The DOI matches its Crossref record; 101 of the 102 references it cites were found in a registry or an index; 8 of the 49 sources its claims cite were checked for support.
School-Based Health Centers to Advance Health Equity
Open accessAbstract
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.
Overview
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
Cites
Statistics
Verification
Claims the paper makes
16 No basis given · 11 Own result · 10 Own method · 7 Not checked yet · 7 Own interpretation · 5 No full text of the sources · 3 Partly supported · 1 Couldn’t confirm · 1 Sources not found · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ School-Based Health Centers to Advance Health Equity > Context
What the sources say
- Not checked yetcites [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 — no full text of the sourcecites [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
- Not checked yetcites [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.
- Supportedcites [15] Davis, 2011, Exercise improves executive function and achievement and alters brain activity in overweight children: a randomized controlled trial, Health Psychol source
The introductory passage reproduced under Abstract > Conclusion says overweight is associated with poorer achievement and vigorous physical activity with better grades. In this multi-citation sentence, the source supports the obesity and physical-inactivity examples, not the entire list of health problems and behaviors. (LLM, conf=0.88)
- Not matchedcites [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.
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [18] Fox, 2010, Physical activity and sports team participation: associations with academic outcomes in middle school and high school students, J Sch Health source
- Not checked — no full text of the sourcecites [19] Geierstanger, 2004, School-based health centers and academic performance: research, challenges and recommendations, J Sch Health source
- Not checked — no full text of the sourcecites [20] Henry, 2010, Academic achievement and adolescent drug use: an examination reciprocal effects and correlated growth trajectories, J Sch Health source
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Additional Analyses
What the sources say
- Could not verifycites [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 sourceExperimental — accuracy not yet measured
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)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Previous reviews have found limited evidence of SBHC effectiveness in improving healthcare utilization and academic outcomes.19,37–41”
§ School-Based Health Centers to Advance Health Equity > Context
What the sources say
- Not checked — no full text of the sourcecites [19] Geierstanger, 2004, School-based health centers and academic performance: research, challenges and recommendations, J Sch Health source
- Supportedcites [37] Mason-Jones, 2012, A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health, Syst Rev source
The Results and Discussion > Access to and utilization of services (page not available) say that most utilization studies were descriptive, limiting evidence of effectiveness. The Results also report no difference in educational outcomes between students with SBHC access and comparison students. The review therefore supports the claim of limited evidence for improvements in these outcomes. (LLM, conf=0.85)
- Not checked — no full text of the sourcecites [38] Murray, 2007, Coordinated school health programs and academic achievement: a systematic review of the literature, J Sch Health source
- Not matchedcites [39] GAO, 1994
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Partly supportedcites [40] Santelli, 1996, School-based health centers and adolescent use of primary care and hospital care, J Adolesc Health sourceExperimental — accuracy not yet measured
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)
- Not checked — no full text of the sourcecites [41] Strunk, 2008, The effect of school-based health clinics on teenage pregnancy and parenting outcomes: an integrated literature review, J Sch Nurs source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Associations between SBHC exposure and risk behaviors were mixed, with apparent increases in cigarette smoking but reductions in consumption of alcohol and other substances.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > School-Based Health Center Effects on Educational and Health-Related Outcomes
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Associations between SBHC exposure and risk behaviors were mixed, with apparent increases in cigarette smoking but reductions in consumption of alcohol and other substances.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > School-Based Health Center Effects on Educational and Health-Related Outcomes
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Analysis of the whole-school effects versus effects for SBHC users only indicated no clear pattern of differences (results not shown).”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Additional Analyses
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Regarding sexual and reproductive behaviors associated with SBHCs, contraceptive use among females increased, childbirth decreased, and prenatal care improved (Table 1).”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > School-Based Health Center Effects on Educational and Health-Related Outcomes
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Data were not adequate to distinguish between the effects of SBHC service proximity and the effects of SBHC service costs.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Additional Analyses
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Healthcare utilization also improved, including substantial increases in recommended immunizations and other preventive services, and a small increase in the proportion of students who reported a regular source of health care.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > School-Based Health Center Effects on Educational and Health-Related Outcomes
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Effects on self-reported health and mental health status were small; however, the presence of SBHCs was associated with substantial reductions in ED visits and hospital utilization for all conditions.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > School-Based Health Center Effects on Educational and Health-Related Outcomes
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 19
- Probably not a substantial claim. 7
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Conversely, low academic achievement is strongly associated with risk-taking behavior, compromised health status, and reduced longevity.22–33”
§ School-Based Health Centers to Advance Health Equity > Context
What the sources say
- Not checked — no full text of the sourcecites [22] Lande, 2003, Elevated blood pressure and decreased cognitive function among school-age children and adolescents in the United States, J Pediatr source
- Partly supportedcites [23] Braveman, 2011, The social determinants of health: coming of age, Annu Rev Public Health sourceExperimental — accuracy not yet measured
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)
- Partly supportedcites [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. sourceExperimental — accuracy not yet measured
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)
- Not matchedcites [25] Ergerter, 2009
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked yetcites [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 matchedcites [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.
- Not checked — no full text of the sourcecites [28] Fiscella, 2009, Disparities in academic achievement and health: the intersection of child education and health policy, Pediatrics source
- Not checked yetcites [29] Kolbe, 2002, Education reform and the goals of modern school health programs, Educ Stand
- Partly supportedcites [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. sourceExperimental — accuracy not yet measured
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)
- Not checked — no full text of the sourcecites [31] Ross, 1996, Education, age, and the cumulative advantage in health, J Health Soc Behav source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Additional Analyses
What the sources say
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [97] Zimmer-Gembeck, 2001, Contraceptive dispensing and selection in school-based health centers, J Adolesc Health source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seven studies54,55,71,72,81,87,97 provided details on contraceptive dispensation, but results were inconclusive (Appendix Figures 16 and 17, available online).”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Additional Analyses
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Additional Analyses
What the sources say
- Not checked — no full text of the sourcecites [72] Kirby, 1991, Six school-based clinics: their reproductive health services and impact on sexual behavior, Fam Plann Perspect source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Additional Analyses
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Discussion > Other Benefits and Potential Harms
What the sources say
- Not checked — no full text of the sourcecites [55] Ethier, 2011, School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students, J Adolesc Health source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Descriptive Results and Applicability of Findings
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only three studies51,75,92 evaluated hybrid school-based and school-linked centers, and no studies evaluated exclusively school-linked centers or mobile clinics.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Descriptive Results and Applicability of Findings
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Descriptive Results and Applicability of Findings
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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”
§ School-Based Health Centers to Advance Health Equity > Abstract > Context
What the sources say
- Not checked yetcites [1] Bloom, 2012, Summary health statistics for U.S. children: National Health Interview Survey, 2011, Vital Health Stat
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Context · plain
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.”
§ School-Based Health Centers to Advance Health Equity > Abstract > Conclusions
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- 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.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Abstract > Context
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
- 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.
- Also stated in: § Context · plain
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Additional Analyses
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Discussion > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Although educational inequalities have declined modestly in recent years, they persist.3,5,9–11”
§ School-Based Health Centers to Advance Health Equity > Context
What the sources say
- Not checked yetcites [3] 2013, CDC health disparities and inequalities report—United States, 2013, MMWR Morb Mortal Wkly Rep
- Not checked yetcites [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 — no full text of the sourcecites [9] Sondik, 2010, Progress toward the Healthy People 2010 goals and objectives, Annu Rev Public Health source
- Not matchedcites [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.
- Not matchedcites [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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“First, lack of randomization might have resulted in selection bias.”
§ School-Based Health Centers to Advance Health Equity > Discussion > Limitations
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Discussion > Limitations
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Discussion > Summary of Findings
What the sources say
- Not matchedcites [36] Lofink, 2013
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [98] Duncan, 2011
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- 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.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Lastly, SBHC effects might have been underestimated or overestimated because evaluators did not obtain true baseline data.”
§ School-Based Health Centers to Advance Health Equity > Discussion > Limitations
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies of limited quality of execution were excluded from analysis.”
§ School-Based Health Centers to Advance Health Equity > Evidence Acquisition > Assessing and Summarizing the Body of Evidence of Effectiveness
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“SBHCs improve both educational and health outcomes”
§ School-Based Health Centers to Advance Health Equity > Conclusions
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two reviewers independently evaluated each study included in the review. Disagreements between reviewers were resolved by consensus.”
§ School-Based Health Centers to Advance Health Equity > Evidence Acquisition > Assessing and Summarizing the Body of Evidence of Effectiveness
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ School-Based Health Centers to Advance Health Equity > Evidence Acquisition > Assessing and Summarizing the Body of Evidence of Effectiveness
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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”
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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Descriptive Results and Applicability of Findings
“one study83 assessed middle school SBHCs”
§ School-Based Health Centers to Advance Health Equity > References
“83. Sanford CC Delivering health care to children on their turf: an elementary school-based wellness center J Pediatr Health Care 2001 15 3 132 137”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Descriptive Results and Applicability of Findings
“only four studies in five papers49,54,70,72,89 before 1990”
§ School-Based Health Centers to Advance Health Equity > References
“72. Kirby D Waszak C Ziegler J Six school-based clinics: their reproductive health services and impact on sexual behavior Fam Plann Perspect 1991 23 1 6 16”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ School-Based Health Centers to Advance Health Equity > Evidence Synthesis > Descriptive Results and Applicability of Findings
“Thirty-two studies in 33 papers46–48,51–53,55–62,65,68,69,74,75,77,79,81–83,86–88,90–93,95,97 were published after 2000”
§ School-Based Health Centers to Advance Health Equity > References
“75. Klostermann BK Perry CS Britto MT Quality improvement in a school health program. Results of a process evaluation Eval Health Prof 2000 23 1 91 106”
Citations
Cites
Awais, A. (2015) · Data Archiving and Networked Services (DANS) · doi:10.17632/zcvgc6m58h.1 · Cited by 6,790
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The Social Determinants of Health: Coming of Age
Braveman, P., Egerter, S., & Williams, D. R. (2011) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031210-101218 · Cited by 2,476
The Links Between Education and Health
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Cohn, A. C., MacNeil, J. R., Clark, T. A., Ortega‐Sanchez, I. R., Briere, E. Z., Meissner, H. C., Baker, C. J., & Messonnier, N. E. (2013) · PEDIATRICS · doi:10.1542/peds.2013-2511 · Cited by 1,845
Whither opportunity?: rising inequality, schools, and children's life chances
(2012) · Choice Reviews Online · doi:10.5860/choice.49-5804 · Cited by 1,745
Youth Risk Behavior Surveillance — United States, 1999
Kann, L. K., Kinchen, S. A., Williams, B. I., Ross, J. G., Lowry, R., Grunbaum, J. A., & Kolbe, L. J. (2000) · Journal of School Health · doi:10.1111/j.1746-1561.2000.tb07252.x · Cited by 1,633
Education and Health: Evaluating Theories and Evidence
Cutler, D., & Lleras-Muney, A. (2006) · doi:10.3386/w12352 · Cited by 1,507
Summary of notifiable diseases--United States, 2012.
Adams, D. A., Jajosky, R. A., Ajani, U. A., Kriseman, J., Sharp, P., Onwen, D. H., Schley, A. W., Anderson, W. J., Grigoryan, A., Aranas, A. E., et al. (2014) · PubMed · Cited by 1,342
The Relationship Between Education and Adult Mortality in the United States
Lleras-Muney, A. (2002) · doi:10.3386/w8986 · Cited by 929
Research works printed but not linked: 4
- 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.
- Kolbe, 2002, Education reform and the goals of modern school health programs, Educ Stand, 3, 4
- Zaza, 2011, Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services, Am J Prev Med, 18, 44
- 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
Sorted by citations
Salvo, D., García, L., Reis, R. S., Stankov, I., Goel, R., Schipperijn, J., Hallal, P. C., Ding, D., & Pratt, M. (2021) · Journal of Physical Activity and Health · doi:10.1123/jpah.2021-0413 · Cited by 247
The Link Between School Attendance and Good Health
Allison, M. A., Attisha, E., COUNCIL ON SCHOOL HEALTH, Lerner, M., De Pinto, C. D., Beers, N. S., Gibson, E. J., Gorski, P., Kjolhede, C., O’Leary, S. C., et al. (2019) · Pediatrics · doi:10.1542/peds.2018-3648 · Cited by 253
Twenty Years Of School-Based Health Care Growth And Expansion
Love, H., Schlitt, J. J., Soleimanpour, S., et al. (2019) · Health Affairs · doi:10.1377/hlthaff.2018.05472 · Cited by 164
Gaylor, E. M., Krause, K. H., Welder, L. E., Cooper, A. C., Ashley, C. L., Mack, K. A., Crosby, A. E., Trinh, E. P., Ivey-Stephenson, A. Z., & Whittle, L. (2023) · MMWR Supplements · doi:10.15585/mmwr.su7201a6 · Cited by 160
“1 53 US Department of Health and Human Services/Centers for Disease Control and Prevention school-based mental health care, especially youths in racial and ethnic minority groups from under-resourced families (12); the increased prevalence of suicidal behaviors among these students might reflect a lack of access to me…”
BackgroundThe Evidence on School-Based Health Centers: A Review
Arenson, M., Hudson, P. J., Lee, N., & Lai, B. S. (2019) · Global Pediatric Health · doi:10.1177/2333794x19828745 · Cited by 145
“Nevertheless, SBHC utilization has been associated with improved academic outcomes, such as improved GPAs, attendance, grade promotion, college preparation, and reduced rates of suspensions.(3,57) The APHA(53) supports SBHCs because they “[create] school-wide programs that address bullying, violence, anger, depression…”
BackgroundInfluential
Metadata
- 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)
- 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
- bronze
- doi.org
- 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 › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Child and Adolescent Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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.
A language model drew the claims from the paper on 2026-10-21, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-21 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (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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