Knowledge and use of folic acid among college women: a pilot health promotion program led by pharmacy students and faculty
As pharmacists and pharmacy students are increasingly called upon to assume roles in public health activities, it is important to recognize unique opportunities to educate community members on health, wellness, and disease prevention.
Objective: To evaluate the impact of a pilot health promotion program on college women’s knowledge regarding folic acid and prevention of neural tube defects (NTD) and frequency of multivitamin use.
Methods: A health promotion program was developed by a pharmacy student and two pharmacy faculty members that included an oral presentation and reminder messages. A multiple-choice test assessing knowledge of folic acid and NTD and frequency of multivitamin use was given to participants before and immediately after the presentation. Participants then received a reminder message regarding folic acid once a week for three weeks. Knowledge and multivitamin use were re-assessed four weeks post-intervention.
Results: Thirty-two college women voluntarily attended the oral presentation. Twenty-five women (78.2%) completed the four-week post-test. Compared to the pre-test, there were statistically significant increases in average test score (p<0.0001) and correct responses to questions regarding folic acid and NTD (p<0.05 for each question). Participants reported a statistically significant increase in regular (≥4 times/week) multivitamin use (p=0.023).
Conclusion: Participants in the pilot health promotion program demonstrated a statistically significant increase in knowledge about folic acid and frequency of multivitamin use. A similarly-modeled health promotion program may be an effective way of increasing folic acid and NTD knowledge and changing behaviors of multivitamin use in college women.
2. American Public Health Association. The role of the pharmacist in public health. [Internet] Washington, DC: American Public Health Association; [updated 8 Nov 2006; cited 25 Nov 2008]. Available from: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1338
3. American Society of Health-Systems Pharmacists. Statement on the role of health-system pharmacists in public health. Am J Health-Syst Pharm. 2008;65(5):462-467.
4. American Pharmacists Association. The role of pharmacists in public health awareness. Adopted Policy Statements 1963-2007.
5. Calis KA, Hutchison LC, Elliott ME, Ives TJ, Zillich AJ, Poirier T, Townsend KA, Woodall B, Feldman S, Raebel MA. Healthy People 2010: challenges, opportunities, and a call to action for America's pharmacists. Pharmacotherapy. 2004;24(9):1241-1294.
6. Babb VJ, Babb J. Pharmacist involvement in Healthy People 2010. J Am Pharm Assoc. 2003; 43(1):56-60.
7. International Pharmaceutical Federation (FIP), United Nations Educational, Scientific and Cultural Organization (UNESCO), and World Health Organization (WHO). Pharmacy Education Taskforce Action Plan 2008 – 2010, 28 January 2008.
8. Joint Commission on Pharmacy Practice. Future vision of pharmacy practice 2015. [Internet] Joint Commission on Pharmacy Practice [created 10 Nov 2004; cited 15 Feb 2009] Available from: http://www.pharmacist.com/
9. Healthy People Curriculum Task Force. Clinical prevention and population health curriculum framework. [Internet] Healthy People Curriculum Task Force. [updated Jan 2008; cited 25 Nov 2008] Available from http://www.atpm.org/resources/pdfs/Official_CPPH_Framework_2008.pdf
10. Center for the Advancement of Pharmaceutical Education. Educational outcomes 2004. [Internet] Center for the Advancement of Pharmaceutical Education. [updated May 2004; cited 25 Nov 2008] Available from: http://www.aacp.org/Docs/MainNavigation/Resources/6075_CAPE2004.pdf
11. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree. [Internet] Chicago (IL): Accreditation Council for Pharmacy Education. [Adopted: 15 Jan 2006; Effective: 1 Jul 2007; cited 25 Nov 2008]. Available from: http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf
12. Spina bifida [homepage on the Internet]. White Plains (NY): March of Dimes Foundation; c2009 [updated 2009 Aug; cited 2009 Aug 31]. Available from: http://www.marchofdimes.com/professionals/14332_1224.asp
13. Medical progress in the prevention of neural tube defects [homepage on the Internet]. Atlanta (GA): Centers for Disease Control and Prevention; [updated 2005 Jun 17; cited 31 Aug 2009]. Available from: http://www.cdc.gov/ncbddd/bd/mp.htm
14. Canfield MA, Honein MA, Yuskiv N, Xing J, Mai CT, Collins JS, Devine O, Petrini JR, Ramadhani TA, Hobbs CA, Kirby RS. National estimates and race/ethnic-specific variation of selected birth defects in the United States, 1999-2001. Birth Defects Res Part A Clin Mol Teratol. 2006;76(11):747-756.
15. Spina bifida [homepage on the Internet]. Atlanta (GA): Centers for Disease Control and Prevention; [updated 2009 Mar 11; cited 2009 Aug 31]. Available from: http://www.cdc.gov/ncbddd/birthdefects/SpinaBifida.htm
16. Centers for Disease Control and Prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR. 1992;41(No. RR-14)
17. Henshaw S. Unintended pregnancy in the United States. Fam Plann Persp. 1998; 30(24):9-46.
18. Institute of Medicine. Dietary reference intake: Folate, other B vitamins, and choline. Washington, DC: National Academy Press; 1998.
19. Food and Drug Administration. Food Standards: Amendment of standards of identify for enriched grain products to require addition of folic acid. Federal Register 1996;61:8781-8797.
20. Centers for Disease Control and Prevention. Spina bifida and anencephaly before and after folic acid mandate – United States, 1995-1996 and 1999-2000. MMWR. 2004;52:362-365.
21. Werler MM, Louik C, Mitchell AA. Achieving a public health recommendation for preventing neural tube defects with folic acid. Am J Public Health. 1999;89(11):1637-1640.
22. Oakley GP, Bell KN, Weber MB. Recommendations for accelerating global action to prevent folic acid-preventable birth defects and other folate-deficiency diseases: Meeting of experts on preventing folic acid-preventable neural tube defects. Birth Defects Res A Clin Mol Teratol. 2004;70(11):835-837.
23. Centers for Disease Control and Prevention. Use of supplements containing folic acid among women of childbearing age – United States, 2007. MMWR 2008;57:5-8.
24. Institute of Medicine. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington, DC: National Academy Press; 2000.
25. Folic acid [homepage on the Internet]. White Plains (NY): March of Dimes Foundation; c2009 [updated 2008 Dec; cited 2009 Aug 21]. Available from: http://www.marchofdimes.com/pnhec/173_769.asp\
26. Facts about folic acid [homepage on the Internet]. Atlanta (GA): Centers for Disease Control and Prevention; [updated 2009 Mar 31; cited 2009 Aug 21]. Available from: http://www.cdc.gov/ncbddd/folicacid/about.html
27. U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office; Nov 2000.
28. Gallup Organization and March of Dimes Foundation. Improving preconception health: women’s knowledge and use of folic acid. White Plains (NY): March of Dimes; Dec 2008.
29. Racette SB, Deusinger SS, Strube MJ, Highstein GR, Deusinger RH. Changes in weight and health behaviors from freshman through senior year of college. J Nutr Educ Behav. 2008;40(1):39-42.
30. Nelson MC, Larson NI, Barr-Anderson D, Neumark-Sztainer D, Story M. Disparities in dietary intake, meal patterning, and home food environments among young adult nonstudents and 2- and 4-year college students. Am J Public Health. 2009;99(7):1216-1219.
31. Lawrence JM, Watkins ML, Ershoff D, Petitti DB, Chiu V, Postlethwaite D, Erickson JD. Design and evaluation of interventions promoting periconceptional multivitamin use. Am J Prev Med. 2003;25(1):17-24.
32. Ahluwalia IB, Lawrence JM, Balluz L. Psychosocial factors associated with use of multivitamins by women of childbearing age. J Commun Health. 2007;32(1):57-69.
33. Quillin JM, Silberg J, Board P, Pratt L, Bodurtha J. College women's awareness and consumption of folic acid for the prevention of neural tube defects. Genet Med. 2000;2(4):209-213.
34. DiPietro NA, Kier KL. An educational intervention about folic acid and healthy pregnancies targeted at college-age women. J Am Pharm Assoc. 2001;41(2):283-285.
35. Chivu CM, Tulchinsky TH, Soares-Weiser K, Braunstein R, Brezis M. A systematic review of interventions to increase awareness, knowledge, and folic acid consumption before and during pregnancy. Am J Health Prom. 2008;22(4):237-245.
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.