Cancer Causes & Control

, Volume 20, Issue 8, pp 1271–1280

Multivitamin use among multi-ethnic, low-income adults

  • Rachel C. Shelton
  • Elaine Puleo
  • Sapna Syngal
  • Karen M. Emmons
Original Paper


There has been growing interest in the protective health benefits of multivitamin use (MVU). Relatively little research has investigated the factors associated with MVU among adults across a broad age range, particularly among lower-income, racially/ethnically diverse adults. In light of standing MVU recommendations and documented health benefits for certain groups, as well as ongoing studies evaluating the potential health benefits of multivitamins, vitamin D, and calcium, research among this understudied population is warranted. The aims of this paper were to assess the association between MVU and (1) sociodemographic, (2) preventive/health, and (3) patient/provider factors among a racially and ethnically diverse adult sample of over 1,500 low-income housing residents living in Boston, Massachusetts (USA). Bivariate and multivariable logistic regression models were the primary analytic strategy for investigating these associations. In multivariable analyses, sociodemographic factors (female gender, older age, and White or Other race/ethnicity) were significantly associated with regular MVU (p ≤ .05). Preventive/health variables (health status, physical activity, and body mass index) and characteristics of patient/provider relationships (having a regular provider, last provider visit, decision-autonomy, and quality of relationship) were not significantly associated with MVU. While more evidence is needed to understand the benefits of MVU, future studies should address low use of MVU among lower-income, multi-ethnic populations, particularly in light of health disparities.


Health disparities Multivitamins Cancer prevention 


  1. 1.
    Huang HY, Caballero B, Chang S, Alberg AJ, Semba RD, Schneyer CR et al (2006) The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a national institutes of health state-of-the-science conference. Ann Intern Med 145:372–385PubMedGoogle Scholar
  2. 2.
    Wei MY, Garland CF, Gorham ED, Mohr SB, Giovannucci E (2008) Vitamin D and prevention of colorectal adenoma: a meta-analysis. Cancer Epidemiol Biomarkers Prev 17(11):2958–2969. doi:10.1158/1055-9965.EPI-08-0402 PubMedCrossRefGoogle Scholar
  3. 3.
    Cui Y, Rohan TE (2006) Vitamin D, calcium, and breast cancer risk: a review. Cancer Epidemiol Biomarkers Prev 15(8):1427–1437. doi:10.1158/1055-9965.EPI-06-0075 PubMedCrossRefGoogle Scholar
  4. 4.
    Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M et al (2007) Optimal vitamin D status for colorectal cancer prevention: a quantitative meta analysis. Am J Prev Med 32(3):210–216. doi:10.1016/j.amepre.2006.11.004 PubMedCrossRefGoogle Scholar
  5. 5.
    Garland CF, Gorham ED, Mohr SB, Grant WB, Giovannucci EL, Lipkin M (2007) Vitamin D and prevention of breast cancer: pooled analysis. J Steroid Biochem Mol Biol 103:708–711. doi:10.1016/j.jsbmb.2006.12.007 PubMedCrossRefGoogle Scholar
  6. 6.
    Gissel T, Rejnmark L, Mosekilde L, Vestergaard P (2008) Intake of vitamin D and risk of breast cancer—a meta-analysis. J Steroid Biochem Mol Biol 111(3–5):195–199. doi:10.1016/j.jsbmb.2008.06.002 PubMedCrossRefGoogle Scholar
  7. 7.
    McCullough ML, Robertson AS, Rodriguez C, Jacobs EJ, Chao A, Carolyn J et al (2003) Calcium, vitamin D, dairy products, and risk of colorectal cancer in the Cancer Prevention Study II Nutrition Cohort (United States). Cancer Causes Control 14:1–12. doi:10.1023/A:1022591007673 PubMedCrossRefGoogle Scholar
  8. 8.
    Huang H, Caballero B, Chang S, Alberg AJ, Semba RD, Schneyer C et al (2007) Multivitamin/mineral supplements and prevention of chronic disease: executive summary. Am J Clin Nutr 85(suppl):265S–268SPubMedGoogle Scholar
  9. 9.
    Stampfer M (2007) Toward optimal health: Meir Stampfer, MD, Dr. PH, discusses multivitamin and mineral supplementation for women. J Womens Health 16(7):959–962. doi:10.1089/jwh.2007.C077 CrossRefGoogle Scholar
  10. 10.
    Park S, Johnson MA, Fischer JG (2008) Vitamin and mineral supplements: barriers and challenges for older adults. J Nutr Elder 27(3/4):297–317. doi:10.1080/01639360802265855 PubMedCrossRefGoogle Scholar
  11. 11.
    McKay DL, Perrone G, Rasmussen H, Dallal G, Blumberg JB (2000) Multivitamin/mineral supplementation improves plasma B-vitamin status and homocysteine concentration in healthy older adults consuming a folate-fortified diet. J Nutr 130(12):3090–3096PubMedGoogle Scholar
  12. 12.
    Chandra RK (2004) Impact of nutritional status and nutrient supplements on immune responses and incidence of infection in older adults. Ageing Res Rev 3(1):91–104. doi:10.1016/j.arr.2003.08.004 PubMedCrossRefGoogle Scholar
  13. 13.
    Smithells RW, Sheppard S, Schorah CJ et al (1980) Possible prevention of neural tube defects by periconceptual vitamin supplementation. Lancet 1:339–340. doi:10.1016/S0140-6736(80)90886-7 PubMedCrossRefGoogle Scholar
  14. 14.
    Smithells RW, Sheppard S, Wild J, Schorah CJ (1989) Prevention of neural tube defect recurrences in Yorkshire: final report. Lancet 2:498–499. doi:10.1016/S0140-6736(89)92103-X PubMedCrossRefGoogle Scholar
  15. 15.
    Radimer K, Bindewald B, Hughes J, Ervin B, Swanson C, Picciano MF (2004) Dietary supplement use by US adults: data from the National Health and Nutrition Examination Survey, 1999–2000. Am J Epidemiol 160:339–349. doi:10.1093/aje/kwh207 PubMedCrossRefGoogle Scholar
  16. 16.
    Archer SL, Stamler J, Moag-Stahlberg A et al (2005) Association of dietary supplement use with specific micronutrient intakes among middle-aged American men and women: the INTERMAP study. J Am Diet Assoc 105:1106–1114. doi:10.1016/j.jada.2005.04.010 PubMedCrossRefGoogle Scholar
  17. 17.
    Ahluwalia IB, Lawrence JM, Balluz J (2007) Psychosocial factors associated with use of multivitamins by women of childbearing age. J Commun Health 32(1):57–69. doi:10.1007/s10900-006-9029-1 CrossRefGoogle Scholar
  18. 18.
    Catov JM, Bodnar LM, Ness RB, Markovic N, Roberts JM (2007) Association of periconceptional multivitamin use and risk of preterm or small-for-gestational-age births. Am J Epidemiol 166(3):296–303. doi:10.1093/aje/kwm071 PubMedCrossRefGoogle Scholar
  19. 19.
    Pawlak R, Connell C, Brown D, Meyer MK, Yadrick K (2005) Predictors of multivitamin supplement use among African–American female students: a prospective study utilizing the theory of planned behavior. Ethn Dis 15(4):540–547PubMedGoogle Scholar
  20. 20.
    Vahratian A, Siega-Riz AM, Savitz DA, Thorp JM Jr (2004) Multivitamin use and the risk of preterm birth. Am J Epidemiol 160(9):886–892. doi:10.1093/aje/kwh305 PubMedCrossRefGoogle Scholar
  21. 21.
    Jacobs EJ, Connell CJ, Patel AV, Chao A, Rodriguez C, Seymour J, McCullough ML, Calle EE, Thun MF (2001) Multivitamin use and colon cancer mortality in the Cancer Prevention Study II Cohort (United States). Cancer Causes Control 12:927–934. doi:10.1023/A:1013716323466 PubMedCrossRefGoogle Scholar
  22. 22.
    Briefel RR, Johnson CL (2004) Secular trends in dietary intake in the United States. Annu Rev Nutr 24:401–431. doi:10.1146/annurev.nutr.23.011702.073349 PubMedCrossRefGoogle Scholar
  23. 23.
    Foote JA, Murphy SP, Wilkens LR, Hankin JH, Henderson BE, Kolonel LN (2003) Factors associated with dietary supplement use among healthy adults of five ethnicities: the Multiethnic Cohort Study. Am J Epidemiol 157:888–897. doi:10.1093/aje/kwg072 PubMedCrossRefGoogle Scholar
  24. 24.
    Gordon NP, Schaffer DM (2005) Use of dietary supplements by female seniors in a large Northern California health plan. BMC Geriatr 5:4. doi:10.1186/1471-2318-5-4 PubMedCrossRefGoogle Scholar
  25. 25.
    Kimmons JE, Blanck HM, Tohill BC, Zhang J, Khan LK (2006) Multivitamin use in relation to self-reported body mass index and weight loss attempts. Med Gen Med 8(3):3Google Scholar
  26. 26.
    Rock CL (2007) Multivitamin-multimineral supplements: who uses them? Am J Clin Nutr 85(suppl):277S–279SPubMedGoogle Scholar
  27. 27.
    Jasti S, Siega-Riz AM, Bentley ME (2003) Dietary supplement use in the context of health disparities: cultural, ethnic and demographic determinants of use. J Nutr 133(6):2010S–2013SPubMedGoogle Scholar
  28. 28.
    Langer RD, White E, Lewis CE, Kotchen JM, Hendrix SL, Trevisan M (2003) The women’s health initiative observational study: baseline characteristics of participants and reliability of baseline measures. Ann Epidemiol 13:S107–S121. doi:10.1016/S1047-2797(03)00047-4 PubMedCrossRefGoogle Scholar
  29. 29.
    O’Rourke KM, Roddy ME, Williams D, Mena K (2006) Predictors of early postpartum vitamin use among women of Mexican origin: implications for healthcare provider recommendations. Ethn Dis 16(1):194–200PubMedGoogle Scholar
  30. 30.
    Greenlee H, White E, Patterson RE, Kristal AR (2004) Supplement use among cancer survivors in the Vitamins and Lifestyle (VITAL) study cohort. J Altern Complement Med 10(4):660–666PubMedGoogle Scholar
  31. 31.
    Satia-Abouta J, Kristal AR, Patterson RE, Littman AJ, Stratton KL, White E (2003) Dietary supplement use and medical conditions: the VITAL study. Am J Prev Med 24(1):43–51. doi:10.1016/S0749-3797(02)00571-8 PubMedCrossRefGoogle Scholar
  32. 32.
    Bennett GG, McNeill LH, Wolin KY, Duncan DT, Puleo E, Emmons KM (2007) Safe to walk? Neighborhood safety and physical activity among public housing residents. PLoS Med 4(10):1599–1606. doi:10.1371/journal.pmed.0040306 PubMedCrossRefGoogle Scholar
  33. 33.
    McNeill LH, Puleo E, Bennett GG, Emmons KM (2007) Exploring social contextual correlates of computer ownership and frequency of use among urban, low-income, public housing adult residents. J Med Internet Res 9(4):e35. doi:10.2196/jmir.9.4.e35 PubMedCrossRefGoogle Scholar
  34. 34.
    Emmons KM, Stoddard AM, Fletcher R, Gutheil C, Suarez EG, Lobb R, Weeks J, Bigby JA (2005) Cancer prevention among working class, multiethnic adults: results of the healthy directions-health centers study. Am J Public Health 95(7):1200–1205. doi:10.2105/AJPH.2004.038695 PubMedCrossRefGoogle Scholar
  35. 35.
    Bennett GG, Wolin KY, Puleo E, Emmons K (2006) Pedometer-determined physical activity among multiethnic low income housing residents. Med Sci Sports Exerc 38:768–773. doi:10.1249/01.mss.0000210200.87328.3f PubMedCrossRefGoogle Scholar
  36. 36.
    Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategies, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182. doi:10.1037/0022-3514.51.6.1173 PubMedCrossRefGoogle Scholar
  37. 37.
    Park SY, Murphy SP, Martin LC, Kolonel KN (2008) Nutrient intake from multivitamin/mineral supplements is similar among users from five ethnic groups: the Multiethnic Cohort Study. J Am Diet Assoc 108(3):529–533. doi:10.1016/j.jada.2007.12.011 PubMedCrossRefGoogle Scholar
  38. 38.
    Emmons KM, McBride CM, Puleo E, Pollak KI, Marcus BH, Napolitano M, Clipp E, Onken J, Farraye FA, Fletcher R (2005) Prevalence and predictors of multiple behavioral risk factors for colon cancer. Prev Med 40(5):527–534. doi:10.1016/j.ypmed.2004.10.001 PubMedCrossRefGoogle Scholar
  39. 39.
    Coups EJ, Manne SL, Meropol NJ, Weinberg DS (2007) Multiple behavioral risk factors for colorectal cancer and colorectal cancer screening status. Biomarkers Prev 16(3):510–516. doi:10.1158/1055-9965.EPI-06-0143 CrossRefGoogle Scholar
  40. 40.
    Cleves MA, Hobbs CA, Collins HB, Andrews N, Smith LN, Robbins JM (2004) Folic acid use by women receiving routine gynecologic care. Obstet Gynecol 103:746–753PubMedGoogle Scholar
  41. 41.
    March of Dimes (2000) Folic acid and the prevention of birth defects. A national survey of pre-pregnancy awareness and behavior among women of childbearing age 1995–2000. Conducted by the Gallup Organization. March of Dimes, White Plains (NY)Google Scholar
  42. 42.
    Giovannucci E, Stampfer MJ, Colditz GA et al (1998) Multivitamin use, folate, and colon cancer in women in the Nurses’ Health Study. Ann Intern Med 129:517–524PubMedGoogle Scholar
  43. 43.
    Rohan TE, Jain MG, Howe GR et al (2000) Dietary folate consumption and breast cancer risk. J Natl Cancer Inst 92:266–269. doi:10.1093/jnci/92.3.266 PubMedCrossRefGoogle Scholar
  44. 44.
    Fairfield KM, Fletcher RH (2002) Vitamins for chronic disease prevention in adults: scientific review. JAMA 287:3116–3126. doi:10.1001/jama.287.23.3116 PubMedCrossRefGoogle Scholar
  45. 45.
    Fletcher RH, Fairfield KM (2002) Vitamins for chronic disease prevention in adults: clinical applications. JAMA 287:3127–3129. doi:10.1001/jama.287.23.3127 PubMedCrossRefGoogle Scholar
  46. 46.
    Ansong KS, Lewis C, Jenkins P, Bell J (2000) Epidemiology of erectile dysfunction: a community-based study in rural New York State. Ann Epidemiol 10(5):293–296. doi:10.1016/S1047-2797(00)00050-8 PubMedCrossRefGoogle Scholar
  47. 47.
    Ellison-Loschmann L, Sunyer J, Plana E, Pearce N, Zock JP, Jarvis D et al (2007) Socioeconomic status, asthma and chronic bronchitis in a large community-based study. Eur Respir J 29(5):897–905. doi:10.1183/09031936.00101606 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Rachel C. Shelton
    • 1
  • Elaine Puleo
    • 2
  • Sapna Syngal
    • 3
    • 4
  • Karen M. Emmons
    • 3
    • 5
  1. 1.Department of Oncological SciencesMount Sinai School of MedicineNew YorkUSA
  2. 2.Department of Public HealthUniversity of MassachusettsAmherstUSA
  3. 3.Department of Medical Oncology/Population SciencesDana-Farber Cancer InstituteBostonUSA
  4. 4.Department of MedicineHarvard Medical SchoolBostonUSA
  5. 5.Department of Society, Human Development and HealthHarvard School of Public HealthBostonUSA

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