School-based Health Clinics: Effects on Youth and Young Adult Sexual Behavior

学校健康诊所：对青少年和青少年性行为的影响

• 批准号: 8704974
• 负责人: MELINA BERSAMIN
• 金额: $ 58.44万
• 依托单位: PACIFIC INSTITUTE FOR RES AND EVALUATION
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-22 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8704974
• 关键词: Address; Adolescence; Adolescent; Age; Attitude; Behavior; Birth Rate; Catchment Area; Characteristics; Clinic; Cognitive; Communities; Confidentiality; Contraceptive Usage; Contraceptive methods; Counseling; Data; Decision Making; Development; Education; Environment; Exposure to; Family Planning; Female; Goals; Health; Health Care Seeking Behavior; Health Services; Health behavior; Healthcare; Home environment; Hour; Institution; Intervention; Interview; Knowledge; Life; Long-Term Effects; Longitudinal Studies; Measures; Mediating; Mediator of activation protein; Medical; Modeling; Neighborhoods; Online Systems; Outcome; Patient Self-Report; Planned Pregnancy; Policies; Pregnancy; Pregnancy Rate; Preventive; Problem behavior; Procedures; Provider; Recruitment Activity; Reproduction; Reproductive Behavior; Reproductive Health; Reproductive Health Services; Research; Resources; Respondent; Risk; Risk Behaviors; Role; Sampling; Schools; Self Efficacy; Services; Sex Behavior; Site; Students; Surveys; Teenagers; Telephone; Time; Unplanned pregnancy; Youth; aged; base; comparison group; cost; cultural competence; design; feeding; high risk; high school; meetings; operation; prevent; prospective; public health relevance; reproductive; satisfaction; sex; sex risk; theories; unintended pregnancy; young adult; young woman

DESCRIPTION (provided by applicant): Interventions targeting structural or contextual variables have been associated with significant reductions in problem behaviors (e.g., Celentano et al., 1998); however, the preventive value of such approaches has not been studied extensively with respect to unintended pregnancy among youth, and across time to young adulthood. School-based health clinics with a family planning component (SBHC-FPCs) may promote the use of family planning services as they (1) are embedded within schools, the only public institution with the capacity to reach a majority of youth (Satcher, 1995); (2) are designed to reduce barriers associated with accessing reproductive services (e.g., finances, confidentiality concerns; Kirby, 2002); and (3) directly or indirectly expose youth to family planning resources and services that exist in their community. Research on SBHC-FPCs and reproductive behaviors has been mixed, largely due to methodological weaknesses (Kirby, 2002). The current study aims to examine whether the presence of SBHC-FPCs in high school is associated with positive short- term effects in adolescence on (A) mediating cognitive variables (e.g., reproductive attitudes, perceived sexual norms), (B) perceived availability and use of family planning services, and (C) pregnancy risk behaviors including age of sexual initiation, number of partners, and contraceptive use. We will also investigate whether students who have access to more comprehensive SBHC-FPC services in high school have (A) greater perceived availability and use of family planning services, and (B) engage in fewer pregnancy risk behaviors including delayed age of sexual initiation, fewer number of partners, and effective contraceptive use, compared to those with less comprehensive services both in high school and later. In addition, by following adolescents as they transition into young adulthood we will be able to examine if lagged and/or carry-over effects of exposure to SBHC-FPCs persist into young adulthood and assess whether family planning behaviors and unplanned pregnancy rates differ among those who attended schools with an SBHC-FPC and those who did not. A secondary goal is to assess the role of clinic characteristics (e.g. staffing, hours, perceived cultural competence of staff) on outcome variables such as family planning self-efficacy, reproductive health seeking behaviors, and family planning behaviors and intentions. Our proposed study goes beyond earlier research by 1) developing a rigorous school matching procedure thus addressing issues associated with lack of adequate comparison schools; 2) recruiting a large sample to detect small effects; 3) using a list-assisted sample to encompass both clinic users and non-users; and 4) measuring use of all family planning providers, which will allow us to capture substitution effects. Findings will increase understanding of the effects f SBHC-FPCs on reproductive health-seeking behavior and effective SBHC-FPC services. Additionally, results will provide important data that can be used in efforts to help better understand how access to medical services more generally influences health behaviors.

描述（由申请人提供）：针对结构或背景变量的干预措施与问题行为的显著减少有关（例如，Celentano等人，1998年）；然而，这些方法的预防价值还没有广泛研究关于意外怀孕的青年，并跨越时间到青年成年。具有计划生育组成部分的校本保健诊所（shbhc - fpcs）可以促进计划生育服务的使用，因为(1)它们嵌入学校，而学校是唯一有能力接触到大多数青年的公共机构（Satcher， 1995年）；(2)设计