School Health Care Research Articles

Feasibility of mobile health game “Fume” in supporting tobacco-related health literacy among early adolescents: A three-armed cluster randomized design

ObjectiveNew interventions supporting health literacy and a tobacco-free lifestyle in adolescence are needed to narrow the widening gap in existing health inequalities. Health games offer potential and could be utilized for example in school healthcare, but more research is needed to increase the understanding of the effects of game elements in health interventions. The aim of this feasibility study is to determine the short-term effectiveness of the tobacco-related mobile health game Fume and a non-gamified website in comparison with a no-intervention control group, regarding tobacco-related health literacy among 10–13-year-old early adolescents. In addition, we compare the demand for and acceptability of Fume to that of the website. MethodsIn total, 151 early adolescents participated in this single-blinded, three-armed cluster randomized trial. The participants from three municipalities in southwest Finland were randomly allocated between a group with access to the health game Fume (n = 61), a group with access to the website (n = 47), and a group with no intervention (n = 43). The intervention groups first participated in a 20-min training session with Fume/the website, and then had two weeks to use Fume/the website based on their own interest. Short-term effectiveness was measured by primary (anti-smoking self-efficacy) and secondary (smoking outcome expectations, attitudes towards tobacco use, tobacco-use motives, motivation to decline tobacco use in the future, and knowledge about tobacco) outcomes derived from the theory-based determinants of tobacco-related health literacy and evaluated with self-assessment questionnaires at baseline and post-intervention (after a two-week follow-up). For evaluating the demand, the actual use of Fume/the website was tracked during the two-week period. Regarding acceptability, the raised interest towards Fume/the website and opinions about the interventions were evaluated post-intervention. Differences were tested with the McNemar, Fisher exact, and non-parametric tests. ResultsStatistically significant favorable changes during the study period were found for positive (P = 0.002) and negative (P = 0.02) smoking outcome expectations and attitudes towards cigarette smoking (P = 0.01) within the group using Fume. No statistically significant changes were detected within the website or control groups. Statistically significant differences were not found for the change in outcome variables among the three groups. The number of visits (P < 0.001), number of separate visit days (P < 0.001) and total duration of use (P < 0.001) were larger for the group using Fume than for that using the website. Fume sparked more interest in early adolescents than the website did (P < 0.001). There were no statistically significant differences in opinions about Fume and those regarding the website. ConclusionsThe intervention with embedded game elements, the health game Fume, was found to be more feasible as a tobacco-related health education intervention than the non-gamified website among early adolescents in light of demand and acceptability (raised interest). Even though no change in anti-smoking self-efficacy was found, the results of this feasibility study demonstrated favorable short-term changes with Fume in some other theory-based determinants of tobacco-related health literacy.

Varicella Outbreak Surveillance in Schools in Sentinel Jurisdictions, 2012-2015.

In 2007, a routine second dose of varicella vaccine was recommended in the United States for children aged 4 to 6 years to better control varicella-zoster virus circulation and outbreaks. Sentinel varicella outbreak surveillance was established to assess feasibility of surveillance and describe outbreaks that are occurring. Through the Centers for Disease Control and Prevention Epidemiology Laboratory Capacity funding, health departments conducted active surveillance for varicella outbreaks in schools from 2012 to 2015. Outbreaks of varicella were defined as ≥5 cases in a school within at least 1 incubation period (21 days). School nurses, healthcare providers, or laboratories reported cases and outbreaks of varicella to health departments; demographic, vaccination, and clinical data were collected. Georgia, Houston, Maine, Minnesota, New York City, and Philadelphia participated in all 3 years; Puerto Rico and West Virginia participated in 2012 to 2013; and Kansas and Arkansas participated in 2014 to 2015. Twenty-nine outbreaks including 262 cases were reported. The median size of the outbreaks was 7 cases (range, 5-31 cases), and the median duration was 31 days (range, 4-100 days). Of the case-patients associated with larger outbreaks (≥8 cases), 55.4% were unvaccinated, and 15.7% and 18.1% had received 1 or 2 doses of vaccine, respectively. In small outbreaks (5-7 cases), 33.3% of case-patients were unvaccinated, and 16.7% and 38.5% had received 1 or 2 doses of vaccine, respectively. The majority of cases associated with outbreaks occurred in undervaccinated children (unvaccinated and 1-dose vaccine recipients). Outbreaks with a greater proportion of 2-dose vaccine recipients were smaller. Varicella outbreak surveillance is feasible, and continued monitoring of outbreaks remains important for describing the epidemiology of varicella during the 2-dose varicella vaccination program.

School nurse perspectives on school policies for food allergy and anaphylaxis

BackgroundAlthough school health care professionals are integral to the management of students with food allergy, their views on school food allergy policies have not yet been reported. ObjectiveTo characterize food allergy policies currently being used in schools and their utility and potential barriers to implementation from the perspective of school health care professionals. MethodsAn electronic survey was disseminated to school nurses at the 2016 National Association of School Nurses meeting and through the Allergy and Asthma Network listserv. Frequencies were calculated to describe participant characteristics and responses. Unadjusted associations were examined using χ2 tests; adjusted associations were examined using multiple logistic regression models. ResultsA total of 242 completed surveys were included in the analysis. Thirty-two percent of nurses reported an allergic reaction in their school in the past year. Most schools used a variety of policies, including anaphylaxis training for staff (96.7%), stock epinephrine availability (81.7%), designated lunch areas (62.2%), and food guidelines for classrooms (61.8%). Barriers to implementation included financial, time, and attitudinal considerations. Schools with pre-K or kindergarten students had higher odds of having designated lunch areas (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.0–4.1; P < .05). The odds of having emergency epinephrine available were higher in schools with a full-time nurse (OR, 2.6; 95% CI, 1.1–6.3; P < .05) and in schools reporting at least 1 severe reaction in the past year (OR, 3.2; 95% CI, 1.2–8.5; P < .05). ConclusionWith one-third of school nurses reporting an allergic reaction in the past year, schools use many strategies to minimize allergen exposures and increase anaphylaxis preparedness. Most school nurses favor these policies and acknowledge barriers to implementation.

Factors associated with mental health among high school students in Iran: Does mobile phone overuse associate with poor mental health?

Mobile phone (MP) overuse is extensively rising among high school students in developing countries. Our aim in this study is to investigate the association between MP overuse and mental health, in the presence of other determinant factors, among high school students in Iran. We recruited a clustered random sample of 1,034 high school students in Saqqez County, Iran, to complete a self-administered questionnaire with three sections: a sociodemographic questionnaire, Mobile Phone Addiction Index, and General Health Questionnaire. A majority of the students (n=654, 63.2%) were found to be with poor mental health. Applying multiple logistic regression, gender (odds ratio [OR]=1.5; 95% confidence interval [CI]=1.15-1.97), education degree (OR=1.47; 95% CI=1.30-1.67), frequency of daily messages (OR=1.18; 95% CI=1.07-1.31), being awakened at night for MP use (OR=1.83; 95% CI=1.54-2.18), and MP overuse (OR=3.21; 95% CI=1.20-8.58) were found in significant associations with poor mental health. Planning gender-based health education programs on proper use of MP for students and their parents is suggested to school healthcare providers. The parents should be educated on the proper ways of dealing with their adolescents while using MP at home.

218 - Applying Adolescent Health Equity to School and Community Healthcare: Community Outreach and Rally for Engaged Aggregate in Health Care (Co-Reach) Initiative

218 - Applying Adolescent Health Equity to School and Community Healthcare: Community Outreach and Rally for Engaged Aggregate in Health Care (Co-Reach) Initiative

Respiratory viral infections in infancy and school age respiratory outcomes and healthcare costs.

To determine the impact of viral lower respiratory tract infections (LRTIs) in infancy including rhinovirus (RV) and infancy respiratory syncytial virus (RSV), on school age pulmonary function and healthcare utilization in prematurely born children. School age respiratory outcomes would be worse and healthcare utilization greater in children who had viral LRTIs in infancy. Prospective study. A cohort of prematurely born children who had symptomatic LRTIs during infancy documented, was recalled. Pulmonary function was assessed at 5 to 7 years of age and health related costs of care from aged one to follow-up determined. Fifty-one children, median gestational age 33+6 weeks, were assessed at a median (IQR) age 7.03 (6.37-7.26) years. Twenty-one children had no LRTI, 14 RV LRTI, 10 RSV LRTI, and 6 another viral LRTI (other LRTI). Compared to the no LRTI group, the RV group had a lower FEV1 (P = 0.033) and the other LRTI group a lower FVC (P = 0.006). Non-respiratory medication costs were higher in the RV (P = 0.018) and RSV (P = 0.013) groups. Overall respiratory healthcare costs in the RV (£153/year) and RSV (£27/year) groups did not differ significantly from the no LRTI group (£56/year); the other LRTI group (£431/year) had higher respiratory healthcare costs (P = 0.042). In moderately prematurely born children, RV and RSV LRTIs in infancy were not associated with higher respiratory healthcare costs after infancy. Children who experienced LRTIs caused by other respiratory viruses (including RV) had higher respiratory healthcare costs and greater pulmonary function impairment.

Critical Success Factors in a High School Healthcare Education Program

Research has demonstrated career and technical education (CTE) programs have a strong positive influence on secondary students’ behavior, attendance, academic achievement, and college persistence. Critical success factors common to career academies, small schools, and CTE programs include socio-emotional support and community, along with a culture of high expectations and student engagement. Yet little research has been conducted on social and cultural factors involved in these programs’ success. This qualitative study focused on one high school healthcare education program in the Mid-Atlantic to identify the social and cultural critical success factors that contributed to successful student outcomes. Through classroom observations; interviews with administrators, teachers, partners, program graduates, and parents; surveys of graduates; and focus groups with current students, the following critical success factors emerged: learning environment and community, focused student support, engagement through a real-world context, and a culture of professionalism. These findings may help educators and districts focus their attention and efforts on the critical factors that impact student success as they seek to expand and improve CTE programs.

School Food Environment Promotion Program: Applying the Socio-ecological Approach

Background Despite of healthy nutrition recommendations have been offered in recent decades, researches show an increasing rate of unhealthy junk food consumption among primary school children. The aim of this study was to investigate the effects of health promotion intervention on the school food buffets and the changes in nutritional behaviors of the students. Materials and Methods In this Quasi-interventional study, eight schools agreed to participate in Tabriz city, Iran. The schools were randomly selected and divided into an intervention and a control group, and a pretest was given to both groups. A four weeks interventional program was conducted in eight randomly selected schools of the city based on the socio-ecological model. A check list was designed for the assessment of food items available at the schools’ buffets, a 60-item semi-quantitative food frequency questionnaire (FFQ) was used to assess the rate of food consumption and energy intake. Results evaluation and practice were analyzed using the Wilcoxon, Mann Whitney-U and Chi-square tests. Results The findings revealed reduction in the intervention group between before and after intervention with regard the range of junk food consumption, except for the sweets consumption. The number of junk foods provided in the schools buffets reduced in the intervention group. After the intervention on the intervention group significant decreases were found in the intake of energy, fat and saturated fatty acids compared to the control group (p = 0.00). Conclusion In order to design effective school food environment promotion programs, school healthcare providers should consider multifaceted approaches.

Conference Report - 'NURTURE A.R.T. Self' - Adolescent Mental Health and Art Therapy International Conference 2016 (Hong Kong)

Creative Arts Educ Ther (2017) 3(1):87–93DOI: 10.15212/CAET/2017/17/10 Conference Report – “NURTURE A.R.T. Self” – Adolescent Mental Health and Art Therapy International Conference 2016 (Hong Kong) 会议报告: “培育艺术自我” – 未成年人心理健康和艺术治疗2016香港国际会议 Grace WY Chan, Tristan NC Chan, Hoi Lam Tang and Sarah MM Tong Hong Kong Association of Art Therapists Abstract Art therapy is becoming a popular topic in the metropolitan city of Hong Kong. The attention it attracts often correlates to the heightened awareness of mental health issues - particularly the rise of adolescent suicide cases and the overwhelmingly high number of young people reportedly affected by both anxiety and depression. As school officials and health care administrators look to different measures to deal with these issues - such as better life education and planning to support the development of teenagers - the general public now wonders if art therapy could be an alternative means of treating and supporting adolescent mental health. In the hope of educating the public about art therapy and promoting its healing power, HKAAT* and CFSC co-hosted the “NURTURE A.R.T. Self” Art Therapy Conference in Hong Kong last year, exploring the scope of practices that art therapy brings to addressing such issues of adolescent mental health. The conference attracted nearly 200 participants and featured over 20 lectures and workshops that were presented by both local and overseas practitioners and scholars. Its aims were to foster an intellectual exchange of research methods and therapy practice insights and to provide an in-depth review of the application of art therapy in a variety of groups – specifically in the treatment of such psychological issues such as self-mutilation, domestic violence and depression. 摘要 艺术治疗正逐渐在大都市香港成为一个广为人知的话题。大家对艺术治疗的觉知伴随着他们对心理健康的重视，特别是在这青少年自杀率上升以及铺天盖地的年轻人被诊为焦虑和抑郁的时期。学校领导和卫生保健管理人员寻找不同方法应对这些事件，比如更好的生活教育和计划来支持青少年的发展。而广大群众如今则设想：艺术治疗也许能成为治疗和保护青少年心理健康的另一个途径。为了教育广大群众艺术治疗以及它的疗效，去年，HKAAT和CFSC在香港合办了“培育艺术自我”的艺术治疗会议。其目的在于探索艺术治疗在保护青少年心理健康中起到的帮助。会议吸引了近二百参与者，提供了二十多个由海内外学者和医生主讲的课程与工作坊。会议的目标在于促进研究方法和治疗实践洞悉间的知识交流，并提供一个怎样用艺术治疗与不同人群工作的细致回顾。会议中主要提到的接受艺术治疗的人群包括有自残行为、面临家暴和抑郁的有心理问题的人群。

Face-to-Face Bullying, Cyberbullying, and Multiple Forms of Substance Use Among School-Age Adolescents in the USA

Face-to-face and cyberbullying are associated with adverse behavioral or health problems. However, little is known about the association between multiple types of bullying and substance use. The current cross-sectional study compares the association among face-to-face and cyberbullying (bully-only, victim-only, bully/victim, non-involved) and multiple forms of substance use (cigarette use, alcohol use, drunkenness, marijuana use) from a sample of 6th–10th grade students. Data were derived from the 2005–2006 Health Behavior in School-Aged Children study (N = 7189). Zero-inflated Poisson regression analyses of substance use on bullying involvement were conducted, controlling for social-ecological factors. For face-to-face bullying, being bully-only was positively associated with all forms of substance use and being bully/victim was correlated with alcohol use. In the case of cyberbullying, being bully-only and bully/victim increased the incidents of all types of substance use, while being victim-only was only correlated with cigarette and alcohol usage. Further, results indicated that there were some interaction effects of parental monitoring and delinquent friends on the link between face-to-face bullying and substance use. The study findings contribute to scholarship on the linkages among face-to-face bullying, cyberbullying, and substance use within a social-ecological framework which has major implications for school mental health. More specifically, these findings can be useful for school practitioners and health care providers in developing and implementing prevention and intervention programs that address multiple risk behaviors among adolescents.

The association between changes in depression/anxiety and trajectories of psychotic-like experiences over a year in adolescence

BackgroundRecent cross-sectional studies suggest that psychotic-like experiences (PLEs) are associated with depression and anxiety in adolescents. While longitudinal studies have observed that adolescents suffer more severe symptoms of depression/anxiety when PLEs persist, it remains unclear whether depression/anxiety worsens or improves with PLE emergence or remission, respectively. In this prospective school-based study, we investigated the association between longitudinal changes in depression/anxiety and one-year PLE trajectories in adolescence. MethodsNine hundred and twelve adolescents participated in the baseline assessment of PLEs and depression/anxiety; 887 (97.3%) adolescents completed the follow-up assessment one year later. Multilevel analysis was conducted to evaluate the change in depression/anxiety, evaluated using the General Health Questionnaire-12 (GHQ-12), during the year according to PLE trajectory, adjusting for baseline depression/anxiety, gender, age, substance use and victimization. ResultsSixteen percent of adolescents reported PLEs at baseline, with 56% of them remitting at follow-up. At follow-up, PLEs were experienced by 6.6% of adolescents not experiencing PLEs at baseline (incident PLE group). After adjusting for covariates, GHQ-12 score worsened significantly during the year in students with incident trajectories (regression coefficient for time, α1=1.91, 95% CI: 1.04–2.77), but in those showing remission, GHQ-12 score did not significantly improve (α1=−0.20, 95% CI: −0.97–0.56). ConclusionsGreater awareness about PLEs and their trajectories in school health care settings may be a key towards the prevention and treatment of adolescent depression and anxiety.

Loneliness and friendships among eight-year-old children: time-trends over a 24-year period.

Loneliness in childhood has a wide range of negative consequences for well-being and mental health later in life. This study reports time-trends in children's loneliness and the association between children's loneliness and psychiatric symptoms over a 24-year period. Information on 3,749 eight-year-old Finnish-speaking children born in 1981, 1991, 1997, and 2004 was gathered at four time points from the area covered by Turku University Hospital in southwest Finland. The actual numbers of participants at these time points were 986 (1989), 891 (1999), 930 (2005), and 942 (2013), with participation rates of 86%-95%. The study design and methods were similar at every time point. Information on children's loneliness and friendships was obtained from the children and also parents and teachers evaluated how many friends children had and their psychiatric symptoms. Approximately 20% of the children reported loneliness at each time point, 5% always felt lonely, and 25% wished they had more friends. Conduct and emotional problems, and hyperactivity were independently associated with loneliness in the multiple-regression analysis. The strength of these associations remained at similar levels over the 24-year study period. Living in a nonnuclear family, parents with a lower level of vocational education, and negative life events among the girls in the study were all associated with loneliness. Loneliness was a common phenomenon in childhood, and no notable changes were found during the 24-year study period. Psychiatric symptoms were strongly associated with loneliness. It is important to pay attention to children's loneliness and make it an integral part of school health care. Further epidemiological research is needed.

QUALITY EVALUATION OF HEALTHCARE SERVICES IN SCHOOLS

Background: School healthcare service standards and quality are the crucial factors for a development of a healthy lifestyle health of younger generation of the country. The goal of the study is an evaluation of the health care quality in schools.Methods: The paper discusses the evaluation of the quality of health care which is provided for school children in different parts of Russia. Assessment of the school health services is performed using the unified WHO recommendations in 21 schools.Results: The study revealed the similar pattern of problems concerning health services in schools located in different regions of the country, specifically: the absence of modern federal rules; shortage of medical professionals and their low sallary; insufficient medical equipment; inadequate list of medical services.Conclusions: This study gives the evidence for the necessity to develop a general strategy of measures to be implemented to solve the problems. The measures should include the regular trainings of medical professionals, determination of the list of basic services to be provided in schools, improvement of the medical equipment.

Physical, emotional, and social illness

PurposeThe purpose of this paper is to examine ideas and notions in the founding and development of the area of mental health services in school in Sweden, with special focus on school psychology and school social work.Design/methodology/approachFrom a history of thought perspective, this paper investigates public Swedish school-related documents from the early 1900s up until the 1980s in order to reveal the influential ideas about school health care, children’s needs, and professionals’ responsibilities. These ideas are linked to the twentieth century development of the behavioural sciences, the school system, and the welfare state in Sweden.FindingsTwo main turning points are identified. The first occurred in the 1940s when psychologists and social workers were invited to become part of schools as experts on children’s mental health care, implying that mental health issues had become included in the school’s responsibility. The second turning point came in the 1970s when the tasks and the ideational context for the mental health experts changed dramatically. The first turning point challenged the dominant explanation model, a model that relied on scientific references to medicine, and eventually led to an acceptance of psychology instead as dominant provider of explanatory models. The second turning point affected the tension between child and system, and implied a subordination of the needs of the system for the benefit of the needs of the child.Originality/valueThis paper highlights how views on children’s needs and on the responsibilities of school and its professionals have been constructed and conceptualised differently over time and how those views are connected to changes in science, school, and society.

Finding A Space In Schools: Female Doctors and the Reform of Girls’ Physical Education in Weimar Germany

Focusing primarily on the discourse of those women doctors who were members of the League of German Female Physicians, this article demonstrates that women became involved in the reform of girls’ physical education programs in the Weimar Republic’s vocational schools by offering a unique expertise to aid young girls in matters of health. Female physicians claimed to be more disposed to answer questions about what types of exercise fit adolescent girls’ bodies and best prepared girls for their future roles as mothers. Through their reform efforts, women physicians also revealed their own class biases in school healthcare, which often aimed at aiding working-class students and guiding working-class mothers in matters of health. By fashioning themselves as indispensable to the new subject of girls’ physical education, and rationalizing their work through biopolitics, women doctors carved out a niche for themselves in a hostile, male-dominated work environment through their professional writing.

Creating a Culture of Accurate and Precise Data.

There are many stakeholders for school health data. Each one has a stake in the quality and accuracy of the health data collected and reported in schools. The joint NASN and NASSNC national school nurse data set initiative, Step Up & Be Counted!, heightens the need to assure accurate and precise data. The use of a standardized terminology allows the data on school health care delivered in local schools to be aggregated for use at the local, state, and national levels. The use of uniform terminology demands that data elements be defined and that accurate and reliable data are entered into the database. Barriers to accurate data are misunderstanding of accurate data needs, student caseloads that exceed the national recommendations, lack of electronic student health records, and electronic student health records that do not collect the indicators using the standardized terminology or definitions. The quality of the data that school nurses report and share has an impact at the personal, district, state, and national levels and influences the confidence and quality of the decisions made using that data.

Nurses' use of pliable and directed strategies when encountering children in child and school healthcare.

Nurses in Swedish child and school healthcare need to balance their assignment of promoting children's health and development based on the national health-monitoring programme with their responsibility to consider each child's needs. In this balancing act, they encounter children through directed and pliable strategies to fulfil their professional obligations. The aim of this study was to analyse the extent to which nurses use different strategies when encountering children during their recurrent health visits throughout childhood. A quantitative descriptive content analysis was used to code 30 video recordings displaying nurses' encounters with children (3-16 years of age). A constructed observation protocol was used to identify the codes. The results show that nurses use pliable strategies (58%) and directed strategies (42%) in encounters with children. The action they use the most within the pliable strategy is encouraging (51%), while in the directed strategy, the action they use most is instructing (56%). That they primarily use these opposing actions can be understood as trying to synthesize their twofold assignment. However, they seem to act pliably to be able to fulfil their public function as dictated by the national health-monitoring programme, rather than to meet each child's needs.

Student Bedtimes, Academic Performance, and Health in a Residential High School.

Inadequate sleep among adolescents is considered an epidemic in the United States. Late night bedtimes could be an important factor in academic performance and health with consequences continuing throughout adulthood. The purpose of this study was to explore the relationships between late night bedtimes, academic performance (grade point average [GPA]), and utilization of health care (school nurse visits) in a residential high school. The data were collected from archival records for one academic semester. The statistical analysis employed the nonparametric Pearson's correlation coefficient ( r) with the standard level of significance (α = .05). Positive and inverse linear relationships were found between bedtime and school nurse visits ( p < .00001) and bedtime and GPA ( p = .007). The findings suggest students' late night bedtimes may be related to increased school nurse visits and lower academic performance. Adolescent late night bedtimes may be an important consideration for academic success and maintaining health in residential high schools.

Child Health Systems in Sweden

On a national level, several factors are responsible for Sweden's leading position in achieving the excellent health of children because Sweden has experienced a long history of peace and success in establishing a parliamentary democracy throughout the 20th century. Among the different sectors of society, Sweden has been able to focus on prevention and health promotion. The Swedish health care system is publicly financed based on local taxation. Pediatricians working in secondary and tertiary care are employed by the public sector, whereas family physicians are employed by both the private and public sectors. The pediatric departments at county and university levels provide a high quality of inpatient care for neonates and children. The county hospital pediatric departments typically include one neonatal ward and one ward for older children. Subspecialization exists even at the county level, and there is close cooperation between the county level and subspecialist units at the university level. Within the primary care sector, most children receive care from family physicians. The majority of family physicians have completed 3months of pediatrics in their basic training program. In the more densely populated areas there are also pediatric ambulatory care centers working mostly with referrals from the family physicians. Preventive care is carried out at midwife-led maternity health centers, nurse-led Child Health Centers, and nurse-led school health care settings and reach almost everyone (99%). All health care for children and adolescents is free of charge up to 18 years of age.

A Qualitative Evaluation of Elev8 New Mexico School-Based Health Centers

There is a scarcity of qualitative studies on school-based health centers (SBHCs). We established two primary aims for this study: (a) to assess stakeholders' perceptions of Elev8 New Mexico SBHCs' functionality and (b) to provide a snapshot of the overall contribution of the program to the schools and communities they serve. We collected the data through observations and semistructured interviews. We identified issues that diminish the functionality of SBHCs, such as limited infrastructure and services, lack of cooperation between school personnel and health care providers, and lack of long-term financial sustainability. These structural, interpersonal, and logistical issues limited the contribution of the SBHCs to the health of the students and the community at large. However, Elev8 New Mexico SBHCs serve communities with considerable education and health needs and constitute a unique opportunity to provide health education, disease prevention, and quality health care to a large number of youth and adults.