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Allukian M, Carter-Pokras OD, Gooch BF, Horowitz AM, Iida H, Jacob M, Kleinman DV, Kumar J, Maas WR, Pollick H, Rozier RG. Science, Politics, and Communication: The Case of Community Water Fluoridation in the US. Ann Epidemiol 2017. [PMID: 28648551 DOI: 10.1016/j.annepidem.2017.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Community water fluoridation (CWF) and its effect in reducing the burden of dental caries (tooth decay) is considered one of the 10 public health achievements in the 20th century. In the U.S., three-quarters (74.4%) of people on community water supplies have optimally fluoridated water, and each year approximately 90 communities actively consider starting or discontinuing CWF. CWF exists within the policy environment and includes actions taken by local community councils, health and water boards, and groups; state legislatures and health departments; national regulatory and science agencies; independent science entities; and professional and nonprofit organizations. Epidemiologists have been in the forefront of CWF. Experience with the past 70 years reveals that the coming decades will bring additional questions, recommendations, and challenges for CWF. The continued involvement of epidemiologists as part of multidisciplinary teams is needed in research, surveillance, peer review of studies, assessment of systematic review findings, and in the translation and communication of science findings to audiences with limited science/health literacy. This chapter's purpose is to 1) examine how epidemiologic evidence regarding CWF has been translated into practice and policy, 2) examine how recommendations for and challenges to CWF have affected epidemiologic research and community decision-making, and 3) identify lessons learned for epidemiologists.
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Affiliation(s)
- Myron Allukian
- President, Massachusetts Coalition for Oral Health, Boston, MA
| | - Olivia D Carter-Pokras
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD
| | | | - Alice M Horowitz
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD
| | - Hiroko Iida
- New York State Oral Health Center of Excellence, Rochester, NY
| | - Matt Jacob
- Children's Dental Health Project, Washington, DC
| | - Dushanka V Kleinman
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD.
| | - Jayanth Kumar
- Oral Health Program, California Department of Public Health, Sacramento, CA
| | - William R Maas
- University of Maryland School of Dentistry, Baltimore, MD
| | - Howard Pollick
- Department of Preventive & Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, CA
| | - R Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
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Rebhun RB, Kass PH, Kent MS, Watson KD, Withers SS, Culp WTN, King AM. Evaluation of optimal water fluoridation on the incidence and skeletal distribution of naturally arising osteosarcoma in pet dogs. Vet Comp Oncol 2016; 15:441-449. [PMID: 26762869 DOI: 10.1111/vco.12188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/25/2015] [Accepted: 09/13/2015] [Indexed: 12/13/2022]
Abstract
Experimental toxicological studies in laboratory animals and epidemiological human studies have reported a possible association between water fluoridation and osteosarcoma (OSA). To further explore this possibility, a case-control study of individual dogs evaluated by the UC Davis Veterinary Medical Teaching Hospital was conducted using ecologic data on water fluoridation based on the owner's residence. The case group included 161 dogs with OSA diagnosed between 2008-2012. Two cancer control groups included dogs diagnosed with lymphoma (LSA) or hemangiosarcoma (HSA) during the same period (n = 134 and n = 145, respectively). Dogs with OSA were not significantly more likely to live in an area with optimized fluoride in the water than dogs with LSA or HSA. Additional analyses within OSA patients also revealed no significant differences in age, or skeletal distribution of OSA cases relative to fluoride status. Taken together, these analyses do not support the hypothesis that optimal fluoridation of drinking water contributes to naturally occurring OSA in dogs.
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Affiliation(s)
- R B Rebhun
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - P H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - M S Kent
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - K D Watson
- UC Davis School of Veterinary Medicine, William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA, USA
| | - S S Withers
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - W T N Culp
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - A M King
- Department of Civil and Environmental Engineering, University of California-Davis, Davis, CA, USA
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9
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Blakey K, Feltbower RG, Parslow RC, James PW, Gómez Pozo B, Stiller C, Vincent TJ, Norman P, McKinney PA, Murphy MF, Craft AW, McNally RJQ. Is fluoride a risk factor for bone cancer? Small area analysis of osteosarcoma and Ewing sarcoma diagnosed among 0-49-year-olds in Great Britain, 1980-2005. Int J Epidemiol 2014; 43:224-34. [PMID: 24425828 PMCID: PMC3937980 DOI: 10.1093/ije/dyt259] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Artificial fluoridation of drinking water to improve dental health has long been a topic of controversy. Opponents of this public health measure have cited the possibility of bone cancer induction. The study objective was to examine whether increased risk of primary bone cancer was associated with living in areas with higher concentrations of fluoride in drinking water. METHODS Case data on osteosarcoma and Ewing sarcoma, diagnosed at ages 0-49 years in Great Britain (GB) (defined here as England, Scotland and Wales) during the period 1980-2005, were obtained from population-based cancer registries. Data on fluoride levels in drinking water in England and Wales were accessed through regional water companies and the Drinking Water Inspectorate. Scottish Water provided data for Scotland. Negative binomial regression was used to examine the relationship between incidence rates and level of fluoride in drinking water at small area level. RESULTS The study analysed 2566 osteosarcoma and 1650 Ewing sarcoma cases. There was no evidence of an association between osteosarcoma risk and fluoride in drinking water [relative risk (RR) per one part per million increase in the level of fluoride = 1·001; 90% confidence interval (CI) 0·871, 1·151] and similarly there was no association for Ewing sarcoma (RR = 0·929; 90% CI 0·773, 1·115). CONCLUSIONS The findings from this study provide no evidence that higher levels of fluoride (whether natural or artificial) in drinking water in GB lead to greater risk of either osteosarcoma or Ewing sarcoma.
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Affiliation(s)
- Karen Blakey
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Richard G Feltbower
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Roger C Parslow
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Peter W James
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Basilio Gómez Pozo
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Charles Stiller
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Tim J Vincent
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Norman
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Patricia A McKinney
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Michael F Murphy
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Alan W Craft
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Richard JQ McNally
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK, Paediatric Epidemiology Group, University of Leeds, Leeds, UK, Clinical Management Unit of Preventive Medicine, Surveillance and Health Promotion, Granada-Metropolitan Primary Health Care District, Andalusian Health Service, Granada, Spain, Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK, School of Geography, University of Leeds, Leeds, UK and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
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