A community-based approach to assessing emotional and behavioral disorders in children chronically exposed to coal ash

Purpose: In the United States, 1.54 million children are exposed to coal ash. Coal ash, the waste product generated from burning coal, is comprised of small particles containing neurotoxic metals. The EPA proposed a coal ash rule in 2010, since no federal regulations exist that govern the storage of coal ash. It is predominately stored in landfills and slurry ponds. Neurotoxic metals such as arsenic, lead, mercury, and manganese are commonly in coal ash; therefore children who are chronically exposed are at risk for emotional and behavioral disorders (EBDs). This is the first study to investigate coal ash exposure and EBDs in children. Methods: This research is based on a community-academic partnership with five low-income, non-transient, multi-generational neighborhoods that are adjacent to a coal burning power plant. The plant has five slurry ponds and a large landfill. Mixed methods were used to assess coal ash exposure and EBDs in children. Results: Overall, 37% of parents reported that their children suffered from EBDs. Learning disabilities and ADHD were the most prevalent. One parent summed it up: “A lot of children with learning difficulties. There are an extreme large amount of kids out there with learning difficulties…” Among those with EBDs, 71% lived in the neighborhood nearest the landfill. The majority of parents performed tasks to protect their children from exposure with little success. Conclusions: Based upon our current results, the prevalence of EBDs in children who are chronically exposed to coal ash is higher than population estimates of EBDs, which range from 5% to 26%. Quantitative findings are supported by focus group results where participants frequently reported neighborhood children affected by EBDs. This is the first research to assess the health of children who are chronically exposed to coal ash. The community-academic partnership will be valuable in conducting more robust studies.