The U.S. Public Health Service recommends multivitamins or another daily supplement that contains folic acid for all women who may become pregnant. Folic acid has been shown to reduce the occurrence of neural tube defects, which affect about 4,000 pregnancies and 2,500 to 3,000 births in the United States each year.
"But most women of childbearing age in the United States do not take a vitamin containing folic acid regularly," say Jean M. Lawrence, Sc.D., M.P.H., M.S.S.A., of Kaiser Permanente Southern California and colleagues, who carried out the study in a group of 3,438 Kaiser Permanente members.
One intervention relied on physicians and other health care professionals to discuss the importance of taking a multivitamin with their patients and to distribute educational pamphlets about the benefits of folic acid. In the second intervention, 50,000 women were mailed a "starter kit" of 100 multivitamins and an educational pamphlet, and pharmacies in their area offered a free refrigerator magnet with the women's' next vitamin purchase.
There was no significant long-term change in vitamin use in either group, although the women who received the multivitamins directly did briefly increase their vitamin use for a short period during the study.
However, the researchers did a follow-up survey of the participating health care professionals and found little support for the interventions, suggesting that they may not have been fully implemented.
"Despite extensive training of staff and repeated reminders from a full-time intervention coordinator to implement the interventions, half of the physicians and other health care professionals who responded to the survey said that they rarely or never gave out the study brochure or informational tear sheets to their patients, and an additional 12 percent said that they did not know about the materials," Lawrence says.
"The success of the provider education intervention was dependent on changing the behavior of both the individual member and the individual health care provider. Doing both things simultaneously is clearly a major challenge and was not accomplished by this intervention," she adds.
Only 30 percent of the pharmacists who responded to the follow-up survey said they spent at least 30 seconds discussing vitamins with a customer, while 12 percent said the refrigerator magnet encouraged new vitamin sales.
"More studies are needed to identify successful ways to increase the use of vitamins containing folic acid among women who may become pregnant, and to determine what proportion of neural tube defects occurs from inadequate folic acid consumption since the U.S. food supply was fortified with folic acid in 1998." Lawrence says.
The study was supported by the Centers for Disease Control and Prevention.
BY BECKY HAM, STAFF WRITER
HEALTH BEHAVIOR NEWS SERVICE
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