The Great East Japan Earthquake occurred on March 11, 2011, and was followed by a nuclear accident at the Fukushima Daiichi Nuclear Power Plant. The government ordered a mandatory evacuation from the high radioactive concentration area in Fukushima. This evacuation may have forced many evacuees to change specific aspects of their lifestyles such as diet and physical activity, which in turn may lead to future incidence of lifestyle diseases such as cardiovascular diseases (CVDs). To address this concern, the association between the evacuation and changes in CVD risk factors before and after the disaster was examined in the Fukushima Health Management Survey. In the present study, we reviewed the results of longitudinal studies in the Fukushima Health Management Survey. The proportion of overweight/obese people and those with hypertension, diabetes mellitus, dyslipidemia, liver dysfunction, atrial fibrillation, and polycythemia increased after the disaster. Furthermore, the evacuation was associated with an increase of these cardiovascular risk factors. Therefore, evacuees may be more disposed to CVDs such as myocardial infarction and stroke after the disaster. The prevention of future CVDs among evacuees from Fukushima requires ongoing preventive programs for obesity, hypertension, diabetes mellitus, and dyslipidemia, in collaboration with local governments and communities.

Few studies have investigated the relationship between living arrangements and dietary intake among evacuees after disasters. To examine the relationship between living arrangements and dietary intake using the data of a large-scale cohort survey of evacuees after the Great East Japan Earthquake in 2011. 73,433 residents in evacuation zones responded to the Fukushima Health Management Survey questionnaire. Subjects were excluded if they did not report their living conditions or were missing more than three pieces of information about dietary intake. The data of 52,314 subjects (23,149 men and 29,165 women ≥15 years old) were used for the analyses. Evacuees' living arrangements were characterized into three categories: evacuation shelters or temporary housing, rental houses or apartments, or a relative's home or their own home. Dietary intake was characterized in terms of grains, fruits and vegetables, meat, soybean products, dairy products, and fish. Daily consumption of the third quartile (Q3) or higher for each food group was defined as 'high consumption'. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using modified Poisson regression analyses. Modified Poisson regression analyses showed that, compared with respondents living in a relative's home or their own home, the PRs and 95% CIs for the people living in rental apartments of high consumption of fruits and vegetables (non-juice), meat, soybean products, and dairy products were 0.69 (95% CI, 0.61-0.77), 0.82 (95% CI, 0.73-0.91), 0.89 (95% CI, 0.83-0.94), and 0.83 (95% CI, 0.74-0.93) respectively. The corresponding PRs and 95% CIs for people living in evacuation shelters or temporary housing were 0.83 (95% CI, 0.78-0.88), 0.90 (95% CI, 0.86-0.95), 0.94 (95% CI, 0.91-0.97), and 0.91 (95% CI, 0.86-0.96) for high consumption of fruits and vegetables (non-juice), meat, soybean products, and dairy products, respectively. The present study suggests that, after the earthquake, living in non-home conditions was associated with poor dietary intake of fruits and vegetables (non-juice), meat, soybean products, and dairy products, suggesting the need for early improvements in the provision of balanced meals among evacuees living in non-home conditions.

Objective Psychological distress is generally associated with poor dietary intake, but this has never been investigated among residents after a major disaster. We attempted to reveal the associations between dietary intake and non-specific mental health distress as well as traumatic symptoms among evacuees after the Great East Japan Earthquake of 2011. Methods In this cross-sectional analysis of 63 047 evacuees (27 901 men, 35 146 women) who responded to The Fukushima Health Management Survey in 2012, non-specific mental health distress was assessed using the Kessler-6 (K6) scale, while traumatic symptoms were evaluated using the Post-traumatic Stress Disorder (PTSD) Checklist—Stressor-Specific Version (PCL-S). The outcome was ‘low frequency’—meaning a daily consumption in the 25th centile or less according to the food frequency questionnaire (FFQ)—of 19 targeted food items. Logistic regression analysis was used to estimate ORs and 95% CIs adjusted for demographic, lifestyle-related and disaster-related factors. Results Of the participants, 14.7% suffered non-specific mental health distress, and 21.2% exhibited traumatic symptoms. Multivariable adjusted logistic regression analysis showed that the former were likely to have a low intake frequency of certain foods, such as rice and bread, fish, meat, vegetables or fruit (non-juice), soya bean products, milk, and yogurt or lactobacillus drinks; the latter were also likely to have a low intake frequency of certain foods, including rice and bread, fish, meat, vegetables (non-juice), milk and yogurt or lactobacillus drinks, but conversely consumed vegetable and fruit juices more often. These associations between dietary intake and non-specific mental health distress, as well as traumatic symptoms, were predominantly observed in women. Conclusions Psychological distress after the Great East Japan Earthquake among evacuees was associated with a low intake frequency of certain foods, and the association was predominantly observed in women.

Residents were forced to evacuate owing to the radiation released after the Fukushima Nuclear Power Plant (NPP) accident following the Great East Japan Earthquake on 11/03/2021; thus, their lifestyles drastically changed. The Comprehensive Health Check (CHC) of the Fukushima Health Management Survey (FHMS) was performed to evaluate health statuses and prevent lifestyle-related diseases in evacuation area residents. The first part of the CHC survey is a retrospective analysis of pre- and post-disaster data on health check-ups of evacuation area residents. The second part is a cross-sectional, prospective analysis of post-disaster (fiscal year (FY) 2011–2017) data on health check-ups. Subjects were men and women living in 13 municipalities in areas surrounding the NPP in Fukushima Prefecture. Post-disaster (FY 2011–2012) overweight, hypertension, dyslipidemia, diabetes mellitus, metabolic syndrome, liver dysfunction, hyperuricemia, polycythemia and atrial fibrillation cases increased from the pre-disaster (FY 2008–2010) levels. This tendency was strongest among residents who were forced to evacuate. Proportion of overweight people remained unchanged, the prevalence of liver dysfunction decreased and the proportion of people with treated hypertension and dyslipidemia increased during FY 2011–2017. Meanwhile, the prevalence of diabetes mellitus and mean levels of HbA1c increased. Furthermore, Evacuees showed higher risks of diabetes mellitus, dyslipidemia, chronic kidney diseases and liver dysfunction than non-evacuees. Therefore, residents in the evacuation area, especially evacuees, are at high risk of developing lifestyle-related diseases, especially cardiovascular diseases; therefore, it is necessary to observe health statuses and implement measures to prevent lifestyle-related diseases.

Socioeconomic status (SES) and lifestyle-related factors are determinants of subjective health. However, changes in SES are inevitable in times of natural disaster, while lifestyle-related factors remain modifiable. The aim of this study was to use a cross-sectional approach to examine lifestyle-related factors that may attenuate the negative impact of disaster-induced changes in SES on poor subjective health. We analyzed 33,350 men and women aged 20–64 years who were living in evacuation zones due to the radiation accident in Fukushima, Japan. Disaster-induced changes in SES were defined by living arrangements and working conditions. Using Poisson regression analysis adjusted for confounders (model 1) and lifestyle-related factors as intermediate variables (model 2), we compared the prevalence ratios (PRs) of poor subjective health of participants who did not undergo disaster-induced changes in SES (did not become unemployed, income did not decrease, and living in relative’s home/own home) with that of participants who did undergo disaster-induced changes in SES (became unemployed, decreased income, or lived in an evacuation shelter, temporary housing, or rental housing/apartment). We calculated the percentage of excess risks explained by lifestyle-related factors as follows: ((PRmodel 1 − PRmodel 2)/(PRmodel 1–1)) × 100. Disaster-induced changes in SES were significantly associated with poor subjective health. The PRs (95% CIs) among participants who underwent disaster-induced changes in SES were 2.02 (1.81–2.24) for men and 1.80 (1.65–1.97) for women. After adjusting for lifestyle-related factors, we found that the PRs in men and women were remarkably attenuated, decreasing to 1.56 (1.40–1.73) and 1.43 (1.31–1.55), respectively. Controlling for lifestyle-related factors resulted in PR attenuation by 45.1% (men) and 46.3% (women). Satisfaction of sleep and participation in recreation and community activity particularly contributed to this attenuation. While disaster-induced changes in SES are unavoidable, lifestyle-related factors have the potential to attenuate the impact of these changes on poor subjective health.

Objective Few studies have comprehensively examined changes in smoking status and related factors after a disaster. We examined these factors among residents of an evacuation area in Fukushima after the Great East Japan Earthquake. Methods The study participants included 58 755 men and women aged ≥20 years who participated in the Fukushima Health Management Survey in 2012 after the disaster. Smoking status was classified as either current smokers or current non-smokers before and after the disaster. The participants were divided into the following groups: (1) non-smokers both before and after the disaster, (2) non-smokers before and smokers after the disaster, (3) smokers before and non-smokers after the disaster and (4) smokers both before and after the disaster. The adjusted prevalence ratios and 95% CIs of changes in smoking status for demographic, disaster-related and psychosocial factors were tested using logistic regression analysis that was stratified by smoking status before the disaster. Results Among the 44 729 participants, who were non-smokers before the disaster, 634 (1.4%) began smoking after the disaster. Among the 14 025 smokers before the disaster, 1564 (11.1%) quit smoking after the disaster, and the proportion of smokers in the evacuation area consequently decreased from 21.2% to 19.6%. In the multivariable model, factors significantly associated with beginning smoking included being a male, being younger, having a lower education, staying in a rental house/apartment, house being damaged, having experienced a tsunami, change jobs and the presence of traumatic symptoms and non-specific psychological distress. On the contrary, factors associated with quitting smoking included being a female, being older, having a higher education and having a stable income. Conclusion The proportion of smokers slightly decreased among residents in the evacuation area. The changes in smoking statuses were associated with disaster-associated psychosocial factors, particularly changes in living conditions, having experienced a tsunami, change jobs and developing post-traumatic stress disorder.