Introduction to special section: Environmental health for rural populations.

The current issue of the Journal of Rural Health includes 4 papers that highlight the importance of environmental health for people who live in rural settings. Much environmental health research, such as exposure to automobile or industrial pollution, or exposure related to housing or neighborhood conditions (lead-based paint, neighborhood safety, etc), has a predominant urban focus. Rural environmental health research has focused primarily on exposures related to agricultural or animal husbandry activities as well as activities typically occurring in rural settings such as mining. One of the papers included in this section, on coal mining and public health, reflects this pattern. However, 3 of the 4 papers extend research into previously underrecognized rural environmental areas. The first paper provides a broad, “bird’s eye view” of the distribution of toxic chemical releases across rural and urban settings nationwide. The study uses data from the Toxics Release Inventory (TRI) program combined with mortality data from the Centers for Disease Control and Prevention and other data sources for covariates. The results show that greater levels of toxic chemical releases are related to higher total age-adjusted mortality rates. Significant statistical associations with mortality are present in rural areas for greater releases of chemicals into both air and water. The study demonstrates that exposure to potential industrial pollutants with corresponding health implications is not solely an urban phenomenon. Given that the design is county-level and ecological, the study is exploratory only. However, the data indicate that further research into the impacts of chemical releases on rural public health is warranted. The second study, led by Luo, explores that next research step. The study investigates how TRI releases of recognized carcinogens are related to adjusted lung cancer mortality rates. The results demonstrate that releases of carcinogenic chemicals, especially those released into the air, are related to higher lung cancer death rates. Furthermore, the study finds this effect specifically in smaller metropolitan areas or larger nonmetropolitan areas as opposed to the largest cities or most rural settings. The authors suggest that larger urban area effects may be masked by additional pollution sources or other population risk factors, but that small metropolitan or nonmetropolitan environments containing TRI facilities may be more independently affected by these facilities. This paper is also an ecological, county-level study (in fact, all 4 studies in the section are), so confirmatory research must be undertaken to determine the impact of specific releases on the health of individuals residing in these areas. As illustrated in the third and fourth papers, the environment includes the social, economic, and humanmade features that impact human health. The third paper, lead authored by Esch, documents both socioeconomic and potential environmental pollutant influences on cardiovascular mortality in areas of central Appalachia where mountaintop coal mining takes place. These mining areas are characterized by higher behavioral and economic risks (eg, smoking, poverty, and lower educational