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

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，这种方法的预防价值尚未被广泛研究，以防止青年中的意外怀孕，并跨越时间跨度到青壮年。具有计划生育部分的学校保健诊所(SBHC-FPC)可以促进计划生育服务的使用，因为它们(1)嵌入学校，这是唯一有能力向大多数青年提供服务的公共机构(Satcher，1995)；(2)设计 减少与获得生殖服务有关的障碍(例如，财务、保密问题；Kirby，2002年)；和(3)直接或间接地使青年接触其社区中存在的计划生育资源和服务。关于SBHC-FPC和生殖行为的研究一直混合在一起，主要是由于方法上的缺陷(Kirby，2002)。本研究旨在研究高中阶段SBHC-FPC的存在是否与青春期在(A)调节认知变量(例如生殖态度、感知的性规范)、(B)感知的可获得性和计划生育服务的使用以及(C)怀孕风险行为(包括性行为开始年龄、伴侣数量和避孕措施的使用)方面的积极短期影响相关。我们还将调查，与高中及以后获得更全面服务的学生相比，在高中获得更全面的SBHC-FPC服务的学生是否(A)有更多的可获得性和计划生育服务的感知，以及(B)参与更少的怀孕风险行为，包括推迟性行为开始年龄、伴侣数量和有效避孕使用。此外，通过跟踪青少年进入青春期，我们将能够检查暴露于SBHC-FPC的滞后和/或遗留影响是否会持续到青年期，并评估在接受SBHC-FPC的学校和没有接受SBHC-FPC的学校的人之间，计划生育行为和计划外怀孕率是否存在差异。第二个目标是评估诊所特征(如人员配备、工作时间、员工感知的文化能力)对结果变量的作用，如计划生育自我效能、生殖健康寻求行为、计划生育行为和意图。我们拟议的研究超越了先前的研究：1)制定严格的学校配对程序，从而解决与缺乏足够的比较学校相关的问题；2)招募大样本来发现微小的影响；3)使用列表辅助样本来涵盖诊所使用者和非使用者；以及4)衡量所有计划生育提供者的使用情况，这将使我们能够捕捉替代效应。研究结果将增加对SBHC-FPC对生殖健康寻求行为和有效的SBHC-FPC服务影响的了解。此外，结果将提供重要的数据，可用于帮助更好地了解获得医疗服务如何更普遍地影响健康行为。

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.