Health Equity: School-Based Health Centers

The Community Preventive Services Task Force (CPSTF) recommends school-based health centers (SBHC's) in low-income communities to improve educational outcomes such as school performance, grade promotion and high school completion and health outcomes such as delivery of vaccinations and preventative services, asthma morbidity, contraceptive use among sexually active females and more.

SBHC's must provide primary care on-site (school-based) or off-site (school-linked). In addition, they may provide mental health and dental services, health education and social services.

The goal of school-based health centers is to reduce gaps in education and increase health equity in low-income communities.

When targeted to low-income communities, school-based health centers are likely to narrow gaps in education and improve health equity.

The Community Preventive Services Task Force (CPTSF) found the following results:

Education-Related Outcomes:
High school non-completion: median decrease of 29.1% (5 studies)
Grade Point Average: median increase 4.7% (studies)
Grade promotion: increases of 8.4% and 14.6% (2 studies); 1 additional study reported that SBHCs were associated with increases in students on pace to graduate

Health-Related Outcomes:
Immunization: median increase of 15.5 percentage points (4 studies)
Other recommended clinical preventive services: median increase of 12.0 percentage points (6 studies)
Regular source of health care: median increase of 2.2% (7 studies)

Asthma-Specific Outcomes:
Hospitalizations: median decrease of 70.6% (3 studies)
Emergency department visits: median decrease of 15.8% (4 studies)
Sickness (measured by numbers and frequencies of asthma symptoms): median decrease of 19.3% (2 studies)

Other Sickness-Related Outcomes:
Self-reported health status (i.e., in various scales of medical, physical, chronic conditions): median decrease of 1.2%, unfavorable (4 studies); 3 additional studies reported mixed results
Self-reported mental health problems: median decrease of 5.7% (4 studies); 4 additional studies reported generally favorable effects
Non-asthma-related emergency department visits: median decrease of 14.5% (15 studies)
Non-asthma-related hospitalization: mean decrease of 51.6% (2 studies)

Risk Behaviors:
Tobacco smoking: median increase of 21.0%, unfavorable (7 studies)
Alcohol use: median decrease of 14.8% (6 studies)
Other illicit substance use: median decrease of 27.2% (5 studies)

Sexual Risk Behaviors and Reproductive Outcomes:
Contraception use among sexually active students:
Both females and males: median increase of 7.8% (4 studies)
Females only: median increase of 17.8% (3 studies)
Males only: median decrease of 3.1%, unfavorable (3 studies)

Sexual activity:
Females only: median decrease of 3.6% (2 studies that reported outcomes by gender)
Males only: median decrease of 8.5% (2 studies that reported outcomes by gender)
Female and male students: median increase of 19.6%, unfavorable (3 studies that did not separately report outcomes for female and male students

Becoming pregnant or causing pregnancy:
Females only: median decrease of 40.0% (5 studies)
Males only: increase of 21.5% in causing pregnancy, unfavorable (1 study)

Specific to pregnancy:
Pregnancy complications: median increase of 25%; unfavorable (3 studies)
Percent low birth weight: median decrease of 58.3% (3 studies)
Prenatal care: median 27.8% increase in the number of prenatal visits (2 studies); 2 additional studies reported increase in percent of pregnant students receiving prenatal care
Prenatal care initiated: pregnant students received prenatal care an average of 0.45 months earlier; 2 studies. One additional study reported 15.1 percentage point increase in the percent of pregnant students who registered for prenatal care during their 1st trimester.