|Year : 2019 | Volume
| Issue : 2 | Page : 61-65
Parental perceptions and drinking water source among pediatric population in the United Arab Emirates
Tarun Walia1, Carel Brigi2, Ruba Odeh2, Ban Hisham Maree3, K Ruaa Yarub4
1 Department of Growth and Development, College of Dentistry, Ajman University, Ajman, United Arab Emirates
2 Department of Research Assistant, College of Dentistry, Ajman University, Ajman, United Arab Emirates
3 Al Sultan Medical Center, Dubai, United Arab Emirates
4 HMRT Clinic, Dubai, United Arab Emirates
|Date of Web Publication||29-Apr-2019|
Department of Growth and Development, College of Dentistry, Ajman University, Ajman
United Arab Emirates
Source of Support: None, Conflict of Interest: None
Aims: The aim of the study is to determine the water source used for drinking and cooking purpose by the pediatric population in the United Arab Emirates (UAE). To ascertain the underlying factors influencing the parental choice for selecting tap water or bottled water. The study was also done to evaluate whether demographic factors have an influence on the parental choice of water consumption source.Materials and Methods: A total of 200 parents who had children aged between 3- and 15-year-old were chosen for this randomized cross-sectional study. The parents of the selected children were given a prewritten questionnaire consisting of 12 questions in four different languages. The questionnaires documented sociodemographic characteristics, water consumption practices, and the rationale for choosing bottled water and tap water. The responses were analyzed using descriptive statistics and a Chi-square test for a single proportion. Results: Majority of the parents in this study preferred bottled water to tap water for drinking and cooking purposes. About 84% of the parents opted bottled water for drinking and 57% selected bottled water for cooking at home. The consumption of tap water for drinking purpose from school and home was only 13% and 16%, respectively. Parental educational background and household income did not affect their selected source of water. A Chi-square test of independence conducted to investigate possible association between source of water and its purpose for drinking and cooking revealed that the source of water (tap/bottled water) was dependent on its purpose. Conclusion: A greater percentage of the UAE pediatric population utilized bottled water for drinking at school and home. The perceptions about the quality and safety of tap water had a great effect on the caregiver's choice on children's water consumption habits. The demographic factors such as socioeconomic status and parental education had no influence on the source of water used for drinking purpose.
Keywords: Bottled water, pediatric population, United Arab Emirates
|How to cite this article:|
Walia T, Brigi C, Odeh R, Maree BH, Yarub K R. Parental perceptions and drinking water source among pediatric population in the United Arab Emirates. J Int Oral Health 2019;11:61-5
|How to cite this URL:|
Walia T, Brigi C, Odeh R, Maree BH, Yarub K R. Parental perceptions and drinking water source among pediatric population in the United Arab Emirates. J Int Oral Health [serial online] 2019 [cited 2019 Jul 16];11:61-5. Available from: http://www.jioh.org/text.asp?2019/11/2/61/257358
| Introduction|| |
Dental caries in children persist as a significant dental public health concern in the United Arab Emirates (UAE) as per the current statistics.,, The World Health Organization 2000 goals are not yet fulfilled for UAE pediatric population, and the prevalence of dental caries is increasing with no evidence of decline. The decayed, missing and filled primary teeth range was 5.1–8.4 for children aged between 4 and 6 years old with the prevalence ranging between 73% and 95%., Several caries risk factors such as poor oral hygiene, decreased fluoride exposure, lower socioeconomic status, frequent snacking, and reluctance for routine dental checkup have been associated with high dental caries score.,
Water is an important source of fluoride. The efficacy of community water fluoridation in preventing dental caries is well documented in scientific literature. While promoting the fluoride exposure to reduce the dental caries, excess fluoride exposure must also be avoided to prevent the risk of fluorosis., The recommended optimal fluoride concentration for dental caries prevention varies from 0.7 to 1.2 part per million (ppm), based on the temperature and quantity of water intake in that region.,, Therefore, it is imperative that drinking water has precise amount of fluoride levels.
In a modern present-day society, the most common alternative to community drinking water is perhaps bottled water. Currently, bottled water constitutes one of the rapidly growing drinks markets in the world with recent studies showing it could surpass soft drinks and turn into the biggest beverage category. The annual report of 2015 on bottled water consumption for the US residents was 44.3 billion liters. This indicates an increase of ≥47% compared to 2005 water consumption level. This present trend of water consumption behavior is influenced by circumstantial and psychological factors., The circumstantial factors are high salary, living in an densely populated area, and families having children below 5 years of age., Psychological factors are subjective characteristics which influence an individual's perception. They include being skeptical about tap water quality due to the presence of chlorine, fluoride, and lead, and certainty that bottled water contains minerals which have health benefits.,, In addition, evidence also suggests that the decision to substitute tap water with bottled water are from lack of belief in the local corporation responsible for community water supply.,
This similar trend of pursuing alternatives to tap water can also be observed among the UAE population. Bottled water consumption among UAE residents is 37.3 gallons per person when compared to the global average of 9.9 gallons per person. The concentration of fluoride in bottled water in majority of countries including UAE has been consistently reported to be suboptimal level which may have ramifications on the prevention of caries., Besides that, the manufacturers of bottled water are not required to add fluoride in drinking water as per law in UAE. Therefore, it is essential to determine the primary source of drinking water among UAE children as it serves as an important data for caries risk assessment and patient counseling.
The present study was conducted to determine (i) source of water consumption among UAE pediatric population; (ii) the rationale for selecting bottled water and tap water; and (iii) if socioeconomic factors and educational backgrounds are associated with the parental choice of drinking water.
| Materials and Methods|| |
This randomized cross-sectional study included 200 parents who had children aged between 3- and 15-year-old and had been residing in UAE for more than a year. Children with a history of any systemic disease were excluded. The ethical approval was obtained from Research Ethical Committee, College of Dentistry (COD), and Ajman University (AU) with the certificate number as GD-2015/16-08. Parents were informed that participation in this study was voluntary. Before participation, an informed consent from the parents and an assent from children were taken. Parents who had been waiting for their children to be seen for a dental examination at dental clinic, COD, and AU were invited to participate in a brief interview regarding the source of their children's drinking water.
The study was formulated according to the methods followed by Sriraman et al. 2009 on drinking water source in children and universally accepted questionnaire on drinking water sources was used for this study., The specially designed questionnaire [Figure 1] consisted of 12 questions in multiple languages (Arabic, English, Farsi, and Urdu). Initially, a small pilot study including five participants was conducted to note any clarifications and doubts. Following the pilot study, the questionnaire was finalized and given to the parents of the selected 200 participants. The questionnaire requested information on sources of water that their children consumed at home, school, or any other public premises. Participant's residing emirate, parental income, and educational qualification were also recorded. Parents were allowed to select ≥1 response if required. The results were evaluated by two researchers and all the participants' data were deidentified and kept by one of the researchers in a secure location.
The results were analyzed using descriptive statistics. Chi-square test of independence was done to investigate the possible association between the source of water and its purpose. The software used for statistical analysis in this study was Statistical Package for Social Sciences (SPSS, versions 20.0. (IBM Corp., Armonk, NY, USA) for Windows).
| Results|| |
The mean age of the children in this study group was 9 years, and the mean duration of residence for the participants in UAE was 7.1 years. The study population consisted of 43% participants from Ajman, 32% from Sharjah, and the rest from other emirates. About 55% of parents had a university degree and 62% of respondents among them choose bottled water for their children at home. Bottled water consumption at school was slightly higher at 65% for children whose parents were graduated or above. Majority of families in this study (around 70%) had monthly income of Arab Emirates Dirham 5000 or above, and almost all of them in this income consumed bottled water [Table 1].
|Table 1: Source of drinking water at homes and schools with the demographic details|
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Among the 200 participants, 84% selected bottled water and 16% chose tap water for drinking purpose at home. At school, the primary source of drinking water was also bottled water for 87% of participants and 13% of children drank tap water. Concerning the consumption of tap water used for cooking purpose, 30% utilized filtered and 12.6% used unfiltered tap water. Majority of the parents (86%) used bottled water for their children when they visited outdoor places such as parks, malls, and shopping centers [Table 2]. Minority of the participants consisting of 14% consumed tap water from public places.
A Chi-square test of independence was conducted to examine the relation between the source of water and its purpose. The relation between these variables was significant, χ2 (6, n = 200) = 70.18, P < 0.05. The statistical results concluded that the source of water (tap/bottled water) was dependent on the purpose of water used for drinking and cooking. The parents in this study showed less preference to utilize tap water for drinking and cooking purposes compared to bottled water.
The results showed that out of the 84% parents who choose bottled water of drinking, 38% classified tap water as either not clean or contaminated, while 46% of the participants believed that bottled water was healthy and/or had more minerals. About 16% of participants used bottled water only due to the reason that majority of the UAE residents preferred to use this mode of water consumption [Figure 2]. However, out of the 16% of the parents who consumed tap water, 56% believed that it was clean and not contaminated, and 35% selected this source due to its ease of availability [Figure 3].
|Figure 2: The rationale for choosing bottled water. *46% of parents considered bottled water to be healthy and 16% preferred this source because bottled water was the most preferred one among UAE population|
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|Figure 3: The rationale for choosing tap water. *56% of parents who chose tap water believed it to be clean and decontaminated and 9% assumed that tap water was cheap|
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| Discussion|| |
The outcome from this cross-sectional study indicated that a relatively higher proportion of pediatric population consumed bottled water at school and home. The percentages of bottled water consumption in school were slightly higher than at home due to lack of trust in the source of drinking water in school. Recent studies conducted among UAE children have shown that the prevalence of early childhood caries is high indicating a greater need for community preventive programs.,, Bottled water in UAE contains <0.1 ppm of fluoride compared to the fluoride content of bottled water worldwide from 2000 to 2010.,, Consequently, a larger percentage of children in this study who had used bottled water for drinking at school and home might not receive the anti-caries benefits of fluoride in drinking water. However, dental caries being a multifactorial disease, there is no definitive evidence of an association with increased dental caries and lack of fluoride exposure.,,
The statistical outcome from this study indicated that a relatively higher percentage of the pediatric population consumed bottled water as a primary source of water for drinking at schools, home, and outdoor places. A Chi-square test of independence conducted clearly revealed that the choice of water used for drinking or cooking was depended on the source (bottled/tap water). The tap water in the UAE has a fluoride concentration varying from 0.04 to 0.3 mg F/L. A limited percentage of the participants in this study has opted for filtered tap water at home for the purpose of drinking and cooking. These filtration processes might remove the existing or added fluoride in the tap water when reverse osmosis or distillation water filters are used, whereas carbon filters models of water filtration system retain the fluoride content.,, Therefore, the minor population of this study who had opted filtered tap water for drinking and cooking purpose also might not receive the anti-caries benefits of fluoride. Parents avoided tap water because it was perceived as contaminated and bottled water was considered healthy and safe. On the other hand, a smaller percentage of the participants who had selected unfiltered/filtered tap water presumed that tap water was economical, clean, and decontaminated. All these outcomes from the present study indicate that a growing population in UAE opts to drink water from sources alternative to tap water. This finding was consistent with the study conducted by Maraqa and Ghoudi 2015 which ascertained the perception of tap and bottled water quality in UAE. Their survey revealed that respondents preferred bottled water to tap water as bottled water had a better taste and the participants were concerned about tap water contamination.
Another important observation in the present study noted was that the parent's educational background, household income, and demographic details had no much influence on the source of water used for drinking. These findings were in contrast to the studies conducted by Castaño-Vinyals et al. 2011, Chen et al. 2012, and Johnstone and Serret 2012, they concluded that social economic status and educational background played a crucial role on individual's source of drinking water. An increased bottled water consumption was seen among families with high household income and educational background in all these studies.,, An increased bottled water consumption in the current study might have occurred because the base price of bottled water in UAE is one of the lowest in the world as compared to the tap water making it affordable for drinking and cooking purposes.
Parents in the UAE should be educated about the general benefits of fluoride and specific benefits of water fluoridation in lowering dental caries risk. Aside from fluoridated water, the overall fluoride consumption from other dietary source of fluoride must also be evaluated. However, the source of drinking water whether fluoridated/nonfluoridated would provide a valuable data point for dental practitioners in judiciously prescribing fluoride supplements or other modalities., In addition, the observations from this study might also aid the local authorities in the UAE to understand the significance of fluoride concentration in bottled and tap water in reducing the incidence of dental caries in children.
The limitations in this study were single location, small suitable sample, and lack of range in socioeconomic status, and the responses regarding other fluoride supplements were not assessed. Future studies representative of the overall population will further clarify the trends in pediatric water consumption source among UAE population.
| Conclusion|| |
This study provided an empirical evidence of the children in UAE utilizing bottled water for drinking purposes at home and school. The primary reason for the high consumption of bottled water was the parent's assumption that it was healthy and safe for consumption in comparison to tap water. Demographic elements such as socioeconomic status and parental educational background had no effect on their choice of water consumption source.
Written informed consent from patient guardian were taken who voluntarily taken part in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Al-Bluwi GS. Epidemiology of dental caries in children in the United Arab Emirates. Int Dent J 2014;64:219-28.
Hashim R, Williams S, Thomson WM. Severe early childhood caries and behavioural risk indicators among young children in Ajman, United Arab Emirates. Eur Arch Paediatr Dent 2011;12:205-10.
Hashim R, Williams SM, Murray Thomson W. Diet and caries experience among preschool children in Ajman, United Arab Emirates. Eur J Oral Sci 2009;117:734-40.
Al Ayyan W, Al Halabi M, Hussein I, Khamis AH, Kowash M. A systematic review and meta-analysis of primary teeth caries studies in Gulf Cooperation Council States. Saudi Dent J 2018;30:175-82.
Anil S, Anand PS. Early childhood caries: Prevalence, risk factors, and prevention. Front Pediatr 2017;5:157.
Fontana M, Gonzalez-Cabezas C. Evidence-based dentistry caries risk assessment and disease management. Dent Clin North Am 2019;63:119-28.
Radfard M, Rahmatinia M, Akbari H, Hashemzadeh B, Akbari H, Adibzadeh A. Data on health risk assessment of fluoride in water distribution network of Iranshahr, Iran. Data Brief 2018;20:1446-52.
Recommendations for using fluoride to prevent and control dental caries in the United States. Centers for disease control and prevention. MMWR Recomm Rep 2001;50:1-42.
Sriraman NK, Patrick PA, Hutton K, Edwards KS. Children's drinking water: Parental preferences and implications for fluoride exposure. Pediatr Dent 2009;31:310-5.
U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. public health service recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Rep 2015;130:318-31.
Mirzabeygi Rad Fard M, Yousefi M, Soleimani H, Mohammadi AA, Mahvi AH, Abbasnia A. The concentration data of fluoride and health risk assessment in drinking water in the Ardakan city of Yazd province, Iran. Data Brief 2018;18:40-6.
McLaren L, Patterson S, Thawer S, Faris P, McNeil D, Potestio ML, et al.
Exploring the short-term impact of community water fluoridation cessation on children's dental caries: A natural experiment in Alberta, Canada. Public Health 2017;146:56-64.
Allen MW. Human values and product symbolism: Do consumers form product preference by comparing the human values symbolized by a product to the human values that they endorse? J Appl Soc Psychol 2002;32:2475-501.
Etale A, Jobin M, Siegrist M. Tap versus bottled water consumption: The influence of social norms, affect and image on consumer choice. Appetite 2018;121:138-46.
Dolnicar S, Hurlimann A, Grün B. What affects public acceptance of recycled and desalinated water? Water Res 2011;45:933-43.
Ross VL, Fielding KS, Louis WR. Social trust, risk perceptions and public acceptance of recycled water: Testing a social-psychological model. J Environ Manage 2014;137:61-8.
Johnstone N, Serret Y. Determinants of bottled and purified water consumption: Results based on an OECD survey. Water Policy 2012;14:668-79.
Yoo S, Yang C. Dealing with bottled water expenditures data with zero observations: A semiparametric specification. Econ Lett 2000;66:151-7.
Doria MF. Bottled water versus tap water: Understanding consumers' preferences. J Water Health 2006;4:271-6.
Saylor A, Prokopy LS, Amberg S. What's wrong with the tap? Examining perceptions of tap water and bottled water at Purdue University. Environ Manage 2011;48:588-601.
Harmon D, Gauvain M, Reisz Z, Arthur I, Story SD. Preference for tap, bottled, and recycled water: Relations to PTC taste sensitivity and personality. Appetite 2018;121:119-28.
Shomar B, Hawari J. Desalinated drinking water in the GCC countries – The need to address consumer perceptions. Environ Res 2017;158:203-11.
Abouleish MY. Evaluation of fluoride levels in bottled water and their contribution to health and teeth problems in the United Arab Emirates. Saudi Dent J 2016;28:194-202.
Jain RB. Concentrations of fluoride in water and plasma for US children and adolescents: Data from NHANES 2013-2014. Environ Toxicol Pharmacol 2017;50:20-31.
Walia T, Abu Fanas S, Akbar M, Eddin J, Adnan M. Estimation of fluoride concentration in drinking water and common beverages in United Arab Emirates (UAE). Saudi Dent J 2017;29:117-22.
Vandevijvere S, Horion B, Fondu M, Mozin MJ, Ulens M, Huybrechts I, et al.
Fluoride intake through consumption of tap water and bottled water in Belgium. Int J Environ Res Public Health 2009;6:1676-90.
Elamin A, Garemo M, Gardner A. Dental caries and their association with socioeconomic characteristics, oral hygiene practices and eating habits among preschool children in Abu Dhabi, United Arab Emirates – The NOPLAS project. BMC Oral Health 2018;18:104.
Hashim R, Thomson WM, Ayers KM, Lewsey JD, Awad M. Dental caries experience and use of dental services among preschool children in Ajman, UAE. Int J Paediatr Dent 2006;16:257-62.
Kowash MB, Alkhabuli JO, Dafaalla SA, Shah A, Khamis AH. Early childhood caries and associated risk factors among preschool children in Ras Al-Khaimah, United Arab Emirates. Eur Arch Paediatr Dent 2017;18:97-103.
Victory KR, Cabrera NL, Larson D, Reynolds KA, Latura J, Thomson CA, et al.
Comparison of fluoride levels in tap and bottled water and reported use of fluoride supplementation in a United States-Mexico Border Community. Front Public Health 2017;5:87.
Aldrees AM, Al-Manea SM. Fluoride content of bottled drinking waters available in Riyadh, Saudi Arabia. Saudi Dent J 2010;22:189-93.
Zhang Y, Wang X, Li H, Ni C, Du Z, Yan F. Human oral microbiota and its modulation for oral health. Biomed Pharmacother 2018;99:883-93.
Wong A, Subar PE, Young DA. Dental caries: An update on dental trends and therapy. Adv Pediatr 2017;64:307-30.
Broffitt B, Levy SM, Warren JJ, Cavanaugh JE. An investigation of bottled water use and caries in the mixed dentition. J Public Health Dent 2007;67:151-8.
Brown MD, Aaron G. The effect of point-of-use water conditioning systems on community fluoridated water. Pediatr Dent 1991;13:35-8.
Jobson MD, Grimm SE 3rd
, Banks K, Henley G. The effects of water filtration systems on fluoride: Washington, D.C. metropolitan area. ASDC J Dent Child 2000;67:350-4, 302, 304.
Konno H, Yaegaki K, Tanaka T, Sato T, Itai K, Imai T, et al.
Neither hollow-fibre membrane filters nor activated-charcoal filters remove fluoride from fluoridated tap water. J Can Dent Assoc 2008;74:443.
Maraqa MA, Ghoudi K. Survey of public attitude towards bottled and tap water quality in the UAE. Global Nest J 2015;17:607-17.
Castaño-Vinyals G, Cantor KP, Villanueva CM, Tardon A, Garcia-Closas R, Serra C, et al.
Socioeconomic status and exposure to disinfection by-products in drinking water in Spain. Environ Health 2011;10:18.
Chen H, Zhang Y, Ma L, Liu F, Zheng W, Shen Q, et al.
Change of water consumption and its potential influential factors in Shanghai: A cross-sectional study. BMC Public Health 2012;12:450.
Jadav UG, Acharya BS, Velasquez GM, Vance BJ, Tate RH, Quock RL. Sources of drinking water in a pediatric population. Pediatr Dent 2014;36:474-7.
Horst JA, Tanzer JM, Milgrom PM. Fluorides and other preventive strategies for tooth decay. Dent Clin North Am 2018;62:207-34.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]