Broadcasting behavior change: a comparison of the effectiveness of paid and unpaid media to increase folic acid awareness, knowledge, and consumption among Hispanic women of childbearing age.

Awareness about folic acid's effectiveness in reducing the risk of certain birth defects has increased among women in the United States; however, few Hispanic women are consuming enough folic acid daily. A 1998 survey conducted by the Gallup Organization for the National March of Dimes Birth Defects Foundation found that English-speaking Hispanic women had lower folic acid awareness (53% vs. 72%) and lower daily consumption (29% vs. 33%) than non-Hispanic White women. In 1999, the Centers for Disease Control and Prevention (CDC) conducted baseline surveys with Spanish-speaking Hispanic women in selected U.S. markets to measure folic acid awareness, knowledge, and consumption. A Spanish-language public service announcement (PSA) volunteer campaign and a paid Spanish-language media and community education campaign were conducted in 2000 and 2002, respectively. Comparisons of postcampaign surveys indicate that the paid media campaign was significantly more effective than the PSA campaign in increasing folic acid awareness, knowledge, and consumption among Spanish-speaking Hispanic women.

Lessons of Risk Communication and Health Promotion - West Africa and United States.

During the response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC addressed the disease on two fronts: in the epidemic epicenter of West Africa and at home in the United States. Different needs drove the demand for information in these two regions. The severity of the epidemic was reflected not only in lives lost but also in the amount of fear, misinformation, and stigma that it generated worldwide. CDC helped increase awareness, promoted actions to stop the spread of Ebola, and coordinated CDC communication efforts with multiple international and domestic partners. CDC, with input from partners, vastly increased the number of Ebola communication materials for groups with different needs, levels of health literacy, and cultural preferences. CDC deployed health communicators to West Africa to support ministries of health in developing and disseminating clear, science-based messages and promoting science-based behavioral interventions. Partnerships in West Africa with local radio, television, and cell phone businesses made possible the dissemination of messages appropriate for maximum effect. CDC and its partners communicated evolving science and risk in a culturally appropriate way to motivate persons to adapt their behavior and prevent infection with and spread of Ebola virus. Acknowledging what is and is not known is key to effective risk communication, and CDC worked with partners to integrate health promotion and behavioral and cultural knowledge into the response to increase awareness of the actual risk for Ebola and to promote protective actions and specific steps to stop its spread. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

Intent to become pregnant as a predictor of exposures during pregnancy: is there a relation?

OBJECTIVE: To evaluate the relationship between intent to be pregnant and selected maternal exposures during pregnancy. STUDY DESIGN: In 1982-1983, 3,029 women who gave birth to infants without birth defects from 1968-1980 (the control mothers from a large case-control study of birth defects) completed a detailed telephone interview. This analysis examined behaviors reported in the third month of pregnancy because most women would be aware of their pregnancies by the end of the first trimester, and our primary interest was assessing exposures that occurred after pregnancy recognition. RESULTS: Women who reported unintended pregnancies tended to be younger, nonwhite and less educated, and tended to have higher gravidity than women who reported intended pregnancies. After adjustingfor maternal age, education, race and previous adverse pregnancy outcome, women who reported unintended pregnancies were more likely to report smoking (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.2, 1.7), illicit drug use (OR=3.4, 95% CI 1.9, 6.4), not taking vitamins (OR = 1.4, 95% CI 1.2, 1.7), and alcohol use (OR=1.2, 95% CI 0.99, 1.4) than women who had intended pregnancies. No association was observed between pregnancy intention and medication use. CONCLUSION: These results suggest that women who report having unintended pregnancies are more likely to have some exposures that may result in adverse pregnancy outcomes.

Prescription medication borrowing and sharing among women of reproductive age.

OBJECTIVE: The purpose of this study was to describe the patterns of prescription medication borrowing and sharing among adults, particularly women of reproductive age. METHODS: Data were collected from the 2001-2006 HealthStyles surveys, an annual mail survey conducted in the United States concerning trends in health behavior. The total responses received were 26,566 of 36,420 surveys mailed (response rate 73%). Of these total responses, there were 7,456 women of reproductive age (18-44 years). Survey questions included whether participants had ever shared or borrowed a prescription medication, how often participants shared or borrowed medications in the past year, and types of medications shared or borrowed. Data were weighted by matching sex, age, income, race, and household size variables to annual U.S. census data. Associations between demographic factors and borrowing and sharing were studied. RESULTS: Overall, 28.8% of women and 26.5% of men reported ever borrowing or sharing prescription medications. Women of reproductive age were more likely to report prescription medication borrowing or sharing (36.5%) than women of nonreproductive age (>or=45 years) (19.5%) (rate ratio [RR] 1.87, 95% confidence interval [CI] 1.77-1.99). Of reproductive-aged women who borrowed or shared prescription medication, the most common medications borrowed or shared were allergy medications (43.8%) and pain medications (42.6%). CONCLUSIONS: Prescription medication borrowing and sharing is a common behavior among adults and is more common among reproductive-aged women than among women in other age groups.

Social marketing: planning before conceiving preconception care.

Social marketing approaches can help to shape the formation of and to create demand for preconception care services. This article describes four components of social marketing, often referred to as the 4 P's, that should be carefully researched and set in place before a national effort to launch and sustain preconception care services is pursued. First, the product or package of services must be defined and adapted using the latest in scientific and health care standards and must be based on consumer needs and desires. Second, the pricing of the services in financial or opportunity costs must be acceptable to the consumer, insurers, and health care service providers. Third, the promotion of benefits must be carefully crafted to reach and appeal to both consumers and providers. Fourth, the placement and availability of services in the marketplace must be researched and planned. With the application of market research practices that incorporate health behavior theories in their exploration of each component, consumer demand for preconception care can be generated, and providers can take preconception care to the market with confidence.

Serum folate levels among women attending family planning clinics--Georgia, 2000.

Since 1998, serum folate levels have increased nationally after mandatory fortification of cereal grain products with folic acid. Whether serum folate levels have increased among all women has not been well-studied. Identifying characteristics of women with lower serum folate levels would also be helpful in designing educational campaigns. Data for this report were collected during January 2000-January 2001. During 2000, blood samples were collected from 1,059 women aged 18-45 years who attended six family planning clinics in Georgia and analyzed for serum folate levels. This sample included women aged 18-25 years (60%), black women (41%), and women who had a high school education or less (49%). The median serum folate level (8.9 ng/mL) among this population was lower than the median of women of childbearing age (13.0 ng/mL) who participated in the 1999-2000 National Health and Nutrition Examination Survey (NHANES). In logistic regression analysis, women who were black (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.48, 3.96), who smoked (OR = 2.1; 95% CI = 1.26, 3.43), or who used Depo-Provera contraceptive injection (manufactured by Pharmacia Corporation, Peapack, New Jersey) (OR = 2.3; 95% CI = 1.15, 4.62) were more likely to be ranked in the lowest quartile (< or = 62 ng/mL) of serum folate concentrations when compared with the highest quartile (> 12.4 ng/mL). Women who consumed cereal regularly (OR = 0.4; 95% CI = 0.26, 0.62) or folic acid supplements (OR = 0.2; 95% CI = 0.09, 0.30) were the least likely to be in the lowest serum folate quartile. This study indicates that certain women are at greater risk for having lower serum folate levels, including women who are black, smokers, Depo-Provera users, and those less likely to eat cereal regularly or to take folic acid supplements. In Georgia, these data are useful in defining target populations (e.g., black women and smokers) for folic acid education campaigns because public health officials can develop contextually appropriate messages and outreach approaches for targeting women for folic acid interventions. Ongoing surveillance of serum folate status among women can guide future intervention efforts.

Sharing prescription medication among teenage girls: potential danger to unplanned/undiagnosed pregnancies.

OBJECTIVE: The objective of this study was to determine how often children and adolescents share prescription medications and, because of teratogenic concerns, assess specific reasons why girls might engage in medication-sharing behaviors. METHODS: Data were collected as part of Youthstyles, a mail survey of children and adolescents 9 through 18 years of age (764 girls and 804 boys) about health issues, attitudinal variables, and media preferences. Information collected by the survey included the respondent's history of borrowing or sharing prescription medications, the frequency with which sharing occurred, the reasons why medications might be borrowed or shared, and who influences their decisions to borrow or share medication. RESULTS: A total of 20.1% of girls and 13.4% of boys reported ever borrowing or sharing medications. Of the girls surveyed, 15.7% reported borrowing prescription medications from others, and 14.5% reported sharing their prescription medication with someone else. The reported likelihood of sharing increased with age. Medication sharing or borrowing was not a "one time only" emergency use for many: 7.3% of girls 15 through 18 years of age had shared medications >3 times. Reasons that girls gave for why they would share medications included having a prescription for the same medicine (40.2%), getting the medication from a family member (33.4%), having the same problem as the person who had the medication (29%), or wanting something strong for pimples or oily skin (10.5%). CONCLUSIONS: Medication sharing is relatively common among children and adolescents and is more common among girls than boys. An adolescent who receives a medication via sharing does not receive the appropriate information about its actions and possible negative interactions with other medications or any other associated risks. Sharing potentially teratogenic drugs is of special concern. Many barriers exist to communicating the risk about teratogenic drugs to women and girls, particularly if they are not planning a pregnancy or are unaware that they are already pregnant. These findings suggest the need for basic research on issues related to the dangers of medication sharing and teratogenic risks, as well as the development of successful approaches to communicate these risks.