people want to live.”

But while CDC hasn't acted, two other federal agencies have. At the request of the state of West Virginia, the federal Office of Surface Mining Reclamation and Enforcement gave the National Academy of Sciences $1 million to examine existing research, primarily done by Indiana University's Michael Hendryx when he was at West Virginia University. "Another study, from the National Institute of Environmental Health Sciences, was announced last year, and has already produced a draft," Becker reports. "NIEHS Director Linda Birnbaum recently visited eastern Kentucky and said she expects that study will be released within the year."

Mercury levels prompt warning to eat top-predator fish no more than once a month, other Ky. fish no more than once a week

All Kentuckians should limit consumption of fish from the state's waters because they are too contaminated with mercury, according to the latest official advisories.

Previously, only children 6 or younger and women of childbearing age were advised to take care eating Kentucky fish. "State officials have found more fish in more waterways with higher levels of mercury, so they've tightened up their consumption warnings," explains James Bruggers, environmental writer for The Courier-Journal. Mercury comes largely from coal-fired power plants; Kentucky gets about 90 percent of its electricity from coal.

“Contaminants, like mercury, can be harmful to the brain and nervous system if a person is exposed to too much of them," Kathy Fowler, director of the Division of Public Health Protection and Safety, said in a news release. "We ask that Kentuckians be mindful of the kinds and amounts of fish they consume, particularly more sensitive populations such as infants, young children and pregnant women.”

The advisories are not as strong for panfish (bluegill, crappie, rock bass and sunfish) and bottom-feeders (buffalo, carp, most catfish, creek chub, drum, redhorse, sturgeon and sucker); as they are for top predators, where mercury can accumulate through the food chain. Those include bass, blue and flathead catfish, gar, muskie, sauger and walleye.

The general public is advised to eat no more than one meal per month of predatory fish and no more than one meal per week of panfish and bottom feeder fish. Sensitive populations (women of childbearing age and children 6 and younger) are advised to eat no more than six meals per year of predatory fish and no more than one meal per month of panfish and bottom feeder fish. A meal for a 150-pound person is considered to be 8 ounces. Here's a chart:

Special advisories remain in effect for certain bodies of water that have been contaminated for years, such as the Mud River, ruined by polychlorinated biphenyls from the Rockwell International plant in Russellville. Here is that chart:

West Virginia researcher says mountaintop-removal mining correlates with poor health in Central Appalachia, including Ky.

Michael Hendryx

By Tim Mandell
Kentucky Health News

No apparent health disparity exists in Appalachia except in areas where mountaintop removal is occurring, said Michael Hendryx, professor at the School of Public Health at Indiana University, during a lecture Thursday at the University of Kentucky. Hendrix's lecture, "Mountaintop Mining and Public Health," examined scientific research—conducted by him and others—into health effects in Appalachia since large-scale mountaintop removal was introduced in the 1990s. Hendrix, who was part of a 2010 study that called for an end of mountaintop removal, did most of his research in West Virginia, which shares most of the Central Applachian coalfield with Kentucky.

Hendrix presented data comparing Appalachian areas that have mountaintop removal with Appalachian areas without it, showing that heart, lung and kidney disease, cardiovascular and respiratory disease, and birth defects are all typically more common in areas with mountaintop removal. Also, air and drinking-water pollution—consisting of both well water and public water—are usually higher in mountaintop removal areas.

Hendryx said politicians have stood in the way of eliminating mountaintop removal, despite plenty of scientific evidence of its negative impact on public health. "It's surprising the political and economic power that the coal industry still has," he said. "It doesn't produce the jobs that it used to. It's clearly in decline. Yet it seems to me that politicians will still fall all over each to see who's more pro-coal, and that still seems to influence voters."

While some have called efforts for clean energy a "war on coal," Hendryx argues that coal-depressed communities can find other ways to improve local economies. "Some of the regions have coal; some don't," he said. "They're hilly, they're forested, they're rural . . . the places that didn't have coal developed other ways for people to make a living. . . . If you look at the data, it's clear that the areas that have the heaviest mining have the highest unemployment rates, the highest poverty rates, the lowest income levels. The other areas that didn't have coal developed better alternatives to generate better economies."

Asked for a reply, Kentucky Coal Association President Bill Bissett said, “Anti-coal ideologue Michael Hendryx continues his road show against coal production and use by, once again, committing sins of commission in discussing his research. He won’t tell you that he gathers his data by employing environmental groups, like Restore Eden, to do his interviews, so should we expect any result than one that agrees with this anti-coal agenda?"

Candidates for governor make misstatements and questionable assertions in debate, many about health issues

By Al Cross
Kentucky Health News

Many of the questionable assertions and outright misstatements in Sunday night's debate for governor were about health care. Here's a fact check:

Bevin said Conway lied when he said Bevin would kick half a million people off health care. Bevin said in February that he would immediately end Gov. Steve Beshear's expansion of the Medicaid program. He has since denied saying that, and said last night that Democratic videos of his quotes omit the question he was asked, but that is not the case with his February quote. He now says he would seek a federal waiver to change the program. It might be argued that he could issue another executive order to replace Beshear's, but the Medicaid program has certain requirements that must be met unless waived, and waivers are not available immediately. While Bevin has been vague about his Medicaid plans, he has made clear for the last three months that his actions would not be as abrupt as he first said they would be.

Conway said the Kynect health-insurance exchange, which Bevin wants to abolish, is three and a half times more efficient than the federal exchange, to which policyholders would go. Bevin said that is "an absolute falsehood" because Kynect is funded by a 1 percent fee on all health-insurance policies in Kentucky and only 2 percent of the policies are bought through Kynect. Conway said afterward that he was referring to the 3.5 percent fee charged by the federal exchange, which would make those policies more expensive. While the term "efficient" could arguably be applied to the cost of those policies, a more common interpretation of Conway's comment would be that he was talking about Kynect's operating efficiency.

Bevin said the Kentucky Health Cooperative, a non-profit health insurer that is closing due to losses and lack of money, was "a distinct part" of the study that predicted the Medicaid expansion would pay for itself until 2020. The cooperative is not mentioned in the study. Bevin said afterward that the co-op was part of the "inputs" considered by the study. Reminded that the issue was the sustainabilty of the Medicaid expansion, Bevin noted the 51,000 co-op policyholders who will be losing their coverage. Reminded that Kynect has seven other insurers they can select from, Bevin asked, "Where are those taxpayers dollars going to go?" He was reminded that the co-op was funded by federal dollars, and "Those are our dollars." Bevin is running for governor, not president, but he is trying to appeal to people who dislike the entire "Obamacare' system. He appears to be using the co-op's failure to suggest that the system is not sustainable. However, the co-op, Kynect and the Medicaid expansion operate separately and are separately funded.

Conway quoted Bevin as saying that early childhood education, Conway's main issue, "serves no purpose." Bevin said was "another of those Democrat lies" because his full quote was that it serves no purpose after the third grade. That is based on a study that showed the effects of Head Start disappear after the third grade. Head Start is not the same as the early-childhood education program advocated by Conway, but Bevin has equated the two in the past.

Conway said he had cut his budget as attorney general by 40 percent. Bevin said that was a lie because the legislature writes the budget. The governor receives budget requests from agencies and proposes a budget to the legislature, which passes it.

Bevin said the state does not have the surplus that Conway mentioned because it has "tens of billions of dollars in unfunded liabilities." He was referring to state pension funds, which get annual appropriations from the budget but are financially separate. Budgets are for two years and the unfunded liability is for projected payments for current employees for the rest of their lives.

Bevin said, "It's a false idea that coal jobs can't come back." He noted that world coal demand has never been higher, but that ignores the facts that many electric plants in the U.S. have abandoned coal for cheaper natural gas and the coal in Central Appalachia is by far the most expensive to mine in the U.S. The Kentucky part of that coalfield has lost half its coal jobs in the last three years.

New test developed by top expert at UK will lead to earlier diagnosis of COPD, in which Kentucky leads the nation

A University of Kentucky professor helped develop a new tool to diagnose chronic obstructive pulmonary disease, which is often diagnosed late and is more prevalent in Kentucky than anywhere else in the nation, Laura Joszt reports for The American Journal of Managed Care.

“Undiagnosed and untreated COPD can lead to detriments in quality of life, and basically people start doing less because they have difficulty breathing,” said Dr. David Mannino, professor of medicine at UK's College of Public Health. “Many people attribute this difficulty of breathing to just getting older when, in fact, they may have a disease that is potentially treatable.” Mannino is recognized as the top U.S. expert on COPD, according to a UK news release.

COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. It includes diseases like emphysema, chronic bronchitis and asthma. It is the third leading cause of death in the U.S., according to the federal Centers for Disease Control and Prevention. Kentucky has the highest COPD rate in the nation, 9.3 percent of its population.

Likely causes of that are Kentucky's high smoking rate (26.5 percent); its high level of poverty, which often limits access to medical care; and its high rate of agriculture and mining jobs, which expose workers to dust and other irritants that can lead to COPD, Maren Auxier writes for the Lung Institute.

“Smoking is the number-one risk factor for COPD. If you look at a map of cigarette smoking, it will match very tightly with a map of COPD," Mannino writes. Several studies, including one by UK researchers, have found that there are fewer COPD hospitalizations in places with comprehensive bans on smoking in workplaces.

On top of all that, at least one-third of Americans get a late-stage diagnosis, which decreases the possibility of an intervention," Joszt reports.

The new five-step diagnostic tool developed by Mannino at UK combines a five-question "yes" or "no" questionnaire that asks about the patient's lifestyle with two common non-invasive methods for diagnosing COPD: a peak-flow examination and spirometry. Previous screening methods to diagnose COPD relied on the patient's smoking history, cough and sputum.

Mannino said at a recent European Respiratory Society meeting that a study has found that his new tool to be the most effective diagnostic approach, and UK will now test the effectiveness of the tool among different populations.

"Not only could the tool help health providers diagnose COPD in mere seconds, but it could help patients find out if they suffer from COPD symptoms before a visit with the doctor," Joszt writes.

Opioid overdose deaths remain a huge concern in poverty-stricken Eastern Kentucky counties; Boston Globe takes note

Drug overdoses from opioid use remain a concern in Eastern Kentucky, especially in poverty-stricken regions where coal mines have shuttered, Brian MacQaurrie reports for The Boston Globe. In 2014 Kentucky had 1,087 deaths from opioid overdoses, more than from traffic mishaps.

In Bell County (Wikipedia map) nearly two-thirds of adults "do not have jobs, and addiction to opioid painkillers has metastasized," MacQuarrie writes. "Miners often turned to painkillers after injuries, and many of their children became dependent on opioids stashed as close as the medicine cabinet. Nearly everyone here knows someone who has become addicted or died from opioids."

"The opioid death rate in 2013 was 93.2 per 100,000 people in Bell County, nearly double that of any other Kentucky county," MacQuarrie writes. "But C. Frank Rapier, who directs a federal task force attacking the epidemic in Appalachia, said the devastation in Bell County also reflects what is happening in neighboring counties, where federal officials believe opioid deaths have been grossly underreported."

"The death rate in Bell County dropped in 2014, but the figure remains troublingly high," MacQuarrie writes. "Many children are raised by grandparents, some mothers prostitute their daughters, and hospice providers lock medications in theft-proof safes at the homes of the soon-to-be deceased. Nancy Hale, who leads the drug-prevention efforts in the region, told him, “We’ve lost a whole generation of people who would have been paying taxes, and buying homes, and contributing to society."

Former state trooper and Pineville native Micky Hatmaker said the blame mostly falls on big pharmaceutical companies for "aggressively marketing painkillers and on unscrupulous doctors and pharmacists who dispense them," MacQuarrie writes. Hatmaker told him, “This thing took over Appalachia like a cancer." Purdue Pharma paid a federal-court settlement of hundreds of millions of dollars in 2007 for its promotion of Oxycontin, and Kentucky has its own lawsuit pending.

In an attempt to eliminate pill mills, Kentucky in 2012 became the first state "to enact a strict mandate that physicians check a patient’s drug history before writing new prescriptions," MacQuarrie writes. As part of the plan, Attorney General Jack Conway has been "aggressively targeting doctors whose practices are designed to profit from addiction." As a result, "prescriptions of oxycodone, a powerful opioid, have dropped 10.5 percent. Prescriptions for hydrocodone—also used to relieve pain—have fallen 11 percent."

Judges have handed down harsher sentences for owners of pain clinics, including a 14-year sentence given in June to the owner of two clinics, MacQuarrie writes. Another area of success "has been Operation UNITE, a large nonprofit group that has carried a drug-prevention message to tens of thousands of students in venues from classrooms to archery camps. More than 3,700 people have received $5,000 vouchers from the group for substance-abuse treatment. And police detectives working with Operation UNITE have removed $12.3 million of drugs from the street since 2003." Operation UNITE has received much federal funding, thanks to House Appropriations Committee Chairman Harold "Hal" Rogers, who represents most of Eastern Kentucky.

The Boston Globe did its story because Massachusetts also faces an opioid overdose epidemic, with 1,256 deaths from opioid overdoses in 2014. That has led to a shared bond between the two states, with Senate Majority Leader Mitch McConnell (R-Ky.) and Sen. Edward J. Markey (D-Mass.) joining forces to ask for a surgeon general’s report on the crisis and detailed answers on how the Department of Health and Human Services will measure progress on opioid deaths and addiction. (Read more)