Sexual Health Service Use Among High School Students Accessing School-Based Versus Non–School-Based Sites in a Health Center System

OBJECTIVES: To preliminarily compare health care utilization, sexual behaviors, and sexual health outcomes among high school students accessing school-based health centers (SBHCs) vs. non-SBHCs and develop an initial hypothesis on the potential impact of SBHCs. DESIGN: Retrospective chart review. SETTING: Three SBHC locations and 5 non-SBHCs locations within an adolescent and young adult health center system in Houston, Texas. PARTICIPANTS: Random sample of 189 high school students receiving care between August 2022 and May 2023 at a SBHC (n = 129) or non-SBHCs (n = 60). MAIN OUTCOME MEASURE: Demographic characteristics, health center utilization patterns, sexual behaviors, and sexual health outcomes, including sexually transmitted infection (STI) testing and results. RESULTS: Students accessing SBHCs were more likely to be male (35.9% vs. 21.7%, P = .03) and Spanish-speaking (24.8% vs. 8.3%, P = .01) compared with students accessing non-SBHCs. Students accessing SBHCs also tended to be uninsured at higher rates (70.3% vs. 54.7%, P = .06), although the difference was not statistically significant. SBHC users were less likely to report having a primary care provider (22.5% vs. 41.7%, P = .01) or being sexually active (30.2% vs. 60.0%, P < .001). No significant differences were observed in STI testing rates or STI outcomes between groups. CONCLUSIONS: These preliminary data show that SBHCs serve adolescents with greater structural barriers to health care, including lack of insurance and limited access to primary care. SBHCs can be accessible points of care within schools that address disparities in health care access. Continued investment and expansion of SBHCs may have positive implications strengthen public health systems by improving access to preventive and sexual health services for underserved youth. Further research is needed to explore correlations between student utilization of health care to SBHC access.