Adolescents' Use of School-Based Health Centers: Racial and Ethnic Group Differences

Background and Purpose: School-based health centers are an increasingly popular strategy to improve youths' access to care, particularly in low-income communities of color where students' unmet health needs have been linked to school dropout, youth violence, delinquency, and suicide (Mulye et al., 2009). Such programs clearly remove structural and practical barriers to help-seeking, but little is known about patterns of health service use in educational settings, particularly across race and ethnicity. This is surprising, given a primary rational for providing services in schools is to reduce unmet need among historically underserved racial and ethnic minority youth (Stephan et al., 2007). Theories of help-seeking suggest that multiple cultural and contextual factors influence adolescents' service use trajectories, so it is likely that racial and ethnic group differences will be observed in adolescents' use of school-based health centers, even when services are free of cost and convenient to use (Cauce et al., 2002). To test this hypothesis, we consider whether the relationship between students' service need and health center use is confounded by race/ethnicity for Black, Latino, Asian and White students.

Methods: The current study uses data from a large and diverse urban school district where health centers have been established at 15 high schools to coordinate and connect students to free medical, health education, mental health, and case management services. As part of the national Youth Risk Behavior Surveillance System, a questionnaire was administered by the Centers for Disease Control and Prevention in randomly selected classrooms, to a representative group of approximately 2,500 students. The response rate was 77%, with a final sample of 1,925 youth. The sample was 53% female and 47% male; 23% were Latino, 7% were Black, 56% were Asian, 10% were White, and 4% were from other racial or ethnic groups. 61% of the sample reported a service need, operationalized as engagement in risky health behaviors or sustained emotional distress. 39% of the sample reported using their school's health center. Logistic regression analysis was used to estimate the relationships between service need, health center use and race/ethnicity.

Results: Our analysis reveals a strong and significant (p < .001) linear relationship between increased student need and school-based health center use, adjusting for gender and age. However, this relationship is confounded by race/ethnicity. Black and Latino youth are significantly more likely (p < .001) than Asian or White youth to access their school-based health center, after accounting for students' service needs.

Conclusions and Implications: These findings indicate that school-based health centers are responsive to student need and are successfully reaching some historically underserved groups. However, Asian students are significantly less likely than their peers to access their school's health center, even when they are engaged in risky health behaviors or experience sustained emotional distress. Unlike White students, there is little evidence that Asian youths' needs, particularly their behavioral health concerns, are being met by other systems of care (Garland et al., 2005). School-based providers may need to tailor their outreach and enrollment practices to address the unique help-seeking barriers faced by Asian students.