Principal components analysis to identify influences on research communication and engagement during an environmental disaster.

OBJECTIVES: To discern community attitudes towards research engagement in Libby, Montana, the only Superfund site for which a public health emergency has been declared. STUDY DESIGN: Survey study of convenience samples of residents near the Libby, Montana Superfund site. PARTICIPANTS: Residents of the Libby, Montana area were recruited from a local retail establishment (N=120, survey 1) or a community event (N=127, survey 2). MEASURES: Two surveys were developed in consultation with a Community Advisory Panel. RESULTS: Principal components of survey 1 showed four dimensions of community members' attitudes towards research engagement: (1) researcher communication and contributions to the community, (2) identity and affiliation of the researchers requesting participation, (3) potential personal barriers, including data confidentiality, painful or invasive procedures and effects on health insurance and (4) research benefits for the community, oneself or family. The score on the first factor was positively related to desire to participate in research (r=0.31, p=0.01). Scores on factors 2 and 3 were higher for those with diagnosis of asbestos-related disease (ARD) in the family (Cohen's d=0.41, 0.57). Survey 2 also found more positive attitudes towards research when a family member had ARD (Cohen's d=0.48). CONCLUSIONS: Principal components analysis shows different dimensions of attitudes towards research engagement. The different dimensions are related to community members' desire to be invited to participate in research, awareness of past research in the community and having been screened or diagnosed with a health condition related to the Superfund contaminant.

Social Support Functions During a Slowly-Evolving Environmental Disaster: The Case of Amphibole Asbestos Exposure in Libby, Montana.

Previous research concluded that victims of rapid-onset natural disasters (e.g., hurricanes) receive and provide high levels of instrumental support. However, different kinds of disasters (natural or human caused [technological, environmental, intentional/terrorism], rapid or slow onset, short or long duration) may create different stressors and thus influence the types of social support most needed and provided. We explored social support functions during an ongoing "slowly-evolving environmental disaster" in Libby, Montana due to widespread exposure to amphibole asbestos. Analyses of focus groups and in-depth interviews focused on the relative salience of support functions (emotional, informational, instrumental, and spiritual) identified as needed or provided. Dominant themes emerged around each function. Results indicated that informational support is particularly salient in this type of disaster. Although not all community members had experienced the disaster's health consequences (asbestos-related disease [ARD]), all had been affected by the disaster and had informational needs. The nature of those informational needs (e.g., medical vs. financial) varied based on experience with ARD. Experience with ARD was associated with awareness of disaster-related emotional and instrumental support needed or provided. Results have implications for future research on slowly-evolving environmental disasters and institutional and community responses to them.

The role of social toxicity in responses to a slowly-evolving environmental disaster: the case of amphibole asbestos exposure in Libby, Montana, USA.

Experiencing a disaster has significant negative effects on psychological adjustment. Case study accounts point to two consistent trends in slowly-evolving environmental disasters: (a) patterns of negative social dynamics, and (b) relatively worse psychological outcomes than in natural disasters. Researchers have begun to explicitly postulate that the social consequences of slowly-evolving environmental disasters (e.g., community conflict) have their own effects on victims' psychological outcomes. This study tested a model of the relationship between those social consequences and psychological adjustment of victims of a slowly-evolving environmental disaster, specifically those whose health has been compromised by the amphibole asbestos disaster in Libby, MT. Results indicate that experiencing greater community conflict about the disaster was associated with greater family conflict about the disaster which, in turn, was associated with greater social constraints on talking with others about their disease, both directly and indirectly through experiencing stigmatization. Experiencing greater social constraints was associated with worse psychological adjustment, both directly and indirectly through failed social support. Findings have implications for understanding pathways by which social responses create negative effects on mental health in slowly-evolving environmental disasters. These pathways suggest points for prevention and response (e.g., social support, stigmatization of victims) for communities experiencing slowly-evolving environmental disasters.

A Typology of Communication Dynamics in Families Living a Slow-Motion Technological Disaster.

With increasing numbers of communities harmed by exposures to toxic substances, greater understanding of the psychosocial consequences of these technological disasters is needed. One community living the consequences of a slow-motion technological disaster is Libby, Montana, where, for nearly 70 years, amphibole asbestos-contaminated vermiculite was mined and processed. Former mine employees and Libby area residents continue to cope with the health consequences of occupational and environmental asbestos exposure and with the psychosocial challenges accompanying chronic and often fatal asbestos-related diseases (ARD). Nine focus groups were conducted with Libby area residents. Transcripts were analyzed to explore patterns of family communication about ARD. The following five patterns emerged: Open/Supportive, Silent/Supportive, Open/Conflictual, Silent/Conflictual, and Silent/Denial. Open/Supportive communication included encouragement to be screened for ARD, information about ARD and related disaster topics, and emotional support for people with ARD. In contrast, communication patterns characterized by silence or conflict have the potential to hinder health-promoting communication and increase psychological distress.

Determining satisfaction with access and financial aspects of care for persons exposed to Libby amphibole asbestos: rural and national environmental policy implications.

Libby, Montana is a Superfund site and epicenter of one of the worst environmental disasters in the USA history in terms of asbestos-related mortality and morbidity. Perceptions of access and financial aspects of care were explored among a national cohort of persons postasbestos exposure and prior to a 2009 Public Health Emergency Declaration. Our findings indicated the Libby cohort was significantly less satisfied with access and financial aspects of care as measured by two PSQ-III scales when compared to an adult, chronically ill patient sample. Participants with higher levels of respiratory morbidity and depression had significantly lower satisfaction scores.

Psychosocial health status of persons seeking treatment for exposure to libby amphibole asbestos.

A cross-sectional exploratory study was conducted to describe the psychosocial health status of persons seeking health care for exposure to Libby amphibole asbestos (LAA). Health indicators including depression, stress, acceptance of illness, and satisfaction with access and financial aspects of care were obtained via electronic and paper-pencil survey. The exposure pathway and demographic data were gleaned from the health record. Of the 386 participants, more than one-third (34.5%) demonstrated significant levels of psychological distress. The oldest group of women had the lowest levels of depression and stress and the highest acceptance of illness. Gender, age, and satisfaction with financial resources were significantly related to depression, stress, and acceptance of illness. Satisfaction with access to care was significant only for stress. No differences in depression, stress, and acceptance of illness were found based on residence, exposure pathway, or insurance status.

Community-level social support responses in a slow-motion technological disaster: the case of Libby, Montana.

Social support is an important resource for communities experiencing disasters. However, a disaster's nature (rapid- versus slow-onset, natural versus technological) may influence community-level responses. Disaster research on social support focuses primarily on rapid-onset natural disasters and, to a lesser extent, rapid-onset technological disasters. Little research has addressed slow-onset disasters. This study explores social support processes in Libby, MT, a community experiencing a "slow-motion technological disaster" due to widespread amphibole asbestos exposure. A comprehensive social support coding system was applied to focus-group and in-depth-interview transcripts. Results reveal that, although the community has a history of normative supportiveness during community and individual crises, that norm has been violated in the asbestos disaster context. Results are interpreted as a failure to achieve an "emergent altruistic community." Specifically, community-level conflict appears to interfere with previously established social support patterns. The observed phenomenon can be understood as the deterioration of a previously supportive community.

Rural public health policy models to address an evolving environmental asbestos disaster.

The health-related dangers of asbestos exposure were recognized early in the 20th century when occupational exposure was found to be associated with excess pneumoconiosis among asbestos industry workers. Today, the epicenter for examining the public health effects and the human toll that this toxin has had on a population is located in the rural community of Libby, MT. Rurality and multideterminants of health frame both the history of asbestos-related disease and the service/policy challenges within a community dealing with chronic illness and designation as a Superfund clean-up site. Despite efforts by public health advocates to address the lingering aftermath of an environmental disaster in this community, policy gaps exist that continue to impact the population's health. The purpose of this paper is to describe the history and outcomes of asbestos exposure in a rural community and discuss 3 models that provide public health policy insights related to rural health and health care for a community affected by both a sentinel and ongoing environmental event.