People in this rural Latino community use bottled or commercially filtered water in preference to the much cheaper, more easily accessible municipal tap water. This is largely because the poor organoleptic qualities of the tap water (i.e., bad taste, cloudy appearance, unpleasant smell) established and maintained basic beliefs in the lack of safety of the water supply.
These water consumption patterns reflect previous research on oral health topics in this rural community and beyond. For example, during interviews with 47 primary caregivers of children under age 5, participants consistently commented that their children consumed bottled or commercially filtered water [24
]. Many of these caregivers also expressed a belief that the local municipal water supply was unsafe. A population-based epidemiologic survey of adult and child oral health status (Mejia et al., 2009, unpublished observations) also revealed a high level of consumption of water from commercial filtration sites or water mills. When asked what kind of water was given to their children to drink, virtually all (99%) of the 178 adults in the 134 households surveyed reported that they purchased filtered water or water from water mills. Ironically, these mills treat the municipal water using reverse osmosis, so any naturally occurring or added fluoride in the water is removed. The remaining one percent of adults reported using bottled water.
Similar findings regarding aversion to consumption of bad tasting, cloudy water have been widely reported in the literature for the population at large [10
] and specifically for Latinos [9
]. Beliefs about water making consumers sick, especially children who are said to be more vulnerable than adults, have also been previously reported [14
]. The same study found that Latino parents were less likely to give tap water to their children than non-Latino parents and more likely to believe tap water would make their children sick [14
Lack of trust in the public water has important implications for adequate fluoride exposure, especially for populations who experience high rates of dental caries. In this study, the majority of residents avoided drinking unfiltered tap water because of a historically justified and collectively transmitted belief that the public water supply is of poor quality. At the same time, they believed that water is the best beverage to drink, so they turned to bottled water. However the bottled or commercially filtered water available in this and many other communities generally lacked an optimal level of fluoride [8
Foul-tasting water does not necessarily indicate water that is unsafe to drink; nor does clear water with a pleasant taste necessarily indicate that it is safe [12
]. Beside the taste, color or odor of the water supply, however, people in this and other communities generally have few other experiential or easily understood or accessible resources to indicate water safety. Nor do they necessarily trust official reports or interpretations of water quality data, especially when these appear to reach conclusions opposite to their experiences [1
]. The Environmental Protection Agency, which regulates water quality in the U.S., has a primary list of 93 chemical and 11 microbiologic factors that are known to affect public water safety and that must be tested for, with results reported annually [12
]. Organoleptic and other qualities that do not affect safety of municipal water supplies, however, are on a list of secondary qualities that are not mandatory to either test for or report.
Printed reports on water safety and quality in this community were easily available only to homeowners but not renters. Reports are available publicly in both English and Spanish on the city’s official website. Few local residents, however, have access to computers. Moreover, even if these reports were more widely disseminated among the populace, the findings would remain inaccessible to many local residents most of whom have less than a high school education and are either basically literate only in Spanish or unable to read.
Despite the region’s naturally high fluoride level in the water, it was challenging for the population to achieve adequate fluoride exposure from this source. Most study participants said they would be willing to increase their children's fluoride intake if needed, but several individuals Said the use of fluoride drops or tablets were problematic. People preferred fluoride to be available through a cheap, easily accessible, improved municipal water supply rather than other means. In this location and similar communities, however, the community’s deep concern about the safety of tap water informed their water consumption practices and their willingness to drink fluoridated tap water.
Findings from this study indicate that building trust in the municipal water supply – within the study community and in similar communities elsewhere [14
] – needs to focus on effective ways of disseminating information, taking into account the ways the population will be most likely to receive and understand this information. For example, in many rural and urban communities with large Spanish-speaking populations, there could be wide distribution of official reports about water quality in the Spanish language on a regular basis – e.g., mailings to every household in the city, public service announcements on Spanish-language radio or television, and news items in Spanish-language newspapers.
Limitations of this study are its single location, small convenience sample and lack of diversity in terms of socioeconomic status, occupational background of participants, and history of water quality deficits. Moreover, its focus is on rural Latinos, just one of several minority populations experiencing disproportionately high rates of caries compared to the U.S. general population. Conducting this study in urban areas or in different regions, with other minority or other Latino sub-populations, or in locations with a different history of water quality issues could produce different results.
Nonetheless, these findings are consistent with previous research in this population group and others in the U.S. as well as in other countries [10
]. Generally, findings point clearly to the ways in which people’s beliefs and perceptions shape their subsequent behaviors. By documenting the connections between bottled water usage and beliefs about water quality, and showing how beliefs and experiences shape water consumption practices, the findings indicate issues and implications for oral health that extend beyond the study. of ensuring optimal fluoride exposure will not suffice, especially in vulnerable and low-income communities whose members may trust direct experience more than technical information they cannot access or understand. Characteristics of the water supply that are secondary in terms of ensuring its official safety but that are primary in establishing its acceptability and consumption by the populace – i.e., water’s organoleptic qualities – must be addressed. In vulnerable populations, abstract, technical reports of water safety have not only to be believed and trusted but matched or superseded by experience before meaningful change will occur in people’s water consumption habits.