Background:
North Carolina is in a region of the United States that has had historically high rates of neural tube defects (NTD's), birth defects of the brain and spine. In 1999, the 5-year NTD rate was highest in the western region of the state, over two times the national rate. Preconceptional use of folic acid has been shown to reduce rates of NTD's by up to 70%. Thus, a multifaceted folic acid outreach program was developed in 2000/2001 for Western North Carolina (WNC.) This program is ongoing.


Objectives:
By the end of the presentation participants will be able to:
1) List three components of a successful preconception outreach program and 2) Describe how the model could be applied to other preconception health messages.


Methods:
Three primary outreach methods are used in this model. 1) In each of the 24 counties, Community Ambassadors are selected, trained and paid a stipend to make presentations and distribute educational materials in their home communities. 2) A professional educator presents 15-30 minute in-services targeting private offices of OB/GYN, pediatric and family practice groups. In each office, a volunteer liaison is chosen with whom ongoing follow-up occurs. 3) Local health departments receive a similar in-service and follow-up. In addition, they are provided free multivitamins for distribution to non-pregnant women of childbearing age through family planning clinics, WIC, community health, primary care and STI clinics.

Results:
Since the fortification of grain products in1998, the national rate of NTD's has decreased approximately 27%. In North Carolina that rate has decreased approximately 34%, yet in WNC the NTD rate has dropped almost 75% and remains the lowest in the state. Measurements of long-term, regular vitamin use among recipients of free vitamins increased from 25% pre-intervention to 62% post-intervention, about twice the national vitamin usage rate reported in March of Dimes Gallup surveys.

Conclusion and implications for practice:
The tools and strategies developed for the WNC folic acid outreach program could be used in addressing other preconception health topics. Based on emerging evidence about message bundling, the Western North Carolina model could also be expanded to include multiple messages.