scholarly journals Emulation of Community Water Fluoridation Coverage Across US Counties

2019 ◽  
Vol 5 (4) ◽  
pp. 376-384
Author(s):  
J.A. Curiel ◽  
A.E. Sanders ◽  
G.D. Slade
Keyword(s):  
United States ◽  
Health Literacy ◽  
Explanatory Power ◽  
The United States ◽  
County Level ◽  
Water Fluoridation ◽  
Community Water ◽  
Percentage Points ◽  
Us Counties ◽  
Community Water Fluoridation

Introduction: Expansion of community water fluoridation has stalled in the United States, leaving 115 million Americans without fluoridated drinking water. Objective: This study used spatial regression methods to assess contributions of supply-side factors (neighboring counties’ fluoridation coverage) and demand-side factors (health literacy, education, and population density of the local county) in predicting the extent of fluoridation in US counties. Methods: For this cross-sectional ecological analysis, data from the 2014 Water Fluoridation Reporting System for all 3,135 US counties were merged with sociodemographic data from the 2014 American Community Survey and county-level estimates of health literacy based on the National Association of Adult Literacy Survey. We employed multilevel geographically weighted autoregressive models to predict fluoridation coverage of each county as a function of fluoridation coverage of neighboring counties and local-county covariates: either health literacy or sociodemographic characteristics. Akaike’s Information Criterion was used to distinguish the better model in terms of explanatory power and parsimony. Results: In the best-fit model, an increase from the first to third quartile of neighboring counties’ fluoridation coverage was associated with an increase of 27.76 percentage points (95% confidence limits [CI] = 27.71, 27.81) in a local county’s fluoridation coverage, while an increase from the first to third quartile of local county’s health literacy was associated with an increase of 2.8 percentage points (95% CL = 2.68, 2.89). The results are consistent with a process of emulation, in which counties implement fluoridation based upon their population’s health literacy and the extent of fluoridation practiced in neighboring counties. Conclusion: These results suggest that demand for community water fluoridation will increase as health literacy increases within a county. Furthermore, when considering expansion of fluoridation, non-fluoridated communities can benefit from precedents from nearby communities that are fluoridated. Knowledge Transfer Statement: Expanded coverage of community water fluoridation has stalled in the United States. The economic theory of diffusion describes how, over time and space, policy enacted in one community can influence public opinion in a neighboring community. This study applies geospatial analysis of county-level data and the theory of policy diffusion to demonstrate that fluoridated counties can promote the implementation of community water fluoridation in their neighboring, non-fluoridated communities.

scholarly journals Community water fluoridation predicts increase in age-adjusted incidence and prevalence of diabetes in 22 states from 2005 and 2010

2016 ◽  
Vol 14 (5) ◽  
pp. 864-877 ◽  
Author(s):  
Kyle Fluegge
Keyword(s):  
Tap Water ◽  
Fluoride Concentration ◽  
The United States ◽  
Sensitivity Analyses ◽  
Diabetes Incidence ◽  
County Level ◽  
Water Fluoridation ◽  
Community Water ◽  
Added Water ◽  
Community Water Fluoridation

Community water fluoridation is considered a significant public health achievement of the 20th century. In this paper, the hypothesis that added water fluoridation has contributed to diabetes incidence and prevalence in the United States was investigated. Panel data from publicly available sources were used with population-averaged models to test the associations of added and natural fluoride on the outcomes at the county level in 22 states for the years 2005 and 2010. The findings suggest that a 1 mg increase in the county mean added fluoride significantly positively predicts a 0.23 per 1,000 person increase in age-adjusted diabetes incidence (P < 0.001), and a 0.17% increase in age-adjusted diabetes prevalence percent (P < 0.001), while natural fluoride concentration is significantly protective. For counties using fluorosilicic acid as the chemical additive, both outcomes were lower: by 0.45 per 1,000 persons (P < 0.001) and 0.33% (P < 0.001), respectively. These findings are adjusted for county-level and time-varying changes in per capita tap water consumption, poverty, year, population density, age-adjusted obesity and physical inactivity, and mean number of years since water fluoridation started. Sensitivity analyses revealed robust effects for both types of fluoride. Community water fluoridation is associated with epidemiological outcomes for diabetes.

scholarly journals Community water fluoridation perceptions and practice in the United States: challenges in governance and implementation

Water Policy ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 365-375 ◽  
Author(s):  
Thomas Walker ◽  
Lori Dickes ◽  
Elizabeth Crouch
Keyword(s):  
United States ◽  
Water System ◽  
The United States ◽  
Water Systems ◽  
Primary Objective ◽  
Water Fluoridation ◽  
Sample Mean ◽  
Community Water ◽  
Large Water ◽  
Community Water Fluoridation

Abstract The primary objective of this research is to reveal potential challenges in achieving the finalized water fluoridation recommendation made by the Federal Water Fluoridation Panel in the United States (U.S.) with data extracted from consumer confidence reports. A secondary objective is to understand community water system manager's perceptions of and ability to meet this new standard using a survey instrument. Mean fluoridation levels are above the recommended level. The confidence interval does not capture the nationally recommended 0.7 mg/L. The t-test revealed two statistically significant results: that the sample mean is not equal to 0.7 mg/L and that the sample mean is higher than 0.7 mg/L. Respondents felt engaged in the policy process, but preferred state over federal policymaking. There is evidence that the optimal fluoridation level may not have been reached by water systems and that some water systems are under-fluoridating, while others are over-fluoridating. Several large water systems and pockets across the U.S. are not practicing artificial water fluoridation which reduces the effectiveness of this policy. Regular engagement by states with water system managers and feedback from water management professionals could be encouraged to better understand local constraints in meeting the federal recommendation.

Costs And Savings Associated With Community Water Fluoridation In The United States

2016 ◽  
Vol 35 (12) ◽  
pp. 2224-2232 ◽  
Author(s):  
Joan O’Connell ◽  
Jennifer Rockell ◽  
Judith Ouellet ◽  
Scott L. Tomar ◽  
William Maas
Keyword(s):  
United States ◽  
The United States ◽  
Water Fluoridation ◽  
Community Water ◽  
Community Water Fluoridation

scholarly journals Referendum opposition to fluoridation and health literacy: a cross-sectional analysis conducted in three large US cities

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022580 ◽  
Author(s):  
John A Curiel ◽  
Gary D Slade ◽  
Thu-Mai L Christian ◽  
Sophia Lafferty-Hess ◽  
Thomas M Carsey ◽  
...  
Keyword(s):  
Health Literacy ◽  
Voter Turnout ◽  
San Antonio ◽  
Sociodemographic Characteristics ◽  
Water Fluoridation ◽  
Cross Sectional ◽  
Community Water ◽  
Literacy Scores ◽  
Community Water Fluoridation ◽  
Us Cities

ObjectiveTo explore health literacy as a marker of voter confusion in order to understand the basis for public opposition to community water fluoridation.DesignA cross-sectional study.SettingConducted in three large US cities of San Antonio, Texas (602 voting precincts); Wichita, Kansas (171 voting precincts); and Portland, Oregon (132 voting precincts). Precinct-level voting data were compiled from community water fluoridation referendums conducted in San Antonio in 2002, Wichita in 2012 and Portland in 2013.ParticipantsVoter turnout expressed as a percentage of registered voters was 38% in San Antonio (n=2 92 811), 47% in Wichita (n=129 199) and 38% in Portland (n=164 301).Main outcome measuresThe dependent variable was the percentage of votes in favour of fluoridating drinking water. Precinct-level voting data were mapped to precinct scores of health literacy, and to US Census and American Community Survey characteristics of race/ethnicity, age, income and educational attainment. Multilevel regression with post-stratification predicted the precinct mean health literacy scores, with weights generated from the National Association of Adult Literacy health literacy survey, with item response theory computed scoring for health literacy. Predictive models on voter support of community water fluoridation were compared using robust linear regression to determine how precinct-level characteristics influenced voter support in order to determine whether health literacy explained more variance in voting preference than sociodemographic characteristics.ResultsPrecinct-level health literacy was positively associated with voter turnout, although sociodemographic characteristics were better predictors of turnout. Approximately 60% of voters opposed community water fluoridation in Wichita and Portland, whereas in San Antonio, a small majority (53%) voted in favour of it. Models suggest that a one SD increase in health literacy scores predicted a 12 percentage point increase support for community water fluoridation.ConclusionEducational attainment and health literacy are modifiable characteristics associated with voting precincts' support for community water fluoridation.

scholarly journals Differential Effects of Intervention Timing on COVID-19 Spread in the United States

2020 ◽  
Author(s):  
Sen Pei ◽  
Sasikiran Kandula ◽  
Jeffrey Shaman
Keyword(s):  
United States ◽  
Disease Transmission ◽  
Metropolitan Areas ◽  
Human Mobility ◽  
The United States ◽  
Aggressive Response ◽  
Control Measures ◽  
County Level ◽  
Social Distancing ◽  
Us Counties

Assessing the effects of early non-pharmaceutical interventions1-5 on COVID-19 spread in the United States is crucial for understanding and planning future control measures to combat the ongoing pandemic6-10. Here we use county-level observations of reported infections and deaths11, in conjunction with human mobility data12 and a metapopulation transmission model13,14, to quantify changes of disease transmission rates in US counties from March 15, 2020 to May 3, 2020. We find significant reductions of the basic reproductive numbers in major metropolitan areas in association with social distancing and other control measures. Counterfactual simulations indicate that, had these same control measures been implemented just 1-2 weeks earlier, a substantial number of cases and deaths could have been averted. Specifically, nationwide, 61.6% [95% CI: 54.6%-67.7%] of reported infections and 55.0% [95% CI: 46.1%-62.2%] of reported deaths as of May 3, 2020 could have been avoided if the same control measures had been implemented just one week earlier. We also examine the effects of delays in re-implementing social distancing following a relaxation of control measures. A longer response time results in a stronger rebound of infections and death. Our findings underscore the importance of early intervention and aggressive response in controlling the COVID-19 pandemic.

scholarly journals Projection of COVID-19 Cases and Deaths in the US as Individual States Re-open May 4,2020

2020 ◽  
Author(s):  
Teresa Yamana ◽  
Sen Pei ◽  
Jeffrey Shaman
Keyword(s):  
United States ◽  
The United States ◽  
Control Measures ◽  
Contact Tracing ◽  
County Level ◽  
Metapopulation Model ◽  
The Us ◽  
Hospital Bed ◽  
Us Counties ◽  
Death Data

AbstractIn March and April 2020, control measures enforcing social distancing and restricting individual movement and contact were adopted across the United States in an effort to slow the spread and growth of COVID-19. However, a number of states have now begun to ease these restrictions. Here, we evaluate the effects of loosening stay-at-home orders on COVID-19 incidence and related outcomes. We use a metapopulation model applied at county resolution to simulate the spread and growth of COVID-19 incidence in the United States. We calibrate the model against county-level daily case and death data collected from February 21, 2020 to May 2, 2020, and project the outbreak in 3,142 US counties for 6 weeks into the future. Projections for daily reported cases, daily new infections (both reported and unreported), new and cumulative hospital bed demand, ICU bed and ventilator demand, as well as daily mortality, are generated. We observe a rebound in COVID-19 incidence and deaths beginning in late May, approximately 2 to 4 weeks after states begin to reopen. Importantly, the lag between infection acquisition and case confirmation, coupled with insufficient broader testing and contact tracing, will mask any rebound and exponential growth of the COVID-19 until it is well underway.

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