ML20133C724
| ML20133C724 | |
| Person / Time | |
|---|---|
| Site: | Three Mile Island  |
| Issue date: | 04/20/1980 |
| From: | Tokuhata G PENNSYLVANIA, COMMONWEALTH OF |
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| ML20132B167 | List: |
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| FOIA-85-285 NUDOCS 8507200556 | |
| Download: ML20133C724 (1) | |
Text
( s c5 Three Mile Island Health Hffects .
Research Program By ,
George K.Tokuhata, Dr.P.H.,Ea D.
Director Division of Epidemiological Research Bureau of Epidemiology and Disease Prqvention Pennsylvania Department of Health P
- Presented at the 56th Pennsylvania Academy of Science Annual Meeting, April 20,1980 held at Seven Springs, Pennsylvania ,
Dick Thornburghbovernor, Commonwealth of Pennsylvania 11. Arnold Muller, M.D., Secretary of Health g720 6 850524 f LODGEBS-285 PDR
,, . p&ings tf the Pennsylnnia Acedemy Qf ScienceW I9 ~21.1900 THREE MILE ISLAND HEALTH EFFECTS RESEARCH PROGRAM' OEORGE K. TOKUHATA8 r
Director Division ofEpidemiologicalResearch Penngyhenie Department ofHealth P. O. Box 90 ,. +
Harrasburg, PA 17120 I r
The Three Mile Island nuclear accident of March 28,1979 has cancer and thyroid disease), recent pregnancy experience, caused a significant impact upon many facets of human life and medical and occupational radiation exposure, and detailed social structure not only within Pennsylvania, but also elsewhere whereabout during the 10 day crisis when abnormal radio-in the U.S. and abroad. As a mandate of the State Health Depart- active releases were reported.
ment, it became immediately clear that possible health effects of A staff of 150 enumerators were hired by the Pennsyhania the accident must be evaluated. During the 10 day crisis, it was -
Department of Health to canvas the TMI area. Other person-not possible to ascertain accurate information regarding radioac- net and techrdcal guidance were provided by the U.S. Bureau tive emissions from the damaged nuclear reactor into the environ- of the Census and the Center for Disesse Control. Sociodem-ment. However, the presence of diffuse and growing ographic analysis and epidemiological observations are now psychological disturbance in the area was apparent. being made of the census results, covering approximately Within a short period of days following the accident the Bureau .13,000 individuals in 14,000 households. A series of reports cf Health Research of the Pennsylvania Department of Health will be forthcorains.
was able to conceptualize and develop a comprehensive plan for a variety of epidemiological and other health studies f lesigned to B. Pregnancy OutcomeStudy:
assess the impact of the TMI accident. Specific studies conceived Both ionizing radiation and severe emotional stress can affect during this critical period reflect mostly the eiusung epidemiolos- human reproductive process and pregnancy ~ outcome. It is ical knowledge regarding biological efffect of low level lonizing known that the fetus is highly sensitive to such environmental radsation and of severe emotional stress. The Bureau Director insults. To evaluate possible health impact of the TM1 acci-was designated by the Governor of Pennsylvania to coordinate dent, a carefully designed prospective Study qf Pregnancy and manage all health-related research activities relative to TMI. Outcome was initiated in August,1979. This study covers all At the same time, a special Advisory Panel was commissioned by pregnant women residing within a 10 mile radius of the TMI, the Secretary of Heshh to oversee and guide all TMI-related who save births from March 28,1979 through March 27, health studies administered by the Bureau of Health Research. A 1930. This study cohort consisting of approximately 4.000 brief description of each study follows: deliveries will be compared with a control cohort of another 4,000 deliveries during a one-year period in the same s'co-A. TMICansurr graphic area immediately following the study cohort. The i One of the first projects initiated after the accident was a study cohort will also be compared with smular data collected special census qf allpersons living withinfive miles of TMI. in the same general area during the immediately preceding Afler careful examination of the amount of radiation emitted four-year period. Pregnancy outcome measures being investi-l and dispersion factor a distance of a five-mile radius was sated are: fetal death (including 16 + week abortions), neo-l chosen for the census. The primary purpose of TMI census natal (28 days) death, hebdomadal(one week) death, pre.
was to develop a population profile which would provide a maturity (gestation < 37), immaturity (birth weight < 2,500 basic framework for future studies of morbidity and mortal- grams), congenital anomalies, and low Apgar score ( < 7).
ity. In addition to usual demographic data, such as age, sex Although the study design is that of "before.and.after" and race, the census questionnaire included such items as comparison of cohorts, measures of radiation exposure and marital status, smoking habits, medical history (particularly psychological stress (expressed in terms of overt statements
' Symposium lecture paper on " Aftermath of Three Mile Island and stress coping patterns, such as taking tranquilizers and sleeping pills) are also included, which will be related to each Accident" delivered at the 56th PAS Annual Meeting, April 20, 1930. The Symposium was sponsored by the Henry C. Frick Edu- of the seven outcome measures described earlier. Smce there cational Commission. are many other factors which can influence pregnancy out-8 Professor of Epidemiology and Blostatistics, University of Pitts- comes, all such influences are taken into account; they are -
burgh Graduate School of Public Health (adjunct); Associate maternal race, age, smoking, drinking, education, occupa.
tion, employment, and marital status; maternal medical and Professor of Community and Family Medicine, Temple Univer-sity College of Medicine (adjunct). o histones, including X ray exposures; prenatal care, including provider charactensucs, medications, instructions Dr. Tokuhats was designated by Governor Thornburgh to and special procedures; prior birth control method; and birth assume overall management of all Health Research Studies order of the offspring.
related to the TMI accident.
~~~-~~m nm -
t .e ',
C. CongenitoWNeonatalHypothyroidism: ~
and is being assisted by the Pennsylvania Department of This is a special feature cf the Pregnancy Oute:me Study be- Health's staff.
ing conducted within a 10 mile radius. By Pennsylvania law, The assessment of economic costs to households is derived all newborn babies must be screened for hypothyroidism from the same telephone survey conducted by an independent since July 1978. The screening consists of two-stage testing, research firm serving also the Health Behavioral (Stress) 1.e.; first, low T4 (thyroxin) and high 73H(pituitary thyroid Study. In other words, the same panel of respondents (ap-stimulating hormone) on filter paper and, second, low T4 and high TSH on serum test. proxirnately 700) chosen randomly was used for these tveo studies.
The reason for this study is that (a) certain amount of radioactive iodine ('"I) was released from the damaged nu. F. Radiation Dose Assessment:
clear reactor during the crisis; and (b) "'I can be taken up by One of the most sensitive and technically difficult tasks was to pregnant women which, in turn, by the fetal thyroid gland evaluate the extent to which local residents may have been ex-through placenta, possibly resulting in congenital hypothy- posed to radiation from the damaged nuclear facility. While roidism. no direct radiation measurements were taken on an mdividual The fetal thyroid gland is much more sensitive to radio- basis (except for some 700 local residents who subjected active iodine than is the mother's thyroid gland, i.e., a rela- themselves to whole body counts sponsored by NRC during tively sma!! dose to the mother can be e relatively large dose to the crisis), available TLD (thermonuclear luminescent dosi-the fetus. meter) recordings and other source data monitored by various in a normal population the incidence of congenital hy- agencies are useful for such a purpose. We negotiated with the pothyroidism is approximately one in 4,500 to 5,000 infants. Department of Radiation Health (Dr. David Gur, Project Di-There are several different diagnostic classes, namely: genetic rector), University of Pittsburgh Graduate School of Public (autosomal recessive; dominant) type, resulting from dyshor- Health to conduct this particular study.
! monogenesis; ectopic type (dyssenesis), indicating incom- Radiation Dose Assessment is directed toward every pcrson resident within the 5-mile radius during the nuclear en, sis and plete or improper development of the thyroid gland; agenesis (without thyroid gland); and other types. 'Very pregnant woman resident within the 10-mile radius dur-During the March 28,1979 March 27,1980 period only one ing the same period. From the 5 mile census data and 10-mile case of congenital hypothyroidism was identified within a pregnancy study data, it is possible to reestablish detailed ac-10 mile radius among approximately 4,000 infants; this is well count of whereabouts during the 10-day period of all in-within a normal range. dividuals including those who evacuated, as well as those who left the area for other reasons. Iri addition, detailed meteor-D. Neoith Behaviora/(Stress) Study: ological data including wind directioft and velocity, as well as Shortly after the nuclear accident we recognized that one of plume combm,-dispersion patterns are being incorporated in the major concerns was thepsychologicallmpact upon heo/th ed monitored radiation dose materials from all among local residents. The Pennsylvania Depanment of reliable sources. With the application of computer mapping Health approached the Department of Behavioral Science at technology and ' elaborate sector analysis, it will be possible to the Hershey Medical Center to conduct such a study in the assign (estimate) a reasonably accurate dosage to an m ,-
TMI area as a joint endeavor. A number of related questions dividualin the study area during the ten-day period.
needed to be answered: It it our hope that the results of this particular study be use-
- 1. How many (and %) people in the area felt emotional ful for a variety of current and future studies of possible strest? health effects, particularly from the radiation standpoint.
- 2. How did they cope with the crisis situation? '
G. Cytogenetic (Chromosome) Study:
- 3. What social and medicauhealth services were utilized by those who were disturbed by the accident? During the early stage of the development of TMl Health Re-search Program, when the level of radiation emission was not
- 4. What kind of psychosomatic symptoms were reported?
- 5. Is the psychologicalimpact shon lived or long-lasting? clearly defined, we recommended that a cytogenetic study be carried out to investigate if the incidence of chromosome The initial survey was conducted in July,1979 and the second breakage in human blood cells is unusually ele.vated among survey in January,1980. Some of the results (Pan I) of this locai residents. including those who are employed by the TMI study will be presented this evening by Dr. Peter Houts of the facility and residents living near the facility. Ionizing radi-Hershey Medical Center.
ation, if the dose is high enough, is known to be mutagenic and teratogenic and can cause physical damage to chromo-E. Health Economics Study:
some structure.
Apart from the health impact of the TMI accident we recos- The TMI Advisory Panel for Health Research Studies ree-nized the need for conducting a heahh economics study. This ommended to cancel this panicular study on the grounds that study was designed to assess immediate and short-term excess (a) the amount of radiation emitted in the area was very small, health costs due to TMI. Health costs are divided into direct and (b) the cost of the study would be to high to detect a costs, including those related Io medication, evacuation, and other personal health expenditures; and indirect carts, includ- minute difference (increment in chtomosome romalies) that may or may not be present, ing productivity losses due to absenteeism during the crisis.
Both individual family costs and institutional costs (e.g., hos- H, CardiacMortalllyStudy pitals and nursing homes) will be considered. For this study During the TMI crisis, there was diffuse and heightened levels we approached the Department of Economics of the Pennsyl- of anxiety, fear of unknown, and deep feelings of despair and vania State University; Dr. Teh.wei Hu is the Project Director helplessness among local residents, panicularly those who
., , 6
, SYMPOSIUM: TH REE MILE ISLAND: TOKUHATA 21 were living within a 15-mile radius. Whether or not such a within the same original cohort of approximately 37,000 per-psychological disturbance affected those adults who had sons.
chronic heart conditions became an epidemiologicalinterest. Concermortality by specific organ sites and by demograph.
To answer this question, we plan to compare the cardiac mor. ic characteristics will be evaluated on an annual basis and ad-tality rate within the 15 mile area for a six month period be- justed cancer death rates compared historically, as wellin re-sinning at March 28,1979 with that for the same six-month lation to the State average rates. When Statewise or regional period beginning at March 28,1980 (one year post accident) tumor registry (an expensive undertaking) is instituted in and same beginning at March 28,1978 (one year pre-acci- Pennsylvania, it will be possible to evaluate cancer incidence ent), all in relation to the State average cardiac mortality rate within the same TMI cohort. It may also be possible, al-for the same six-month period. For these comparisons, age, though not the best alternative, to conduct a cancerincidence sex, and race factors will be taken into account. study by mail and other feasible means without tumor registry as such. These and other related logistic, fiscal, and technical
- 1. Family Breskoge(Divorce) Study: . Issues must be dealth with in the near future.
How did TMI nuclear accident affect the family bond in the Subsequent to the Pregnancy Outcome Study described area in terms of either unification or disruption? To look at earlier, we plan to conduct a five-year epidemiological study possible such effect we plan to conduct a des;riptive study de- of ChildGrowth andDevelopment based on the 4,000 infants signed to determine if the divorce rete in the TMI area has already a<certained within the 10 mile radius. This would be a changed (increased or decreased) after the March 28 accident. Joint study with the Department of Pediatrics, Hershey Medi-The divorce rate during the March 28,1979-March 27,1980 cal Center. Both physical growth and psycho-behavioral de-period will be compared to that during a comparabie period velopment will be assessed at each anniversary and the results one year before (control) and one year after (control), all in will be compared with national norms already established for relation to the State average divorce rate during the same per- possible significant differences. In addition, certain selected iod. Available information regarding sociodemographic cancers, thyroid disorders, and other clinical manifestations characteristics will be taken into account. will be investigated by pediatriciars.
- 3. MentalHealth Study:
SUMMARY
An in-depth epidemiological study of psychologicalimpact in a more psychiatric context is being conducted by Western The TMI nuclear accident has caused an extensive social-Psychia:ric Research Institute. This study, financed by the political unrest worldwide. At the same time, it has presented National Institute of Mental Health, covers three selected social scientists and biomedicalinvestigators a unique opportun-
"high risk" groups in the TMI area, namely: (1) TMI em- ity to esaluate its impact upon local population. Probably the ployes, (2) mothers with small children, and (3) mental health most ist.portant concern is that of safety and health effects of tne clinic patients, accidera.
From the currently available epidemiological knowledge, no K. Long-Term Disease Surveillsace significant physical health effects are expected from the low level
- Although the level of radiation releases from the TM1 was radiation released from the damaged TM1 facility. However, very low, there is still some disagreement among epidemiolo- some substantial psychological impacts are apparent. It is not sists and radiation biologists as to the health effects of low known, at this time, how long such psychological dis:urbance will level radiation in general. Furthermore, there is some indica- continue, to what extent " reported" psychosomatic symptoms tion that the heightened levels of anxiety and emotional dis- are true, and what significant physical manifestations may actu.
4 tress will continue to exist among local residents. For these ally ensus over an extended period of years, in addition, careful reasons, a long-term epidemiological surveillance of the local evaluation of pregnancy outcome, both immediate and long term population is indicated. This view is consistent with the rec- in the local population, should be pursued because of high sensi-i ommendations made by both the Presidential Commission livity of the fetus to ionizing radiation and severe stress.
l on TMI and the Pennsylvania Commission on TMI. I believe it is the responsibility of government agencies and
- Probably the most viable vehicle for such an undertaking academic communities to properly inform the general public with l
would be to make use of the already completed special TMI the objective results of carefully-designed scientific studies of census. Our immediate and long-term plan is to update an- possible health effects of the TMI accident. It is also critical that nually the Population Registry now being finalized for an in- safery of nuclear energy is properly addressed in relation to that of i definite period of years. During the course of update, num- othdr available means of energy production. Equally important is bers and causes of deaths in the cohort can be identified an- the public understanding of various alternatives, so that the socie.
nually. Periodically (e.g., every three or five years) a special ty can make a rational choice for its constituents. It is hoped that I morbidity survey may be conducted to determine the inci- - TMI Health Effect Research Program will serve as a means to
! dence and distribution of,various diseases and conditions achieve such goals.
l
,.5 Q .
y Prtwerdces of Ike Pennnisema Academy of Science 30:22 - 28. 1980.
EXTENT AND DURATION OF PSYCHOLOGICAL DISTRESS OF PERSONS IN THE VICINITY OF THREE MILE ISLAND' PETER S. HOUTS', ROBERT W. MILLER 2, KUM SHIK HAM', and GEORGE K. TOKUHATA' ABSTRACT While this literature is extensiv e, it is of limited applicabihty in understandirg responses to the nuclear incident at Three Mile The " nuclear incident" at the Three Mile Island (TMI) nuclear Island. First, all of the disasters analyzed in the w orks cited abos e power plant, beginning on March 28, 1979, resulted in wide- had a vastly greater physical impact than that at Three Mile spread fear on the part of the surrounding population, and the Island. Even the less severe events, such as the flood described by temporary esacuation of a substantial portion of the people in the Melick (1978) and Logue et al., (1979), produced some direct in.
immediate vicinity of the plant (Houts, et al.,1980). Since the jury, along with a variety ofindirect damage in the form of con-
, event, there has been continuous publicity about the situation at taminated food and water, exposure to heat and cold stress, loss the erippled reactor with the result that, what began as a brief of suitable sleeping accommodations, and the like. While the crisis, has become an ongoing situation with, as yet, no clear accident at Three Mile Island probably did produce some dis-resolution.
ruption for those who evacuated, the physical magnitude is ob-The purpose of this paper is to describe the psychological re- viously smaller.
sponses of persons living in the sicinity of TMI at the time of the Second, the events at Three Mile Island have so far lacked a initial crisis as w eli as ihree and nine months later. We wish to des- sense of resolution. In all of the situations described in the studies cribe three relatively distinct features of this reaction:(1) feelings cited above, a point was reached w hen all significant damage had of overall concern;(2) effects on self-reports of stress-related so- been discosered, and the event could be said to be oser. This is matic and behasioral symptoms: and (3) effects on responses to much less true of the present situation. Not only does the original the Langner (1%7) index of psychological distress. source of threat remain, but the population surrounding the plant has been faced with frequent assertions that the original danger was greater than originally thought and that danger may still be BACKGROUND present.
Because of the uniqueness of the Three Mile island crisis, it was There is a substantial literature on the psychologicalimpact of not possible to predict degree or type of stress that would be pres-natural and man-made disasters. A sariety of situations hase ent in the population. The studies reported here assessed per-been studied, ranging from large-scale events, such as floods or ceived mental and physical distress on the part of persons hving in earthquakes, to localized but highly intense ones, such as tor- the vicinity of the facuity. Related studies of health care utiliza-nados, and flas;. floods. Overt psychiatric symptomology has tion and of health care providers are also being carried out under been the most common object of ttudy(e.g. Rangell,1976, Hud- sponsorship of the Pennsylvania Department of Health, but are gens,1974, Lifton, et al.,1976), but researchers have also dealt not yet completed.
with generalized su bclinical distress (Moore, et al.,1959) and w it h physical symptoms (Melick,1978, Logue, et al.,1979). At least t* o prior studies have attempted to determine a he extent to w hich METHODS disasters produce long-term distrest One,(Moore et. al.,1959),
measured the proportion of families containing one or more Sampling and Intemew Procedures members u ho continued to experience " emotional stress" four The findings to be reported here come from two sourcet (1) a months af ter a tornado, while a second (Logue et al.,1979) ob-telephone survey of 1506 persons hving within $5 miles of the tained a retrospecti,e assessment of families' os erall distress dur-plant, in July,1979, and (2) a telephone survey of 550 persons ing a self defined recosery period and of the duration of distress within 55 miles of the plant, in January,1980. The July sursey for the most severely affected family member. Both studies report was carried out by the Nuclear Regulatory Commission, and in-esidence of long term psychological distress. Physical symptoms cluded items on stress-related symptoms and feelings about Three have also been studied by Melick,(1978), using retrospective re-Mile Island. Some items in the July survey referred only to re-ports of oserall health status. She teported an increase in length spondents' bGefs and feelings at the time of the etnis in April, of llnew but not f requency of illness.
while others required irrormation for both April and July. The
' Symposium lecture paper on " Aftermath of Three Mile Island January sursey, which was carried out by Penn State repeated Accident" delisered at the 56th PAS Annual Meeting, April 20, theseitems, and also included the Langner indes of psychological 1980. The Sy mposium was sponsored by the Henry C. Frick Edu- distress (Langner,1%7).
cational Commission. Both interviews were conducted by Ciniton Research Sersices.
'The Pennsylsania State University, College of Medicine, Mer-shey, PA 17033 a professional intersiewmg orgamzation in Radnor Pennsyl-
- The Penns>lvania Department of Health vania. The population to be sampled consisted of allindmduals
]
.. ~. . - -
, SYMPOSIUM:THREEMILEISLAND:HOUTS ET. AL. 23 a
living within a 15 mile (radius) ring surrounding the plant, and in- report higher symptom frequer.cies (Mechanic,1972).-
dividuals clustered along north-south and east-west transects ex- 4. Atritudes and Commitments-Many social psychological tending from 15 to $$ miles from the plant (See Flynn,1979 for a studies have shown that people tend to remember and report more detailed description of sampling procedures.) events in a manner that is consistent with their attitudes or -
Random digit dialing was used for all telephone exchanges their behavior (Festinger,1957). This tendency could, for ex-within the designated area, in order to assure access to both listed ample, play a role in what pro or anti nuclear power people re-and unlisted phones. Interviewers were instructed to call until member from their experiences during the crisis.
they reached a number which was a home (rather than business) 5. Conscious Distortion-It is possible that some respondents phone, and to establish that the home was within the designated consciously distoned their answers in hopes of affecting pub.
- area. They then randomly requested to speak to either the male or lic policy toward Three Mile Island. For example, a person female head of household. If this person was not present the - who is opposed to re-opening TMI might over-state symptoms opposite-sex head was requested. Numbers with no answer were or feelings which he or she experienced during the crisis in an called up to four times, wFle those at which an interview had been attempt to influence survey results toward showing that people refused were recalled once. At the beginning of each interview the in the vicinity of the island were experiencing distress.
respondent was read an informed consent statement which des-cribed the purpose of the interview and indicated that all re-sponses were voluntary, and would remain confidential. RESULTS The July survey achieved a response rate of 69%. Thst is,69%
- of the eligible households yielded a completed interview, while The inclusion of persons who live at a considerable distance
- 17% produced a refusal; the remaining 14% could not be com-. from the plant has made it possible to use the farthest group, i.e.
pleted for some other reason. Rate of response, refusal and non- ' persons living beyond 40 miles of TMI, as a control group against completion for the January survey were 82%,11% and 7%, which to compare responses of persons closer to TMI. By match-respectively, ing persons at different distances on demographic variables (i.e.,
age, sex, education, income and marital status) we can infer that,
, Measures and theirInterpretation if distress is higher close to TMI, that this is related to events at Two distinctly different types of questions were included in the Three Mile Island. (Since not all possible demographic variables I surveys. The first type refers to beliefs and attitudes. This includes have been controlled, we cannot be absolute certain that prox.
questions such as "How serious a threat do you feel the Three imity to Three Mile Island is the only cause of distance effects, on-Mile Island Nuclear Station is for you and your family's safety?" ly that it is a likely cause.) This analysis can be carried out using and "How upset do you feel about the situation at Three Mile multiple regression analysis with lummy variables for each dis-Island". Responses to questions such as these can usually be tance group.
taken at face value, since one can generally assume that normal it should be pointed out that the distance variable is a conserva-
- individuals can, if they so choose, give an accurate description of tive indicator of distress due to Three Mile Island. Persons living these kinds of states. Some distortion can be expected because of in the farthest group may have experienced some degree of dis-4
' poor memory (if the question refers to a previous belief or at- tress because of the crisis and these effects are lost in con.parisons titude) or an unwillingness to acknowledge strong feelings. across the distance. Therefore, while we may reasonably infer The second type of question included in the interviews refers to that, if distress levels are higher close to TMI than farther away, the occurance of physical or behavioral symptoms where the pro- that this is a result of proximity to Three Mile Island, we are not cess of interpretation is much more complicated. There are at sure that this reflects all the distress that was caused by the crisir least five factors which may distort respondents' reports of these and its aftermath, symptoms during and after the Three Mile Island Crisis. Interpretation ofdistress response :
Three types of stress indicators were collected in these surveys:
. I. Memory-Most of the questions concerning symptoms and (1) direct statements about how worried, upset, etc. respondents health-related behaviors asked respondents to remember have been about the situation at Three Mile Island, (2) the Lang-events that occurred during the crisis period or during the two ner index of psychological distress (Langner,1%7), and (3) re-weeks just prior to the interview. Since memory is rarely per- spondents' reports of mental and physical syrr.ptoms that are of-fect and often selective (i.e. people tend to remember things ten associated with stress. The stress-related symptoms t. sed in that they think areimportant and sometimes forget things that this study were drawn from research on stress (Selye, in) as w ell c.re upsetting), there is ampic opportunity for distortion to oc- as from interviews wi th patients at the Hershey Medical Center
{
=
tur. . and in the practice of Dr. Joseph Leaser in Middletown, Pa., im-2.- Menta/ Status-It has been shown (Mechanic,19%) that per- mediately following the crisis. These stress-related symptoms sons wit h poor mental status (e.g. anxiety, confusion, depress- were broken into two groups, based on a factor analysis. The first ion, etc.) tend to report more physical symptoms than others. group, which deals primarily with physical symptoms, includes it is not clear whether these people experience more syr,ptoms headaches, diarrhea, constipation, abdominal pam, sweating or whether they simply attend to and remember symptoms spells, stomach trouble, frequent urination and rash, and we will
' which otherwise would have been forgotten. To the extent that call this group " physical stress symptoms." The second group,
. it is the latter, people with poor mental status may report in- which deals with overt behaviors, includes irritability, fits of flated symptom rates. anger, sleeplessness, loss of appetite, feeling trembly, trouble i'
- 3. Willingness to Acknowledge Feelings and Symptoms-Some thinking, and overeating. We will call this second group "be-
, persons are more open in telling others about t heir feelings and havioral stress symptoms." Results will be discussed separately physical conditions than are others. It has been suggested that for the two groups of symptoms.
this variable may play a role in why women report more symp. The hree areas of interest noted abose-feelings of overall toms than men and why persons from certain cultural groups concern, reports of stress-related physical and somatic symp-
24 PROCEEDINGS OF THE PENNSYLVANIA ACADEMY OF SCIENCE Vol. 54. toue 1.1980 D 1 70 -
DIFFERENCES FROM THE GROUP BEYOND 40 MILES'
~
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50 .30 h hw APRIL,1979 cc APRIL,1979 /
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A E 10- - - - - . , ' MILES FROM TMI JANUARY,1980 .10 -
' Age. sex, education, income and
, , , , , marital status controlled.
05 610 1115 16 25 26 40 4g FIGURE 2. Ratings of extremely upset or very upset about TMI S FRM M A circled point indicates that the percent of persons w ho are extremely or very upset about TMI at that distance is significantly greater than the per.
FIGURE 1. % of respondents extremely upset or quite upset about TMI cent of persons beyond 40 miles who are extremely or very upset toms, and responses to the Langner index of psychological dis- fered somewhat at different distar.ces, and, therefore, may hase tress-will be discussed separately and then compared. In each distorted the results. These " refined" results are shown in figure 2 case we will present responses as a function of distance from the in terms of variations from the farthest group (beyond 40 miles).
plant, first as absolute scores, and then as percentages corrected Figure 2 also shows where response levels are significantly dif-for demographic variables and plotted as differences from the 40 ferent from the response levels beyond 40 miles when age, sex, mile control group. education, income and marital status have been controlled.
Fec/mgs ofconcern about TM/ Figure 2 shows a marked distance effect in April,1979 immedi-Two questions concerning feelings about TMI were asked in ately following TMI, as well as in January,1980, though the per-both the July 1979 survey as well as in the Jenuary 1980 survey. centages for January within 15 miles are half what they were in Results will be reported separately for each question. The first April. In April, the probabilities of being extremely or very upset question asked about how upset the respondent was about TMI. are significantly higher than the farthest group for the 0-5,6-10 The exact phrasing was as follows. and 11-15 mile groups and then drop to below the level of (1) How upset do (did) you feel about t! e situation at Three so -
Mile Island?
extremely upset yo -
quite upset somewhat upset o a little upset y 60-not at all upset g APRIL,1979 don't know Sg ,
This question was asked twice; first in tne July 1979 survey EE when respondents were asted how they had felt in April 1979, EE %. \
during the crisis period, and, second, in the January 1980 survey y $ 40 % --" \
when they were asked how upset they presently felt.
Results are reported in figures I and 2. Data are presented in 2$ \/ JULY,1979 two ways. First is the percent of persons within each distance o0 30-
] \.N g g group who reported being extremely or quite upset about the g \ \.g situation at Three Mile Island (figure 1). This chart shows a sharp 5 20- N f ,-
overall drop from April 1979 to January,1980, though both lines '
JANUARY,1980 */'
/
are higher close to TMI. It is interesting to note that, even in the farthest group, over 20% were extremely or very epset in April 10 - N' and 7% still felt this way in July. This indicates, as suggested earlier, that distress was experienced to some degree even in the i i i i i farthest group. 05 6-10 11 15 16-25 26-40 41 Second, these same data are reported after using multiple re-MILES FROM TMI
- gression analysis to control for a number of demographic var-FIGURE 3. % of respondents who feel TMI is a serious threat or sery iables (age, sex, education, income and marital status), w hich dif- serious threat to their families' safety
, _ . _ . _ . . _ , . . . . . .- _ m t> . N.
statistical significance beyond that. In January, they are signifi- (H EAD ACH E. DI ARRH E A.
' cantly different for only the 0-5 and 6-10 mile groups. CONSTIPATION, ABDOMINAL PAIN.
9 ', The second question concerns perceived threat to the respon. SWEATING SPELLS. STOMACH TROUBLE. ;
dent and his or her family. This question was phrased as follows. yo -
FREQUENT URINATION. AND RASH)
How serious a threat do (did) you feel the Three Mile Island Nuclear Station is (was) for you and your family's safety?
a very serious threat - 60 -
a serious threat 5 somevsat of a threat 5 no threat at all "uw 50 - % 1 m more symptens don't know -8Z
- 5
.<N Ja nua ry,1980
'% s s
,c,
- 5m 40-This question was asked in the July,1979 survey about how re. N spondents had felt in April, immediately following the accident as 6 \g \ ~ ~~ ~~ ' ""4 -
well as for how they felt in July.The same question was also asked 0 ?" 30 N % 1 or more symptoms in the January survey for how respondents felt in January. ,E N July.1979 Results are shown in figures 3 and 4. The methods of analysis z .,,,,,'N -
were the same as for the previous question and the findings are M 20 -
strikingly similar. While the overall percentages dropped sharply E' from April to July, (figure 3), there was relatively little change ,,- % 1 or more symptoms j~ ' ' from July,1979 to January,1980. When the three time periods 10 -
ADr'l 1979 are plotted as deviations from the farthest group with demo-graphic variables controlled (figure 4), the three time periods are , , , , ,
strikmgly similar. There is a 10 percent drop from April to July 05 610 1115 16 25 26-40 41
- with January scores between the two. For all three times the 0-5, 6-10 and ! ! 15 mile groups are significantly higher than the group MILES FROM TMI beyond 40 miles. FIGURE 5. Percent of respondents with one or more physical stress symptoms DIFFERENCES FROM THE GROUP BEYOND 40 MILES.*
that July rates are higher than Aprilis probably due to memory y ao -
since bot h sets of data were collected in July. That is, in answering g abou' April, respondents had to remember back three months, g but in answering about July, they only had to remember for the mw 3d ,,,
two weeks just prior to the interview. The higher rates for January f
1~
lh g 0; a.,,,,,,
%,,,M APRIL,1979 may be due to seasonal variations in symptom reporting. TI,e Health Interview Survey, a nationwide survey conducted by the 20 g5 .0--M National Center for Health Statistics, reports that acute symp-a3 _
JU LY,1979 - k JANU ARY,1980 toms are, on the average,1.4 times higher in January thartin July (DHEW Publication No. (PHS) 79-1560). This is approximately oq A . . ~ ~'N the same as the differences found here.
.E O
6.'10 11 15
' \.N e s'N ,,
N The fact that all three sets of data slope suggests that, as with the attitude measures reported earlier, closeness to TMI did have 05 16-25 7 N .,7. # 41-an influence on symptom reporting. Figure 6 makes this point 26 40 more convincingly' Here, demographic variables (age, sex,
.- 10 -
MILES FROM TMl education, income and marital status) have been controlled and
- Age, ses, education, income probabilities are plotted as deviations from the control group (be-and maritat status are contrelled. yond 40 miles), this eliminates the generallevel differences and al-npa ns pes abne. Qure 6 not onh sbs FIGURE 4. Ratings of very serious or serious threat to family's safety.
A circled point indicates that the percent of persons feeling thtt TMI is a raised response frequencies close to TMI, it also shows a sharp ~
very serious threat or serious threat at that distance is significantly greater drop between 15 and 25 miles, :he same as with the attitude data.
- than the percent of perso-s beyond 40 mb who feel TMI is a very serious Statistical significance, as shown in figure 6 also drops after 15
, or serious threat. miles. The percent of the population above baseline at all three times is approximately ten percent.
Symptom Reporting Analysis of behavioral stress symptoms (i.e. loss of appetite,
, ' The frequency of reported physical strass symptoms (i.e. head- overeating, trouble sleeping, feeling trembly or shaky, trouble -
ache, diarrhea, constipation, abdominal pain, sweating spells, thinking clearly irritability and extreme anger)is shown in figures
- stomach trouble, frequent urination and rash)is summarized in 8 and 9. The method of analysis and presentation parallels those figures 5 and 6. Results are reported in terms of percent ofpersons reported earlier. Figure 7 shows the same general differences who reported at least one of these symptoms for each time period. among the three time periods that were found with the " phys-
. Data analysis and presentation format are the same as for the two ical" stress symptoms These are probably due :o the same questions cited earlier.: causes. Figure 8, which includes controls for demograp'iic var.
. The percent distributions, shown in figure 5, show large overall iables as well as differences in general levels, again snows signi-differences for April July and January. The highest rates are . ficantly higher levels of symptom reporting out to 15 miles for 4
reported in January, followed by July and then April. The fact April and January, but only for the 0-5 mile and 11-15 miles
-.- - - . . _ , - _ _ . ,-. a_ ~ _ _ _ , , . ,-- .. , . . _ . ,,._--m _ _ = _ _ _ . . . _ _ -.
- . 4.
26 PROCEEDINGS OF THE PENNSYLVANIA ACADEMY OF SCIENCE Vol. 54. Issue I,1980 DIFFERENCES DIFFERENCES FROM THE GROUP BEYOND 40 MILES
- FROM THE GROUP BEYOND 40 MILES
- O 40 -
@ ,40 -
O C E E gg .30 -
SU .30 -
/As JANUARY,1980 z z o ;5 $z$
$0 ' ~
.20 5E 2O .10 q
.g APRIL,1979 23 2I
]#
^\
's Ei Q @\ %.qJULY,1979 gq .10 g y'j '
- JAN.,1580k N
- V[ N.
JULY,1979 N.
\
w %- - - - -
z N
E 05 610 1115 16 25 --- -2Y40 41- U E"
w a:
w 0-5 6101115 16 25 26-40 4 I-MILES FROM TMI
- Age. sex, education, income .10 -
and marital status controlled. . Age, sex, education, mcome FIGURE 6. One or more physical stress symptoms and marital status controlled.
A circled point indicates that the percent of persons who report at least FIGURE 8. One or more behavioral stress symptoms.
one symptom at that distance is significantly greater than the percent of persons beyond 40 miles who report at least one symptom. A circled point indicates that the percent of persons u ho report at least one symptom at that distance is significantly greater than the percent of
!- persons beyond 40 miles who r port at least one symptom.
ILOSS OF APPETITE, OVEREATING. TROUBLE SLEEPING, FEELING pression, anxiety and some psychosomatic symptoms. Data were TREMBLY OR SHAKY, TROUBLE THINKING CLEARLY, analyzed in the same manner as for the other distress indices.
IRRITABILITY AND EXTREME ANGER) However, in this case, there were no statistically significant dif-70 -
ferences between groups close to TMI and the farthest com-parison group.
60 -
o Y
Y DISCUSSION g 50 -
$0 As was pointed out earlier, there are a number of variables that g z /a % 1 or mote symptoms J
can affect symptom reportit g rates in addition to actually having 3E \ anuary, M80 symptoms. As a result, we cannot be certain that what people E[ \
\
report is the same as what they experienced. However, it is pos-sible to make some inferences from the general pattern of results 2W 30
\f/,4 g" \ \ that do not require accepting responses at face value.
- % 1 or more symptoms \ While there are several possible explanations for why symptom E*
w 20 -
.# ' reporting is higher near TMI than farther away, they all indicate N.'J uly.1979
~~~'~~~ ~~
higher levels of stress near the Island. For example, if poor mental
' status (e.g. anxiety, depression, etc.) caused the higher reporting 10 -
/ -
rates, poor mental status is, itself an indicator of distress. If the syrnptorns
[p,2"3 g higher reporting rates near TMI are due to strong negatise atti-
' ' ' tudes toward TMI which lead people to notice and remember 05 6'10 11 15 16 25 26-40 41 symptoms, this too, indicates higher distress near the Idand.
MILES FROM TMi Finally, if conscious distortion played a role in raising rates, this too can be considered an indicator of distress, since it would be FIGURE 7. % of respondents with one or more behavioral stress symp-toms. expected only where feelings are very strong. As a result, it is possible to conclude that distress (whether expressed through ac-groups during July. Figure 8 also shows the highest rates within l 5 tual symptoms, increased tendency to notice and remember miles for January, followed by April and july. There is also a rise symptoms or conscious distortion in reporting symptoms) is in symptom reporting in January for the 26-40 mile group, but higher close to Three Mile Island.
this is not significantly different from the group beyond 40 miles. The similarity between findings for attitudes and for stress-In general, this figure repeats the patterns of the other measures, related symptoms is striking. Both sets of data show raised lesels showing raised Icvels of symptom reporting out to 15 miles for of distress out to 15 miles and both sets of data indicate essentially April, July and January. the same pattern for Anril, July and January. This suggests that Psycho /oricalDistress they are reflecting the same underlying distress levels. The fact The last set of data to be reported here are responses to the that the 1.angner scale shows a different patterr, from the other Langner index of psycholog; cal distress, which was included uly distress measures suggests that it may be measuring a different in the January survey. This scale includes questions about de- degree of distress or a different type of distress than are questions
a .. .0, .
SYMPOSIUM: THREE MILE ISLAND: HOUTS. ET. AL. 27 about attitudes or stress-related symptoms. An examination of The second task force measure involsed the " distrust of items in the Langner scale suggests that both may be the case. For authority" scale. The task force reported that the level of distrust example, the Langner scale asks if the respondent is often was markedly elevated immediately following the accident and troubled with headaches, w hile the stress-related symptom items that it dropped slightly in May with a slight additional drop in only ask whether the respondent had experienced a headache in July. Howeser, they also found in July that it was higher near the past two weeks. Alto, the Langner scale includes questions TMI than in a control group Wilkes-Barre, Pa. They also com-about depression as well as psychosomatic symptoms not in- pared responses in July to results of a national sursey which in-cluded in either the physical stress or behavioral stress symptom cluded similar questions. They concluded that, even in July, dis-lists. trust near TMI was above the nationallevel. These findings show A detailed analysis of each of the items in the Langner index a similar pattern to those reported here w here ratings of uptet and and the stress-related symptom lists supports this interpretation. concern about safety of TMI were elevated near TMI in both Several items in the Langner index allow for three responses: April and July in comparison to persons living beycnd 40 miles.
never, sometimes or often. The usual Langner scoring of these While the report of the presidential task force and thestudies items is to only count "often" as a positive response. When this is reported here are in substantial agreement, this may not appear to done, none of these items show an increase close to TMI. be the case from reading the summary statement of the Presi-Howeser, when the response "sometimes" is also included, a dential Commission on Three Mile lsland (Kc:neny, et. al.,1979).
procedure w hich makes the scoring more comparable to the PSU This is because writers of the summary report (who were not the and NRC studies, a distance effect is seen, but only for those same people who wrote the task force report) included only the items which overlap with the stress-related symptom lists. This in- findings drom the Demoralization scale in their discussion of long dicates that differences in both type and severity of symptoms term effects and ignored the findings about trust in authority.
assessed contribute to the different findings with these two dis- Their conclusion that "There was immediate, short-lived mental tress measures. distress produced by the accident among certain groups of the Relationship of thesefindings to other studies general population . " is correct if, by mental distress, is meant This is one of seseral studies concerned with the psychological only behaviors assessed by the demoralization scale (and the effects of the Three Mile Island incident. Of those made public to Langner scale). However, long term effects through July were date the one which oserlaps most with this work is the report by shown in the task force studies in the form of distrust of authori-the Task Force on Behavioral Effects of the President's Com. ty. In our study, long term effects were demonstrated through mission on the Accident at Three Mile Island (Dohrenwend et al, January 1980 in the form of being upset about TMI, concern 1979), about safety of self and family, and, closely related to these.
The task force report included findings for several different awareness and reporting of symptoms frequently associated with sub groups including workers at TMI, mothers of young stress.
children, as well as some general population data. Since much of the task force's work concerned sub-groups,it is not directly rele-
SUMMARY
vant to the findings reported here. How es er, two specific findings are relevant: (1) The results of three administrations of the "de- Between ten and tuerty percent of the population within 15 moralization" scale to persons within 20 miles of TMI and one miles of TMI had heightened levels of distress (compared to per-administration to a control group in Wilkes-Barre, Pennsylvania sons beyond 40 miles from TMI) as indicated by statements of be-and (2) The results of three administrations of " distrust of ing upset about TMI, concern about safety for themselves and authorities" scale to persons within 20 miles of TMI and one ad- their families and reporting of symptoms frequently associated ministration to a control group in Wilkes-Barre. The "demoral- with stress. This distress, which began during the crisis period, ization" scale is made up of questions that are sery similar to continued into Jan.tary,1980, nine months after the original questions in the Langner scale used in our studies. In fact, the tw o crisis.
scales share some of the same items and the correlation between the Langner and demoralization scales is oser .90, which makes them essentially equivalent. The distrust of authority scale ACKNOWLEDGEMENTS includes questions about trust in federal or utility company of-ficials regarding safety of TMI and w hether respondents feel state The authors wish to acknowledge the help of Dr. Cynthia Bul-or federal officials had been truthful. With this in mind, we will lock Flynn, Michael Kaltman, Nancy Kreuser, Carol DeGen-review the findings of the two studies. naro, Dr. Joseph Leaser, Dr. Dasid Mechanic, and Paul Cleary.
The Presidential Commission Task Force found thar demorali- Funds for this work were provided, in part, by the Electric zation scores were markedly raised among persons interviewed in Power institute through a contract with the Pennsylvania Depart-April, immediately after the accident, but that they fell sharply in ment of Health.
a second sample in May and showed a small additional drop in a third sample in July. A comparison of demoralization scores of mothers with small children in the vicinity of TMI and in Wilkes- BIBLIOGRAPHY Barre show ed no significant difference in July. These facts led the task force researchers to conclude that, on this measure of dis- Dohrenwend. B., Dohrenwend, B., Kast, S., and Warheit, G.
tress, the population had returned to baseline by July. The task Final draft of the report of the task force on behariora/ c/fects force findings are consistent with the findings reported here for effects of the President 's Commission on the A ccident at Three the Langner index. In January, we, too found no differences in Afile Island, unpublished manuscript October 15,1979.
Langner scale scores betw een persons living close to TMI and per- Festinger, L. A Theory of Coemtive Dissonance Esanston: Row-sons hsing beyond 40 miles. In this respect, f ae results of the two Peterson,1957.
studies are censistent. Flynn, Cy nthia Three AfileIsland TelephoneSurvey, Prehminary
e ... 7.
28 PROCEEDINGS OF THE PENNSYLVANIA ACADEMY OF SCIENCE Vol. 54. Issue 1.1980 Report ofFindings. A Report to the U.S. Nuclear Regulatory distress following hurricane Agnes in Wyommg Valu; of Commission, September,1979. Pennsylvania. Public Health Reports. 94:495-502, 1979.
Houts, P., Miller, R., Tokuhata, G. and Ham, K. Health-Re- Mechanic, David Menta/ Health and Socia / Policy Prentice-Hall, latedBehavioralimpact of the Three MileIslandNuclearinci- l980.
dent Part / Report submitted to the TMI Advisory Panel on Mechanic, David Social psychological factors affecting the pres-Health Research Studies of the Pennsylvania Department of entation of bodily complaints. NewEngland/ournalofMedi.
Health. April,1980. cine 1972,186, pp i132-1139.
Hudgens, R. Personal catastrophe and depression. In B. Dohren- Melick, M. Life change and illness: lilness behavior of males in wend and B. Dohrenwend (Eds.), StressfulLife Events. New the recovery period of a natural disaster. Journalo/ Health and York: John Wiley,1976. SocialBehavior. 19:335-42, 1978.
Kemeny, J. et. al. The Report of the President's Commission on Moore, H. and Friedsam, H. Reported emotional stress follow-ThcAccidentat ThreeMileisland, Washington, October 1979. ing a disaster. SocialForces. 38:135-9, 1959.
Langner, T. A twenty-two item screening score of psychiatric National Center for Health Statistics Acute Conditions /ncidence symptoms indicating impairment. Journal of Health and Hu. and Associated Disability DHEW Publication No. (PHS) man Behavior 1%7,3,269-2'/6. 79-2560, 1979.
Lifton, R. and Olson, E. The human meaning of total disaster. Rangell, L. Discussion of the Buffalo Creek disaster. American Psychiatry. 39:1 18, 1976. JournalofPsychiatry. I33:313-16,1976.
Logue, J., Hansen, H. and Struening, E. Emotional and physical Scyte, Hans The Stress of Life New York: McGraw-Hill,1956.
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