State Health Department Websites Fail to Promote Community Water Fluoridation

Objectives: State health departments (SHDs) have a mission to advance population health by providing accurate and timely information to promote health and prevent diseases such as dental caries. The most cost-effective, safe and equitable way to prevent dental caries is consuming tap water in areas where community water fluoridation (CWF) exists. With eight in ten adult internet users reporting they search online for health information, SHD websites should have CWF content. The study objective was to assess all 50 SHD websites for content about CWF and its role in preventing dental caries.
Methods: For this descriptive study we used the web component of Rudd’s, HLE2: The Health Literacy Environment of Hospitals and Health Centers (HLE2), to evaluate the CWF content of SHD websites. HLE2 assessment scores indicate how easy or difficult it is to navigate a website and find information. We determined if CWF content existed, how easy it was find, if it was written in plain language and whether it was written for a consumer or health professional/technical audience.
Results: Forty-one SHD websites had CWF information; nine lacked CWF content. Thirty-seven states had content written for a consumer audience; 36 had content for a health professional/technical audience. HLE2 scores ranged from 0 to 54 points (60 possible). Only five states had websites with a HLE2 score of at least 50. SHDs with higher HLE2 scores were easy to navigate and their content was written for a consumer audience, enhancing the odds that visitors to the site would understand CWF’s benefits.
Conclusions: Despite scientific evidence backing the safety and effectiveness of CWF, many Americans are not aware of the benefits of drinking fluoridated tap water. SHDs can and should be a key resource for this information.