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EMJ Online First, published on May 16, 2012 as 10.1136/emermed-2011-201000
Original article

Preventive behaviours against radiation and related
factors among general workers after Fukushima’s
nuclear disasters
Hideyuki Kanda,1,2 Takehito Hayakawa,1 Kikuo Koyama2
1
Department of Hygiene andPreventive Medicine, Fukushima
Medical University, Fukushima,
Japan
2
Fukushima Occupational Health
Promotion Center, Fukushima,
Japan

Correspondence to
Dr Hideyuki Kanda, Departmentof Hygiene and Preventive
Medicine, Fukushima Medical
University, Hikarigaoka 1,
Fukushima 920-1295, Japan;
hkanda@fmu.ac.jp
Accepted 31 March 2012

ABSTRACT
Background The nuclear power plant accidents inFukushima resulted in a widespread release ofradioactive substances in the Fukushima prefecture.
Aim To clarify what factors led to precautions among
general workers who displayed preventive behaviours
against radiation following the nuclear disasters inFukushima.
Methods Descriptive study of preventive behaviours
among general workers 3e5 months following the nuclear
disasters. The subjects were 1394 regular workers who
took part in radiation seminars conducted by the Fukushima
Occupational Health Promotion Center between July andAugust 2011. Of 1217 responses, 1110 eligible responses
were included in this study. This anonymous questionnaire
survey was asking for characteristics and questions on
preventive behaviours following the nuclear disasters. The
authors assessed the contribution of each variable bya logistic regression analysis.
Results Keeping track of environmental radiation levels andwashing hands and gargling were significantly more
frequent among female subjects, older age and workers
residing up to approximately 80 km away from the power
plants. Washing hands and gargling were also related withliving with children. Wearing a mask when leaving homeand buying bottled water were significantly more often
observed with female subjects and workers residing up to
80 km. Refraining from going outdoors was positively
associated with workers residing up to 80 km and workers
living with children.
Conclusions These results provide information that may
help with the targeting of health information after a nuclear
disaster. This may contribute to determining an order ofpriority when distributing information after a nuclear
disaster.

INTRODUCTION
Many people living in Fukushima are concerned
about radiation levels in their areas. The Fukushima
Dai-ichi nuclear power plants (FDNPP), operated
by the Tokyo Electric Power Company, sufferedmajor damage from the magnitude 9.0 earthquakeand subsequent tsunamis that hit Eastern Japan on
11 March 2011.1 2 The earthquakes and tsunamis
disabled the reactor’s cooling systems,2 3 which led
to a hydrogen explosion at the No. 1 building of the
FDNPP on 12 March 2011, and a second hydrogen
explosion at the No. 3 building on 14 March 2011.
The pressure valves of the nuclear reactor containment vessel at the No. 2 building were opened on 13
March 2011. These accidents resulted in the releaseof radioactive substances from the FDNPP,3 andtriggered the Japanese government to implement

a 20 km evacuation zone surrounding them. The
radiation pollution has now contaminated areas
throughout Fukushima prefecture and various partsof Eastern Japan as well.4 Both the Nuclear andIndustrial Safety Agency, which is one of thegovernment organisations, and the Fukushima
prefectural government showed information callingfor nuclear attention such as refraining from goingoutside, rigorous enforcement of washing hands andgargling, brushing dirt off clothing after returning
home, and wearing a mask when leaving home soonafter the nuclear accidents.5 6 There had been public
information broadcasting suggesting these preventive
behaviours against radiation at that time.
According to the Fukushima prefectural government, as of 22 August 2011, over 50 000 citizens
have evacuated from Fukushima to other prefectures since 11 March 2011.7 Many of those affectedby the natural and nuclear disasters have been
forced to live as evacuees, having lost their homes
due to earthquake and tsunami damage, or fromliving within the 20 km evacuation zone. In addition, as a result of these nuclear plant accidents,
many households with children have taken voluntary refuge at other prefectures due to concerns ofradiation and its effects on the health of theirchildren.8 Many of the households taking voluntary
refuge have one or two household members that arein their prime working years, meaning an outﬂow
of skilled labour to other prefectures has been
unavoidable.9 On the other hand, workers who arestaying in Fukushima have been forced to copewith issues related to radiation exposure. In an
attempt to minimise their exposure, workers inFukushima have been displaying preventive behaviours against radiation, such as wearing masks andrefraining from going outside. However, no studies
have been done so far on what factors are inﬂuencing workers while they are deciding to takepreventive actions.
This present study attempts to clarify what factors
inﬂuenced workers in Fukushima when deciding ona preventive behaviour to take against radiation.
Our aim is to contribute to a better understandingof the types of factors that associate with individuals
making decisions on such behaviours against
radiation when following a nuclear accident.

METHODS
Subjects
This study design was a cross-sectional questionnaire survey conducted among regular workers,
3e5 months following the nuclear disasters inFukushima. The Fukushima Occupational Health

Kanda
H, HayakawaArticle
T, Koyamaauthor
K. Emerg Med(2012).employer)
doi:10.1136/emermed-2011-201000
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Original article
Promotion Center (FOHPC) serves as an active base for promoting
occupational health activities within the Fukushima prefecture.
One of the roles of the centre is to provide assistance to workers
and to industrial health nurses and health supervisors. After the
nuclear incidents, the FOHPC informed about holding the seminars against radiation on their website and through a pamphletfrom May to August, 2011. The lectures on radiation and healthwere either hosted by or conducted under the joint auspices of the
FOHPC between June and August, 2011. The reason why theseminars were delayed until 3e5 months after the nuclear incidents is because it took until July 2011 for the Japanese government and Tokyo Electric Power Company to announce thecompany had completed the initial stages of its restoration efforts
at the Fukushima nuclear power plants, ensuring that the nuclear
reactors were in fact being cooled and emissions of radiation
substances were on the decline. The seminar for each participant
was just one time from 60 min to 90 min. The content was asfollows: a summary of the Fukushima nuclear power plant accident, the difference between radioactive activity and radiation, thekind of radioactive activity and radiation and the effects on thehuman body due to radiation (probabilistic effects and nonstochastic effects). In total, 41 seminars were held, and 1394
workers were given information on radiation and health. The
subjects of our study were participants who took part in one ormore of these radiation seminars. All participants gave informed
consent to release information for the study. This study wasreviewed and approved by the FOHPC.

seminar. There were two parts to the questionnaire: the ﬁrst asked
for biographical and background information such as gender, age
category, and questions asking whether they evacuated, whether
they are living with someone who is pregnant, whether they areliving with children or teenagers, what industry they work in, andin what area of Fukushima they reside currently. The residential
areas in the questionnaire were divided into four areas: ‘coastal
areas’, up to approximately 40 km away from the FDNPP and
excluding the evacuation zone; ‘central area’, approximately
40e80 km away from the FDNPP; ‘mountainous area’, approximately 80 km and furthest away from the FDNPP; and ‘otherprefecture’ (ﬁgure 1). The second part of the questionnaire asked
subjects about the types of preventive behaviours they practiced
following the nuclear disasters. A list of 10 preventive behaviours,
namely, keeping track of environmental radiation levels using news
sources such as newspapers, washing hands and gargling every day,wearing a mask when leaving home, buying bottled water,refraining from going outside, not buying agricultural products
made in Fukushima, brushing dirt off clothing after returning home,
spending more time in areas with lower doses of radiation within
Fukushima, evacuating family members to low radiation areas, andspending more time in prefectures outside of Fukushima, was given
to subjects who were then asked to select all of the behaviours
they had taken following the nuclear accidents. Upon completion of
the survey, the questionnaires were collected by workers at the
FOHPC. Of 1217 responses, 107 responses did not have all the dataneeded for analysis, leaving 1110 eligible responses in the study.

Outcomes

Statistical analysis

The study was conducted by distributing anonymous questionnaires to all subjects and collecting them prior to the start of each

A c2 test was used to compare frequencies between subjects
who practiced preventive behaviours and subjects who did not.

Figure 1 Residential areas from the Fukushima Dai-ichi nuclear power plants.
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Original article
A multiple logistic regression analysis was used to assess thecontribution of each biographical variable to the ﬁve mostcommon preventive actions over 25% in frequency. The signiﬁcance of the interaction of gender with other factors related tocharacteristics was tested using interaction term in multivariate
models in the gender-combined analysis. The Statistical Package
for the Social Sciences (SPSS Japan Inc. V.16.0J) was used for the
analyses. All probability values were two-tailed and at a 5% levelof signiﬁcance.

RESULTS
Table 1 shows the characteristics of 917 workers who displayed
preventive behaviours against radiation and 193 workers who
did not. When using a c2 test, it was found that among those
who displayed preventive behaviours against radiation, female
workers and workers residing in coastal and central areas more
often displayed preventive behaviours than others. On the other
hand, workers in the building industries displayed less preventive behaviours than others.
Table 1 also shows a prevalence of certain preventive behaviours among 917 workers who acted against radiation following

the nuclear disasters in Fukushima. Workers who showed such
behaviours selected an average of 2.3 (SD 62.0) preventive
behaviours each. The highest prevalence of preventive behaviours was 72.2%, which was keeping track of environmental
radiation levels using sources such as newspapers.
Table 2 shows an OR and 95% CI of the ﬁve most commonly
displayed preventive behaviours as determined using a logistic
regression analysis. Keeping track of radiation levels was statistically signiﬁcant with female workers, workers belonging toolder age categories, and residents of central and coastal areas.
Washing hands and gargling were positively related with female
workers, older age categories, residents in central and coastal
areas, and workers living with children or teenagers. Wearing
a mask when leaving home and buying bottled water weresigniﬁcantly more observed among female workers and residents
in central and coastal areas. Refraining from going outside waspositively associated with workers residing in central and coastal
areas, and workers living with children or teenagers. Then, theinteraction term of gender with other factors related to characteristics in multivariate models did not have statisticalsigniﬁcance.

Table 1 Characteristics of 917 workers who took preventive measures against radiation and 193 workers who did not following Fukushima’s nuclear
disasters

Female workers (number, %)Age category (number, %)
<30
30e39
40e49
50e59
60 over
Workers who evacuated (number, %)Government-ordered
Voluntary
Workers living with a pregnant woman (number, %)Workers living with children or teenagers (number, %)Industry of profession (number, %)Building industry
Manufacturing industry
OthersArea of current residence in Fukushima prefecture (number, %)Coastal area without the evacuation zone
Central area
Mountainous area
Other prefectures
Number of preventive behaviours
Number of preventive behaviours displayed (Mean 6 SD)
Types of preventive behaviours
Keeping track of environmental radiation levels through sources suchas newspapers (number, %)Rigorous enforcement of washing hands and gargling (number, %)Wearing a mask when leaving home (number, %)Buying bottled water (number, %)Refraining from going outside (number, %)Not buying agricultural products made in Fukushima (number, %)Brushing dirt off clothing after returning home (number, %)Spending more time in areas with lower doses of radiation within
Fukushima (number, %)Evacuating family members to lower radiation areas (number, %)Spending more time in prefectures outside of Fukushima (number, %)Workers who took preventive
behaviours (N[917)Workers who did not takepreventive behaviours (N[193)p Values*

266 (29.0%)

23 (11.9%)<0.01

84 (9.1%)
186 (20.3%)
264 (28.8%)289 (31.5%)
94 (10.2%)

20 (10.3%)
37 (19.2%)
55 (28.5%)
61 (31.6%)
20 (10.4%)

0.95

11 (1.2%)
6 (0.7%)19 (2.1%)
418 (45.6%)

1 (0.5%)0 (0.0%)2 (1.1%)74 (38.3%)

0.67

155 (16.9%)
393 (42.9%)369 (40.2%)

43 (22.3%)
90 (46.6%)
60 (31.1%)

0.04

185 (20.2%)616 (67.2%)
90 (9.8%)
26 (2.8%)

13 (6.7%)
117 (60.6%)
51 (26.4%)
12 (6.2%)

<0.01

0.35
0.07

2.362.0662 (72.2%)
379 (41.3%)
354 (38.6%)
293 (32.0%)
255 (27.8%)
154 (16.8%)
144 (15.7%)
129 (14.1%)
104 (11.3%)
98 (10.7%)*p Values for c2 test.

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Table 2

OR and 95% CIs for each of the common behaviours following Fukushima’s nuclear disaster
Keeping track ofenvironmental radiationlevels in the newspapers, etc
OR (95% CI)

Gender (0¼man, 1¼woman)
1.67 (1.23 to 2.25)
Age category (+10 years)
1.39 (1.24 to 1.56)
Living with a pregnant woman
1.13 (0.46 to 2.80)(0¼no, 1¼yes)
Living with children or teenager
1.08 (0.84 to 1.39)(0¼no, 1¼yes)
Industry of profession
Others
1.00
Building industry
0.79 (0.55 to 1.13)
Manufacturing industry
0.82 (0.62 to 1.08)
Area of current residence in Fukushima prefecture
Mountainous area
1.00
Other prefectures
0.70 (0.33 to 1.48)
Central area
1.68 (1.16 to 2.44)
Coastal area without the
1.78 (1.13 to 2.81)
evacuation zone
Evacuated or not
Did not evacuate
1.00
Government-ordered
1.71 (0.42 to 6.91)
Voluntary
0.71 (0.14 to 3.70)

Rigorous enforcementof washing hands andgargling
OR (95% CI)

Wearing a mask
when leaving home
OR (95% CI)

Buying bottledwater
OR (95% CI)

Refraining fromgoing outside
OR (95% CI)

1.77 (1.31 to 2.39)
1.21 (1.08 to 1.37)
0.55 (0.22 to 1.39)

1.59 (1.18 to 2.16)
0.99 (0.88 to 1.12)
0.71 (0.28 to 1.78)

1.85 (1.35 to 2.55)
0.92 (0.81 to 1.04)
0.41 (0.16 to 1.05)

1.19 (0.85 to 1.66)
1.06 (0.93 to 1.22)
0.51 (0.20 to 1.31)

1.64 (1.26 to 2.13)

1.12 (0.86 to 1.47)

1.31 (0.98 to 1.74)

2.24 (1.66 to 3.02)

1.00
1.12 (0.81 to 1.70)
0.86 (0.64 to 1.14)

1.00
1.33 (0.91 to 1.95)
0.87 (0.65 to 1.16)

1.00
1.31 (0.87 to 1.99)
1.01 (0.74 to 1.38)

1.00
0.99 (0.64 to 1.53)
0.91 (0.66 to 1.25)

1.00
0.36 (0.12 to 1.10)
2.01 (1.31 to 3.11)
2.79 (1.69 to 4.62)

1.00
1.56 (0.61 to 3.96)
2.97 (1.78 to 4.95)
6.74 (3.81 to 11.91)

1.00
1.91 (0.52 to 7.00)
7.38 (3.38 to 16.12)
13.89 (6.10 to 31.63)

1.00
1.25 (0.32 to 4.96)
4.80 (2.38 to 9.67)
6.95 (3.27 to 14.75)

1.00
1.20 (0.34 to 4.24)
0.31 (0.04 to 2.75)

1.00
1.07 (0.30 to 3.74)
1.41 (0.27 to 7.39)

1.00
3.26 (0.87 to 12.31)
0.31 (0.03 to 2.72)

1.00
1.39 (0.37 to 5.18)
2.76 (0.52 to 14.56)

DISCUSSION
The present study suggested that residents within 80 km from
FDNPP, female gender, older age and living with children or teenagers were important determinants of some preventive behaviours
against radiation among general workers in Fukushima after the
nuclear disasters. This is the ﬁrst study to report a prevalence of
certain types of preventive behaviours displayed against radiationand to assess the factors that became associated with thesebehaviours among regular workers following the nuclear disasters.
Although there have been studies performed on the different
types of preventive behaviours following a natural disaster,10
there have never been any studies that research the types of
preventive behaviours following a nuclear accident. Our researchstudies the preventive actions taken against radiation by workers
who participated in the FOHPC’s seminars in Fukushima 3e5months following the nuclear incidents. Our research is therefore
signiﬁcant as it clariﬁes which types of factors are associated withpreventive behaviours in a short time span following a nuclear
accident. Our results suggested that those who had relatedcharacteristics to display some preventive behaviours, such as
female subjects and residents near the nuclear power plants,might be more sensitive for radiation protection than those who
did not have them. Therefore, our results provide informationthat may help with the targeting of health information in the
future.
The area in which the subject resided was associated with allof the top ﬁve responses in the list of preventive behaviours.
Through this, it is evident that the closer people live to the
FDNPP, the more likely they are to display preventive behaviours
against radiation. The evacuation areas near the FDNPP weredivided into three areas by the Japanese government:11 12 evacuation zone within a 20 km radius of the FDNPP, evacuationprepared areas within a 20e30 km radius and deliberate evacuation
areas outside of the 20 km radius where residents could potentiallyaccumulate over 20 mSv of annual radiation. The government’s
separating and designating areas in radial distances like this may
have created a relationship between radial distance from the
4 of 5

FDNPP and the preventive behaviours of its residents. Thisobservation explains why residents living in coastal areas that arecloser to the FDNPP were more likely to display preventive
behaviours against radiation than others. Furthermore, the spreadof radioactive materials was not determined by radial distancefrom the FDNPP, but by wind directions on the day of the nuclear
accidents. Due to this, some areas in Fukushima resulted in having
higher levels of radiation than others. For this reason, it wasobserved that people with tendencies to display preventive
behaviours against radiation were those living close to the FDNPP
such as residents from coastal areas and those from a wider range,
including those from the central area, 40e80 km away from the
FDNPP.
Furthermore, whether the worker was of female gender or
not also had a positive association with each of the ﬁve mostcommonly displayed preventive behaviours. According toprevious ﬁndings from the report titled ‘Suicide Ideation after
the 1999 Earthquake in Marmara, Turkey’, the thought ofsuicide following an earthquake was 0.71 (95% CI: 0.60 to 0.85)
times lower with female than with male subjects.13 Studies
also reported that following the Hanshin-Awaji Earthquake in
1995, traumatic reactions among female undergraduate
students decreased after 3 months, while feelings of survival
guilt did not.14 Therefore, these reports suggested that female
subjects were psychologically stronger than male subjects
following large-scaled earthquakes. However, our study reports
for the ﬁrst time that female subjects are more likely to display
preventive behaviours against radiation following a nuclear
accident triggered by large-scaled earthquakes. This result
likely was due to with factors that are less to do with thepsychological toughness of female subjects, and more to dowith other factors such as social responsibility and sensitivity.
Then, our results indicated that gender was an independent
factor to act on preventive behaviours independent of having
children or not. Our results suggested the information tofemale subjects about radiation was given with greater carethan that to male subjects.

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Original article
Meanwhile, workers living with children or teenagers wereassociated with preventive actions such as washing hands andgargling, and refraining from going outside. A possible explanation for this association is adults living with children are acting
the same way as they are instructing the children to act in orderto minimise the amount of radiation the children are being
exposed to. According to Fujiwara and coworkers, generally
speaking, children have higher sensitivity to radiation and therelated diseases than adults.15 Studies of the atomic bomb
survivors in Hiroshima found that in cases of cancer andleukaemia, the age at the time of radiation exposure had effects
on both early risks and temporal risks of radiation related
conditions.15 The younger the age when exposed to radiation,
the higher were the early risks while the larger the drops were inlater temporal risks. For these reasons, adults living together
with children are displaying adequate preventive behaviour by
washing hands, gargling and refraining from going outside, as
these behaviours indicate a desire by adults to reduce thechances of inner and outer radiation exposure by the children.
Finally, increases in age categories showed signiﬁcances withbehaviours such as keeping track of radiation levels using sources
such as newspapers, and washing hands and gargling. It is
possible that workers belonging to the older age groups weremore likely to belong to senior positions at their workplace andwere therefore expected to keep track of environmental radiationin order to supervise their coworkers’ working conditions. The
same reason may have also played a factor in why basic sanitary
actions such as washing hands and gargling were more common
with those belonging to older age groups. It is possible thatworkers belonging to senior positions need to act as role models
in their workplaces, and actively practice sanitary actions likethese in order to persuade other workers to follow, and therefore
reduce overall radiation exposure.
There are some limitations in the present study. First, ourstudy uses a cross-sectional design, which does not prove a
causal relation. Second, these results include a selection bias andan eventual bias due to targeting only participants of a radiation
seminar. These must be taken into consideration when interpreting our results. Finally, the results may show overestimationsof preventive behaviours among participants, as the participants
include regular workers and industrial health nurses and healthsupervisors who have relatively higher levels of knowledge withregard to radiation safety. To conﬁrm this, more data will beneeded.

CONCLUSIONSIn conclusion, we clariﬁed that among general workers inFukushima, those living within approximately 80 km of thenuclear power plants, female workers, those belonging to older
age categories, and those living with children or teenagers werepositively associated with preventive behaviours against radiation. The results of this study are signiﬁcant, as they provide an

objective view on how general workers reacted on an individual
basis against radiation following the nuclear disasters inFukushima. Our results provide information that may help withthe targeting of health information in the future.
Acknowledgements We are grateful to Mr Masamichi Kondo for the collection of
the data, Ms Junko Ogata for the assembling, inputting and managing of the data,
and to Mr William DY McMichael for the English editing of the manuscript.
Contributors HK initiated the study, designed the protocol, analysed data, wrote thepaper and is the guarantor for the study. TH helped design the protocol, review theliterature and analyse data. KK collected data and reviewed the literature.
Competing interests None.
Ethics approval Ethics approval was provided by Fukushima Occupational Health
Promotion Center.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Dr Kanda had full access to all the data in the study andtakes responsibility for the integrity of the data and the accuracy of the data analysis.

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Preventive behaviours against radiation andrelated factors among general workers after
Fukushima's nuclear disasters
Hideyuki Kanda, Takehito Hayakawa and Kikuo Koyama
Emerg Med J published online May 16, 2012

doi: 10.1136/emermed-2011-201000

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