Lay epidemiologies of asbestos-related disease in Libby, MT

Background: Slow-motion technological disasters (SMTDs) can engender multiple, often conflicting construals of the “problem,” the legitimacy of possible health threats, and how they should be rectified. Community organizations responding to SMTDs need to understand the diversity of citizens' lay beliefs about potential health hazards. Purpose: We explored lay epidemiologies (beliefs about disease distribution, determinants, morbidity, and mortality) held by residents of Libby, MT, where widespread amphibole asbestos exposure created what EPA called the worst environmental disaster in U.S. history (>290 deaths; hundreds with asbestos-related disease (ARD)); given ARD's lengthy latency period, thousands remain at risk. Method: Nine focus groups (N=66) were conducted in Libby with people with ARD, family members of people with ARD, and people without personal or family experience with ARD. Transcripts were analyzed for relevant themes. Results: Participants' beliefs about the distribution and determinants of ARD varied by personal experience. Many perceived ARD as clustering in families; those with personal experience attributed it to shared asbestos exposure, while some without personal experience attributed it to shared risky lifestyles or genetic propensity. Personal experience with ARD increased perceived seriousness of health risks and disease severity, but for some, certainty about the scope of the problem was undermined by a history of not diagnosing or misdiagnosing ARD. Conclusion: In Libby, lay epidemiologies influenced perceptions of personal risk for ARD and community conflict about the legitimacy and “true” nature of the disaster. Elucidating these beliefs may be critical to appropriate and effective community and agency responses to SMTDs.