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.

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.

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

Associations of Community Water Lead Concentrations with Hemoglobin Concentrations and Erythropoietin-Stimulating Agent Use among Patients with Advanced CKD

2021 ◽  
pp. ASN.2020091281
Author(s):  
John Danziger ◽  
Kenneth J. Mukamal ◽  
Eric Weinhandl
Keyword(s):  
United States ◽  
Drinking Water ◽  
Kidney Disease ◽  
The United States ◽  
Water Systems ◽  
Adverse Outcomes ◽  
Content Type ◽  
Community Water Systems ◽  
Community Water ◽  
Lead Levels

BackgroundAlthough patients with kidney disease may be particularly susceptible to the adverse health effects associated with lead exposure, whether levels of lead found commonly in drinking water are associated with adverse outcomes in patients with ESKD is not known.MethodsTo investigate associations of lead in community water systems with hemoglobin concentrations and erythropoietin stimulating agent (ESA) use among incident patients with ESKD, we merged data from the Environmental Protection Agency (EPA) Safe Drinking Water Information System (documenting average 90th percentile lead concentrations in community water systems during 5 years before dialysis initiation, according to city of residence) with patient-level data from the United States Renal Data System.ResultsAmong 597,968 patients initiating dialysis in the United States in 2005 through 2017, those in cities with detectable lead levels in community water had significantly lower pre-ESKD hemoglobin concentrations and more ESA use per 0.01 mg/L increase in 90th percentile water lead. Findings were similar for the 208,912 patients with data from the first month of ESKD therapy, with lower hemoglobin and higher ESA use per 0.01 mg/L higher lead concentration. These associations were observed at lead levels below the EPA threshold (0.015 mg/L) that mandates regulatory action. We also observed environmental inequities, finding significantly higher water lead levels and slower declines over time among Black versus White patients.ConclusionsThis first nationwide analysis linking EPA water supply records to patient data shows that even low levels of lead that are commonly encountered in community water systems throughout the United States are associated with lower hemoglobin levels and higher ESA use among patients with advanced kidney disease.

scholarly journals Anthropogenic organic compounds in source water of select community water systems in the United States, 2002-10

2014 ◽  
Author(s):  
Joshua F. Valder ◽  
Gregory C. Delzer ◽  
James A. Kingsbury ◽  
Jessica A. Hopple ◽  
Curtis V. Price ◽  
...  
Keyword(s):  
United States ◽  
Organic Compounds ◽  
The United States ◽  
Water Systems ◽  
Source Water ◽  
Community Water Systems ◽  
Community Water

scholarly journals Causes of Outbreaks Associated with Drinking Water in the United States from 1971 to 2006

2010 ◽  
Vol 23 (3) ◽  
pp. 507-528 ◽  
Author(s):  
Gunther F. Craun ◽  
Joan M. Brunkard ◽  
Jonathan S. Yoder ◽  
Virginia A. Roberts ◽  
Joe Carpenter ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Distribution System ◽  
Water System ◽  
The United States ◽  
Water Systems ◽  
Outbreak Detection ◽  
Waterborne Disease ◽  
Public Water Systems ◽  
Annual Proportion

SUMMARY Since 1971, the CDC, EPA, and Council of State and Territorial Epidemiologists (CSTE) have maintained the collaborative national Waterborne Disease and Outbreak Surveillance System (WBDOSS) to document waterborne disease outbreaks (WBDOs) reported by local, state, and territorial health departments. WBDOs were recently reclassified to better characterize water system deficiencies and risk factors; data were analyzed for trends in outbreak occurrence, etiologies, and deficiencies during 1971 to 2006. A total of 833 WBDOs, 577,991 cases of illness, and 106 deaths were reported during 1971 to 2006. Trends of public health significance include (i) a decrease in the number of reported outbreaks over time and in the annual proportion of outbreaks reported in public water systems, (ii) an increase in the annual proportion of outbreaks reported in individual water systems and in the proportion of outbreaks associated with premise plumbing deficiencies in public water systems, (iii) no change in the annual proportion of outbreaks associated with distribution system deficiencies or the use of untreated and improperly treated groundwater in public water systems, and (iv) the increasing importance of Legionella since its inclusion in WBDOSS in 2001. Data from WBDOSS have helped inform public health and regulatory responses. Additional resources for waterborne disease surveillance and outbreak detection are essential to improve our ability to monitor, detect, and prevent waterborne disease in the United States.

scholarly journals Approximating Community Water System Service Areas to Explore the Demographics of SDWA Compliance in Virginia

2021 ◽  
Vol 18 (24) ◽  
pp. 13254
Author(s):  
Cristina Marcillo ◽  
Leigh-Anne Krometis ◽  
Justin Krometis
Keyword(s):  
United States ◽  
Water Quality ◽  
Drinking Water ◽  
Negative Binomial ◽  
Water System ◽  
The United States ◽  
Drinking Water Quality ◽  
Safe Drinking Water ◽  
Community Water ◽  
Service Areas

Although the United States Safe Drinking Water Act (SDWA) theoretically ensures drinking water quality, recent studies have questioned the reliability and equity associated with community water system (CWS) service. This study aimed to identify SDWA violation differences (i.e., monitoring and reporting (MR) and health-based (HB)) between Virginia CWSs given associated service demographics, rurality, and system characteristics. A novel geospatial methodology delineated CWS service areas at the zip code scale to connect 2000 US Census demographics with 2006–2016 SDWA violations, with significant associations determined via negative binomial regression. The proportion of Black Americans within a service area was positively associated with the likelihood of HB violations. This effort supports the need for further investigation of racial and socioeconomic disparities in access to safe drinking water within the United States in particular and offers a geospatial strategy to explore demographics in other settings where data on infrastructure extents are limited. Further interdisciplinary efforts at multiple scales are necessary to identify the entwined causes for differential risks in adverse drinking water quality exposures and would be substantially strengthened by the mapping of official CWS service boundaries.

scholarly journals Community-Level Analysis of Drinking Water Data Highlights the Importance of Drinking Water Metrics for the State, Federal Environmental Health Justice Priorities in the United States

2021 ◽  
Vol 18 (19) ◽  
pp. 10401
Author(s):  
Uloma Igara Uche ◽  
Sydney Evans ◽  
Soren Rundquist ◽  
Chris Campbell ◽  
Olga V. Naidenko
Keyword(s):  
United States ◽  
Drinking Water ◽  
Cancer Risk ◽  
Environmental Health ◽  
The United States ◽  
Water Systems ◽  
Community Level ◽  
Community Water ◽  
Health Justice ◽  
The U.S

Research studies analyzing the geospatial distribution of air pollution and other types of environmental contamination documented the persistence of environmental health disparities between communities. Due to the shortage of publicly available data, only limited research has been published on the geospatial distribution of drinking water pollution. Here we present a framework for the joint consideration of community-level drinking water data and demographic data. Our analysis builds on a comprehensive data set of drinking water contaminant occurrence for the United States for 2014–2019 and the American Community Survey 5-year estimates (2015–2019) from the U.S. Census Bureau. Focusing on the U.S. states of California and Texas for which geospatial data on community water system service boundaries are publicly available, we examine cumulative cancer risk for water served by community water systems of different sizes relative to demographic characteristics for the populations served by these water systems. In both California and Texas, greater cumulative cancer risk was observed for water systems serving communities with a higher percentage of Hispanic/Latino and Black/African American community members. This investigation demonstrates that it is both practical and essential to incorporate and expand the drinking water data metrics in the analysis of environmental pollution and environmental health. The framework presented here can support the development of public policies to advance environmental health justice priorities on state and federal levels in the U.S.

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