School-Based Health Centers' Presence: The Role of School and Community Factors.

INTRODUCTION: School-based health centers (SBHCs) offer an efficient mechanism for delivering health services to large numbers of underserved youth; however, their availability varies across communities. Data on sociocontextual variables were analyzed to investigate factors that inhibit and facilitate SBHCs.

METHODS: Secondary data from 2012 to 2015 state databases were linked to examine the association between SBHCs' presence in California high schools and demand, resource, and political conservatism at the school and community levels that may influence where SBHCs are located and the number of provided health services. Data were analyzed in 2015 using hierarchical binary and Poisson models.

RESULTS: Presence of a local non-school-based family planning clinic was the strongest correlate of SBHC presence. School size, percentage non-white, and percentage receiving free or reduced-price lunches were positively associated with SBHC presence. Percentage who voted Republican in the 2012 general election and teen pregnancy rates were negatively associated with SBHC presence. None of the predictors were associated with number of services provided by SBHCs.

CONCLUSIONS: School and community factors appear to play a role in supporting or impeding the establishment of SBHCs. In addition to variables tapping communities' need for and resources available to support SBHCs, political conservatism appears to affect SBHC availability. SBHC advocates can use this information to understand where opportunities for growth might exist, identify collaborative partners, and prepare for challenges to supporting new SBHCs. Researchers may also use this information in evaluation studies to control for school-level confounders and develop appropriate comparison samples through matching procedures.