Estimates of the effects of folic-acid fortification and folic-acid bioavailability for women.

OBJECTIVE: With the recent implementation of the folic-acid-fortification program, our objective was to estimate its benefits in adult women and account for the higher bioavailability of synthetic folic acid in fortification programs and supplements. METHODS: The study used a cross-sectional design. Dietary assessment data were collected with a quantitative food-frequency questionnaire, the Nutrition DISCovery program. Fortification was simulated with the use of fortification standards (140 microg/100 g of flour) and new bioavailability standards for synthetic folic acid. Data were collected from 289 women 18 to 89 y old. Subjects were recruited from participants in two health-screening events in autumn of 1997. Chi-square tests were used to estimate the differences between categoric variables, and F tests were used in analysis of variance for continuous outcome measures. Results were considered significant at P < 0.05. RESULTS: Estimated mean dietary intake of folate increased considerably with simulation of fortification (320 to 608 microg of dietary folate equivalents). Women in the lower quartiles for age (18 to 39 and 40 to 46 y) consumed more servings from the bread group than women did in the upper quartile (55 to 89 y). Thus, the improvement in folate intake with fortification was significantly greater for the younger than for the older women (P < 0.05). Despite the limitations of estimating folate intakes, these data suggest that most women met the new estimated average requirement. However, 61% of women of childbearing age had intakes of synthetic folic acid below the recommended level of 400 microg/d, and only those using supplements containing folic acid met the guideline. CONCLUSIONS: Based on this sample of well-educated, adult women, the current level of folic-acid fortification should improve the intakes of a large proportion of women, especially when accompanied by supplements containing folic acid. These improvements in folate intake might not be seen in groups with limited resources, however. Further, under existing standards and practices, many women will not meet current recommendations for prevention of neural-tube defects.

Knowledge, attitudes, and behaviors of college students regarding the 1990 Nutrition Labeling Education Act food labels.

OBJECTIVES: This study examined the influence of 1990 Nutrition Labeling and Education Act food labels on college students. The purposes of the study were to examine knowledge, attitudes, and behaviors of college students regarding labels and relationships among these factors, and whether educational experience with labels was associated with label-reading knowledge, attitudes, and behaviors. DESIGN: A descriptive, nonexperimental research design was used. Data were gathered using a survey designed for the study. SUBJECTS: The study surveyed 208 undergraduate students enrolled in general education classes at a midwestern university. STATISTICAL ANALYSIS: Descriptive statistics analyzed knowledge, attitudes, and behaviors of college students regarding food labels. The Student t test and chi 2 analysis evaluated specific measures of behavior. Pearson correlation coefficients and multiple regression analysis examined relationships among variables and identified factors associated with label use. RESULTS: Students' mean knowledge score was 48%. Knowledge score was positively correlated with attitudes toward labels (r = .14, P = .04) and use of labels (r = .87, P = .0001). Previous education in reading labels was associated with higher knowledge scores (P = .04). Ninety-five percent of participants perceived the label to be useful, but many distrusted nutrition claims. Seventy percent looked at the Nutrition Facts label when purchasing a product for the first time. The single best predictor of general label use was a positive attitude toward labels (P < .001), followed by being a woman (P < .01). CONCLUSIONS: The 1990 National Labeling and Education Act food label has influenced college students. Labeling education efforts are associated with greater knowledge about labels, more favorable attitudes toward them, and increased label use in making food choices. Special attention should be directed toward explaining terms and phrases on labels and the guidelines that ensure truthfulness of nutrition claims. College students need to understand their need for numerous nutrients instead of merely focusing on the fat and caloric content of foods.

Clergy perspectives and practices regarding intimate violence: a rural view.

Intimate violence has been recognized as a major problem in the United States. The financial and social hardships of declining rural economies, the social isolation of distance and poor transportation, inadequate social services for families in crisis, and limited options for women who might otherwise leave abusive partners are risk factors for intimate violence in rural areas. Church-based prevention programs are considered particularly useful in rural communities. If preventive health programs engage them properly, rural church members' overlapping social structures and their especially interconnected social circles can spread and support new ideas and practices. This study was conducted in four rural, predominately white, southern Illinois counties. The survey instrument used consisted of four subscales, measuring knowledge about, attitudes toward, and practices to prevent intimate violence as well as religious ideology. Overall, clergy knowledge and attitudes about intimate violence in this study did not necessarily translate into actual prevention practices against intimate violence. However, liberal clergy tend to employ prevention practices more often when compared with conservative clergy. Nevertheless, rural churches and their clergy seem to be promising sources for diffusion of intimate violence prevention information, attitudes and acceptable standards of behavior to rural communities.

A survey of rural parents' attitudes toward sexuality education.

Although local attitudes and values influence a community's support for sexuality education, educators rarely assess local views in a systematic way. A survey of community parents provides a simple, relatively inexpensive way to assess support for sexuality education and strengthen the school's leadership in implementing an effective curriculum. This paper describes the use of a parent survey for building a comprehensive sexuality education program in a rural community. Most respondents supported sexuality education even for the elementary grades. Compared to a survey conducted 10 years earlier, respondents were significantly less confident of themselves and other parents as sexuality educators. Attitudes varied by demographic characteristics. Using these findings, the paper illustrates how the strategic use of a parent survey can strengthen school-based sexuality education by minimizing potential controversy and building a broader base of active community support and involvement for sexuality education.

Norplant: what health educators need to know.

PIP: The US Food and Drug Administration approved the contraceptive implant Norplant in December 1990. Many US physicians and nurse practitioners have received training in inserting the implant, but few health educators know enough about Norplant and potential users to provide adequate education and counseling. The 6-capsule system steadily releases 50-80 mg levonorgestrel into the bloodstream for five years for a contraceptive effectiveness rate greater than 99%. Levonorgestrel keeps the pituitary gland from releasing two hormones needed for ovulation, thickens the cervical mucus, and suppresses endometrial development. Irregular bleeding is the most common side effect. Contraindications for Norplant include liver tumors, active liver disease, breast cancer, active thrombophlebitis, unexplained uterine bleeding, pregnancy, blood clots in the eyes or lungs, diabetes, hypertension, and cigarette smoking. Advantages are its 5-year effectiveness period, that it is easy and convenient to use, does not require compliance, and is reversible. Disadvantages are that it offers no protection against sexually transmitted diseases, especially HIV/AIDS; it requires a surgical procedure; and its cost ($500-$750/patient). Few studies present a profile of US women using Norplant. Potential users are adolescents, vulnerable women, low income women with children, and women who do not want to become pregnant for a long time but do not consider the pill or sterilization viable options. Extensive research indicates that Norplant is safe in the short and intermediate term. More research is needed to identify the demographic profile of a typical user, why she chooses Norplant, how well she understands it, or whether she was well informed about it; to learn about satisfaction with Norplant; and to find out who discontinues Norplant before the end of 5 years. This information would help health educators in their counseling and education strategies.^ieng

Factors related to school absence among children with cardiac conditions.

This study compared psychosocial and health factors related to school absence among 62 children with cardiac disease and 62 age-, sex-, and race-matched peers without chronic health conditions. Parents of children with cardiac conditions perceived their children as more vulnerable and rated themselves and their children as having less control over improving their children's health status than did parents of the well children. Increased school absentee rates for the cardiac group were associated with measures of illness severity, parental patterns of absenting their child from school for minor illnesses, and decreased belief in their child's ability to improve his or her health status. For the well comparison group, increased absence was related to external health locus of control beliefs, increased maternal sick days, and demographic factors. School absence was not significantly related to social adaptation, self-esteem, or school achievement for either the well or cardiac groups.