Dental Health Foundation's Submission to the Forum on Fluoridation

Summary of Presentation

The results of recent research, both qualitative and quantitative, into the public's perception of fluoridation were presented to the Forum.

A qualitative survey, using focus groups was carried out in July 2000 followed by a Landsdowne Omnibus survey of 1,180 adults between September 26th and October 6th 2000. Questions relating to oral health and fluoride issues were included in a questionnaire which covered a broad range of issues which were known to be topics of concern in the public's mind; such issues included crime, drugs, pollution, health services, homelessness, litter, house prices, genetically modified foods and CJD.

The qualitative element of the survey, performed in July 2000, set out to determine the following:

• awareness, understanding of and behaviour towards fluoride in water and toothpaste and its perceived relationship with dental health,


• public opinion and attitudes towards water fluoridation: benefits and drawbacks and to


• explore both current and future credible sources of information about fluoridation and


• examine the level of public trust in a range of organisations: Department of Health and Children, Dental Health Foundation, Voice of Irish Concern for the Environment etc.

The researchers concluded that:

• There was a high level of misunderstanding about the purpose and function of fluoride and the specific benefits it provides. It was often confused with chlorine and mistakenly perceived as a purifying or cleaning agent. Its dental benefits were often overlooked or forgotten.


• The public did not appear to be conscious of the dangers to children of ingesting excessive levels of fluoride from toothpaste.


• A high level of subliminal awareness appeared to exist about the presence of fluoride in the water supply.


• Debate on the issue was welcomed because they perceived it as indicative of the shift in attitude of Irish society to challenge as opposed to accept government policy.


• However, while the media campaign pertaining to the positive and negative aspects of water fluoridation has had little impact, where it has had an impact, has been with regard to the potential negative effects.


• The issue of fluoride was perceived at present to be a general health issue over and above an issue about dental health.


• The public believed that an independent objective spokesperson (with a scientific background) is necessary to communicate a balanced perspective on the potential benefits and drawbacks of fluoride to general health.


• Key information required by the public includes general information on fluoride: what it is, why we need it, its benefits, long term effects, alternative sources, Irish and European legislation, monitoring of levels in water.

Some of the findings of the qualitative survey were employed in the development of a questionnaire for the quantitative section.

With regard to fluoride in water it was found that when it comes to people's general concerns, fluoride was not a high level concern. Less than 25% were very concerned, and 22% were fairly concerned. However, with regard to water pollution, over 50% were very concerned about water pollution. The researchers believed that if water fluoridation were to be presented in the light of a water pollutant, then it could potentially be a much higher-level concern.

Information was gathered with regard to sources of information concerning fluoride. The mass media was the predominant source of information. The purpose of fluoride in water was confused between water purification and dental health.

Participants were asked a number of questions to determine their attitudes to fluoride. Overall the findings were consistent with those of the qualitative survey findings.

It appeared that the public have higher-level concerns other than fluoride in water.

• While the anti-campaign messages were being "played back", there was an obvious wish for public consultation and for more information to be made available.


• The issue and information regarding fluoride in water was seen to be the remit of the Department of Health and Children.


• There is an environmental dimension to the topic that has the potential to be emotive. Water quality and purification is linked in the public mind to fluoridation.

The researchers recommended that a more balanced debate than is currently taking place is required in order to educate the public with regard to all aspects of water fluoridation. Particular mechanisms will be required to increase public awareness of the potential for ingestion of excessive amounts of fluoride and the subsequent adverse effects (via dental products in addition to drinking water), in light of the fact that both the environmental and dental health perspectives along with the issue of water purity are emotive issues and have been used by the anti-fluoridation campaign.


Report on the content analysis of media coverage of water fluoridation

The Dental Health Foundation monitors the media coverage of water fluoridation in Ireland. Drury Research examined and evaluated this coverage in the period December 1999 to November 2000 and presented a written report of their findings to the Forum.

The process involved the analysis of all monitored print, radio and television coverage of the water fluoridation issue. The total number of media articles / bulletins examined was 240 and included the following:

• National newspapers, Leinster, Munster and Connaught / Ulster Regionals and other periodicals.


• National television news


• National and regional radio coverage

Each individual article / bulletin was examined and evaluated under three separate areas:

• The headline


• The first three paragraphs or the first part of the bulletin


• The overall tone

They were rated on a three point scale ranging from "Negative" (-1) to "Neutral " (0) to "Positive" (+1)

The coding of all individual scores was carried out by executives from Drury Research and each rating was doubled checked by a second executive to ensure consistency in the evaluation process.

Media coverage of the water fluoridation issue across print, T.V. and radio tended to be negative (over 50% scoring Ð1). The Researchers pointed out that the high percentage of negative coverage must be understood in light of its increased dramatic / sensational appeal and that the impact of this negative media coverage should not be underestimated as consumers may be more likely to recall negative versus positive information.

Almost 50% of the total number of media headlines concernin g water fluoridation were negative with 43% being neutral and only 8% adopting a positive stance. The balance of the overall coverage also tended to be negatively predisposed towards water fluoridation (55%) with only 32% and 13% being neutral and positive respectively.

Forty five percent of all printed articles headlines were negative (45%) with only 8% being positive. Only 15% of all printed articles were positively predisposed towards water fluoridation in their first three paragraphs.

A little over half of all the national headlines printed were negative (51%). Only 4% of headlines were positive with the remainder being neutral. Only 6% of the first three paragraphs of the national articles were negative.

In general the overall balance of the national articles tended to be negative (57%) with only 8% positive. Approximately one third of all national articles written adopted a neutral perspective.

The Irish Independent appeared to be particularly negative in its overall coverage of the fluoridation issue (84%) negative. In contrast the Irish Times appeared to offer a more balanced perspective on the issue with 50% being negative, 33% neutral and 17% positive.

With regard to the regional newspapers, coverage was even more negative, with 59% of Leinster, 63% of Munster and 51% of Connaught / Ulster regionals adopting a negative perspective overall. The overall positive scores for Leinster (11%), Munster (10%) and Connaught /Ulster (20%) were low.

Printed articles outside the mainstream press seemed to adopt a more balanced outlook with approximately (49%) of the articles being neutral. The researchers suggested that this may be due to the more scientific nature of the medical publications such as the Irish Medical Times, Irish Medical News etc.

While the monitoring of television coverage was limited to 6 bulletins, the researchers made the point that the impact of television coverage should not be underestimated. The majority of coverage tended to be negative. Of the six items monitored, 4 were negative and 2 were neutral.

Total "overall" radio coverage was decidedly negative (63%) with approximately 1 in 5 programmes being neutral (21%) and only (16%) being positive. Regional radio was also decidedly negative with over two thirds (67%) of monitored programmes being negative and only 13% being positive.

In summary, overall media coverage of the water fluoridation issue was predominately negative (52%) versus 14% positive. The printed media tended to be consistently negative in its communication of the water fluoridation issue at both nation and regional levels. Both radio and television (the two most impactful media) coverage tended to adopt a negative stance.

Drury Research concluded that there is obviously a need to redress the balance, particularly in regional press, radio and general TV and radio coverage.

A summary of presentations to the Forum on Fluordiation is available at:
www.fluoridationforum.ie/forum_reports2.htm