Recent publications have associated the environmental impacts of mountain top coal mining in Appalachia with increased prevalence of chronic conditions such as obesity (OB) and comorbidities, i.e., diabetes mellitus (DM), heart diseases, cancers, and kidney diseases. Our previous review and subsequent study findings on chronic health conditions in coal communities in Central Appalachia indicated regional differences in lifestyle behaviors and sociodemographic factors. Programs targeting specific geographic areas can benefit using evidence based knowledge to implement interventions with measureable goals to reduce localized and persistent rates of chronic diseases. The objective of this cross-sectional study was to identify distinguishing social determinants of health affecting OB and DM in coal producing counties in West Virginia (WV) and Virginia (VA). Percent OB and DM and sociodemographic data on various factors were obtained from County Health Rankings (RWJF 2015) for the year 2012 for coal producing counties in WV (n = 31) and VA (n = 7). An analysis of external causes of death (NJ) served as a control for chronic health conditions. There were no significant differences in WV and VA county averages for coal production, DM, NJ, population, income, unemployment, poverty, persons over age 65, rurality, annual health care costs, and smoking. The significant differences noted were a higher OB rate in WV coal counties (33.94 ± 3.0, mean standard deviation) compared to VA coal counties (30.86 ± 2.27) (p = 0.02). The coal producing counties in VA had lower educational attainment in the population over 25, with 73 ± 4.7 percent with at least a high school education vs. WV rates of 79.9 ± 6.9 percent (p = 0.02). Likewise, 16.29 ± 0.49 percent of the population was uninsured in VA coal counties and 18.9 ± 1.8 percent uninsured in WV (p<0.001). Pearson's correlations indicated that seven sociodemographic factors correlated with NJ, six correlated with OB and four with DM. Consistently, unemployment and adult smoking positively correlated to OB, DM and NJ. Coal production was not correlated to OB, DM or NJ. In conclusion, health disparities continue to persist in coal production counties. Unemployment and smoking cessation were two factors identified to include in future intervention programs to benefit coal counties in WV and VA. Education with a focus on health literacy may benefit VA coal communities, and in WV counties weight reduction and strategies to improve rates of uninsured are suggested to benefit coal county residents. Our findings add support for multidisciplinary health care teams to engage local residents in prevention and self-managed care in communities with persistent health disparities. Funding source: This study was sponsored by the Appalachian Research Initiative for Environmental Science (ARIES). ARIES is an industrial affiliates program at Virginia Tech, supported by members that include companies in the energy sector. The research under ARIES is conducted by independent researchers in accordance with the policies on scientific integrity of their institutions. The views, opinions and recommendations expressed herein are solely those of the authors and do not imply any endorsement by ARIES employees, other ARIES-affiliated researchers or industrial members. Information about ARIES can be found at http://www.energy.vt.edu/ARIES.