Risk perception and water fluoridation support and opposition in Australia

Abstract

Objectives: A considerable body of evidence confirms that water fluoridation effectively reduces the community incidence of dental caries with minimal side effects. However, proposals to introduce this widely endorsed public-health measure are often perceived as controversial, and public opinion frequently plays a role in the outcome. Despite this, the public's perception of risk associated with water fluoridation has not been well researched and remains poorly understood. Our objectives were to determine whether risk perceptions reflecting various "outrage" factors are associated with water fluoridation support and opposition. Methods: We conducted a cross-sectional questionnaire survey of a national sample of 517 Australian adults (response rate = 34.7 percent) aged 18-92 years.Results: Approximately 70.5 percent of respondents supported water fluoridation, with 15.1 percent opposed and 14.3 percent neutral. Sixteen of the 20 assessed outrage factors were significantly associated with water fluoridation stance in the predicted direction, with greater outrage being related to increased water fluoridation opposition. An overall outrage index computed from the 16 significant outrage factors accounted for a statistically significant 58 percent of the variance in water fluoridation stance beyond the effects of age, gender, socioeconomic status, and age and presence of children. Conclusion: Outrage factors are important aspects of the public's perception of risk in relation to water fluoridation. Given that water fluoridation appears to be a lowrisk, high-outrage controversy, efforts to mitigate the level of public outrage, rather than continuing to deny possible hazards, may offer a worthwhile strategy in gaining public acceptance for the extension of water fluoridation.

Qualitative investigation of the reasons behind opposition to water fluoridation in regional NSW, Australia

“…Scepticism about the benefits of water fluoridation 9 and its safety 7,9 are commonly reported reasons for opposition. A systematic review examined the efficacy and safety of water fluoridation, concluding that it is a safe and effective community-based intervention for preventing caries.…”

“…Indeed, previous studies show that the public believe they should be provided with more information about water fluoridation and other public health initiatives. 4,9,11,16 Participants discussed concentration versus dose concerns, specifically that differing ingestion amounts between individuals could not be regulated. The difference between a concentration and a dose, and the difficulty in regulating an individual's fluoride consumption have been reported previously.…”

“…Studies have identified socio-economic status as an independent factor in determining support, with those of lower socio-economic status more likely to oppose water fluoridation. 9,10,12 As well, both a lack of trust in authority and a desire for greater community autonomy have statistically significant predictive values for opposition to water fluoridation. 11,12 Previous data have been derived mainly from studies using quantitative methodologies, limiting the breadth of potential responses and restricting effective exploration of the reasons for opposition.…”

“…In 2011, an Australian study found that, of 510 participants, 70% supported water fluoridation, and up to 13% of those opposed would be likely to change their view if presented with new information. 9 Similarly, two large localitybased studies from southeast Queensland (2012) and the Central Tablelands of NSW (2010) found that 60% and 70% of participants, respectively, supported water fluoridation. 10,11 Certain population demographics may be associated with support for water fluoridation.…”

Water fluoridation: It really is this simple

“…[6] However, the survey also found that the majority of respondents expressed support for water fluoridation, and overall, little outrage. To the opponents in the minority, fluoridation remains a high-outrage issue, despite scientific evidence that is strongly suggestive of its very low risk.…”