News | Focus Environmental Health Perspectives • volume 124 | number 1 | January 2016 A 13 A Scourge Returns

In the early 1970s, coal workers ’ pneumoconiosis, or black lung, affected around one-third of long-term underground miners. After new dust regulations took effect, rates of black lung plunged. Today, however, they are once again rising dramatically, and the new generation of black lung patients have disease that progresses far more rapidly than in the past. © Tyler Stableford/Getty Focus | Black Lung in Appalachia Once a month, a group of men in t-shirts, jeans, and baseball caps gather around a long table at the New River Health Clinic. The clinic, a small, one-story yellow clapboard building, is located in the tiny town of Scarbro, nestled in the bituminous hills of southern West Virginia. The members of the Fayette County Black Lung Association greet each other by name while they pour bitter black coffee into small Styrofoam cups. Amidst the chatter and the coffee are the coughs. Some of the men hack loudly, others more quietly. All of them have advanced black lung, a disease they acquired working in the local mines. Although roughly 22 % of underground miners smoke,1 compared with about 18 % of U.S. adults in general,2 none of these men do. They gather not just as a support group but also to help one another complete the stacks of paperwork necessary to apply for government-mandated benefits for black lung and navigate the tortuous appeals process. Aside from the group’s leader, a bespectacled septuagenarian named Joe Massie, all the other members are in their 50s or early 60s. That’s relatively young for someone with advanced blac