title: The use of folic acid for the prevention of birth defects in Puerto Rico.
abstract: BACKGROUND
  The occurrence of neural tube defects (NTDs) varies by race/ethnicity, and the highest rates are among women of Hispanic ethnicity. Women of reproductive age are advised to use folic acid to prevent NTDs and other birth defects. Since 1994, Puerto Rico has had a campaign to promote the use of folic acid, and since 1998, enriched grain products have been fortified with folic acid. After fortification, the incidence of NTDs in the island decreased. The objective of this study was to assess the use of folic acid by women of reproductive age in Puerto Rico and determine factors associated with its use.
  
  
  METHODS
  A self-administered questionnaire was answered by 964 women around the island.
  
  
  RESULTS
  Folic acid consumption was reported by 30% of the participants, 21% reported consuming it at least 4 times per week, and only 14% consumed it the day before the survey. Knowledge about the recommendation for women to consume folic acid was reported by 97% of the participants. The use of folic acid was lower among women of lower education and lower social class. Women with higher education were 8.3 times more likely to consume folic acid.
  
  
  CONCLUSIONS
  The folic acid campaign has improved women's knowledge about the recommendation for folic acid supplementation. Nevertheless, its use is lower than is needed to continue reducing the incidence of birth defects in Puerto Rico. Education and social class continue to be barriers to eliminating the disparities in the preconception health of our population.
authors.affiliation: University of Puerto Rico School of Medicine, Department of Pediatrics, Neonatology Section, San Juan, Puerto Rico, USA. lougarcia@rcm.upr.edu
authors.forename: Lourdes
authors.initials: L
authors.lastname: García-Fragoso
authors.forename: Inés
authors.initials: I
authors.lastname: García-García
authors.forename: Cynthia E
authors.initials: CE
authors.lastname: Rivera
mesh_terms: D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D016009:Chi-Square Distribution; D002648:Child; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D015995:Prevalence; D011647:Puerto Rico / Q000453:epidemiology
chemical_list: D005492:Folic Acid