This electronic thesis or dissertation has been downloaded from the King’s Research Portal at https://kclpure.kcl.ac.uk/portal/ Developing evidence-based risk communication strategies to promote protective health behaviours in nuclear emergencies Gauntlett, Louis Awarding institution: King's College London The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without proper acknowledgement. END USER LICENCE AGREEMENT Unless another licence is stated on the immediately following page this work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence. https://creativecommons.org/licenses/by-nc-nd/4.0/ You are free to copy, distribute and transmit the work Under the following conditions: Attribution: You must attribute the work in the manner specified by the author (but not in any way that suggests that they endorse you or your use of the work). 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Oct. 2021 Developing evidence-based risk communication strategies to promote protective health behaviours in nuclear emergencies Louis Gauntlett Thesis submitted for the degree of Doctor of Philosophy ___________________________________________________ Department of Psychological Medicine Institute of Psychiatry, Psychology and Neuroscience King’s College London 1 Abstract Catastrophic terror attacks, including the use of a nuclear device, are amongst the highest priority risks to the UK according to the 2017 National Risk Register. A nuclear attack could result in mass fatalities, contamination of people and buildings, widespread infrastructure damage, and interruption to the supply of essential goods (Cabinet Office, 2017i). Despite the severity of a nuclear incident, there are actions which members of the public can take to reduce the risk to themselves and others. These include preparedness actions, such as assembling an emergency supply kit (Taylor et al., 2011), and taking actions following a nuclear attack, such as sheltering-in-place (e.g. Florig & Fischhoff, 2007; Khripunov, 2010). To understand more about factors which influence engagement with pre-nuclear incident information, and to examine ways to overcome potential barriers, I conducted multi-phase, mixed methods research involving a systematic review of relevant literature, scenario-based focus groups and two surveys. In my systematic review I found preparedness for nuclear disasters to be low, though it is notable that nuclear-specific studies have focused on nuclear power plant disasters. Outcomes of these studies also show a mixed-picture of adherence to recommended countermeasures such as instructions to shelter-in-place or to evacuate. A wide range of preferences were expressed for pre-incident communications including for communicating source and for method of communications. Focus groups were split into groups of London residents and groups residing close to Hinkley Point nuclear plant. Little difference was found across all groups for factors such as perceived risk of a nuclear disaster (attack or radiation leak), nor was there a strong desire to receive pre- nuclear incident risk communications, unless an attack was known to be imminent. Notably, groups suggested that a nuclear risk communication campaign would be received poorly unless it was normalised in society, such as by being introduced slowly through institutions such as workplaces or schools. Groups also suggested that levels of trust in the source of information is not important if suggested countermeasures are felt to not be efficacious. My surveys were conducted with the UK public and with the Hawai’i public following the ballistic missile false alert that Hawai’i experienced in January 2018. Low levels of deliberate adherence to the missile alert recommendation to shelter was found in the Hawaiian public, though the timing of the warning meant that most were already at home and so remained there. I found preparedness of both UK and Hawai’i participants, in terms of owning 2 recommended items, to be higher than is suggested by previous literature; however, preparedness was for general disasters, not for nuclear disaster specifically. Individuals who felt nuclear disaster to be more likely to occur were more prepared but less likely to desire preparedness communications. There was also low belief in the efficacy of recommended countermeasures (such as sheltering). A critical finding of the Hawai’i-based survey, the only study of its kind to investigate preparedness with a population warned of an incoming nuclear attack, was the early warning confirmation sought. This need appeared to drive people to social media and friends and family. Insights such as this and others gained throughout this thesis are crucial for public health authorities in their preparedness and response planning. Overall, the outcomes of this thesis suggest that increased engagement with pre-incident communications can be achieved where messaging: primarily concerns preparedness, sheltering, radiation effects and, if appropriate, stable iodine; details actions that authorities would take in a disaster, including how food would be supplied to affected people; contains a range of actions for varying radiation-disaster situations; is clear in layout and recommended actions; is distributed via multiple methods; shows how recommended actions can be effective, achievable or reasonable; maintains honesty, including stating where there is uncertainty; includes how families can be protected if not together (such as advice around the collection of children from school) and how to communicate with loved ones and, is embedded in institutions such as schools and workplaces. To facilitate increased adherence with protective instructions in the event of a nuclear attack, messages should: provide adequate information (such as how long to shelter) to enable the public to undertake actions; inform the public as to whether food and water could be delivered to those who are sheltering and; use basic terminology. As catastrophes go, perhaps none are as unthinkable as nuclear attack. And yet, evidence shows that preparedness for such an event is essential. By implementing the measures discussed in this thesis, policy makers charged with communicating pre-nuclear incident preparedness messages to the public may more effectively get their information across. 3 Table of Contents Abstract .............................................................................................................................. 2 List of figures .................................................................................................................... 12 List of tables ..................................................................................................................... 14 Acknowledgements ........................................................................................................... 16 Abbreviations ................................................................................................................... 17 Publication status.............................................................................................................. 18 Chapter 1: Introduction ..................................................................................................... 19 1.1. Background ............................................................................................................ 19 1.1.1. Nuclear risk ............................................................................................................. 19 1.2. Nuclear Detonation .................................................................................................... 22 1.2.1. Nuclear power plant accidents ..................................................................................... 26 1.3. What can the public do in the immediate aftermath of a nuclear incident? .................. 28 1.3.1. Sheltering-in-place ........................................................................................................ 29 1.3.2. Evacuation ..................................................................................................................... 31 1.3.3. Secondary protective actions........................................................................................ 31 1.4. Preparedness ............................................................................................................. 31 1.4.1. Recommended preparedness actions .......................................................................... 32 1.4.2. What preparedness information is there in the UK? .................................................... 34 1.5. Nuclear preparedness in the UK .................................................................................. 34 1.5.1. Other attempts to change behaviour ........................................................................... 37 1.5.2. Need for improved public communication around radiation emergencies ................