# Presentation: 133216

## 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**

## 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

## 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

## NTDs by Maternal Hispanic Origin, Florida 1996-2000

- University of South Florida, Department of Pediatrics, Birth Defects Surveillance Center

## NTD by Maternal Hispanic Origin and Maternal Place of Birth, Florida 1996-2000

**Overall Non-Hispanic Rate: 5.5**

**Overall Hispanic Rate: 5.4**

## 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

## 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

## 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

## USF Research: Focus Groups

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

## 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

## 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

## Grant Activities

- Target population – Mexican Hispanic and low income women
- Distribution of multivitamins (>540,000 bottles) and preconception health education materials statewide
- Provider training
- Folic acid tool kits and videos
- 254 sites
- Media campaign

## 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

## 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)
- >650 posters at locally-owned businesses (English, Spanish and Haitian Creole)

## 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

## Outcomes for the Evaluation Sites:Two 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 risk—Mexican Hispanic Women
- Intervention=Folic Acid and preconception education and free bottles of vitamins (60 days)

## Outcomes: RCMA Demographics

- n=291
- Mostly Hispanic
- 91.75% Hispanic
- 2 cases Puerto Rican, 247 cases Mexican
- 7% White Non-Hispanic
- Wide Age Distribution
- 28.47% age <25
- 38.08% age 25-29
- 34.45% age >29

## Outcomes: RCMA

## 	RCMA Race/Ethnicity-Related FA 	Consumption Change

## RCMA Age-Related FA Consumption Change

## Outcomes: Healthy Start/Healthy Families

- n=161
- 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% >29

## HS/HF Race/Ethnicity FA Consumption Change

## HS/HF Race/Ethnicity-Related FA Consumption Change

## HS/HF Age-Related FA Consumption Change

## 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 Florida’s Hispanics Identified sites serving predominantly Mexican Hispanic women
- Provided training to healthcare providers on increased risk for Mexican Hispanic population and motivating behavior change

## For further information:

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