Understanding Optimal Nutrition Among Women of Childbearing Age in the United States and Puerto Rico: Employing Formative Research to Lay the Foundation for National Birth Defects Prevention Campaigns

Abstract

Neural tube defects (NTDs) are serious birth defects of the brain and spine that affect approximately 3,000 pregnancies in the United States each year and affected 404 pregnancies in Puerto Rico from 1996 to 2002. Consuming the B vitamin folic acid can reduce the incidence of NTDs 50%-70%, and recent efforts to reduce NTD rates have focused on increasing the number of childbearing-aged women who take a vitamin containing folic acid every day. As the first stage of formative research in campaign planning, two exploratory, qualitative studies were conducted in order to (a) understand the complexity of vitamin use among women in the United States and Puerto Rico and (b) serve as a foundation on which to develop national communication and education interventions. Also, this information shed light on theories that might be used to guide campaign development. Results indicated that campaign messages designed to increase folic acid use through multivitamin supplementation in the United States must address women's barriers to vitamin use (e.g., cost, time), increase women's perceived need for multivitamins (e.g., identify immediate, tangible results from taking a daily multivitamin), and address the relationship between daily food choices and the need for supplementation. Future campaign messages in Puerto Rico must focus on many of these same issues, in addition to increasing women's knowledge about when folic acid should be taken in relation to pregnancy and addressing women's perceptions that vitamins cause weight gain (an undesirable outcome for most participants). The practical and theoretical implications of these results are discussed in terms of their contribution to the development of a creative new approach to increase multivitamin consumption among women of childbearing age in the United States and Puerto Rico.

Chemoprevention of colorectal cancer: systematic review and economic evaluation

“…Nine studies were conducted in the USA; 185,186,189,192,[194][195][196][197]199 one of these was colocated in Puerto Rico; 185 five were conducted in the UK, [167][168][169][170][171] three in Australia, 190,193,198 two in Canada 187,188 and one in Germany. 191 Thirteen studies evaluated adults' views concerning the taking of vitamins and minerals, 169,185,187,[189][190][191][192][193][195][196][197][198][199] five studies considered aspirin or NSAIDs, [168][169][170][171]194 two folic acid 167,185 and two dietary supplements generally. 186,188 Only four studies explored the views of participants who had either a cancer diagnosis 186,197,…”

“…186,188 Only four studies explored the views of participants who had either a cancer diagnosis 186,197,199 or a family history of cancer, 198 but 10 of the other included studies did focus specifically on either prevention alone 167 or the long-term management of chronic conditions, which included elements of prevention, including arthritis, 170,194 heart disease, 192,193 renal problems, 188 type 2 diabetes, 196 or a range of conditions. 168,187,191 Most studies used interviews and/or focus groups to elicit people's opinions and views on the taking of the relevant agents; 167,168,170,[185][186][187]189,190,[193][194][195][196] eight studies used structured surveys or questionnaires. 169,171,188,191,192,[197][198][199] The 15 studies identified by the initial search came from six different databases: EMBASE, 168,169,171,187 AMED, 189,191,1...…”

“…168,187,191 Most studies used interviews and/or focus groups to elicit people's opinions and views on the taking of the relevant agents; 167,168,170,[185][186][187]189,190,[193][194][195][196] eight studies used structured surveys or questionnaires. 169,171,188,191,192,[197][198][199] The 15 studies identified by the initial search came from six different databases: EMBASE, 168,169,171,187 AMED, 189,191,193,194 MEDLINE,190,192 MEDLINE InProcess & Other Non-Indexed Citations, 167,170,185 CINAHL, 188 and the Science and Social Science Citation Index. 186 This is typical of findings regarding the distribution and degree of dispersal of social science and qualitative studies.…”

“…the inclusion of non-UK studies, and identified 10 new papers, as noted above. [185][186][187][188][189][190][191][192][193][194] Five further studies were identified by unstructured searching. [195][196][197][198][199] In total, 20 studies were included.…”

“…[167][168][169][170][185][186][187][188]190,191,193 Family and friends played two principal roles, determined in large part by whether the agents concerned were antioxidants, such as vitamins, minerals and other supplements, or if they were drugs such as NSAIDs. On the one hand, family acted as a source of information and advice about agents.…”