School-based health services and educational attainment: Findings from a national longitudinal study

This study examined whether availability and use of different types of school-based health services (SBHS) during adolescence were associated with educational attainment in adulthood. Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed in 2018 to assess relationships between different types of SBHS provided by schools and use of SBHS among adolescents in 1995, and educational attainment in young adulthood (2001-02) and later adulthood (2008). Multi-level linear regression models included SBHS such as providing immunizations, physical exams and emotional counseling at the school level, and receiving a school-based physical exam, emotional counseling or family planning counseling at the individual level, with other school and individual characteristics included as covariates. At the school level, providing immunizations in 1995 was associated with higher educational attainment in 2001-02 and 2008. Providing physical exams and physical fitness/recreation centers also were marginally associated with higher educational attainment in 2001-02 and 2008, respectively. At the individual level, receiving a physical exam at school in 1995 was associated with higher educational attainment in 2001-02, while receiving emotional counseling at school was inversely associated with educational attainment in 2008. None of the other types of SBHS at the school or individual level were associated with later educational attainment. This study suggests that preventive SBHS such as immunizations, physical exams and physical fitness/recreation centers may contribute to academic achievement and higher educational attainment during young and later adulthood.