The purpose of this study was to analyze the factors influencing a school-based fluoride mouthrinse program (FMR) in the community. Subjects in this study were 112 municipalities and 742 primary schools in Niigata prefecture, and the period was 17 years from 1970 to 1986. There were three levels of factors: A, factors at the level of a municipality; B, factors at the level of a primary school; and C, factors at the level of a prefecture. A multivariate analysis was performed using many sociological items, such as attitudes of municipality officials toward introducing FMR, characteristics of the community, etc.
The results were as follows;
A: Factors at the level of the municipality. Eight of 48 items were significant in a stepwised multiple regression analysis (stMRA). The influential power of these factors was estimated from the magnitude of the absolute value of the partial correlation coefficient. It became clear that three kinds of attitude (those of the division of health, the board of education, and the dentists) were especially important factors for spreading FMR. It was also found that FMR was spread relatively easy in municipalities where dentists eagerly promoted dental health.
B: Factors at the level of the primary school. (1) Factors influencing the spread of FMR: Three of 13 items were significant in the stMRA. The attitudes of school personnel were most important and FMR was carried out relatively easily in towns and villages, especially in remote places. Community size was related to the spread of FMR, because agreement to FMR was obtained easily in those schools where the number of personnel was small, and parents in such a school tended to have much demand for dental health. (2) Factors influencing continuation of FMR: Four of 15 items were significant in the stMRA. Information regarding continuation or discontinuation of FMR in neighboring schools had influence on the school. (3) Factors influencing the percentage of children participaing in FMR: Only one of 15 items were significant in the stMRA. This item was the size of the school. The percentage of children had a tendency to be smaller in large schools. Maintenance of FMR in large schools was not so easy, because of the difficulty of obtaining consensus among school personnel. In the other hand, despite many antifluoride articles in newspapers and the antiflu oride movement, almost all parents (>95%) continuously allowed their children to take part in FMR. However, negative information from the mass media or others occasionally caused school personnel to decide to discontinue FMR.
C: Background Factors at the level of the prefecture. In this analysis, 742 schools were classified into 4 groups based on the possibility of beginning FMR by means of discriminant analysis using the items mentioned above. Spreading of FMR in Niigata prefecture had distinctive pattern during the period of this study. Background factors influenced factors at the levels of the municipality and the school. In the early stage, many schools took part in FMR. Promoters were a school of dentistry, a private promotive organization and the prefectural dental association. In the next stage (1976-1980), the number of schools starting FMR leveled off. It seemed that much negative information from newspapers influenced the attitudes of the persons concerned. In the later stage (1981-), the main promoter was the prefectural administration, strengthening enlightenment, and even of schools which seemed to have little probability, about 20% took part in FMR.
In conclusion, when dental health programs are planed, importance must be given to promote attitudes and to obtain a consensus of the persons concerned. In addition, the promoter needs to cope with the mass media, and to analyze many characteristics of the community.
