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Title: The effectiveness of community milk fluoridation schemes in England
Author: Foster, Geraldine R. K.
ISNI:       0000 0004 2677 2914
Awarding Body: The University of Manchester
Current Institution: University of Manchester
Date of Award: 2009
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Aim: To investigate the effectiveness of and views on school milk fluoridation schemes in England. Method: The impact of process variables on the effectiveness of milk fluoridation (MF) schemes, in terms of caries reduction, was investigated using a modelling approach. Water fluoridation was used as a surrogate for a notional, ideal MF scheme in which no process variables operate to reduce effectiveness. A predictive tool was developed to estimate the potential caries reduction of water fluoridation and then used to estimate caries reduction for a typical MF scheme with process variables. Data on process variables in MF schemes, which included parental consent, loss of children from the scheme, absence rate, number of days milk was consumed and the daily volume children drank, were collected and sensitivity analysis used to model the caries reduction compared with an ideal MF scheme and with water fluoridation. The effect of socio-economic status on some process variables was also investigated. The reasons why process variables impede the effectiveness of MF schemes and how best to reduce these effects were also investigated, by examining the perceptions and views of those involved in MF schemes on the barriers and potential solutions to optimizing these variables. Seventy two participants were interviewed using focus groups and one to one interviews. Thematic content analysis was used to analyze themes arising from interviews with health professionals. These themes were used to draft the preliminary topic guide for interviews with school participants. Analysis of the interview transcripts in the school setting was based on the grounded theory approach. Results and key findings: Process variables reduce the effectiveness of school MF schemes to 24% of an ideal MF scheme by the time children are 7 years old, and to 12% by the age of 11 years. The modelled relative improvement in caries experience in a typical MF scheme was 2.0% (0.48% absolute improvement in caries free) in the permanent dentition at age 11 years. Some potential solutions to optimizing process variables in MF schemes were identified. The emerging theory was the need for engagement with the MF scheme in schools for optimizing process variables using a whole school approach. However, there are significant barriers to optimal performance, not easily amenable to change. Conclusions: Modelling suggests that under the present implementation arrangements, there is significant cause for concern about the effectiveness ofMF schemes. Engagement in MF schemes using a whole school approach is a potential solution for optimizing performance. However barriers outside the influence of schools and peTs may mean that MF schemes are seriously flawed as a public health intervention delivered in schools. A health economic evaluation is needed to compare MF schemes with alternative caries prevention interventions in the school setting before a large amount of resources is put into trying to address these issues.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available