Folic Acid Education: Delivering the Message to Hispanic Women through the Florida VitaGrant Project

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Folic Acid Education Delivering the Message to
Hispanic Women through the Florida VitaGrant
Project

• Elizabeth Jensen
• VitaGrant Project Manager
• Maternal and Child Health
• Epidemiology Conference
• December 12-14th, 2007

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Neural Tube Defects (NTDs)in Special Populations

• Women of Mexican-origin are at increased risk of
  having a NTD affected pregnancy
• Studies in California and Texas showed increased
  risk in Hispanic populations of Mexican-origin
• Similar data found in Florida

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Florida

• Florida ranks 4th in the nation in the number of
  annual births and Hispanic births, behind
  California, Texas, and New York
• There were 237,166 births in Florida during 2006,
  of which 70,094 were Hispanic births (29.6)
• Each year in Florida, approximately 100 infants
  are born with a NTD

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NTDs by Maternal Hispanic Origin, Florida
1996-2000
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NTD by Maternal Hispanic Origin and Maternal
Place of Birth, Florida 1996-2000
Overall Non-Hispanic Rate 5.5
Overall Hispanic Rate 5.4
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University of South Florida (USF) Research

• Researched barriers to folic acid education among
  the Mexican population in Florida
• Use of social marketing concepts to develop
  culturally appropriate materials, folic acid
  education materials including
• Video Novella Story of Three Sisters (La
  Historia de Tres Hermanas)
• Photo Novella
• Low literacy card

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USF Research Folic Acid Knowledge

• Hispanic women were less likely than Caucasian
  women to
• Know about folic acid
• Know that it lowers risk for some birth defects
• Take it every day

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USF Research Folic Acid Knowledge

• Hispanic women were more likely to
• Use vitamins through injection
• Believe birth defects were an act of God
• Believe oral vitamins cause weight gain and
  nausea

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USF Research Focus Groups

• Sampled farm worker populations
• Mexican
• Mexican-Americans
• Teens
• Adults
• NTD family history

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USF Research Focus Groups

• Results
• Vitamins important only during pregnancy
• No link between folic acid and NTD or birth
  defects
• Birth defects a result of not complying with
  cultural/social norms
• Found some existing materials inappropriate
• Spokesperson normal person, female, healthcare
  provider
• Receptive to message of before pregnancy
• Very willing to make behavior change for health
  of future babies
• Younger Hispanic women link general health to
  beauty
• Open to hear weight gain has no basis in fact

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Florida VitaGrant Purpose

• Improve preconception health among childbearing
  age women through provision of preconception
  health education materials and multivitamins with
  folic acid
• Three-year grant (2004 2007)
• 2 million

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Grant Activities

• Target population Mexican Hispanic and low
  income women
• Distribution of multivitamins (gt540,000 bottles)
  and preconception health education materials
  statewide
• Provider training
• Folic acid tool kits and videos
• 254 sites
• Media campaign

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Florida VitaGrant Project Resources

• Multivitamins (supplemental labels attached in
  Spanish, Haitian Creole and Vietnamese, where
  appropriate)
• Educational materials
• Folic acid tool kits and video novellas
• Provider training on preconception health
• Provider training on promoting folic acid use
  among Mexican Hispanic women

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Florida VitaGrant Project

• Media campaign
• Radio PSAs (English version from NC campaign and
  Spanish version from USF Research Project)
• Television on Univision and Telefutura (from NC
  campaign)
• gt650 posters at locally-owned businesses
  (English, Spanish and Haitian Creole)

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Florida VitaGrant Evaluation

• Distribution sites
• Aggregate, demographic data
• Evaluation sites
• Demographics
• Folic acid knowledge
• History of taking supplements
• Birth defect history
• Experience taking vitamins provided through grant

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Outcomes for the Evaluation SitesTwo Sites
Selected

• Healthy Start / Healthy Families
• Offered diversity in population demographics and
  better quality data
• RCMA (Redlands Christian Migrant Association)
• Provided good quality data on population at
  highest riskMexican Hispanic Women
• InterventionFolic Acid and preconception
  education and free bottles of vitamins (60 days)

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Outcomes RCMA Demographics

• n291
• Mostly Hispanic
• 91.75 Hispanic
• 2 cases Puerto Rican, 247 cases Mexican
• 7 White Non-Hispanic
• Wide Age Distribution
• 28.47 age lt25
• 38.08 age 25-29
• 34.45 age gt29

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Outcomes RCMA
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RCMA Race/Ethnicity-Related FA Consumption
Change
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RCMA Age-Related FA Consumption Change
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Outcomes Healthy Start/Healthy Families

• n161
• Mostly Black women
• 65.99 Black Non-Hispanic
• 28.57 White Non-Hispanic
• 8.7 Hispanic
• Mostly young women
• 48.41 less than age 25
• 24.84 25-29
• 26.75 gt29

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HS/HF Race/Ethnicity FA Consumption Change
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HS/HF Race/Ethnicity-Related FA Consumption
Change
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HS/HF Age-Related FA Consumption Change
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Summary

• Project resulted in significant change in vitamin
  taking behavior at evaluation sites at follow-up,
  particularly among Mexican Hispanics
• Utilized tools developed and field-tested for
  Floridas Hispanics Identified sites serving
  predominantly Mexican Hispanic women
• Provided training to healthcare providers on
  increased risk for Mexican Hispanic population
  and motivating behavior change

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For further information

• Elizabeth Jensen, Project Manager
• March of Dimes
• Elizabeth_jensen_at_doh.state.fl.us
• 850-245-4465 ext. 2769
• Melanie Simmons, Principal Investigator
• Healthy Communities Program
• FSU Center for Demography and Population Health
• msimmons_at_fsu.edu
• 850-644-3311