Associations between the perception of risk in radiation exposure and changes in smoking and drinking status after a disaster: The Fukushima Health Management Survey

The risk for people evacuated from Fukushima following the Great East Japan Earthquake of developing cancer from radiation exposure may be lower than that associated with smoking and alcohol drinking. However, the perception of those risks may change risk-related behavior. Therefore, we investigated whether the perceived risk of radiation exposure was associated with the initiation and/or cessation of smoking and of drinking alcohol following the disaster. Participants were 82,197 people aged ≥20 years who completed the Fukushima Health Management Study survey. A multivariable logistic regression model, with adjusted odds ratios (AORs) and 95 % confidence intervals (CIs), was used to calculate the risk of (1) starting smoking (or drinking) among people who did not smoke (or drink) before the earthquake, and (2) quitting smoking (or drinking) among people who smoked (or drank) before the earthquake; the main factor was perceived risk of developing cancer from radiation. The AORs for starting smoking among participants who perceived radiation exposure risks as unlikely, likely, and very likely, compared with very unlikely, were 0.96(0.78–1.18), 1.17(0.95–1.45), and 1.69(1.39–2.06), respectively (Trend p < 0.01). The corresponding ORs for starting drinking were 1.05 (0.95–1.16), 1.17(1.06–01.30), and 1.38(1.25–1.52), respectively (Trend p < 0.01). The AORs for quitting smoking were 0.90(0.82–0.98), 0.81(0.73–0.90), and 0.75(0.68–0.83), respectively (Trend p < 0.01). The same association was not found among alcohol quitters. In Fukushima, people who perceived greater risk of developing cancer from radiation exposure had higher odds of starting smoking and drinking alcohol, which, ironically, increases the risk of developing cancer.