New Fluoridation Challenges,The Internet and Social Media

Myron Allukian Jr DDS MPHPresident, Massachusetts Coalition for Oral Health

Past President, American Public Health Association

PREVALENCE OF TOOTH DECAY AND MEAN NUMBER OF PERMANENT TOOTH SURFACES AFFECTED BY AGE GROUP, US, 1999 -2004

Age Group % Prevalence Mean Number Affected Tooth Surfaces

6 – 8 10.16 0.33

9 – 11 31.36 1.32

12 – 15 50.67 2.8516 – 19 67.49 5.79

20 – 34 85.58 13.39

35 – 49 94.30 31.46

50 – 64 95.62 53.8765 – 74 93.25 69.88

75 + 92.70 74.08

COMMUNITY WATER FLUORIDATION (CWF)

210 million Americans, 74.6% of US public water supplies

The foundation for better oral healthOne of the 10 greatest public health

achievements, 20th Century, CDC

Safe, effective and economicalColorless, tasteless, odorless at 1 ppm

Healthy People 2020 Goal: 79.6%

NUMBER OF PEOPLE IN THE US WHO HAD ACCESS TO ADJUSTED WATER FLUORIDATION 1945-2012

Year Number of People

1945 231,9301950 1,578,5781955 26,278,8201960 41,179,6941965 58,369,3551970 83,725,7711975 94,627,2941980 106,170,1491985 120,100,100 (est.)2008 195,545,1092010 204,283,5542012 210,655,401

Whack – A – Mole Strategy

FDA – EPA – CDC – IOM – APHA – Cities – Towns

WE NEED A PLAN

I. EVERY COMMUNITY IS DIFFERENT

II. Know Your Community

III. Know Your Opposition

ANTIS ARE EVERYWHERE

III. KNOW YOUR OPPOSITION A. Nature of Opposition

* Origin of anti-fluoridation movement * Hard core opposition * Soft core opposition

B. How are they organized? * Local, or state or nationally linked

C. Communication Network * Internet * Social Media * Newsletters and brochures * Letters to the editor * Local meetings and presentations * Signs * Mailings

D. Supporters and leaders

E. Avoid debates if possible

F. Tactics

* Petitions * Media* Town meetings * City Council * Bills and legislature

FLUORIDATION CHALLENGES Opposition since 1950, despite be ing

a proven e ffective public hea lth mea sure

Since 2010, ~ 90 US communities ha ve re jected or discontinued fluorida tion

Public policy deba te ha s cha nged since 1950 Ma ss Media

Television

Inte rne t

Socia l Media

Anti-fluorida tion website

87% of US adults Used by over 75% of all races, ages (except 65+), education, income, and

location

95% of US teens

97% of ages 18-29

72% of Internet users looked for health information in 2012

Internet Usage

% OF AMERICAN ADULTS USING THE INTERNET1995-2014

Baby Boomers

Generation X Generation YMillennials

Generation Z

Years Born 1946-1964 1965-1976 1977-1994 1995-2012

Popula tion 76 M 51 M 83 M 82 M, growing ra pidly, $ 44 billion in purcha sing power

Fa mous people

Bill Clinton, Meryl Streep

Barak Obama, Jennifer Lopez

Miley Cyrus, Serena Williams

Malala Yousafzai

Changing Generations

INTERNET SEARCH ENGINES

77% of online hea lth informa tion seekers begin by using a sea rch engine

Top 6 sea rch engines: Google

Bing

Ya hoo

AOL

Ask

Wow

Websites through which users create online communities to share information, ideas, messages and other content

As of January 2014, used by 74% of online adults

66% of social media users use the platform for civic or political activities

Post thoughts React to others Press friends to act on issues and

vote 50% of social media users share

news Stories, images or videos

46% have discussed a news issue or event

Social Media

Anti - Picture Shared on social media

FACEBOOK Users crea te profiles to sha re persona l inte rests

1.35 billion monthly a ctive users in Q3 2014

71% of Inte rne t users, 58% of US a dult popula tion

Importa nt source of website re fe rra ls through sha ring from posts

Groups

Sha re thoughts with people with simila r inte rests

Pa ges

Used by orga niza tions a s a wa y to a dvertise

A tool to expa nd business, bra nd or orga niza tion

Events

Inform people of upcoming events, eg. town ha ll mee tings with CWF votes

Above: Anti-CWF ima ges from socia l media

Distribution of the 15 Most Common Anti-Fluorida tion Tweet Arguments

Ma rch 1-14 a nd April 1-14, 2012, N=1815

ACTUAL TWEET EXAMPLES

Fluoride in wa te r ca uses hypertension. We ha ve a n epidemic of this in Ire la nd tha nks la rge ly to fluorida tion

#Fluorida tion vic tories continue a s Wa shington town ba nishes toxic chemica l from wa te r supply

Ma yor sa ys 3 dentists priva te ly expressed concern re fluorida tion but won’t spea k public ly 4 fea r of losing license

During WW2 the NAZIS used FLUORIDE in the wa te r to do mind control on the c itie s tha t they ha d ta ken over.

FLUORIDE is found in 25% of ma jor tra nquillize rs a nd is often ca lled “The Chemica l Lobotomy”

Fluoridation Information Website Tra fficJ une 2011-Ma y 2012

FluorideAction

Network (FAN)

CDC Fluoridation Section

Wikipedia "Water Fluoridation”

ADA Fluoridation Webpage

All ADA Webpages –Fluoridation

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12

Num

ber o

f Pa

ge V

iew

s

MOST COMMON TWITTER & SOCIAL MEDIA ANTI-FLUORIDATION ARGUMENTS 2012 &2014 Social Media

2014Twitter2012

Anti Pro

2012 2014 2012 2014

Facebook 100%(193)

96%(109)

0%(0)

4% (5)

Twitter 94.5%(343)

82% (850)

5.5% (20)

8%(188)

YouTube 100%(3,645)

99% (527)

0%(0)

1% (4)

Social Media Search Result Using The Keywords: Fluoride, Fluoridation, Water Fluoridation, and

CWF

Social Media2014

Twitter2012

Cancer 41% Cancer 13%

Toxicity 32% Useless 12%

Brain Damage 11% Poison 10%

Calcified Pineal Gland 7% IQ/Cost 8%

Fluorosis/Bone Deformation 3% Criminal 7%

Decrease Fertility 2% Fluorosis/Industrial Waste 6%

IQ 1% Endocrine/Environ’t/Pacify 5%

Most Common Twitter and Social Media Anti-Fluoridation Arguments

CDC CWF Website Traffic2011-2012 & 2014-2015

27,040

42,754

2011-2012 2014-2015

The number increased by15,714 (58%)

Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15

ADA.org/Fluoride Page Views 7,216 7,578 6,296 5,014 5,517 7,517 8,881 10,763 12,869

Discussion

● The public views most fluoridation information on anti-CWF websites

● The majority of search engine results are anti-CWF

● Most search results on social media were anti-CWF

● Anti-fluoridationists have a much better Internet and social media presence than pro-fluoridationists

PERCEPTION- REALITY- CREDIBILITY

VS

Public Interest

Scientific

consensus and

credibility

Junk science EmotionConfusion

IV. KNOW YOUR RESOURCES

Digital Promotion Toolkit

Social Media Messages Specific to Preventing Tooth Decay

WE SUPPORT COMMUNITY WATER FLUORIDATION AS A SAFE AND EFFECTIVE PUBLIC HEALTH MEASURE

Massachusetts Agencies and Organizations:

Massachusetts Department of Public HealthMassachusetts Coalition for Oral HealthMassachusetts Department of Environmental ProtectionMassachusetts Public Health AssociationMassachusetts Health CouncilMassachusetts Hospital AssociationMassachusetts Medical SocietyMassachusetts Dental SocietyMassachusetts Dental Hygienists’ AssociationMassachusetts League of Community Health CentersMassachusetts Coalition of School-Based Health CentersMassachusetts Chapter, American Academy of PediatricsMassachusetts Association For Mental Health

V. DEVELOP BROAD BASED COMMUNITY SUPPORT

Action Alert

Sa y NO to Ed Begley J r., a n Anti-F spea ker a t the APHA Opening Session, November 4

Conta ct APHA Executive Boa rd Members

Pa mela Aa ltonen, PhD, RN Cha ir, Executive Boa rd a a ltonen@purdue .edu(Director of Nursing Progra m, Purdue University, India na )

Shiriki Kuma nyika , PhD, MPH President, APHA skuma nyi@ma il.med.upenn.edu(Emeritus Professor of Epidemiology , Univ. of Penn. School of Medicine)

Ca ma ra P. J ones, MD, PhD, MPH President-e lect, APHA cpjones@msm.edu(Adult a nd Community hea lth, Na tiona l Ctr for chronic disea se prevention a nd hea lth promotion)

Georges Benja nmin, MD, Executive Director, APHA georges.benja min@a pha .org

VI. ALWAYS BE READY

THANKS TO FLUORIDATION OUR NATION HAS BETTER ORAL HEALTH!