Canadians' Representation of Chemical,Biological, Radiological,Nuclear, and Explosive (CBRNE) Terrorism: A Content Analysis

The global threat of terrorism raises questions about preparedness and risk communication in the context of public health and security. Although experts discriminate between chemical, biological, radiological, nuclear, and explosive (CNRNE) terrorist events, little is known about how the Canadian public represents these forms of terrorism. A stratified random sample of 1502 Canadians participated in a telephone survey on CBRNE terrorism. A word association technique was used to assess first words or images that came to mind while thinking about different types of terrorist scenarios. Content analysis of this data revealed a number of potential uncertainties and misconceptions regarding different types of terrorism scenarios. Despite most frequently providing agents in response questions surrounding chemical or biological terrorism, respondents frequently confounded agents of biological and chemical nature. Similarly, different aspects of nuclear events were not consistently distinguished. Most notably, however, a sizable proportion of respondents had difficulty providing word associations to the different types of terrorist events or only provided vague responses that closely mirrored the scenario in question. Finally, images regarding the potential impacts of scenarios were infrequent. Implications for risk communication and preparedness are discussed; in particular, the need to provide the public with more detailed information regarding the nature of different forms of CBRNE terrorism and how to best prepare for a potential event.     

Learning from the 2011 Great East Japan Disaster: insights from a special radiological emergency assistance mission

On March 11, 2011, the eastern portion of Japan was struck by a massive earthquake and tsunami that killed more than 15,700 people, left thousands of others hurt or missing, and caused widespread destruction. In addition, the Great East Japan Disaster seriously damaged the Fukushima Dai-ichi nuclear power station, knocking out power, severely affecting communications, and causing a loss of cooling to some reactor cores. Significant quantities of radioactive materials were released, a "no go" zone was created around the crippled reactors, and thousands of people were evacuated. With concern about the radiological emergency growing, one of Japan's largest hospital and healthcare groups issued a request for assistance to a U.S.-based international disaster relief organization. After consultations with the Japanese, a special Radiological Emergency Assistance Mission was assembled. The mission, which traveled to Japan in April 2011, had several aims: (1) to rapidly assess the situation on the ground, (2) to exchange information, experiences, and insights with Japanese colleagues, and (3) to provide radiological information and practical refresher training to Japanese healthcare professionals and first responders. In addition to achieving these aims and laying the groundwork for future cooperation, the mission produced dozens of insights and lessons. These have potential relevance not only for future large-scale radiation accidents, but also for radiological and nuclear terrorism situations. They also have more general relevance for emergency planning, preparedness, and response. In this article, several of the most salient insights and lessons are highlighted.     

Predicting response to reassurances and uncertainties in bioterrorism communications for urban populations in New York and California

Recent national plans for recovery from bioterrorism acts perpetrated in densely populated urban areas acknowledge the formidable technical and social challenges of consequence management. Effective risk and crisis communication is one priority to strengthen the U.S.'s response and resilience. However, several notable risk events since September 11, 2001, have revealed vulnerabilities in risk/crisis communication strategies and infrastructure of agencies responsible for protecting civilian populations. During recovery from a significant biocontamination event, 2 goals are essential: (1) effective communication of changing risk circumstances and uncertainties related to cleanup, restoration, and reoccupancy; and (2) adequate responsiveness to emerging information needs and priorities of diverse populations in high-threat, vulnerable locations. This telephone survey study explored predictors of public reactions to uncertainty communications and reassurances from leaders related to the remediation stage of an urban-based bioterrorism incident. African American and Hispanic adults (N=320) were randomly sampled from 2 ethnically and socioeconomically diverse geographic areas in New York and California assessed as high threat, high vulnerability for terrorism and other public health emergencies. Results suggest that considerable heterogeneity exists in risk perspectives and information needs within certain sociodemographic groups; that success of risk/crisis communication during recovery is likely to be uneven; that common assumptions about public responsiveness to particular risk communications need further consideration; and that communication effectiveness depends partly on preexisting values and risk perceptions and prior trust in leaders. Needed improvements in communication strategies are possible with recognition of where individuals start as a reference point for reasoning about risk information, and comprehension of how this influences subsequent interpretation of agencies' actions and communications.     

Communicating Risk to Aboriginal Peoples: First Nations and Metis Responses to H1N1 Risk Messages

Developing appropriate risk messages during challenging situations like public health outbreaks is complicated. The focus of this paper is on how First Nations and Metis people in Manitoba, Canada, responded to the public health management of pandemic H1N1, using a focus group methodology (n = 23 focus groups). Focus group conversations explored participant reactions to messaging regarding the identification of H1N1 virus risk groups, the H1N1 vaccine and how priority groups to receive the vaccine were established. To better contextualize the intentions of public health professionals, key informant interviews (n = 20) were conducted with different health decision makers (e.g., public health officials, people responsible for communications, representatives from some First Nations and Metis self-governing organizations). While risk communication practice has improved, ‘one size’ messaging campaigns do not work effectively, particularly when communicating about who is most ‘at-risk’. Public health agencies need to pay more attention to the specific socio-economic, historical and cultural contexts of First Nations and Metis citizens when planning for, communicating and managing responses associated with pandemic outbreaks to better tailor both the messages and delivery. More attention is needed to directly engage First Nations and Metis communities in the development and dissemination of risk messaging.     

Models for evaluating agents intended for the prophylaxis, mitigation and treatment of radiation injuries. Report of an NCI Workshop, December 3-4, 2003

To develop approaches to prophylaxis/protection, mitigation and treatment of radiation injuries, appropriate models are needed that integrate the complex events that occur in the radiation-exposed organism. While the spectrum of agents in clinical use or preclinical development is limited, new research findings promise improvements in survival after whole-body irradiation and reductions in the risk of adverse effects of radiotherapy. Approaches include agents that act on the initial radiochemical events, agents that prevent or reduce progression of radiation damage, and agents that facilitate recovery from radiation injuries. While the mechanisms of action for most of the agents with known efficacy are yet to be fully determined, many seem to be operating at the tissue, organ or whole animal level as well as the cellular level. Thus research on prophylaxis/protection, mitigation and treatment of radiation injuries will require studies in whole animal models. Discovery, development and delivery of effective radiation modulators will also require collaboration among researchers in diverse fields such as radiation biology, inflammation, physiology, toxicology, immunology, tissue injury, drug development and radiation oncology. Additional investment in training more scientists in radiation biology and in the research portfolio addressing radiological and nuclear terrorism would benefit the general population in case of a radiological terrorism event or a large-scale accidental event as well as benefit patients treated with radiation.     

Chemical (VX) terrorist threat: public knowledge, attitudes, and responses

This article reports the results of a study of people's perceptions and reactions to a hypothetical terrorist attack involving a chemical agent (specifically, the nerve agent VX). Thirteen focus groups composed of 8 to 12 participants each were conducted using trained moderators. To achieve a broad representation of perspectives, the groups were conducted in several regions and included urban and rural locations. In addition, a variety of population groups, such as African Americans, Hispanics, American Indians, Asians, and people with English as a second language, were included in the study. Findings demonstrated fear, fatalism, and unfulfilled information needs related to the threat agent. To better prepare the public for VX threats or threats from other highly toxic chemical agents, it will be important to emphasize that VX exposure can be avoided or reduced, that VX effects can be treated, and that VX can be survived if appropriate protective measures are taken. Related findings from the focus groups are that participants preferred television, radio, and the Emergency Alert System for emergency messages and that people prefer to hear information about a chemical attack from a well-known, well-respected public figure or from a content expert on chemical attacks, protective actions, and health. In addition, local television meteorologists were identified as a category of trusted conveyers of important information in relation to chemical terrorist attacks.     

Public Experiences of Mass Casualty Decontamination

In this article, we analyze feedback from simulated casualties who took part in field exercises involving mass decontamination, to gain an understanding of how responder communication can affect people's experiences of and compliance with decontamination. We analyzed questionnaire data gathered from 402 volunteers using the framework approach, to provide an insight into the public's experiences of decontamination and how these experiences are shaped by the actions of emergency responders. Factors that affected casualties' experiences of the decontamination process included the need for greater practical information and better communication from responders, and the need for privacy. Results support previous findings from small-scale incidents that involved decontamination in showing that participants wanted better communication from responders during the process of decontamination, including more practical information, and that the failure of responders to communicate effectively with members of the public led to anxiety about the decontamination process. The similarity between the findings from the exercises described in this article and previous research into real incidents involving decontamination suggests that field exercises provide a useful way to examine the effect of responder communication strategies on the public's experiences of decontamination. Future exercises should examine in more detail the effect of various communication strategies on the public's experiences of decontamination. This will facilitate the development of evidence-based communication strategies intended to reduce anxiety about decontamination and increase compliance among members of the public during real-life incidents that involve mass decontamination.     

A psychosocial risk assessment and management framework to enhance response to CBRN terrorism threats and attacks

Evidence in the disaster mental health literature indicates that psychosocial consequences of terrorism are a critical component of chemical, biological, radiological, and nuclear (CBRN) events, both at the clinical level and the normal behavioral and emotional levels. Planning for such psychosocial aspects should be an integral part of emergency preparedness. As Canada and other countries build the capacity to prevent, mitigate, and manage CBRN threats and events, it is important to recognize the range of social, psychological, emotional, spiritual, behavioral, and cognitive factors that may affect victims and their families, communities, children, the elderly, responders, decision makers, and others at all phases of terrorism, from threat to post-impact recovery. A structured process to assist CBRN emergency planners, decision makers, and responders in identifying psychosocial risks, vulnerable populations, resources, and interventions at various phases of a CBRN event to limit negative psychosocial impacts and promote resilience and adaptive responses is the essence of our psychosocial risk assessment and management (P-RAM) framework. This article presents the evidence base and conceptual underpinnings of the framework, the principles underlying its design, its key elements, and its use in the development of decision tools for responders, planners, decision makers, and the general public to better assess and manage psychosocial aspects of CBRN threats or attacks.     

What does the public want to know in the event of a terrorist attack using plague?

We used formative research to assess the information needs and information-seeking strategies with general public audience segments in response to a hypothetical attack using plague, and we pretested informational materials about plague. Twelve focus groups were conducted across the country, with 129 individuals being purposively sampled by ethnicity and place of residence. Across groups, participants wanted to understand: the nature of the threat of plague, how to protect themselves from transmission, how to detect exposure and symptoms, how to treat infection, and progress in apprehending perpetrators. Participants reported that they would seek information from both the news media and local authorities. Based on the findings and the challenges posed by a terrorist attack using plague, the authors recommend that message materials answer key questions, provide clear action steps, be clear and easily understood, include sources for credibility, and reflect full government disclosure. A dissemination plan is required to ensure that critical information will be available when people need it and where they look.     

Public Reactions to Risk Messages Communicating Different Sources of Uncertainty: An Experimental Test

There is an abundant literature on the challenge of integrating uncertainties in experts’ risk assessments, but the evidence on the way they are understood by the public is scarce and mixed. This study aims to better understand the effect of communicating different sources of uncertainty in risk communication. A causal design was employed to test the effect of communicating risk messages varying in type of advisory warning (no risk and suggests no protective measure, or risk and recommends a protective measure) and sources of uncertainty (no uncertainty, divergence between experts, contradictory data, or lack of data) on public reactions. Participants from the general public (N = 434) were randomly assigned to read and react to variants of a fictitious government message discussing the presence of a new micro-organism found in tap water. Multiple analysis of variance showed that to report uncertainty from divergence between experts or from contradictory data reduced the adherence to the message, but not to mention the lack of data. Moreover, the communication of diverse sources of uncertainty did not affect trust in the government when the advisory warning stated there was a risk and recommended a protective measure. These findings have important implications for risk communication.     

Tchernobyl : le vrai, le probable et le faux

The Japanese earthquake and tsunami drew attention worldwide to nuclear power plant accidents and associated health risks. Since Chernobyl 25 years ago, several studies were published and we now have precise information concerning the long-term health of the population living near nuclear power plants and also in different European countries. The authors hope to bring some answers to the key questions from the public concerning radioactive units used and their significance, the evaluation of the number of radio-induced cancers within the different countries of Europe, other eventual health effects and the problem of possible congenital anomalies. Finally, French public perception on nuclear risk is examined and the feedback of the Japanese experience is evoked.     

Comparison Between Radiological and Chemical Health Risks Assessments: The Nord-Cotentin Study

In 1997, the French Ministries of the Environment and Health commissioned a detailed radioecological analysis of the Nord-Cotentin region in response to public concern about radiological risks associated with local nuclear facilities. This work was entrusted to the Groupe Radioécologie Nord-Cotentin (GRNC), a working group of experts from various origins (industrial facilities operators, public institutions, monitoring agencies, public interest and citizens groups, foreign experts). An epidemiology investigation in 1995 had reported an excess of two radiation-induced leukemia cases in an area near a nuclear reprocessing plant, a finding that attracted great interest in France, and which stimulated the need for further investigation. After the publication of its report in 1999, the GRNC was again commissioned to perform, inter alia, a corresponding assessment on the chemical releases of the local nuclear facilities. This second stage is now achieved and has revealed important similarities as well as some important differences between radiological and chemical risk assessments when applied to the specific case of the Nord-Cotentin nuclear facilities. Due to the considerable amount of work and results of the GRNC, the purpose for this article is to briefly describe the main developments of the risk assessment methodology followed by the GRNC in both cases, to detail some of the main results and to identify and explain, at each step, the similarities and the differences. The whole technical documents that support these works are available on the Internet at ?http://www.irsn.fr/nord-cotentin/?.     

Temporal trends in childhood leukaemia incidence following exposure to radioactive fallout from atmospheric nuclear weapons testing

Notably raised rates of childhood leukaemia incidence have been found near some nuclear installations, in particular Sellafield and Dounreay in the United Kingdom, but risk assessments have concluded that the radiation doses estimated to have been received by children or in utero as a result of operations at these installations are much too small to account for the reported increases in incidence. This has led to speculation that the risk of childhood leukaemia arising from internal exposure to radiation following the intake of radioactive material released from nuclear facilities has been substantially underestimated. The radionuclides discharged from many nuclear installations are similar to those released into the global environment by atmospheric nuclear weapons testing, which was at its height in the late-1950s and early-1960s. Measurements of anthropogenic radionuclides in members of the general public resident in the vicinity of Sellafield and Dounreay have found levels that do not differ greatly from those in persons living remote from nuclear installations that are due to ubiquitous exposure to the radioactive debris of nuclear weapons testing. Therefore, if the leukaemia risk to children resulting from deposition within the body of radioactive material discharged from nuclear facilities has been grossly underestimated, then a pronounced excess of childhood leukaemia would have been expected as a consequence of the short period of intense atmospheric weapons testing. We have examined childhood leukaemia incidence in 11 large-scale cancer registries in three continents for which data were available at least as early as 1962. We found no evidence of a wave of excess cases corresponding to the peak of radioactive fallout from atmospheric weapons testing. The absence of a discernible increase in the incidence of childhood leukaemia following the period of maximum exposure to the radioactive debris of this testing weighs heavily against the suggestion that conventional methods are seriously in error when assessing the risk of childhood leukaemia from exposure to man-made radionuclides released from nuclear installations.     

Perceptions of Mercury Risk and Its Management

Anthropogenic activities, such as coal burning for electricity generation, release mercury (Hg), a toxic, bioaccumulative pollutant with potential health impacts primarily borne by specific population groups such as women of child-bearing age and subsistence fishers. Current Hg risk communication efforts and much of the extant research on Hg risk perceptions focus on these groups most at-risk. Little is known about the perceptions of Hg risk among the general public, although their support is required for implementing Hg emissions mitigation policies. We report results from two surveys—one a U.S. nationally representative Internet survey and the other a mail survey of New England residents—on a range of perceptions of the general population regarding Hg risk and its management. Our analysis of quantitative and qualitative data from the surveys point toward some gaps in public understanding of Hg risk, on aspects such as sources of mercury release, agencies responsible for mercury information, and products that contain mercury. Our results suggest that agencies responsible for providing Hg information should go beyond fish advisories and enhance their efforts at wider dissemination of information on Hg risk and its management.     

Solid cancer risk dependence on the Pasquill–Gifford atmospheric stability classes in a radiological event

In a radiological event, the lack of preliminary information about the site of explosion and the difficulty in predicting the accurate path and distribution of radioactive plumes makes it difficult to predict expected health effects of exposed individuals. So far, in such a health evaluation, radiation-induced stochastic health effects such as cancer are not included. The Pasquill–Gifford atmospheric classes generally allow connecting atmospheric stability with dispersion of radioactive contaminants to the environment. In this work, an environmental release of radioactive Cs-137 was simulated and the resulting relative risk for solid cancer incidence among the affected population calculated. The HotSpot health physics code was used to simulate the radioactive atmospheric dispersion and calculate the Total Effective Dose Equivalent (TEDE), which was then used to estimate the relative risk of cancer incidence. The main results from this work suggest that the relative cancer risk and atmospheric stability classes are linked by differences in the TEDE. Such a finding may support triage, because it adds additional information on the potentially affected population at the early stages of an emergency response.     

我国转基因技术风险交流分析

随着生物技术的迅猛发展,发展转基因产业的战略选择与公众对转基因安全疑虑的矛盾十分突出。通过转基因舆情分析,指出我国转基因风险交流存在的不足主要为风险交流工作缺乏顶层设计,信息公开程度较低,风险交流方式和内容单调,公益机构未能发挥应有作用。在此基础上,提出了加强转基因风险交流的政策建议:(1)明确转基因风险交流的目标;(2)建立转基因风险交流协调框架;(3)建立转基因信息公开平台和信息监测平台;(4)完善管理部门和公益机构的风险交流职能;(5)改革科技项目政策。     

Community perceptions and treatment-seeking behaviour regarding reproductive tract infections including sexually transmitted infections in Lao PDR: a qualitative study

Creating community awareness of reproductive tract infections (RTI), including sexually transmitted infections (STI), and how to prevent them is essential to minimize their spread. Data on people's views about RTI/STI are entirely lacking in Laos. The aim of this study was thus to explore people's perceptions, treatment-seeking behaviour and understanding of information about RTI/STI, in urban and rural communities in two provinces in Laos. Fourteen focus group discussions and 20 in-depth interviews were held with 76 women and 56 men, selected purposively to provide diversity of socio-demographic backgrounds. Qualitative content analysis was employed for the data analysis. The major finding was that both male and female participants had a variety of misconceptions about the causes and symptoms of RTI/STI and their cure, and a reluctance to seek health care, which could cause delay in appropriate diagnosis and treatment. The most common treatment-seeking behaviour was self-medication through private pharmacies, following advice mostly given by friends and drug sellers. The main reasons for not going to health facilities were fear of social discrimination or shyness of genital examination. Complaints were also made about clinicians' negative attitudes towards 'dirty disease'. Although condom use was mentioned as a way to prevent RTI/STI, an unwillingness to use condoms was commonly expressed. The main media sources of RTI/STI information were radio and television, and access to health information was more difficult in rural areas. The health messages provided were mostly understood, except for some technical terms. The findings indicate that strengthening health education and promotion through interventions at the community level is recommended to improve quality of RTI/STI management. Health education messages should be more accessible in rural areas. There is also an urgent need to improve communication between RTI/STI patients and clinicians.     

The nuclear hormone receptor peroxisome proliferator-activated receptor beta/delta potentiates cell chemotactism, polarization, and migration

After an injury, keratinocytes acquire the plasticity necessary for the reepithelialization of the wound. Here, we identify a novel pathway by which a nuclear hormone receptor, until now better known for its metabolic functions, potentiates cell migration. We show that peroxisome proliferator-activated receptor beta/delta (PPARbeta/delta) enhances two phosphatidylinositol 3-kinase-dependent pathways, namely, the Akt and the Rho-GTPase pathways. This PPARbeta/delta activity amplifies the response of keratinocytes to a chemotactic signal, promotes integrin recycling and remodeling of the actin cytoskeleton, and thereby favors cell migration. Using three-dimensional wound reconstructions, we demonstrate that these defects have a strong impact on in vivo skin healing, since PPARbeta/delta-/- mice show an unexpected and rare epithelialization phenotype. Our findings demonstrate that nuclear hormone receptors not only regulate intercellular communication at the organism level but also participate in cell responses to a chemotactic signal. The implications of our findings may be far-reaching, considering that the mechanisms described here are important in many physiological and pathological situations.     

The risk of leukaemia in young children from exposure to tritium and carbon-14 in the discharges of German nuclear power stations and in the fallout from atmospheric nuclear weapons testing

Towards the end of 2007, the results were published from a case–control study (the “KiKK Study”) of cancer in young children, diagnosed <5 years of age during 1980–2003 while resident near nuclear power stations in western Germany. The study found a tendency for cases of leukaemia to live closer to the nearest nuclear power station than their matched controls, producing an odds ratio that was raised to a statistically significant extent for residence within 5 km of a nuclear power station. The findings of the study received much publicity, but a detailed radiological risk assessment demonstrated that the radiation doses received by young children from discharges of radioactive material from the nuclear reactors were much lower than those received from natural background radiation and far too small to be responsible for the statistical association reported in the KiKK Study. This has led to speculation that conventional radiological risk assessments have grossly underestimated the risk of leukaemia in young children posed by exposure to man-made radionuclides, and particular attention has been drawn to the possible role of tritium and carbon-14 discharges in this supposedly severe underestimation of risk. Both ³H and ¹⁴C are generated naturally in the upper atmosphere, and substantial increases in these radionuclides in the environment occurred as a result of their production by atmospheric testing of nuclear weapons during the late 1950s and early 1960s. If the leukaemogenic effect of these radionuclides has been seriously underestimated to the degree necessary to explain the KiKK Study findings, then a pronounced increase in the worldwide incidence of leukaemia among young children should have followed the notably elevated exposure to ³H and ¹⁴C from nuclear weapons testing fallout. To investigate this hypothesis, the time series of incidence rates of leukaemia among young children <5 years of age at diagnosis has been examined from ten cancer registries from three continents and both hemispheres, which include registration data from the early 1960s or before. No evidence of a markedly increased risk of leukaemia in young children following the peak of above-ground nuclear weapons testing, or that incidence rates are related to level of exposure to fallout, is apparent from these registration rates, providing strong grounds for discounting the idea that the risk of leukaemia in young children from ³H or ¹⁴C (or any other radionuclide present in both nuclear weapons testing fallout and discharges from nuclear installations) has been grossly underestimated and that such exposure can account for the findings of the KiKK Study.