A new industry-funded report disputes a series of West Virginia University studies that linked mountaintop removal to premature deaths, but also says coal mining's role in public health problems in the coalfields remains unclear.

Yale University researcher Dr. Jonathan Borak and his co-authors concluded that "coal mining is not per se an independent risk factor for increased mortality in Appalachia."

But the new paper, published this month in the peer-reviewed Journal of Occupational and Environmental Health, says that the results of a new data analysis "do not rule out the possibility that mining contributes to the development of the social environments and cultural practices that adversely impact health."

"This possibility seems most likely in those specific areas where mining is the principal industry," the paper says. "Likewise, our analyses do not rule out the possibility that some specific mining methods may have greater adverse effects than others on the physical environment."

In their paper, Borak and his co-authors said their results "underscore the substantial economic and cultural disadvantages that adversely impact health in Appalachia, especially in the coal-mining areas of Central Appalachia.

"Such overlapping risk factors and mortality rates illustrate how difficult it can be to disentangle the effects of the cultural environment from those of the physical environment, a difficulty made greater because the two interact," the Borak paper said.

The paper, "Morality Disparities in Appalachia: Reassessment of Major Risk Factors," strikes a much different tone than previous public relations statements about Borak's work from the National Mining Association, which funded his research on the issue.

Nearly two years ago, the association posted a message on social networking sites saying that a critique by Borak "debunks bogus studies" by WVU researcher Michael Hendryx. Last year, an industry law firm tried to dismiss one of Hendryx's studies, examining Appalachia's high rate of birth defects, by suggesting any such disparity was caused by inbreeding.

Over the last five years, Hendryx and various co-authors have published a series of 20 peer-reviewed studies examining possible links between mountaintop removal and various illnesses.

Hendryx has not pinpointed an exact cause and hasn't yet published work that tries to connect specific pollutants to health impacts. Instead, his work has linked health and coal-mining data to show, among other things, that residents living near mountaintop removal mines face a greater risk of cancer, birth defects, and premature deaths. Hendryx has not been funded by environmental and citizen groups, but those groups have seized on his findings to show that mountaintop removal isn't just an issue about mining's effects on salamanders, mayflies or isolated mountain streams.

In an email message Wednesday, Hendryx declined to comment in detail on Borak's paper, saying that he is preparing a formal response that he will submit to the journal that published it.

Hendryx did say that the Borak study examined different data, looking at only counties in Appalachia rather than nationwide and comparing counties only by whether they had mining or not, instead of using more detailed data on the amount of mining.

"They claim that their paper was intended to 'closely resemble' ours, but this is not the case," Hendryx said.

In his paper, Borak writes that, "to the extent that coal mining is a factor in defining the cultural fabric and socioeconomic environment of Appalachian communities, the coal-mining industry must play a role in efforts to increase economic diversity, develop job-creation programs, ensure access to appropriate health-care services, improve educational opportunities, and facilitate access to nutritious foods and diets."

Borak, in a phone interview, said that he believes it's more important for Appalachian leaders and communities to focus on fixing the region's serious economic and health problems than it is to argue over whether his study or Hendryx's work is correct.

"If he wants to say it's coal mining, he can say that, but I'm not sure he's correct," Borak said.

"There is a confluence of bad stuff that happens to these people," Borak said. "It is very difficult to distinguish the coal mining from the culture that surrounds them.

Richard Clapp, a retired professor of public health from Boston University, said that's exactly one of the problems with Borak's paper.

"The other factors these authors analyze are so intermixed with coal mining that it would be impossible to tease out coal mining as an 'independent risk factor' for mortality in Central Appalachia," Clapp said.

The National Mining Association has not issued any formal statements about Borak's paper. Last week, Bruce Watzman, vice president of the NMA, updated association members about the study in a note that was posted, and then removed, from a mining consultant firm's public website.

"We are advised that Dr. Borak has discussed the story with The Associated Press and that an article may be forthcoming," Watzman wrote. "It would be advisable that we defer to him to ensure the proper characterization of the study methodology and findings."

A coalition of coal companies has contributed $15 million to a multi-university effort to re-examine Hendryx's research and the work of other scientists who reported that mountaintop removal is damaging the environment.

"I think [Hendryx] is the object of a witch hunt," said University of California, San Francisco, professor Dr. Stanton Glantz, whose research on smoking's health effects has made him a frequent target of the tobacco industry.

Glantz said he read several of Hendryx's papers, Borak's previous critique of Hendryx and the published Borak study and wasn't impressed by the criticisms of Hendryx.

"There is no perfect study," Glantz said. "I can take any study -- including everything I've ever done -- and find things wrong with it. The National Mining Association is just nitpicking at minor problems that aren't really that important."