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Cited by 248School Health and Nursing EducationChild and Adolescent HealthFood Security and Health in Diverse Populations

School-Based Health Centers to Advance Health Equity

Open access
Knopf, John A., Finnie, Ramona K.C., Peng, Yinan, Hahn, Robert A., Truman, Benedict I., Vernon-Smiley, Mary, Johnson, Veda C., Johnson, Robert L. +5 more·2016·American Journal of Preventive Medicine
DOI 10.1016/j.amepre.2016.01.009PMC PMC5759331
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Abstract

Context Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children. They are more often chronically stressed, tired, and hungry, and more likely to have impaired vision and hearing-obstacles to lifetime educational achievement and predictors of adult morbidity and premature mortality. If school-based health centers (SBHCs) can overcome educational obstacles and increase receipt of needed medical services in disadvantaged populations, they can advance health equity. Evidence acquisition A systematic literature search was conducted for papers published through July 2014. Using Community Guide systematic review methods, reviewers identified, abstracted, and summarized available evidence of the effectiveness of SBHCs on educational and health-related outcomes. Analyses were conducted in 2014-2015. Evidence synthesis Most of the 46 studies included in the review evaluated onsite clinics serving urban, low-income, and racial or ethnic minority high school students. The presence and use of SBHCs were associated with improved educational (i.e., grade point average, grade promotion, suspension, and non-completion rates) and health-related outcomes (i.e., vaccination and other preventive services, asthma morbidity, emergency department use and hospital admissions, contraceptive use among females, prenatal care, birth weight, illegal substance use, and alcohol consumption). More services and more hours of availability were associated with greater reductions in emergency department overuse. Conclusions Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.

AI snapshot

Written from the paper’s full text.

TL;DR

This Community Guide systematic review found that school-based health centers (SBHCs) improve educational and health-related outcomes among disadvantaged students, supporting their potential to advance health equity. Greater effectiveness was associated with more services and extended hours of availability.

Key findings

  • Among 46 included studies, SBHCs were associated with improved educational outcomes (grade point average, grade promotion, suspension, and non-completion rates) and health-related outcomes (vaccination and other preventive services, asthma morbidity, emergency department use and hospital admissions, contraceptive use among females, prenatal care, birth weight, illegal substance use, and alcohol consumption).
  • Enrollment and use: median 59% (IQI=43%, 88%) of students in SBHC schools enrolled; median 69% (IQI=61%, 82%) of enrollees received services; across 15 studies, median 52% (IQI=38%, 61%) of students in SBHC schools used the clinics.
  • Emergency department utilization: schools with SBHCs offering four services had a median reduction of 25.1% (IQI=−34.1%, −12.5%) versus a median increase of 4.5% (range, −39.8% to 37.8%) for three or fewer services. SBHCs accessible outside regular school hours had a median reduction of 37.0% (range, −75% to −15.5%) versus 5.2% (range, −47.9% to 37.8%) for regular-hours-only SBHCs.
  • Sensitivity analysis: 26 outcomes were reported; 16 findings were based on bodies of evidence including at least one study of greatest design suitability. Findings were consistent with the overall body of evidence for 13 outcomes and inconsistent for three (non–asthma-related ED use, contraception use, and sexual activity); nine greatest-design-suitability studies were also of good quality, and all were consistent with the overall body of evidence.

Methods

  • Systematic literature search through July 2014 across eight databases using Community Guide methods. Inclusion required evaluating SBHC exposure/use versus a comparison without such exposure/use, reporting at least one school achievement or health-related outcome, serving pre-Kindergarten through Grade 12, publication in English, and conduct in a high-income nation. Fifty studies in 52 papers met criteria; four were excluded for quality-of-execution limitations, leaving 46 studies in the analytic dataset. Analyses were conducted in 2014–2015.
  • Two reviewers independently abstracted data and assessed threats to internal and external validity; quality was characterized as good, fair, or limited, and limited studies were excluded. Effect estimates were calculated as relative percent or absolute percentage point change/difference; medians were pooled for sufficiently homogeneous outcomes, with interquartile intervals when at least five independent estimates were available. No meta-analysis was conducted because of heterogeneity and small numbers of studies per outcome.
  • Studies were categorized as whole-school effects or SBHC user–only effects; when both were reported, whole-school estimates were used for summary medians, and overall medians combined both types. Stratified analyses addressed secondary questions, and a sensitivity analysis examined studies with better design and execution.

Limitations

  • Stated in the paper: lack of randomization might have resulted in selection bias; few studies adjusted for background health differences; it is unclear whether users and non-users or SBHC and non-SBHC sites were comparable. SBHC placement was influenced by greater healthcare needs, the presence/proximity/quality/absence of other community health resources, or political and financial factors, and these selection biases were not controlled. SBHC effects might have been underestimated or overestimated because evaluators did not obtain true baseline data.
  • Also stated: data were not adequate to distinguish between effects of SBHC service proximity and service costs; program contents were often incompletely described; and associations between program focus and assessment/reporting of targeted outcomes may have biased evaluation of program focus.
  • Evident from the text: applicability is largely limited to urban contexts (only 10 studies in mixed rural/urban or suburban areas; none in predominantly rural areas) and mostly high school (26 studies), with only one middle school study and seven pre-K/elementary studies. Only three studies evaluated hybrid school-based and school-linked centers, and no studies evaluated exclusively school-linked centers or mobile clinics. Many studies did not report hours of operation, SES, or race/ethnicity.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.amepre.2016.01.009

Cites

101 of 101 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

8 of 49 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Health problems and risk-taking behavior are associated with low scholastic performance.

    “Health problems (e.g., vision and oral health problems, asthma, teen pregnancy, malnutrition, obesity, chronic stress, and inattention and hyperactivity disorders) and risk-taking behavior (e.g., aggression and violence, unsafe sexual activity, unhealthy eating, physical inactivity, and substance use) are associated with low scholastic performance.12–22”
    Quote in the paperSubstantial claim2 of 10 sources checked
    • cites [12] Basch CE. Healthier students are better learners: a missing link in school reforms to close the achievement gap. Equity Matters: Research Review No. 6. 2010; A Research Initiative of the Campaign for Educational Equity.

      Not checked in the free run.

    • cites [13] Bradley, 2013, Do health and education agencies in the United States share responsibility for academic achievement and health? A review of 25 years of evidence about the relationship of adolescents’ academic achievement and health behaviors, J Adolesc Health source
    • cites [14] CDC, National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health. Alcohol and other drug use and academic achievement: What is the relationship between alcohol and other drug use and academic achievement? Data from the 2009 National Youth Risk Behavior Survey 2009; www.cdc.gov/healthyyouth/health_and_academics/pdf/alcohol_other_drug.pdf.

      Not checked in the free run.

    • cites [15] Davis, 2011, Exercise improves executive function and achievement and alters brain activity in overweight children: a randomized controlled trial, Health Psychol source
    • cites [16] Dilley J, Washington State Board of Health, Washington State Office of Superintendent of Public Instruction, Washington State Department of Health. Research review: school-based health interventions and academic achievement. here.doh.wa.gov/materials/research-review-school-based-health-interventions-and-academic-achievement/12_HealthAcademic_E09L.pdf. Published 2009. Accessed September 3, 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [17] Edwards, 2011, Relationship of nutrition and physical activity behaviors and fitness measures to academic performance for sixth graders in a midwest city school district, J Sch Health source
    • cites [18] Fox, 2010, Physical activity and sports team participation: associations with academic outcomes in middle school and high school students, J Sch Health source
    • cites [19] Geierstanger, 2004, School-based health centers and academic performance: research, challenges and recommendations, J Sch Health source
    • cites [20] Henry, 2010, Academic achievement and adolescent drug use: an examination reciprocal effects and correlated growth trajectories, J Sch Health source
    • cites [21] Ickovics, 2013, Health and academic achievement: cumulative effects of health assets on standardized test scores among urban youth in the United States, J Sch Health source

      The Results section (Bivariate Associations Between Health Assets and Standardized Test Scores; page not provided) links weight, fitness, sugary-drink consumption, and several other health measures with test performance. The paper does not establish the full list in the citing sentence: its Limitations and Strengths section explicitly says it lacked measures of substance use and bullying, and the supplied findings do not address several other listed conditions or behaviors. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Findingcitation

    One study found greater reduction in high school non-completion for students at schools with SBHCs who received free or reduced-price lunch compared with those not eligible for free or reduced-price lunch.

    “One study79 found greater reduction in high school non-completion for students at schools with SBHCs who received free or reduced-price lunch compared with those not eligible for free or reduced-price lunch.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [79] McNall, 2010, The impact of school-based health centers on the health outcomes of middle school and high school students, Am J Public Health source

      The Methods describe matching schools by the percentage of students receiving free or reduced-price lunch, but do not report a comparison of outcomes by individual lunch eligibility. The Results and Conclusions address self-reported health and health behaviors, not high school non-completion. Searches for non-completion, dropout, graduation, and lunch-eligibility effects found no passage supporting the claimed finding. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Premisecitation

    Previous reviews have found limited evidence of SBHC effectiveness in improving healthcare utilization and academic outcomes.

    “Previous reviews have found limited evidence of SBHC effectiveness in improving healthcare utilization and academic outcomes.19,37–41”
    Quote in the paperSubstantial claim2 of 6 sources checked
    • cites [19] Geierstanger, 2004, School-based health centers and academic performance: research, challenges and recommendations, J Sch Health source
    • cites [37] Mason-Jones, 2012, A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health, Syst Rev source
    • cites [38] Murray, 2007, Coordinated school health programs and academic achievement: a systematic review of the literature, J Sch Health source
    • cites [39] GAO, 1994

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [40] Santelli, 1996, School-based health centers and adolescent use of primary care and hospital care, J Adolesc Health source

      The Discussion reports mixed utilization findings: the Baltimore study found increased use of some primary-care services and reduced hospital care, but also calls for further study of emergency-room use. It found no difference in school attendance because of illness. This paper is an original study, not a review, and it does not assess academic outcomes beyond attendance. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [41] Strunk, 2008, The effect of school-based health clinics on teenage pregnancy and parenting outcomes: an integrated literature review, J Sch Nurs source
  • Findingnone given

    SBHC exposure was associated with apparent increases in cigarette smoking.

    “Associations between SBHC exposure and risk behaviors were mixed, with apparent increases in cigarette smoking but reductions in consumption of alcohol and other substances.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    SBHC exposure was associated with reductions in consumption of alcohol and other substances.

    “Associations between SBHC exposure and risk behaviors were mixed, with apparent increases in cigarette smoking but reductions in consumption of alcohol and other substances.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 19
  • Classified as probably not a substantial claim. 7

  • May combine two claims.

    Premisecitation

    Low academic achievement is strongly associated with risk-taking behavior, compromised health status, and reduced longevity.

    “Conversely, low academic achievement is strongly associated with risk-taking behavior, compromised health status, and reduced longevity.22–33”
    Quote in the paperSubstantial claim3 of 10 sources checked
    • cites [22] Lande, 2003, Elevated blood pressure and decreased cognitive function among school-age children and adolescents in the United States, J Pediatr source
    • cites [23] Braveman, 2011, The social determinants of health: coming of age, Annu Rev Public Health source

      The 'Education and health' discussion (page unavailable) links lower educational attainment with poorer health and fewer health-promoting behaviors. But the paper defines attainment as completed schooling, not academic achievement, and the passages do not directly establish an association between low academic achievement and reduced longevity. Its mention of higher mortality concerns unemployment, which it describes as more common among less-educated people. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [24] Cutler DM, Lleras-Muney A. Education and health: evaluating theories and evidence. NBER Working Paper 12352. Cambridge, MA: National Bureau of Economic Research; 2006. source

      Section II, “The Relationship Between Health and Education” (page unavailable), reports strong associations between fewer years of schooling and risk-related behaviors, poorer health, and higher five-year mortality. The claim uses “low academic achievement,” which could mean academic performance; the paper’s evidence measures educational attainment, not grades or achievement scores. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [25] Ergerter, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [26] Feinstein L. Quantitative estimates of the social benefits of learning, 2: health (depression and obesity). Centre for Research on the Wider Benefits of Learning. 2002; Wider Benefits of Learning Research Report no. 6.

      Not checked in the free run.

    • cites [27] Feinstein L, Sabates R, Anderson TM, Sorhaindo A, Hammond C. What are the effects of education on health? Measuring the effects of education on health and civic engagement. Proceedings of the Copenhagen Symposium; 2006.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [28] Fiscella, 2009, Disparities in academic achievement and health: the intersection of child education and health policy, Pediatrics source
    • cites [29] Kolbe, 2002, Education reform and the goals of modern school health programs, Educ Stand

      Not checked in the free run.

    • cites [30] Lleras-Muney A. The relationship between education and adult mortality in the United States. Princeton, NJ: National Bureau of Economic Research, 2002. NBER Working Paper No.: 8986. source

      The Introduction (page unavailable in our copy) reports a strong association between education and health, as well as lower mortality among more educated adults. It discusses smoking-related research, but does not establish a broad association with risk-taking behavior. The paper measures educational attainment rather than academic achievement, so the claim extends beyond what it supports. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [31] Ross, 1996, Education, age, and the cumulative advantage in health, J Health Soc Behav source

  • May combine two claims.

    Findingcitation

    Two studies with internal comparisons both found onsite access to contraceptives associated with increased contraceptive uptake and reduced pregnancy rates.

    “Two studies87,97 investigated this question with internal comparisons, and both found onsite access to contraceptives associated with increased contraceptive uptake and reduced pregnancy rates.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [87] Smith, 2011, Does immediate access to birth control help prevent pregnancy? A comparison of onsite provision versus off-campus referral for contraception at two school-based clinics, J Adolesc Health source
    • cites [97] Zimmer-Gembeck, 2001, Contraceptive dispensing and selection in school-based health centers, J Adolesc Health source

  • May combine two claims.

    Findingown data

    Seven studies provided details on contraceptive dispensation, but results were inconclusive.

    “Seven studies54,55,71,72,81,87,97 provided details on contraceptive dispensation, but results were inconclusive (Appendix Figures 16 and 17, available online).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    One study found that onsite access to contraceptives increased female but not male use of contraceptives, with no effect observed for pregnancy outcomes.

    “One study72 compared multiple study sites and found that onsite access to contraceptives increased female but not male use of contraceptives, with no effect observed for pregnancy outcomes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [72] Kirby, 1991, Six school-based clinics: their reproductive health services and impact on sexual behavior, Fam Plann Perspect source

  • May combine two claims.

    Findingown data

    Nine of the greatest design suitability studies were also of good quality of execution; all were consistent with the overall body of evidence.

    “Nine of the greatest design suitability studies51,59–61,69,81,82,90,91 were also of good quality of execution; all were consistent with the overall body of evidence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Results from this review neither support nor contradict the hypothesis that increased access to contraceptive services increases sexual activity.

    “Another postulated harm involves increased sexual activity owing to increased access to contraceptive services.55 Results from this review neither support nor contradict this hypothesis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Ethier, 2011, School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students, J Adolesc Health source

  • May combine two claims.

    Findingown data

    The literature search identified 50 studies in 52 papers that met the inclusion criteria, and four of these were excluded from analysis because of quality of execution limitations.

    “The literature search identified 50 studies in 52 papers that met the inclusion criteria46–97; four50,63,64,80 of these were excluded from analysis because of quality of execution limitations (Figure 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only three studies evaluated hybrid school-based and school-linked centers, and no studies evaluated exclusively school-linked centers or mobile clinics.

    “Only three studies51,75,92 evaluated hybrid school-based and school-linked centers, and no studies evaluated exclusively school-linked centers or mobile clinics.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only six studies evaluated SBHCs in majority white populations, with more studies evaluating SBHCs in majority black, majority Hispanic, or populations without a majority racial or ethnic group.

    “Only six studies61,74,89,90,96,97 evaluated SBHCs in majority white populations, with more studies evaluating SBHCs in majority black (16 studies in 18 papers47,48,53,60,62,69,70,72,77,78,81–86,94,95); majority Hispanic (eight studies46,55,56,59,65,87,88,93); or populations without a majority racial or ethnic group (seven studies49,51,68,76,79,91,92).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children.

    “Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children.”
    • Also stated in: § Context · plain
      “Children from low-income and racial or ethnic minority populations in the U.S. are more likely to develop chronic health problems than are more-affluent and non-Hispanic white children and less likely to have a usual source of medical care.1”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Bloom, 2012, Summary health statistics for U.S. children: National Health Interview Survey, 2011, Vital Health Stat

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.

    “Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: If SBHCs are effective in improving health outcomes and are targeted to low-income and minority communities, SBHCs are effective in improving health equity.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    If SBHCs can overcome educational obstacles and increase receipt of needed medical services in disadvantaged populations, they can advance health equity.

    “If school-based health centers (SBHCs) can overcome educational obstacles and increase receipt of needed medical services in disadvantaged populations, they can advance health equity.”
    • Also stated in: § Context · plain
      “Thus, if school-based health centers (SBHCs) can increase receipt of needed medical services and overcome educational obstacles in disadvantaged populations, they can advance health equity.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: If SBHCs are effective in improving health outcomes and are targeted to low-income and minority communities, SBHCs are effective in improving health equity.

  • May combine two claims.

    Interpretationnone given

    Descriptions of program contents were often incomplete in available studies, and there were likely associations between program focus and the assessment and reporting of targeted outcomes, thus biasing the evaluation of the association between program focus and program outcomes.

    “Descriptions of program contents were often incomplete in available studies; in addition, there were likely associations between program focus and the assessment and reporting of targeted outcomes, thus biasing the evaluation of the association between program focus and program outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Few studies adjusted for background health differences, and it is unclear whether users and non-users or SBHC sites and non-SBHC sites were comparable.

    “Few studies adjusted for background health differences, and it is unclear whether users and non-users or SBHC sites and non-SBHC sites were comparable.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Educational inequalities have declined modestly in recent years but persist.

    “Although educational inequalities have declined modestly in recent years, they persist.3,5,9–11”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [3] 2013, CDC health disparities and inequalities report—United States, 2013, MMWR Morb Mortal Wkly Rep

      Not checked in the free run.

    • cites [5] U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics. National assessment of educational progress (NAEP), various years, 1992-2013 mathematics and reading assessments. nces.ed.gov/nationsreportcard/subject/publications/main2013/pdf/2014087.pdf. Published 2014. Accessed September 3, 2015.

      Not checked in the free run.

    • cites [9] Sondik, 2010, Progress toward the Healthy People 2010 goals and objectives, Annu Rev Public Health source
    • cites [10] U.S. Department of Education, National Center for Education Statistics, Institute of Education Sciences. Achievement gaps: how black and white students in public schools perform on the national assessment of educational progress. nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2009455. Published 2009. Accessed September 3, 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [11] U.S. Department of Education, National Center for Education Statistics, Institute of Education Sciences. Achievement gaps: how Hispanic and white students in public schools perform on the national assessment of educational progress. nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2011459. Published 2009. Accessed September 3, 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Lack of randomization might have resulted in selection bias.

    “First, lack of randomization might have resulted in selection bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    SBHC placement was influenced by the greater healthcare needs of the school community, the presence, proximity, quality, or absence of other community health resources, or political and financial factors, and the effects of these selection biases on estimates of SBHC effectiveness were not controlled.

    “SBHC placement was influenced by the greater healthcare needs of the school community, the presence, proximity, quality, or absence of other community health resources, or political and financial factors; the effects of these selection biases on estimates of SBHC effectiveness were not controlled.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    SBHCs have the potential to promote social mobility and improve health equity.

    “Because SBHCs aim to meet the needs of disadvantaged populations,36 address the health-related obstacles to educational achievement, and address the cultural, financial, and privacy- and transportation-related barriers to clinical, preventive, and healthcare services, they have the potential to promote social mobility98 and improve health equity.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [36] Lofink, 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [98] Duncan, 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • The authors state this as an assumption: If SBHCs are effective in improving health outcomes and are targeted to low-income and minority communities, SBHCs are effective in improving health equity.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    SBHC effects might have been underestimated or overestimated because evaluators did not obtain true baseline data.

    “Lastly, SBHC effects might have been underestimated or overestimated because evaluators did not obtain true baseline data.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Studies of limited quality of execution were excluded from analysis.

    “Studies of limited quality of execution were excluded from analysis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    School-based health centers improve both educational and health outcomes.

    “SBHCs improve both educational and health outcomes”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Two reviewers independently evaluated each study included in the review, and disagreements between reviewers were resolved by consensus.

    “Two reviewers independently evaluated each study included in the review. Disagreements between reviewers were resolved by consensus.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A sensitivity analysis was conducted to determine whether studies with better design and execution, the strongest evidence available, were consistent with the overall body of evidence.

    “A sensitivity analysis was conducted to determine whether studies with better design and execution—the strongest evidence available—were consistent with the overall body of evidence.”
    Quote in the paperNot a substantial claim
23 of 23

  • The authors state this as an assumption.

    If SBHCs are effective in improving health outcomes and are targeted to low-income and minority communities, SBHCs are effective in improving health equity.

    “In addition, it is assumed that if SBHCs are effective in improving health outcomes and are targeted to low-income and minority communities, SBHCs are effective in improving health equity.”

  • The paper relies on this without support.

    School-based health centers are commonly implemented in low-income communities and communities with high proportions of racial and ethnic minority populations.

    “SBHCs are commonly implemented in low-income communities and communities with high proportions of racial and ethnic minority populations”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reference 83 is classified as a middle-school study despite its elementary-school title

    Minor

    The text identifies reference 83 as the sole study assessing middle-school SBHCs, while the cited paper's title identifies its center as elementary-school-based.

  • A 1991 paper is classified as published before 1990

    Minor

    The list of papers published before 1990 includes reference 72, whose publication year is given as 1991.

  • A 2000 paper is classified as published after 2000

    Minor

    The list of studies published after 2000 includes reference 75, but the reference gives its publication year as 2000. Reference 92 in the same list is also dated 2000.

3 of 3

Cites

Flagged first, then by citations

1 of the 102 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Dilley J, Washington State Board of Health, Washington State Office of Superintendent of Public Instruction, Washington State Department of Health. Research review: school-based health interventions and academic achievement. here.doh.wa.gov/materials/research-review-school-based-health-interventions-and-academic-achievement/12_HealthAcademic_E09L.pdf. Published 2009. Accessed September 3, 2015.
  2. Kolbe, 2002, Education reform and the goals of modern school health programs, Educ Stand, 3, 4
  3. Zaza, 2011, Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services, Am J Prev Med, 18, 44
  4. Santelli, 1996, School-based health centers and adolescent use of primary care and hospital care, J Adolesc Health, 19, 267, 10.1016/s1054-139x(96)00088-2 · DOI · Paper page

Cited by

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Related

Authors
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.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention (US)
  • Emory University (US)
  • Rutgers New Jersey Medical School (US)
  • University of California, Los Angeles (US)
  • University of Toronto (CA)
  • Columbia University (US)
Corresponding author
Hahn, Robert A.
ORCID
Venue
American Journal of Preventive Medicine
Publisher
Elsevier BV
Published
2016-07
Volume
51
Issue
1
Pages
114-126
ISSN
0749-3797 (ISSN-L)
DOI
10.1016/j.amepre.2016.01.009
PMC
PMC5759331
OpenAlex
W2432155496
Semantic Scholar
0147ac22f6d2656b19de341415024420f58aa255
Cited by
248
References
102
Citations by year
2026: 19 · 2025: 33 · 2024: 29 · 2023: 29 · 2022: 28 · 2021: 45 · 2020: 24 · 2019: 21 · 2018: 11 · 2017: 5 · 2016: 4
FWCI
25.98
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Preventive Medicine (acceptedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
Funders
National Institutes of Health (CC999999)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
  • Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
  • Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
Keywords
school-based health centers, health equity, low-income children, racial and ethnic minority students, educational outcomes, health care access, emergency department overuse, vaccination, asthma, prenatal care, birth weight, substance use, adolescent alcohol use, contraceptive use, high school students
MeSH terms
Health Equity, Educational Status, Health Services Accessibility, Humans, Minority Groups, Poverty, School Health Services, Outcome Assessment, Health Care

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-21.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-21.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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