In this analysis of a large, nationally representative sample of U.S. males aged 18 to 44 years, suboptimal preconception health indicators were prevalent. These indicators included poor or fair self-rated health; low education and household income status; lack of health insurance and no recent utilization of health care and dental care; cigarette smoking; frequent alcohol consumption and binge drinking; marijuana and illegal drug use; obesity; low fruit and vegetable intake and no multi-vitamin use; low physical activity; short sleep durations; depressive symptoms; and hypertension and asthma. Approximately 14% of men reported having at least one disability related to vision, hearing, cognition, mobility, self-care, or independent living. Compared to males with no disabilities, males with any disabilities were more likely to report poor or fair health, low education, current smoking, frequent alcohol consumption, drug use and rehabilitation, physical inactivity, long sleep durations, depression, and chronic medical conditions.

Even with an acknowledged need for reproductive health, preconception care, and family planning services for males of reproductive age (Gavin et al., 2014), few previous studies have examined indicators of preconception health in this population. In an analysis of the U.S. National Survey of Family Growth, 2006–2010, 60% of males (aged 15–44 years) were deemed to be in need of preconception or family planning care, especially those who were in the younger age group (15–29 years) (Choiriyyah et al., 2015; Marcell et al., 2016). Need for care was based on various factors including sociodemographic characteristics, birth intentions, fecundity, sexual behaviors, health behaviors (e.g., obesity, alcohol, drug use), and receipt of health services (Choiriyyah et al., 2015; Marcell et al., 2016). Similarly, among males, aged 35 to 39 years, participating in the National Survey of Adolescent Males (2008–2010), 33% were in need of preconception care, 40% were in need of family planning, and 12% were in need of both (Casey et al., 2016). In studies of males who were trying to conceive or had partners with current or recent pregnancies, alcohol consumption, smoking, poor sleep hygiene, use of prescription medication or marijuana, and low levels of screening for sexually transmitted infections were commonly reported despite some positive behavior changes in response to pregnancy, such as improved nutrition or physical activity, elevated BMI (>25 kg/m²) (Bodin et al., 2017; Dennis et al., 2022; Shawe et al., 2019). Collectively, these findings are consistent with those from this study; in addition, we found that significant proportions of males reported drug use, depressive symptoms, and chronic medical conditions. Although lack of health insurance or health care utilization may partially account for these health disparities, more than 70% of males reported having access to these resources. This suggests that despite many males having recent health care visits, they may not be receiving necessary health counseling and services (e.g., screening and testing for sexually transmitted infections) during these visits (Choiriyyah et al., 2015).

Importantly, similar to our previous results among females with disabilities (Deierlein et al., 2022), we found that males with disabilities were more likely to have suboptimal preconception health indicators compared to their counterparts without disabilities. Much of the current, though still limited, literature focuses on the preconception and prenatal health of disabled women, revealing differences in health and lifestyle behaviors, health care services, subfertility, sexually transmitted infections, unintended pregnancies, and sexual violence (Deierlein et al., 2022; Holdsworth et al., 2018; Horner-Johnson et al., 2019, 2020; Horner-Johnson, Akobirshoev, et al., 2021; Mitra et al., 2012). Less information is available for males of reproductive age with disabilities. Greater likelihood of sexual dissatisfaction, sexual anxiety, sexual dysfunction, and sexually transmitted infections have been reported among males with disabilities compared to those without disabilities (Bollier et al., 2019; McCabe & Taleporos, 2003). Among fathers participating in the 2016 Behavioral Risk Factor Surveillance System, those with disabilities were approximately 1.5 to 5.5 times more likely than their nondisabled counterparts to report insufficient sleep, current smoking, poor or fair health, frequent physical distress, or frequent mental distress (Namkung et al., 2019). Fathers with disabilities, particularly those who were married, were also more likely to report unintended births (Namkung & Mitra, 2021). Much more research is necessary to understand issues related to sexual health, intimate relationships, preconception health, family planning, and fatherhood among adolescent and adult males with disabilities.

In an essay by Kotelchuck and Lu, they review the influence of men’s preconception health and health care on pregnancy and offspring outcomes, as well as on men’s overall health throughout the life course (Kotelchuck & Lu, 2017). Cultural views on men’s roles as partners and fathers have evolved over the past several decades, and there is a growing body of literature from public health (e.g., life course epidemiology, maternal and child health, and environmental health) and child development fields supporting paternal contributions to reproductive, women’s, and children’s health (Kotelchuck & Lu, 2017). The “well-man visit” is one strategy to ensure delivery of preconception health and family planning care among males of reproductive age (Frey et al., 2008; Warner & Frey, 2013). A comprehensive framework for health care providers has been developed, which includes content related to family and social history; health behaviors; nutrition; mental health; physical health and laboratory medicine; health promotion; and clinical and psychosocial intervention (Frey et al., 2008; Warner & Frey, 2013). Development of personal reproductive life plans during these visits may also help to increase awareness of reproductive health and pregnancy intentions (Frey, 2010; Warner & Frey, 2013). Both receiving preconception health information from a health care provider and self-seeking health information have been associated with improving knowledge and health and lifestyle behaviors (Barker et al., 2007; Bersamin et al., 2017; Hemsing et al., 2017). Self-care interventions that engage men to participate in activities related to their own health (e.g., use of telemedicine and digital platforms for reproductive health) are also positively associated with men’s health-seeking behaviors, which could improve both immediate and long-term health outcomes (Narasimhan et al., 2021).

In this study, males with disabilities were more likely to report having a health care visit within the previous year compared to those without disabilities. Males with disabilities often interact with multidisciplinary health care teams, including primary-care providers, neurologists, and physical medicine and rehabilitation specialists. These interactions may offer greater opportunities for health care providers to incorporate discussions regarding sexual activity, reproductive health, and family planning while addressing other health concerns with their patients. Sexual and reproductive health needs among persons with disabilities have traditionally been disregarded by society, and the health care field, with assumptions that these individuals are asexual, unable to reproduce, and incapable of romantic relationships and parenthood (Addlakha et al., 2017; Esmail et al., 2010; Neufeld et al., 2002). Medical school curricula often do not include formal training in caring for persons with disabilities (Rotoli et al., 2020; Sapp et al., 2021) or sexual health care (outside of gynecology and urology) (Beebe et al., 2021). Increasing awareness through formal and informal educational experiences may help to greatly reduce barriers to care in this population. Clinical practice guidelines on sexual health, which emphasize integration of sexual health training within health care teams, are available for spinal cord injury and could be adapted for other disabilities (“Sexuality and Reproductive Health in Adults With Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals,” 2010). Training programs within the rehabilitation medicine setting have been successful at improving providers’ knowledge and ability to recognize sexual health issues, as well as their comfort level and conversational skills with discussing patients’ sexual health (Pieters et al., 2018). Further implementation and evaluation of programs are necessary to encourage proactive discussions, information sharing, and provision of screenings/treatments related to sexual and reproductive health between providers and their patients with disabilities.

This study has several strengths. Data were from a nationally representative sample of U.S. males of reproductive age that included the collection of numerous sociodemographic-, health-, and lifestyle-related factors. We examined preconception health indicators for the entire sample, as well as stratified by disability status. The quality of the data was limited, however, by self-report (all indicators except BMI) and the cross-sectional study design. The disability questionnaire only asked participants about having serious difficulty with functional domains (yes or no), which differs from the Washington Group questions that assess level of difficulty: no difficulty, some difficulty, a lot of difficulty, cannot do at all (Madans et al., 2011). Owing to limited sample size, we were unable to examine associations stratified by type of disability (e.g., vision, hearing, and physical) or other sociodemographic factors. Finally, as highlighted by Kotelchuck and Lu, men’s preconception health often encompasses more factors than those related to sperm health, such as their maturity, financial stability, and psychological readiness to enter fatherhood (Kotelchuck & Lu, 2017). Studies are needed to better understand how these factors may differentially affect males with disabilities.