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Physician Assistant (PA) students are educated that 400 micrograms (μg) of daily folic acid (FA) is a vital component of prenatal care to reduce fetal development abnormalities. Studies have shown that higher education level is correlative with the use of daily FA in women of reproductive age. The objective of this study was to assess PA students' knowledge of the physiologic implications of FA supplementation, the recommended dosage and intake regimen, and how having this knowledge impacted their behavior. A knowledge-based questionnaire was given to 59 first year female PA students and 39 third year female PA students at the University of Texas Medical Branch at Galveston (UTMB). Overall FA use amongst female UTMB PA students is 66.3%. Furthermore, 40% of the third year students consumed 400 μg of FA daily as opposed to 7.8% of the first year students. One-hundred percent of the third year students knew that FA deficiency caused NTDs, and 86.4% of the first year students recognized this causation. There was poor compliance for following the United States Preventative Services Task Force (USPSTF) recommended FA regimen amongst students in the UTMB PA program. The results in our study were comparable to the previous publications, finding that the majority of women in both our study and the general population acknowledged the importance of FA supplementation. BACKGROUND AND SIGNIFICANCE Folate, Vitamin B9, is a naturally occurring water-soluble vitamin. Foods containing folate include leafy green vegetables, oranges, legumes, and liver (Brown et al., 1997). Due to the poor bioavailability and limited food sources of folate, a synthetic form was developed: FA (Winkels, Brouwer, Siebelink, Katan, & Verhoef, 2007). The U.S. Public Health Service issued a recommendation in 1992 stating “all women of reproductive age in the U.S., capable of becoming pregnant, should consume 400 μg of FA daily to reduce the risk of having a pregnancy affected by [neural tube defect] NTD” (Prue, Flores, Panissidi, & Lira, 2008). The Food and Drug Administration (FDA) utilized this recommendation in 1998, and mandated that all enriched grains be fortified with FA (CDC, 2007). In 2005 the Dietary Guidelines for Americans (DGA) made an effort to inform the general population about these new recommendations, and advocated women consume 400 μg of FA daily in multivitamin or supplement form in addition to the FA provided by enriched foods (Cena et al., 2008). In May 2009, the USPSTF recommended “all women planning or capable of pregnancy take a daily supplement containing 400 μg – 800 μg of FA” (U.S. Preventative Services Task Force, 2009). The importance of FA is annually recognized by the Department of Health and Human Services, the Centers for Disease Control, and the National Birth Defects Prevention Network during January’s National Birth Defects Prevention Month (Center for Disease Control and Prevention, 2007). Lifetime healthcare costs for children suffering from spina bifida can exceed two million dollars per child for medical and surgical care of the individual (Spina Bifida Association, 2009). It is important for women of reproductive age to be proactive regarding their health and the health of a potential

Knowledge and Usage Patterns of Folic Acid amongst Physician Assistant Students at the University of Texas Medical Branch at Galveston.