Environmental exposures and pulmonary function among adult residents of rural Appalachian Kentucky

John C. Flunker, Wayne T. Sanderson, W. Jay Christian, David M. Mannino, Steven R. Browning

Research output: Contribution to journalArticlepeer-review


Background: Estimated residential exposures of adults to roadway density and several metrics of resource extraction, including coal mining and oil and gas drilling, were hypothesized to contribute to the prevalence of respiratory disease in rural Appalachia. Objective: Determine how small-area geographic variation in residential environmental exposures impacts measures of pulmonary function among adults in a community-based study. Methods: We examined associations between residential environmental respiratory exposures and pulmonary function among 827 adult participants of the “The Mountain Air Project”, a community-based, cross-sectional study in Southeastern Kentucky during 2016–2018. Exposures characterized the density of roadways, oil/gas wells, or current/past surface and underground coal mining at the level of 14-digit hydrologic unit code (HUC), or valley “hollow” where participants resided. Each participant completed an in-person interview to obtain extensive background data on risk factors, health history, and occupational and environmental exposures, as well as a spirometry test administered by experienced study staff at their place of residence. Multivariable linear regression was used to model the adjusted association between each environmental exposure and percent predicted forced expiratory volume in one second (FEV1PP) and forced vital capacity (FVCPP). Results: Adjusted regression models indicate persons living in HUCs with the highest level of roadway density experienced a reduction in both FEV1PP (−4.3: 95% CI: −7.44 −1.15;) and FVCPP (−3.8: 95% CI: −6.38, −1.21) versus persons in HUCs with the lowest roadway density. No associations were detected between the metrics associated with mining and oil and gas operations and individual pulmonary function. Impact statement: Our work demonstrates the potential adverse impact of roadway-related exposures on the respiratory health of rural Appalachia residents. We employed a novel method of small-area exposure classification based on the hydrologic unit code (HUC), representing potential exposure levels per hollow occurring in proximity to the residence, and controlled for individual-level risk factors for reduced respiratory health. We highlight an overlooked yet ubiquitous source of residential exposure from motor vehicles that may contribute to the regionally high prevalence of respiratory disease in rural Appalachia.

Original languageEnglish
JournalJournal of Exposure Science and Environmental Epidemiology
StateAccepted/In press - 2023

Bibliographical note

Funding Information:
The authors received support for this work from three federal grants: NIEHS R01 ES024771; NIEHS P30 ES026529; and CDC/NIOSH T42 OH010278 This work was supported by NIEHS R01ES024771-01, CDC/NIOSH T42OH010278, and NIH/NIEHS T32ES015459.

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer Nature America, Inc.


  • Hydrologic unit code
  • Pulmonary function
  • Resource extraction
  • Respiratory
  • Roadway exposure

ASJC Scopus subject areas

  • Epidemiology
  • Toxicology
  • Pollution
  • Public Health, Environmental and Occupational Health


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