State Center for Health Statistics 3 SCHS Study No. 126 – Folic Acid Use
Health Statistics and the Division of Reproductive
Health within the CDC. PRAMS is an ongoing,
population- based survey of North Carolina resident
women who have recently given birth. The survey
is carried out according to strict protocols for data
quality, as specified by CDC. Each month,
approximately 200 women who are 2 to 3 months
postpartum are randomly selected from the North
Carolina birth certificate files. Participants are
asked to complete a self- administered mailed
questionnaire, which collects information on a
variety of risk factors for poor pregnancy outcomes,
including behavioral and psychosocial risks, access
to and use of health care services, and other issues.
Non- respondents are contacted by telephone in
order to increase the survey response rate. The
overall response rate for PRAMS is approximately
75 percent.
The questionnaire used by the North Carolina
PRAMS program contains three questions that
pertain to folic acid. These are:
  Have you ever heard or read that taking the
vitamin folic acid can help prevent some
birth defects?
  Where did you hear or read that taking the
vitamin folic acid can help prevent some
birth defects?
  Before you knew you were pregnant, how
frequently did you take either vitamins
containing folic acid or multivitamins?
Sample weights were applied to the survey data so
that the responses are representative of all North
Carolina women who delivered live born infants
during calendar year 1999. All percentages reported
here are based on the weighted estimates. Ninety-five
percent confidence intervals ( CIs) based on the
weighted responses were generated using
SUDAAN software, which is used for analysis of
weighted data from complex samples. 10
Results
A total of 1,780 women responded to the North
Carolina PRAMS survey in 1999, for a total response
rate of 73.8 percent. The survey indicated that,
overall, 76.8 percent of women who delivered in
1999 had heard or read that taking folic acid can help
prevent birth defects ( Table 1). However there were
marked differences in folic acid awareness according
to maternal demographics. Knowledge of folic acid
was highest among women ages 25- 34 ( 86.1 percent)
and women ages 35 and above ( 82.9 percent), and
lowest among women under 20 years old ( 60.9
percent). Caucasian women were more likely to have
heard or read about folic acid compared to African
American women or women of other races ( 80.8
percent, 67.2 percent, and 56.6 percent, respectively).
The difference in knowledge of folic acid by
mother’s education was quite pronounced. Among
women with more than a high school education, 90.3
percent had heard or read about folic acid, compared
to only 54.8 percent among women with less than a
high school education. Awareness of folic acid also
increased with increasing family income, ranging
from 63.6 percent for women with annual incomes
less than $ 16,000, to 91.4 percent among women
with incomes of $ 40,000 or more. Mothers who
were unmarried, who were enrolled in WIC, or who
received Medicaid were also less likely to have heard
or read about folic acid.
Table 2 shows the percentage of women who had
heard or read about folic acid from various sources.
Among all women who delivered in 1999, 51.3
percent were told about folic acid by their doctor,
nurse, or other clinic staff. Slightly less than one- half
of women heard about folic acid through the media
( radio, TV, newspaper). About 37 percent of women
read about folic acid through brochures or other
literature obtained from their health care provider’s
office, and about 14 percent heard about it through
other sources ( e. g., friends, family members,
coworkers). The percentages add to more than 100
because many women heard about folic acid from
more than one source.