Thinking Outside of the Box: Engaging Adolescents in Preconception Health

Thinking Outside of the Box: Engaging Adolescents in Preconception Health

By Lissa Pressfield, MHS
Program Manager, Adolescent Health
Association of Maternal & Child Health Programs




While preconception health for adolescents may seem like a curious notion, it actually provides a new, broader framework to address a range of risks and protective factors facing adolescents that will affect present and future health, and for many, future pregnancies. Including adolescents in preconception health efforts, which have thus far predominantly focused on women, fits within the paradigm of the life course approach and challenges us to expand our reach to critical periods during adolescence.


What do we know?


·         Healthy and unhealthy behaviors in one period of life can be carried on into subsequent periods of life and impact health outcomes.


·         Pregnant teenagers have higher risk than women in their twenties and early thirties of low birth weight, preterm births, death in infancy, and higher risk than their peers for high school dropout and other social and financial hardships that negatively influence health and well-being. (1-3)


·         In 2008, the teen birth rate was 41.5 per 1,000 teenagers – one of the highest rates among developed countries. (4) Over two-thirds of teenage pregnancies are unplanned.


·         46 percent of 15-19 year-olds reported ever having sex on the 2009 Youth Risk Behavior Survey. (5)


·         In 2006, Chlamydia, Gonorrhea or Syphilis was present in about 1 million youth aged 10 to 24 years.


·         During 2004 to 2006, approximately 105,000 adolescents and young adults 10 to 24 years of age were seen at a hospital emergency department for nonfatal sexual assault injury.


·         Similar to the majority of adults, young people are often unaware of how their behaviors and lifestyle factors can influence reproductive health and future health outcomes. (6)


What is AMCHP doing?


In 2006, CDC released the Recommendations to Improve Preconception Health and Health Care — which focused on changing the knowledge, attitudes and behaviors related to reproductive health among both men and women of reproductive age — and AMCHP saw an opportunity to bridge adolescent and women’s health by launching a Preconception Health and Adolescents Action Learning Collaborative (PHA ALC). In partnership with the Association of State and Territorial Health Officials (ASTHO), AMCHP has been working with six multidisciplinary state teams from Missouri, Ohio, Oregon, Pennsylvania, South Carolina and Utah to develop innovative approaches for integrating preconception health concepts into adolescent health efforts.


What are the six state doing?


These state teams are composed of representatives from both health and education agencies, as well as community organizations, universities, youth leaders and other partners. The expertise of team members includes adolescent health, women’s health, family planning, health education and much more. Each of these teams has identified one or more of four select preconception health recommendations for their work. The four recommendations include:


·         Recommendation #1: Individual responsibility across the lifespan, which includes the development, evaluation and dissemination of reproductive life planning tools and education materials to increase “reproductive awareness.”

·         Recommendation #2: Consumer awareness to develop, evaluate and disseminate age-appropriate educational curricula and modules for use in school health education programs; integrate reproductive health messages into existing health promotion campaigns; and design and conduct social marketing campaigns to develop messages for promoting preconception health knowledge and attitudes and behaviors.

·         Recommendation #4: Interventions for identified risks to increase health/education provider awareness concerning the importance of ongoing care for chronic conditions and interventions for identified risk factors, and disseminate existing evidence-based interventions that address risk factors (i.e., alcohol misuse, HIV/AIDS, smoking, STD, obesity).

·         Recommendation #8: Public health programs and strategies, which focuses on developing and supporting public health practice collaborative groups to promote shared learning and dissemination of approaches for increasing preconception health, and incorporating preconception care efforts into existing public health and education programs.


Key Successes


The six ALC states have been working a variety of projects since October 2009 and continue to build broader support to achieve their goals. Utah, by engaging educators and health experts, integrated preconception health concepts into the State Office of Education Secondary Health Core Curriculum and is disseminating a life planning tool for youth called “Plan your Health, Live your Life.” South Carolina is using a youth engagement approach to develop a culturally and age-appropriate website and social media strategy to raise awareness about preconception health among young adults (18-20). Oregon, with strong involvement from youth with disabilities and advocates for people with disabilities, is assessing the preconception health issues and needs of this population in order to develop recommendations and a model policy for integrating youth with disabilities in preconception health efforts. Missouri conducted an assessment of the needs of both students and teachers related to preconception health in order to identify priorities for updating health curriculum resources. Pennsylvania, with broad stakeholder involvement, is working to incorporate preconception health for adolescents into parenting education models. And, Ohio is taking a look at their broad efforts related to adolescent sexual health to strategically integrate preconception health.


A Common Challenge


In spite of the many successes, one of the key lessons learned is that “preconception health” is not a term that resonates with their target populations, which include youth and young adults, educators, parents, etc. This challenge is not new, but the strategies for framing preconception health as it relates to adolescents will be unique. Over the next six months, AMCHP and ASTHO, along with these states and a communications consultant, will be working to reframe the concept of preconception health to more effectively convey the essential messages related to health promotion, screening and prevention.



Are you interested in learning more?


If you are interested in learning more about the work of these six states and others around the nation, in addition to the work that is being done around framing preconception health for adolescents, please consider attending the Preconception Health Symposium: Extending Our Reach to Adolescents and Young Adults on Saturday, February 12, 2011 from 1 to 4:30 p.m. EST. This dynamic session will provide an opportunity to learn from states about their successes and challenges with promoting preconception health with adolescents and explore how these concepts could be applied in your state. The event will be in conjunction with the 2011 AMCHP and Family Voices National Conferences in Washington, DC and is open to conference participants and invited guests only. Space is limited. AMCHP will continue to highlight the efforts of the PHA ALC teams and other states that are implementing preconception health with adolescents through webinars and fact sheets. So, stay tuned!



1. Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2007. National vital statistics reports; vol 58 no 24. Hyattsville, MD: National Center for Health Statistics. 2010.


2. Martin JA, Osterman MJK, Sutton PD. Are preterm births on the decline in the United States? Recent data from the National Vital Statistics System. NCHS data brief, no 39. Hyattsville, MD: National Center for Health Statistics. 2010.


3. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics reports; vol 58 no 17. Hyattsville, MD: National Center for Health Statistics. 2010.


4. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2008. National vital statistics reports; vol 58 no 16. Hyattsville, MD: National Center for Health Statistics. Released April 6, 2010.


5. CDC. Youth Risk Behavior Surveillance—United States, 2009. MMWR 2010;59(SS-5):1–142.


6. Centers for Disease Control and Prevention. Recommendations to improve preconception health and health care — United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006;55(No. RR-6).