Adolescent school-based health care: a description of two sites in their 20th year of service.

Purpose: While there are currently nearly 1,400 school-based health centers (SBHC) nationwide, only 20% have been in operation for more than 10 years. The Mount Sinai Adolescent SBHC Program is now in its 20th year of service. The purpose of this study is to: (a) present the demographic data for 2003 high school SBHC medical visits, including age, sex and insurance status; (b) describe the current prevalence of medical and psychosocial risk factors of the students seen for examination; and (c) present general distributions for psychosocial risk factors found in 1988 archival information and note differences from current risk factors.

Methods: A retrospective chart review was conducted in high school A, whose SBHC serves students mainly interested in going to college, and in high school B, whose SBHC has a heterogeneous population with a large proportion of recent immigrants. Data collected included demographic variables as well as reports of risk factors such as: considering oneself to be overweight, history of sexual activity, history of sexually transmitted diseases, same-sex attraction, use of alcohol, cigarette smoking, use of marijuana, suicidal ideation and exposure to violence.

Results: For those participating from high school A (n=231): 78% female, mean age 15.75; asthma (17%); think oneself overweight (30%); family member with HIV (11%); sexually active (35%); same-sex attraction (3%); cigarette use (14%); marijuana use (13%); alcohol use (38%); suicide ideation (14%); witnessed violence (37%); and overweight and obese (33%). For those participating from high school B (n=241): 64% female; mean age 16; asthma (16%); think oneself overweight (32%); family member with HIV (9%); sexually active (43%); same-sex attraction (7%); cigarette use (38%); marijuana use (24%); alcohol use (53%); suicide ideation (23%); witnessed violence (33%); and overweight and obese (31%). In 1988, students at these schools reported: sexually active status (41%); marijuana use (13%); cocaine use (12%); alcohol use (20%); and sadness/depression (43%).

Conclusions: While a snapshot of the risk factors in 2003 might indicate that sexual activity has decreased somewhat, substance use, as well as eating-related and AIDS-related issues have come to the forefront. SBHCs continue to serve students with intense medical and psychological needs. It remains crucial that SBHCs provide comprehensive medical and mental health services.