Abstract
Despite attention paid to parental refusal of child vaccines, the phenomenon of topical fluoride refusal is poorly understood. We examine the extent to which parent attitudes and Internet use regarding topical fluoride treatment and vaccines may overlap and, in turn, uniquely or distinctly correlate with fluoride and vaccine refusal for the child. In 2017, we analyzed data collected from 2011 to 12 for 361 children from three Washington state dental clinics. The instrument included analogous measures of topical fluoride and vaccine safety concerns, perceived severity of preventable cavities/disease, and Internet use for fluoride/vaccine information; and measures of non-fluoridated toothpaste use, attitudes towards dental x-rays and amalgam and composite fillings. We assessed dental chart-based topical fluoride refusal occurring in 2009 or 2010 and parent-reported vaccine refusal. All analogous fluoride and vaccine items were substantively correlated. However, in a series of adjusted models, none of these items were significantly associated with fluoride refusal. Multiple fluoride and vaccine items were associated with vaccine refusal in unadjusted models; but only vaccine safety concerns, perceived severity of a preventable cavity, and Internet use for vaccine information remained significant in adjusted models. Although there is concordance between the two refusal behaviors as well as analogous attitudes and Internet use, these findings challenge the idea that fluoride refusal should be addressed with interventions focusing on vaccine refusal. Further research is required on the factors underlying refusal of preventive dental care.
Highlights
Vaccine-preventable disease outbreaks in the US and internationally have led to increased attention towards understanding and addressing vaccine hesitancy among parents
Recent evidence indicates that vaccine refusal correlates with topical fluoride treatment, a type of preventive dental care regularly provided at a dental office and offered at medical clinics (Chi, 2014)
Our findings indicate that (a) correlations between topical fluoride- and vaccine-specific concern, disease severity, and Internet-based information-seeking show evidence of converging constructs; (b) topical fluoride-related items are only predictive of vaccine refusal and these associations are mostly explained by their correlation with vaccine-related factors
Summary
Vaccine-preventable disease outbreaks in the US and internationally have led to increased attention towards understanding and addressing vaccine hesitancy among parents. Numerous studies have identified how health attitudes, norms, and behaviors cluster and constitute individualistic and collective health lifestyles (Abel, 1991; Cockerham, 2005; Slater and Flora, 1991), yet little attention has been paid to how vaccination attitudes and refusal potentially cluster with other health domains. Such clustering may reflect more latent orientations towards treatments viewed as more “natural” and safer; or even broader dimensions of parenting, including “intensive parenting” practices that heavily emphasize managing a child's potential health and developmental risks (Reich, 2016). The extent to which refusal of these two types of preventive care reflect common attitudes and behaviors is unclear
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