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Innovative Approaches for
Integrating Preconception Health
Concepts into Adolescent Health
Efforts
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ad⋅o⋅les⋅cent – adj.
A young person who has undergone puberty but who
has not reached full maturity; a teenager.
Age range: 10-24 years old
Adolescence is the bridge period between adulthood
and childhood – it is a transitional stage marked by
physical and mental developmental changes
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Quick Stats
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Stats …
 Adolescent population is increasing in numbers!
 Adolescents are increasing in ethnic diversity.
 Characteristics of adolescent experience changing –
the current generation of youth is one that can be
characterized in part by “firsts.”
 Disparities – adolescent population experiencing
significant racial, ethnic, geographic,
socioeconomic, and other disparities.
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Our Framework
Why preconception health for
adolescents?
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Our Framework
…To Bridge Adolescent and
Women’s Preventive Health (A
Life Course Approach)
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…To Lay the Foundation for
Lifelong Positive Reproductive
Health Outcomes
Preconception | Birth | Early Childhood |
Adolescence | Young Adulthood |
Adulthood | Midlife | Old Age | Death
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Timing matters
As the border …
between adulthood and
childhood, adolescence is a critical time for
health promotion
Many adolescents behave in risky ways or live
in environments that not only affect their
immediate health, but also have a significant
impact on their health as adults.
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The intersect …
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Key Facts - Reproductive and Sexual Health
~48% of teens have had sex; 35% are currently sexually active
~15% of teens have had sex with 4 or more partners
~62% of sexually active youth used a condom at last intercourse
~23% of sexually active youth used drugs/alcohol prior to last
sexual intercourse
In 2006, 14% of HIV cases reported to CDC was among young
people aged 13-24
1 in 4 U.S. teen girls has sexually transmitted infection (more than
3 million teens)
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The strategy …
The Preconception Health & Adolescents Action
Learning Collaborative
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Our strategy …
#1: Individual responsibility
across the lifespan
(“reproductive awareness”)
#2: Consumer Awareness
#4: Interventions
for Identified Risks
#8: Public Health
Programs and Strategies
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Our strategy …
 Created partnership between Women’s and Adolescent Health
Teams & ASTHO
 Worked with advisory group to shape the project
 Working with teams to support integration of guidelines
 Providing on-going financial and technical support
 Helping teams assess learning and revise strategies
 Helping teams evaluate their efforts
 Evaluating our efforts
 Analyzing implications for the broader community
 Disseminating results
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State teams …
 Explore implications of taking CDC guidelines and
transferring to practice
 Build partnerships
 Discover barriers and enablers of change
 Create strong, visible leaders/champions for this idea
 Create and implement action plans
 Assess learning and revise strategies
 Evaluate strategies
 Share learning
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Participating states …
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Successes
• Tools & Resources
• Reproductive life plans
• Website for youth and young adults
• Information dissemination
• Awareness
• Partnerships
• PHA Symposium
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Lessons Learned
 It can be done!!!!
• Framing can be challenging, but
not impossible
• Partnerships!
• Youth voice
• Males
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Look to the Future …
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Know Your Plan…
Just One Click Away:
South Carolina
Adolescent Preconception Health
Initiative
Breana Lipscomb, MPH
SC Department of Health and Environmental Control
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1331 Elmwood Avenue, Suite 140, Columbia, SC 29201
www.teenpregnancysc.org
PH: 803-771-7700
South Carolina’s Team
 SC Campaign to Prevent Teen
Pregnancy
 SC Department of Health and
Environmental Control
 SC Department of Education
 Teen Health Center
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1331 Elmwood Avenue, Suite 140, Columbia, SC 29201
www.teenpregnancysc.org
PH: 803-771-7700
South Carolina’s Team
 SC Campaign to Prevent Teen
Pregnancy
 SC Department of Health and
Environmental Control
 SC Department of Education
 Teen Health Center
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1331 Elmwood Avenue, Suite 140, Columbia, SC 29201
www.teenpregnancysc.org
PH: 803-771-7700
Know Your Plan…
Just One Click Away:
South Carolina
Adolescent Preconception Health
Initiative
Breana Lipscomb, MPH
SC Department of Health and Environmental Control
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1331 Elmwood Avenue, Suite 140, Columbia, SC 29201
www.teenpregnancysc.org
PH: 803-771-7700
South Carolina’s Team
 SC Campaign to Prevent Teen
Pregnancy
 SC Department of Health and
Environmental Control
 SC Department of Education
 Teen Health Center
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1331 Elmwood Avenue, Suite 140, Columbia, SC 29201
www.teenpregnancysc.org
PH: 803-771-7700
Pregnancy
Prevention
Preconception Health
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Population Left Behind
 Older youth harder to reach and often “left
behind” in health interventions
– 94% of men and 86 of women 18-29 believe
pregnancy should be planned
– 86% of men and 88% of women 18-29 say it is
important to avoid pregnancy right now
– Only about 50% are well protected against
pregnancy
(Fog Zone, National Campaign to Prevent Teen and Unplanned Pregnancy)
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Only Part of the
Message…
 Pregnancy prevention is only part of the
message
 Older youth also need to know how to
stay healthy:
– Nutrition
– Exercise
– Substance use
– Reproductive life planning
– Goal setting
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Know Your Plan…
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Know Your Plan…
The Process
 Decided to target older youth
·
– Partner with a health center in a high needs
area to promote preconception health and
pregnancy prevention
 Gathered Team
 Worked with AMCHP technical assistance
 Outcome:
– Brochure/ Flyers to Promote Preconception
Health
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Know Your Plan…
The
Research
 Literature Review
 Focus Groups (3 groups, 27 youth)
 Site Visit to health center serving target
population
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Focus Group Findings:
 Use internet and social media to connect with young
people
 Images should be bold, colorful and eye
catching
 Youth want to see people who “look like them” – age,
race, gender
 Youth want to hear from other youths
 Celebrity culture is powerful
 Messages should emphasize the present, not the
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future
Focus Group Findings
BROCHURES
ARE
NOT
THE ANSWER
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Serendipity
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The
Collaboration
Know Your Plan…
 SC Campaign was developing a youth
website with pregnancy prevention focus
 Partnered with SC Campaign to include
preconception health information
 Tested youth site with target population in
December 2010
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January
th
4
2011 Launch
www.carolinateenhealth.com
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Know Your Plan…
The
Evaluation
 Website hits
 Friends and tweets
 Number of placements in health centers,
colleges, and other youth gathering points
 Improvement and expansion of content
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Know Your Plan…
The
Evaluation
 January 4th – May 4th:
– 3,222 unique visits
– 19,257 page views
– 67% new visits
– 47 states
– 58% of visitors visiting site directly; 32%
referred from other sites, including
Facebook, our corporate website, etc.; 10%
referred from search engine
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Know Your Plan…
The
Evaluation

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Bounce rate: 38%
Average # of pages viewed: 4
Length of time on site: 3:13
Most viewed pages:
– Teen Expressions
– Know the Facts
– Know Your Plan
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Know Your Plan…
The
Successes
 Strong Partnerships improved our
product
 SC Campaign’s website improved:
– Youth testers liked having information about
more general health issues
– Less intimidating for youth
 Opportunities for cross promotion
 Great Support from AMCHP
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Know Your Plan…
The Lessons
Learned
 Talk to target population
 Find partnerships
 Leverage other funds
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Know Your Plan…
The
Challenges
 Stay Flexible
 Change the plan when needed
 Understand that web development takes
time
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Know Your Plan…
The Next
Steps
 Promotion, promotion, promotion
 Marketing:
– Wallet cards
– QR Codes
 Distribute wallet cards to:
–
–
–
–
All public health centers in SC
Youth serving organizations
Community Colleges
Urgent Care Offices
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Contact Me!
Breana Lipscomb
LIPSCOBN@dhec.sc.gov
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AMCHP Action Learning Collaborative , Team Members:
State of Oregon Public Health :
Bob Nystrom, & Emilee Coulter-Thompson,Contact: Julie McFarlane , Julie.M.McFarlane@state.or.us
971-673-0365
Oregon Health Sciences University
Michelle Berlin and Lisa Isabel
Women with Disabilities Health Equity Coalition (WowDHEC)
Portland State University (PSU) Marjorie McGee
National Youth Leadership Network (NYLN), Stacey Milbern
Gimpgirl.com (GGC), Jennifer Cole
Community Youth Representative, Marneet Lewis, Portland Community College
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 No recommendations exist, yet 1 in5 women in
the U.S. has a disability (16.8 to 28.6 million)
 Young women with disabilities are much less
likely to receive adequate preconception health
support and services, including reproductive
health care
 cost and insurance issues
 inability to get an appointment
 inability to find a health care provider who understood
or was willing to treat their disability
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 Self identified and doesn’t require equipment or
alternative formats (difficulty seeing, hearing,
or self care)
 Sometimes or often needing ADA accommodations
(movie captions, large text/Braille, ramp or elevator)
 Self identified and using equipment (cane, wheelchai
or amplified telephone)
 Other people see me as disabled (due to cancer, HIV
or Fibromyalgia)
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90
80
70
60
50
40
30
20
10
0
Ever had sexual
intercourse
Sexual intercourse in
past 3 months
Females-D
Source: 2008 Oregon Healthy Teen, 11th Grade (N=7091,
weighted percentages; 23.7% disabled, 76.3% non-disabled)
Marjorie McGee mcgee@pdx.edu
Used condom*
Females-Nd
Used method to prevent
pregnancy*
Males-D
Alcohol and drug use*
Males-Nd
* Before/at last
sexual intercourse
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45
40
35
30
25
20
15
10
5
0
Harassed*
Felt unsafe to go to
Threatened on
Girl/boy friend
Physically forced to Gave in to sexual
school*
school grounds w/ hit/slap on purpose
have sexual
activity because of
weapon**
**
intercourse
pressure
Females-D
* Past 30 days
** Past 12 months
Females-Nd
Males-D
Males-Nd
Source: 2008 Oregon Healthy Teen, 11th Grade
(N=7091, weighted percentages; 23.7% disabled & 76.3% non-disabled)
Marjorie McGee mcgee@pdx.edu
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 Team formed a mutual understanding of
the issues.
 Data Analysis and literature review.
 Involving youth with disabilities on the
team.
 Survey is complete. Analysis is under way
and results will be used to inform the final
recommendations. Stay tuned for the
final recommendations!
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 On-line survey promoted through chat-rooms,
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e-mail, listservs for young people with disabiliti
Data from the first 50 surveys (May 25th 2011)
Age Range 18 – 28
Female 60%; Male 38%
25% from Oregon, (other States included
CA., NY, TX, PA, FL, & WA)
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 Respondents concerns related to the
health of Young Adults with Disabilities:
 Safety from violence, abuse, bullying,
and/or harassment (24%)
 Access to health care services (16%)
 Access to mental health services (13%)
 Being included in sex education classes
(12%)
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• “People often forget that people with disabilities have
sexual feelings at all. People assume that goes away
when full use of the body/mind does”.
• “…Health care professionals and those responsible
for sex education doesn’t view people with disabilities
as being capable of having romantic and/or sexual
relationships.”
• “When it comes to young adults with disabilities and
sex we mostly get treated like a child.”
• “[it is challenging] to find Doctors who believe people
with disabilities should be having sex.”
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 Activities took more time than anticipated.
 Maintaining membership over an extended
period of time, when some are volunteers.
 Budget was very small $2,500.
 IRB view of Disability under a Medical Model vs
Team view of Disability
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 Youth with disabilities were engaged in the process.
 Understanding of the Disability, Preconception, and
Youth Health frameworks.
 A survey of youth with disabilities ensured input
from the target population
• The work of the Team will be shared at two state and
three national conferences. Possible publication of
the final recommendations.
 Stay tuned for the recommendations to be released Fall 2011.
 Contact: Julie.M.McFarlane@state.or.us
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Personal note …
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Questions?
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AMCHP Staff:
Sharron Corle –
scorle@amchp.org
Jessica Hawkins –
jhawkins@amchp.org
Lissa Pressfield –
lpressfield@amchp.org
Cristina Sciuto –
csciuto@amchp.org
ASTHO Staff:
Ellen Pliska –
epliska@astho.org
PHA 6 States:
Ohio
Oregon
Missouri
Pennsylvania
South Carolina
Utah
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