Background:
Because of their educational and economic status and their relatively low death rates, college students have traditionally not been a priority for the public health field. They have also not been a target group for public health practitioners working to improve pregnancy outcomes. However, data and experience argue that college students should become an overall public health priority and, in particular, a priority population for preconception care programs. The rationale for this includes the fact that college students:
• are a large group. There are over 17 million college students in the United States and more than 9 million are women. Over 40% of all 18-24 year olds are enrolled in post-secondary education at any one time. During the 18-24 year old period 60% of individuals spend some time enrolled in a post-secondary institution. are establishing lifestyle patterns and behaviors that will stay with them the rest of their lives. The recognition that tobacco, alcohol, and illicit drug use; poor diet; physical inactivity; and sexual activity (each of these being a major part of the lives of college students) are the “real” leading causes of death reinforce the need to make college students a public health priority.
• have a low pregnancy rate. The pregnancy rate among college students is less than 3%. However, pregnancy rates rise rapidly shortly after students leave school. This makes college students an excellent target for preconception care initiatives. play a role in setting societal norms. If public health and preconception care programs become routine for college students, it will be more likely that they will become routine in the overall society.
• are role models for younger individuals. Changing the behaviors of college students has an indirect impact on the more traditionally “high risk” individuals.
• are reachable through college health services – the last best chance of intervening with this large group of men and women.
Most 4-year colleges and universities have an on-campus health service that addresses the many health needs of students. These health services are unique in the array of services that they provide. Unlike most community agencies they provide both population based public health services and primary medical care. Their responsibility for the health of the entire population fosters a broad array of campus-wide disease prevention and health promotion activities. In addition, college health services have a responsibility for assuring access to health care either through provision of services or the development of health insurance options. Because of the population served, the clinical services also include a major focus on disease prevention and health promotion in addition to treatment. All of this is done with a syndemic and student development perspective.
The unique funding mechanism for college health services provides them the flexibility to try different methods of public health and medical care delivery. This allows college health services to address particular health issues in unique and innovative ways.

Objectives:
• Identify the characteristics of college students that make them a high priority for preconception care initiatives
• Define college health services' role in preconception care
• Outline the ways college health services could help improve the provision of preconception care to an at-risk population
• Highlight the ways college health services could collaborate with local public health agencies in the efforts to improve community-wide pregnancy outcomes.

Methods:
While it is evident that college health services can play a major role in providing preconception care to a large group of young adults, how to best implement in providing this care is still an open question. College health services need to first be educated about and embrace the role they can play in preconception care. They then need to make preconception care education and services a contextual part of their existing services. That context could include:
• During the counseling that occurs after a negative pregnancy test
• During the provision of emergency contraception which is a teachable moment
• When discussing alcohol and tobacco use and its implications for future child bearing
• During nutrition counseling where it can be pointed out that obesity is a risk factor for poor pregnancy outcomes
• During clinic visits when consideration should be given to the pregnancy implications of drugs that are prescribed for short-term and chronic use
• During routine health care where discussions of fish consumption, folic acid, exercise, etc., could occur
• During outreach efforts to students on campus
Community public health agencies could also look to college health services for data on the preconception needs of 18-24 year olds and provide consultation on preconception care issues. A collaborative relationship between college health services and local public health agencies holds promise for enhancing the provision of a broad range of public health services, particularly preconception care.

Results:
The outcome of efforts in this area are pending.

Conclusion and implications for practice:
Traditional age college students are at a developmental stage in their lives where they are making and solidifying behavioral and lifestyle choices that will have a long-term impact on their health. These choices also have the potential to affect the lives of their offspring. In addition, college students serve as role models for younger individuals and will help set societal trends. College students will also be community leaders for several decades after graduation. All of these factors argue for the inclusion of college students as a public health priority.
College health services provide access to this large group of individuals in the prime of their reproductive years. By incorporating preconception care into their routine activities, college health services have the potential to help improve pregnancy outcomes in this country. Developing collaborative relationships between college health services and local public health agencies on the issue of preconception care could lay the groundwork for collaboration on many other public health issues facing colleges and the communities in which they are located.