School Nurses: Luxury or Necessity?

School-based health centers (SBHCs) offer accessible, youth-oriented, and holistic health services for students. Many research studies have attempted to quantify the impact of school-based health services on student health outcomes, specifically sexual health. In a study of 12 California schools, Ethier et al. found higher rates of contraception use by women in schools with health centers. Kirby et al. found higher condom and contraception use in schools with health centers, though there were “inconsistent effects on self-reported pregnancy rates.” However, these results are relatively inconclusive due to small sample sizes and inappropriate analytic methods.

In “Association Between Availability and Quality of Health Services in Schools and Reproductive Health Outcomes Among Students: A Multilevel Observational Study,” Denny et al. are able to confront the sample-size and methodological issues seen in many American studies and assess the impact of New Zealand’s SBHCs on student health outcomes using a large nationally representative sample and multilevel analytical techniques.

Denny et al. used a two-stage cluster design to collect necessary data. The researchers first randomly selected 115 schools to participate in the study and then randomly selected 12,355 students from those 115 schools to participate in their study. Ninety-six of the 115 schools, and 9,107 of the 12,355 students, agreed to participate in the study. School and student demographics reflected those of New Zealand’s general population.

Administrators were asked to complete questionnaires regarding the availability and quality of their SBHCs. These questionnaires asked school administrators about a variety of access and quality indicators, including number of health practitioners, weekly hours worked by health practitioners, if health practitioners met as a team weekly, etc.

Students self-reported personal health outcomes in an anonymous survey.  Questions on this survey encompassed the following sexual health behaviors: if students were sexually active, levitra vardenafil for ed, condom use for sexually transmitted infections prevention, contraceptive use for pregnancy prevention, and history of or current pregnancy. If students stated they “always” or “most of the time” used condoms or contraception (the options being “always,” “most of the time,” “sometimes,” and “never”), this was defined as consistent contraception use. If students stated they had never been involved in a pregnancy or were not sure if they had not been involved in a pregnancy (the options being “yes,” “no,” and “not sure”), this was defined as no history of or current pregnancy.

Researchers used general linear models to assess if the accessibility and quality of school-based health services impacted sexual health outcomes as reported by students. There was a statistical association between increased weekly practitioner hours and consistent contraceptive use. Sexually active students in schools with greater than 10 weekly health practitioner hours per 100 students reported greater consistent contraception use than their sexually active peers in schools without SBHCs. However, researchers found no relationship between team-based meetings, non-health personnel-based meetings, and administration of the grade-9 health screening and consistent contraception use.

Although these findings are significant, the nuanced impacts of SBHCs are still unknown. Services vary within schools—for example, some schools give students contraception, while others do not. Second, there is variance among staff’s SBHC experience. Lastly, the particular health service that impacts reproductive health outcomes is unknown—perhaps access to mental health or substance abuse services in SBHCs is the true driver behind improvements in students’ sexual health outcomes. Understanding the impact of the nuances in school-based health service provision may be the key to improving student health outcomes. Although this research leaves some questions unanswered, it bolsters American researchers’ findings of the correlation between SBHCs and improved sexual health outcomes.

Photo credit: cc/Allen.Hillsborough