The role of school health centers in health care access and client outcomes.

OBJECTIVES: We describe the impact of school health centers in Alameda County, California, on adolescents' access to care and their mental and physical health outcomes. METHODS: We used a multimethod evaluation of 12 school health centers to track data on clients (n=7410), services, and provider-reported outcomes; client pre-post surveys (n=286); and student focus groups (n=105 participants). RESULTS: School health centers were the most commonly reported source of medical (30%), family planning (63%), and counseling (31%) services for clients. Mental health providers reported significant improvements (P<.05) from baseline to follow-up in clients' presenting concerns and resiliency factors. Medical providers and clients also reported general improvements in reproductive health, particularly in the use of birth control other than condoms. Student focus group participants noted that school health centers helped improve access to services students might not seek out otherwise, particularly counseling and family planning services. Furthermore, students noted that they liked school health centers because of their confidentiality, free services, convenience, and youth-friendly staff. CONCLUSIONS: School health centers increase access to care and improve mental health, resiliency, and contraceptive use.

Evaluation of a peer provider reproductive health service model for adolescents.

CONTEXT: The use of peer providers in family planning clinics has been proposed as a strategy that could better serve sexually active adolescent populations. METHODS: Baseline and follow-up survey data from 1,424 female and 166 male adolescent clients of five California community health clinics were analyzed to assess the effectiveness of a peer provider model between 1996 and 1999. Multivariable analyses examined differences in outcomes between clients' first and last clinic visits, and by whether clients received only clinical services or other components of the model (outreach and telephone follow-up) as well. RESULTS: Female clients were significantly more likely at their last visit than at their first visit to report consistent birth control use (odds ratio, 1.9), use at last intercourse (1.8) and use of effective methods (3.5), and were significantly less likely to report consistent condom use (0.7). There were no significant differences in male birth control or condom use between first and last visits. Females who received all components of the model were more likely than those who received only clinical services to return for an annual exam (2.2) and to make three or more visits during the study period (1.7). The full model was particularly effective for females who were Hispanic, had been born to adolescent mothers or had had more than one sexual partner in the six months before their first clinic visit. CONCLUSIONS: The peer provider model appears to be a promising addition to the mix of service delivery models, particularly for certain subgroups of clients. The findings underscore the importance of tailoring programs on the basis of clients' risk profiles.

Differences and similarities in sexual and contraceptive knowledge, attitudes, and behavior among Latino male adolescent students in California, United States and Lima, Peru

Identificar las diferencias y similitudes en cuanto a conocimiento, actitudes y comportamientos sexuales y de antinconcepción entre los estudiantes adolescentes latinos que vivem en California y en Lima. Estudiantes adolescentes varones latinos de 12-19 años completaron las encuestas anónimas, autoaplicables tanto en California como en cuatro colegios secundarios en Lima. Ambas encuestas contenían preguntas con respecto a actividad sexual y comportamiento de anticoncepción. La media de edade fue de 16 y 15 años, respectivamente. Más varones adolescentes en California señalaron haber tenido relaciones coitales (69 por ciento vs 43 por ciento). Entre éstos, la media de edade de inicio sexual fue de 13 años en ambas muestras. Más estudiantes en California sabian del riesgo de embarazo en la primera relación sexual (82 por ciento vs 50 por ciento). Un tercio de los adolescentes varones de California señalaron que hablar sobre sexo y anticoncepción con su pareja es "fácil", comparados al 53 por ciento de los de Lima. Más estudiantes en California señalaron conocer un lugar para obtener anticonceptivos si ellos los necesitan (85 por ciento vs 63 por ciento), haber embarazado a alguien alguna vez (29 por ciento vs 7 por ciento) y haber tenido un hijo (67 por ciento vs 16 por ciento).