The relationship of sex and risk behaviours to students' use of school-based health centres in Cape Breton, Nova Scotia

Pediatric School Outreach: Clinical Needs of an Urban Student Population

Pediatric School Outreach (PSO) is a school-based health center (SBHC) in an urban elementary school in Toronto, Canada. PSO focuses on developmental, behavioral, mental health, and educational concerns. A retrospective chart review aimed to characterize demographics, diagnoses, and referrals of patients attending PSO. Of 137 children, ages 2 to 15 years, 73.7% were male; 58.1% had a household annual income of <$30 000 CAD. Possible or confirmed diagnoses included attention deficit hyperactivity disorder (48.5%), learning disability (35.6%), anxiety (22.0%), autism spectrum disorder (16.7%), oppositional defiant disorder (14.4%), and expressive language delay (11.4%). Involvement of community mental health and other agencies was advised in 37.9% of cases. Psychoeducational testing was recommended for 25.0% of patients. Results suggest the need for timely developmental testing, particularly for autism spectrum disorder, and accessible learning disability diagnostic support. There is potential for expansion of interprofessional care at PSO, including psychology, psychiatry, social work, and behavior therapy.

Sex differences in adolescent mental health profiles in South Korea

Accumulating evidence indicates that sex of adolescents is a major factor affecting mental health. This study aimed to compare mental health profiles and longitudinal effects of various factors on mental health between male and female adolescents using the Korean Children and Youth Panel Survey. Results showed that females were more depressed, aggressive, and likely to develop somatic symptoms than males, while males exhibited more attention deficits than females. Moreover, abusive parenting behavior was associated with a lower level of mental health in both male and female adolescents. In addition, we found significant differences in the effects of individual factors (subjective health status and smartphone addiction), family-related factors (living with both parents, working mother, and neglectful parenting behavior), and school-related factors (school adjustment and satisfaction with grades) on mental health between male and female adolescents. These findings indicate sex differences in adolescent mental health profiles in South Korea. Further studies are needed to develop comprehensive mental health strategies that consider personal, family, and school-related factors and sex differences.

School-Based Health Centers, Depression, and Suicide Risk Among Adolescents

INTRODUCTION

This study examined whether increasing availability of mental health services at school-based health centers in Oregon public schools would be associated with a decrease in the likelihood of depressive episodes and suicide risk among adolescents.

METHODS

The study included 168 Oregon public schools that participated in the Oregon Healthy Teens Survey in 2013 and 2015. Twenty-five schools had a school-based health center, and 14 of those schools increased the availability of mental health services from 2013 to 2015. The Oregon Healthy Teens Survey included questions about having a depressive episode, suicidal ideation, and attempting suicide in the past year. Multilevel logistic regression analyses were conducted in 2017 to examine associations between increasing mental health services and the likelihood of past year depressive episodes, suicidal ideation, and suicide attempts. Analyses also compared student subgroups defined by demographic characteristics (e.g., gender).

RESULTS

Students at school-based health center schools that increased availability of mental health services were less likely to report depressive episodes (OR=0.88, p<0.01), suicidal ideation (OR=0.84, p<0.01), and suicide attempts (OR=0.82, p<0.01) from 2013 to 2015 compared with all other schools. Significant risk reductions in past year depressive episodes and suicidal ideation were also observed in school-based health center schools that increased availability of mental health services relative to other schools with school-based health centers. No significant differences were observed for student demographic subgroups.

CONCLUSIONS

This study suggests that increasing availability of school-based mental health services can help to reduce depressive episodes and suicide risk among adolescents.

School-based mental health services, suicide risk and substance use among at-risk adolescents in Oregon

This study examined whether an increase in the availability of mental health services at school-based health centers (SBHCs) in Oregon public schools was associated with the likelihood of suicidal ideation, suicide attempts and substance use behaviors among adolescents who experienced a depressive episode in the past year. The study sample included 168 Oregon public middle and high schools and 9073 students who participated in the Oregon Healthy Teens Survey (OHT) in 2013 and 2015. Twenty-five schools had an SBHC, and 14 of those schools increased availability of mental health services from 2013 to 2015. The OHT included questions about having a depressive episode, suicidal ideation, attempting suicide in the past year, and substance use behaviors in the past 30days. Multi-level logistic regression analyses were conducted in 2017 to examine associations between increasing mental health services and the likelihood of these outcomes. Analysis results indicated that students at SBHC schools that increased mental health services were less likely to report any suicidal ideation [odds ratio (OR) (95% C.I.)=0.66 (0.55, 0.81)], suicide attempts [OR (95% C.I.)=0.71 (0.56, 0.89)] and cigarette smoking [OR (95% C.I.)=0.77 (0.63, 0.94)] from 2013 to 2015 compared to students in all other schools. Lower frequencies of cigarette, marijuana and unauthorized prescription drug use were also observed in SBHC schools that increased mental health services relative to other schools with SBHCs. This study suggests that mental health services provided by SBHCs may help reduce suicide risk and substance use behaviors among at-risk adolescents.

School-Based Health Centers and Adolescent Substance Use: Moderating Effects of Race/Ethnicity and Socioeconomic Status

BACKGROUND

School-based health centers (SBHCs) have been associated with many positive health and academic outcomes. The current study extends previous research and examines possible differences in the association between SBHC exposure and adolescent alcohol, tobacco, and other drug use by race/ethnicity, sex, and socioeconomic status (SES).

METHODS

California Healthy Kids Survey data from 504 traditional high schools in California were linked with publicly available data on SBHCs and school demographics. Multilevel logistic regression analyses were conducted controlling for school and individual characteristics.

RESULTS

Significant interactions suggest that SBHC exposure was inversely associated with past 30-day alcohol use, binge drinking, and cigarette and e-cigarette use among African American youth and negatively associated with cigarette and marijuana use among Asian youth, relative to whites. There was also a significant interaction between SBHC exposure and parent education for past 30-day alcohol use and binge drinking. No significant sex interactions were observed.

CONCLUSIONS

SBHC exposure appears to be inversely related to substance use among youth in some ethnic minority groups and youth of lower SES. This may have implications regarding SBHC placement and investment. Additional research is necessary to understand the mechanisms through which SBHCs may influence adolescent substance use and other health behaviors.

Access to and use of sexual health care services among young Canadians with and without a history of sexual coercion

OBJECTIVE

To determine access to and use of sexual health care services among adolescents and young adults with and without a history of sexual coercion, and to examine whether a history of sexual coercion was a barrier to using sexual health care services.

DESIGN

Online survey.

SETTING

Canada.

PARTICIPANTS

A total of 405 adolescents and young adults aged 16 to 21.

MAIN OUTCOME MEASURES

Participants' sexual histories, sexual coercion histories, current psychological functioning, and perceptions and use of health care services.

RESULTS

A history of sexual coercion was reported by 29.6% of participants; more female participants reported a history of sexual coercion than male participants did, and female participants reported more related distress than male participants did. Those with a history of sexual coercion reported more sexual health-related visits than those without a history of sexual coercion did. Among participants with and without sexual coercion histories, there were no differences in difficulty accessing care, perceived quality of care, or rates of unmet health needs. Among those who reported a history of sexual coercion, the odds of having a sexual health-related visit increased for those who had had a routine checkup in the previous year (odds ratio = 8.29) and those who believed it was not difficult to access care (odds ratio = 1.74).

CONCLUSION

Having a history of sexual coercion was not a barrier to the use of health care services among adolescents and young adults. In fact, rates of health care service use were higher among those with a history of sexual coercion than those without such a history.

A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health

BACKGROUND

Accessible sexual, reproductive, and mental healthcare services are crucial for adolescent health and wellbeing. It has been reported that school-based healthcare (SBHC) has the potential to improve the availability of services particularly for young people who are normally underserved. Locating health services in schools has the potential to reduce transport costs, increase accessibility and provide links between schools and communities.

METHODS

A systematic review of the literature was undertaken. Pubmed, Psychinfo, Psychnet, Cochrane CENTRAL, and Web of Science were searched for English language papers published between January 1990 and March 2012

RESULTS

Twenty-seven studies were found which fitted the criteria, of which, all but one were from North America. Only three measured adolescent sexual, reproductive, or mental health outcomes related to SBHC and none of the studies were randomized controlled trials. The remaining studies explored accessibility of services and clinic utilization or described pertinent contextual factors.

CONCLUSIONS

There is a paucity of high quality research which evaluates SBHC and its effects on adolescent sexual, reproductive, and mental health. However, there is evidence that SBHC is popular with young people, and provides important mental and reproductive health services. Services also appear to have cost benefits in terms of adolescent health and society as a whole by reducing health disparities and attendance at secondary care facilities. However, clearer definitions of what constitutes SBHC and more high quality research is urgently needed.

Does grade level relate to school-based youth health center utilization among male youth? Quantitative findings from a mixed-methods study in Nova Scotia, Canada

BACKGROUND

Male adolescents underutilize youth health centers' (YHC) services despite facing a variety of significant health issues. The purpose of our study was to explore adolescent males' perceptions of health service needs, utilization of YHC services, and barriers and facilitators for such utilization as a function of school grade among a sample of males from rural Nova Scotia in Canada.

METHODS

A 76-item self-completion survey was developed to obtain quantitative data on male students' use and perceptions of YHCs. The survey was pilot tested in June of 2009 and subsequently revised for readability and layout purposes. In October 2009, the revised survey was administrated to male youth in grades 10-12 at 4 high schools in Cape Breton, Nova Scotia.

RESULTS

Although more than 50% of the participants reported that they would be comfortable using the YHC in their school, only 16.5% had ever accessed the center, and only 5% indicated frequent use. Differences according to grade were noted, especially regarding knowledge of YHCs and intention to use a variety of YHC services.

CONCLUSIONS

School-based YHCs are becoming more common as a means of responding to adolescent health needs. Despite experiencing numerous health challenges, male youth continue to underutilize these services. Multisectoral health promotion strategies are needed, especially in higher grades, to help create an environment that encourages utilization of YHCs.

Use of school-based health centres for mental health support in Cape Breton, Nova Scotia

OBJECTIVE

To determine whether students with self-reported needs for mental health support used school-based health centres (SBHCs) for this purpose.

METHOD

A secondary analysis was conducted on self-reported data collected from 1629 high school students from Cape Breton, Nova Scotia. Descriptive statistics and logistic regression analyses were employed to determine the influence of sex, grade, sexual orientation, socioeconomic status (SES), school performance, social involvement, and health risk-taking behaviours on need for mental health support and use of SBHC for that purpose.

RESULTS

One-half of surveyed students reported needs for mental health support. Risk for depression was the most commonly reported indicator of need. Only 13% of students visited a SBHC nurse for mental health support, and 4 times as many females than males used the SBHC for this purpose (20.4%, compared with 5.3%, P < 0.001). There was a significantly increased likelihood of use of SBHC for mental health support, given the presence of a greater number of need factors. Multivariate logistic regression determined that female sex (OR 5.57, 95% CI 3.07 to 10.09), lower SES factor (OR 1.19, 95% CI 1.11 to 1.28), sexual health risk-taking behaviours (OR 1.72, 95% CI 1.28 to 2.31), and suicidal behaviour (OR 1.83, 95% CI 1.48 to 2.27) were significantly associated with the use of SBHCs for mental health support.

CONCLUSIONS

Substantial need for mental health support and significant unmet need were observed. In particular, male students underused the services relative to their self-reported need. Implications for SBHCs and directions for future research are discussed.