Data to Action Success Stories: Vermont

Vermont PRAMS Data Shows Folic Acid Education Campaign Is Successful

Problem Overview

A benefit to taking a folic acid supplement is the reduced risk of neural tube defects in babies. Because the timing of tube closure occurs during the first 4 to 6 weeks of pregnancy, before most women realize they are pregnant, it is critical for women to have adequate levels of folate before conception. A public health strategy to reduce neural tube defects in babies is to increase the number of women taking vitamins with folic acid before becoming pregnant.

PRAMS data from 2001–2004 indicated 80% of women knew of the benefits of folic acid, but in subsequent years, that percentage has declined to 74% by 2008. During the same time, PRAMS data revealed that only 33% to 39% of women took a multivitamin during the month before they got pregnant. In addition, the data showed disparities among Vermont mothers regarding their knowledge and use of folic acid based on age, education, and income. Younger women (up to age 24), those with a high school education or less, and those with low household income ($25,000 or less) were significantly less likely to take folic acid on a daily basis or to know about its benefits.

Program Activity Description

During 2006, Vermont began a population-based birth defects surveillance program known as the Birth Information Network (BIN). Funded by CDC, the main objectives of the BIN were to (1) increase the percentage of women of childbearing age who associate folic acid use with preventing birth defects, and (2) increase the percentage of childbearing age women who take a multivitamin or folic acid vitamin supplement daily. To address the disparities identified by PRAMS data, the Vermont Department of Health developed targeted media campaigns, counseling, and specific interventions to increase knowledge about the benefit of folic acid and increase the use of daily multivitamins.

Program Activity Outcomes

A public marketing firm developed a targeted folic acid media campaign for young Vermont women aged 18–24 years. The media campaign consisted of radio ads, an accompanying poster and a page on the Vermont Department of Health (VDH) Web site. The radio ads ran for 5 weeks from the end of September to the end of October 2009, and the stations selected were based on those most frequently listened to by the target audience according to the campaign pretest. Posters were distributed by the VDH staff in local health offices and by a postering service. Posters were distributed at locations such as video stores, laundromats, and beauty parlors. Posters were also sent to all primary care physicians in the state with a letter describing the campaign and the CDC’s Folic Acid: Frequently Asked Questions and Answers factsheet. The Web page provides information about multivitamins, guidance in purchasing them, and how folic acid prevents birth defects. Women Infant Children (WIC) staff and their partners—including Planned Parenthood, Federally Qualified Health Centers, and the March of Dimes—received training on counseling their clients on folic acid use. The training was recorded on DVD and is used for new staff training, refresher trainings, and sharing with local partners. Free vitamins were also distributed at district Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics to nonpregnant women, including postpartum women and mothers of children on WIC.

The marketing firm conducted pre- and post-campaign surveys to measure the effectiveness of the media campaign. A pretest was conducted in the 4 weeks prior to the launch of the campaign (August 2009), and the post-test was conducted in the 5 weeks immediately following the campaign (November 2009). It was found that vitamin use increased by 15% during the 3-month period. Thirty-seven percent of the post-test group recalled hearing the radio ad, and of these, 70% recalled the correct message after an average of 17 seconds. Twenty-two percent recalled seeing the poster. The outreach also showed the following:

• The vast majority of women (86%) accepted the free vitamins containing folic acid (86%).
• Of those who hadn’t been taking multivitamins prior to their WIC visit, 61% of those who accepted them, took them in the past month. Of those that said they were taking vitamins, 97% stated that they would continue.

Vermont continues to monitor rates of vitamin consumption during the 3 months prior to pregnancy using the PRAMS survey and shares this information with CDC’s Maternal and Child Health Epidemiology Program.

Using PRAMS Data for Legislation to Support Breastfeeding in the Workplace

Problem Overview

Vermont women enrolled in the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) have lower rates of breastfeeding initiation and duration than women not enrolled in the program, despite nearly 70% of Vermont WIC enrollees stating during their prenatal WIC visits that they intended to breastfeed their infant. 2004–2006 Vermont PRAMS data indicate WIC participants’ breastfeeding initiation rates are 15% lower than their non-WIC counterparts. In addition, the WIC participants’ rates for continuing to breastfeed at 4 and 8 weeks postpartum are more than 20% lower than their non-WIC counterparts.

Program Activity Description

In 2008, USDA Food and Nutrition Service announced a Special Project grant to allow states to develop innovative programs that support the National WIC food package policy and provide replicable, transferable breastfeeding interventions. Vermont PRAMS surveillance data provided evidence for the client- and provider-based intervention designed to target breastfeeding rates among women enrolled in WIC and in 2009 the Vermont WIC program successfully obtained grant funding.

The Vermont grant researched the following question: If mothers who intend to breastfeed are screened for predictors of success, offered education and support, and connected with breastfeeding resources, will a higher percentage of women exclusively breastfeed at 4 weeks postpartum? The goals for the program include a 10% increase in exclusive breastfeeding at 4 weeks postpartum and to assess the Vermont WIC program’s reputation in the community as a credible, effective, and sincere partner in breastfeeding promotion and support. The project is taking place in 3 of Vermont’s 12 Local Health Clinic sites, which serve 33% of the state’s yearly resident births.

Client-based “You Can Do It” materials, some of which were developed using PRAMS respondent’s comment data, are being distributed at three prenatal client visits, and all enrolled mothers are given access to the study’s enrollee-only Web site. Further, WIC’s Peer Counseling Program provides additional support for all study participants during the prenatal and early postpartum periods. Provider “WIC Can Help” materials and training modules are delivered to the provider practice and district office WIC staff visit practitioner’s offices to provide additional support.

Program Activity Outcomes

As of April 2011, the WIC program had recruited 248 of the 298 clients expected to participate in the program. When Vermont’s WIC Special Project is completed in 2013, the results, resources and evidence-based tools produced will be distributed to all WIC Programs for use, further testing, and adaptation.