Contextual influences on school provision of health services

Purpose: To examine contextual factors that may facilitate or impede the pr ovision of school health services. Methods: Using a composite database derived primarily from the National Lon gitudinal Study of Adolescent Health, we used logistic regression to examin e how selected characteristics of communities, schools, and state-level pol icies are related to the provision of specific health services by high scho ols. Results: Schools whose students experienced more health risks were generall y more likely to provide related services than schools whose students exper ienced fewer risks. State policies and requirements for health-related prog rams and services were associated with greater school-based provision of se rvices. Availability of health care services within the community was assoc iated with a reduced likelihood that schools provided similar services on-s ite; however, for some health services, the reverse was true. In general, m ore affluent communities were more likely to provide school health services than less affluent communities. Public schools were more likely to offer h ealth services than private schools. Conclusions: Certain characteristics of communities, schools, and state-lev el policies are associated with the provision of school health services. Th ese contextual factors appear to operate by creating a demand for services and by creating the opportunity for schools to provide health services. (C) Society for Adolescent Medicine, 2000.