The Three Mile Island Health and Environmental Information Series

Transcription

1 The Three Mile Island Health and Environmental Information Series Prepared and presented by Sandra Prince-Embury, Ph.D. At Penn State Capital Campus 1

2 Presentation Outline What was the Three Mile Island Health and Environmental Information Series? How was it unique? Access to information under conditions of uncertainty and risk. Loss of faith in experts. Attending to hyper-vigilance and emotional reactivity. Structure and content of the course. Current thought on risk communication.

3 What was the TMI Public Health and Environmental Information Series? The TMI Public Health and Environmental Information Series was a series of educational sessions designed to provide information to community members in language that they could understand delivered by experts that were considered credible. The Series consisted of twelve two hour sessions offered free of charge to the public at Penn State Capital Campus from February to May of 3

4 The Three Mile Island Public Health and Environmental Series was initiated in 1983, parallel to survey research being conducted by Prince-Embury & Rooney. The TMI Series arose out of proposals developed between 1983 and 1985 by Prince-Embury in conjunction with the TMI Health Issues Committee of TMI-PIRC, a community organization. Members of the committee included Beverly Hess, Jane Lee, Mary Osborne, Patti Longenecker, Kay Pickering, & Dr. Judith Weisz. Petitions for funding were submitted to Judge Rambo as mediated by the Berger law firm representing the TMI Public Health Fund. Funding was provided by the Three Mile Island Public Health Fund and sponsored by Penn State Capital Campus beginning in spring of 1985 and extending for 12 4

5 History of Conflicting & Inconsistent Information at the time of the Accident Reports of incidents during and following the TMI accident suggest that the situation had lent itself to cognitive contradiction in that area residents were given contradictory messages during and after the accident; local radio stations had reported safe conditions, cable stations at a distance were reporting warnings; officials were offering reassuring messages to be followed by emergency evacuation instructions (Walsh, 1988; Lindy & Lindy, 1985). At the time, lack of consistent and accurate information was interpreted as intentional omission or falsification of information for vested interest of the information conveyers and not in the best interest of the 5

6 Psychosocial Circumstances The aftermath of the TMI accident was characterized by conflicting information and conditions of uncertainty regarding what had actually occurred during and after the Three Mile Island that had occurred March 28, 1979 and what risk these occurrences presented for the community. Community members remained concerned about clean-up of the damaged reactor for which there was regular venting of radioactive gas. Also at this time, community members demonstrated a loss of faith in experts which cast doubt on the credibility of information that had been provided. At that time also the community was still fraught by intense polarization between those who supported restart of the nuclear facility and those who opposed 6

7 Why is the TMI Health & Environmental Information Series of Interest? The Series presented information of scientific complexity to community members; The Series presented information for which there remained several unanswered questions pertaining to potential hazard; The Series was presented to a population that was highly polarized on issues pertaining to the TMI accident; The Series was presented at a time when the community faced imminent restart of the plant which many viewed as increasing potential hazard in the 7

8 Access to Information about Possible Negative 8

9 Ongoing Interest in Information The remaining need for TMI related information was substantiated in survey research (conducted in 1983)of a 5% stratified representative sample (n=214) of Middletown residents by Prince-Embury & Rooney, then faculty of the Community Psychology Program at Penn State Capital Campus. Prince-Embury, S., & Rooney, J. F. (1987). Interest in information as a function of worry and perceived control in the aftermath of nuclear disaster. International Quarterly of Community Health Education, 8(1), 33 9

10 Ongoing Interest in information In their earlier survey of Middletown (survey conducted in 1983), Prince-Embury & Rooney (1987) had found that 68% of a stratified random sample of Middletown residents (n=214) expressed moderate to great interest in information on radiation, epidemiology and cancer four years after the accident. For 44% of this sample interest in TMI related information was very much or great. Most interest was expressed in information about cancer detection and treatment (79%) but over 58% expressed interest in radiation monitoring and 56% expressed interest in epidemiology of cancer. Prince-Embury, S., & Rooney, J. F. (1987). Interest in information as a function of worry and perceived control in the aftermath of nuclear disaster. International Quarterly of Community Health Education, 8(1), 33 10

11 Interest in Information and TMI related worry These authors also found that interest in information was significantly correlated with worry about these topics among area residents (r=.52, p<.0001). Topics of information considered individually, TMI worry contributed most to interest in information on radiation monitoring (23%). Among specific TMI worries, worry about radiation exposure during clean-up accounted for the most interest in information (10% to 23%). Prince-Embury, S., & Rooney, J. F. (1987). Interest in information as a function of worry and perceived control in the aftermath of nuclear disaster. International Quarterly of Community Health Education, 8(1), 33 11

12 Ongoing need for information Assumptions prevalent at the time of the course were that stressed individuals do not desire information about adverse circumstances particularly if this information does not increase predictability. Miller (1984) addressing this issue found that delivery of information which matches the information seeking style of the individual minimized anxiety while that which does not match increases 12

13 Ongoing need for information The TMI series was based on the assumption that part of the healing process in the aftermath of technological disaster was the availability of accurate, reliable and understandable information in a way that allows individuals to pace information intake consistent with their ability to integrate information into a meaningful 13

14 Access to Information Access to information related to possible adverse circumstances is sought by impacted community members and can be delivered in a format and manner that increases the experience of understanding of the lay 14

15 Loss of Faith in 15

16 Loss of Faith in Experts Loss of faith in experts can occur for a variety of reasons such as withholding accurate information or for breach of promise such as failure of technology that has been presented as safe. Lack of perceived credibility of information was associated with a significant loss of faith in experts and demoralization (Prince-Embury & Rooney, 1987; Holt, 1983; Houts, et. al., 1980; Dohrenwend, et al., 16

17 Loss of Faith in Experts Survey research by Prince-Embury & Rooney indicated that members of the Three Mile Island vicinity reported they had lost faith in those whom they once considered experts. This included 47% of the stratified random sample (n=210) and 51% of the 159 individuals in that sample who had been residents at the time of the TMI accident. Prince-Embury, S., & Rooney, R. (1987). Perception of control and faith in experts among residents in the vicinity of Three Mile Island. Journal of Applied Social Psychology, 17, 11, 17

18 Attention to loss of faith in experts and sensitivity to inconsistency Design of the TMI Series assumed that an intervention delivered in a stressed population should be sensitive to and address sources of lowered credibility of experts such as vested interest of the expert and perceived and unexplained discrepancies between expert 18

19 Selection of Credible Expert Speakers Speakers were selected in collaboration with community members and the TMI Public Health Fund. Many had been identified by a panel of scientist commissioned by the Three Mile Island Public Health Fund, as politically neutral on potentially controversial issues relevant to their areas of expertise. Many of the speakers were already known to the community as experts who did not have a vested interest regarding nuclear 19

20 Selection of Credible Expert Speakers The choice of scientist experts included national experts in their areas of expertise, who were knowledgeable about areas of uncertainty and disagreement in their field and could discuss this openly. It had been identified that some conflicting information in the scientific community was due to actual uncertainty and objective differences of scientific 20

21 Guidelines for Expert Speakers Potential expert speakers were asked if they would be comfortable addressing lay community members, be willing to present in language that was readily understandable to non-scientists, distinguish between what is known, what is unknown and what we need to find out and to address questions from community 21

22 Hyper-vigilance & Emotional Reactivity in a Traumatized 22

23 Attention to Emotional Reactivity in Stressed Populations Baum, Gatchel & Schaefer (1983) identified chronic, low-level elevated stress in the TMI community using repeated physiological measures. Davidson and Baum (1990) identified members of a sample of TMI residents as manifesting symptoms of post-traumatic 23

24 Hyper-vigilance; heightened Emotional Reactivity Researchers have noted that one aspect of posttraumatic stress state is hyper-vigilance or the ability to continue to respond to stimuli with emotional intensity appropriate only to emergency situations (Krystal, 1978; Kardiner, 1941; VanderKolk, 1987). McCurdy (1943) identified events that are "near-miss" catastrophes, such as the TMI accident, as critical determinants of 24

25 Hyper-vigilance and lack of adequate Information Among the factors most frequently implicated as antecedents of hyper-vigilant reactions are lack of perceived control over dangerous events and lack of preparatory information about what is to be expected (Janis, 1971; Epstein, 1973; Monat, Averill & Lazarus, 25

26 Hyper-vigilance and restricted ability to process information Hyper-vigilance has been described as impairing cognitive functioning by constricting cognition with premature closure, restricting range of attention, narrowing range of perceived alternatives, reduction in immediate memory, and fostering of simplistic ideas, (George, 1974; Hamilton, 1975; Janis, 1971; Janis & Leventhal, 1968; Janis & Mann, 26

27 Structure for managing emotional reactivity to lessen the possibility of increased stress as an obstacle to 27

28 Addressing Emotional Reactivity The TMI Series was based on the assumption that communication of information in an environment of intense polarization on different sides of the nuclear power debate (Walsh, 1988) must in some way address the possibility of intense emotionality among course 28

29 Addressing Emotional Reactivity Ground rules were developed by this author to maximize the likelihood of information flow and comprehension by minimizing or controlling emotional reactivity. The specific ground rules were read to participants at the beginning of each session and were presented in the form of a mutually agreed upon verbal contract for participation in the sessions. Break times between the first and second half of each session and following each session allowed informal debriefing to 29

30 Addressing Emotional Reactivity The opportunity to express questions and comments to the speaker in a formal way during the second half of each session served also as a tension release and an opportunity for attendees to ask questions to clarify points of uncertainty or perceived inconsistency. The coordinator of the series, a psychologist, and two psychology graduate students were available to individuals who wanted to express concerns 30

31 Addressing Emotional Reactivity with Specific Ground rules for Participation Specific Ground Rules: Ground rules addressing tolerance of disagreement respecting the opinions of others, managing ones own emotions and anticipating uncertainty were stated at the beginning of each 31

32 Ground Rule A It was stated that the mission of the course was conveyance of information not agreement among participants; that participants held varied opinions and perspectives and that each person was asked to respect the right of all others to hold a different opinion. Furthermore, course participants were asked to treat each other and speakers with 32

33 Ground Rule A cont. The specific request that participants acknowledge and accept diversity in opinion was intended to prepare participants with a more realistic expectation for the series so that emotional reactivity would not be aroused by discrepancies between expectation and 33

34 Ground Rule B. It was acknowledged that some of the topics to be presented might be stressful for some participants. It was asked that each participant be responsible for controlling his or her own emotional reaction so that it not prevent him or her from hearing the information presented, or lead them to treat anyone else with 34

35 Ground rule B cont. This ground rule was intended to clarify that information presented was not designed to assuage emotion and might be stressful. This ground rule also addressed expectations by predicting elevated stress. It was believed that anticipation of stress would allow participants to prepare for this with the suggestion of possible control of emotions as a positive 35

36 Ground Rule C It was stated that the purpose of the series was to give information that was understandable but that everyone's questions would not necessarily be answered either because the answer was not available or perhaps because the answer was not yet 36

37 Ground Rule C cont. Ground rule C was based on the assumption that unwarranted expectation of certainty would lead to disappointment and distrust whereas an expectation of incomplete knowledge would prepare participants more realistically for what they would 37

38 Structure & Content of the Course

39 TMI Health and Environmental Series Content The series was divided into three segments to address three areas of interest expressed by area residents. Each segment was divided into several individual sessions addressing different aspects of the topic. Basic explanations of relevant concepts and general issues were presented earlier in sequence. Topics and questions relevant to TMI specifically were presented in the middle or towards the end of each 39

40 TMI Health & Environmental Information Series: Content Session 1: Series Overview "Introduction to Health effects and radiation epidemiology. Speakers: Dr. K. C. Morgan, Dr. Sandra Prince-Embury Session 2: "Radiation in the environment, basic concepts, definitions and findings." Speakers: Arthur Sokolow, Director of the Pennsylvania Bureau of Topographical and Geological Survey; Dr. Paul Todd, Professor of Biophysics at Penn 40

41 TMI Series Content (cont.) Session 3: "Three Mile Island Accident Dose Assessment: Dr. Jan Beyea, Senior Staff Scientist of the National Audubon Society. Session 4: "Radiation monitoring, basic concepts, methods and understanding results." Dr. Ruth Patrick of the Academy of Natural Sciences. Session 5: "Overview of Health Effects of Radiation. Dr. Daniel Hoffman, Senior Epidemiologist of the National Cancer 41

42 TMI Series Content cont. Session 6: "Cancer, basic concepts and relationship to immunological functioning." Dr. John W. Kreider, Professor of Pathology and Microbiology At Penn State College of Medicine. Session 7: "Radiation related cancer and treatment." Dr. Robert L. Comis, Chairman of Medical oncology at the Fox Chase Cancer Center. Session 8: "Stress and immunological functioning the Three Mile Island area. Dr. Andrew Baum, Health Psychologist, Uniformed Services, University of Health 42

43 TMI Series Content cont. Session 9: "Local facilities for cancer early detection and treatment. Dr. Andrea Manni, Division of Endocrinology, Penn State College of Medicine, Christine Wilson, Fox Chase Session 10: "Overview of basic concepts of epidemiology and application in the community. Dr. Vilma R. Hunt, Professor of Environmental Health at Penn State. Session 11: "Health Findings in the Three Mile Island Area and ongoing studies. Dr. John Cobb, Dr. Maureen Hatch of the Department of Epidemiology at Columbia 43

44 TMI Series Content cont. Session 12: "Community/Expert Collaboration in the Assessment of Health Effects." Dr. Marvin S. Legator, Professor of Environmental Toxicology at University of 44

45 Series Attendance Total attendance of the series was 278, this represented repeated attendance by some of a group of 117 distinct individuals who attended the series one or more times. Average attendance of the twelve sessions in the TMI series was slightly over 47 persons per session. Attendance ranged from a high of 80 persons at session three which addressed dose assessments of radiation released at the time of the TMI accident, to a low of 12 persons at session ten addressing basic concepts of epidemiology and application in the 45

46 Series Attendees Seventy-one percent of participants had lived in the Middletown area at the time of the accident, 36% had evacuated at that time, 35% had not; 51% were male, 49% were females; 62% were parents, 38% were not; 49.8% reported some college or more. The average age of course participants was 41 46

47 Series Attendees Professions Course attendees represented a variety of professional and educational backgrounds including homemakers (12%), teachers (12%), nurses (4%), engineers and environmental scientist (10%), pipe fitters and laborers (5%), lobbyist (1%), activists (10%); retired individuals (8%), employees of the U.S. Environmental Protection Agency, the U.S. Nuclear Regulatory Commission, and the Pennsylvania State Health Department (5%), mental health professionals (4%), students (6%), clerical/sales (10%), and (13%) occupation unaccounted 47

48 Series attendees compared to Middletown representative sample Course participants as a group were not representative of the general population in the area. They were younger, better educated, reported less worry about TMI issues and reported slightly less faith in experts than a normative sample of TMI area residents. (See Prince-Embury, 1991 for a discussion of these differences). Prince-Embury, S. (1991). Information seekers in the aftermath of technological disaster. Journal of Applied Social Psychology, 21, 7, 48

49 Attendee Response Open-ended questionnaires were distributed to participants to allow them to record their responses. In addition, selfreported assessment of information attributes as perceived by participants was conducted in each session (Prince- Embury, 1992). Participation was voluntary. Therefore findings are offered as suggestive rather than conclusive. Prince-Embury, S. (1992). Information attributes as related to psychological symptoms and perceived control among information seekers in the aftermath of technological disaster. Journal of Applied Social Psychology, 22, 14, 49

50 Self-Reported Information Attributes Understandability Assessment of information attributes revealed that participant mean self-reported understandability was (.98) on a scale of zero to one. However, it is important to note that increased understandability reported by course participants was not synonymous with answered questions and increased certainty. Seventy-five percent of respondents to open-ended surveys reported that they still had unanswered questions about radiation. Also self-reported degree that questions had been answered in each session was (.76) on a scale of zero to 50

51 Credibility/Reliability of information Presented Subjective experience of reliability of information received the second highest rating (.82) on a scale of zero to one. Regarding credibility of information, comments made by some community participants reflected an increased appreciation for "the other side" for experts who were investigating unanswered questions. (Notable in an extremely polarized 51

52 Impact of TMI Information Series on Stress Findings suggest that the average level of stress did not increase across the duration of the Series, across all participants of all sessions or considering only repeat attendees. Also, self-reported understanding was slightly related to a lower level of psychological symptoms (Prince-Embury, 1992), suggesting that the experience of greater understanding is related to lower levels of psychological 52

53 What Current Risk Communication Experts 53

54 Fischhoff, B. (2011). Communicating about the risks of terrorism (or anything else). American Psychologist, 66(6), The importance of communicating accurately about risks was persuasively expressed by Baruch Fischhoff in the Special Issue of the American Psychologist titled 9/11: ten years later (Fischhoff, 2011). Psychological Research has essential roles to play in identifying the public s information needs, designing responsive communications and evaluating their success. Fulfilling these roles requires policies that treat two-way communication as central.(p.520). Fischhoff warns against obstacles to this pursuit such as underestimating the public s ability to learn and make decisions, a tendency seen in the myth of panic and popular accounts of human 54

55 Fischhoff, B. (2011). Communicating about the risks of terrorism (or anything else). American Psychologist, 66(6), In his article Fischhoff identifies steps to be taken in creating communications about risks of terror (or anything else). Some of these steps may be summarized as follows. Identify the information most relevant to helping audience members make decisions. Identify subject matter experts, who can ensure fidelity to the best available technological knowledge. Draft communications in precise and comprehensive form. Assure the maintenance of respectful, two-way communications 55

56 References: Three Mile Island Health & Environmental Information Series Prince-Embury, S. (2013). Community-Level Resiliency Intervention in a post-disaster Environment: The Three Mile Island Health and Environmental Information Series: Theoretical Assumptions, Implementation. In Prince-Embury, S. and Saklofske, D. (Eds.) Translating Resilience Theory for Assessment and Application with Children, Adolescents and Adults. New York: Springer. Prince-Embury, S., & Rooney, J. F. (1995). Psychological adaptation of residents following restart of Three Mile Island. Journal of Traumatic Stress, 8(1), Prince-Embury, S. (1992). Information attributes as related to psychological symptoms and perceived control among information seekers in the aftermath of technological disaster. Journal of Applied Social Psychology, 22(14), Prince-Embury, S. (1992). Psychological symptoms as related to cognitive appraisals and demographic differences among information seekers in the aftermath of technological disaster at Three Mile Island. Journal of Applied Social Psychology, 22(1), Prince-Embury, S. (1991). Information seekers in the aftermath of technological disaster at Three Mile Island. Journal of Applied Social Psychology, 21(7),

57 References: Psychological Reaction in the Aftermath of Three Mile Island Prince-Embury, S., & Rooney, J. F. (1995). Psychological adaptation of residents following restart of Three Mile Island. Journal of Traumatic Stress, 8(1), Prince-Embury, S., & Rooney, J. F. (1994). Life stage differences in resident coping with restart of the Three Mile Island nuclear generating facility. In Wayne Lesko (Ed.), Readings in social psychology: General, classic, and contemporary selections (2nd ed.). Needham Heights, MA: Allyn & Bacon. Prince-Embury, S., & Rooney, J. F. (1989). A comparison of residents who moved versus those who remained prior to restart of Three Mile Island. Journal of Applied Social Psychology, 19, 11. Prince-Embury, S., & Rooney, J. F. (1988). Psychological symptoms of residents in the aftermath of the Three Mile Island nuclear accident. Journal of Social Psychology, 128(6), Prince-Embury, S., & Rooney, J. F. (1987). Interest in information as a function of worry and perceived control in the aftermath of nuclear disaster. International Quarterly of Community Health Education, 8(1), Prince-Embury, S., & Rooney, J. F. (1987). Perception of control and loss of faith in experts among residents in the vicinity of Three Mile Island. Journal of Applied Social Psychology, 17, 57

58 Contact information: Sandra Prince-Embury, Ph.D. Resiliency Institute of Allenhurst West Allenhurst, N.J Phone: