Risk Perception and Anxiety Regarding Radiation after the 2011 Fukushima Nuclear Power Plant Accident: A Systematic Qualitative Review

The perception of air pollution and its health risk: a scoping review of measures and methods

BACKGROUND

Although there is increasing awareness of the health risks of air pollution as a global issue, few studies have focused on the methods for assessing individuals' perceptions of these risks. This scoping review aimed to identify previous research evaluating individuals' perceptions of air pollution and its health effects, and to explore the measurement of perceptions, as a key resource for health behaviour.

METHODS

The review followed the methodological framework proposed by Arksey and O'Malley. PubMed and Web of Science were searched. After initial and full-text screening, we further selected studies with standardised scales that had previously been tested for reliability and validity in assessing awareness and perceptions.

RESULTS

After full-text screening, 95 studies were identified. 'Perception/awareness of air quality' was often measured, as well as 'Perception of health risk.' Only nine studies (9.5%) used validated scaled questionnaires. There was considerable variation in the scales used to measure the multiple dimensions of risk perception for air pollution.

CONCLUSION

Few studies used structured scales to quantify individuals' perceptions, limiting comparisons among studies. Standardised methods for measuring health risk perception are needed.

Public knowledge, perception of and willingness-to-accept nuclear energy in China: Evidence from a representative national survey

The Chinese government promotes nuclear energy development in the context of mitigating climate change. However, the large-scale development is still facing challenges related to the knowledge gap among the general public and the potential "not-in-my-back-yard" objection. Based on a representative national survey, we analyze Chinese people's knowledge and perceptions of nuclear energy and estimate their willingness-to-accept the potential risks of new nuclear programs in neighborhoods via the Contingent Valuation Method. Generally, more than half of people do not know anything about nuclear energy. The main factors influencing public knowledge are identified, such as the residential distance to existing nuclear power stations and the frequency of internet use. Moreover, approximately 12% of individuals with some knowledge seem to be willing to accept new nuclear power plants in their neighborhoods with no compensation needed. Specifically, the perceptions of nuclear risks and pollution from fossil fuels are significant factors influencing people's acceptance of nuclear energy. Although public knowledge does not directly influence acceptance, more knowledge seems to reduce risk perception and increase benefit perception. The residential distance to exiting nuclear stations has limited effects on people's acceptance of newly planned nuclear programs for those living in the same county with some knowledge. In general, a typical Chinese household is willing to accept USD $5.66 every month or USD $67.97 every year to bear the potential risks of the new nuclear program in neighborhoods. Significant practical implications that can be transferable to other new energy technologies and countries or regions are provided.

Optimal conversion coefficient from easily measurable dose to effective dose with consideration to radiation quality for posterior-anterior chest radiography

Effective dose is sometimes used to compare medical radiation exposure to patients and natural radiation for providing explanations about radiation exposure to patients, but its calculation is lengthy and requires dedicated measuring devices. The purpose of this study was to identify the most suitable conversion coefficient for conversion of easily measurable dose to effective dose in posterior-anterior chest radiography, and to evaluate its accuracy by direct measurement. We constructed an examination environment using Monte Carlo simulation, and evaluated the variation in conversion coefficients from incident air kerma (IAK), entrance-surface air kerma (ESAK), and air kerma-area product (KAP) to effective dose when the irradiation field size and radiation quality were changed. Effective doses were also measured directly using thermoluminescence dosimeters and compared with the effective dose obtained from conversion coefficients. The KAP conversion coefficient most effectively suppressed the effect of irradiation field size, and was then used to set conversion coefficients for various half-value layers. The optimal conversion coefficient was 0.00023 [mSv/(mGy·cm2)] at 120 kVp (half-value layer = 5.5 mmAl). Evaluation of the direct measurements obtained with various radiation qualities revealed that the accuracy of the conversion coefficient was maintained at ≤ 11%. The proposed conversion coefficient can be easily calculated even in facilities that do not have equipment for measuring effective dose, and might enable the use of effective dose for providing explanations about radiation exposure to patients.

How Do Disaster Relief Nurses in Japan Perceive and Respond to Risks? A Cross-Sectional Study

This study assessed the risk perceptions among disaster relief nurses (DRNs) in Japan by focusing on 15 risk factors associated with frequent natural disasters and the ongoing coronavirus disease 2019 (COVID-19) pandemic. We conducted a cross-sectional study that targeted DRNs across six prefectures in Japan and explored nurses' perceptions of risks including radiation exposure, volcanic eruptions, and mass infections. The findings indicated a heightened perception of radiation and nuclear-related risks. In the context of the COVID-19 pandemic, DRNs perceived "mass infection" as a significant risk. An age-based analysis revealed that younger nurses had more dread about "mass infection" and had heightened uncertainty about the "X-ray test" compared with their older peers. Understanding DRNs' risk perceptions is crucial for effective disaster response preparedness and training. The study highlights the need to address these perceptions to ensure that DRNs are well prepared and supported in their roles. This study was not pre-registered on a publicly accessible registry.

Development of a novel Electrical Industry Safety Risk Index (EISRI) in the electricity power distribution industry based on fuzzy analytic hierarchy process (FAHP)

Many workers are exposed to electrical energy during the fulfillment of their tasks. It is necessary to identify the potential risk factors for electrical damages. The present study aimed to develop a novel Electrical Industry Safety Risk Index (EISRI) in the electricity power distribution industry based on fuzzy analytic hierarchy process (FAHP). In this study several different safety risk assessment methods were analyzed. Then, common activities in the electricity distribution industry were classified into ten occupational groups. To identify the general structure of risk assessment and determine three main components, including personal, environmental, and organizational a three-stage Delphi study was conducted with the participation of 30 experts. The fuzzy analytic hierarchy process approach was used to weight the components and parameters in each job group. Finally, the results of the EISRI were compared with the failure mode and effect analysis (FMEA) method. The most effective component in determining the risk level was the personal component (PC), with a 0.537 weighted average. Cronbach's alpha values for each of the personal, environmental, and organizational components and the entire model were 0.90, 0.85, 0.82, and 0.86, respectively, and model reliability was confirmed. The results obtained from the EISRI method were compared with the FMEA method, the results of both methods were very close to each other (p < 0.05). The results of this study revealed that the highest weighted average was related to the personal component due to the high impact of the human factors in carrying out activities in various occupations. The EISRI can be applied as a substitute for general risk assessment methods due to the suitability of this method with the nature of activities in this industry. The present technique can be a practical step toward developing suitable risk management algorithm.

Loss of participation among evacuees aged 20-37 years in the disaster cohort study after the Great East Japan Earthquake

The present study aimed to clarify the characteristics of young evacuees who had missed the Comprehensive Health Check of the Fukushima Health Management Survey (FHMS) after the Great East Japan Earthquake in 2011. The FHMS has been conducted as a prospective cohort study to evaluate the health status of evacuees annually after the great earthquake in 2011. This study focused on the annual participation rate in the Comprehensive Health Check of evacuees aged between 20 and 37 years in 2011 who evacuated due to the Fukushima Daiichi Nuclear Power Plant accident. The characteristics of subjects who did not participate after the second survey year were identified with a multivariate logistic regression model. The participation rate was estimated at 26.6% (9720 among 36,502 residents) and 15.6% (5691 residents) in 2011 and 2012, respectively. The logistic regression model revealed the following characteristics at baseline as independent predictors of non-participation after the second year of the survey: age ≤ 24 years (adjusted odds ratio 2.11, 95% CI 1.84-2.42), 25-29 years of age (1.28, 1.13-1.45), men (1.52, 1.38-1.69), evacuation outside the municipality but within Fukushima prefecture (1.54, 1.40-1.70), evacuation outside the Fukushima prefecture (1.40, 1.21-1.63), anemia (1.23, 1.06-1.43), smoking habit (1.34, 1.21-1.48), and drinking habit (1.20, 1.09-1.32). A medical history of heart disease showed opposite odds ratios, which indicate the association with continuous participation (0.43, 0.26-0.72, respectively). We observed deteriorated participation in the prospective study of the Comprehensive Health Check of the FHMS among evacuees of a younger age group, men, those evacuated outside their municipalities, and those with history of anemia, smoking and drinking habits. Hence, the cohort study may have missed certain population groups with worse health behaviors. Thus, it is necessary to consider various measures to increase the participation rate in the disaster cohort study to understand the long-term health effects of disasters on younger residents in evacuation zones.

Objective stress values during radiation emergency medicine for future human resources: Findings from a survey of nurses

Introduction

Shortages of human resources in radiation emergency medicine (REM) caused by the anxiety and stress of due to working in REM, are a major concern. The present study aimed to quantify stress and identify which tasks involved in REM response are most stressful to help educate (human resource development) and effectively reduce stress in workers. Furthermore, the final goal was to reduce the anxiety and stress of medical personnel in the future, which will lead to sufficient human resources in the field of REM.

Methods

In total, 74 nurses who attended an REM seminar were asked to answer a questionnaire (subjective) survey and wear a shirt-type electrocardiogram (objective survey). Then, informed consent was obtained from 39 patients included in the analysis. In the objective survey, average stress values of participants for each activity during the seminar were calculated based on heart rate variability (HRV). The average stress value was output as stress on a relative scale of 0–100, based on the model which is the percentile of the low-frequency/high-frequency ratio derived from HRV at any point in time obtained over time.

Results

A total of 35 (89.7%) participants answered that they had little or no knowledge of nuclear disaster and 33 (84.6%) had more than moderate anxiety. Stress values observed during the decontamination process were significantly higher than those observed when wearing and removing protective gear and during the general medical treatment process (P = 0.001, 0.004, and 0.023, respectively). Stress values did not increase during general medical treatment performed in protective clothing, but increased during the decontamination process, which is the task characteristic of REM.

Discussion

Stress felt by medical personnel throughout the entire REM response may be effectively reduced by providing careful education/training to reduce stress during the decontamination process. Reducing stress during REM response effectively could contribute to resolving the shortage of human resources in this field.

Disaster Resilience Reduces Radiation-Related Anxiety Among Affected People 10 Years After the Fukushima Daiichi Nuclear Power Plant Accident

This study examined whether disaster resilience affects the recovery of mental health states and mitigates psychosocial anxiety 10 years later the Fukushima Daiichi nuclear power plant accident. The survey was conducted in Fukushima's evacuation-directed and non-evacuation-directed areas in January 2020. The 695 participants responded to a questionnaire including items on radiation-related anxiety regarding the Fukushima Daiichi accident, an action-oriented approach as a resilience factor, psychological distress, and demographic information. The structural equation modeling showed that the action-oriented approach also eased radiation-related anxiety by mediating with improving mental health states. Moreover, a multi-group model analysis was conducted for evacuation-directed and non-directed areas. In the evacuation-directed area, we found stronger associations among resilience, mental health states, and radiation-related anxiety, and a direct effect of resilience factors on radiation risk anxiety. These findings emphasize the importance of resilience in post-disaster contexts, at least for a decade, where mental health deteriorates and various psychosocial issues become more complex.

Citizens’ Communication Needs and Attitudes to Risk in a Nuclear Accident Scenario: A Mixed Methods Study

The potential devastation that a nuclear accident can cause to public health and the surrounding environment demands robust emergency preparedness. This includes gaining a greater knowledge of citizens’ needs in situations involving radiation risk. The present study examines citizens’ attitudes to a remediation scenario and their information and communication needs, using focus group data (n = 39) and survey data (n = 2291) from Sweden. The focus groups uniquely showed that adults of all ages express health concerns regarding young children, and many also do so regarding domestic animals. Said protective sentiments stem from a worry that even low-dose radiation is a transboundary, lingering health risk. It leads to doubts about living in a decontaminated area, and high demands on fast, continuous communication that in key phases of decontamination affords dialogue. Additionally, the survey results show that less favorable attitudes to the remediation scenario—worry over risk, doubt about decontamination effectiveness, and preferences to move away from a remediation area—are associated with the need for in-person meetings and dialogue. Risk managers should thus prepare for the need for both in-person meetings and frequent information provision tasks, but also that in-person, citizen meetings are likely to feature an over-representation of critical voices, forming very challenging communication tasks.

Addressing Risk Perceptions of Low-Dose Radiation Exposure

Concern over low-dose radiation (LDR) (exposure of less than 100 milligray (mGy)) is resulting in people refusing diagnostic procedures and medical treatment¹ and also inhibiting revision of the linear no-threshold (LNT) assumption that informs much of science policy. This article reviews representative surveys in Ontario and Saskatchewan and focus groups conducted with science and policy stakeholders in addressing how the public and policy stakeholders understand issues of exposure to LDR and how policy issues can be addressed.

Research results from focus groups demonstrated that policy stakeholders are knowledgeable about issues surrounding the public and perceptions about LDR and implications for policy consistent with LDR literature. Participants understood that the challenge went beyond providing more education about LDR and issues of emotions and biases must be addressed. This research resulted in rich suggestions for public communication and engagement surrounding LDR and a process for addressing the issue of the LNT.

Occupational Difficulties of Disaster-Affected Local Government Employees in the Long-Term Recovery Phase after the Fukushima Nuclear Accident: A Cross-Sectional Study Using Modeling Analysis

Local government officials play a central role in post-disaster community reconstruction. However, few studies have reported on the actual difficulties during a complex disaster involving a nuclear accident. A self-rated questionnaire survey was administered to a total of 583 public employees in four municipalities around the Fukushima Daiichi Nuclear Power Station. The relationship between universal occupational factors and radiation disaster-specific factors on job satisfaction and intention to leave the job due to radiation anxiety was evaluated using structural equation modeling. The results showed that interpersonal problems (β = −0.246) and service years (β = −0.127) were related to job satisfaction, whereas radiation-specific factors were not related to job satisfaction, and only to the intention to leave work due to radiation anxiety. A sense of coherence was associated with job satisfaction (β = 0.373) and intention to leave work due to radiation anxiety (β = −0.182), and it served as a moderator of the universal occupational factors and the radiation disaster-specific factors. Therefore, it is suggested that outcomes could be improved through increased stress coping capacity by providing support for relationships and radiation risk communication to public employees during the disaster recovery period.

Trends and Factors Associated With Risk Perception, Anxiety, and Behavior From the Early Outbreak Period to the Controlled Period of COVID-19 Epidemic: Four Cross-Sectional Online Surveys in China in 2020

Background: The first wave of the COVID-19 epidemic in China was brought under with 3 months-from mid-January 2020 to the end of March 2020. Less studies examined dynamic psychological effect and behaviors during COVID-19 pandemic. This study aims to examine perceived risk, anxiety, and behavioral response of the general public related to the outbreak of COVID-19 in four cross-sectional surveys conducted throughout China. Methods: In 2020, four cross-sectional, population-based online survey were conducted from January 28 to February 3, from February 10 to 12, from February 20 to 22, and from March 1 to 10, respectively. Convenience sampling was used for easy recruiting survey participants under the long-term impact of the COVID-19 epidemic. The four independent online questionnaires were sent from the same approach (WeChat and MicroBlog), and anyone who receives the questionnaire on the Internet or mobile phone and meets the inclusion criteria could fill in it. The same questionnaires repeatedly used in the four surveys. Socio-demographic information and individual protective practice were collected and the state-trait anxiety inventory (STAI) was used for measuring anxiety. Propensity score matching was used to adjust for differences in baseline characteristics among the four surveys. Wilcoxon signed ranks test was used to compare people's perceived risk, anxiety and protective behaviors changes in four stages. General linear model was used to identify associations between some demographic factors and perceived risk, anxiety scores, and protective behaviors. Results: The proportion of high perceived risk has dropped from 24.7 to 4.7%. The proportion of severe anxiety has declined from 12.2 to 1.2%. The proportion of people wore masks when they went out has increased from 97.0 to 98.3%. Women were more likely to develop anxiety (OR = 1.5, 95%CI: 1.4-1.6) and more positively adopted recommended behaviors (OR = 2.1, 95%CI: 1.3-3.4) than men. People at age 30-39 years, with high-degree education, with married status, and accompanied with poor self-rated health status were prone to have higher risk perception and anxiety. Perceived risk was significantly associated with anxiety over the entire periods. Anxiety levels had stronger associations with adoption of protective behaviors (wearing mask and avoiding crowed place) in the early epidemic periods than in the late epidemic periods. Conclusions: The levels of perceived risk and anxiety showed a trend of rising first and then falling. Gradually upward trend on initiative preventive behaviors including wearing mask and avoiding visiting crowded places also was observed through scanning data at four stages. People at age 30-39 years, with high-degree education, and accompanied with poor self-rated health status were prone to have higher risk perception and anxiety. Our findings showed that people simultaneously presented both high-level risk perception and anxiety across the four wave surveys, leading to their positive self-prevention and protective behavior.

Role of melatonin mediated G-CSF induction in hematopoietic system of gamma-irradiated mice

AIMS

Hematopoietic acute radiation syndrome (H-ARS) can cause lethality, and therefore, the necessity of a safe radioprotector. The present study was focused on investigating the role of melatonin in granulocytes colony-stimulating factor (G-CSF) and related mechanisms underlying the reduction of DNA damage in hematopoietic system of irradiated mice.

MAIN METHODS

C57BL/6 male mice were exposed to 2, 5, and 7.5Gy of whole-body irradiation (WBI), 30 min after intra-peritoneal administration of melatonin with different doses. Mice were sacrificed at different time intervals after WBI, and bone marrow, splenocytes, and peripheral blood lymphocytes were isolated for studying various parameters including micronuclei (MN), cell cycle, comet, γ-H2AX, gene expression, amino acid profiling, and hematology.

KEY FINDINGS

Melatonin100mg/kg ameliorated radiation (7.5Gy and 5Gy) induced MN frequency and cell death in bone marrow without mortality. At 24 h of post-WBI (2Gy), the frequency of micronucleated polychromatic erythrocytes (mnPCE) with different melatonin doses revealed 20 mg/kg as optimal i.p. dose for protecting the hematopoietic system against radiation injury. In comet assay, a significant reduction in radiation-induced % DNA tail (p ≤ 0.05) was observed at this dose. Melatonin reduced γ-H2AX foci/cell and eventually reached to the control level. Melatonin also decreased blood arginine levels in mice after 24 h of WBI. The gene expression of G-CSF, Bcl-2-associated X protein (BAX), and Bcl2 indicated the role of melatonin in G-CSF regulation and downstream pro-survival pathways along with anti-apoptotic activity.

SIGNIFICANCE

The results revealed that melatonin recovers the hematopoietic system of irradiated mice by inducing G-CSF mediated radioprotection.

Adolescence Outside the Restricted Zone: A Narrative Study of Nuclear Disaster Response Trajectories intertwining with Life (TiL)

Responses to trauma can involve complex meaning-making processes and the perception of ambiguous threats. This study sought to explore response trajectories to a nuclear disaster and their intertwining courses with ecological factors (Trajectories intertwining with Life—TiL) from adolescence onward among a non-evacuated population. Four women and four men (mean age 20) who were adolescents during the 2011 nuclear accident in Fukushima (mean age 14), and who grew up outside the restricted zone participated in the study. Semi-structured life story interviews were conducted in the form of in-depth qualitative inquiries. A holistic analysis was employed to identify the TiL patterns following the Fukushima nuclear disaster in the overall context of the stories and to reveal important themes throughout adolescence. Four TiL patterns were found: three trajectories corresponding with those identified in prior research and one newly identified trajectory. The perceived, distal, and continuous threat of radiation played a central role in all patterns and exerted secondary impacts throughout the lives of non-evacuated adolescents. The study’s implications shed light on rarely studied response trajectories to ambiguous Potentially Traumatic Events (PTEs) throughout adolescence and point out the benefits of using a life story approach to this end for the first time.

PSYCHOPHYSIOLOGICAL FEATURES OF RADIATION RISK PERCEPTION

OBJECTIVE

to determine the subjective and psychophysiological characteristics of the perception of radiation risk,to identify destructive individual-typological personality traits, as well as factors that can be the basis of psycho-logical compensation for victims of various radiation disasters and accidents.

OBJECT AND METHOD

A comparative analysis of psychometric and neurophysiological parameters of hypertrophiedperception of radiation risk in the following groups was carried out: liquidators (clean-up workers) of the conse-quences of the Chornobyl accident and evacuees from the Chornobyl exclusion zone (CEZ) - 317 people total, par-ticipants in the anti-terrorist operation (ATO) - 101 people, and control group - 85 people. We used psychodiagnos-tic and neurophysiological (computerized electroencephalography) techniques.

RESULTS

In the groups of liquidators and evacuees from CEZ there are significantly more people with hypertrophiedperception of radiation risk compared to the control group and the comparison group (liquidators - 71.88 %, liqui-dators-evacuees - 80.0 %, evacuees 76.92 %, ATO participants - 33.78 %, control group - 35.0 %). Among therespondents with hypertrophied perception of radiation risk radiation factors, and, most of all, diseases associatedwith ionizing radiation, hold the first rank places among 31 evaluated factors in all groups. The respondents withadequate perception of the radiation risk are primarily concerned about social stress and environmental factors.Correlation analysis showed that there are no correlation between hypertrophied perception of radiation risk andactual documented radiation dose. Hypertrophied perception depends on gender, level of education, family incomeand level of knowledge about ionizing radiation. It affects perception of one's health, makes you feel helpless,increase the level of distress from the Chornobyl disaster and the Fukushima-1 disaster in Japan, and is also associ-ated with the Revolution of Dignity. Hypertrophied perception of radiation risk contributes to disorders of psycho-somatic health and deformation of personality traits. Comparative analysis of the parameters of bioelectrical activ-ity of the brain of persons with hypertrophied perception of the radiation threat showed an increase in brain's delta-,theta- and beta- activity with suppression of alpha-activity and dominant frequency.

CONCLUSIONS

In all examined groups a significant percentage of people with hypertrophied perception wererevealed. The key role in the process of perception of a radiation risk is played not by the real danger of the situa-tion and the documented dose of radiation, but by its perception and awareness. Hypertrophied perception of theradiation risk contributes to psychosomatic health disorders and deformation of personality traits, which is con-firmed by neurophysiological studies.

Trajectory and factors of radiation risk perception of students aged 10-12 years at the time of the Fukushima Daiichi Nuclear Power Station accident

Various studies have investigated radiation risk perceptions after the accident at the Fukushima Daiichi Nuclear Power Station. However, student surveys are limited. This study aimed to investigate the perception of radiation risk among students aged 18-20 years who were in the 5th and 6th grades of elementary school at the time of the accident. We surveyed students in the Fukushima Prefecture and outside the prefecture. Out of all the data, 59% of the respondents were living in the Fukushima Prefecture at the time of the accident and 41% outside the prefecture. Trajectory analysis showed that changes in anxiety levels over time since 2011 could be divided into five classes: (a) the anxiety was the highest, and this tendency persisted. (b) High at the beginning, but decreased more quickly than class 1. (c) High at the beginning, but it diminished quickly. (d) Not high, but did not diminish easily in later years. (e) Low from the beginning, and persisted. Multinomial logistic analysis showed that among students living outside the prefecture at the time of the accident, a significantly higher proportion was in groups 4 and 5 than in group 2. A significant proportion of boys were present in groups 3, 4 and 5. A significant proportion of students whose current educational institutions were inside the prefecture were present in group 3. The level of anxiety was associated with the academic course, but not with subjective knowledge of radiation. In contrast, in the qualitative analysis of the free text, 31% considered 'knowledge about radiation' as the reason for the reduction in anxiety level. At the time of the investigation, most young people were not anxious about radiation. However, approximately 20% still had strong anxiety. We established that continuous risk communication is necessary. Furthermore, that stabilization and support related to life in general is important.

Influential Factors on Collective Anxiety of Online Topic-Based Communities

Background: Under the uncertainty led by the decentralized information on social media, people seek homogeneity in either opinions or affection to establish group identity to better understand the information. This also means they are easily polarized, not only ideologically but also in their actions. Affective polarization is the emotional tendency for people to show animosity toward opposing partisans while seeking homogeneity from fellow partisans. Much research into online affective polarization has focused on quantifying anxiety at an individual level while neglecting that on a collective basis. Therefore, this paper examined the polarization of collective anxiety in topic-based communities on Weibo. Methods: We aim to interpret correlations between collective anxiety online and topic characteristics, user competence, as well as the proportion of influencers of Weibo topic-based communities. Our neural networks model and statistical analysis were based on 200 communities with 403,380 personal accounts and 1,012,830 messages. Results: Collective anxiety levels are correlated to (1) the extent to which a topic captures public interest, (2) how community members articulate topics on social network platforms, and (3) the ratio of influencers in the community. Specifically, people's conflicting perceptions and articulations of topics might increase collective anxiety, while the extent to which a topic is of the public interest and the number of influencers engaged in a topic account for any decline in its ranking. Furthermore, familiarity with a topic does not help predict collective anxiety levels. There are no significant links between community size or interactivity dynamics and the level of collective anxiety in the topic-based community. Our computational model has 85.00% precision and 87.00% recall. Conclusion: This study found the collective anxiety augment due to topic proximities to public interest and members' lack of declarative knowledge on topics, while to decline with an increasing portion of online influencers. These findings indicate that collective anxiety is induced due to a lack of credibility. Also, the amount of conflicting information shared by different people places them in a state of flux. Therefore, a community with more influencers may be more likely to experience anxiety polarization, bringing forth the issue of layered information and inequality.

Social and Mental Health Impact of Nuclear Disaster in Survivors: A Narrative Review

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.

Who Is the Most Vulnerable to Anxiety at the Beginning of the COVID-19 Outbreak in China? A Cross-Sectional Nationwide Survey

(1) Background: The COVID-19 pandemic has not only changed people’s health behavior, but also induced a psychological reaction among the public. Research data is needed to develop scientific evidence-driven strategies to reduce adverse mental health effects. The aims of this study are to evaluate the anxiety reaction of Chinese people and the related determinants during the earliest phase of the COVID-19 outbreak in China. Evidence from this survey will contribute to a targeted reference on how to deliver psychological counseling service in the face of outbreaks. (2) Methods: A cross-sectional, population-based online survey was conducted from 28 January to 5 February 2020 using an open online questionnaire for people aged 18 years or above, residing in China and abroad. The socio-demographic information of the respondents was collected, and anxiety scores were calculated. A direct standardization method was used to standardize anxiety scores and a general linear model was used to identify associations between some factors (e.g., sex, age, education, etc.) and anxiety scores. (3) Results: A total of 10,946 eligible participants were recruited in this study, with a completion rate of 98.16% (10,946/11,151). The average anxiety score was 6.46 ± 4.12 (total score = 15); women (6.86 ± 4.11) scored higher than men (5.67 ± 4.04). The age variable was inversely and significantly associated with the anxiety score (β = −2.12, 95% CI: −2.47–−1.78). People possessing higher education (β = 1.15, 95% CI: 0.88–1.41) or a higher awareness of cognitive risk (β = 4.89, 95% CI: 4.33–5.46) reported higher levels of anxiety. There was a close association between poor subjective health and anxiety status (β = 2.83, 95% CI: 2.58–3.09). With the increase of confidence, the anxiety of the population exhibited a gradual decline (β = −2.45, 95% CI: −2.77–−2.13). (4) Conclusion: Most people were vulnerable to anxiety during the earliest phase of the COVID-19 outbreak in China. Younger women, individuals with high education, people with high cognitive risk and subjective poor health were vulnerable to anxiety during the epidemic. In addition, increasing confidence in resisting this pandemic is a protective determinant for individuals to develop anxiety. The findings suggest that policymakers adopt psychosocial interventions to reduce anxiety during the pandemic.

Nuclear Energy Perception and Ecological Attitudes

This paper focuses on the analysis of trends in the development of nuclear energy in selected European and non-European countries in the context of the pace of renewable energy development in the world. The perception of Poles related to their openness to various energy sources against the background of European trends was also examined, as well as their ecological approach to the quality of the environment in this context. The survey was carried out using the Computer Assisted Web Interview (CAWI) technique. The total number of correctly completed forms was 923. To identify the ecological attitude, purchasing attitude, and the perception of nuclear energy, the research tool contained a number of statements on the issues studied, and the respondents assessed compliance with their opinion using a seven-point bipolar scale. The semantic differential was also used to gather opinions on the characteristics of nuclear energy. This paper shows that global trends are promoting the development of unstable renewable energy sources and the reduction of the share of nuclear power plants as an energy source. It has also been shown that the Organization for Economic Co-operation and Development (OECD) countries are more skeptical about nuclear power than countries that do not belong to the OECD (for example, China and Africa).

Relationship Between Risk Perception, Social Support, and Mental Health Among General Chinese Population During the COVID-19 Pandemic

BACKGROUND

The Coronavirus Diseases (COVID-19) pandemic is a global public health challenge and provides an opportunity to investigate the unclear relationship between risk perception, social support, and mental health. This study aims to examine the association between risk perception and mental health while taking social support as a moderator.

METHODS

An online cross-sectional study recruiting 2993 participants was conducted in China, from 1st to 10th, February 2020. The relationship between risk perception, social support, and mental health was examined using multivariate linear regression analyses.

RESULTS

This study indicated that risk perception was associated with a higher level of mental health symptoms. The subscale "Perceived uncontrollability" seemed to present a stronger correlation with depressive symptoms (Beta=0.306) and post-traumatic stress disorder (PTSD) symptoms (Beta=0.318) than the subscale "Perceived Severity" did. Moreover, social support moderated the relationship between perceived uncontrollability and mental health symptoms.

CONCLUSION

In the context of the COVID-19 pandemic, it is necessary to design mental health strategies and programs from a risk perception perspective (more mental health strategies should be delivered to build reasonable risk perception), while social support from family and friends may be protective to against depressive symptoms and PTSD symptoms. There is a demand for mental health intervention from a risk perception perspective.

Nuclear Power Risk Perception in Serbia: Fear of Exposure to Radiation vs. Social Benefits

Nuclear power remains one of the most accessible choices in addressing environmental and social concerns due to the continuously increasing energy needs around the world. While it remains an excellent source of energy due to its low price and low level of emissions, potential accidents remain a serious problem. An example of such is the most recent accident in the Fukushima Daiichi Nuclear Power Plant (2011), which reminded the world of the potential risks of nuclear energy and the consequences of which continue to have a lasting effect. There is no nuclear power plant in Serbia, but there are about 15 nuclear power stations scattered within its neighboring countries. Therefore, the Serbian Government decided to study how the Serbian public perceives the risks related to the potential construction of nuclear power stations in the country, nuclear energy in general, and its possible benefits and risks. The objective of this paper is to present the results of this assessment along with a literature overview on the (environmental) risk of nuclear power. A pilot study consisted of a series of 270 randomized face-to-face interviews that took place in the public square of Belgrade in March 2019. Logistic regression was used to examine the cumulative effects of the different risk factors. The results showed that the majority of the respondents are skeptical and do not support the construction of nuclear power stations in Serbia. Furthermore, this research identified several additional important correlations that have a significant impact on the public perception of risk.

Communicating personalized risks from COVID-19: guidelines from an empirical study

As increasing amounts of data accumulate on the effects of the novel coronavirus SARS-CoV-2 and the risk factors that lead to poor outcomes, it is possible to produce personalized estimates of the risks faced by groups of people with different characteristics. The challenge of how to communicate these then becomes apparent. Based on empirical work (total n = 5520, UK) supported by in-person interviews with the public and physicians, we make recommendations on the presentation of such information. These include: using predominantly percentages when communicating the absolute risk, but also providing, for balance, a format which conveys a contrasting (higher) perception of risk (expected frequency out of 10 000); using a visual linear scale cut at an appropriate point to illustrate the maximum risk, explained through an illustrative 'persona' who might face that highest level of risk; and providing context to the absolute risk through presenting a range of other 'personas' illustrating people who would face risks of a wide range of different levels. These 'personas' should have their major risk factors (age, existing health conditions) described. By contrast, giving people absolute likelihoods of other risks they face in an attempt to add context was considered less helpful. We note that observed effect sizes generally were small. However, even small effects are meaningful and relevant when scaled up to population levels.

Assessment of an Emergency Medicine System for Radiation Accidents in Korea: A State Survey of the Workers Involved the Medical Response to Radiation Accidents

Radiation emergency medicine systems are operated around the world to provide special care for the injured that require immediate medical attention in accidents. The objective of this survey was to evaluate people’s perception of those who design the emergency medical plan for radiation accidents and those who supervise it in Korea. A questionnaire survey was conducted on the people involved in a regulatory system for medical response in a radiation emergency. Of 150 survey recipients, 133 (88.7%) completed the survey, including 92 workers and 41 inspectors. The respondents expressed the view that the national emergency medical plan is prepared above the average level using a Likert-style scale of 1 to 5 (mean = 3.55, SD = 0.74). Interestingly, using the Mann–Whitney U test, it could be shown that inspectors evaluated the emergency medical system for radiation accidents more strictly in all of the questions than the licensee workers, especially on radiation medical emergency preparedness (p = 0.004) and the governmental regulatory policy for radiation safety (p = 0.007). For a more efficient system of radiation emergency medicine, licensee workers prioritized the workforce, whereas inspectors favored laws and regulations for safety. The survey results show different perspectives between inspectors and licensee workers, which stem from the actual properties of each occupational role in the regulatory system for radiation medical emergency. These data could be utilized for communication and interaction with relevant people to improve the medical response preparedness against radiation accidents.

Evacuation after a nuclear accident: Critical reviews of past nuclear accidents and proposal for future planning

Standards and guidelines for preparedness and response in the case of a nuclear accident cover radiation protection, health management and communication with affected populations. Decision makers use these recommendations to decide on measures that protect people residing around a nuclear power plant that suffers an accident from radiation exposure; for example, sheltering, evacuation and relocation. While technological and radiological criteria exist for these protective measures, studies on past radiological and nuclear emergencies have shown that evacuation and relocation result in serious health effects; this needs to be considered in accident preparedness and responses in the future. Within the framework of the Nuclear Emergency Situations Improvement of Medical and Health Surveillance (SHAMISEN) (Ohba et al., 2020), a critical review of recommendations and experiences of previous major nuclear accidents was conducted, and the current paper focuses on the lessons learned about evacuation and relocation. We reviewed the contents of official documents and literature relating to the evacuation and relocation of residents, and to the evacuation of medical and other facilities in the three largest nuclear accidents to date: the Three Mile Island accident, Chernobyl accident, and Fukushima accident. We developed recommendations classified into the preparedness phase, early and intermediate phases, and recovery phase after an accident. In the cases of Three Mile Island and Fukushima, the evacuation area was set at 8-10 km from the nuclear power plant in the disaster prevention plan, and emergency responses, such as information provision and evacuation, had been developed only in this area. When the Fukushima accident occurred, evacuation beyond this area was urgently planned or instructed, resulting in marked confusion, such as forced multiple evacuations and relocations for long periods. Furthermore, information was lacking, and personal protective measures such as respiratory protection and iodine prophylaxis were not applied to evacuees. In hospital and facility evacuation, it became more difficult to implement evacuation owing to a lack of advance planning and support in the event of the accident. In Fukushima, more than 60 people in hospitals and nursing care facilities died during or soon after evacuation. In long-term relocation, in addition to continuing adverse mental effects, there were health effects relating to relocation, such as lifestyle-related disease. The return of residents to the evacuation area required many issues, such as a delayed recovery of the living environment, to be overcome in addition to measures to reduce the effects of radiation. Recommendations for evacuation in the SHAMISEN framework were developed (SHAMISEN Consortium, 2017; Liutsko et al., 2020) from these lessons of previous accidents.

Discriminative Measurement of Absorbed Dose Rates in Air from Natural and Artificial Radionuclides in Namie Town, Fukushima Prefecture

Ten years have elapsed since the accident at the Fukushima Daiichi Nuclear Power Plant in 2011, and the relative contribution of natural radiation is increasing in Fukushima Prefecture due to the reduced dose of artificial radiation. In order to accurately determine the effective dose of exposure to artificial radiation, it is necessary to evaluate the effective dose of natural as well as artificial components. In this study, we measured the gamma-ray pulse-height distribution over the accessible area of Namie Town, Fukushima Prefecture, and evaluated the annual effective dose of external exposure by distinguishing between natural and artificial radionuclides. The estimated median (range) of absorbed dose rates in air from artificial radionuclides as of 1 April 2020, is 133 (67–511) nGy h⁻¹ in the evacuation order cancellation zone, and 1306 (892–2081) nGy h⁻¹ in the difficult-to-return zone. The median annual effective doses of external exposures from natural and artificial radionuclides were found to be 0.19 and 0.40 mSv in the evacuation order cancellation zone, and 0.25 and 3.9 mSv in the difficult-to-return zone. The latest annual effective dose of external exposure discriminated into natural and artificial radionuclides is expected to be utilized for radiation risk communication.

Are lifestyle pattern changes associated to poor subjective sleep quality?: a cross-sectional study by gender among the general Japanese population underwent specified medical check-ups in 2014 and 2015

OBJECTIVES

Subjective sleep quality (SSQ) is defined by the satisfaction of one's overall sleep experience and is composed of sleep depth and restfulness. It has not been clarified how poor SSQ is associated to changes in lifestyles. The purpose is to reveal the association of lifestyle pattern changes and poor SSQ.

DESIGN

A cross-sectional study.

SETTING

The data on basic attributes, SSQ and lifestyle such as presence/absence of smoking, exercise, physical activity, supper time close to bedtime, drinking habits and alcohol intake amount per day were obtained from database and questionnaire of specified medical check-ups in fiscal year 2014-2015 in Japan. The analysis was conducted in 2019.

PARTICIPANTS

The subjects comprised 49 483 residents (26 087 men and 23 396 women), aged 40-74 years who had undergone an annual specified medical check-up from 2014 to 2015 in Fukushima Prefecture, Japan.

OUTCOME MEASURE

Status of SSQ in 2015 was assessed using a question asking whether or not the subjects usually got enough sleep. Poor SSQ in 2015 and lifestyle pattern changes in 2014-2015 were compared between those who were in healthy status both in 2014 and 2015 (referent) and non-referent, using binary logistic regression analysis.

RESULTS

Unhealthy lifestyle pattern for 2014-2015 was significantly associated to poor SSQ in 2015: 'absent to absent' in exercise for men (OR=1.472; 95% CI 1.316 to 1.647) and women (OR=1.428; 95% CI 1.285 to 1.587), physical activity for men (OR=1.420; 95% CI 1.270 to 1.588) and women (OR=1.471; 95% CI 1.322 to 1.638) and 'present to present' in supper time for men (OR=1.149; 95% CI 1.020 to 1.294) and women (OR=1.288; 95% CI 1.102 to 1.505).

CONCLUSIONS

Healthcare workers may be able to contribute to the improvement of SSQ, focusing on changeable lifestyles.

Analysis of direction of association between radiation risk perception and relocation using a random-intercept and cross lagged panel model: The Fukushima Health Management Survey

In the aftermath of a nuclear disaster, a person's radiation risk perception can harm their sociopsychological health. Although there are reports of an association between radiation risk perception and relocation, the direction of this association has not been clarified yet. In this study, we used a random-intercept and cross lagged panel model (RI-CLPM) to investigate the association and its direction between radiation risk perception and the prefectural-level relocation (i.e., inside/outside of Fukushima Prefecture). We did this by using five waves of longitudinal surveys between 2011 fiscal year and 2015 fiscal year among the people affected by the Fukushima disaster in 2011. We included 90,567 participants aged ≥15 years during the time of the disaster who responded to the questionnaire at least once. RI-CLPM was applied to examine the reciprocal relationship between radiation risk perception and locations. We used two radiation risk perception indicators (i.e., genetic effect and delayed effect) and two handling methods on missing data (i.e., listwise deletion and full information maximum likelihood estimation) as sensitive analyses. The effects of radiation risk perception on relocation were found to be negligibly small. Living inside Fukushima Prefecture reduced radiation risk perception irrespective of the difference of indicators or methods, highlighting that radiation risk perception did not dominantly govern whether people were living inside Fukushima Prefecture, but that the locations also affected radiation risk perception. This was the first study to reveal the direction of the association between radiation risk perception and relocation in the aftermath of nuclear disasters.

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Directionality between radiation risk perception and relocation is ambiguous.

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We analyzed the bidirectionality after the Fukushima disaster in Japan.

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The effects of radiation risk perception on relocation are negligibly small.

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Living inside Fukushima Prefecture reduces radiation risk perception.

Exploring Community Psychosocial Stress Related to Per- and Poly-Fluoroalkyl Substances (PFAS) Contamination: Lessons Learned from a Qualitative Study

The purpose of this study was to qualitatively explore the per- and poly-fluoroalkyl substances (PFAS) exposure experience and associated stressors, to inform public health efforts to support psychosocial health and resilience in affected communities. Semi-structured interviews (n = 9) were conducted from July-September 2019 with community members and state public health department representatives from areas with PFAS-contaminated drinking water. Thematic analysis was completed and themes were described and summarized. Reported stressors included health concerns and uncertainty, institutional delegitimization and associated distrust, and financial burdens. Interviewees provided several strategies to reduce stress and promote stress coping capacity and resilience, including showing empathy and validating the normalcy of experiencing stress; building trust through visible action and sustained community engagement; providing information and actionable guidance; discussing stress carefully; fostering stress coping capacity and resilience with opportunities to build social capital and restore agency; and building capacity among government agencies and health care providers to address psychosocial stress. While communities affected by PFAS contamination will face unavoidable stressors, positive interactions with government responders and health care providers may help reduce negative stress. More research on how best to integrate community psychosocial health and stress coping and resilience concepts into the public health response to environmental contamination could be helpful in addressing these stressors.

Radiation Risk Analysis of Neuropsychiatric Disorders in Ukrainian Chornobyl Catastrophe Liquidators

Goal: To explore the possible impact of ionizing radiation in the pathophysiology of neuropsychiatric disorders amongst clean-up workers of the Chornobyl catastrophe (liquidators). Design, object, and methods: Retrospective-prospective study (1987-2015) of liquidators from the State Register of Ukraine (SRU) with radiation doses records and Clinical-Epidemiological Register (CER) of the State Institution ≪National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine≫ (NRCRM). Moreover, cohort and cross-sectional studies of the randomized sample of liquidators from the CER (exposed group, 198 subjects) were examined. Internal control group included the liquidators irradiated in doses <50.0 mSv (42 persons). All subjects were assessed by a detailed clinical examination and a battery of standardized neuropsychiatric scales, psychometric, and neuropsychological tests. Descriptive and variation statistics, non-parametric criteria, regression-correlation analysis, survival analysis by Kaplan & Meier, and risk analysis were used. Results: Exposed group vs. control group showed cognitive disorders in 99 (50.0%) vs. 20 (18.1%), (P = 0.04); affective disorders in 96 (48.3%) vs. 36 (32.7%) (P = 0.007), and stress-related disorders in 115 (58.4%) vs. 8 (7.3%) (P < 0.001). In the main group exposed to ≥50 mSv vs. internal control group (exposed to <50 mSv), affective disorders were present, respectively, in 89 (56.4%) vs. 7 (19.1%) (P < 0.001), and stress-related disorders in 98 (62.8%) vs. 17 (40.4%) (P = 0.009). Relative risks (RR) and 95% confidential intervals (95%CI) of Incidence of some neuropsychiatric disorders in liquidators of 1986-1987 related to internal control (doses <50 mSv) were as follows: organic psychosis (RR = 3.15; 95% CI: 2.6; 3.7); non-psychotic organic brain damage (RR = 1.99; 95% CI: 1.6; 2.5); acute (RR = 1.40, 95% CI: 1.3; 1.5), and chronic cerebrovascular disorders (RR = 1.23; 95% CI 1.0;1.5). Neuropsychiatric diseases show a strong, increasing, and approximately quadratic statistically significant (Pv < 0.001) relationship with individual dose, yielding an estimated excess relative risk ERR = 2.76 Sv-2 (95% CI 1.06-7.15). Conclusions: Liquidators have an excess of cognitive, affective, and stress-related disorders. The risk of diseases rises with radiation dose. Radiation risks are revealed for organic psychoses, non-psychotic organic brain damage, acute and chronic cerebrovascular pathology.

The psychological consequences of (perceived) ionizing radiation exposure: a review on its role in radiation-induced cognitive dysfunction

PURPOSE

Exposure to ionizing radiation following environmental contamination (e.g., the Chernobyl and Fukushima nuclear accidents), radiotherapy and diagnostics, occupational roles and space travel has been identified as a possible risk-factor for cognitive dysfunction. The deleterious effects of high doses (≥1.0 Gy) on cognitive functioning are fairly well-understood, while the consequences of low (≤0.1 Gy) and moderate doses (0.1-1.0 Gy) have been receiving more research interest over the past decade. In addition to any impact of actual exposure on cognitive functioning, the persistent psychological stress arising from perceived exposure, particularly following nuclear accidents, may itself impact cognitive functioning. In this review we offer a novel interdisciplinary stance on the cognitive impact of radiation exposure, considering psychological and epidemiological observations of different exposure scenarios such as atomic bombings, nuclear accidents, occupational and medical exposures while accounting for differences in dose, rate of exposure and exposure type. The purpose is to address the question that perceived radiation exposure - even where the actual absorbed dose is 0.0 Gy above background dose - can result in psychological stress, which could in turn lead to cognitive dysfunction. In addition, we highlight the interplay between the mechanisms of perceived exposure (i.e., stress) and actual exposure (i.e., radiation-induced cellular damage), in the generation of radiation-induced cognitive dysfunction. In all, we offer a comprehensive and objective review addressing the potential for cognitive defects in the context of low- and moderate-dose IR exposures.

CONCLUSIONS

Overall the evidence shows prenatal exposure to low and moderate doses to be detrimental to brain development and subsequent cognitive functioning, however the evidence for adolescent and adult low- and moderate-dose exposure remains uncertain. The persistent psychological stress following accidental exposure to low-doses in adulthood may pose a greater threat to our cognitive functioning. Indeed, the psychological implications for instructed cohorts (e.g., astronauts and radiotherapy patients) is less clear and warrants further investigation. Nonetheless, the psychosocial consequences of low- and moderate-dose exposure must be carefully considered when evaluating radiation effects on cognitive functioning, and to avoid unnecessary harm when planning public health response strategies.

Relationships between radiation risk perception and health anxiety, and contribution of mindfulness to alleviating psychological distress after the Fukushima accident: Cross-sectional study using a path model

One of biggest public health impacts of the Fukushima Daiichi Nuclear Power Station accident is psychosocial. Anxiety about radiation is still present, and radiation risk perception, particularly with regard to genetic effects, is known to affect mental health. However, roles of other risk factors such as health anxiety and of mindfulness remain to be proved. Here, we examined how radiation risk perception (genetic effects) mediates in health anxiety and psychological distress, and how mindfulness influences those variables. Seven years after the accident, we commissioned a self-reported online survey with 832 participants, 416 each from Fukushima and Tokyo, and modeled the relationship between those variables using Structural Equation Modeling. Health anxiety had a much stronger influence on psychological distress than radiation risk perception. Mindfulness was significantly correlated with both health anxiety and psychological distress, but not with radiation risk perception. The total effects on psychological distress were -0.38 by mindfulness and +0.38 by health anxiety. These results suggest the potential application of mindfulness-based interventions to alleviate health anxiety and psychological distress rather than therapy focused on radiation anxiety. The results underline the effectiveness of community support efforts in Fukushima and highlight the importance of enhancing mindfulness during the chronic phase following a disaster.

Pre-outbreak determinants of perceived risks of corona infection and preventive measures taken. A prospective population-based study

OBJECTIVES

Assess how people perceive the risks of coronavirus infection, whether people take preventive measures, and which pre-outbreak factors contribute to the perceived risks and measures taken, such as pre-outbreak respiratory problems, heart problems, diabetes, anxiety and depression symptoms, loneliness, age, gender, marital and employment status and education level.

METHODS

Data were collected in the longitudinal LISS panel, based on a random sample of the Dutch population. The coronavirus survey started on March 2, and the data collection ended on March 17 2020. Data were linked with surveys on health and social integration conducted at the end of 2019 (Nstudy sample = 3,540).

RESULTS

About 15% perceived the risk of infection as high, and 11% the risk becoming ill when infected. Multivariable logistic regression analyses showed the following. Older age-groups perceived the risk for coronavirus infection as lower (all adjusted Odd Ratio's [aOR] ≤ .070). In total, 43.8% had taken preventive measures, especially females (aOR = 1.46, 95% CI = 1.26-1.70). Those with lower education levels less often used preventive measures (aOR = 0.55, 95% CI = 0.45-0.67). Those with pre-outbreak respiratory problems (aOR = 2.75, 95% CI = 2.11-3.57), heart problems (aOR = 1.97, 95% CI = 1.34-2.92) and diabetes (aOR = 3.12, 95% CI = 2.02-4.82) perceived the risk becoming ill when infected as higher than others. However, respondents with pre-outbreak respiratory problems and diabetes did not more often take preventive measures.

CONCLUSIONS

Vulnerable patients more often recognize that they are at risk becoming ill when infected by the coronavirus, but many do not take preventive measures. Interventions to stimulate the use of preventive measures should pay additional attention to physically vulnerable patients, males and those with lower education levels.

Development and Evaluation of a Gatekeeper Training Program Regarding Anxiety about Radiation Health Effects Following a Nuclear Power Plant Accident: A Single-Arm Intervention Pilot Trial

After the Fukushima Daiichi Nuclear Power Plant accident in March 2011, residents perceived a radiation exposure risk. To address the concerns about radiation exposure and the subsequent effects on their health, we developed the gatekeeper training program for radiation health anxiety and mental health issues. The program consisted of a presentation and roleplay, with educational objectives to the increase knowledge and understanding around radiation health anxiety, alcoholism, depression, and suicide. Twenty-six counselors participated in the program as a single-arm intervention. To measure the outcomes, the subjects reported self-confidence when they counselled with residents with radiation health anxiety and other mental health issues. Comparing the answers to pre- and 2-month follow-up surveys, the confidence levels were higher after 2 months than at baseline, especially for the question "How confident are you at supporting a resident with mental health issues?", which showed the largest increase (p < 0.001). Regarding radiation health anxiety the questions "Can you communicate coping skills to a resident with radiation health anxiety?" (p = 0.007) and "Can you refer a resident with radiation health anxiety to professionals who can cope appropriately?" (p = 0.016) showed significant increases in their confidence levels. This program could be useful for on-going health activities and future nuclear disasters.

The Association between Utilization of Media Information and Current Health Anxiety Among the Fukushima Daiichi Nuclear Disaster Evacuees

The 2011 nuclear disaster in Fukushima was not only a health disaster, but also an information disaster. Although media can promote health communication following disasters, studies have revealed associations between media information and negative psychological reactions. To clarify the relationship between media utilization and current health anxiety due to radiation exposure, a cross-sectional questionnaire survey was conducted in Fukushima. We selected 2000 subjects from evacuation (i.e., 500) and non-evacuation (i.e., 1500) areas by two-stage stratified random sampling. As the independent variable, participants were asked about current health anxiety due to radiation exposure at the time of answering the questionnaire. For utilization of media about radiation exposure, local media, national media, Internet media, public broadcasts, and public relations information from local government were set as the dependent variables. Questionnaire data were analyzed by evacuation type (i.e., forced/voluntary). In a multivariate logistic regression analysis, the use of public relations information was significantly associated with lower anxiety for the forced evacuees (odds ratio: 0.72; 95% confidence interval: 0.56–0.93). Our findings highlight the importance of public relations information from local government in terms of it being associated with lower current health anxiety, and this could potentially aid in preparing for future disasters.

Evaluation of the Fight BAC! The Story of Your Dinner Campaign Video: A Multistate Study

ABSTRACT

This study was conducted to evaluate the effectiveness of the holiday food safety campaign, "The Story of Your Dinner," launched in 2016 by the Partnership for Food Safety Education. The campaign was designed to change knowledge, risk perception, and perceived behavioral control ideas among U.S. consumers. Results from the study, conducted from 2016 through 2018, were analyzed overall and among specific demographic groups. For respondents from all 3 years, overall knowledge significantly increased from presurvey to postsurvey. Survey findings indicated that after viewing the educational intervention, adult respondents were significantly more confident in their ability to use a food thermometer while cooking small cuts of meat and poultry and developed a significantly higher perception of the risk of suffering from foodborne illness. The educational intervention was more effective for changing risk perception and perceived behavioral control among some demographic groups. Respondent risk perception and perceived behavioral control significantly increased in more categories for adolescents than for adults. Consumers tended to overestimate their safe food handling practices. Prior to the educational intervention, adult respondents rated themselves highly (5.49 ± 1.64 of 7.00) on their confidence in cooking meat and poultry that is safe to eat. However, these respondents were less comfortable complying with the safe food handling practice of using a thermometer on small (4.47 ± 1.98) and large (4.61 ± 2.02) cuts of meat and poultry. More educational interventions are needed to improve compliance with safe food handling in home kitchens. Future studies will be conducted to identify and address barriers to food safety behavioral change among various population groups.

HIGHLIGHTS

Considered Factors of Online News Based on Respondents’ Eye Activity Using Eye-Tracker Analysis

Development of the internet as a source of information has penetrated many aspects of human life, which is shown in the increasingly diverse substance of news in online news sources. Previous studies have stated that the presentation of the substance of online news information can have negative impacts, especially the emergence of anxiety in users; thus, managing the presentation of information becomes important. This study intends to explore factors that should be considered as possible anxiety-inducers for readers of news sites. Analyses of areas of interest (AOIs), fixation, and heat maps from respondents’ eye activity obtained from eye-tracker data have been compiled with Beck Anxiety Inventory (BAI) measurement results to analyze anxiety among newsreaders. The results show that text is the dominant center of attention in various types of news. The reason for the higher anxiety that arises from text on online news sites is twofold. First, there are the respondents’ experiences. Second, text usage allows for boundless possibilities in respondents’ imaginations as a response to the news that has occurred.

Characteristics of Disaster-Related Suicide in Fukushima Prefecture After the Nuclear Accident

Abstract.Background: Suicide is a major concern after the 2011 earthquake and nuclear accident in Fukushima. Aims: This study delineates characteristics of the disaster-related suicides in Fukushima. Method: Data provided by the Fukushima Prefectural Police and data published by the Fukushima or Japanese Government were analyzed. Numbers of disaster-related suicides and evacuees were compared among the three prefectures affected. Age, sex, occupation, and means for disaster-related suicides in Fukushima were compared with overall suicides in Fukushima or Japan. History of medical treatment, changes in job and family structure after the disaster, and signs of contemplation were examined within the disaster-related suicides of Fukushima. Results: While other prefectures have experienced a drop in disaster-related suicides, Fukushima has not. Age-standardized disaster-related suicide rates were remarkably higher in men than in women. Moreover, disaster-related suicide rates in Fukushima were higher in women in their 50s and 80s as compared with overall suicide rates in Fukushima or Japan. Limitations: No detailed comparisons were made between disaster-related and non-disaster-related suicides. Conclusion: Disaster-related suicide rates were higher in men than in women. Also, it was found that the disaster-related suicide rates of elderly women were higher compared with overall suicide rates in Japan and Fukushima. In addition, many who died by suicide showed signs of contemplation before the attempt and had started psychiatric treatment. Improvement of suicide risk assessment skills for mental health professionals and gatekeeper training among residents will be essential to prevent disaster-related suicides.

Usefulness of the whole-body counter for infants and small children (BABYSCAN) as a risk communication tool after the Fukushima Daiichi nuclear power plant incident

Responding to the radiation-related concerns of parents/guardians with infants/small children is an important public health issue for regional recovery after radioactive contamination. This study summarizes the results of a systematic internal contamination screening of infants/small children, aged 0-6 years, using BABYSCAN and individual counselling sessions with physicians about radiation concerns from 2014 to 2018 in Minamisoma City. Of 3,114 participants, no one was found to have internal contamination with radioactive caesium with a detection limit of 50 Bq/body. The questionnaire survey showed a decreasing trend of concerns about food contamination and playing outside as possible causes of internal contamination over time. Because people's concerns were diverse in counselling sessions, individual responses are required. This study showed that examinations using BABYSCAN provide an opportunity for direct dialogue between the parents/guardians of infants/small children and experts. This can be considered a model case for risk communication conducted by the local government after a radioactive contamination incident.

Association of Anxiety over Radiation Exposure and Acquisition of Knowledge Regarding Occupational Health Management in Operation Leader Candidates of Radioactivity Decontamination Workers in Fukushima, Japan: A Cross-Sectional Study

An operation leader (OL) of radioactivity decontamination workers is required by law to have accurate knowledge of occupational health management (OHM) such as working environment management, control of operations, and health management as a field supervisor in Japan. The purpose of the current study is to examine the association between anxiety over radiation exposure and the possession/acquisition of the OHM knowledge required for OLs. In this cross-sectional study, data were collected before and after training sessions held by Fukushima Prefecture Labor Standard Associations in Fukushima, Japan, in 2017. Eighty-seven males who completed the questionnaires were enrolled to this study. As a result, acquisition of knowledge of working environment management was significantly associated with an increase of anxiety over radiation exposure after the session comparing the situation before and after the session (knowledge possession; odds ratio = 4.489; 95% confidence interval = 1.216, 16.571). In conclusion, acquisition of accurate knowledge of how to manage working environment management was associated with anxiety over radiation exposure. Although acquisition of said knowledge may contribute to the reduction of physical health risks, it may increase mental health risks. Both mental health support for OLs with accurate knowledge and educational support for those without accurate knowledge are required.

Modeling reconstruction-related behavior and evaluation of influences of major information sources

Reconstruction has progressed steadily since the 2011 TEPCO's Fukushima Daiichi Nuclear Power Station accident. However, some people still hesitate to eat foods from Fukushima or to travel there, and there are concerns about the health risks of radiation. We investigated the relationships among reconstruction-related behavior, risk perception, types of information, and information sources, in order to consider appropriate measures for providing information and promoting reconstruction-related behavior a number of years after the accident. We conducted an online questionnaire survey (n = 1000) of Tokyo residents. First, a factor analysis was conducted on knowledge associated with radiation. Two factors were extracted; namely, "physical knowledge" and "health/social knowledge." We conducted structural equation modeling to construct a model of "knowledge," "radiation risk perception," and "intention concerning reconstruction-related behavior." "Intention concerning reconstruction-related behavior" decreased with "radiation risk perception" and increased with "health/social knowledge." In addition, "health/social knowledge" negatively affected "radiation risk perception;" this effect was not large, but it was significant. Second, respondents were clarified by information sources using a cluster analysis. Clusters that included respondents who got information from public relations materials issued by municipalities and websites of administrative agencies had a higher factor score for "health/social knowledge" than other clusters. The cluster of respondents who did not get any particular knowledge had the lowest factor score, which was significant, and also had a low "perception of reconstruction."

Mental distress in the rural Kazakhstani population exposed and non-exposed to radiation from the Semipalatinsk Nuclear Test Site

The present study investigates the rates of depression, anxiety, somatic distress, and fatigue in a rural population of Abayskiy, Borodulikha and Mayskiy districts exposed to radiation from Semipalatinsk Nuclear Test Site in comparison with the unexposed population of Kurchum district. The sample size included 901 people, of whom 656 were residents of radioecological contaminated areas, while 245 resided at ecologically safe territories and had no radiation exposure in the past. Both study groups had no significant differences concerning age, sex, level of education, smoking habit, and alcohol consumption. The prevalence of depression, anxiety, somatic distress and fatigue in the exposed group was found to be considerably higher than that in the unexposed. Results of logistic regression analysis showed considerable differences in associations between depression and anxiety, as wells as between depression and somatic distress in the exposed group. Besides, depression was significantly associated with general fatigue, reduced activity, physical fatigue, reduced motivation and mental fatigue in the unexposed group. There is a need to tailor public health interventions focused on the identification and management of individuals exhibiting mental distress, including the provision of adequate information about radiation-induced health effects, quality routine check-ups and psychological counseling.

Intention to return to the town of Tomioka in residents 7 years after the accident at Fukushima Daiichi Nuclear Power Station: a cross-sectional study

The aim of our study was to identify the factors associated with intention to return (ITR) in residents of Tomioka town, Fukushima Prefecture. We contacted approximated 8000 residents aged 20 years or older who lived in Tomioka. We invited them to take part in a written survey on ITR. In all, 1749 residents' replies were included in the analysis. We asked about ITR in former residents of Tomioka town. We also asked about relevant factors and about risk perception in relation to the health effects of radiation exposure. Of those contacted, 469 (26.8%) had an ITR. Logistic regression analysis revealed that being male (OR = 1.6, 95% Cl: 1.24-1.96, P < 0.001), the anticipation of improving shopping in the town (OR = 1.5, 95% Cl: 1.26-1.67, P < 0.001) and requests for individual consultation with experts on the health effects of radiation (OR = 2.7, 95% Cl: 2.10-3.48, P <0.001) were associated with the ITR (+), and living with children under 18 years of age (OR = 0.7, 95% Cl: 0.51-0.95, P = 0.023), reluctance to drink tap water (OR = 0.5, 95% Cl: 0.36-0.69, P < 0.001) and anxiety regarding genetic effects of radiation in the next generation (OR = 0.6, 95% Cl: 0.45-079, P <0.001) were associated with the ITR (-) to Tomioka town, independent of other covariates. To allay the anxieties of residents who have an ITR to their hometown, careful risk communication, including information on the potential effects of radiation on health, is important.