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Takada M, Kuroda Y, Kanai Y, Yasutaka T. Impacts of environmental decontamination on the rebuilding of returnees' lives after the Fukushima accident. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:031513. [PMID: 37647870 DOI: 10.1088/1361-6498/acf504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/30/2023] [Indexed: 09/01/2023]
Abstract
Environmental decontamination after a nuclear disaster not only contributes to reducing the public's exposure to radiation, it also introduces waste disposal issues arising from the decontamination process. In addition to that issue, the optimisation of decontamination efforts necessitates the consideration of various environmental, economic, and societal factors. Stakeholders' perspectives are important for identifying the multifaceted aspects to be considered. We conducted a semi-structured interview survey in 2019 with ten residents in a rural community in Fukushima, Japan, which experienced a six-year-long evacuation due to the 2011 Fukushima Daiichi Nuclear Power Plant accident. The main survey questions addressed returnees' perceptions of the decontamination of farmlands and forests. The 'Steps for Coding and Theorization' procedure was used for qualitative analysis. The analysis illuminated the positive and negative impacts of the decontamination process on the rebuilding of the returnees' rural lives from various perspectives and identified elements to be considered for the optimisation of future remediation efforts. The removal of radioactive materials had a positive psychological impact on the returnees, fostering a sense of security that their crops were safe and instilling confidence that the high-quality environment of the region had been restored. These aspects were not included among the initial governmental objectives for decontamination, which were aimed solely at reducing radiation exposure. By contrast, the removal of fertile topsoil from farmland had a negative impact on the residents, making them hesitant to resume farming. Our findings suggest that emphasising procedural fairness in decision-making of decontamination options such as reflection of stakeholders' opinions led to residents perceiving their post-decontamination situation more positively. Our results provide valuable insights for optimising remediation strategies for the recovery process following a significant nuclear accident.
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Affiliation(s)
- Momo Takada
- Institute for Geo-Resources and Environment, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
| | - Yujiro Kuroda
- Department of Prevention and Care Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yumiko Kanai
- Institute for Geo-Resources and Environment, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
| | - Tetsuo Yasutaka
- Institute for Geo-Resources and Environment, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
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Yashima S, Chida K. Effective Risk Communications through Personalized Consultations with Pregnant Women and Parents by Radiologic Technologists after the 2011 Fukushima Daiichi Nuclear Disaster. TOHOKU J EXP MED 2022; 256:259-269. [PMID: 35264512 DOI: 10.1620/tjem.2022.j001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Koichi Chida
- International Research Institute of Disaster Science
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Social and Mental Health Impact of Nuclear Disaster in Survivors: A Narrative Review. Behav Sci (Basel) 2021; 11:bs11080113. [PMID: 34436103 PMCID: PMC8389263 DOI: 10.3390/bs11080113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/03/2022] Open
Abstract
This narrative review synthesizes the literature on the psychological consequences of the Three Mile Island nuclear accident of 1979, the Chernobyl nuclear disaster of 1986, and the Fukushima nuclear disaster of 2011. A search was conducted on OVID for studies in English from 1966 to 2020. Fifty-nine studies were included. Living through a nuclear disaster is associated with higher levels of PTSD, depression, and anxiety. Decontamination workers, those living in closest proximity to the reactor, and evacuees experience higher rates of mental health problems after a nuclear disaster. Those with greater psychological resilience and social supports experience lower rates of psychological distress. Individual-level interventions, such as mindfulness training, behavioral activation, and cognitive reappraisal training, have shown modest benefits on improving psychological wellbeing. At the population level, many of the measures in place aimed at reducing exposure to radiation actually increase individuals’ anxiety. Technology-based supports have been studied in other types of natural disasters and it may be beneficial to look at mobile-based interventions for future nuclear disasters.
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Kuroda Y, Goto A, Terauchi H, Suzuki S. Change in sense of food safety associated with social connectedness and information sources-A 10-year longitudinal survey before and after the Fukushima nuclear power plant accident. Public Health 2021; 194:156-162. [PMID: 33945928 DOI: 10.1016/j.puhe.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/08/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study analyzes the change in the sense of food safety over time, from 2 years before to 8 years after the Fukushima accident in 2011, and its association with social connectedness using cohort data, taking into account regional differences in Fukushima Prefecture. STUDY DESIGN Repeated cross-sectional data from Fukushima Prefectural Government from 2009 to 2018 were used. METHODS We randomly selected 1300 people every fiscal year (FY). The survey gathered data on age, gender, occupation, residential region, and the explanatory variables 'sense of social connectedness' and 'recovery-related information source' (information source). The prefecture was divided into three regions for the survey-Hamadori region, where the nuclear power plant is located, Nakadori region, where the air dose rate after the earthquake was high, and in Aizu, far from the nuclear power station but has suffered from harmful rumors. RESULTS Focusing on FY 2014, when the sense of safety first showed recovery, we performed a binominal logistic regression analysis with 'sense of safety' as the outcome and 'sense of social connectedness' and 'information source' as the explanatory variables. The sense of safety significantly decreased in all regions in 2011 relative to earlier years. The sense of food safety decreased markedly in Hamadori and Nakadori but started to improve 3 years after the earthquake and reached the pre-earthquake level in 2018. The effect sizes were larger in the Hamadori region and in Nakadori than in Aizu. In FY 2014, multivariate analysis found that a sense of food safety was significantly positively associated with a sense of social connectedness, whereas the use of information from newspapers and TV and word of mouth was negatively associated. CONCLUSION Although the recovery of a sense of food safety may take some time, a focus on social connectedness during recovery and scrutiny of information sources may facilitate recovery. Health communication has an important role when the provider sends information intelligibly and the recipient can distinguish good news from bad and link it to self-determination. It is necessary to improve literacy.
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Affiliation(s)
- Y Kuroda
- Center for Integrated Science and Humanities, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan; Research Department, Fukushima Prefectural Centre for Environmental Creation, Japan.
| | - A Goto
- Center for Integrated Science and Humanities, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - H Terauchi
- Research Department, Fukushima Prefectural Centre for Environmental Creation, Japan
| | - S Suzuki
- Ken-poku Development Bureau, Fukushima Prefectural Goverment, Japan
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Moriyama N, Iwasa H, Tsubokura M, Kuroda Y, Yasumura S. Living in the Restoration Public Housing after the Great East Japan Earthquake Correlates with Lower Subjective Well-Being of Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152696. [PMID: 31357741 PMCID: PMC6696690 DOI: 10.3390/ijerph16152696] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
Abstract
We aimed to (1) describe the subjective well-being (SWB) of older residents in Fukushima Prefecture seven years and seven months after the Great East Japan Earthquake (GEJE) and examine the effect of relocation to the restoration public housing (RPH) on SWB, social capital, and health indicators; and (2) investigate the association between social capital and SWB. Questionnaires were administered to collect data of both RPH and non-RPH residents (≥65 years). Respondents' SWB was collected via the Japanese version of the World Health Organization Five Well-Being Index. Additionally, residents' social capital (trust, reciprocity, and participation), physical activity level, social network, functional health, history of chronic disease, and demographic data were collected. We analyzed 101 responses (valid response rate: approximately 34%) from RPH and 158 (53%) from non-RPH residents. SWB was lower in RPH compared to non-RPH residents but not statistically significant. Older RPH residents may demonstrate lower social capital and health indicators after the GEJE. Mistrust was found to be positively associated with low SWB in RPH residents. Future studies should examine the effectiveness of support for enhancing the trust of older RPH residents regarding, for example, the involvement of scientists-including medical professionals-in risk communications in promoting SWB.
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Affiliation(s)
- Nobuaki Moriyama
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima Prefecture 960-1295, Japan.
| | - Hajime Iwasa
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima Prefecture 960-1295, Japan
| | - Masaharu Tsubokura
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima Prefecture 960-1295, Japan
| | - Yujiro Kuroda
- Center for Integrated Science and Humanities, Fukushima Medical University, Japan
- National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki Prefecture 305-8560, Japan
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima Prefecture 960-1295, Japan
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Moriyama N, Iwasa H, Orui M, Kuroda Y, Ono M, Okazaki K, Takamura M, Sato N, Yasumura S. Efficacy of group intervention involving physical activity on subjective well-being of elderly returnees after evacuation following the Great East Japan Earthquake. Psychogeriatrics 2019; 19:246-254. [PMID: 30556223 DOI: 10.1111/psyg.12392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/21/2018] [Accepted: 11/10/2018] [Indexed: 11/28/2022]
Abstract
AIM In general, physically activity contributes to better subjective well-being (SWB) in the elderly. However, the physical activity level of older people who experienced relocation after the Great East Japan Earthquake has been reported to be low, possibly leading to low SWB. This study aimed to examine the efficacy of group intervention involving physical activity on SWB among older returnees after the Great East Japan Earthquake. METHODS The participants were randomly allocated to an intervention group (4 men, 10 women) or a control group (7 women). Participants in the intervention group attended a series of weekly classes over eight weeks to encourage daily physical activity, whereas participants in the control group received no intervention. SWB, the primary outcome, was assessed by the World Health Organization Five Well-Being Index. RESULTS Median variation in the World Health Organization Five Well-Being Index scores at 3 months from the baseline in the intervention and control groups was -1.0 and -2.0 points, respectively; the difference was borderline significant (P = 0.06). There was no significant difference between the groups in the median of variation in muscle strength (P = 0.79) or mobility (P = 0.77) at 3 months. CONCLUSION The intervention might prevent deterioration in participants' SWB. Further studies involving older returnees with poor physical activity and/or sedentary lifestyle may be beneficial for health promotion in the area.
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Affiliation(s)
- Nobuaki Moriyama
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hajime Iwasa
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masatsugu Orui
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yujiro Kuroda
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michiko Ono
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kanako Okazaki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Motoaki Takamura
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan.,Faculty of Health Sciences, Tohoku Fukushi University, Miyagi, Japan
| | - Noriko Sato
- Social Health and Welfare Department, Fukushima Prefectural Government, Fukushima, Japan
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan.,Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
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Murakami M, Hirosaki M, Suzuki Y, Maeda M, Yabe H, Yasumura S, Ohira T. Reduction of radiation-related anxiety promoted wellbeing after the 2011 disaster: 'Fukushima Health Management Survey'. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:1428-1440. [PMID: 30375359 DOI: 10.1088/1361-6498/aae65d] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
After the Fukushima disaster in 2011, affected residents experienced increased radiation-related anxiety and reduced subjective wellbeing. We investigated whether reduction of radiation-related anxiety promoted wellbeing among evacuees in Fukushima and assessed the role of mental health distress as a mediator. We used data from questionnaire surveys of evacuees in the 2011 and 2012 fiscal years (N = 34 312). We used radiation risk perception as an indicator of radiation-related anxiety and the frequency of laughter as an indicator of wellbeing. We measured changes in radiation risk perception from 2011 and 2012, and the frequencies of laughter and mental health distress (Kessler 6-item scale) in 2012, and investigated associations between radiation risk perception and frequency of laughter with and without covariates of mental health distress. Perceived genetic risk in 2011 had a significant inverse association with the frequency of laughter. Lowering of radiation risk perception was significantly associated with the frequency of laughter in the absence of covariates of mental health distress, but not in their presence. Lowering of radiation risk perception was also significantly associated with low mental health distress. Reduction of radiation-related anxiety promoted wellbeing via alleviation of mental health distress.
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Affiliation(s)
- Michio Murakami
- Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295 Japan
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Sawano T, Nishikawa Y, Ozaki A, Leppold C, Tsubokura M. The Fukushima Daiichi Nuclear Power Plant accident and school bullying of affected children and adolescents: the need for continuous radiation education. JOURNAL OF RADIATION RESEARCH 2018; 59:381-384. [PMID: 29635385 PMCID: PMC5967459 DOI: 10.1093/jrr/rry025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/03/2018] [Indexed: 05/12/2023]
Abstract
The health threats of radiation-release incidents are diverse and long term. In addition to direct radiation effects, it is imperative to manage the indirect effects of radiation such as stigma, prejudice and broader mental health impacts. Six years after the Fukushima Daiichi Nuclear Power Plant accident of March 2011, bullying caused by stigma and prejudice toward evacuees, including children, has become a social problem in Japan. This phenomenon may be associated with the fact that knowledge about radiation has still not reached the general public, and to a potential lack of motivation among Japanese citizens to learn about radiation and bullying. Continuous and sustained education regarding radiation is warranted in order to enhance the general knowledge level about the effects of radiation in Japan after the Fukushima Daiichi Nuclear Power Plant accident, and this education will become an important reference for education after future nuclear disasters.
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Affiliation(s)
- Toyoaki Sawano
- Department of Surgery, Minamisoma Municipal General Hospital, Fukushima 975-0033, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, 606-8501, Japan
| | - Akihiko Ozaki
- Department of Surgery, Minamisoma Municipal General Hospital, Fukushima 975-0033, Japan
- Graduate School of Public Health, Teikyo University, Tokyo 173-8605, Japan
| | - Claire Leppold
- Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, EH8 9LD, UK
| | - Masaharu Tsubokura
- Department of Radiation Protection, Minamisoma Municipal General Hospital, Fukushima 975-0033, Japan
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Murakami M, Tsubokura M, Ono K, Maeda M. New "loss of happy life expectancy" indicator and its use in risk comparison after Fukushima disaster. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 615:1527-1534. [PMID: 28931457 DOI: 10.1016/j.scitotenv.2017.09.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023]
Abstract
To assess the effects of policy measures taken to ensure health and promote well-being, we developed a novel indicator, "loss of happy life expectancy" (LHpLE), under the concept that an objective of life is maximization of lifelong happiness, by using objective survival probabilities and a simple question regarding emotional happiness: "Did you experience a feeling of happiness yesterday [yes/no]?" We measured the emotional happiness of 4990 Japanese respondents through a questionnaire. We then used LHpLE to compare risks after the 2011 Fukushima disaster. LHpLE due to psychological distress was estimated from a decline of emotional happiness, whereas that due to radiation exposure was assessed from shortened life expectancy caused by additional cancer mortality. LHpLE values due to psychological distress in evacuees were approximately 1 to >2 orders of magnitude higher than those due to cancer mortality caused by actual radiation exposure, highlighting the importance of measures to minimize distress following public health emergencies. LHpLE could be used for integrated risk comparison among different types of harms and therefore in government policy-making.
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Affiliation(s)
- Michio Murakami
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
| | - Masaharu Tsubokura
- Department of Radiation Protection, Minamisoma Municipal General Hospital, 2-54-6 Takami, Haramachi, Minamisoma, Fukushima 975-0033, Japan
| | - Kyoko Ono
- Research Institute of Science for Safety and Sustainability, National Institute of Advanced Industrial Science and Technology (AIST), 16-1, Onogawa, Tsukuba, Ibaraki 305-8569, Japan
| | - Masaharu Maeda
- Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan
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Effect of Radiological Countermeasures on Subjective Well-Being and Radiation Anxiety after the 2011 Disaster: The Fukushima Health Management Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010124. [PMID: 29329263 PMCID: PMC5800223 DOI: 10.3390/ijerph15010124] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 11/16/2022]
Abstract
After the Fukushima Daiichi Nuclear Power Station accident in 2011, concerns about radiation exposure and decline in subjective well-being have been reported. To tackle these problems, various countermeasures in relation to radiation have been implemented. In this study, we comprehensively evaluated the effects of radiological countermeasures on subjective well-being (e.g., satisfaction with life (SWL) and emotional well-being) and radiation anxiety, through a questionnaire survey targeting Fukushima residents (N = 1023). Propensity scores matching was applied to evaluate significant effects of radiological countermeasures on subjective well-being and radiation anxiety. Among the radiological countermeasures, thyroid examination, whole body counter, and air dose monitoring showed the highest proportions of participation, utilization, and useful evaluation, suggesting a high degree of public attention focused on these countermeasures. The basic survey was associated with significant increases in SWL and self-rated health (SH). Thyroid examination was significantly associated with not only a reduction in radiation anxiety but also an increase of emotional stress, suggesting the importance of careful design of system and detailed communication. Food inspection was associated with deterioration in SH. Those who utilized explanatory meetings showed increases in sadness, worry, and radiation anxiety, indicating that additional attention is required of the experts and authorities involved in explanatory meetings.
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Takebayashi Y, Lyamzina Y, Suzuki Y, Murakami M. Risk Perception and Anxiety Regarding Radiation after the 2011 Fukushima Nuclear Power Plant Accident: A Systematic Qualitative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1306. [PMID: 29077045 PMCID: PMC5707945 DOI: 10.3390/ijerph14111306] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/13/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to provide a review of the publications of the risk perceptions or anxiety regarding radiation among people living in Japan after the 2011 Fukushima nuclear power plant accident. Two database (MEDLINE and PsycINFO) and hand-searched the references in identified publications were searched. For each identified publication, the measurements and time related-change of risk perception and anxiety regarding radiation were summarized. Twenty-four publications were identified. Quantitative measures of risk perception or anxiety were roughly divided into two types: single-item Likert scales that measure anxiety about radiation; and theoretical, or model-based measures. Rates of Fukushima residents with radiation-related anxiety decreased from 2012 to 2015. Factors governing risk perception or radiation-related anxiety were summarized by demographics, disaster-related stressors, trusted information, and radiation-related variables. The effects of risk perception or anxiety regarding radiation were summarized as severe distress, intention to leave employment or not to return home, or other dimensions. This review provides summary of current findings on risk perception or anxiety regarding radiation in Japan after the accident. Further researches are needed about detailed statistical analysis for time-related change and causality among variables.
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Affiliation(s)
- Yoshitake Takebayashi
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan.
| | - Yuliya Lyamzina
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan.
| | - Yuriko Suzuki
- Department of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan.
| | - Michio Murakami
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan.
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