Subjective Physical Health and Health Related Behavior

Apart from psychological distress, it seems clear that the Chornobyl disaster caused considerable subjective physical health problems among the affected population. In the study by Havenaar et al. [15] described earlier, large differences were found between exposed and unexposed populations in subjective evaluations of overall health. In the exposed region, 74.5% of the population rated their physical health as ''moderate'' or ''poor'', in contrast to 56.5% in the unexposed region. These differences in subjective health could not be accounted for by differences in actual clinical health status as assessed with a standardized physical examination by a Dutch medical team with considerable diagnostic resources [18]. Subjects from the exposed region reported significantly more visits to doctors (OR 1.31; 95%CI 1.14-1.50) and a higher consumption of prescribed medications (OR 1.52; 95%CI 1.30-1.78). Cognitive variables, such as perception of risk and sense of control over the situation, appeared to be important explanatory factors for both the subjective health ratings and service utilization [19].

Several other authors have reported changes in health-related behavior following the Chornobyl accident. Allen and Rumyantseva [20] showed that adherence to safety advisories and ingested dose of radionuclides by villagers in the area was modified by psychological variables such as fatalism. Fatalistic attitudes and behaviors were observed most frequently among elderly people and among women. The authors believe the latter finding may reflect the fact that women are faced more directly with the need to compromise and accept local foods in the absence of alternatives.

A number of studies report on changes in reproductive behavior. Rachmatulin et al. [21] reported a 240% increase in induced abortions in factory workers in an area partly contaminated by fall-out from Chornobyl. Bertollini et al. [22] reported a reduction of births in Italy 9-12 months after the Chornobyl disaster, followed by a catch-up increase in the ensuing months. In some Italian regions, there was an increase of induced abortions in the first 3 months following the disaster. Lower pregnancy rates and a rise in the number of induced abortions in the year following the disaster were observed in the Scandinavian countries [23-25]. Although a direct link between these changes in reproduction behaviors and the accident remains speculative, Knudsen [23] concluded, on the basis of these data, that the fear of radiation from this disaster probably caused more fetal deaths than the released radioactivity itself.

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