Toxic social environments: A model for understanding and responding to slow-motion technological disasters based on the case of amphibole-asbestos exposure in Libby, Montana

Background: Widespread amphibole-asbestos exposure in Libby, Montana created what EPA has called the worst environmental disaster in U.S. history. Lincoln County has the highest per capita asbestosis mortality rate of all U.S. counties. Like Love Canal, Libby represents “a different kind of disaster” (Levine, 1982). Significance: Slow-motion technological disasters (SMTDs) are on the rise. Nearly half of the U.S. population lives within a 10-mile radius of designated/proposed Superfund sites. Current models for disaster responses, based on rapid-onset disasters, do not apply well to SMTDs. Little is known about their impact on psychosocial responses and mitigating/exacerbating factors. Purpose: Using population-based survey results, we developed a model for understanding the role of the social environment in psychosocial responses of victims' whose health has been compromised by a SMTD. Our previous qualitative (focus group) research guided the survey design. Methods: We surveyed randomly-selected households (n=528) and ARD patients (n=68), in Libby. Questions/measures assessed perceived community/family conflict, stigma and social support processes, perceived health/QOL, and psychosocial adjustment. Results: Our composite findings suggest that intra-community conflict, stigma, and resulting diminished/failed social support comprise a negative social environment which likely influences psychosocial adjustment among ARD patients. Our model posits that: (a) severity of disease affects patients' psychosocial adjustment, and (b) the impact of severity of disease on psychosocial adjustment is exacerbated by negative aspects of patients' social environment. Conclusion: Identifying factors that affect psychosocial adjustment and are amenable to intervention is important to planning effective responses by agencies, communities, and health professionals caring for SMTD victims.