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( Aomori , Akita , Iwate , Miyagi , and Yamagata ) excluding Fukushima Prefecture , and Tokyo , with the proportion of those who believe that there are health risks associated with radiation exposure reported to be higher among residents of other prefectures than among residents of Fukushima Prefecture ( Ministry of the Environment , 2023 ). In addition , a higher percentage of women than men has been shown to have a higher perception of health risks ( Ministry of the Environment , 2023 ). In Fukushima Prefecture , it is widely believed that discussing the disaster and issues related to radiation exposure with acquaintances and friends has become more difficult because over 10 years have passed since the accident . Among the 32,699 residents of the affected areas in Fukushima Prefecture , those who have no one to talk to or ask for help are reported to have higher levels of psychological stress ( Horikoshi et al ., 2021 ). However , the level of anxiety regarding future childbirth and childcare among men in Fukushima Prefecture and people in neighboring prefectures remains unclear .
Given this background , the present study aimed to determine the actual level of confidence in future childbearing and child-rearing at 11 years after the nuclear accident and to determine whether radiation-related factors affect future childbearing expectations . We also investigated whether radiation-related factors affect confidence in future childbearing and child-rearing among those who hope to have children in the future through a comparison of Fukushima Prefecture , its neighboring prefectures ( Tochigi , Ibaraki , and Miyagi ), and other prefectures , as well as by gender . The findings may reveal whether support is needed for men and women in prefectures neighboring the affected prefectures .
2 Methods
2.1 Study design and participants
A cross-sectional study was conducted in February 2022 using a questionnaire survey via an Internet research company . The inclusion criteria were between 18 and 40 years of age , male or female gender , and having no children . The survey and analysis were conducted by dividing the respondents into three groups according to the prefecture in which they resided on March 11 , 2011 , the date of the Great East Japan Earthquake : Fukushima Prefecture , prefectures neighboring Fukushima ( Tochigi , Ibaraki , and Miyagi ), and other prefectures . A total of 985 people participated in the survey : 240 residents of Fukushima Prefecture ( 67 males and 173 females ), 305 residents of prefectures neighboring Fukushima ( 143 males and 162 females ), and 440 residents of other prefectures ( 212 males and 228 females ).
2.2 Questionnaire 2.2.1 Personal characteristics
Regarding the questionnaire items , data on the respondents ’ personal characteristics were obtained from their responses to single-item questions on age , gender , marital status , family structure , hopes for future children , knowledge about radiation , radiation advisors , stress in daily life , and concerns about radiation effects on a future partner . The scales used were the Fukushima Future Parents Attitude Measure ( FPAM ) ( Ito et al ., 2018a ), the Rosenberg Self-Esteem Scale ( RSES ) ( Rosenberg , 1965 ), and the World Health Organization-Five Well-Being Index ( WHO-5 ) ( Awata et al ., 2007 ), Communicative and Critical Health Literacy ( Ishikawa et al ., 2008 ), the Attitudes Towards Seeking Professional Psychological Help Scale-Short Form ( ATSPPH-SF ) ( Elhai et al ., 2008 ), the 2-item Depression Rating Scale ( Mishina et al ., 2009 ), and the Perception of Radiation Health Effects Risk survey ( Yabe et al ., 2014 ).
2.2.2 Fukushima Future Parents Attitude Measure ( FPAM )
The FPAM measures attitudes toward childbirth and infant care after radiation exposure ( Ito et al ., 2018a ). Respondents are instructed to answer questions on the assumption that they will be living and raising a family in Fukushima Prefecture . The FPAM consists of two factors : three items measuring “ Caring for a baby ” and three items measuring “ Giving birth to a baby .” The responses are rated on a 4-point Likert scale , from 1 = strongly agree to 4 = strongly disagree . The score for each item ranges from 3 to 12 , with lower scores indicating more confidence in the future delivery and care of an infant .
2.2.3 Rosenberg Self-Esteem Scale ( RSES )
The RSES is a widely used measure for assessing selfesteem ( Rosenberg , 1965 ). It is composed of 10 items rated on a four-point Likert-type scale , from 10 = strongly disagree to 40 = strongly agree , with higher scores indicating higher selfesteem .
2.2.4 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 ( Awata et al ., 2007 ). Each item measures the respondents ’ sense of positive well-being during the previous 2 weeks , with responses rated on a six-point ranking scale ranging from zero to five , with higher scores indicating greater well-being .
2.2.5 Communicative and critical health literacy
The Health Literacy Scale is composed of three items on communicative health literacy and two items on critical health literacy ( Ishikawa et al ., 2008 ). Communicative health literacy , as defined by Nutbeam et al . ( 1998 ), is the skill to participate actively in daily activities , to draw information from various forms of communication , and to apply new information to changing situations . Critical health literacy also involves the skill to analyze information critically and use that information to control life events and situations more effectively ( Nutbeam , 1998 ). Response options are rated on a five-point Likert-type scale , ranging from 1 = strongly disagree to 5 = strongly agree , with higher scores indicating better health literacy .