Public opinions on community water fluoridation

Risk Communication in Public Health: Lessons from a Historic Fluoridation Debate in Saskatchewan

Effective risk communication is critical to gain public support when implementing population-level health interventions. Analysis of previous public health campaigns can provide guidance for future efforts. This case study examined a successful community water fluoridation campaign in Saskatoon, Canada, during 1953/54. The key strategies and messaging used by both sides of the debate were assessed using two publicly available historic data sources: documents in the city archives and newspaper coverage. The anti-fluoridation campaign approaches (e.g. misinformation, innuendo, half-truths and scare words, requesting a plebescite) were similar to those used elsewhere by this movement as described in the literature. Key features of the effective pro-fluoridation campaign included extensive community outreach, involvement of local experts, dissemination of supporting evidence while aggressively addressing misinformation, highlighting the support of relevant health organizations, and ensuring key messages received media coverage. This study illustrates how misinformation and public opposition has posed a challenge to public health efforts long before the advent of social media and highlights strategies, consistent with current risk communication principles, that have stood the test of time.

Surveying Dentists' Perceptions of Caregiver Refusal of Topical Fluoride

The objective of this study was to assess dentists' perceptions of caregiver topical fluoride refusal behaviors. We administered an 8-item survey in 2015 and 2016 ( N = 582) and asked dentists about the extent to which fluoride refusal is a problem, refusal trends, comfort talking to caregivers who refuse, and perceived reasons why caregivers refuse. To examine geographic variation, we ran χ² tests between dentists' location (US West vs. non-West) and the first 3 perception measures (α = 0.05). Nearly 80% of dentists believed fluoride refusal was a problem, and 42.3% believed it was a growing problem. A significantly larger proportion of dentists who saw fluoride refusal as a problem also believed refusal was a growing problem compared to those who thought refusal was not a problem (89.6% and 41.2%, respectively; P < 0.0001). Caregiver characteristics perceived to be associated with fluoride refusal included immunization refusal (41.3%), White race (37.6%), and high income (33.7%). Thirty-seven percent of surveyed dentists were uncomfortable talking to caregivers who refused. There were no geographic differences in perceptions of fluoride refusal as a problem ( P = 0.52). A significantly larger proportion of non-West dentists believed fluoride refusal has gotten worse (non-West: 65.5%, West: 41.2%; P < 0.0001), but more dentists from the West were uncomfortable talking to caregivers who refused (West: 86%, non-West: 67.4%; P < 0.0001). Caregiver refusal of topical fluoride may be a growing problem, and many dentists are uncomfortable talking to caregivers who refuse. Additional interdisciplinary research is needed to identify the reasons why caregivers refuse fluoride, which is an important next step in developing chairside interventions that address fluoride refusal behaviors. Knowledge Transfer Statement: The results of this study can be used by researchers to develop chairside strategies to help dentists identify and manage fluoride refusal behaviors in clinical settings. This could help preserve topical fluoride as an evidence-based preventive therapy and address a growing public health problem.

Community water fluoridation: attitudes and opinions from the New Zealand Oral Health Survey

OBJECTIVE

To report the responses of adult participants in the 2009 New Zealand Oral Health Survey (NZOHS) to questions about community water fluoridation (CWF).

METHODS

The study used quantitative data from the NZOHS. All adult participants aged 18 years and over in the nationally representative NZOHS sample were included in the study (n=3475). Univariate analysis and multinominal logistic regression models were used to examine the associations between variables.

RESULTS

Overall, 57.7% of respondents thought that there were dental benefits to adding fluoride to drinking water and 31.7% responded that they did not know. More than 45% of respondents did not know whether there were health risks from adding fluoride to drinking water. Overall, 42.0% of respondents were strongly or somewhat in favour of CWF.

CONCLUSION AND IMPLICATIONS

People in the Māori, Pacific and Asian ethnic groups, from the two most deprived quintiles, with no education after high school and who brushed their teeth less than twice a day expressed significantly greater uncertainty about CWF than other population groups. This study suggests further research is required to gain a greater understanding of health literacy about CWF and the cultural appropriateness of CWF in NZ.

Perceived safety and benefit of community water fluoridation: 2009 HealthStyles survey

OBJECTIVES

To describe perceived benefits and safety of community water fluoridation (CWF) and investigate factors associated with those perceptions of CWF among respondents to a proprietary survey in the United States.

METHODS

We obtained data from the 2009 HealthStyles survey, a convenience sample of 4,556 respondents. Pearson's chi-squared and logistic regression were used to determine the associations between certain socio-demographic factors and perceptions regarding the safety and health benefits of CWF.

RESULTS

The majority of respondents (55.3 percent) strongly agreed/agreed that CWF was safe, while 31.5 percent were neutral, and 13.2 percent disagreed/strongly disagreed. Twenty-seven percent of respondents reported CWF had no health benefit, 57.3 percent reported some benefit, and 15.5 percent reported great benefit. Perceived CWF safety and benefit in the bivariate analyses were associated with gender, age, race/ethnicity, education, marital status, income, sealant knowledge, CWF knowledge, past year dental utilization, and perceived vaccine safety. Respondents with knowledge of CWF (47.9 percent) were more likely to agree that it was safe (69.8 percent) than those who reported no knowledge (41.3 percent). Among respondents who said childhood vaccines were not safe (4.0 percent), almost half disagreed that CWF was safe. Logistic regression results indicated that perceived CWF safety and benefits increased with CWF knowledge, perceived vaccine safety, and income.

CONCLUSIONS

Although only a minority of the US population perceived CWF as unsafe or providing no benefit to health, perceptions regarding CWF varied by knowledge of CWF and socio-demographic factors. Oral health promotion activities should consider these differing perceptions of CWF among groups to tailor oral health messaging appropriately.

Risk perception, psychological heuristics and the water fluoridation controversy

OBJECTIVES

Increasingly, support for water fluoridation has come under attack. We seek an explanation, focusing on the case of Waterloo, Ontario, where a 2010 referendum overturned its water fluoridation program. In particular, we test whether individuals perceive the risks of water fluoridation based not on 'hard' scientific evidence but on heuristics and cultural norms.

METHODS

A sample of 376 residents in Waterloo were surveyed in June 2012 using random digit dialing. We use factor analysis, OLS regression, as well as t-tests to evaluate a survey experiment to test the credibility hypothesis.

RESULTS

Perceptions of fluoride as a risk are lower among those who perceive fluoride's benefits (B = .473, p &lt; 0.001) and those whose cultural view is 'egalitarian' (B = .156, p &lt; 0.05). The experiment shows a lower level of perception of fluoride's benefits among respondents who are told that water fluoridation is opposed by a national advocacy group (Group A) compared to those who are told that the government and the World Health Organization support fluoridation (Group B) (t = 1.6547, p &lt; 0.05), as well as compared to the control group (t = 1.8913, p &lt; 0.05). There is no difference between Group B and the control, possibly because people's already general support for fluoridation is less prone to change when told that other public organizations also support fluoridation.

CONCLUSION

Public health officials should take into account cultural norms and perceptions when individuals in a community appear to rise up against water fluoridation, with implications for other public health controversies.

Caregivers who refuse preventive care for their children: the relationship between immunization and topical fluoride refusal

OBJECTIVES

The aim of this study was to examine caregivers' refusal of preventive medical and dental care for children.

METHODS

Prevalence rates of topical fluoride refusal based on dental records and caregiver self-reports were estimated for children treated in 3 dental clinics in Washington State. A 60-item survey was administered to 1024 caregivers to evaluate the association between immunization and topical fluoride refusal. Modified Poisson regression models were used to estimate prevalence rate ratios (PRRs).

RESULTS

The prevalence of topical fluoride refusal was 4.9% according to dental records and 12.7% according to caregiver self-reports. The rate of immunization refusal was 27.4%. In the regression models, immunization refusal was significantly associated with topical fluoride refusal (dental record PRR = 1.61; 95% confidence interval [CI] = 1.32, 1.96; P < .001; caregiver self-report PRR = 6.20; 95% CI = 3.21, 11.98; P < .001). Caregivers younger than 35 years were significantly more likely than older caregivers to refuse both immunizations and topical fluoride (P < .05).

CONCLUSIONS

Caregiver refusal of immunizations is associated with topical fluoride refusal. Future research should identify the behavioral and social factors related to caregiver refusal of preventive care with the goal of developing multidisciplinary strategies to help caregivers make optimal preventive care decisions for children.

The dentist's role in promoting community water fluoridation: a call to action for dentists and educators

BACKGROUND AND OVERVIEW

Community water fluoridation is an important public health intervention that reduces oral health disparities and increases the health of the population. Promotion of its safety and effectiveness is critical to maintaining its widespread acceptance and ensuring its continued use. Dentists are a potentially important source of knowledge regarding the oral health benefits and safety of water fluoridation. However, few dentists regularly discuss fluorides, and water fluoridation in particular, with patients. The authors aim to describe and discuss the role and importance of dentists' promotion of public water fluoridation, barriers to dentists' involvement and some approaches that might influence dentists to promote water fluoridation more actively.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Ongoing promotion of fluoridation by dentists is a key factor in ensuring sustained municipal water fluoridation. However, current undergraduate dental curricula do not adequately prepare dentists for this role, and continuing dental education may be insufficient to change clinical practice. Although smoking-cessation literature can shed some light on how to proceed, changing dentists' practice behavior remains a largely unstudied topic. Dental associations are a key resource for dentists, providing information that can assist them in becoming advocates for water fluoridation.

Opinion of residents from the Gold Coast, Queensland, on community water fluoridation

OBJECTIVE

To investigate opinions and concerns of Gold Coast residents regarding fluoridation of community water supplies.

MATERIAL AND METHODS

Anonymous data were collected in four major shopping centers from approximately 500 Gold Coast residents.

RESULTS

Eighty-one percent of participants were aware of the addition of fluoride to the water supply. More than half obtained information on water fluoridation through the print and electronic media. Sixty percent of respondents supported water fluoridation. The majority preferred the public and/or health professionals to have made the decision on water fluoridation rather than the government. The percentage of residents supporting water fluoridation was lower than that found in other Queensland, Australian, and worldwide surveys. In this study, only age and the highest level of education attained were factors significantly related to levels of support for water fluoridation.

CONCLUSION

The Queensland Government's decision to implement water fluoridation without a referendum caused disquiet amongst some Gold Coast residents. Future public health initiatives therefore may be assisted by more consultation with, and involvement from, health professionals in the relevant fields. Public health campaigns may benefit more from interaction with the community in order to address their specific concerns.

Australian opinions on water fluoridation: do Queenslanders believe differently?

AIM

To test whether residents of Queensland differ from residents elsewhere in Australia with respect to support for water fluoridation.

METHODS

Questionnaire data were obtained from an Australia-wide sample of 517 adults. The study occurred in 2008, shortly after the state government mandated fluoridation across Queensland.

RESULTS

There were no significant differences in fluoridation support or in beliefs regarding the benefits and harms of fluoridation between Queensland and non-Queensland residents. However, respondents from Queensland were more resistant to changing their minds regarding their fluoridation stance, more distrusting of public health officials, and more supportive of decisions to introduce fluoridation being made by the people via a referendum. After controlling for potentially confounding variables, Queenslanders demonstrated significantly more support for water fluoridation than non-Queenslanders.

CONCLUSIONS

Perceived Queensland characteristics, which political scientists have used to explain aberrant political behavior or public policy, were not relevant to the longstanding pre-2009 disparity in water fluoridation coverage between Queensland and the rest of Australia. The findings of this investigation do not support the assumption that Queenslanders are more opposed to fluoridation than residents elsewhere in Australia.