School-Based Health Care and Adolescent Sexual-Risk Behaviors.

Abstract

School-based health centers (SBHCs) and school-linked health centers (SLHCs), a community-based model of adolescent focused health care, and adolescent sexual-risk behaviors were explored in this dissertation. The psychological, sociological, and biological predictors of adolescent development and the environmental, social and personal determinants of adolescent sexual-risk behavior were the focus of this exploration. This dissertation also considered how policy governing the services offered by SBHCs and SLHCs provide access to sexual health services for sexually active adolescents (SAA). Findings were integrated into a conceptual model: A Biopsychosocial Model of Adolescent Development and Behavior to guide subsequent research and interventions. Data for this dissertation were extracted from two Michigan sources. Data about adolescent health- and sexual- risk behaviors were provided by the Rapid Assessment for Adolescent Preventive Services (RAAPS) survey. Data about the clinical outcomes related to the sexual-risk behaviors of SBHC and SLHC users were drawn from clinic utilization reports. It was hypothesized that the clinic type that provided condoms and/or contraceptives to SAA (SLHCs) would be associated with greater use of condoms and/contraceptives (UOP) and the clinic that did not (SBHCs) would be associated with non-use of condoms and/contraceptives. Analyses revealed that clinic type was not associated with UOP, however age, gender, race/ethnicity and insurance status were associated with sexual-risk behaviors. This dissertation also examined clinical outcomes of SLHCs and SBHCs. It was hypothesized that SBHCs would have a greater proportion of adolescent users with positive test results for chlamydia, gonorrhea, and pregnancies than SLHCs, because SBHCs in Michigan do not provide condoms or contraceptives to SAA. Analyses indicated that SBHCs had a greater proportion of positive tests for pregnancy, but there were no significant differences in positive tests for chlamydia or gonorrhea. It was hypothesized that gender would be associated with UOP, modified by race/ethnicity and various adolescent stressors. Analyses revealed that gender was associated with UOP. Race/ethnicity and adolescent stress modified the association. The results of this dissertation indicate that strategies to modify adolescent sexual-risk behaviors should be informed by the myriad constructs that influence adolescent development and behaviors, including policy.