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Abstract
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PURPOSE: Comprehensive school-based health services were reviewed as part of preparing World Health Organization guidelines.
METHODS: Six databases were searched for controlled trials with schoolchildren aged 5-19 years, involving school-linked health services incorporating 4 of 7 health areas.
RESULTS: Seventeen quasi-experimental studies conducted in high-income countries found school health services associated with reductions in suicide planning (male: 7.1% vs. 7.7%, p <.01), hospitalization (relative risks 3.403, 95% confidence interval [CI] 1.536 to 8.473, p <.05), emergency department visits (odds ratio.85, 95% CI.75 to.95, p =.006), school absence (odds ratio.78, 95% CI.69 to.87, p <.0001), carrying weapons (male: 16.1% vs. 25.1%, p <.01), fighting (male: 32.6% vs. 43.1%, p <.01), sexual activity (53.5% vs. 60.5%, p <.05), drinking alcohol (60.1% vs. 70.5%, p <.001), using drugs (28.0% vs. 38.3%, p <.001), and physical activity (female: 57.4% vs. 50.4%, p <.01). They can be cost-saving, were also associated with smoking and less contraceptive use, and had no effect on depression prevalence. Acceptability/satisfaction was good. The certainty of evidence was low to moderate. Heterogeneity was high for some outcomes.
CONCLUSIONS: Results suggest moderate desirable and trivial undesirable effects of school health services in high-income countries. This article compiles evidence on effectiveness, cost-effectiveness, and acceptability into one review, enabling decision-makers to consider all essential factors.
Language: en |