Impact of a school-based intervention on access to healthcare for underserved youth

Britto, Maria T.; Klostermann, Brenda K.; Bonny, Andrea E.; Altum, Shari; Hornung, Richard

doi:10.1016/s1054-139x(01)00196-3

Cited by 43 publications

(35 citation statements)

References 16 publications

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“…SHCs represent a unique setting for addressing ARA because of the prevalence of ARA, ease of access to clinical services, [12][13][14] emphasis on psychosocial assessments during visits, and potential to engage students through peer leaders. 15,16 With health reform legislation, SHCs are an authorized federal program essential for health services delivery for adolescents.…”

Section: What This Study Addsmentioning

confidence: 99%

A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT

et al. 2015

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BACKGROUND AND OBJECTIVES: Few evidence-based interventions address adolescent relationship abuse in clinical settings. This cluster randomized controlled trial tested the effectiveness of a brief relationship abuse education and counseling intervention in school health centers (SHCs). METHODS:In 2012-2013, 11 SHCs (10 clusters) were randomized to intervention (SHC providers received training to implement) or standard-of-care control condition. Among 1062 eligible students ages 14 to 19 years at 8 SHCs who continued participation after randomization, 1011 completed computer-assisted surveys before a clinic visit; 939 completed surveys 3 months later (93% retention).RESULTS: Intervention versus control adjusted mean differences (95% confidence interval) on changes in primary outcomes were not statistically significant: recognition of abuse = 0.10 (20.02 to 0.22); intentions to intervene = 0.03 (20.09 to 0.15); and knowledge of resources = 0.18 (20.06 to 0.42). Intervention participants had improved recognition of sexual coercion compared with controls (adjusted mean difference = 0.10 [0.01 to 0.18]). In exploratory analyses adjusting for intensity of intervention uptake, intervention effects were significant for increased knowledge of relationship abuse resources and self-efficacy to use harm reduction behaviors. Among participants reporting relationship abuse at baseline, intervention participants were less likely to report such abuse at follow-up (mean risk difference = 20.17 [20.21 to 20.12]). Adolescents in intervention clinics who reported ever being in an unhealthy relationship were more likely to report disclosing this during the SHC visit (adjusted odds ratio = 2.77 [1.29 to 5.95]).CONCLUSIONS: This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.WHAT'S KNOWN ON THIS SUBJECT: Adolescent relationship abuse (ARA) is prevalent in confidential clinic settings such as school health centers (SHCs) and is associated with poor health outcomes. No evidence-based interventions target reduction of ARA in the SHC setting.

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Section: What This Study Addsmentioning

confidence: 99%

A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT

et al. 2015

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“…SHCs reduce barriers to health care faced by adolescents, such as concerns about confidentiality, lack of health insurance, and limited knowledge of the health care system. [24][25][26] These comprehensive clinics are well positioned to offer prevention education as well as interventions for youth experiencing abusive relationships. 27 The purpose of this study was to examine characteristics of cyber dating abuse and how such abuse may be associated with other forms of ARA, nonpartner sexual violence victimization, and sexual and reproductive health risks among youth seeking care in SHCs.…”

mentioning

confidence: 99%

Cyber Dating Abuse Among Teens Using School-Based Health Centers

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Cyber dating abuse victimization has been correlated with physical, sexual, and psychological adolescent relationship abuse. WHAT THIS STUDY ADDS:This is the first clinic-based study of cyber dating abuse. Forty-one percent of youth reported cyber dating abuse victimization, female more than male respondents. Compared with nonexposed youth, abuse victims reported more sexual assault; female victims reported more contraceptive nonuse and reproductive coercion. abstract OBJECTIVE: To estimate the prevalence of cyber dating abuse among youth aged 14 to 19 years seeking care at school-based health centers and associations with other forms of adolescent relationship abuse (ARA), sexual violence, and reproductive and sexual health indicators. METHODS:A cross-sectional survey was conducted during the 2012-2013 school year (participant n = 1008). Associations between cyber dating abuse and study outcomes were assessed via logistic regression models for clustered survey data. RESULTS:Past 3-month cyber dating abuse was reported by 41.4% of this clinic-based sample. More female than male participants reported cyber dating abuse victimization (44.6% vs 31.0%). Compared with no exposure, low-("a few times") and high-frequency ("once or twice a month" or more) cyber dating abuse were significantly associated with physical or sexual ARA (low: adjusted odds ratio [aOR] 2.8, 95% confidence interval [CI] 1.8-4.4; high: aOR 5.4, 95% CI 4.0-7.5) and nonpartner sexual assault (low: aOR 2.7, 95% CI 1.3-5.5; high: aOR 4.1, 95% CI 2.8-5.9). Analysis with female participants found an association between cyber dating abuse exposure and contraceptive nonuse (low: aOR 1.8, 95% CI 1.2-2.7; high: aOR 4.1, 95% CI 2.0-8.4) and reproductive coercion (low: aOR 3.0, 95% CI 1.4-6.2; high: aOR 5.7, 95% CI 2.8-11.6).CONCLUSIONS: Cyber dating abuse is common and associated with ARA and sexual assault in an adolescent clinic-based sample. The associations of cyber dating abuse with sexual behavior and pregnancy risk behaviors suggest a need to integrate ARA education and harm reduction counseling into sexual health assessments in clinical settings.

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“…Despite the need for preventive services, adolescents experience significant barriers to accessing ageappropriate care [4,5]. Numerous studies indicate that most adolescents are not receiving recommended preventive counseling and screening services, particularly for behavioral risks, and that there are many missed opportunities for providing such services during primary care visits [6 -15].…”

mentioning

confidence: 99%

Attitudinal and contextual factors associated with discussion of sexual issues during adolescent health visits

Merzel

VanDevanter

Middlestadt

et al. 2004

Journal of Adolescent Health

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Impact of a school-based intervention on access to healthcare for underserved youth

Cited by 43 publications

References 16 publications

A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT

A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT

Cyber Dating Abuse Among Teens Using School-Based Health Centers

Attitudinal and contextual factors associated with discussion of sexual issues during adolescent health visits

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