Association between availability and quality of health services in schools and reproductive health outcomes among students: a multilevel observational study.
OBJECTIVE
We determined the association between availability and quality of school health services and reproductive health outcomes among sexually active students.


METHODS
We used a 2-stage random sampling cluster design to collect nationally representative data from 9107 students from 96 New Zealand high schools. Students self-reported whether they were sexually active, how often they used condoms or contraception, and their involvement in pregnancy. School administrators completed questionnaires on their school-based health services, including doctor and nursing hours per week, team-based services, and health screening. We conducted analyses using multilevel models controlling for individual variables, with schools treated as random effects.


RESULTS
There was an inverse association between hours of nursing and doctor time and pregnancy involvement among sexually active students, with fewer pregnancies among students in schools with more than 10 hours of nursing and doctor time per 100 students. There was no association between doctor visits, team-based services, health screening, and reproductive health outcomes.


CONCLUSIONS
School health services are associated with fewer pregnancies among students, but only when the availability of doctor and nursing time exceeds 10 hours per 100 students per week.
Department of Community Paediatrics, School of Population Health, University of Auckland, New Zealand. s.denny@auckland.ac.nz
Simon
S
Denny
Elizabeth
E
Robinson
Catriona
C
Lawler
Sue
S
Bagshaw
Bridget
B
Farrant
Fionna
F
Bell
Dianne
D
Dawson
Diana
D
Nicholson
Mo
M
Hart
Theresa
T
Fleming
Shanthi
S
Ameratunga
Terryann
T
Clark
Maria
M
Kekus
Jennifer
J
Utter
D000293:Adolescent; D002648:Child; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009520:New Zealand; D017063:Outcome Assessment, Health Care / Q000379:methods; D036301:Qualitative Research; D011787:Quality of Health Care; D060728:Reproductive Health; D021841:Safe Sex; D012572:School Health Services / Q000592:standards* / Q000600:supply & distribution*; D011795:Surveys and Questionnaires