title: Effectiveness of a free folic acid supplement program in family planning clinics.
abstract: BACKGROUND
  Adequate periconceptional folic acid consumption lowers the risk for neural tube defects. We report the results of an evaluation of a folic acid intervention in Georgia family planning clinics that provided free folic acid supplements or fortified breakfast cereal.
  
  
  METHODS
  Six family planning clinics participated in the evaluation. Three clinics provided folic acid pills and educational materials to clients, two provided super-fortified cereal and educational materials, and one clinic provided educational materials only. Participants between the ages of 18 and 45 who visited the clinics in 2000 completed a brief survey and provided a blood sample. Of the 1093 women who participated, we evaluated the 165 women who had returned to the clinic at least once during the study period. We compared participants' survey and serum folate data from their first and subsequent visits.
  
  
  RESULTS
  Participation in the intervention was associated with increased knowledge about folic acid, (odds ratio, 1.94; 95% confidence interval, 1.37-2.76), but was not directly associated with increased self-reported folic acid consumption or increased serum folate levels. Reported use of folic acid supplements or cereal within two days of a visit was associated with higher serum folate levels. Knowledge about folic acid was one of the best predictors of self-reported folic acid consumption.
  
  
  CONCLUSIONS
  Participation in the intervention increased clients' knowledge about folic acid but did not directly increase reported folic acid consumption. Because knowledge predicted folic acid consumption, the intervention may be indirectly associated with increased consumption of folic acid.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. maw8@cdc.gov
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Watkins
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brustrom
authors.forename: Jane
authors.initials: J
authors.lastname: Schulman
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003625:Data Collection; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000097:blood; D005527:Food, Fortified; D015438:Health Behavior; D006266:Health Education; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D009436:Neural Tube Defects / Q000517:prevention & control; D016017:Odds Ratio; D012306:Risk
chemical_list: D005492:Folic Acid