Background: Dietary supplements, such as herbals/complementary nutritionals and micronutrients (vitamins/minerals), are commonly used in the U.S., yet national data on adverse effects are limited. Methods: We used a nationally representative stratified probability sample of 63 emergency departments (2004–2013) to describe U.S. emergency department visits for dietary supplement adverse events. Results: Based on 3,667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611–27,398) emergency department visits, resulting in 2,154 (CI, 1,342–2,967) hospitalizations, were attributed to adverse events from supplements annually. Emergency department visits for supplement adverse events commonly involved young adults aged 20–34 years (28.0%; CI, 25.1%−30.8%) and unsupervised children (21.2%; CI, 18.4%−24.0%). Excluding unsupervised child ingestions, 65.9% (CI, 63.2%−68.5%) of emergency department visits for single-supplement adverse events involved herbals/complementary nutritionals; 31.8% (CI, 29.2%−34.3%) involved micronutrients. Herbal/complementary nutritional products for weight loss (25.5%; CI, 23.1%−27.9%) and increased energy (10.0%; CI, 8.0%−11.9%) were commonly implicated. These weight loss or energy products caused 71.8% (CI, 67.6%−76.1%) of supplement adverse events involving palpitations, chest pain, and/or tachycardia, and 58.0% (CI, 52.2%−63.7%) involved persons aged 20–34 years. Among adults aged ≥65 years, choking or pill-induced dysphagia/globus caused 37.6% (CI, 29.1%−46.2%) of all emergency department visits for supplement adverse events; micronutrients were implicated in 83.1% (CI, 73.3%−92.9%) of these visits. Conclusions: Over 20,000 emergency departments visits in the US annually are attributed to dietary supplement adverse events; these commonly involve cardiovascular manifestations from weight loss or energy products in younger adults, micronutrient ingestions by unsupervised children, and swallowing problems, usually from micronutrients, in older adults.

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Although not well quantified, a portion of food-borne illnesses results from voluntary behaviors that are entirely avoidable, such as eating raw foods of animal origin or engaging in unsafe food preparation practices. A telephone survey of 1,620 respondents was conducted to assess the prevalence of selected self-reported food consumption and preparation behaviors associated with increased risks of food-borne illness and the demographic characteristics related to such behaviors. The percentages of survey respondents who reported consuming raw foods of animal origin were 53%, raw eggs; 23%, undercooked hamburgers; 17%, raw clams or oysters; and 8%, raw sushi or ceviche. A fourth of the respondents said that after cutting raw meat or chicken, they use the cutting board again without cleaning it. Safer food consumption and preparation behaviors were consistently reported by persons who were female, were at least 40 years old, and had a high-school education or less. These findings suggest that risky food consumption and preparation behaviors are common in the United States and that educational campaigns aimed at changing these behaviors may need to be targeted to specific groups of persons.

Sulfite-sensitive individuals can experience adverse reactions after consuming foods containing sulfiting agents (sulfites), and some of these reactions may be severe. In the 1980s and 1990s, the U.S. Food and Drug Administration (FDA) acted to reduce the likelihood that sulfite-sensitive individuals would unknowingly consume foods containing sulfites. The FDA prohibited the use of sulfites on fruits and vegetables (except potatoes) to be served or presented fresh to the public and required that the presence of detectable levels of sulfites be declared on food labels, even when these sulfites are used as a processing aid or are a component of another ingredient in the food. In the present study, data from FDA recall records and adverse event reports were used to examine the current status of problems of sensitivity to sulfites in foods. From 1996 through 1999, the FDA processed a total of 59 recalls of foods containing undeclared sulfites; these 59 recalls involved 93 different food products. Fifty (55%) of the recalled products were classified as class I, a designation indicating that a consumer reasonably could have ingested > or = 10 mg of undeclared sulfites on a single occasion, a level that could potentially cause a serious adverse reaction in a susceptible person. From 1996 through mid-1999, the FDA received a total of 34 reports of adverse reactions allegedly due to eating foods containing undeclared sulfites. The average of 10 reports per year, although derived from a passive surveillance system, was lower than the average of 111 reports per year that the FDA received from 1980 to 1987, a decrease that may have resulted in part from FDA regulatory action.

PURPOSE. To identify factors that might be targeted for intervention to increase breastfeeding among black mothers DESIGN. Secondary analysis of the 2988 National Maternal Infant Health Survey PARTICIPANTS. Black mothers (N = 5,142) from a nationally representative sample of mothers who had births in 2988 MAIN OUTCOME MEASURES. Breastfeeding rates RESULTS. Factors associated with breastfeeding included a mother's plan to breastfeed; Women, Infants and Children (WIC) advice, or advice from a prenatal-care provider on breastfeeding; and discussion of breastfeeding practices at prenatal birth classes. CONCLUSIONS. The results suggest that the prenatal period may be a critical time to influence a prospective black mother's decision to breastfeed her infant .

This study characterizes CAERS dietary supplement adverse event data for the 2004-2013 period and estimates a reporting rate of 2% for dietary supplement adverse events based on CAERS data. The findings show that the 2006 Dietary Supplements and Nonprescription Drug Consumer Protection Act had a substantial impact on the reporting of adverse events.

To determine the prevalence of individual vitamin and mineral supplement use during pregnancy and their relationships with selected characteristics of mothers, data from the 1988 National Maternal and Infant Health Survey were analyzed. The responses of 18,549 mothers were used in the analysis, which consisted of both univariate and multivariate statistical analyses. The prevalence of use for each of six supplements varied from 1.89% for zinc to 33.45% for iron. The use of these supplements did not appear to be strongly intercorrelated. Young age was associated with iron use, black race was associated with iron and vitamin A supplementation, and prenatal care and Women with Infants and Children food were associated with iron and vitamin A intake. Smoking was associated with folic acid and iron use, alcohol consumption was associated with folic acid use, and low family income was associated with iron use. The findings of the study may be useful in the future for more specific epidemiologic and clinical studies on supplementation during pregnancy.

Given that supplements containing ephedra were banned in April 2004, the results from this study may serve as a baseline estimate against which future studies of the use of C. aurantium products may be compared.