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Coal has historically been a primary energy source in the United States (U.S.). The byproducts of coal combustion, such as fine particulate matter (PM2.5), have increasingly been associated with adverse birth outcomes. The goal of this study was to leverage the current progressive transition away from coal in the U.S. to assess whether coal PM2.5 is associated with preterm birth (PTB) rates and whether this association differs by maternal Black/White race/ethnicity. Using a novel dispersion modeling approach, we estimated PM2.5 pollution from coal-fired power plants nationwide at the county-level during the study period (2000–2018). We also obtained county-level PTB rates for non-Hispanic White and non-Hispanic Black mothers. We used a generalized additive mixed model to estimate the relationship between coal PM2.5 and PTB rates, overall and stratified by maternal race. We included a natural spline to allow for non-linearity in the concentration–response curve. We observed a positive non-linear relationship between coal PM2.5 and PTB rate, which plateaued at higher levels of pollution. We also observed differential associations by maternal race; the association was stronger for White women, especially at higher levels of coal PM2.5 (>2.0 μg m−3). Our findings suggest that the transition away from coal may reduce PTB rates in the U.S.

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Metrics & MoreArticle RecommendationsI n the United States, the basic functions of cooking, heating, cooling, and hot water are often powered by natural gas. However, gas is responsible for the majority (81−87%) of carbon emissions generated by buildings. 1 Moreover, cooking with gas contributes to significant indoor air pollution. 2 A recent study published in Environmental Science & Technology further uncovered the presence of multiple volatile organic compounds in unburned gas from kitchen stoves, providing the most comprehensive documentation to date of healthdamaging pollutants stemming from gas stoves. 3 Among these pollutants was benzene, which decreases immune function and is a known carcinogen. The study also found that indoor gas leaks are an underappreciated source of indoor pollutants because most small leaks go undetected, 3 adding to the concerning finding that gas stoves leak even when turned off. 4 The implications of this study are clear: home dwellers need an alternative to gas-powered stoves that protects their health. However, transitioning away from such a ubiquitous appliance will carry an inherent set of infrastructural and individual-level challenges. Notably, very little is known about the barriers and facilitators of such a transition from a user perspective and through an equity lens.

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