Purpose: Little is known about student attitudes toward school-based health centers (SBHCs) or about factors that influence SBHC enrollment.
Methods: Students in 9 Baltimore schools with SBHCs and 4 schools without health centers were surveyed in May 1991, using an anonymous classroom questionnaire. SBHC enrollees, nonenrollees from health center schools, and students in schools without health centers were compared using bi-variate analyses. Logistic regression analyses identified predictors of enrollment.
Results: A total of 91% of enrollees supported having a SBHC compared with 89% of nonenrollees and 77% of students from non-health center schools (p < .001). Support for a variety of services (including contraceptive services) was significantly higher among enrollees and nonenrollees compared with students in non-SBHC schools. A total of 86% of enrollees rated the quality of care "satisfactory" to "excellent" and 79% rated privacy in the school health center as "satisfactory" to "excellent." The most common reason given for not enrolling was satisfaction with current provider. Independent predictors of student confidence in the privacy of SBHCs included prior SBHC use and enrollment of close peers. Predictors of enrollment included: one or more self-reported health problems; having medical assistance; attending one or more special education classes; enrollment of close peers; membership in a school club, sports team, or church organization; and being African-American.
Conclusions: Students overwhelmingly supported school-based health centers. Personal experience and peer influences were important in shaping student attitudes. We found evidence of a "learning curve" gradient in student attitudes such that students with the greatest exposure to SBHCs (as measured by attending a SBHC school, enrolling in the SBHC, and using the health center) had the most favorable attitudes.