December 2001 // Volume 39 // Number 6 // Tools of the Trade // 6TOT4

Previous Article Issue Contents

An Ounce of Prevention: Addressing Birth Defects Related to Folic Acid, Alcohol and Tobacco, A High School Curriculum

Students in Missouri schools are learning about the preventive factor of birth defects related to folic acid in the diet, and alcohol and tobacco use during pregnancy. A comprehensive new curriculum was developed and implemented as a joint project of University of Missouri Extension and Health Sciences-Genetics. Topics include: prenatal development, birth defects, folic acid, alcohol, tobacco, pre-pregnancy planning, pre-natal screening and diagnosis, and genetic counseling. 80% of Missouri school districts and 74% of Missouri Department of Health county offices received the curriculum.

Brenda Bell
Human Environmental Sciences Specialist
University of Missouri Outreach & Extension
West Plains, Missouri
Internet Address:

A Comprehensive New Curriculum Focuses on Birth Defects

Students in Missouri schools are learning about the preventive factor of birth defects related to folic acid in the diet, and alcohol and tobacco use during pregnancy. An Ounce of Prevention: Addressing Birth Defects Related to Folic Acid, Alcohol and Tobacco is a curriculum targeting adolescents. It was developed jointly by University of Missouri genetic counselors Lori Williamson-Kruse and Carrie McMahon, and University of Missouri Extension Human Environmental Sciences Specialist, Brenda Bell.

The curriculum includes: teacher background information and resources to enhance the instruction of pre-conception health, birth defects and prenatal diagnosis in high school family and consumer sciences, health, and/or biology classes. Its development was based on a need identified by Missouri teachers for an organized curriculum written from current, research-based information. A 2-year grant from the Missouri March of Dimes funded the project, with an additional funds contributed by the Missouri Department of Health.

Curriculum Organization

The curriculum contains five chapters, appendices of resources, Web sites, activities, and a packet of resources. Those resources include more than 30 March of Dimes publications, plus publications from other health-related sources. Each publication accompanies a specific learning activity within the curriculum. All chapters include behavioral objectives, hands-on learning activities, overhead masters, assessments and recommended resources for teaching about birth defects: Key concepts presented are:

  • Prenatal Development: the causes and impacts of birth defects.
  • Folic Acid: definition, function and sources, reduction vs. prevention of neural tube defects, impact on general health.
  • Alcohol Use During Pregnancy: fetal alcohol syndrome--characteristics and impact.
  • Risks of Tobacco Use During Pregnancy: associated risks of post natal tobacco use.
  • Pre-conception planning: elements of a healthy pregnancy, pre natal screening and diagnosis, and genetic counseling.

The authors chose these areas as the focus of the curriculum due to the prevention factor of each. A variety of teaching methods have been incorporated to approach different learning styles, with many interactive and hands-on techniques included.

While the target audience is ninth and tenth grades, content can be readily adapted to the junior high and upper high school levels.

The curriculum was written in accordance with:

  • Missouri Competencies for Family and Consumer Sciences
  • Show Me Goals and Standards.
  • National Standards for Family and Consumer Sciences.
  • Missouri Science and Health Framework Strands.

The format for the curriculum incorporates the practical problem-solving approach and the scientific method. Practical problems involve value questions and typically affect people and their well being, while scientific problems involve specific knowledge. Technical assistance to meet current educational standards and expectations was provided by the Missouri Department of Elementary and Secondary Education Family and Consumer Sciences Curriculum Supervisor

The Development Process

The curriculum development process included focus group sessions to identify components needed in the curriculum, field-testing a draft copy of the curriculum during the spring 2000 semester, and follow-up evaluation data that was incorporated in the final revision of the curriculum. Evaluation data from the more than 300 students involved indicated a significant increase in knowledge about birth defects and improvement in health lifestyle factors that affect birth defect incidence.

The distribution process included 17 curriculum-implementation workshops presented in locations around the state. Each 4-hour session provided training in the teacher background information, or the scientific content, as well as a review of the curriculum organization, activities, and audio visual aids.

In addition to the teachers, participants included county department of health case managers and health educators, Parents As Teachers Educators, resource mothers coordinators, adolescent at-risk program staff, and medical clinic nurses. Eighty percent of the school districts in Missouri and 74% of the county health department offices have received the curriculum. More than 500 individuals participated in the implementation workshops.

Feedback from the teachers has been very positive:

  • "I'm sure this notebook will be one of the most used resources in my classroom. The information has already been used in Child Development and Health classes and as a resource for speeches and research papers in Senior English. The real-life pictures have been excellent teaching tools: they are worth a thousand words for the students." Cecila Dotson, Salisbury High School, Salisbury, MO

  • "I have been using the materials in my class and they are great, the students love it and it is very user friendly." Rhonda Galbraith, Central high School, Springfield.

Outcomes and Impact

The educational package produced through this project has been reviewed and recognized through the following awards:

  • 2001 Educational Curriculum Package, Central Region NEAFCS, 2nd place
  • 2001 University of Missouri Extension Association (UMEA) Educational Curriculum Package, 1st place
  • 2001 Teamwork Award Recipient - University of Missouri Outreach & Extension
  • 2001 UMEA Innovator in Education Award

Increased knowledge and the resulting reduction of the numbers of birth defects through implementation of this curriculum could be significant. According to March of Dimes statistics, approximately 4% of all babies in the United States are diagnosed with a birth defect. With the average lifetime cost of $236,00 per incidence, the potential financial impact alone would be considerable.

Training Opportunities and Ordering Information

The authors will consider requests for training in locations outside Missouri. For information about training opportunities or answers to questions, contact: Brenda Bell, University of Missouri Outreach & Extension, 217 S. Aid Avenue, West Plains, MO 65775, or; ph. 417-256-2391.

Recently published by MU Extension Publications, the curriculum can be ordered at this address:

Extension Publications
University of Missouri, 2800 Maguire Blvd.,
Columbia, MO 65211
Call toll free: 1-800-292-0969, or order online:
Request: CB15, An Ounce of Prevention