The 2011 Japanese earthquake: an overview of environmental health impacts.
On March 11, 2011, at 2:46:23 p.m., a magnitude (M) 9.0 earthquake occurred approximately 130 km off the east coast of Japan (U.S. Geological Survey [USGS], 2011). The earthquake, known as the Tohoku event, was the fourth-largest recorded since the advent of modern seismometry more than 100 years ago. The energy release was equivalent to an M 9.4 event including the subsequent faulting in the following 25 minutes (Ishii, 2011). Along with severe shaking of the island nation, the earthquake triggered a tsunami affecting the entire Pacific rim. The northeast coast of Japan, the region closest to the epicenter and facing the tsunami propagation direction, suffered the most devastating effects with a wall of water exceeding a height of 10 m in places. In areas of subdued topography, the tsunami raced several kilometers inland before receding, as evidenced by the moderate resolution imaging spectroradiometer (MODIS) satellite images (National Aeronautics and Space Administration, 2011) (Figure 1).
The impact of the tsunami is readily apparent from the extent of deposited silts and sands that reached several kilometers inland, over almost all the populated regions in the images. Standing water and extensive sediments are seen throughout both cities in the bottom image (Figure 1). Many hundreds of aftershocks, ranging into the mid 7s in magnitude, have occurred and will continue to occur over the better part of the coming year, underscoring the instability of the situation. The purpose of this article is to provide an overview of the spectrum of the natural disaster and its environmental health impact to the human population.
As the Earth is a dynamic planet, the health and well-being of human society have always been susceptible to impacts from natural events. Earthquakes in particular have a long history of significantly impacting societies through direct effects of building collapse and infrastructure damage due to ground shaking and subsequent disasters such as fires and tsunamis. Earthquakes occur wherever stresses build up in the Earth's crust beyond its elastic breaking point (Stein & Wysession, 2003). Stresses build relatively quickly (thereby inducing earthquakes) at tectonic boundaries where two or more plates come in contact with one another. For example, the San Andreas fault in California delineates where the Pacific and North American plates slide against one another. In addition to sliding against each other, a plate also may be pushed beneath its neighbor in a process known as subduction (Figure 2). Many populous regions including much of China, Japan, the Mediterranean, the Caribbean, Indonesia, South America, and western North America including the San Andreas fault in California are near plate boundaries (DeMets, Gordon, & Argus, 2010) and thus prone to significant seismic risk.
Because this article is meant to illuminate a recent event, fewer scientific sources could be used as references than we would normally prefer. Moving forward, more in-depth scientific analyses of the environmental health significance and impact of the Tohoku event will undoubtedly occur. Many of these future analyses and findings are likely to confirm or challenge the information presented here.
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Geological Setting of Earthquake and Tsunami
The country of Japan sits at the junction of several converging tectonic plates (Figure 3). Notably, the Pacific plate subducts below (is pushed underneath) northern Honshu along the Japan trench at a rate of 93 mm/yr., while the Philippine plate subducts beneath southern Honshu along the Nankai trough at a rate of 58 mm/yr. (DeMets et al., 2010). As the plates subduct they tend to lock with the overriding plate, thereby building up tectonic strain. When the strain becomes larger than the strength of the locked fault surface, the fault causes an earthquake. The magnitude of the event depends on both the area of the strain and the amount of slip along the interface. The M 9.0 Tohoku event occurred along the Pacific plate. The fault rupture area was nearly 400 km long and 150 km wide (Ishii, 2011; USGS, 2011) with slip as great as 32 m (Geospatial Information Authority of Japan, 2011). A portion of the northeastern Honshu permanently shifted more than 4 m eastward and dropped three-quarters of a meter downwards (Geospatial Information Authority of Japan, 2011).
The Tohoku earthquake was felt around the world, and three traces of a seismogram recorded at Southern Illinois University in Carbondale, Illinois, show ground movement in three perpendicular directions (Figure 4). Four distinct arrivals can be observed: Direct P and S along with Love and Rayleigh surface waves. The spacing in time arises from the waves traveling at different speeds. All waves hit Japan within a minute. The extended-duration, large-amplitude shaking arose from the surface waves (Figure 4).
Because shallow subduction occurs along deep ocean trenches and entails a significant amount of vertical motion, a resulting earthquake can transmit energy efficiently into the water column above, leading to a tsunami. In the open ocean, a tsunami travels at a speed of roughly 800 km/hr. with an amplitude of less than a meter. As the wave enters shallow water, however, the increased drag on the seafloor slows the wave and amplifies crest height, potentially reaching tens of meters in height (Stein & Wysession, 2003).
Infrastructural and Environmental Impact
The country of Japan has a long history of deadly earthquakes and their effects (e.g., tsunamis and fires) and has spent considerable resources over the last several decades in advancing engineering and safety given the earthquake danger. In the face of the Tohoku event, notable successes are visible in these efforts, such as tsunami warnings and infrastructure that did not lend itself to widespread fires. Without either protection in place, the numbers of deaths and degree of damage would undoubtedly have been far higher, such as the 1923 M 7.9 Kanto earthquake that killed well over 100,000 people and left much of Tokyo in ashes and ruin (De Boer & Sanders, 2005).
Despite these advances, extensive damage occurred to infrastructure from the Tohoku event, with impacts to human health both immediately and into the foreseeable future. As of May 12, 2011, the death toll stood at 14,998 with an additional 9,761 people still missing (Japan National Police Agency, 2011). The number of homeless is estimated in the hundreds of thousands (Showstack, 2011), with over 163,000 people living in temporary shelters as a result of evacuations following the disasters (Reuters, 2011a). More than 46,000 buildings were damaged or destroyed (Reuters, 2011a).
Damage to roads and railroad lines disrupted relief efforts; shelters lacked adequate food and water for several days (Magnier & Demick, 2011; National Public Radio, 2011). Three weeks after the earthquake, high-speed rail service had been restored to all but two lines (Fountain, 2011) but train service continued to be affected by rolling electrical blackouts (White, 2011). Airports were closed immediately following the quake although all but the airport in Sendai reopened within a few days. The Sendai airport was impacted by the tsunami and after four weeks was able to partially reopen to commercial traffic (Fackler, 2011). In addition, all major ports were closed right after earthquake; 15 ports in the immediate disaster area remained closed while the rest of the nation's ports reopened within several days (Manila Bulletin Publishing Corporation, 2011). As of May 6, 2011, the remaining ports were provisionally functional although some were still limited to emergency aid transports (Inchcape Shipping Services, 2011).
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Communication largely remained intact; phone and Internet services were only briefly interrupted. Within hours, people in affected areas were able to use technology to communicate with people in unaffected areas (Vijayan, 2011).
The earthquake and tsunami also affected water service. One irrigation dam failed as a result of the earthquake, and six more had shallow cracks on their crests (Chinese National Committee on Large Dams, 2011). The Japanese Ministry of Land, Infrastructure, Transport and Tourism reported that about 50 sewage treatment plants had been damaged. No count has been given of the number of drinking water systems affected (Jaffe, 2011), although some estimates of the number of people that may have been without drinking water run as high as one million (Showstack, 2011).
Electrical service was interrupted, and electrical shortages including rolling blackouts were still occurring more than three weeks after the earthquake. Electrical shortages were exacerbated by the fact that Japan does not have a unified national electrical power grid and uses 50-hertz and 60-hertz systems that are incompatible (Williams, 2011). Electrical production was also disrupted due to damage to numerous nuclear reactors.
A new concern not encountered in previous events in Japan or elsewhere following an earthquake is severe damage to nuclear power plants that could result in deleterious health effects from the release of radiation into the atmosphere, hydrologic cycle, or soils. Fifteen nuclear power plants underwent emergency procedures during the earthquake, with four remaining closed for an extended period of time (Reuters, 2011b). All plants withstood the initial shaking and were able to successfully insert control rods into the core to halt uranium fission. Problems at two of the power plants soon developed, however. The most worrisome problem was that reactors at the Fukushima-Daiichi power plant were impacted by the tsunami. When the 14-meter waves topped a sea wall designed to withstand only a 5.7 m tsunami, the entire plant was flooded (Cyranoski, 2011). The flooding irreparably damaged the diesel backup generators that supply coolant (fresh water) during emergencies. Without a continual supply of fresh coolant, the decay of nonuranium products that have built up in the system will boil off the coolant water and eventually heat the fuel pellets past their melting point, causing a meltdown. Coolant is always needed in nuclear reactors because fission occurs spontaneously even when control rods are inserted and the reactor is shut off, causing heat to build up in the cladding, fuel, and the reactor core. If uncontrolled, the heat can lead to explosions (Shults & Faw, 2008). Following explosions at the plant, an area of 20 km surrounding the plant was placed under mandatory evacuation, and an additional area up to 30 km surrounding the plant was designated a voluntary evacuation area; these evacuation areas are much smaller than the United States' recommended 80 km evacuation zone (BBC News, 2011a).
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The International Atomic Energy Agency (IAEA) has established a measurement tool, the International Nuclear and Radiological Event Scale (INES), to rank the safety significance of release of radioisotopes from various incidents. The scale ranges from 0 (no safety impact) to 7 (highly dangerous). The level 7 criteria indicate "widespread health and environmental effects [and] external release of a significant fraction of reactor core inventory (International Atomic Energy Agency [IAEA], 2008)." Event ratings at the Fukushima-Daiichi plant originally were computed for individual reactors, rating them as 5, but on April 12, 2011, the disaster was upgraded to 7 because the accidents were considered as a single event (IAEA, 2011a). The same rating of 7 was given to the nuclear disaster at Chernobyl, Russia, in 1986. Reasons for the upgrade include the fact that the Japanese Nuclear and Industrial Safety Agency and the Japan Nuclear Safety Organization indicated the following:
The value representing radiation impact, which is converted to the amount equivalent to Iodine-131, exceeds several tens of thousands of tera-becquerels (of the order of magnitude as [10.sup.16] Bq) ... [and] ... this results in the value corresponding to Level 7 of INES rating (Ministry of Economy, Trade, and Industry, 2011).
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Although the Fukushima accident has the same rating as the Chernobyl accident, "the amount of discharged radioactive materials is approximately 10% of the Chernobyl accident (Ministry of Economy, Trade, and Industry, 2011)."
Evidence indicates that damaged fuel rods, either spent rods in cooling ponds or rods in the core of one or more of the reactors, have been the source of environmental contamination by radioactive isotopes of iodine and cesium. Radioactive material was released into the air and water, with about 11,500 tons of radioactive water released into the ocean on April 4, 2011 (IAEA, 2011b), raising global concerns about possible contamination of fish and other sea life.
Environmental Health Impacts
The Tohoku disaster has relevance in each of the 11 core areas of environmental health identified by Ratnapradipa and co-authors (2011): air quality, water quality, weather/ climate change, food safety, healthy housing, waste/sanitation, infectious disease/vector control, radiation, injury prevention, emergency preparedness, and toxicology. This disaster highlights how many of these core areas overlap and interconnect.
Although widespread fires did not occur following the earthquake, localized areas burned for days, such as the fishing village of Kesennuma (Russian Television, 2011). Because no widespread fires followed the earthquake, the impact on air quality was largely limited to particulate from rubble immediately following the earthquake and radioactive fallout from the explosions and emissions at the nuclear reactors.
As previously stated, sewage treatment facilities were damaged by the earthquake and tsunami, and hundreds of thousands of people were immediately without adequate safe drinking water. Damage and destruction of water treatment and sewage systems increase the likelihood of outbreaks of cholera and typhoid, although outbreaks are less likely to occur in developed countries. Outbreaks of gastrointestinal illnesses are more likely among crowded survivors in temporary shelters. The National Travel Health Network and Centre of Britain's April 7, 2011, clinical update advised people traveling to Japan that the "... flooding, stagnant water, and contamination of water supply are conducive to development of diseases such as salmonellosis, Campylobacter infection, shigellosis, hepatitis A and E, and intestinal parasites including Giardia and Cryptosporidium (National Travel Health Network and Centre, 2011)." In addition, traces of radioactivity were detected in drinking water in several prefectures, including Tokyo (Hur, 2011; IAEA, 2011c).
The unusually cold weather at the time of the earthquake brought heavy snows to some affected areas and added to the difficulties faced by survivors, as many were homeless or in emergency shelters immediately following the Tohoku event. Without electricity, many were without heat.
Food shortages in affected areas were a great concern immediately following the disaster. Failure of electrical service resulted in large amounts of rotting food in warehouses (Makinen, 2011), and damage to transportation routes meant that food delivery was difficult immediately following the disaster. The largest continuing food safety concerns relate to radiological contamination of both land and sea. Radiation levels exceeding legal limits were found in milk and certain vegetables (notably leafy greens such as spinach) in areas as far away as 120 km from the Fukushima plant (Hur, 2011; IAEA, 2011d; Olsen & McDonald, 2011).
Fish consumption in Japan is expected to drop for the next several months due to a combination of factors. Prior to these disasters, Japan was second only to China in per capita consumption of fish (Zabarenko, 2011). Japan's fishing industry was heavily impacted by the tsunami. Several fishing villages were destroyed, thousands of coastal fishing vessels were lost, and shellfish and aquaculture sites and processing plants were destroyed (Ydstie, 2011), decreasing physical capacity to produce, harvest, and process seafood. In addition, human bodies were washed out to sea and unrecovered, which may have a psychological impact on fish consumption. Potential radioactive contamination of sea water is also a concern, given the contamination of seafood. Monitoring of fish indicated that elevated levels were being recorded in sand lance as early as April 4, 2011 (IAEA, 2011e). Not only did radioactive wastewater leak directly from the damaged reactor to the sea for several days (Brumfiel, 2011), but the immediate imperative to move coolant through the reactor resulted in deliberate dumping of 10,000 tons of radioactive wastewater into the ocean (Butler, 2011). The prevailing wind direction also carried airborne radioactive contamination out to sea. The contaminated seawater dumped into the ocean may lead to radioactive bioaccumulation in fish and shrimp, which if eaten by local residents, may lead to increased human radiation exposure (Friis, 2007).
The tsunami completely engulfed large areas of coastline. Some villages were completely destroyed and many homes were damaged. Homes that withstood the tsunami waves will be faced with issues typical of flooding, including structural damage, mold and mildew growth, removal of contaminated mud and dirt, and seawater-specific issues such as groundwater well contamination. In addition, many homes that were undamaged by the earthquake and tsunami are within the radiological evacuation zone and are therefore uninhabitable at present. It may be necessary to pass emergency laws allowing demolition crews to knock down homes and structures thought to be too damaged to repair, without first contacting the property owner (Makinen, 2011). Estimates for rebuilding have been as much as $310 billion (BBC News, 2011b).
The Japanese traditionally cremate their dead, but with damage to crematoria, impassible roads, and electrical outages, the cremation of more than 12,000 bodies, perhaps even twice that number, cannot occur immediately. Instead, human remains have been temporarily placed in mass graves, with the intention to eventually exhume and cremate them. This may take up to several years (Russian Television, 2011).
Disposal of the debris from the earthquake and the tsunami is very problematic. Much of it is contaminated with mud and dirt, which may carry harmful bacteria or be tainted with PCBs or asbestos. As the piles of debris begin to dry, asbestos may become airborne (Makinen, 2011). Decaying waste may also lead to increases in insects and other pests, further threatening human health. Another concern is that the debris may ferment and ignite (Makinen, 2011). The sheer amount of waste resulting from the disaster, estimated at over 80 million tons, is a logistical problem that extends beyond the zones directly impacted due to the limited space for landfills (Makinen, 2011). Waste in Tokyo began to accumulate because incinerators were affected by the power supply problems (Makinen, 2011).
Infectious Disease/Vector Control
With evacuees concentrated in schools and other relief shelters, epidemics such as influenza pose a real threat. Rotting food in warehouses, mass graves, and decaying debris all increase the likelihood of insect and other pest infestations, which may serve as vectors for human disease.
Emergency personnel working to restore safety functions to the damaged nuclear reactors have had direct exposure to radiation. In response to the Fukushima disaster, the Japanese Health Ministry raised the legal limit of emergency radiation exposure for workers from 100 to 250 millisieverts (mSv) (Pinoy Global Online News, 2011). Two workers were exposed in excess of 200 mSv, with one receiving 240.8 mSv of radiation (Pinoy Global Online News, 2011). That dose is slightly below the 250-1000 mSv acute radiation sickness exposure level, in which some people suffer from nausea, loss of appetite, and bone marrow, spleen, and lymph damage (Sherer, Visconti, & Ritenour, 2006). It is important to note that exposure received by this individual was in minutes rather than years, which means that the human body has less time to repair acute cellular damage than when it receives chronic exposure (over a period of years) (Sherer et al., 2006). Acute exposure to high doses of radiation may diminish effective cellular repair mechanisms and may exacerbate somatic (in the person) and genetic (in their biological offspring) radiation effects (Sherer et al., 2006).
From a human health perspective, Iodine-131 is problematic because it is readily absorbed by the thyroid gland, which can lead to diminished function and tumor development (Arena, 1971; Eaton & Klaassen, 1996; Sherer et al., 2006). Cesium-137 is easily absorbed by the skeletal system, and with a half-life of 30 years, this isotope results in long-term, unwanted chronic exposure, which may lead to bone necrosis and cancer (Arena, 1971).
Although drowning due to the tsunami is responsible for most of the fatalities (Healy, 2011), many also died from physical trauma including head wounds and crushing wounds resulting from the earthquake and the tsunami. Building codes designed to withstand earthquakes undoubtedly prevented many more injuries and death from building collapse. For comparison, although the January 12, 2010, M 7.0 earthquake in Haiti was 1,000 times smaller than the Tohoku quake, over 230,000 people died in the Haiti quake, primarily from building collapse (Bilham, 2010).
Japan has done much as a nation to prepare for earthquakes and tsunamis with tsunami warning systems and building codes to promote safety during seismic events. Japan was seemingly unprepared, however, for the damage to nuclear reactors and the failure of emergency backup systems. This nuclear disaster largely overshadowed responses to address the immediate needs of individuals in the earthquake and tsunami areas, many of whom were still without adequate food, water, and shelter several days after the event.
As with many severe flooding situations, harmful substances released directly into the environment can cause large-scale contamination of water and land. Contaminants such as fuel products and pesticides are likely present in areas inundated by the tsunami flood waters (Centers for Disease Control and Prevention, 2005). The cardinal rules of toxicology involve the relationship between dose and response. If no exposure occurs, then dose is irrelevant, but if exposure does occur, dose is paramount in determining possible health effects and treatment for the exposed population (Eaton & Klaassen, 1996). Because population exposure has occurred in the Tohoku event, the problem regarding effective treatment and long-term population monitoring hinges on determining exact individual doses for everyone exposed to toxic substances and radiation both from the Tohoku event and the Fukushima-Daiichi nuclear power plant accident.
As with any environmental health concern, certain populations are more at risk for negative health consequences from environmental exposures than others. Radiological and toxicological exposures are assessed in terms of both the volume and duration of the exposure. Emergency workers are at risk for acute, high-volume doses, while those living in and around the evacuation zones are at risk for low-to-moderate volume over a prolonged period of time. Physical characteristics such as age are also risk factors. Pregnant women and infants are at higher risk than the general population due to the potentially negative developmental impact of higher concentrations entering smaller bodies. Likewise, the younger population is more at risk for chronic low-dose radiation exposure than the elderly.
The combined effects of the earthquake and tsunami that devastated the area of northeast Japan resulted in widespread infrastructure destruction, loss of life, and environmental contamination. Perhaps the longest-lasting impact of the Tohoku event will result from the damage to the nuclear power plants along the coast and the subsequent release of radioactive elements into the environment. The impacts were both immediate and local as they related to loss of life, injuries sustained during the disaster, displacement due to building damage, and food and water shortages. In addition, the disaster will continue to have long-term environmental impacts that extend beyond the immediate destruction zones, particularly as they relate to radiological and toxicological contamination. Environmental health professionals will have much to learn from the study of and response to this disaster.
Arena, V. (1971). Ionizing radiation and life: Laboratory experiences (pp. 161, 167). St. Louis, MO: C.V Mosby Company.
BBC News. (2011a). Japan nuclear: Workers evacuated as radiation soars. Retrieved May 9, 2011, from http://www.bbc.co.uk/news/ world-asia-pacific-12872707
BBC News. (2011b). Japan says quake rebuilding to cost as much as 25tn yen. Retrieved May 11, 2011, from http://www.bbc.co.uk/ news/business-12828181?print=true
Bilham, R. (2010). Lessons from the Haiti earthquake. Nature, 463, 878-879.
Brumfiel, G. (2011, April 5). Fukushima update: Radioactive isotopes spill into the sea. Nature Newsblog. Retrieved July 25, 2011, from http://blogs.nature.com/news/2011/04/ fukushima_update_radioactive_i_1.html
Butler, D. (2011, April 4). TEPCO forced to deliberately pollute ocean with radioisotopes. Nature Newsblog. Retrieved July 25, 2011, from http://blogs.nature.com/news/2011/ 04/fukushima_update_tepco_forced.html
Centers for Disease Control and Prevention. (2005). Tsunamis: Water quality. Retrieved June 28, 2011, from http://www.bt.cdc.gov/ disasters/tsunamis/waterquality.asp
Chinese National Committee on Large Dams. (2011). A quick report on Japanese dams after the earthquake. Retrieved April 3, 2011, from http://www.chincold.org.cn/dams/NewsEvents/ webinfo/2011/03/1299639147955756.htm
Cyranoski, D. (2011, March 29). Japan faces up to failure of its earthquake preparations. Nature News. Retrieved July 25, 2011, from http://www.nature.com/news/2011/110329/full/471556a.html
De Boer, J.Z., & Sanders, D.T. (2005). Earthquakes in human history. Princeton, NJ: Princeton University Press.
DeMets, C., Gordon, R.G., & Argus, D.F (2010). Geologically current plate motions. Geophysical Journal International, 181, 1-80.
Eaton, D.L., & Klaassen, C.D. (1996). Principles of toxicology. In C.D. Klaassen (Ed.), Casarett and Doull's toxicology: The basic science of poisons (pp. 15-24, 187, 787). New York, NY: McGraw-Hill.
Fackler, M. (2011, April 14). U.S. airmen quietly reopen wrecked airport in Japan. The New York Times, p. A6. Retrieved May 9, 2011, from http://www.nytimes.com/2011/04/14/world/asia/14sendai.html
Fountain, H. (2011, March 25). Extent of damage to Japan's infrastructure still unclear. The New York Times, p. A8. Retrieved May 9, 2011, from http://www.nytimes.com/2011/03/25/world/ asia/25infrastructure.html
Friis, R.H. (2007). Essentials of environmental health (p. 121). Sudbury, MA: Jones and Bartlett.
Geospatial Information Authority of Japan. (2011). The 2011 off the Pacific coast of Tohoku earthquake: Crustal deformation and fault model. Retrieved August 1, 2011, from http://www.gsi.go.jp/cais/ topic110421-index-e.html
Healy, M. (2011, March 13). Japan will face extraordinary health challenges after tsunami. Los Angeles Times. Retrieved May 11, 2011, from http://www.latimes.com/health/ la-he-japan-quakehealth-20110313,0,2408721.story
Hur, J. (2011, March 27). Food contamination set to rise as Japan fights radiation crisis at reactor. Bloomberg. Retrieved May 10, 2011, from http://www.bloomberg.com/news/2011-03-27/ food-contamination-set-to-rise-as-japan-fights- radiation-crisis-at-reactor.html
Inchcape Shipping Services. (2011). Japanese dry cargo ports and terminals report--Update 06 May, 2011. Retrieved May 9, 2011, from http://www.iss-shipping.com/NewsDetails.aspx?newsid=5462
International Atomic Energy Agency. (2008). INES: The international nuclear and radiological event scale (Factsheet 08-26941/E). Retrieved May 10, 2011, from http://www.iaea.org/Publications/ Factsheets/English/ines.pdf
International Atomic Energy Agency. (2011a). IAEA briefing on Fukushima nuclear accident. Fukushima nuclear accident update log. Retrieved May 10, 2011, from http://www.iaea.org/newscenter/ news/2011/fukushima120411.html
International Atomic Energy Agency. (2011b). Fukushima nuclear accident update. Fukushima nuclear accident update log. Retrieved May 10, 2011, from http://www.iaea.org/newscenter/news/2011/ fukushima050411.html
International Atomic Energy Agency. (2011c). IAEA briefing on Fukushima nuclear accident. Fukushima nuclear accident update log. Retrieved May 10, 2011, from http://www.iaea.org/newscenter/ news/2011/fukushima260311.html
International Atomic Energy Agency. (2011d). IAEA briefing on Fukushima nuclear emergency. Fukushima nuclear accident update log. Retrieved May 12, 2011, from http://www.iaea.org/newscenter/news/2011/fukushima190311.html
International Atomic Energy Agency. (2011e). IAEA briefing on Fukushima nuclear accident. Fukushima nuclear accident update log. Retrieved May 11, 2011, from http://www.iaea.org/newscenter/ news/2011/fukushima060411.html
Ishii, M. (2011). Preliminary rupture modeling of the March 11, 2011, Tohoku-Chiho Taiheiyo-Oki earthquake and sequence of events using the US Array Transportable Array. Retrieved April 5, 2011, from http://www.seismology.harvard.edu/research_japan.html
Jaffe, E. (2011, March 29). Assessing Japan's infrastructure damage will take time. The Infrastructurist. Retrieved May 9, 2011, from http://www.mfrastructurist.com/2011/03/29/assessing-japans- infrastructure-damage/
Japan National Police Agency. (2011). Damage situation and police countermeasures associated with 2011 Tohoku district--off the Pacific Ocean earthquake. Retrieved May 12, 2011, from http://www. npa.go.jp/archive/keibi/biki/higaijokyo_e.pdf
Magnier, M., & Demick, B. (2011, March 19). Japanese citizens decry lack of aid. Los Angeles Times. Retrieved May 9, 2011, from http://www.postandcourier.com/news/2011/mar/19/ citizens-decry-lack-of-aid/
Makinen, J. (2011, April 3). After Japan disaster, disposing of waste creates dilemmas. Los Angeles Times. Retrieved May 11, 2011, from http://www.latimes.com/news/nationworld/world/ la-fg-japan-trash-20110403,0,7628794,full.story
Manila Bulletin Publishing Corporation. (2011). Status of Japanese ports 5 days after devastating quake and tsunami. Retrieved May 9, 2011, from http://www.mb.com.ph/articles/309623/ status-japanese-ports-5-days-after-devastating-quake-and-tsunami
Ministry of Economy, Trade, and Industry. (2011). INES (the international nuclear and radiological event scale) rating on the events in Fukushima-Daiichi nuclear power station by the Tohoku District--off the Pacific Ocean earthquake (news release). Retrieved May 10, 2011, from http://www.nisa.meti.go.jp/english/files/en20110412-4.pdf
National Aeronautics and Space Administration. (2011). NASA/ GFSC, MODIS rapid response. Retrieved July 25, 2011, from http:// modis.gsfc.nasa.gov/
National Public Radio. (2011, March 14). Millions of stricken Japanese lack water, food, heat. Retrieved May 9, 2011, from http://www.npr.org/2011/03/18/134527591/millions-of-stricken japanese-lack-water-food-heat
National Travel Health Network and Centre. (2011). Advice for travel to areas of Japan affected by the earthquake and tsunami of 11 March 2011. Retrieved May 10, 2011, from http://www.nathnac. org/pro/clinical_updates/japanearthquake_150311.htm
Olsen, K., & McDonald, J. (2011, March 20). Japan finds more types of radiation-tainted food. The Huffington Post. Retrieved May 9, 2011, from http://www.huffingtonpost.com/2011/03/20/ japannuclear-radiation-food_n_838109.html
Pinoy Global Online News. (2011, May 1). NHK update: Fukushima-Daiichi nuclear power plant accident in Japan--May 1, 2011. Pinoy Global Online News. Retrieved May 11, 2011, from http://filamimage.com/blog/2011/05/01/nhk-update- fukushimadaiichi-nuclear-power-plant-accident-in-japan-%E2%80%93 may-1-2011/
Ratnapradipa, D., Brown, S., & Wodika, A. (2011). Modified Delphi technique to determine what the general public needs to know about environmental health. American Journal of Health Education, 42(1), 50-57.
Reuters. (2011a). Factbox: Japan's disaster in figures. Retrieved May 12, 2011, from http://www.reuters.com/article/2011/04/06/ us-factbox-japan-figures-idUSTRE73551020110406
Reuters. (2011b). TABLE--japan nuclear plant ops (Japan Atomic to conduct planned maintenance). Retrieved May 12, 2011, from http://www.reuters.com/article/2011/05/11/nuclear-japan- statusidUSL3E7G92B220110511
Russian Television. (2011, March 28). Japanese pay last respects to earthquake victims. Retrieved May 11, 2011, from http://rt.com/news/japanese-earthquake-dead-town/print/
Sherer, M.A.S., Visconti, P.J., & Ritenour, E.R. (2006). Radiation protection in medical radiography (pp. 117-119, 121-123, 129). St. Louis: Mosby-Elsevier.
Showstack, R. (2011). Scientists examine challenges and lessons from Japan's earthquake and tsunami. Eos, Transactions of the American Geophysical Union, 92(12), 97-99.
Shults, J.K., & Faw, R.E. (2008). Fundamentals of nuclear science and engineering (pp. 103-118). Boca Raton, FL: CRC Press. Stein, S., & Wysession, M. (2003). An introduction to seismology, earthquakes, and earth structure (pp. 99, 215). Malden, MA: Black well Publishing.
United States Geological Survey. (2011). Magnitude 9.0--Near the east coast of Honshu, Japan. Retrieved May 10, 2011, from http://earthquake.usgs.gov/earthquakes/eqinthenews/2011/ usc0001xgp/
Vijayan, J. (2011, March 13). Japan's Internet largely intact after earthquake, tsunami. Computer World. Retrieved May 9, 2011, from http://www.computerworld.com/s/article/print/9214358
White, S. (2011, April 5). Japanese companies react to tsunami disaster. Construction Week Online. Retrieved May 9, 2011, from http://www.constructionweekonline.com/article-11722- japanesecompanies-react-to-tsunami-disaster/1/print
Williams, M. (2011, March 18). A legacy from the 1800s leaves Tokyo facing blackouts. IT World. Retrieved May 9, 2011, from http://itworld.com/business/140626/legacy-1800s-leaves- Tokyofacing-blackouts
Ydstie, J. (2011, March 29). Japan's fishing industry crushed by tsunami. National Public Radio. Retrieved May 11, 2011, from http://www.npr.org/2011/03/29/134941845/japans- fishingindustry-crushed-by-tsunami
Zabarenko, D. (2011, March 28). U.S. experts: Significant water contamination in Japan. Reuters. Retrieved May 10, 2011, from http:// www.reuters.com/assets/print?aid=USTRE72R6AQ20110328
Dhitinut Ratnapradipa, PhD, MCHES
James Conder, PhD
Ami Ruffing, MS
Victor White, MS, CHES
Corresponding Author: Dhitinut Ratnapradipa, Assistant Professor, Department of Health Education and Recreation, Southern Illinois University, 475 Clocktower Drive, Pulliam Hall 307, Carbondale, IL 62901. Email: firstname.lastname@example.org.