The Health Belief Model (HBM) was created by social scientists at the US Public Health Service in the early 1950s to explain the widespread failure of people to participate in programs for prevention and early detection of disease (Baum et al., 1997). It helps to understand why people don't use disease prevention techniques or screening tools for early illness diagnosis. According to the HBM, a person's belief in their personal risk of illness or disease, as well as their belief in the effectiveness of the recommended health activity or action, can predict whether they will engage in the practice. Individual attitudes about health issues, which predict individual health-related actions, are central to the health belief model. A multilevel approach to population health is based on the concept that several levels of exposure interact to affect health consequences. Generally, this method involves asking questions to determine what factors can influence the eventual goal of enhancing an individual or community's health. The HBM defines perceived susceptibility to illness or disease, belief in the severity of the consequences, potential positive benefits of action, perceived barriers to action, exposure to aspects that prompt action, and trust in one's ability to succeed as the key factors that influence health behaviors. The Health Belief Model (HBM) model looks at the "patient's perceived risk of negative health outcomes and perceived severity of the disorder, as well as their weighing of potential benefits and barriers" (Olsen et al., 2008).
According to the HBM, a person's belief in their personal risk of illness or disease, as well as their belief in the effectiveness of the recommended health activity or action, can predict whether they will engage in the practice. Working as a dentist in the past, I always wanted to know more about the behaviors associated with caries prevention. As a dental intervention patient coming for treatment are advised to use fluoridated toothpastes, mouthwashes, varnishes, and sealants as in home and at office procedures. Caries is a common oral disease that affects millions of people around the world (Peterson, 2003). For youngsters in the United States, dental caries is a severe public health issue. Dental caries affects one-quarter of 2-to 5-year-olds and half of 6-to 8-year-olds in the primary dentition. It affects one in every five 6- to 11-year-olds in permanent dentition, with prevalence rates that have remained stable throughout the 1900s (Šket et al., 2017). Traditional oral disease treatment is prohibitively expensive in a number of developed countries and unavailable in the vast majority of low- and middle-income countries.
Fluoridation of community water has become a widespread intervention, sometimes described as a mainstay of modern public health, since the discovery of fluoride as a caries-preventing agent in the mid-twentieth century. At that time, around 90% of children had tooth decay, and rampant caries was widespread among preschool children. There were few public dental health services available; there was no access to free dental care; and fluoride-containing toothpastes were unavailable. From the 1950s to the 1970s, tooth decay rates climbed. This led to the intervention of community water fluoridation. Over the period, this method resulted in higher fluoride intake and has sparked debate for two reasons. To begin with, topical fluoride accessibility and easy administration in the oral cavity appear to be a more direct and appropriate method of caries prevention. Second, systemic fluoride intake has been linked to negative consequences, including neurotoxicity and various other side effects in children and adults (Grandjean, 2019). Epidemiological studies' findings indicate that high fluoride intake during early development can result in significant IQ impairments. Hence, when assessing the safety of fluoride-contaminated community drinking water and fluoride use for preventive dentistry, neurotoxic concerns must be considered. Fluoride is classified as a developmental neurotoxin (Choi, 2012). A meta-analysis done by Choi of 27 cross-sectional studies of children exposed to fluoride in community drinking water, mostly from China, found that children exposed to higher fluoride concentrations had an average IQ loss of roughly seven points (Choi, 2012). Higher levels of fluoride in tap water have been linked to an increased incidence of ADHD symptoms and diagnoses among Canadian youngsters, particularly adolescents (Riddell, 2019). Thyroid function disruption is also associated with fluoride exposure, but appropriate iodine consumption can help to offset this effect (Malin et al., 2018).
With the development of caries as a disease, a new paradigm was introduced, making dental caries a complex multifactorial disease (Fejerskov, 2004). Hence, there is a limited impact of fluoride associated with caries prevention. The HBM has been shown to predict tooth brushing, flossing, and dental visit behaviors in various studies. Self-efficacy was added to the model to extend the original HBM's predictability, and it was further proved as the biggest predictor of health behaviors in this model. Stronger self-efficacy views and a greater perception of the severity of oral disorders have been linked to increased tooth brushing frequency, leading to better oral health (Orji et al., 2012). This belief system of individuals has a positive impact on their oral health, but the concept that fluoride acts as an anti-cariogenic agent leads them to increase their consumption of fluoride. Given the increased number of fluoride sources and rising rates of fluoride intake in the population since water fluoridation began in the 1940s, it has become imperative to reduce and work toward eliminating avoidable sources of fluoride exposure, such as water fluoridation, fluoride-containing dental materials, and other fluoridated products (Kennedy et al., 2017). The influence of all these sources' exposure levels is sometimes neglected. Nonetheless, this cumulative fluoride exposure has the potential to cause fluoride-related ailments for the rest of one's life.
Fluoridation of community water is a major source of fluoride exposure for Canadians today. Community water fluoridation schemes have been employed for over 50 years (McGrady et al., 2011). Over the years, there has been a lot of interest in lowering fluoride levels or eliminating fluoride in drinking water, despite resistance from some human rights and environmental groups. However, community water fluoridation has received unwavering support from public health officials, dental and medical professionals, and researchers (Tobias et al., 2022). Support for community water fluoridation was linked to both educational attainment and health literacy, indicating the influence of basic and advanced information when supporters exercise their right to vote. HBM plays a big role in this situation as it involves its six constructs, including perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cue to action, and self-efficacy. While literacy and other demographic factors are greater predictors of community water fluoridation poll participation, health literacy is a better predictor of fluoride support (Curiel et al., 2019). The removal of water fluoridation impacts everyone. Individuals with lower incomes, poorer oral health, and major barriers to dental treatment suffer more than those with higher socioeconomic status (Shahrabani, 2015). Whereas HBM can help with information literacy and can be applied to individuals to educate them about the adverse effects of use of fluoride and limit its consumption.
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FLUORIDE EXPOSURE AND HUMAN HEALTH RISKS: A Fact Sheet from the International Academy of Medicine & Toxicology (IAOMT)
References:
Baum, A., Newman, S., Weinman, J., West, R., & McManus, C. (1997). Cambridge Handbook of Psychology, Health and Medicine. The Press Syndicate of the University of Cambridge. Retrieved from https://books.google.ca/books?hl=en&lr=&id=zVh30FrAuDsC&oi=fnd&pg=PR17&dq=cambridge+handbook+of+psychology+health+and+medicine&ots=Im5RqwyIvv&sig=rmI40NhremqIXV3PeCZNb4lWnlY#v=onepage&q=cambridge%20handbook%20of%20psychology%20health%20and%20medicine&f=false
Choi, A. L., Sun, G., Zhang, Y., & Grandjean, P. (2012). Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environmental health perspectives, 120(10), 1362–1368. https://doi.org/10.1289/ehp.1104912
Curiel, J. A., Slade, G. D., Christian, T. L., Lafferty-Hess, S., Carsey, T. M., & Sanders, A. E. (2019). Referendum opposition to fluoridation and health literacy: a cross-sectional analysis conducted in three large US cities. BMJ open, 9(2), e022580. https://doi.org/10.1136/bmjopen-2018-022580
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Shahrabani, S., Benzion, U., Machnes, Y., & Gal, A. (2015). The use of dental services for children: implications of the 2010 dental reform in Israel. Health policy (Amsterdam, Netherlands), 119(2), 117–126. https://doi.org/10.1016/j.healthpol.2014.11.007
Šket, T., Kukec, A., Kosem, R., & Artnik, B. (2017). The history of public health use of fluorides in caries prevention. Zdravstveno varstvo, 56(2), 140–146. https://doi.org/10.1515/sjph-2017-0018
Tobias, G., Mordechai, F., Tali, C., Yaron, B., Beatrice, G. P., Jonathan, M., & Harold, S. C. (2022). The effect of community water fluoridation cessation on children's dental health: a national experience. Israel journal of health policy research, 11(1), 4. https://doi.org/10.1186/s13584-022-00514-z
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