Courtesy stigma at the community level: Stigmatized by association with the slow-motion technological disaster (SMTD) in Libby, MT

Background: Widespread amphibole-asbestos exposure in Libby, Montana created what EPA has called the worst environmental disaster in U.S. history (>290 deaths; hundreds with asbestos-related disease (ARD)). Stigma, a communication phenomenon involving labeling, manifests itself in us-them interpersonal relationships (Goffman, 1963) having potential public health consequences. “Courtesy stigma” is stigma “by association.” Our previous research found Libby advocates and people with ARD have been personally stigmatized. Purpose: We examined perceptions and experiences indicating the community as-a-whole has been stigmatized, and whether those perceptions and experiences were associated with experience with ARD (ARD Diagnosis, Family Members with ARD, No ARD Experience) and other psychosocial factors. Our previous qualitative (focus group) research guided the survey design. Significance: Previous courtesy stigma research focuses on individuals: family/friends of people with stigmatizing diseases, disabilities, or lifestyles; little is known about community-level courtesy stigma. Methods: We conducted a survey of randomly-selected households (n=528) and ARD patients (n=68) in Libby. Questions assessed perceptions and experiences of community-level stigma, and potentially associated psychosocial factors and consequences. Results: Substantial proportions of the community have personally experienced courtesy stigma; no differences occurred as a function of ARD experience. Courtesy stigma was significantly associated with psychosocial outcomes (adjustment, social support, relational resource losses); these relationships differ based on ARD experience. Conclusion: Courtesy stigma may constitute “common ground” and be a basis for developing community consensus in responding to the on-going disaster. The Libby experience may inform public health responses to SMTDs, including among those whose health is not compromised by the disaster.