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CDC Telebriefing Transcript
Two CDC Reports Present New Data: Fluoridated Drinking Water and Women With Diabetes

February 21, 2002

MS. Coffin: Hi, everyone. Thank you very much for calling in today. We're going to be discussing two CDC reports that were released today in the MMWR. The first one will be Populations Receiving Optimally Fluoridated Public Drinking Water, U.S. 2000. The expert speaking on that will be Dr. William Maas. He is the Director of CDC's Oral Health Division. He'll give brief comments, and then we'll open it up for questions and answers.

At about 12:15 we'll close the Q&A for fluoride and open up the section on diabetes. The article we'll be highlighting is The Socioeconomic Status of Women with Diabetes. And the experts here for you today are Dr. Gloria Beckles and Patricia Thompson-Reid. Both are CDC diabetes experts.

I'm going to hand it over to Dr. Maas. His last name is spelled M-a-a-s. That's M-a-a-s. Dr. Maas.

DR. MAAS: Thank you. The article published in the February 22nd MMWR, "Populations Receiving Optimally Fluoridated Public Drinking Water-United States 2000," provides the most current information on the status of water fluoridation by state.

Between 1992 and 2000 the percentage of the U.S. population receiving fluoridated water increased from 62.1 percent to 65.8 percent, bringing the total U.S. population receiving fluoridated water to 162 million people. That's an increase of over 17 million persons since the last time this report was done.

The Healthy People 2010 National Health Objective has set an objective for 75 percent of the U.S. population on public water systems to receive fluoridated water. Between 1992 and 2001 five additional states achieved the Healthy People Objective. They are: Delaware, Maine, Missouri, Nebraska and Virginia. And another state, Oklahoma, came very close to achieving this goal.

26 states and the District of Columbia have now met this national objective. State-specific percentages range from 2 percent to 100 percent of persons on public water systems receiving optimally fluoridated water.

There's a considerable need, as well as opportunity, for additional opportunities to implement water fluoridation which is a cost-effective means for preventing tooth decay, particularly in the 24 states that have not yet met the Healthy People 2010 Objective.

The information reported today is now being gathered through a new water fluoridation reporting system. It can be viewed on CDC's Oral Health Website by looking at the National Oral Health Surveillance System Section and clicking to "Fluoridation." And we will now be able to update this information on an annual basis.

The system will not only assist states in monitoring the extent and consistency of fluoridation, we hope that having up-to-date information available online will facilitate public knowledge about whether their water is optimally fluoridated.

And I'll be happy to take questions.

AT&T MODERATOR: And once again, ladies and gentlemen, if you do have a question at this time, please press the 1 on your touchtone phone. And we do have a question from the line of [inaudible] Marcus with Health Scout. Please go ahead.

QUESTION: Hi, Dr. Maas. Thanks for holding this briefing. I'd like to know about the states that are very low. Utah, for example, has a 2 percent rate. Why is it so low? Does it have to do with access to public water lines or is that a sort of community-based effort to prevent fluoridation?

DR. MAAS: Good question. Thank you. The specifics we have here are just the percentage of people on public water systems. So we are not including those that might be in very rural areas on home wells. But there are--the jurisdictions, whether they be city, county or state, is where the decision is made for fluoridation, rather than at the federal level. So the reasons for differences among states, you know, really vary. Each state has their own history.

In some cases there are perceptions, incorrect perceptions by policy makers and members of the public that tooth decay, dental caries is no longer a public health problem, or that fluoridation is not effective.

There's frequently very complex political processes involved in adopting fluoridation. And finally, many opponents of water fluoridation make unsubstantiated claims about alleged adverse health effects.

You mentioned Utah in particular. That's a state that has had a low proportion on community--fluoridated community water systems, but recently, the three largest counties did have favorable votes for community water fluoridation, and they are presently in the planning and design phase of determining just how the fluoridation equipment will be installed into those water systems. So by the next time we are able to do this update, we hope to be able to see the numbers for Utah, for example, to rise.

AT&T MODERATOR: And our next question is from the line of Sam Fawny (ph) with Newstar. Please go ahead.

QUESTION: Good afternoon, Dr. Maas. Sam Fawny with the Newstar in Monroe, Louisiana. Our city council is actually considering fluoridating the water here, and it's been met by a lot of debate, kind of it's a small minority of people who are talking things like cancer, bone breakage, things like that. I've looked at the research.

My question is: why does fluoridation tend to scare people the way it does?

DR. MAAS: Well, I think it--I'm not sure I can answer that question. Certainly, I suppose drinking water is something people recognize as being very important, so they are going to be cautious about that. And the ability of people to make allegations, and certainly now with the Internet, people being able to spread allegations and misinformation at the speed of light all over the world, has enabled those people that kind of are suspicious to receive these information in these claims.

Now, every time the issues have been studied by independent review bodies such as those constituted by the National Academy of Science, the Institute of Medicine, and the National Research Council, those scientific bodies that we rely on to give us advice about many scientific and environmental issues for the nation, every time they've looked at this issue they've found no credible evidence for the adverse health claims that have been made.

So I don't--I can't really answer the question why people don't trust the recommendations from these esteemed scientific bodies, since they are the same ones that give us recommendations for many other things that people, you know, immediately try to take in as far as their personal behavior or the public policy and things like that.

AT&T MODERATOR: Our next question is from the line of Emma Hitts with Reuters Health. Please go ahead.

QUESTION: Yes, thank you. My question's already been answered. Thanks.

AT&T MODERATOR: Thank you. And we'll move on to Delthea (ph) Ricks (ph) with NewsDay. Please go ahead.

QUESTION: Yeah, and it's pronounced Delthea Ricks. A quick question. I was at a triple AS, American Association for the Advancement of Science last week, and it was mentioned in a session on fluoridation that all large cities in the United States have fluoridated water supplies except Los Angeles. Have you any reasons why that may be the case, a city that large and supposedly as sophisticated as it is, has not fluoridated its water supply?

DR. MAAS: Well, actually, I think the numbers are 43 out of the largest 50, approximately that. It's 43, 45 out of the largest 50 are fluoridated. Los Angeles is fluoridated. Historically in Los Angeles, some of the people had water that was naturally fluoridated. In other words, it was the aquifer was in an area that drew the fluoride out of the minerals, and then the majority of Los Angeleans did not have such water.

But a few years back the state passed a law requiring the larger cities to fluoridate as soon as they were able to find the funds to do that. And within a year of that, the county council put that in the water--in the budget for the water system, and I believe Los Angeles has been fluoridated now for at least two and maybe three years.

But, yes, the point is that most of our largest cities in fact do have fluoridated water.

AT&T MODERATOR: And once again, ladies and gentlemen, if you do have a question, please press the 1 at this time.

[No response.]

AT&T MODERATOR: And, Ms. Coffin, no further questions in queue.

MS. Coffin: Okay, great. I'm going to turn it over to Dr. Gloria Beckles, who is going to talk about "The Socioeconomic Status of Women with Diabetes." Dr. Beckles. Could you spell your name to begin?

DR. BECKLES: My surname is B-e as in egg - c-k-l-e-s. First name Gloria.

While we know that socioeconomic position of people is a major determinant of the general health status, and by that we mean that the poorer one is, the less likely one is to be healthy, and furthermore, we have good evidence also that the poorer one is the less likely one is to have optimal access to high-quality care. And it's important to bear in mind that this is not an either-or. In other words, if one is of low socioeconomic status, the obverse is not high, it is just not low.

The relationship between social position and health status is a graded and continuous relationship. The worst outcomes are for the people at the worst extreme or the lowest extreme of the socioeconomic position, and the best for those at the best extreme, if you like, the most affluent of well off. But the relationship, the risk relationship is a continuous one, so between those two extremes, everybody has a risk which decreases as one becomes more affluent. I think that's important to bear in mind.

Diabetes is a very widespread disease in the United States, and it is--the prevalence is increasing, is expected to double in the next 25 years. And because we made a count for more than half of people with diabetes, as much as 52 percent, and the older the age group, the greater the proportion because women tend to live longer than men. We thought that we would take a look at the socioeconomic position of women to see if we could describe or get some intimations of their capacity to manage this lifelong chronic disease.

And so to do that we looked at the 2000 BRFSS prevalent system data for that year. And what we found was that women with diabetes have twice as likely as women without diabetes to report that they were in low socioeconomic status. By that we mean either they had not completed high school or they lived in families with an annual household income of less than $25,000 a year.

And I think I will stop there to see if--because I think the article and the tables are quite straightforward--to entertain any specific questions that people might have.

AT&T MODERATOR: And just this quick reminder, ladies and gentlemen, if you do have a question, please press the 1. We do have a question from the line of Emma Hitts with Reuters Health. Please go ahead.

QUESTION: Yes, hello. I wanted to understand if you had any idea about the relationship between perhaps obesity in this population and the risk of diabetes. I understand, you know, low socioeconomic status has been linked with an increased prevalence of obesity, and I wonder if that had any bearing on diabetes?

DR. BECKLES: Well, that would be one of the reasons. Poor people tend to be more obese, to be heavier on average and more obese, and in truth, they have worse diets, diets that are energy dense. They engage in less physical activity on a regular basis. And as a consequence, these individuals have three immediate reasons why they might be at high risk of development Type 2 diabetes, which is the most common form of the disorder. Does that answer the question?

QUESTION: Yes, thank you. I appreciate that.

AT&T MODERATOR: And, Ms. Coffin, no further questions in queue.

MS. Coffin: Okay. Any other questions at all on either one of these subjects, fluoridation or diabetes?

AT&T MODERATOR: And again, ladies and gentlemen, should you have a question, please press the 1 on your touchtone phone.

[No response.]

AT&T MODERATOR: And no further questions.

MS. KAUFMAN: Okay, thank you very much.

AT&T MODERATOR: Ladies and gentlemen, that does conclude your conference for today. We do thank you for your participation, and you may now disconnect.

[End of telebriefing.]

Listen to the telebriefing

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