The number of school-based health centers (SBHC) across the country is increasing, with over 1900 centers open nationally. SBHC may be effective structural/contextual health promotion investments as they (1) are embedded within schools, the only public institution with the capacity to reach a majority of youth; (2) are designed to reduce barriers associated with accessing services (e.g., finances, confidentiality concerns, inconvenient hours, distance from home); and (3) directly or indirectly expose youth to medical and mental services that exist in their community. When placed in areas of high need, the potential exists for improving youth, family, and community outcomes and ultimately reducing health disparities.
Few studies have focused on contextual or structural factors characterizing environments in which young people live and make decisions about reproduction. To date, research on SBHC with a family planning component (SBHC-FPC) and birth rates, contraceptive use, and sexual behaviors has been mixed, largely due to methodological weaknesses such as self-selection by clinic users, substitution effects, and nonequivalent comparison groups. Additionally, long-term impacts are not measured as adolescents age out of the system and become more difficult to track. The current study aims to address these issues by conducting an impact evaluation on the role of SBHC-FPC on female adolescent and reproductive health behaviors. Previous methodological limitations are addressed by surveying a large national sample of youth (selected through a list-assisted random sample; n = 3600), across 160 schools (including matched control schools without a SBHC), and following them for a three year period from adolescence into young adulthood.
Specifically we aim to asses 1) whether the presence of SBHC-FPCs in high school is associated with positive short-term effects in adolescence and carry-over effects into young adulthood, including effects on attitudes, beliefs, and behaviors (e.g. contraceptive use, pregnancy intentions); and 2) how access to different types of sexual and reproductive health services impacts outcomes (e.g. birth control counseling versus birth control dispensing). Results of the proposed application will inform whether and what types of health services influence young women's reproductive behaviors and whether exposure to school-based health services has broader impacts on health care seeking over time. Findings from the proposed study will inform research and school and state policy through (a) increased understanding of the effects of SBHC-FPCs on reproductive health-seeking behavior, planned and unplanned pregnancy, and (b) increased knowledge of which services are effective. Findings will also inform our understanding of how access to medical services more generally influences health behaviors.