Quantitative Assessment of Preventive Behaviors in France during the Fukushima Nuclear Crisis

Abstract

BackgroundThe Fukushima nuclear disaster has generated worldwide concern on the risk of exposure to nuclear radiations. In Europe, health authorities had to issue statements about the lack of usefulness of iodine based preventive treatments within their borders. However a lack of confidence in official messages has developed in various European countries due to recent perceived failures in managing public health crises. The lay population preventive behaviors in this context are largely unknown. Consequently, to examine the effects of public health crisis on lay behaviors leading to pharmaceuticals purchases, we studied the sales of iodine-based products in France before, during and after the crisis.MethodsWe focused our study on 58 iodine-based drugs available with and without a physician prescription. Our data came from a stratified sample of 3004 pharmacies in metropolitan France. Our study period was from January 2010 to April 2012, with a focus on March-April 2011. We differentiated sales of drugs prescribed by physicians from sales of drugs obtained without a prescription. We used a CUSUM method to detect abnormal increases in sales activity and cross-correlations to assess shifts in sales timing.ResultsSales of iodine-based nutritional complements, and later sales of iodine-based homeopathic remedies, substantially increased (up to 3-fold) during a period of 20 days. Their temporal patterns were correlated to specific events during the crisis. Prescriptions for iodine-based homeopathy increased (up to 35% of all sales). Iodine pills, strictly regulated by health authorities, have also been sold but on a very small scale.ConclusionThese results indicate uncontrolled preventive behaviors resulting in the potentially unjustifiable consumption of available drugs. They have implications in public policy, and demonstrate the usefulness of drug sales surveillance for instantaneous evaluation of population behavior during a global crisis.

How would citizens react to official advice in a nuclear emergency? Insights from research in three European countries

“…Moreover, a large fraction of respondents may take an iodine tablet contrary to the advice from authorities. This converges with findings from previous research in the context of emergency preparedness, as well as lessons learned from the Fukushima and Chernobyl accidents (Crépey et al, 2013; Drottz‐Sjöberg & Sjoberg, 1990; Orita et al., 2015; Turcanu, Carlé, Hardeman, Bombaerts, & Van Aeken, 2007).…”

“…However, this is not always the case, leading to the “risk perception paradox” (Wachinger, Renn, Begg, & Kuhlicke, 2013). In the particular case of nuclear accidents, higher risk perception may lead to adoption of actions contradicting official advice, such as unnecessary evacuation (Johnson & Zeigler's, 1983) or intake of stable iodine when not recommended (Crépey et al, 2013). Based on this, we formulated the following hypotheses:…”

“…The Fukushima accident highlighted several challenges in the public response to a nuclear accident and the communication of protective actions during and after the accident (Callen & McKenna, 2018; Crépey et al, 2013; Hasegawa et al., 2016; Hobson, 2015; Kanda, Tsuji, & Yonehara, 2012; NAIIC, 2012; NAIIC, 2012; Yasumura, 2014). Examples include over‐protective behaviours (e.g., unnecessary evacuation or intake of iodine, boycott of products), non‐compliance with official advice (e.g., not to consume salt in order to get iodine) and elevated public concern about health effects due to the accident (e.g., concern about how the contamination from the accident will affect children's health, including thyroid abnormalities).…”

“…Furthermore, literature in the field of disaster research investigated public behaviours in disaster situations (see Ejeta, Ardalan, & Paton, 2015, for a review). A relatively limited number of studies have also addressed citizens' actual or expected compliance with protective actions in nuclear accident situations and the potentially influencing factors (e.g., Crépey, Pivette, & Bar‐Hen, 2013; Cutter & Barnes, 1982; Hasegawa, Ohira, Maeda, Yasumura, & Tanigawa, 2016; Houts et al., 1984; Malešič, Prezelj, Juvan, Polič, & Uhan, 2015; Verbeeck, Bergmans, & Cools, 2017). However, such studies remain sparse, particularly in Europe where there is no systematic research carried out with representative samples of the population.…”

Social uncertainties related to stable iodine intake in a nuclear emergency

“…This may lead to unnecessary intake of tablets. Following a study in France in the aftermath of the Fukushima accident, Crépey et al (2013) suggest that pharmacies could help identify such an issue and advice about the proper use of tablets.…”