Reactions of asbestos-exposed workers to notification and screening

Our plain-English summary of Reactions of asbestos-exposed workers to notification and screening, by B.E. Meyerowitz, C.D. Sullivan, C.L. Premeau (American Journal of Industrial Medicine, 1989).

The study

• Authors: B.E. Meyerowitz, C.D. Sullivan, C.L. Premeau
• Journal: American Journal of Industrial Medicine
• Published: 1989;15(4):463-75
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000130).

Abstract

In the wake of efforts to pass legislation mandating notification of workers at high risk of developing occupational disease, considerable controversy exists regarding the potential costs and benefits of such notification efforts. It has been suggested that individual notification would cause undue psychological distress, especially when primary prevention efforts are no longer possible. In this study, we assessed reactions of asbestos-exposed workers to a letter notifying them of their risk for asbestos-related illnesses and the availability of a medical screening program. Two hundred forty-seven workers who attended the screening program and 53 who chose not to attend completed a questionnaire that tapped reactions to notification. Workers reported neither undue psychological distress nor avoidance behavior in response to notification, and many respondents reported engaging in active and appropriate coping behaviors. Workers who first learned of their risk through the notification letter (33.7%) were no more likely to report distress or denial than were workers who had learned previously through other sources. Individuals who chose not to attend the screening program were less likely than attenders to report experiencing distress upon learning of their risk status, more likely to engage in minimization of risk, and less likely to have taken direct action. Our results suggest that the psychological costs of notifying workers of increased risk for asbestos-related illness appear to be outweighed by the benefits of notification and screening.

In plain English

This study asked asbestos-exposed paperworkers how they reacted to a union letter warning them of high risk for asbestos-related illness and offering free medical screening. They had worked at an acoustical tile and wallboard plant in Minnesota, where asbestos was used from about 1958 to 1974. In 1986, 247 workers who attended the screening and 53 who did not completed anonymous questionnaires. About one-third (33.7%) said they first learned of the hazard from the letter. In reaction to the letter, 39.3% reported feeling worried and 26.5% upset. Appreciation for the screening was reported by 84.3% of attenders and 48.9% of nonattenders. Workers who first learned from the letter did not differ from others on any listed item about reactions to it. Nonattenders more often reported minimizing the risk. Screening found 55.3% of attenders had bilateral pleural disease (excluding costophrenic-angle blunting) and/or profusion scores of 1/0 or higher, attributed to asbestos. The authors concluded that the benefits of notification appear to outweigh its psychological costs. They cautioned that reports were retrospective and that all workers had a strong union and free screening.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional anonymous questionnaire survey of workers notified of asbestos risk, comparing those who attended a screening program with those who did not
• Who was studied: Workers identified from union records as high-risk (at least 5 years employment at the plant and at least 15 years since exposure). 247 screening attenders and 53 nonattenders completed questionnaires in 1986. All attenders were male and 98.4% were white.
• Exposure: Past asbestos exposure, fiber type not specified, at an acoustical tile and wallboard manufacturing plant in Minnesota where asbestos was routinely used from about 1958 to 1974. The study's main focus was the workers' reaction to a notification letter about this exposure.
• Main results:
  • 33.7% of respondents said they first learned of the health hazards from the notification letter.
  • When first learning of job-related hazards, 74.4% of respondents reported at least one of five worry or distress reactions, but only 15.6% reported more than two.
  • At least one minimizing reaction on first learning of risk was reported by 34.7% of nonattenders and 15.8% of attenders.
  • In reaction to the notification letter, a minority of workers reported feeling worried (39.3%) or upset (26.5%).
  • Appreciation for the screening program was reported by 84.3% of attenders and 48.9% of nonattenders (p = .002).
  • Workers who first learned of their risk from the letter did not differ from workers with previous knowledge on any of the listed items about reactions to the letter.
  • 60.5% of workers reported taking some direct action, beyond attending screening, on learning of the hazards. This fell to 48% when non-responders to that item were included.
  • 55.8% of respondents rated their health as excellent or good. Screening results, given to the authors by personal communication, showed 55.3% of attenders had bilateral pleural disease (excluding blunting of the costophrenic angle) and/or ILO profusion scores of 1/0 or higher, attributed to asbestos exposure.
  • At the time of screening, 37.0% of attenders reported any negative mood.
  • Among nonattenders, 16.3% (eight workers) said they would rather not know if they had an asbestos-related illness. Practical problems were the most common reason given (30.6%).
• The authors' conclusion: The authors concluded that the benefits of notifying workers of increased risk for asbestos-related illness appear to outweigh the psychological costs of notification.
• Limitations the authors state:
  • All respondents had a strong local union and a free screening program. Without such resources, distress might have been greater.
  • Data were collected before the medical examinations, so screening results had not yet affected workers' psychological states.
  • 16% of notified workers took part in neither the screening nor the research and may have reacted differently.
  • Differences between attenders and nonattenders need caution because of multiple univariate analyses and retrospective reporting.
  • Questionnaires were completed after workers had decided whether to attend, so answers may partly justify that choice after the fact.
  • It is unknown whether the findings apply to workers exposed to other health hazards.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Occupational Disease.

Related studies

• Experiences of a state-sponsored notification and screening program for asbestos workers — A.P. Bender, A.N. Williams, et al. (1993)
• Yield of Low-Dose Computerized Tomography Screening for Lung Cancer in High-Risk Workers: The Case of 7189 US Nuclear Weapons Workers — S.B. Markowitz, A. Manowitz, et al. (2018)
• Assessing quality of life when planning and evaluating worker notification programs: two case examples — B.E. Meyerowitz (1993)
• The costs and effects of screening for cancer among asbestos-exposed workers — B.J. McNeil, D.M. Eddy (1982)
• CT scan screening is associated with increased distress among subjects of the APExS — C. Paris, M. Maurel, et al. (2010)
• Feasibility of a screening programme for lung cancer in former asbestos workers — G. Mastrangelo, M.N. Ballarin, et al. (2008)

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