Abstract
Background
While researchers have demonstrated the positive effects of School-Based Health Centers (SBHCs) on student health outcomes, less is known about the long-term impact of SBHC use on academic outcomes, such as attendance.
Objective
Our objective was to examine the direct and indirect effects of SBHC use on attendance among high school students over time. We posed three hypotheses: (1) SBHC use will predict less absenteeism, (2) SBHC use will positively predict physical activity and health status, and (3) The relationship between high school students’ SBHC use and absenteeism will be mediated by physical activity and health status over time.
Method
Using structural equation techniques, we estimated autoregressive cross-lagged models for a subsample of high schoolers (N = 413) from a 3-year statewide SBHC evaluation.
Results
SBHC use did not predict self-reported health status, physical activity, or attendance, but was predicted by physical activity and absenteeism. In addition, student health status, physical activity, and attendance were positively correlated with each other cross-sectionally and longitudinally.
Conclusions
Our findings build upon previous research on the important role student health plays in attendance and provide unique insights into the potential bi-directional relationship between student SBHC use and attendance, suggesting that SBHCs could be an opportunity to connect students to non-healthcare resources. Several implications also emerged for future longitudinal SBHC research, such as more frequent data collection intervals and examining the effects of different types of SBHC use with clinic or electronic health record data.
Similar content being viewed by others
References
Akaike, H. (1987). Factor analysis and AIC. Psychometrika, 52(3), 317–332.
Allison, M. A., & Attisha, E. (2019). The link between school attendance and good health. Pediatrics, 143(2). https://doi.org/10.1542/peds.2018-3648
Allison, M. A., Crane, L. A., Beaty, B. L., Davidson, A. J., Melinkovich, P., & Kempe, A. (2007). School-based health centers: Improving access and quality of care for low-income adolescents. Pediatrics, 120(4). https://doi.org/10.1542/peds.2006-2314
Bailis, D. S., Segall, A., & Chipperfield, J. G. (2003). Two views of self-rated general health status. Social Science and Medicine, 56(2), 203–217. https://doi.org/10.1016/S0277-9536(02)00020-5
Bains, R. M., & Diallo, A. F. (2016). Mental health services in school-based health centers: Systematic review. Journal of School Nursing, 32(1), 8–19. https://doi.org/10.1177/1059840515590607
Bains, R. M., Franzen, C. W., & White-Frese’, J. (2014). Engaging African American and Latino adolescent males through school-based health centers. Journal of School Nursing, 30(6), 411–419. https://doi.org/10.1177/1059840514521241
Bains, R. M., Cusson, R., White-Frese, J., & Walsh, S. (2017). Utilization of mental health services in school-based health centers. Journal of School Health, 87(8), 584–592. https://doi.org/10.1111/josh.12528
Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238–246. https://doi.org/10.1037/0033-2909.107.2.238
Bersamin, M., Garbers, S., Gold, M. A., Heitel, J., Martin, K., Fisher, D. A., & Santelli, J. (2016). Measuring success: Evaluation designs and approaches to assessing the impact of school-based health centers. Journal of Adolescent Health, 58(1), 3–10. https://doi.org/10.1016/j.jadohealth.2015.09.018
Bersamin, M., Paschall, M. J., & Fisher, D. A. (2017). School-based health centers and adolescent substance use: Moderating effects of race/ethnicity and socioeconomic status. Journal of School Health, 87(11), 850–857. https://doi.org/10.1111/josh.12559
Bustamante, E. E., Williams, C. F., & Davis, C. L. (2016). Physical activity interventions for neurocognitive and academic performance in overweight and obese youth: A systematic review. Pediatric Clinics of North America, 63, 459–480. https://doi.org/10.1016/j.pcl.2016.02.004
Cole, D. A., & Maxwell, S. E. (2003). Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112(4), 558–577. https://doi.org/10.1037/0021-843X.112.4.558
Crump, C., Rivera, D., London Phd, R., Landau, M., & Rodriguez Drph, E. (2013). Chronic health conditions and school performance among children and youth. Annals of Epidemiology, 23, 179–184. https://doi.org/10.1016/j.annepidem.2013.01.001
Dinger, M. K., Brittain, D. R., & Hutchinson, S. R. (2014). Associations between physical activity and health-related factors in a national sample of college students. Journal of American College Health, 62(1), 67–74. https://doi.org/10.1080/07448481.2013.849710
Ethier, K. A., Dittus, P. J., DeRosa, C. J., Chung, E. Q., Martinez, E., & Kerndt, P. R. (2011). School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students. Journal of Adolescent Health, 48(6), 562–565. https://doi.org/10.1016/j.jadohealth.2011.01.018
Flores, G., & Lin, H. (2013). Trends in racial/ethnic disparities in medical and oral health, access to care, and use of services in US children: Has anything changed over the years? International Journal for Equity in Health, 12,. https://doi.org/10.1186/1475-9276-12-10
Forrest, C. B., Bevans, K. B., Riley, A. W., Crespo, R., & Louis, T. A. (2013). Health and school outcomes during children’s transition into adolescence. Journal of Adolescent Health, 52, 186–194. https://doi.org/10.1016/j.jadohealth.2012.06.019
Foy, J. E., & Hahn, K. (2009). School-based health centers: A four year experience, with a focus on reducing student exclusion rates. Osteopathic Medicine and Primary Care, 3(3). https://doi.org/10.1186/1750-4732-3-3
Geierstanger, S. P., Amaral, G., Mansour, M., & Walters, S. R. (2004). School-based health centers and academic performance: Research, challenges, and recommendations. Journal of School Health, 74(9), 347–352. https://doi.org/10.1111/j.1746-1561.2004.tb06627.x
Gershenson, S., Jacknowitz, A., & Brannegan, A. (2017). Are student absences worth the worry in U.S. primary schools? https://doi.org/10.1162/EDFP_a_00207
Gottfried, M. A. (2009). Excused versus unexcused: How student absences in elementary school affect academic achievement. Educational Evaluation and Policy Analysis, 31(4), 392–415. https://doi.org/10.3102/0162373709342467
Gottfried, M. A. (2010). Evaluating the relationship between student attendance and achievement in urban elementary and middle schools: An instrumental variables approach. American Educational Research Journal, 47(2), 434–465. https://doi.org/10.3102/0002831209350494
Guo, J. J., Jang, R., Keller, K. N., McCracken, A. L., Pan, W., & Cluxton, R. J. (2005). Impact of school-based health centers on children with asthma. Journal of Adolescent Health, 37(4), 266–274. https://doi.org/10.1016/j.jadohealth.2004.09.006
Hodges, M., (Maggie), Guendelman, S., & Soleimanpour, S. (2020). Adolescents’ use of school-based health centers and receipt of mental health supports. Children and Youth Services Review, 120, 105700. https://doi.org/10.1016/j.childyouth.2020.105700
Hu, L.-T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
Hutchinson, P., Carton, T. W., Broussard, M., Brown, L., & Chrestman, S. (2012). Improving adolescent health through school-based health centers in post-Katrina New Orleans. Children and Youth Services Review, 34(2), 360–368. https://doi.org/10.1016/j.childyouth.2011.11.005
Jerdén, L., Burell, G., Stenlund, H., Weinehall, L., & Bergström, E. (2011). Gender differences and predictors of self-rated health development among Swedish adolescents. Journal of Adolescent Health, 48(2), 143–150. https://doi.org/10.1016/j.jadohealth.2010.06.005
Kaplan, D. W., Brindis, C. D., Phibbs, S. L., Melinkovich, P., Naylor, K., & Ahlstrand, K. (1999). A comparison study of an elementary school-based health center: Effects on health care access and use. Archives of Pediatrics and Adolescent Medicine, 153(3), 235–243. https://doi.org/10.1001/archpedi.153.3.235
Kearney, C. A. (2021). Integrating systemic and analytic approaches to school attendance problems: Synergistic frameworks for research and policy directions. Child & Youth Care Forum, 50(4), 701–742. https://doi.org/10.1007/s10566-020-09591-0
Knopf, J. A., Finnie, R. K. C., Peng, Y., Hahn, R. A., Truman, B. I., Vernon-Smiley, M., Johnson, V. C., Johnson, R. L., Fielding, J. E., Muntaner, C., Hunt, P. C., Phyllis Jones, C., & Fullilove, M. T. (2016). School-based health centers to advance health equity: A community guide systematic review. American Journal of Preventive Medicine, 51(1), 114–126. https://doi.org/10.1016/j.amepre.2016.01.009
Larson, S., Chapman, S., Spetz, J., & Brindis, C. D. (2017). Chronic childhood trauma, mental health, academic achievement, and school-based health center mental health services. Journal of School Health, 87(9), 675–686. https://doi.org/10.1111/josh.12541
Little, T. D. (2013). Longitudinal Structural Equation Modeling. The Guilford Press.
Love, H. E., Schlitt, J., Soleimanpour, S., Panchal, N., & Behr, C. (2019). Twenty years of school-based health care growth and expansion. Health Affairs, 38(5), 755–764. https://doi.org/10.1377/hlthaff.2018.05472
Mason-Jones, A. J., Crisp, C., Momberg, M., Koech, J., De Koker, P., & Mathews, C. (2012). A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health. Systematic Reviews, 1(49). https://doi.org/10.1186/2046-4053-1-49
McNall, M. A., Lichty, L. F., & Mavis, B. (2010a). The impact of school-based health centers on the health outcomes of middle school and high school students. American Journal of Public Health, 100(9), 1604–1610. https://doi.org/10.2105/AJPH.2009.183590
McNall, M. A., Lichty, L., Mavis, B., & Bates, L. (2010b). The Michigan Evaluation of School-Based Health.
Minguez, M., Santelli, J. S., Gibson, E., Orr, M., & Samant, S. (2015). Reproductive health impact of a school health center. Journal of Adolescent Health, 56(3), 338–344. https://doi.org/10.1016/j.jadohealth.2014.10.269
Minkkinen, J., Lindfors, P., Kinnunen, J., Finell, E., Vainikainen, M., Karvonen, S., & Rimpela, A. (2017). Health as a predictor of students’ academic achievement : A 3-level longitudinal study. Journal of School Health, 87(12), 902–910.
Muthén, L. K., & Muthén, B. O. (1998–2017). MPlus User’s Guide (8th Ed.). Muthén & Muthén.
Nail, J. E., Christofferson, J., Ginsburg, G. S., Drake, K., Kendall, P. C., McCracken, J. T., Birmaher, B., Walkup, J. T., Compton, S. N., Keeton, C., & Sakolsky, D. (2015). Academic impairment and impact of treatments among youth with anxiety disorders. Child and Youth Care Forum, 44(3), 327–342. https://doi.org/10.1007/s10566-014-9290-x
Paschall, M. J., & Bersamin, M. (2018). School-based health centers, depression, and suicide risk among adolescents. American Journal of Preventive Medicine, 54(1), 44–50. https://doi.org/10.1016/j.amepre.2017.08.022
Pengpid, S., & Peltzer, K. (2019). Sedentary behaviour, physical activity and life satisfaction, happiness and perceived health status in university students from 24 countries. International Journal of Environmental Research and Public Health, 16(12), 2084. https://doi.org/10.3390/ijerph16122084
Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6(2), 461–464.
Sclove, S. L. (1987). Application of model-selection criteria to some problems in multivariate analysis. Psychometrika, 52(3), 333–343.
Selig, J. P., & Preacher, K. J. (2009). Mediation Models for Longitudinal Data in Developmental Research. Research in Human Development, 6(2–3), 144–164. https://doi.org/10.1080/15427600902911247
Starfield, B., Riley, A. W., Green, B. F., Ensminger, M. E., Ryan, S. A., Kelleher, K., Kim-Harris, S., Johnston, D., & Vogel, K. (1995b). The adolescent child health and illness profile: A population-based measure of health. Medical Care, 33(5), 553–566. https://doi.org/10.1097/00005650-199505000-00008
Starfield, B., Riley, A. W., Green, B. F., Ensminger, M. E., Forrest, C. B., Robertson, J., Ryan, S., & Kim Harris, S. (1995a). Manual for the child health and illness profile: Adolescent edition.
Steiger, J. H. (1998). A note on multiple sample extensions of the RMSEA fit index. Structural Equation Modeling, 5(4), 411–419. https://doi.org/10.1080/10705519809540115
Stone, S., Whitaker, K., Anyon, Y., & Shields, J. P. (2013). The relationship between use of school-based health centers and student-reported school assets. Journal of Adolescent Health, 53(4), 526–532. https://doi.org/10.1016/j.jadohealth.2013.05.011
Strolin-Goltzman, J., Sisselman, A., Melekis, K., & Auerbach, C. (2014). Understanding the relationship between school-based health center use, school connection, and academic performance. Health and Social Work, 39(2), 83–91. https://doi.org/10.1093/hsw/hlu018
Thomas, C. L., Price, O. A., Phillippi, S., & Wennerstrom, A. (2020). School-based health centers, academic achievement, and school discipline: A systematic review of the literature. Children and Youth Services Review, 118, 105467. https://doi.org/10.1016/j.childyouth.2020.105467
Timmons, A. C., & Preacher, K. J. (2015). The importance of temporal design: How do measurement intervals affect the accuracy and efficiency of parameter estimates in longitudinal research? Multivariate Behavioral Research, 50(1), 41–55. https://doi.org/10.1080/00273171.2014.961056
Van Cura, M. (2010). The relationship between school-based health centers, rates of early dismissal from school, and loss of seat time. Journal of School Health, 80(8), 371–377. https://doi.org/10.1111/j.1746-1561.2010.00516.x
Wade, T. J., Mansour, M. E., Line, K., Huentelman, T., & Keller, K. N. (2008). Improvements in Health-Related Quality of Life among school-based health center users in elementary and middle school. Ambulatory Pediatrics, 8(4), 241–249. https://doi.org/10.1016/j.ambp.2008.02.004
Walker, S. C., Kerns, S. E. U., Lyon, A. R., Bruns, E. J., & Cosgrove, T. J. (2010). Impact of school-based health center use on academic outcomes. Journal of Adolescent Health, 46(3), 251–257. https://doi.org/10.1016/j.jadohealth.2009.07.002
Webber, M. P., Carpiniello, K. E., Oruwariye, T., Lo, Y., Burton, W. B., & Appel, D. K. (2003). Burden of asthma in inner-city elementary schoolchildren: Do school-based health centers make a difference? Archives of Pediatrics and Adolescent Medicine, 157(2), 125–129. https://doi.org/10.1001/archpedi.157.2.125
Whitaker, K., Stone, S. I., Anyon, Y., Blankenbaker, S., & Rozum, A. (2019). Academic, psychosocial, and demographic correlates of school-based health center utilization: Patterns by service type. Child and Youth Care Forum, 48(4), 545–562. https://doi.org/10.1007/s10566-019-09495-8
Acknowledgements
The original MESH study was funded by grants from the Michigan Department of Community Health and the Families and Communities Together coalition. We thank Dr. Steven J. Pierce (Center for Statistical Training and Consulting, Michigan State University) for his consultation on our statistical approach. The corresponding author affirms she has listed everyone who has contributed significantly to the work.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Gruber, J.A., Anderson-Carpenter, K.D., McNall, M. et al. Understanding the Longitudinal Impact of School-Based Health Centers on Student Attendance. Child Youth Care Forum 52, 331–350 (2023). https://doi.org/10.1007/s10566-022-09691-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10566-022-09691-z