Disparities in Unmet Health Care Needs Among US Children During the COVID-19 Pandemic.

PURPOSE: The COVID-19 pandemic disrupted pediatric health care in the United States, and this disruption layered on existing barriers to health care. We sought to characterize disparities in unmet pediatric health care needs during this period. METHODS: We analyzed data from Wave 1 (October through November 2020) and Wave 2 (March through May 2021) of the COVID Experiences Survey, a national longitudinal survey delivered online or via telephone to parents of children aged 5 through 12 years using a probability-based sample representative of the US household population. We examined 3 indicators of unmet pediatric health care needs as outcomes: forgone care and forgone well-child visits during fall 2020 through spring 2021, and no well-child visit in the past year as of spring 2021. Multivariate models examined relationships of child-, parent-, household-, and county-level characteristics with these indicators, adjusting for child's age, sex, and race/ethnicity. RESULTS: On the basis of parent report, 16.3% of children aged 5 through 12 years had forgone care, 10.9% had forgone well-child visits, and 30.1% had no well-child visit in the past year. Adjusted analyses identified disparities in indicators of pediatric health care access by characteristics at the level of the child (eg, race/ethnicity, existing health conditions, mode of school instruction), parent (eg, childcare challenges), household (eg, income), and county (eg, urban-rural classification, availability of primary care physicians). Both child and parent experiences of racism were also associated with specific indicators of unmet health care needs. CONCLUSIONS: Our findings highlight the need for continued research examining unmet health care needs and for continued efforts to optimize the clinical experience to be culturally inclusive.

Annual STI Testing Among Sexually Active Adolescents.

OBJECTIVES: National guidelines call for annual testing for certain sexually transmitted infections (STIs) among specific adolescent populations, yet we have limited population-based data on STI testing prevalence among adolescents. With inclusion of a new item in the 2019 national Youth Risk Behavior Survey, we provide generalizable estimates of annual STI testing among sexually active high school students. METHODS: We report weighted prevalence estimates of STI testing (other than HIV) in the past 12 months among sexually active students (n = 2501) and bivariate associations between testing and demographic characteristics (sex, age, race and ethnicity, sexual identity, and sex of sexual contact). Multivariable models stratified by sex and adjusted for demographics examine the relationships between testing and sexual behaviors (age of initiation, number of sex partners, condom nonuse at last sexual intercourse, and substance use at last sexual intercourse). RESULTS: One-fifth (20.4%) of sexually active high school students reported testing for an STI in the previous year. A significantly higher proportion of female (26.1%) than male (13.7%) students reported testing. Among female students, prevalence differed by age (≤15 years = 12.6%, age 16 = 22.8%, age 17 = 28.5%, or ≥18 years = 36.9%). For male students, there were no differences by demographic characteristics, including sexual identity, but most sexual risk behaviors were associated with increased likelihood of STI testing (adjusted prevalence ratios ranging from 1.48 to 2.47). CONCLUSIONS: Low prevalence of STI testing suggests suboptimal adherence to national guidelines, particularly for sexually active adolescent females and young men who have sex with men who should be tested for Chlamydia and gonorrhea annually.

Addressing HIV/Sexually Transmitted Diseases and Pregnancy Prevention Through Schools: An Approach for Strengthening Education, Health Services, and School Environments That Promote Adolescent Sexual Health and Well-Being.

Adolescents' health behaviors and experiences contribute to many outcomes, including risks for HIV, other sexually transmitted diseases, and unintended pregnancy. Public health interventions and approaches addressing risk behaviors or experiences in adolescence have the potential for wide-reaching impacts on sexual health and other related outcomes across the lifespan, and schools are a critical venue for such interventions. This paper describes a school-based program model developed by the Centers for Disease Control and Prevention's Division of Adolescent and School Health for preventing HIV/sexually transmitted diseases, unintended pregnancy, and related health risk behaviors and experiences among middle and high school students. This includes a summary of the theoretical and evidence base that inform the model, and a description of the model's activities, organized into three key strategies (sexual health education, sexual health services, and safe and supportive environments) and across three cross-cutting domains (strengthening staff capacity, increasing student access to programs and services, and engaging parent and community partners). The paper also outlines implications for adolescent health professionals and organizations working across schools, clinics, and communities, to address and promote adolescent sexual health and well-being.

Adolescent Mental Health, Connectedness, and Mode of School Instruction During COVID-19.

BACKGROUND: Because COVID-19 was declared a pandemic in March 2020, nearly 93% of U.S. students engaged in some distance learning. These school disruptions may negatively influence adolescent mental health. Protective factors, like feeling connected to family or school may demonstrate a buffering effect, potentially moderating negative mental health outcomes. The purpose of the study is to test our hypothesis that mode of school instruction influences mental health and determine if school and family connectedness attenuates these relationships. METHODS: The COVID Experiences Survey was administered online or via telephone from October to November 2020 in adolescents ages 13-19 using National Opinion Research Center's AmeriSpeak Panel, a probability-based panel recruited using random address-based sampling with mail and telephone nonresponse follow-up. The final sample included 567 adolescents in grades 7-12 who received virtual, in-person, or combined instruction. Unadjusted and adjusted associations among four mental health outcomes and instruction mode were measured, and associations with school and family connectedness were explored for protective effects. RESULTS: Students attending school virtually reported poorer mental health than students attending in-person. Adolescents receiving virtual instruction reported more mentally unhealthy days, more persistent symptoms of depression, and a greater likelihood of seriously considering attempting suicide than students in other modes of instruction. After demographic adjustments school and family connectedness each mitigated the association between virtual versus in-person instruction for all four mental health indicators. CONCLUSION: As hypothesized, mode of school instruction was associated with mental health outcomes, with adolescents receiving in-person instruction reporting the lowest prevalence of negative mental health indicators. School and family connectedness may play a critical role in buffering negative mental health outcomes.

Long-Acting Reversible Contraception, Condom Use, and Sexually Transmitted Infections: A Systematic Review and Meta-analysis.

INTRODUCTION: Given mixed findings regarding the relationship between long-acting reversible contraception and condom use, this systematic review and meta-analysis synthesizes studies comparing sexually transmitted infection‒related outcomes between users of long-acting reversible contraception (intrauterine devices, implants) and users of moderately effective contraceptive methods (oral contraceptives, injectables, patches, rings). METHODS: MEDLINE, Embase, PsycINFO, Global Health, CINAHL, Cochrane Library, and Scopus were searched for articles published between January 1990 and July 2018. Eligible studies included those that (1) were published in the English language, (2) were published in a peer-reviewed journal, (3) reported empirical, quantitative analyses, and (4) compared at least 1 outcome of interest (condom use, sexual behaviors other than condom use, sexually transmitted infection‒related service receipt, or sexually transmitted infections/HIV) between users of long-acting reversible contraception and users of moderately effective methods. In 2020, pooled ORs were calculated for condom use, chlamydia/gonorrhea infection, and trichomoniasis infection; findings for other outcomes were synthesized qualitatively. The protocol is registered on the International Prospective Register of Systematic Reviews (CRD42018109489). RESULTS: A total of 33 studies were included. Long-acting reversible contraception users had decreased odds of using condoms compared with oral contraceptive users (OR=0.43, 95% CI=0.30, 0.63) and injectable, patch, or ring users (OR=0.58, 95% CI=0.48, 0.71); this association remained when limited to adolescents and young adults only. Findings related to multiple sex partners were mixed, and only 2 studies examined sexually transmitted infection testing, reporting mainly null findings. Pooled estimates for chlamydia and/or gonorrhea were null, but long-acting reversible contraception users had increased odds of trichomoniasis infection compared with oral contraceptive users (OR=2.01, 95% CI=1.11, 3.62). DISCUSSION: Promoting condom use specifically for sexually transmitted infection prevention may be particularly important among long-acting reversible contraception users at risk for sexually transmitted infections, including adolescents and young adults.

Association of Children's Mode of School Instruction with Child and Parent Experiences and Well-Being During the COVID-19 Pandemic - COVID Experiences Survey, United States, October 8-November 13, 2020.

In March 2020, efforts to slow transmission of SARS-CoV-2, the virus that causes COVID-19, resulted in widespread closures of school buildings, shifts to virtual educational models, modifications to school-based services, and disruptions in the educational experiences of school-aged children. Changes in modes of instruction have presented psychosocial stressors to children and parents that can increase risks to mental health and well-being and might exacerbate educational and health disparities (1,2). CDC examined differences in child and parent experiences and indicators of well-being according to children's mode of school instruction (i.e., in-person only [in-person], virtual-only [virtual], or combined virtual and in-person [combined]) using data from the COVID Experiences nationwide survey. During October 8-November 13, 2020, parents or legal guardians (parents) of children aged 5-12 years were surveyed using the NORC at the University of Chicago AmeriSpeak panel,* a probability-based panel designed to be representative of the U.S. household population. Among 1,290 respondents with a child enrolled in public or private school, 45.7% reported that their child received virtual instruction, 30.9% in-person instruction, and 23.4% combined instruction. For 11 of 17 stress and well-being indicators concerning child mental health and physical activity and parental emotional distress, findings were worse for parents of children receiving virtual or combined instruction than were those for parents of children receiving in-person instruction. Children not receiving in-person instruction and their parents might experience increased risk for negative mental, emotional, or physical health outcomes and might need additional support to mitigate pandemic effects. Community-wide actions to reduce COVID-19 incidence and support mitigation strategies in schools are critically important to support students' return to in-person learning.

Truth Be Told: Adolescents' Disclosure of Sexual Activity to Healthcare Providers.

PURPOSE: The purpose of this study was to describe whether adolescent and young adult patients truthfully disclose sexual activity to providers during a sexual history and explore associations between disclosure and receipt of recommended services. METHODS: Data from the 2018 National Survey of Sexual Health and Behavior were used to describe self-reported disclsoure of sexually active 14- to 24-year-olds who had a health care visit in the previous year where a sexual history was taken (n = 196). We examined bivariate associations between disclosure and age, race/ethnicity, sex, sexual identity, and receipt of sexual health services. RESULTS: Most (88%) respondents reported telling their provider the truth about sexual activity. A higher proportion of the younger adolescents (14- to 17-year-olds) did not disclose compared with the 18- to 24-year-old respondents (25.4% vs 3.9%; p < .001). A higher proportion of patients who disclosed reported having a sexually transmitted disease test (69.6% vs 26.7%; p < .001); being offered a sexually transmitted disease test (44.3% vs 4.5%; p < .001); and being asked by providers about number of partners (54.3% vs 15.4%; p < .01). CONCLUSIONS: Most young patients disclose their sexual history to their provider, but younger patients might be less likely to do so. Positive patient-provider relationships may encourage disclosure of sexual activity and support receipt of indicated sexual and reproductive health services.

Confidentiality Matters but How Do We Improve Implementation in Adolescent Sexual and Reproductive Health Care?

Confidentiality protections are a key component of high-quality adolescent sexual and reproductive health (SRH) care. Research has shown that adolescents value confidentiality and are more likely to seek care and provide honest information when confidentiality protections are implemented. However, many adolescents do not receive confidential SRH care. We synthesize studies of adolescents, parents, and providers to identify confidentiality-related factors that may explain why adolescents do not seek care or receive confidential services when they do access care. We present themes relevant to each population that address individual-level knowledge, attitudes, and behaviors, as well as clinic-level characteristics such as protocols, billing mechanisms, and clinic type. These findings have the potential to inform intervention efforts to improve the delivery of confidential SRH care for young people.

Get Yourself Tested Goes to High School: Adapted Sexually Transmitted Disease Prevention Campaign and Associated Student Use of Clinic Sexually Transmitted Disease Testing Services.

BACKGROUND: In an attempt to increase high school students' sexually transmitted disease (STD) testing rates, the Centers for Disease Control and Prevention's Division of Adolescent and School Health partnered with ICF and Chicago Public Schools to adapt and implement the "GYT: Get Yourself Tested" health marketing campaign for a high school. METHODS: Clinic record data and student retrospective self-report surveys (n = 193) tested for differences between the GYT intervention school and a comparison school on a number of outcomes, including human immunodeficiency virus and STD testing. RESULTS: Clinic record data showed that testing increased significantly more for the intervention than the comparison school during the GYT implementation period (B, 2.9; SE, 1.1, P < 0.05). Furthermore, the odds of being tested at the referral clinic were more than 4 times (odds ratio, 4.4) as high for students in the campaign school than for those in the comparison school (95% confidence interval, 2.3-8.2). Survey data did not show increased self-reported testing but, more students in the GYT school (92.7%) were aware of where to receive free, low-cost, or affordable human immunodeficiency virus and STD testing than students in the comparison school (76.0%; P < 0.01). Among sexually experienced students (n = 142), significantly more from the campaign school reported that they intended to test for STDs in the next 3 months (48.4% strongly agree and 33.2% agree) compared with those at the comparison school (27.4% strongly agree and 32.9% agree; P < 0.05). CONCLUSIONS: Our pilot suggests that a student-led GYT campaign in high schools may successfully increase STD testing of students. Although some of the findings from this pilot evaluation are promising, they are limited, and broader implementation and evaluation is needed. Future evaluation efforts can include more rigorous study designs, multiple schools or districts, longer campaign and evaluation across an entire school or calendar year, or in combination with other school-based testing strategies like a mass school-based screening event.

"Is It Really Confidential?" A Content Analysis of Online Information About Sexual and Reproductive Health Services for Adolescents.

PURPOSE: Many young people are not aware of their rights to confidential sexual and reproductive health (SRH) care. Given that online health information seeking is common among adolescents, we examined how health education Web content about SRH for young people addresses confidentiality. METHODS: In Spring 2017, we conducted Google keyword searches (e.g., "teens" and "sex education") to identify health promotion Web sites operated by public health/medical organizations in the United States and providing original content about SRH for adolescents/young adults. Thirty-two Web sites met inclusion criteria. We uploaded Web site PDFs to qualitative analysis software to identify confidentiality-related content and conduct thematic analysis of the 29 Web sites with confidentiality content. RESULTS: Sexually transmitted infection testing and contraception were the SRH services most commonly described as confidential. Clear and comprehensive definitions of confidentiality were lacking; Web sites typically described confidentiality in relation to legal rights to receive care without parental consent or notification. Few mentioned the importance of time alone with a medical provider. Only half of the Web sites described potential inadvertent breaches of confidentiality associated with billing and even fewer described other restrictions to confidentiality practices (e.g., mandatory reporting laws). Although many Web sites recommended that adolescents verify confidentiality, guidance for doing so was not routinely provided. Information about confidentiality often encouraged adolescents to communicate with parents. CONCLUSIONS: There is a need to provide comprehensive information, assurances, and resources about confidentiality practices while also addressing limitations to confidentiality in a way that does not create an undue burden on adolescents or reinforce and exacerbate confidentiality concerns.

Get Yourself Tested (GYT) Campaign: Investigating Campaign Awareness and Behaviors Among High School and College Students.

Adolescents and young adults are disproportionately affected by sexually transmitted diseases (STDs). This study examined the association of GYT: Get Yourself Tested (GYT), a sexual health social marketing campaign, with several sexual health behaviors on a nationally representative sample of high school (HS) and college students ( n = 2,329) recruited through an online panel survey. Behaviors examined were STD testing, HIV testing, and whether students had communication with health care providers and their romantic partners about STDs and STD testing. Rao-Scott chi-square tests and multivariable logistic regression models were conducted. The results indicated college students were more aware of GYT than HS students. Awareness of GYT was significantly associated with STD testing ( p < .05), HIV testing ( p < .01), and talking with romantic partners ( p < .01) for college students but only with STD testing ( p < .05) and talking to a provider ( p < .05) for HS students. The differences between HS and college students provide insight for those developing and implementing interventions across such a broad age range of youth.

Condom Availability Programs in Schools: A Review of the Literature.

OBJECTIVE: This review synthesizes findings from the peer-reviewed evaluation literature on condom availability programs (CAPs) in secondary schools. DATA SOURCE: Peer-reviewed evaluation literature indexed in MEDLINE, EMBASE, PsychINFO, ERIC, CINAHL, Sociological Abstracts, SCOPUS, and POPLINE. STUDY INCLUSION AND EXCLUSION CRITERIA: Manuscripts had to be, written in English, and report evaluation data from a US school-based CAP. DATA EXTRACTION: Articles were coded independently by 2 authors. Discrepancies were resolved through open discussion. DATA SYNTHESIS: We grouped findings into outcome evaluation and process evaluation findings. Outcome evaluation findings included sexually transmitted infections (STIs), pregnancy rates, condom use, contraception use, sexual risk, and substance use. Process evaluation findings included awareness of CAPs, attitudes toward CAPs, attitudes toward condoms, and receipt of education and instruction. RESULTS: Of the 138 citations reviewed, 12 articles published between 1995 and 2012 met the inclusion criteria, representing 8 programs. Evaluations indicate CAPs yield condom acquisition rates between 23% and 48%, have mixed results related to condom use, and are not associated with increases in sexual and other risk behaviors. One program found CAPs were associated with a decrease in a combined rate of chlamydia and gonorrhea. One program found no association between CAPs and unintended pregnancy. Students' attitudes toward CAPs were favorable and awareness was high. CONCLUSIONS: Condom availability programs are accepted by students and can be an appropriate and relevant school-based intervention for teens. Condom availability programs can increase condom use, but more evaluations are needed on CAP impact on rates of HIV, STIs, and unintended pregnancy.

Use of Long-Acting Reversible Contraception Among Adolescent and Young Adult Women and Receipt of Sexually Transmitted Infection/Human Immunodeficiency Virus-Related Services.

PURPOSE: Long-acting reversible contraceptive (LARC) methods do not require annual clinic visits for continuation, potentially impacting receipt of recommended sexually transmitted infection (STI)/human immunodeficiency virus (HIV) services for young women. We assess service receipt among new and continuing LARC users versus moderately and less effective method users and non-contraceptors. METHODS: Using 2011-2015 National Survey of Family Growth data from sexually active women aged 15-24 years (n = 2,018), we conducted logistic comparisons of chlamydia, any STI and HIV testing, and sexual risk assessment in the past year by current contraceptive type. RESULTS: Less than half of respondents were tested for chlamydia (40.9%), any STI (47.3%), or HIV (25.9%); 66.5% had their sexual risk assessed. Differences in service receipt between new and continuing LARC users as compared with moderately effective method users were not detected in multivariable models, except that continuing LARC users were less likely to be tested for HIV (adjusted prevalence ratio [aPR] = .52, 95% confidence interval [CI] = .32-.85). New, but not continuing, LARC users were more likely than less effective method users (aPR = 1.35, 95% CI = 1.03-1.76) and non-contraceptors (aPR = 1.43, 95% CI = 1.11-1.85) to have their sexual risk assessed, although both groups were more likely than non-contraceptors to be tested for chlamydia (new: aPR = 1.52, 95% CI = 1.08-2.15; continuing: aPR = 1.69, 95% CI = 1.24-2.29). CONCLUSIONS: We found little evidence that LARC use was associated with lower prevalence of STI testing. However, new, but not continuing, LARC users, as compared with those not using a method requiring a clinic visit, were more likely to have had their risk assessed, suggesting that initiating LARC may offer an opportunity to receive services that does not persist.

Unequal interactions: Examining the role of patient-centered care in reducing inequitable diffusion of a medical innovation, the human papillomavirus (HPV) vaccine.

RATIONALE: Studies of inequities in diffusion of medical innovations rarely consider the role of patient-centered care. OBJECTIVE: We used uptake of the human papillomavirus (HPV) vaccine shortly after its licensing to explore the role of patient-centered care. METHODS: Using a longitudinal multi-site survey of US parents and adolescents, we assessed whether patient-centered care ratings might shape racial/ethnic and socioeconomic gaps at two decision points in the HPV vaccination process: (1) Whether a medical provider recommends the vaccine and (2) whether a parent decides to vaccinate. RESULTS: We did not find evidence that the association of patient-centeredness with vaccination varies by parent education. In contrast, parent ratings of providers' patient-centeredness were significantly associated with racial/ethnic disparities in parents' reports of receiving a HPV vaccine recommendation from a provider: Among parents who rate patient-centered care as low, white parents' odds of receiving such a recommendation are 2.6 times higher than black parents' odds, but the racial/ethnic gap nearly disappears when parents report high patient-centeredness. Moderated mediation analyses suggest that patient-centeredness is a major contributor underlying vaccination uptake disparities: Among parents who report low patient-centeredness, white parents' odds of vaccinating their child are 8.1 times higher than black parents' odds, while both groups are equally likely to vaccinate when patient-centeredness is high. CONCLUSION: The results indicate that patient-centered care, which has been a relatively understudied factor in the unequal diffusion of medical innovations, deserves more attention. Efforts to raise HPV vaccination rates should explore why certain patient groups may be less likely to receive recommendations and should support providers to consistently inform all patient groups about vaccination.

Systematic Mapping of Relationship-Level Protective Factors and Sexual Health Outcomes Among Sexual Minority Youth: The Role of Peers, Parents, Partners, and Providers.

Sexual minority youth (SMY) experience elevated rates of adverse sexual health outcomes. Although risk factors driving these outcomes are well studied, less attention has been paid to protective factors that potentially promote health and/or reduce negative effects of risk. Many factors within interpersonal relationships have been identified as protective for the sexual health of adolescents generally. We sought to systematically map the current evidence base of relationship-level protective factors specifically for the sexual health of SMY through a systematic mapping of peer-reviewed observational research. Articles examining at least one association between a relationship-level protective factor and a sexual health outcome in a sample or subsample of SMY were eligible for inclusion. A total of 36 articles reporting findings from 27 data sources met inclusion criteria. Included articles examined characteristics of relationships with peers, parents, romantic/sexual partners, and medical providers. Peer norms about safer sex and behaviorally specific communication with regular romantic/sexual partners were repeatedly protective in cross-sectional analyses, suggesting that these factors may be promising intervention targets. Generally, we found some limits to this literature: few types of relationship-level factors were tested, most articles focused on young sexual minority men, and the bulk of the data was cross-sectional. Future work should expand the types of relationship-level factors investigated, strengthen the measurement of relationship-level factors, include young sexual minority women in samples, and use longitudinal designs. Doing so will move the field toward development of empirically sound interventions for SMY that promote protective factors and improve sexual health.

Sustained Reduction in Chlamydia Infections Following a School-Based Screening: Detroit, 2010-2015.

We describe school-based screening events in four Detroit, Michigan public high schools. To examine trends, we analyzed Chlamydia trachomatis data from 2010 to 2015. Prevalence of C. trachomatis decreased significantly (P < .01): from 10.24% to 6.27%. Future school-based screening events may bring about similar results if the program is instituted in a high-prevalence area and can achieve high student participation.

Provider communication with adolescent and young females during sexual and reproductive health visits: findings from the 2011-2015 National Survey of Family Growth.

OBJECTIVE: This study assesses provider communication with adolescent and young women about birth control, emergency contraception and condoms during sexual and reproductive health visits. STUDY DESIGN: Using data from sexually active 15-24-year-old women in the 2011-2015 National Survey of Family Growth, we examined provider communication about contraception and condoms at sexual and reproductive health services in the past year and assessed differences by demographics, sexual behavior and source of care. RESULTS: Approximately two thirds of women received provider communication about condoms (65.0%) and birth control (64.0%-66.8%). Communication was higher among Title-X-funded clinic vs. private providers. Differences by age, race/ethnicity, mother's education, number of partners and condom use were also found. CONCLUSION: Most sexually active young women attending sexual and reproductive health visits received provider communication about condoms and birth control, but communication is not universal and varies by source of care, demographics and sexual behavior.

The Importance of School Staff Referrals and Follow-Up in Connecting High School Students to HIV and STD Testing.

This study examined predictors of having received HIV and sexually transmitted disease (STD) testing and having been referred by school staff for HIV/STD testing. In 2014, students in seven high schools completed paper-and-pencil questionnaires assessing demographic characteristics, sexual behavior, referrals for HIV/STD testing, and HIV/STD testing. The analytic sample ( n = 11,303) was 50.7% female, 40.7% Hispanic/Latino, 34.7% Black/African American (non-Hispanic), and mean age was 15.86 ( SD = 1.22). After controlling for demographic characteristics, significant predictors of reporting having been tested for HIV or STDs were reporting having received a referral for HIV/STD testing (odds ratio [ OR] = 3.18; 95% CI = [2.14, 4.70]) and reporting staff following-up on the referral ( OR = 3.29; 95% CI = [1.31, 8.23]). Students reporting referrals had significantly higher odds of being male ( OR = 2.49; 95% CI = [1.70, 3.65]), "other" or multiracial (non-Hispanic; compared to White, non-Hispanic; OR = 2.72; 95% CI = [1.35, 5.46]), sexual minority ( OR = 3.80; 95% CI = [2.57, 5.62]), and sexually experienced ( OR = 2.58; 95% CI = [1.76, 3.795]). School staff referrals with follow-up may increase HIV/STD testing among students.

High School Students' Self-Reported Use of School Clinics and Nurses.

Access to school health clinics and nurses has been linked with improved student achievement and health. Unfortunately, no studies have examined how many students report using school clinics or nurses and for which services. This study addressed this gap with data from a nationally representative sample of 15- to 25-year-olds. Respondents who reported being in high school were provided a list of services and asked whether they had gone to a school nurse or clinic for any of the listed services. Nearly 90% reported having access to a school clinic or nurse. Among students with access, 65.6% reported using at least one service. Non-White students and younger students were more likely to report having access to a clinic or nurse. These results show many students have access to clinics or nurses and are using these services, although not uniformly for all services.