Improving adolescent health through school-based health centers in post-Katrina New Orleans

In spring 2009, students in six New Orleans public high schools were surveyed in order to evaluate the effectiveness of School Based Health Centers (SBHCs) in increasing access to and utilization of essential health services, promoting healthy lifestyles, and facilitating good decision-making skills in a complex urban environment. A quasi-experimental research design was utilized, involving three intervention schools with SBHCs and three comparison schools slated to eventually contain SBHCs. Propensity score matching was used to estimate the effects of SBHCs on indicators of adolescent utilization of health services and risky behaviors. Results indicate that adolescents with access to SBHCs report higher rates of utilization of essential health services, particularly vital mental health services, but they are also less likely to engage in behaviors that put their health at risk, including drug use, risky sexual activity, violence, smoking, unhealthy eating habits and lack of exercise. Sensitivity testing using Rosenbaum bounds confirms that the results are relatively insensitive to selection bias arising from unobservable school- or student-level confounders.