Where are the Boys… Using Peer Leadership to Address Barriers to Male Adolescent Utilization of an Urban School-Based Health Center

Abstract

Adolescent men have higher mortality and morbidity than their female peers resulting from many preventative conditions, including substance abuse, accidental injuries, and violence. However, use of primary care decreases as adolescent men age (opposite to the trend among females) and this gender disparity persists through adulthood. School-based health centers (SBHC) were established to target unmet adolescent health needs with accessible, low cost, comprehensive care. In theory, they address many barriers identified by adolescent males, but low utilization persists. Using the principles of community-based participatory research and peer leadership, a forum was established at a selected urban high school aiming to empowering male student leaders in identifying and addressing relevant health issues and barriers preventing their demographic from accessing primary care, especially their SBHC. The setting is a technology-focus pilot high school (within the public school system) with a state department of public health sponsored SBHC. Each year, seven to ten male students (sophomores or juniors) are selected by guidance counselors based on perceived leadership potential and academic eligibility. Participants meet weekly with a SBHC clinician, research volunteer, and occasionally community leaders for 60 minute sessions to discuss health issues and barriers to SBHC use as identified by an annual school-wide survey. Participants are then encourage to collaborate in order to address these issues with the support and guidance of SBHC staff. The research volunteer moderates conversation, takes notes, and identifies common themes. Average weekly attendance was > 85%. In 2008, participants focused on barriers to adolescent male use of primary care, especially how perceptions of masculinity, such as “toughness,” discourages prevention while promoting violent/aggressive stereotypes. They advocated for a peer leadership program where male students learned leadership skills through open and respectful discussions of health issues with community leaders. This provides a foundation for peer interactions around healthy behaviors and decision-making. Piloted in 2011, the program has been refined through participant input. Topical discussions addressed the top issues identified by the annual survey (stress, sleep, violence, neighborhood safety, sports injuries, substance use and mental health). Participants also explored survey data demonstrating a preference for emergency room care over their SBHC, and top barriers to SBHC use (fear of parents finding out and peer judgment). Participants have addressed these issues by tabling to advertise SBHC services, classroom presentations, and advocating on behalf of SBHCs at the State Capitol. Adolescents exert a powerful influence on the attitudes and behaviors of one another. A selected group of urban high school adolescent males designed a peer leadership program aimed at building leadership skills and health literacy. The program has demonstrated its ability to fostering agency and initiative among participants in advocating for and reducing stigma associated with seeking preventative healthcare. Future research will assess the project's effectiveness in impacting school-wide attitudes and behaviors.