title: Health care provider knowledge and practices regarding folic acid, United States, 2002-2003.
abstract: OBJECTIVE
  To assess health care providers (HCP) knowledge and practices regarding folic acid (FA) use for neural tube defect (NTD) prevention.
  
  
  METHODS
  Two identical surveys were conducted among 611 obstetricians/gynecologists (OB/GYNs) and family/general physicians (FAM/GENs) (2002), and 500 physician assistants (PAs), nurse practitioners (NPs), certified nurse midwives (CNMs), and registered nurses (2003) to ascertain knowledge and practices regarding FA. For analysis, T-tests, univariate and multivariate logistic regression modeling were used.
  
  
  RESULTS
  Universally, providers knew that FA prevents birth defects. Over 88% knew when a woman should start taking folic acid for the prevention of NTDs; and over 85% knew FA supplementation beyond what is available in the diet is necessary. However, only half knew that 50% of all pregnancies in the United States are unplanned. Women heard information about multivitamins or FA most often during well woman visits in obstetrical/gynecology (ob/gyn) practice settings (65%), and about 50% of the time during well woman visits in family/general (fam/gen) practice settings and 50% of the time at gynecology visits (both settings). Among all providers, 42% did not know the correct FA dosage (400 mug daily). HCPs taking multivitamins were more than twice as likely to recommend multivitamins to their patients (Odds Ratio [OR] 2.27 95%, Confidence Interval [CI] 1.75-2.94). HCPs with lower income clients (OR 1.49, CI 1.22-1.81) and HCPs with practices having more than 10% minorities (OR 1.46, CI 1.11-1.92) were more likely to recommend supplements. NPs in ob/gyn settings were most likely and FAM/GENs were least likely to recommend supplements (OR 3.06, CL 1.36-6.90 and OR 0.64, CL 0.45-0.90 respectively).
  
  
  CONCLUSIONS
  Knowledge about birth defects and the necessity of supplemental FA was high. Increasing knowledge about unintended pregnancy rates and correct dosages of FA is needed. The strongest predictor for recommending the use of FA supplements was whether the provider took a multivitamin.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, NE MS E 86, Atlanta, GA, 30333, USA. jwilliams2@cdc.gov
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Williams
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Abelman
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Fassett
authors.forename: Cheryl E
authors.initials: CE
authors.lastname: Stone
authors.forename: Joann R
authors.initials: JR
authors.lastname: Petrini
authors.forename: Karla
authors.initials: K
authors.lastname: Damus
authors.forename: Joseph
authors.initials: J
authors.lastname: Mulinare
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005194:Family Practice / Q000193:education* / Q000592:standards; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009436:Neural Tube Defects / Q000517:prevention & control*; D009774:Obstetrics / Q000193:education* / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D005492:Folic Acid