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

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.

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Emulation of Community Water Fluoridation Coverage Across US Counties

JDR Clinical & Translational Research ◽

10.1177/2380084419887696 ◽

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.

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The Effectiveness of Community Water Fluoridation in the United States

Journal of Public Health Dentistry ◽

10.1111/j.1752-7325.1996.tb02448.x ◽

1996 ◽

Vol 56 (5) ◽

pp. 253-258 ◽

Cited By ~ 54

Author(s):

Herschel S. Horowitz

Keyword(s):

United States ◽

The United States ◽

Water Fluoridation ◽

Community Water ◽

Community Water Fluoridation

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Urinary Fluoride Levels among Canadians with and without Community Water Fluoridation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126203 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6203

Author(s):

Julia K. Riddell ◽

Ashley J. Malin ◽

Hugh McCague ◽

David B. Flora ◽

Christine Till

Keyword(s):

Drinking Water ◽

Tap Water ◽

Tea Consumption ◽

Water Fluoridation ◽

Fluoride Level ◽

Community Water ◽

Urinary Fluoride ◽

Community Water Fluoridation ◽

Water Fluoride ◽

Age And Sex

Drinking water is a major source of dietary fluoride intake in communities with water fluoridation. We examined the association between urinary fluoride adjusted for specific gravity (UFSG) and tap water fluoride levels, by age and sex, among individuals living in Canada. Participants included 1629 individuals aged 3 to 79 years from Cycle 3 (2012–2013) of the Canadian Health Measures Survey. We used multiple linear regression to estimate unique associations of tap water fluoride levels, age, sex, ethnicity, body mass index (BMI), use of fluoride-containing dental products, smoking in the home, and tea consumption with UFSG. UFSG concentration was significantly higher among participants who received fluoridated drinking water (mean = 1.06 mg/L, standard deviation = 0.83) than among those who did not (M = 0.58 mg/L, SD = 0.47), p < 0.01. UFSG increased over adulthood (ages 19 to 79). Higher UFSG concentration was associated with being female, tea drinking, and smoking in the home. In conclusion, community water fluoridation is a major source of contemporary fluoride exposure for Canadians. Lifestyle factors including tea consumption, as well as demographic variables such as age and sex, also predict urinary fluoride level, and are therefore important factors when interpreting population-based fluoride biomonitoring data.

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A Half-century of Community Water Fluoridation in the United States: Review and Commentary

Journal of Public Health Dentistry ◽

10.1111/j.1752-7325.1993.tb02666.x ◽

2008 ◽

Vol 53 (1) ◽

pp. 17-44 ◽

Cited By ~ 104

Author(s):

Louis W. Ripa

Keyword(s):

United States ◽

The United States ◽

Water Fluoridation ◽

Half Century ◽

Community Water ◽

Community Water Fluoridation

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Associations between Household Water Fluoridation Status and Plain Tap or Bottled Water Consumption

JDR Clinical & Translational Research ◽

10.1177/2380084420960419 ◽

2020 ◽

pp. 238008442096041

Author(s):

M. Lin ◽

S.O. Griffin ◽

S. Park ◽

C. Li ◽

V. Robison ◽

...

Keyword(s):

Water Consumption ◽

Parental Education ◽

Tap Water ◽

Bottled Water ◽

Fluoride Content ◽

Water Fluoridation ◽

Community Water ◽

Household Water ◽

Community Water Fluoridation ◽

Water Fluoride

Introduction: The benefits of community water fluoridation for preventing dental caries are attenuated if people do not consume tap water. Objectives: We examined associations between household water fluoride content and consuming plain tap or bottled water among US youth. Methods: We used National Health and Nutrition Examination Survey data for 2013 to 2016 for 5,193 youth aged 2 to 19 y. Fluoride content in youth’s household tap water samples was measured electrometrically with ion-specific electrodes and designated low (<0.6 mg/L) or about optimal (0.6 to 1.2 mg/L). Plain tap and bottled water consumption was obtained from one 24-h dietary recall. We used binomial regression models to estimate adjusted prevalence ratios (APRs) and 95% CIs for consuming plain tap water (including tap only or both tap and bottled) and consuming only bottled water as related to household water fluoride content (low or about optimal) and sociodemographic characteristics. Results: On a given day, 52.6% of youth consumed plain tap water (43.8% exclusively and 8.8% both tap and bottled) and 28%, only bottled water. Neither tap water (APR, 0.96; 95% CI, 0.84 to 1.10) nor only bottled water (APR, 1.03; 95% CI, 0.86 to 1.22) consumption was associated with household water fluoride content. Non-Hispanic Black youth and Hispanic youth were about 30% relatively less likely to consume tap water and 60% to 80% relatively more likely to consume only bottled water than non-Hispanic Whites. Low income, low parental education, and no past-year dental visit were associated with not consuming tap water. Conclusion: Half of youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This study is the first to find that up to 50% of the population served by fluoridated water may not receive its full caries-preventive benefits due to not consuming plain tap water. Knowledge Transfer Statement: Half of US youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This finding suggests that up to 50% of the population served by fluoridated water systems may not receive its full caries-preventive benefits due to not consuming plain tap water. Our findings add support for the need to identify and address barriers to tap water consumption and promote health benefits of fluoridation.

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A Case-Control Study of Fluoridation and Osteosarcoma

Journal of Dental Research ◽

10.1177/0022034520919385 ◽

2020 ◽

Vol 99 (10) ◽

pp. 1157-1164

Author(s):

F.M. Kim ◽

C. Hayes ◽

S.L. Burgard ◽

H.D. Kim ◽

R.N. Hoover ◽

...

Keyword(s):

Case Control Study ◽

Phase 1 ◽

The United States ◽

Case Control ◽

Bottled Water ◽

Phase 2 ◽

Water Fluoridation ◽

Community Water ◽

Community Water Fluoridation ◽

Control Study

Public health policy decisions in the United States have resulted in 62.4% of the population having access to fluoridated water. The purpose of this study was to examine the association between community water fluoridation and osteosarcoma. A secondary data analysis was performed with data collected from 2 separate but linked studies. Patients for phase 1 and phase 2 were selected from US hospitals via a matched case-control study design. For both phases, cases included patients diagnosed with osteosarcoma, and controls were patients diagnosed with other bone tumors or nonneoplastic conditions. In phase 1, cases ( n = 209) and controls ( n = 440) were patients of record in the participating orthopedic departments from 1989 to 1993. In phase 2, cases ( n = 108) and controls ( n = 296) were incident patients who were identified and treated by orthopedic physicians from 1994 to 2000. This analysis included all patients who met eligibility criteria on whom we had complete data on covariates, exposures, and outcome. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs for the association of community water fluoridation with osteosarcoma. A modestly significant interaction existed between fluoridation living status and bottled water use ( P = 0.047). The adjusted OR for osteosarcoma and ever having lived in a fluoridated area for nonbottled water drinkers was 0.51 (95% CI, 0.31 to 0.84; P = 0.008). In the same comparison, the adjusted OR for bottled water drinkers was 1.86 (95% CI, 0.54 to 6.41; P = 0.326). Findings from this study demonstrated that community water fluoridation is not associated with an increased risk for osteosarcoma.

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Fluoride exposure and indicators of thyroid functioning in the Canadian population: implications for community water fluoridation

Journal of Epidemiology & Community Health ◽

10.1136/jech-2017-209129 ◽

2017 ◽

Vol 71 (10) ◽

pp. 1019-1025 ◽

Cited By ~ 11

Author(s):

Amanda M Barberio ◽

F Shaun Hosein ◽

Carlos Quiñonez ◽

Lindsay McLaren

Keyword(s):

Drinking Water ◽

Logistic Regression ◽

Multinomial Logistic Regression ◽

Tap Water ◽

Water Fluoridation ◽

Fluoride Exposure ◽

Community Water ◽

Community Water Fluoridation ◽

Tsh Levels ◽

Dental Products

BackgroundThere are concerns that altered thyroid functioning could be the result of ingesting too much fluoride. Community water fluoridation (CWF) is an important source of fluoride exposure. Our objectives were to examine the association between fluoride exposure and (1) diagnosis of a thyroid condition and (2) indicators of thyroid functioning among a national population-based sample of Canadians.MethodsWe analysed data from Cycles 2 and 3 of the Canadian Health Measures Survey (CHMS). Logistic regression was used to assess associations between fluoride from urine and tap water samples and the diagnosis of a thyroid condition. Multinomial logistic regression was used to examine the relationship between fluoride exposure and thyroid-stimulating hormone (TSH) level (low/normal/high). Other available variables permitted additional exploratory analyses among the subset of participants for whom we could discern some fluoride exposure from drinking water and/or dental products.ResultsThere was no evidence of a relationship between fluoride exposure (from urine and tap water) and the diagnosis of a thyroid condition. There was no statistically significant association between fluoride exposure and abnormal (low or high) TSH levels relative to normal TSH levels. Rerunning the models with the sample constrained to the subset of participants for whom we could discern some source(s) of fluoride exposure from drinking water and/or dental products revealed no significant associations.ConclusionThese analyses suggest that, at the population level, fluoride exposure is not associated with impaired thyroid functioning in a time and place where multiple sources of fluoride exposure, including CWF, exist.

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

Water Policy ◽

10.2166/wp.2020.044 ◽

2020 ◽

Vol 22 (3) ◽

pp. 365-375 ◽

Cited By ~ 1

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.

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