Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

W. Jay Christian PhD, MPH

Committee Member

Steven Browning, PhD, MSPH

Committee Member

Erin N. Haynes, DrPH, MS


Background: Extraction of coal through mountaintop removal mining (MTR) alters many dimensions of the landscape, and explosive blasts, exposed rock, and coal washing have the potential to pollute air and water with substances known to increase risk of developmental and birth anomalies. Previous research suggests that infants born to mothers living in MTR coal mining counties have higher prevalence of most types of birth defects.

Objectives: This study seeks to examine further the relationship between MTR activity and birth defects by employing individual level exposure estimation through precise satellite data of MTR activity in the Appalachian region and maternal residence location.

Methods: Distance to active MTR from geocoded maternal address was calculated for live births to Appalachian Kentucky mothers between 1997 and 2003 (N=95,586). A dichotomous exposure, distance ≤ 1 kilometer was assigned, in addition to presence or absence of a birth defect grouped into six major organ systems. Separate multivariable logistic regression models determined associations with MTR exposure, adjusting for available covariates from birth certificate records.

Results: Only gastrointestinal birth defects were associated with maternal residential proximity to MTR mining (OR = 2.37, 95% CI = 1.19, 4.72).

Discussion: This study both agrees and contrasts with previous research while building upon the literature with a more rigorous exposure assessment. Research addressing the relationship between gastrointestinal birth defects and MTR coal mining is warranted but should consider the need to better characterize the type and amount of MTR contaminant exposure to strengthen results.

Available for download on Monday, October 30, 2023