School-Based Health Centers, Access to Care, and Income-Based Disparities

Putting Health care Where the Kids Are: US Public Attitudes About School-Based Health Centers

BACKGROUND

School-based health centers (SBHCs) have been shown to offer substantial benefits to students but we know little about how the public thinks about them. We sought to assess US public attitudes about SBHCs and the provision of 7 health service lines-primary care, preventive care, vaccinations, preventive dental care, preventive vision care, mental health care, and nutrition counseling.

METHODS

We administered a national online survey (N = 4196) of US adults using Lucid, a large, internet-based, opt-in panel to assess public attitudes about SBHCs as well as 7 commonly offered health services in SBHCs. We then used t-tests and weighted linear regression models to carry out our study objectives.

RESULTS

Unadjusted analysis revealed that more than 2 in 3 respondents supported SBHCs in general as well as the provision of all health services in SBHCs. Regression analysis indicated that ideology, partisanship, and trust in public school principals served as consistent predictors of attitudes when controlling for demographic and health characteristics. The provision of vaccinations stood out as particularly controversial. Subanalysis of parents found even higher levels of support as well as a more subdued role of ideology and partisanship.

CONCLUSIONS

The US public broadly supports the provision of health services in SBHCs. Our results should inform policymakers, advocates, and providers seeking to improve access to health care among school-aged children, particularly for underserved populations. Increasing knowledge about SBHCs and providing stable funding should be a priority. In the immediate future, SBHCs may offer an important buffer against ongoing Medicaid disenrollments.

Unmet Dental Needs in Children Following Suspension of School-Based Oral Health Services Due to COVID-19

BACKGROUND

Dental caries (tooth decay) is the world's most prevalent noncommunicable disease and can lead to pain, infection, and edentulism. Many children with caries lack access to traditional dental services. School-based caries prevention can increase access to care and reduce health inequities. Disruptions in school-based care due to pandemic control policies may result in children losing access to their primary dental care option.

METHODS

The CariedAway project was a school-based caries prevention program in operation from 2019 to 2023 in urban schools with a high proportion of low-income, minority students. Program operations were suspended for 2 years due to the COVID-19 pandemic. We estimated the prevalence of untreated decay, swelling, fistula, and pulpal involvement in participants at baseline and again after restrictions were lifted.

RESULTS

A total of 2998 children between the ages of 5 and 13 years were enrolled and received preventive care prior to pandemic shutdowns, and 1398 (47%) completed a follow-up observation after 2 years. At baseline, approximately 30% had untreated caries on any dentition, 11% of children presented with evidence of dental sealants, and no participants had swelling, fistula, or pulpal involvement. After 24 months, 12% of participants had swelling fistula, or pulpal involvement that was not treated during the pandemic period.

CONCLUSION

There are considerable unmet dental needs in high-risk children that may be further exacerbated by a lack of access to care during disease outbreaks.

US public opinion about reproductive health care in school-based health centers

OBJECTIVES

This study aimed to examine public support for the provision of seven reproductive health services in school-based health centers, including pregnancy testing, over-the-counter contraceptives, prescription (Rx) contraceptives, sexually transmitted disease testing, sexually transmitted disease treatment, gynecological examinations, sexual violence counseling, and an index measure combining all services.

STUDY DESIGN

We administered a large national online survey (N = 4196, response rate 31%) of US adults using Lucid, a large, internet-based, opt-in panel to assess public attitudes about offering sexual and reproductive health services in school-based health centers. We then used t tests and weighted linear regression models to carry out our study objectives.

RESULTS

Unadjusted analysis revealed that 60% of respondents supported the provision of all reproductive health services (combined) at school-based health centers. Regression analysis based on the index measure suggested that individuals identifying as Trump voters (p-value = 0.00) or conservatives (p-value = 0.00) reported the lowest support, while those identifying as liberal (p-value = 0.00) reported the highest support, controlling for demographic and health characteristics.

CONCLUSIONS

Respondents overwhelmingly support the provision of reproductive health services at school-based health centers, including pregnancy testing, over-the-counter contraceptives, prescription contraceptives, testing and treatment for sexually transmitted infections, and sexual violence counseling.

IMPLICATIONS

Adolescence is an important stage for sexual maturation, and access to appropriate sexual and reproductive health services can support healthy development into adulthood. Findings suggest that most respondents support the provision of reproductive health services at school-based health centers while there are important factors that influence public support.