Descriptive Analysis of the Health Status of a National Asbestos-Related Cohort

Funder:	Office of Rural Health Policy (ORHP)
Research center:	ORHP-funded Individual Grantees
Lead researcher:	Charlene A. Winters, PhD, ACNS-BC , 406.243.4608, winters@montana.edu
Project funded:	September 2006
Project completed:	August 2009
Topics:	Chronic diseases and conditions Health services

Injuries from asbestos exposure include asbestosis, pleural abnormalities, mesothelioma, and other cancers. Exact morbidity/mortality projections are complicated by the long latency period, inconsistent state reporting, and the absence of a national registry of fatal and non-fatal asbestos-related disease (ARD). However, national mortality surveillance of occupation-related respiratory diseases designated asbestosis as the leading pneumoconiosis recorded on death certificates from 1982-2000. As of 2002, more than 700,000 individual asbestos related disease claims had been filed in U.S. courts with as many or more claims expected in the future.

Considered one of worst occupational health disasters in U.S. history, a significant source of exposure to asbestos came from contaminated vermiculite ore mined in rural Libby, Montana and then distributed to over 200 regional processing and expanding plants in 32 states, providing nearly 80% of the world's supply of vermiculite. In 2000 the Center for Asbestos Related Disease (CARD) was established in Libby, Montana as a screening and treatment clinic for ARD. Today CARD manages a national cohort of approximately 1800 patients from 32 states. Although the physiological aspects of ARD exposure (asbestosis and mesothelioma) are known, the bio-psychosocial and health services implications have not been studied.

The purpose of this descriptive study is to establish a more comprehensive understanding of the bio-psychosocial health status and health service needs of persons exposed to Libby asbestos. Using existing clinical data and results from a questionnaire administered to patients of CARD, the following aims will be achieved: (a) describe the bio-psychosocial health status of persons exposed to Libby asbestos through an examination of the severity of chronic illness, depression, acceptance of illness, and stress, (b) explore the associations among severity of chronic illness, depression, acceptance of illness, and stress in persons exposed to Libby asbestos, and (c) evaluate access, availability, convenience, and financial aspects of care among the national Libby cohort. Dissemination of the results of this study through publications and presentation will give health care providers and policymakers a better understanding of the bio-psychosocial effects of this chronic illness and the health care needs of rural patients.

Publications

• Determining Satisfaction with Access and Financial Aspects of Care for Persons Exposed to Libby Amphibole Asbestos: Rural and National Environmental Policy Implications
  Author(s): Charlene A.Winters, Wade Hill, Sandra W. Kuntz, Clarann Weinert, Kimberly Rowse, Tanis Hernandez, Brad Black
  Citation: Journal of Environmental and Public Health
  Volume 2011, Article ID 789514
  Date: 05 / 2011
  The rural community of Libby, Montana is the epidemiological epicenter of asbestos-related disease with mortality rates 40–80 times higher when compared to rates in Montana and the USA.
• Psychosocial Health Status of Persons Seeking Treatment for Exposure to Libby Amphibole Asbestos
  Author(s): Clarann Weinert, Wade G. Hill, Charlene A.Winters, SandraW. Kuntz, Kimberly Rowse, Tanis Hernandez, Brad Black, Shirley Cudney
  Citation: International Scholarly Research Network, ISRN Nursing, Volume 2011, 11 pages
  Date: 2011
  A cross-sectional exploratory study was conducted to describe the psychosocial health status of persons seeking health care for exposure to Libby amphibole asbestos.
• Rural Public Health Policy Models to Address an Evolving Environmental Asbestos Disaster
  Author(s): Sandra W. Kuntz, Charlene A.Winters, Wade G.Hill, Clarann Weinert, Kimberly Rowse,Tanis Hernandez, Brad Black
  Citation: Public Health Nursing Vol. 26 No. 1, pp. 70–78, 2009
  Date: 2009
  Describes the history and outcomes of asbestos exposure in the Libby community and discusses 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. The foundation for the publication was our work with the Center for Asbestos Related Disease in Libby and our study funded by the Office of Rural Health Policy.