Adherence of children taking vitamin D supplements

Adherence to a Vitamin D Supplement Intervention in Urban Schoolchildren.

J Acad Nutr Diet. 2013 Aug 30. pii: S2212-2672(13)01114-3. doi: 10.1016/j.jand.2013.06.350.

Au LE, Harris SS, Jacques PF, Dwyer JT, Sacheck JM.

Vitamin D supplementation is an important strategy for preventing low levels of serum 25OHD and improving bone health and consequent associated health risks, especially in children at risk of deficiency. Although vitamin D supplements are recommended, there is limited research on the factors that influence adherence to taking them. In a cross-sectional sample of 256 child (aged 9 to 15 years) and parent pairs in the Boston, MA, area during January to March 2012, analysis of covariance was used to determine associations between health beliefs about vitamin D, parental vitamin D-containing supplement use, and the individual responsible for pill administration with supplement adherence measured by pill counts. Mean and median supplement pill count adherence over 3 months were 84% and 89%, respectively.

• Adherence was positively associated with parents' use of vitamin D-containing supplements (7% higher, P=0.008) and with

• combined child and parent responsibility for administration of the supplement compared with child only (9% higher, P=0.03).

• Parents' beliefs about vitamin D neither predicted their children's beliefs nor positively influenced children's adherence.

• Adherence was higher when parents took vitamin D-containing supplements and when parents and children shared responsibility for administering the supplement.

• Promoting child supplement use through parent involvement and role modeling may be a practical solution for registered dietitians who are aiming to improve vitamin D adherence in at-risk youth.

Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

PMID: 23999277

Some ways to improve adherence (suggested by Vitamin D Life)

1. Initial and on-going education of the benefits (to children and parents)
   • such as: printed, video, presentation followed by Q/A, online information and forum,
   • Educate them about the benefits anticipated: fewer colds, less tooth decay, better academic performance, fewer growing pains, fewer ear infections, less asthma

2. Have competition between classrooms (different classrooms take different amounts)– and let classes notice the differences

3. Having a larger dose pill which need only be taken weekly or monthly

   • Along with calendar-associated memory aids

4. Having the vitamin D incorporated into food eaten (optional fortification at school or home)

5. Good tasting (e.g. gummy bear)

6. Provide other forms – such as liquid: many children are uncomfortable with taking pills.

   Note: In many previous studies people know that the desired outcome is to have no pills at the end of the trial, so they just throw out the remaining pills

See also Vitamin D Life

• Delayed scholastic achievement associated with low vitamin D levels – Aug 2012

• Infants in France and Finland need 1000 IU of vitamin D, but apparently infants in US need only 400 - 2013

• Middle ear infection (Otitis Media) and Vitamin D – many studies

• Symptoms of vitamin D deficiency vary with the age of the child – Feb 2013

• UVB added in classroom reduced cavities, increased height, increased academics. etc UV instead of supplements

• Vitamin D Deficiency is a Strong Predictor (4X) of Asthma in Children – Oct 2012

• Acute lower respiratory infection 5X more frequent with low vitamin D intake – June 2012

• When prescribed by mail, vitamin D compliance is low – June 2013

• Restoring vitamin D - ways to encourage - scores of additional ways

• All items in category Follow-thru Vitamin D items

See also Vitamin D Council review of this study (behind a $5 paywall)