Role of School-Based Health Centers in Adolescent Immunization

BACKGROUND:   School-based health centers (SBHCs) offer students an array of healthcare services, including immunizations, and present a promising model for the delivery of adolescent primary care in the United States. To determine the role of SBHCs in providing adolescent immunizations, we assessed overall and on-time completion of the human papillomavirus vaccination (HPV) series, which consists of three doses recommended for adolescents aged 11-12, among users of SBHCs and adolescents receiving vaccines from other healthcare facilities. 

METHODS:   Immunization records for King County adolescents aged 13 to 18 years as of December 31, 2013 with ≥1 dose of HPV series were analyzed using data from the Washington State Immunization Information System (WSIIS). Users of SBHCs were defined as adolescents who received at least one dose of the HPV series at any SBHC; non-users received doses of HPV from other healthcare facilities. Comparisons were made between users of SBHCs and non-users regarding overall completion (three doses at any time) and on-time completion (three doses by age 13 among those receiving dose one by age 13).

RESULTS:   Approximately 3% of adolescents with ≥1 dose of HPV received at least one dose from an SBHC. SBHC users were more likely to be uninsured, underinsured, and have publicly funded insurance compared to non-users. Among females, 73% of SBHCs users completed the series compared with 64% of non-users (p<0.0001); overall completion rates for male users of SBHCs (47%) were also significantly higher than non-users (38%, p<0.0001). There was no difference in overall completion between female users of high school located SBHCs and non-users (p=0.1825); however, significantly more male users of high school located SBHCs (43%) completed the series compared to non-users (38%, p=0.0062). Overall completion (86%) and on-time completion (47%) were significantly higher for female users of middle school located SBHCs compared to overall completion (64%) and on-time completion (41%) among non-users (p<0.0001 and p=0.0154, respectively). Male users of middle school located SBHCs also had higher overall completion (64%) and on-time completion (36%) compared to overall completion (38%) and on-time completion (23%) among male non-users (p<0.0001, p=0.0074, respectively). 

CONCLUSIONS:   In King County, users of SBHCs had higher overall and on-time completion rates compared to non-users.  SBHCs fulfill a vital role as a safety net provider, but are underutilized by adolescents for immunization services. These results suggest that expanded use of SBHCs can increase overall completion and on-time completion of the three-dose HPV series among adolescents.