THE JOURNAL OF SCHOOL HEALTH 345 -

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?;at,ional Alliance Football Committee, Fatality Repor t , National Federation of State High School Athletic Associations, Chicago, (Issued A4nr~uallyj and, Arnerican Football Coaches Association, Futality Repor t , Tho Assocint ion, Ch:ipel Hill, North Carolina, (Issued Annually).

Conmiittee on the Medical Aspects of Sports of the American Medical :bxocin- tion, Tips on Athlelic Training 1.11, “Food Facts and Fallacies,” M I A , Chic‘:igo. 1966. Iconishi, F. “Food Energy Equivalents of Various Activities,” Jozirnnl of the A m r i c a n Dietetic Association, 46: 186, March 1965. Johnson, e t al. “Relative Importance of Inactivit,y and Overeating in Energ!- 1Jal:ince of Obese High School Girls.” American Journal of Clinical Nrifrifioii, - 4: 37, 1956. IIein. F. V. 42. April, 1964. (:allagher, .J. R. and Harris, H. FYil ion, 1964, Oxford University Press, New York.

“Teenage Gap in Knowing and Doing,” School Lunch Joitrttal, 18.

Emot iod Problems of the Adolescent, Reviietl

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FACTORS INVOLVED IN VOTING ON FLUORIDATION AND THEIR IMPLICATIONS FOR HEALTH EDUCATION

EVELYZJ. FOWLER, R.N., M.A.

Assistant Professor in Health Edzication, Jersey Cily Stale College, S e w Jersey

The discovery of the effectiveness of fluorine in reducing dental caries came about by chance. Excessive fluorine was found to be the ngent causing mottling of teeth in certain western states. Where the water supply contained very large amounts of fluorine, teeth were not only dis- colored Init also relatively free of caries. This led to studies, in the 1930’s, of twenty-one (21) cities where an inverse relationship between the amount of fluoride in the water and the amount of dental caries was found to exist. When the concentration of fluorides in the water was owr 1.5 parts per idlion, a brown discoloration began to appear.

After studying the matter for several years, the United States Puhlic Health Service had, by 1944, become satisfied that no toxic effects nould result if local water supplies were brought to the level of 1 part per million of fluorine content artificially. Controlled field studies were en- couraged and had their origin in Newburgh, New York and Grand Rapids, Michigan, Within five years the results were so impressive in these communit,ies, as ~ l l as in others, that by 1950 the Public Health Service encouraged all communities to fluoridate their water systems. Shortly following this, the American Dental Association, the American iissocia- tion of Public Health Dentists, the National Research Council, the Anierican Medical Association, as well as others, made a puhlic endorsc- ment of fluoridation.

In communities where the water is deficient in fluorine, the dental caries rate drops 50 to 65 percent when it is introduced and the children i n these areas grow up with fluoridated water. Yet despite the fact that

346 THE JOURNAL OF SCHOOL HEALTH

the cost of adding fluorine is nominal and that there are no hariniul side effects, the proposal to introduce fluorine into water supplies l i : ~ pro- voked bitter controversy in many communities.

As a result, social scientists have devoted much time and effort and have viewed the problem from many different angles in order to coiiic LIP with some answers. Studies have been conducted to find out why an individual votes for or against fluoridation, what attitudes the indi- vidual has that affect his action, is there anything in his background to account for his views? Other studies have been concerned with thp com- munity as a whole and the groups within it to find out how characteristics of the community and the process of community decision-making nHect the outcome of a referendum. Do wealth, size, education or other char- acteristics have an effect on the outcome of fluoridation? As :i rehidt of their studies, it was found that the problem was a puzzling, c o n i l h one fraught with inconsistencies and unexpected findings.

Taylor, Munro and Fuqun found that women, people bet \I t w i the ages of 21 and 30, and those with high education were inclined to i;ivor fluoridation. In their study of Fairfield, California, they also foiintl that white collar respondents were least favorable of all occupational g i ~ i p - ings and the least favorable age group was the 41 to 50 year catepor.?..

Simmel found that people who oppose fluoridation tend to h a w lower incomes and jobs of lower occupational status.

Gamson in his study of voters in Cambridge, Massachusetts. found that those with less than eighth grade education and those with ccdlcge educations were strongly for fluoridation. Those with medium etlr ic<ition were less likely to be for it.

Kirscht and Knutson in their Berkeley study found highly pk-itive general attitudes toward science regardless of position on fluoridnt ion I nit the opponents scored higher on an index of the indirect threat of wieiice and put less value on science as compared with other values.

Rlarmor, Bernard, and Ottenberg suggested that opposition to fiuori- dation may he connected with failures of ego integration. Individuals unable to cope with their world may regress to excessive conwt’ii with hodily control.

Another study has emphasized hostility to authority as a con! plnent in the opposition to fluoridation. Green in his study was concerned nith the anti-fluoridation leaders, for he believed it was the intensity 0 1 tlicii. objections that made the dispute occur. Their concerns, he tclt i v w ’ ideological, in that they were troubled by what fluoridation meant rsthcr than by what, as a scientific matter, fluoridation was. The issue, they felt, was a moral one. The leaders used the poison argument in :L k \ i i i - holic manner. They felt that man was being manipulated inore ;mI more and was losing his initiative and that in the end would find hiinsell totally dependent on impersonal agencies. Green found that, “fliioridn- tion is tagged with a contempt for individuality, and is emblematic 01 :in ultimate aim to smother personal identity in a homogeneous mass.”

Simmel, in his study, felt that opposition to fluoridation is likely t o tie concentrated in categories of people who have a sense of deprivatioil rela- tive to some reference group. The deprivation might be economic, in prestige or self-esteem, political efficacy, and also, due to rank disequilibrium.

THE JOURNAL OF SCHOOL HEALTH 347

Green, in another study, claimed that authoritarian elements in the pro-fluoridationists' stance toward the public helped to defeat fluoridation.

Ganison concluded, in his study, that publicizing the facts about fluoridation did not automatically create support nor did opposition stem solelv from those who have been insufficiently educated. Education should not be abandoned but there must be recognition that the factors that shape public opinion in a fluoridation campaign are coniples arid that the task requires not only education but political persuasion as well.

There has been, states Green, a tendency to see the problem as one of how to deal with the confusion caused by irrational anti-fluoridation leaders among a sluggish and ill-informed public. In addition, there has been a trend among the proponents of fluoridation to see themselves as misunderstood purveyors of reason, fairness, and scientific progress. Ho~.ever these proponent leaders have been responsible for serious errors in tnrtics and outlook. He feels that in a campaign concerning fluoridn- tion, the public is not being educated by either side but rather that it is being persuaded. In the above mentioned study by Gamson, he examined the extent to which factual knowledge about fluoridation influenced voting behavior in a referendum in Cambridge, Massachusetts. He found that the reasons given for accepting or rejecting fluoridation were vague and oftcn factually incorrect. His findings showed no significant indication that proponents were more fully informed of the facts than those who soted against it.

<lfter reviewing all the related literature pertaining to the subject, one is left with the feeling that an educational program for the voting populace, although necessary, is not the only deciding factor in this issue. Although professional people in the field attempted to present a rational program, if ~vas oiten met with defeat. It would seem a more varied program \voiild Ire necessary, using psychology as its guide. Fluoridation ap- pawfitly seems to evoke feelings, emotions, perceptions, and attitudes to a greater extent than other issues. Basic human needs and drives and their satisfaction seem to be the motivation in many cases. Individual rights aiid perceptions of government interference in private affairs spurred other opponents. Fear of the consequences of long term use deterred others from making a positive vote, while indecision one way or another made itself felt a t the polls also. The problem ran the gamut of ramifications, making itself felt in most unlikely places. Where people feel that they have little political influence, where their self-esteem has been damaged, their attitudes would need to be changed to where they could feel that here, a t least in this issue, they have some say in what concerns them and that here their vote can be decisive. 111 this way at least some of their basic needs will have been satisfied.

If they can I,e shown that they would stand to save a considerable amount of 111011ey, formerly spent for dental care, this too may help to tip the scales. Pointing out that fewer visits to a dentist (often associated with fear and pain) would be needed, should have a positive effect on their behavior a t the polls. Perhaps if the general populace were apprised of the fact that there are other ways of administering fluoride for the reduction of caries than through the introduction into the general water supply, but that the Inttrr is more efficient, less costly, and not subject to normal human for-

To those of lower incomes, the econoniic approach might help.

34s T H E JOURNAL OF SCHOOL HEALTH

getfulness, they would be more prone to consider it. If people could be convinced that the government and other powers that be were not trying to cram something down their throats but were trying to reduce a major health problem, some headway could be made. Perhaps concentration 011 Rosenstock’s three (3) hypotheses would help bring about the attitude change needed. By placing emphasis on the susceptibility of all to dental caries and the seriousness of the problem, then the available control to the problem might be more willingly accepted.

During the heat of some of the controversies the profesaionnl pro- ponents antagonized the opposition by patronizing them, talking down to them and criticizing them for expressing their opinions in :in area in which it was thought they were not qualified to do so. This in itself is :t sure-fire method of antagonizing people. If democracy is to be served and hostility kept a t a minimum, both sides mist be given the opportunity to be heard. Very often being given the opportunity to air their viewpoint will make people more amenable to listening to and considering the op- posing viewpoint.

It is felt by social psychologists that one of the more effective ways of changing attitudes is through group processes. If the leaders of various social clubs, organizations and agencies are in favor of fluoridation, then the membership too is likely to be in favor. If the organization means anything to its members, they will conform to the norms of that par- ticular organization. It would seem logical then that if the lenders of community organizations were approached and convinced of the value of fluoridation, one could expect the support of most of the membership. Thus by the use of roundabout methods one might succeed where one failed in the direct approach. One thing is certain, leaders of communities who wish to have fluoridation accepted, would be wise to enlist the aid of behavioral scientists when planning their strategy.

Another solution to the problem is to educate our youth before their attitudes crystallize. This could best be accomplished in the rnriron- ment of the school, where there are no political axes to grind, nncl, where we are concerned only with the truth and Mith the preparation of young- sters to be able to make wise decisions concerning their health and that of the community. Then, when the time comes for them to vote on the issue of fluoridation, they will not be swayed by either side but will make their own decisions based on the merit and the value of the issue :*t hand.

BIBLIOGRAPHY Gnmson, William A. “Social Science Aspects of Fluoridation: A Siipl~leiiienl~”

Heultla Education Journal, Vol. 24, (September, 1965). Gamson, William A. “Community Issues and Their Outcome.” L’nfi erstty ot

Michigan, 1965. Gamson, William A. “Social Science Aspects on Fluoridation--A S u ~ i i n i : ~ ~ Y oi

Research.” Health Ediication Journal, (September, 1961). Gamson, Williani A. “The Fluoridation Dialogue: It is an Ideological Conflict+?”,

The Public Optnion Quarterly, Vol. 25, (Winter, 19GI). Gamson, Williani A., and Peter H. Irons. “Community Characteristic* x i c l Fluoi i-

dation Outcome,” The Journal of Social Issues, Vol. XVII, No. 4, (1961) Gamson, William A. “Public Information in a Fluoridation Referendnm.” lienltli

Educational Journal, (March, 1961). Green, Arnold L. “A Critical Look a t Pro-Fluoridation Campaigns,” Soci ,~I Science

Program, Hnrvard School of Public Health, March, 1962.

T H E JOURNAL OF SCHOOL HEALTH 349

Green, Arnold L., and Jean L. Briggs, “Fluoridation in Massachusetts: A Statistical Comparison of Communities,” Soczal Science Program, Harvard School of Pulslic Health, December, 1957.

Green, Arnold L. “The Ideology of Anti-Fluoridation Leaders,” Journal (tf Social Issues, Vol. XVII, NO. 4, (1961).

Iiegeles, Stephen S. “Some Unanswered Questions and Action Implications of Social Research in Fluoridation,” Journal of Social Issues, Vol. XVII. No. 4, (1961).

Iiirscht, John P., and Andie L. Gutson . “Science and Fluoridation: An Attitilde Study,” Journal of Social Issues, Vol. XVII, No. 4, (1961).

Paul, Benjamin D. “Fluoridation and the Social Scientists: A Review,” Journal of Social Issues, Vol. XVII, No. 4, (1961).

Plaut, Thomas F. A. “Analysis of Voting Behavior on a Fluoridation Referendum,’’ The Public Opinion Quarterly, Vol. XXIII, No. 2, (Summer, 1959).

Raulet, Harry M. “The Health Professional and the Fluoridation Issue: A C:i>e of Role Conflict,” Jourizal of Social Issues, Vol. XVII, No. 4, (1961).

Sanders, ,frwin T. “The Physician and Fluoridation: A Summary of Reseaich Find- ings, Social Science Program, Harvard School of Public Health, (August, 1060).

Sanders, Irwin T. “The Stages of a Community Controversy: The Case of Fluorl- dation,” Journal of Social r m e s , Vol. XVII, No. 4, (1961).

Sanders, Irwin T. “The Dentist m d Fluoridation: Siunmary of Research Findings,” Social Science Program, Harvard School of Public Health, (October, 1959)

Sinimel, Arnold. “A Signpost for Rebearch on Fluoridation Conflicts: The Concept of Relative Deprivation,” Journal of Social Issues, Vol. XVII, No. 4, (19GI).

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NEW HORIZONS IN SCHOOL HEALTH SERVICES: THE COMPUTER

STEPHEN M. SCHNEEWEISS Assistant Professor, Health Education, Ithaca College

ADDISON LOCKE Data Processing Manager, I thaca College

AND

Piled high in basements of thousands of high schools, standing niute testimony to millions of hours of manual labor, lie numerous school health records. At a time when our nation’s educational need is at its greatest, when we are doubling class sizes, tripling school sessions and making gal- lant efforts to upgrade education on all levels, there stands testimony to a waste of valuable time. Skilled teachers, school doctors, school nurses, clerical help and large sums of money were invested in an effort which did not provide a full return for the investment made.

Most enlightened educators will agree with the need to niaintain health records for our students. Solnewhere in the past educators came to understand the value of health records as an aid to learning. Pefore proceeding further let us briefly review why me maintain such records:

Health records and the statistics collected from them help edu- cators plan health education curriculums. Health records enable the school to provide examining physicians with a past history of a student. Health records aid the school psychologist to understand better a child’s mental health in the light of his physics1 condition.

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