96 S . Ito and A . Goto : Radioprotection 2024 , 59 ( 2 ), 95 – 103
reported that the number of students who said they were not confident childbirth increased from 16.8 % in 2015 to 19.4 % in 2018 . However , whether more women in Fukushima Prefecture are anxious about future childbirth and childcare compared with women in other prefectures remains unclear . In addition , to our knowledge , no studies on anxiety about childbirth and childcare have been conducted on men who have been exposed to radiation . Suzuki et al . ( Suzuki et al ., 2015 ) assessed stress and anxiety about radiation exposure and health hazards among residents who had experienced the Fukushima Daiichi Nuclear Power Plant accident . The results showed that a greater proportion of women perceived anxiety compared with men . However , 3133 ( 35.9 %) of the 8717 respondents who reported feeling very stressed were men , which suggests that many men also experience anxiety . In addition , Kuroda et al . ( Kuroda et al ., 2018 ) conducted a questionnaire survey on residents in the evacuated and nonevacuated areas of Fukushima and reported that radiation anxiety was correlated with health literacy only in the evacuated areas . This difference between evacuated and nonevacuated areas suggests that regional differences may also affect confidence in future childbearing and child-rearing .
Given this background , the present study aimed to compare and identify factors that influence anxiety about future childbirth and childcare associated with radiation exposure between genders , as well as between Fukushima and other prefectures .
2 Materials and methods
2.1 Study design and participants
In December 2018 , a cross-sectional , online questionnairebased survey was conducted on 620 adults in the general population ( 310 males and 310 females ; age range , 18 – 35 yr ). The survey included 155 men and 155 women who lived in Fukushima Prefecture at the time of the Great East Japan Earthquake ( March 11 , 2011 ), and 155 men and 155 women who lived outside of Fukushima Prefecture . This survey was conducted via an online survey company , and because the number of respondents living in Fukushima Prefecture was small , all applicable residents of Fukushima Prefecture registered with the survey company were included in the survey . Those who lived outside of Fukushima Prefecture were randomly selected from prefectures other than Fukushima .
2.2 Questionnaire 2.2.1 Personal characteristics
Data on the respondents ’ demographic characteristics were derived from their responses to single-item questions on age , gender , marital status , family structure , desire for future children , whether they had a radiation adviser ( regardless of the subject ), knowledge of radiation (“ Do you consider yourself knowledgeable about nuclear power and radiation ?”), stress in daily life , and concerns about radiation effects on a future partner .
2.2.2 Fukushima Future Parents Attitude Measure ( FPAM )
The FPAM assesses attitudes about childbirth and infant care following radiation exposure ( Ito et al ., 2018a ). First , the respondents were given the following instructions : “ Please answer the following questions . Please assume that you will live and raise a family in Fukushima Prefecture .” The FPAM consists of two factors , “ Caring for a baby ” and “ Giving birth to a baby ,” each of which contain three items . “ Caring for a baby ” includes the item ‘ I look forward to caring for the baby ,’ and “ Giving birth to a baby ” includes the item ‘ I am confident that I will have a normal childbirth .’ All items are measured on a four-point Likert-type scale , from 1 = strongly agree to 4 = strongly disagree . The scores of the constructs range from 3 to 12 , with lower scores indicating more confidence in successful future childbirth and infant care .
2.2.3 Depressive symptoms
The following two items were used to screen for depressive symptoms ( Mishina et al ., 2009 ): ‘ During the past month , have you often felt down , depressed , or hopeless ?’ and ‘ During the past month , have you often found little interest or pleasure in doing things ?’. Participants who answered yes to at least one of these questions were classified as displaying depressive symptoms .
2.2.4 Rosenberg Self-Esteem Scale ( RSES )
The RSES defines self-esteem as a global concept about the self and a sense of worth or value , not as the possession or accumulation of particular qualities or abilities ( Rosenberg , 1965 ). It is composed of 10 items that offer response options on a four-point Likert-type scale , from 10 = strongly disagree to 40 = strongly agree , with higher scores indicating higher self-esteem .
2.2.5 World Health Organization-Five Well-Being Index ( WHO-5 )
The WHO-5 is a self-administered five-item scale used to measure quality of life ( QOL ) ( Awata et al ., 2007 ). Each item measures the respondent ’ s sense of positive well-being during the previous 2 weeks . Response options are offered on a sixpoint ranking scale ranging from 0 to 5 , with higher scores indicating greater well-being .
2.2.6 Communicative and Critical Health Literacy Scale
The Communicative and Critical Health Literacy Scale is composed of three items on communicative health literacy ( e . g ., obtaining health-related information from various sources ) and two items on critical health literacy ( e . g ., assessing the reliability of health information ) ( Ishikawa et al ., 2008 ). Response options are offered on a five-point Likert-type scale , from 1 = strongly disagree to 5 = strongly agree . The mean of the five item scores is considered to indicate overall communicative and critical health literacy .
2.2.7 Attitudes Toward Seeking Professional Psychological Help-Short Form ( ATSPPH-SF )
The ATSPPH-SF is a self-administered 10-item index that assesses attitudes about mental health treatment ( Elhai et al ., 2008 ). Response options are offered on a four-point Likert-type scale , from 0 = disagree to 3 = agree . Total scores range from 0 to 30 , with higher scores indicating a more positive attitude .