Center for Asbestos Related Disease Asbestos Health Screening Program - Libby, Montana was the site of vermiculite mining and processing operations from the early 1920’s through 1990 and, at peak production, was the world’s largest source of vermiculite. Commercial uses of vermiculite include insulation, fireproofing, and use as a soil conditioner. Among residents, vermiculite was distributed freely and used extensively in lawns, driveways, and gardens, as well as in many houses and commercial buildings as insulation. There were vermiculite processing and bagging facilities in downtown Libby where piles of ore were accessible for children to play in adjacent to the local baseball fields. High levels of dust in the ambient air due to mining and processing operations were also documented. Unfortunately, Libby’s vermiculite ore is contaminated with amphibole asbestos. Reports of pervasive asbestos-related health outcomes in Libby led to EPA and ATSDR investigations. ATSDR screened over 7,000 people from 2000-2001 and found that approximately 17% had asbestos related abnormalities on chest X-rays. Since then, the state of Montana conducted screening programs from 2000-2008 followed by Lincoln County from 2009-2011. The Center for Asbestos Related Disease (CARD) has conducted screenings from 2001- present funded by previous iterations of this grant. The purpose of the proposed program is to continue to (1) provide medical screening to persons with possible exposure to LA that occurred in Lincoln County, Montana; (2) conduct nationwide outreach to raise awareness of the screening program among persons eligible to participate as well as of the availability of certain Medicare benefits; (3) provide health education to multiple audiences to detect, prevent, and treat environmental health conditions related to LA exposure. The three components of this project will be conducted concurrently in an integrated manner both locally and nationwide with no gap in program implementation between the current grant period and the new grant period. Screening services for ARD screening and LCS will continue as described in reports for the previous versions of this grant. Quality control processes will continue as currently established, while Outreach and Education activities will also remain similar as noted in more detail below. Short-term and intermediate outcomes are expected to be accomplished within the project period while long-term outcomes are anticipated as long-term results of project activities and may not be measurable during the project period. The target populations, as specified in the ACA legislation, are individuals at risk for environmental health conditions, both malignant and non-malignant asbestos related diseases (ARD), due to possible exposure to amphibole asbestos occurring in the Libby area. An at-risk individual will be defined as having been present for a sum of at least 6 months in the area subject to an emergency declaration, Lincoln County, Montana. The six months must have been at least ten years ago due to the extended latency period for developing ARD following exposure. Specific short-term and intermediate outcomes are as follows: Short-term outcomes: Increased awareness of screening services and increased awareness of Medicare eligibility (outreach), increased enrollment in Medicare for individuals with covered diagnoses (screening), increased knowledge about exposure prevention, risks of smoking, asbestos-related disease, and disease management among the target community and physicians (education). Intermediate outcomes: Increased enrollment in disease management programs (outreach), increased awareness of smoking reduction/ cessation programs in the target population (screening), increased referrals for treatment for asbestos-related cancers (screening), improved treatment/ management of individuals with asbestos-related disease (education), decreased rate of smoking (education/screening), reduction in asbestos exposure (education), increased continuity of screening among previous
