Us-them relationships in a slow-motion technological disaster: Dynamics and consequences of stigma associated with asbestos-related disease in Libby, MT

Background: Widespread amphibole asbestos exposure in Libby, Montana created what EPA called the worst environmental disaster in U.S. history (more than 280 deaths, hundreds of asbestos-related disease (ARD) cases). Due to ARD's lengthy latency-period, the disaster continues to unfold. Stigma, a communication phenomenon involving labeling, manifests itself in us-them interpersonal relationships (Goffman, 1963) having potential public health consequences. Purpose: We analyzed stigma dynamics and their relationships to health/risk behavior (reducing risk, seeking diagnosis/treatment, providing social support, alcohol/tobacco use) in a community experiencing a slow-motion technological (human culpability involved) disaster. Significance: Previous research addressed rapidly-striking natural disasters' psychosocial consequences and stigmatizing responses to cancer and HIV. Prior to our recent qualitative (focus-group) research, which informed our survey design, research had not identified ARD as stigmatizing. Methods: A population-based survey mailed to randomly-selected households (n=1200) and ARD patients (n=100) was conducted in Libby. Questions assessed stigma processes (ARD-related prejudice, ARD-related secrecy/disclosure, stigmatizing beliefs/perceptions), stigma experiences of people with ARD (personal hurt, social rejection, social constraints against disclosing/discussing ARD), and the community at-large being stigmatized. Results: Results identify (a) factors associated with experiencing stigma and engaging in stigmatizing responses, (b) associations between stigma and health behavior, and (c) areas of “common ground.” Conclusion: Identified areas of “common ground” may provide a platform for interventions to reduce stigmatizing processes and thereby improve quality of life among people with ARD and heal the community. The Libby experience may facilitate understanding potential stigmatizing responses to ARD in other communities and developing interventions for other stigmatizing conditions.