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CALIFORNIA [September 1995]

ANOTHER OPINION POLL WHICH ASKS A LOADED QUESTION:

"Some communities add fluoride to their drinking water to help prevent tooth decay. This process is called fluoridation. If an election were being held today and your community DID NOT have fluoridated water, would you vote for or against a ballot measure to fluoridate your water supply?"

IS IT NOT SURPRISING THAT WHEN YOU MAKE A STATEMENT IN FAVOUR OF WATER FLUORIDATION AND THEN ASK THE RESPONDENT IF THEY WOULD SUPPORT SUCH A CONTENTION, YOU GET THE ANSWER YOU ARE LOOKING FOR? OF COURSE NOT. AS USUAL, THOSE PRO-FLUORIDATIONISTS WHO WANT A MAJORITY VOTE IN THEIR FAVOUR ARE INCAPABLE OF ASKING AN UNBIASED QUESTION.

Division of Communicable Disease Control

California Morbidity

September, 1995

Biweekly Report from the

Division of Communicable Disease Control

2151 Berkeley Way, Berkeley, CA 94704-1011

(510) 540-2566 After Hours (510) 540-2308

Contributions are Welcome

PUBLIC SUPPORT FOR WATER FLUORIDATION IN CALIFORNIA, 1991-94

Dental caries (tooth decay) affects over 84% of United States children {ref. 1} and over 95% of United States adults {ref. 2}. Adding an optimal level of fluoride to community water supplies can reduce dental caries by 17%-40% {ref. 3}. As of 1992, 62% of the United States population received optimal levels of fluoride in their water supply. In California, however, only 17% receive optimal levels of fluoridated water. As a consequence, California ranks 48th among 50 states and Washington, D.C., in terms of the proportion of people served by adjusted fluoridated water supplies {ref. 4}.

This report presents data from the California Behavioral Risk Factor Survey (BRFS) regarding a question on water fluoridation (Table). The BRFS is an ongoing telephone survey of a random sample of adults conducted by the California Department of Health Services (CDHS). It is designed to assess trends in health-related behaviors in California's adult population. The survey began in 1984 in collaboration with the Centers for Disease Control and Prevention (CDC) and contacts about 4,000 respondents, annually. Since 1991, the BRFS asked over 14,500 Californians the following question:

"Some communities add fluoride to their drinking water to help prevent tooth decay. This process is called fluoridation. If an election were being held today and your community DID NOT have fluoridated water, would you vote for or against a ballot measure to fluoridate your water supply?"

Based on pooled responses for the years 1991-94, 71.0% of Californians would vote for the hypothetical ballot measure. Over the survey period, there have been slight fluctuations in the support for fluoridation. Between 1991 and 1993, there was a slight decline in the percentage of respondents who would vote in favor (73.4% in 1991; 71.7% in 1992; and 68.3% in 1993), and a slight increase to 70.9% in 1994 (Figure). These fluctuations can largely be explained in terms of people moving into the "don't know" category rather than into opposition to fluoridation. Overall, opposition to fluoridation remains low and relatively stable at 15.5%.

With the exception of 1994, the survey showed a greater percentage of women than men would vote for fluoridated water in their community (75% vs. 72% in 1991; 73% vs. 70% in 1992; 69% vs. 67% in 1993; and 70% vs. 71% in 1994).

College graduates are more likely to favor fluoridation than those who did not complete high school (73.0% vs. 66.9%).

There does not appear to be a clear correlation between age and voting favorably for a measure to fluoridate. Those between 39 to 59 years of age were most likely to vote for the measure (73.2%), while 18- to 38-year olds were least in favor at 69.5%. However, opposition declined as age increased. Of respondents who were 18 to 38 years of age, 17.7% were opposed to a measure to fluoridate, 14.1 % of 39- to 59-year olds were opposed, and 12.3% of those over 60 years of age were opposed.

Slight differences existed in terms of race and ethnicity. Blacks were the group most in favor of water fluoridation at 76.8%, followed by Hispanics at 74.1%, Whites (70.1%), and Asians and Pacific Islanders (68.7%).

Reported By: Joanne P. Wellman, R.D.H., M.P.H., Office of Dental Health Services, Chronic Disease Control Branch, and Greg Schiller, Ph.D., Cancer Control Branch, Department of Health Services.

Editorial Note: Providing optimally fluoridated water to all Californians would help accomplish the Year 2000 Healthy People Objective 13.9, which calls for75% of the nation's water supplies to adjust to an optimal level of fluoride (1 part per million) {ref. 5}. Of 152 cities in the United States over 50,000 population that are not fluoridated, 87 are in California. These include: Anaheim, Los Angeles, Sacramento, San Diego, San Jose, and Stockton. Over 24 million Californians could reap the benefits of improved dental health if all public water systems in California were fluoridated.

Numerous studies have confirmed water fluoridation's safety, effectiveness, and favorable benefit/cost ratio. Two recent comprehensive reviews of fluoride's benefits and potential risks were conducted. Among the areas reviewed were cancer, bone fractures, and effects on the reproductive, renal, gastrointestinal, and immune systems effects. These studies reconfirmed fluoride's safety and value {ref. 6, 7}.

Fluoridation remains one of the most economical preventive measures in the United States and the single most cost-effective public health measure available to prevent dental caries. The annual cost of providing fluoridated water is about $0.51 per person {ref. 8}, depending on community size, labor costs, and types of chemicals and equipment used. Over a lifetime, this cost amounts to less than the cost of one filling. The California Dental Association estimates that every dollar spent on fluoridation saves about $140 in dental treatment costs.

Community water fluoridation provides benefits to the entire community, regardless of education or income. Furthermore, it is endorsed by nearly 100 state, national, and international health and civic organizations including the California Dental Association, California Medical Association, California Dental Hygienists' Association, California Conference of Local Health Officers, and the AFL-CIO.

Recently, Governor Wilson signed AB 733 (Speier-Burlingame), Drinking Water: Fluoridation, which requires publicly owned water systems with at least 10,000 surface connections to fluoridate their water supplies. Funding will not be provided by ratepayers but rather by private foundations, federal block grants, and other non-State funds. A collaborative effort between CDHS, the California Dental Association, and the California Fluoridation Task Force will mount the fund-raising effort.

REFERENCES

Public Health Service. Oral health of United States children: the National Survey of Dental Caries in United States School Children: 1986-87: National and Regional Findings. United States Department of Health and Human Services, 1989; NIH publication no. 89-2247.

Public Health Service. Oral health of Unites States adults: the National Survey of Oral Health in United States Employed Adults and Seniors: 1985-86. National Findings. United States Department of Health and Human Services, 1989; NIH publication no. 89-1232.

Newbrun E. Effectiveness of water fluoridation. Journal of Public Health Dentistry 1989; 49:279-89.

Public Health Service. Fluoridation census 1992. Atlanta, Georgia: United States Department of Health and Human Services, Centers for Disease Control and Prevention, September 1993.

Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: United States Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. 91-50212.

National Research Council. Health effects of ingested fluoride. Washington, DC: National Academy Press, 1993.

Public Health Service. Review of Fluoride -- benefits and risks. Report of the Ad Hoc Subcommittee on Fluoride of the Committee to Coordinate Environmental Health and Related Programs. Public Health Service, United States Department of Health and Human Services, February 1991.

Centers for Disease Control and Prevention. Public health focus: fluoridation of community water systems. MMWR 1992; 41:372-5,381.

TABLE. Fluoride Voter Support, by Percent (Ref. www.dhs.cahwnet.gov/...):