Fluid consumption and fluoride intake among children in the United States: Implications for water fluoridation *policy.

Current standards for water fluoridation in the U.S. have stood since 1962. Research on which current public policy is based was conducted in the 1940s and 50s. Since the 1980s, declines in dental caries and an increase in dental fluorosis have been observed. The literature indicates that children today are ingesting more fluoride than in the past. This dissertation aimed to evaluate assumptions pertaining to water fluoridation, with a focus on the fluid consumption among children in the U.S. Specific aims are: (1) to evaluate the relationship between fluid consumption among children and local climate, (2) to investigate the relationship of fluid consumption patterns and sociodemographic factors, (3) to estimate fluoride intake and to identify population groups with a risk of high fluoride intake, based on the fluid consumption patterns. A secondary analysis of data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988--1994) was conducted. Fluid consumption data was from a 24-hour dietary recall survey. Data for local climate from the US National Climatic Data Center was incorporated. Cluster analysis was conducted using SAS to determine fluid consumption patterns. Fluoride intake was estimated using assumptions of fluoride concentrations in drinking water and beverages. SUDAAN was used to adjust standard errors for the complex sampling design. This dissertation found that; (1) there is no evidence that fluid consumption is significantly related to local climate in modern conditions, (2) age, sex, race/ethnicity, and SES are significantly associated with children's fluid consumption patterns, (3) the amount of fluoride intake may vary greatly depending on fluid consumption patterns and sociodemographic characteristics. From the results, it is suggested that; (1) the current national temperature-related guidelines for fluoride concentration in drinking water may be due for re-evaluation, (2) fluid consumption patterns and sociodemographic factors should be considered in future research and public policy making for fluoride use, (3) the possibility of additional risk of fluorosis with supplement use should be recognized, and (4) a regulation to require the labeling of the fluoride content in beverages would help parents and health care providers to make informed decisions on their children's risk of fluorosis.Dr.P.H.DentistryHealth and Environmental SciencesPublic administrationPublic healthSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studies, School of Public Healthhttp://deepblue.lib.umich.edu/bitstream/2027.42/132523/2/9974997.pd