Journal of School Health最新文献_第10页

Foodservice Directors' Perceived Barriers to Student Participation in School Meals When Meals Were Served Free of Charge During the 2021–2022 School Year 2021-2022学年免费供餐时，餐饮服务主管认为学生参与学校供餐的障碍。

IF 1.8 4区医学 Q2 EDUCATION & EDUCATIONAL RESEARCH

Journal of School Health

Pub Date : 2025-06-16 DOI: 10.1111/josh.70019

Deborah A. Olarte, Wendi Gosliner, Leah E. Chapman, Christina Hecht, Ken Hecht, Punam Ohri-Vachaspati, Anisha I. Patel, Margaret Read, Lorrene D. Ritchie, Marlene B. Schwartz, Monica D. Zuercher, Dania Orta-Aleman, Michele Polacsek, Juliana F. W. Cohen

Background

School meals were served free of charge to all public school students in the United States during the COVID-19 pandemic, but some students still did not participate.

Methods

In this mixed-methods study, surveys and interviews were conducted with food service directors (FSDs) from California (n = 556 surveys; n = 29 interviews) and Maine (n = 43 surveys; n = 20 interviews) during spring 2022. Survey data was analyzed using multivariable logistic regression models, and interview data was analyzed using the immersion/crystallization approach.

Results

Students' preference to eat meals from home or elsewhere (81.5%) and negative perceptions of the school food's taste (67%) were the most common barriers reported. Schools' prior community eligibility provision (CEP) participation and smaller student enrollment were associated with fewer reported barriers. Inadequate time to eat lunch and stigma were also reported as barriers to participation.

Implications for School Health Policy, Practice, and Equity

Investments are needed to help schools partner with students to optimize school meal experiences and to improve food taste. Policies that provide school meals free of charge for all students can also help reduce negative social barriers such as stigma.

Conclusions

Despite the provision of USM, barriers to participation remain. Policies to enhance meal quality and program implementation are needed.

背景：在新冠肺炎疫情期间，美国所有公立学校的学生都免费享用校餐，但仍有一些学生没有参加。方法：在这项混合方法研究中，对来自加利福尼亚州的食品服务主管（fsd）进行了调查和访谈(n = 556份调查；n = 29次访谈)和缅因州(n = 43次调查；N = 20次访谈)在2022年春季。调查数据采用多变量logistic回归模型进行分析，访谈数据采用浸没/结晶法进行分析。结果：学生更喜欢在家里或其他地方吃饭（81.5%）和对学校食物味道的负面看法（67%）是报告中最常见的障碍。学校先前的社区资格规定（CEP）参与和较小的学生入学率与较少的报告障碍有关。据报告，没有足够的时间吃午餐和耻辱也是参与的障碍。对学校卫生政策、实践和公平的影响：需要投资帮助学校与学生合作，优化学校膳食体验并改善食物味道。为所有学生提供免费校餐的政策也有助于减少负面的社会障碍，如耻辱。结论：尽管提供USM，但参与的障碍仍然存在。提高膳食质量的政策和项目的实施是必要的。

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引用次数: 0

Are Policies Implemented Where Most Needed? Exploring Equity in School-Based Smoking Prevention in 2013 and 2016 in Six European Cities 政策在最需要的地方实施了吗？2013年和2016年欧洲六个城市学校预防吸烟公平性研究

IF 1.8 4区医学 Q2 EDUCATION & EDUCATIONAL RESEARCH

Journal of School Health

Pub Date : 2025-06-15 DOI: 10.1111/josh.70031

Nora Mélard, Alexandre Jacquemain, Julian Perelman, SILNE-R Consortium, Vincent Lorant

Background

Health policies are key social determinants of health, but may cause inequalities if their implementation does not match local needs and if resources are misallocated. This study tests the inverse prevention law on school tobacco policies, assessing inequity in their implementation and identifying contributing factors.

Methods

A student survey and a staff survey were conducted in 38 schools across six European cities in 2013 and 2016. We assessed tobacco policy and calculated policy-need ratios to measure how well schools implemented a policy in line with adolescent smoking. Gini coefficients of policy-need ratios were used as an inequity measure. We ran a penalized Lorenz regression to identify factors contributing to inequity and used the Shapley decomposition technique to decompose explained Gini coefficients.

Results

Gini coefficients were 8.8% in 2013 and 8.9% in 2016, indicating moderately inequitable implementation of school tobacco policies and limited change over time. Socio-economic characteristics and family/home environment contributed the most to these inequities.

Conclusions

In line with the inverse prevention law, stronger tobacco policies are not implemented in schools that most need them, and this persisted between 2013 and 2016. Policy-makers should prioritize equity in health policy implementation and devote more resources to contexts with greater need.

背景：卫生政策是健康的关键社会决定因素，但如果其执行不符合当地需求和资源分配不当，则可能造成不平等。本研究对学校烟草政策的反预防法进行了测试，评估了其实施中的不公平并确定了促成因素。方法：2013年和2016年在欧洲6个城市的38所学校进行了学生调查和教职员工调查。我们评估了烟草政策，并计算了政策需求比率，以衡量学校执行与青少年吸烟相关的政策的情况。政策需求比的基尼系数被用作不平等度量。我们使用惩罚洛伦兹回归来确定导致不平等的因素，并使用沙普利分解技术来分解解释基尼系数。结果：2013年和2016年的基尼系数分别为8.8%和8.9%，表明学校烟草政策的执行适度不公平，且随着时间的推移变化有限。社会经济特征和家庭/家庭环境是造成这些不平等的最主要原因。结论：根据反预防法，在最需要的学校没有实施更强有力的烟草政策，这种情况在2013年至2016年期间持续存在。决策者应优先考虑卫生政策执行的公平性，并将更多资源用于需求更大的地区。

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引用次数: 0

Implementation Drivers of COVID-19 Prevention Strategies in K-12 School Settings: A Qualitative Analysis K-12学校实施COVID-19预防战略的驱动因素：定性分析

IF 1.8 4区医学 Q2 EDUCATION & EDUCATIONAL RESEARCH

Journal of School Health

Pub Date : 2025-06-13 DOI: 10.1111/josh.70025

Dana Keener Mast, Syreeta Skelton-Wilson, Chloe Chung, Melissa Fahrenbruch, Sarah Lee

Background

In August 2020, the Centers for Disease Control and Prevention (CDC) released guidance to prevent transmission of coronavirus disease 2019 (COVID-19) in K-12 education settings. Schools varied in the degree to which they were able to implement COVID-19 prevention strategies during the height of the pandemic.

Methods

An evaluation team conducted interviews with state education staff and focus groups with district and school staff over 2 years to explore contextual factors that influenced the implementation of CDC's recommended COVID-19 prevention strategies.

Results

Eight implementation drivers influenced COVID-19 response efforts in school settings, including COVID-19 guidance, political climate, communication challenges, state health and education agency support, partnerships, physical and financial resources, staffing, and student needs.

Implications for School Health Policy, Practice, and Equity

Evaluation results offer insights for future guidance and support for schools and educators as they continue efforts to prevent the spread of COVID-19 and other infectious diseases for safe in-person learning.

Conclusions

The authors describe key drivers and conditions that influenced, facilitated, and/or impeded schools' implementation of COVID-19 prevention strategies. Federal, state, district, and school leadership can use the results to bolster future emergency preparedness and response efforts to protect student and school employee health.

背景：2020年8月，美国疾病控制与预防中心（CDC）发布了在K-12教育环境中预防2019冠状病毒病（COVID-19）传播的指南。在疫情最严重期间，学校实施COVID-19预防战略的程度各不相同。方法：评估小组对州教育工作人员进行访谈，并对学区和学校工作人员进行焦点小组访谈，为期2年，探讨影响疾病预防控制中心推荐的COVID-19预防策略实施的背景因素。结果：八个实施驱动因素影响了学校环境中的COVID-19应对工作，包括COVID-19指导、政治气候、沟通挑战、州卫生和教育机构支持、伙伴关系、物质和财政资源、人员配备以及学生需求。对学校卫生政策、实践和公平的影响：评估结果为学校和教育工作者继续努力防止COVID-19和其他传染病的传播，以实现安全的面对面学习，提供了未来指导和支持的见解。结论：作者描述了影响、促进和/或阻碍学校实施COVID-19预防战略的关键驱动因素和条件。联邦、州、地区和学校的领导可以利用这些结果来加强未来的应急准备和响应工作，以保护学生和学校员工的健康。

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引用次数: 0

A Call for States to Level the Playing Field in School Recess 呼吁各州在学校课间创造公平的竞争环境。

IF 1.8 4区医学 Q2 EDUCATION & EDUCATIONAL RESEARCH

Journal of School Health

Pub Date : 2025-06-12 DOI: 10.1111/josh.70032

William V. Massey, Catherine L. Ramstetter, Julie McCleery, Reegan von Wildenradt

引用次数: 0

Does Appearance Matter? Students' Perceived Body Size, Physical Appearance, and Attraction to Physical Activity at Recess 外表很重要吗？学生对身体大小、外貌及对课间体育活动的吸引力之感知。

IF 1.8 4区医学 Q2 EDUCATION & EDUCATIONAL RESEARCH

Journal of School Health

Pub Date : 2025-06-09 DOI: 10.1111/josh.70035

Danielle J. Belcher, Megan B. Stellino, Dannon Cox, William V. Massey

Background

Various psychosocial variables are critical predictors of students' recess experiences. It is still relatively unknown how self-perceptions of bullying and body size impact recess physical activity (PA) for certain groups of students. The purpose of this study was to examine group differences and relationships in levels of appearance-related victimization, physical self-perceptions, and attraction to PA at recess among various self-identified body-size and gender identity students.

Methods

Students in 3rd—5th grades (N = 787, 49.3% male, 56.1% regular body size, 46.4% 4th grade, 27.3% Hispanic) completed surveys that included demographics, one self-reported body size question, perceived victimization scale, physical appearance subscale of the Self-Perception Profile for Children, and the Children's Attraction to Physical Activity (CAPA) scale.

Results

Group difference analyses showed that gender nonconforming (p = 0.030, p < 0.001) and smaller body size students (p < 0.001, p = 0.001) had significantly lower perceptions of physical appearance and attraction to physical activity compared to their peers.

Implications for School Health Policy, Practice, and Equity

Students' gender identity and perceived body size are a meaningful focus of recess interventions.

Conclusions

Findings provide evidence that in addition to physical appearance perceptions, body size and gender may diminish students' attraction to PA.

背景：各种社会心理变量是学生休息体验的重要预测因子。对于某些群体的学生而言，欺凌和体型的自我认知如何影响课间体育活动（PA）仍然是相对未知的。本研究的目的是探讨不同体型和性别认同的学生在课间受外表伤害、身体自我知觉和受PA吸引的程度上的群体差异和相互关系。方法：3 -5年级学生787名，其中男性49.3%，正常体型56.1%，四年级46.4%，西班牙裔27.3%。调查内容包括人口统计学、一个自我报告体型问题、感知受害量表、儿童自我知觉概况外貌子量表和儿童对体育活动的吸引力量表。结果：群体差异分析显示，性别不符合（p = 0.030, p）对学校健康政策、实践和公平的影响：学生性别认同和感知体型是课间干预的重要关注点。结论：研究结果提供证据表明，除了外貌感知，体型和性别可能会降低学生对PA的吸引力。

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引用次数: 0

The Role of Adult Support in Mitigating Students' Feelings of Unwelcomeness at Recess* 成人支持在减轻学生课间不受欢迎感中的作用。

IF 1.8 4区医学 Q2 EDUCATION & EDUCATIONAL RESEARCH

Journal of School Health

Pub Date : 2025-06-09 DOI: 10.1111/josh.70029

Jim P. Arnold, Megan B. Stellino, Nazlı Özkoca, Danielle J. Belcher, William V. Massey

Background

Researchers have documented that recess quality is critical to understanding outcomes, with supportive adults and positive peer interactions being critical components. The purpose of this study was to examine the experiences of students feeling unwelcome or uncomfortable during recess and to examine how perceptions of adult support impact those experiences.

Methods

A total of 483 elementary school students were surveyed at four time points across one school year. Students reported feelings of being unwelcome or uncomfortable at recess and their perceptions of adult support. Data were analyzed using descriptive statistics and longitudinal binary logistic regression to identify trends, demographic predictors, and the role of adult support.

Results

The percentage of students who reported feeling unwelcome or uncomfortable at recess decreased from 47.7% to 34.6%. Students who reported increased perceptions of adult support across the school year were 76.3% less likely to report feeling unwelcome or uncomfortable at the end of the year.

Implications for School Health Policy, Practice, and Equity

Schools should adopt policies and programs that prioritize intentional adult participation to foster inclusivity and improve recess quality.

Conclusion

Adult support plays a vital role in creating high-quality recess environments, including reducing students' feelings of being unwelcome or uncomfortable.

背景：研究人员已经证明，休息质量对理解结果至关重要，成年人的支持和积极的同伴互动是关键组成部分。本研究的目的是研究学生在课间休息时感到不受欢迎或不舒服的经历，并研究成人支持的感知如何影响这些经历。方法：在一学年的四个时间点对483名小学生进行问卷调查。学生们报告了课间休息时不受欢迎或不舒服的感觉，以及他们对成人支持的看法。使用描述性统计和纵向二元逻辑回归分析数据，以确定趋势、人口预测因素和成人支持的作用。结果：在课间休息时感到不受欢迎或不舒服的学生比例从47.7%下降到34.6%。在整个学年中，那些认为自己得到了更多成人支持的学生，在学年结束时感到不受欢迎或不舒服的可能性降低了76.3%。对学校健康政策、实践和公平的启示：学校应采取优先考虑成人有意参与的政策和计划，以促进包容性和提高课间休息质量。结论：成人的支持在创造高质量的休息环境中起着至关重要的作用，包括减少学生不受欢迎或不舒服的感觉。

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引用次数: 0

“It's a Fine Line”: Parent and Educator Perceptions on the Effects of Adolescent Digital Media Use on Mental Health “这是一条细线”：家长和教育者对青少年数字媒体使用对心理健康影响的看法。

IF 1.8 4区医学 Q2 EDUCATION & EDUCATIONAL RESEARCH

Journal of School Health

Pub Date : 2025-06-05 DOI: 10.1111/josh.70028

Adam M. McCready, Katherine C. Rohn

Background

Parents and educators are concerned about adolescents' social media use and how it affects their mental health. It is unclear how these adults perceive how social media use affects adolescent mental health or view the role of schools in addressing these effects. We explored how adults define social media, perceive the effects of social media use on adolescents' mental health, and view the role of schools in addressing student social media use.

Methods

This study draws on a thematic analysis of 19 focus groups with 71 participants. Participants included parents, administrators, teachers, and health professionals of middle and high school students across four Connecticut school districts.

Results

Three themes emerged in the study: adults conflate student digital media and social media use, they view student social media use as a double-edged sword related to mental health, and student digital media use policies without multi-pronged educational interventions to promote digital citizenship will likely not change digital media habits.

Conclusions

Educators and researchers should consider reframing social media as digital media in interventions and research and developing or enhancing multi-pronged educational interventions to promote digital citizenship among students and adults.

背景：家长和教育工作者都很关注青少年的社交媒体使用以及它如何影响他们的心理健康。目前尚不清楚这些成年人如何看待社交媒体使用对青少年心理健康的影响，也不清楚学校在解决这些影响方面所扮演的角色。我们探讨了成年人如何定义社交媒体，感知社交媒体使用对青少年心理健康的影响，以及学校在解决学生社交媒体使用方面的作用。方法：本研究对19个焦点小组71名参与者进行了专题分析。参与者包括康涅狄格州四个学区的中学生的家长、管理人员、教师和卫生专业人员。结果：研究中出现了三个主题：成年人将学生数字媒体和社交媒体的使用混为一谈；他们将学生社交媒体的使用视为与心理健康相关的双刃剑；如果没有多管齐下的教育干预措施来促进数字公民，学生数字媒体的使用政策可能不会改变数字媒体的习惯。结论：教育工作者和研究人员应考虑在干预和研究中将社交媒体重新定义为数字媒体，并制定或加强多管齐下的教育干预措施，以促进学生和成年人的数字公民意识。

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引用次数: 0

After Mandates End: Complex Decision Making Regarding COVID-19 Masking in San Diego Elementary Schools Through the Social Ecological Model 任务结束后：基于社会生态模型的圣地亚哥小学COVID-19掩蔽复杂决策

IF 1.8 4区医学 Q2 EDUCATION & EDUCATIONAL RESEARCH

Journal of School Health

Pub Date : 2025-06-05 DOI: 10.1111/josh.70026

Ashkan Hassani, Marlene Flores, Sam Streuli, Yan Jiang, Alison Wishard Guerra, Rebecca Fielding-Miller

Background

While mask mandates are unlikely to return in the event of a major resurgence in COVID-19 or another major respiratory disease surge, voluntary masking still shows promise. This ethnographic study seeks to understand the masking decision-making processes of parents and children in the diverse San Diego region, including US–Mexico Border school districts and military housing school communities.

Methods

We conducted 19 interviews with parents and their young children focused on COVID-19 efforts at their child's school in English and Spanish and collected detailed field notes on masking culture from over 60 systematic observations from elementary schools across San Diego County from December 2021 to May 2022. We conducted analysis using Dedoose, including multiple rounds of coding and ongoing consensus meetings between researchers.

Results

Guided by the social ecological model (SEM), we categorized the results into the following categories: Children's Attitudes and Behaviors, Parent Belief and Influence, School Culture, and District/School Mask Mandates. Each level of the SEM influenced individual and family masking behavior. In our data, School Culture in particular differentiated schools in mask adherence and encouraged masking after state mandates ended.

Implications for School Health Policy, Practice and Equity

Masking does not need to end with mandates. Masking has been proven to reduce COVID-19 transmission, and school health policies should consider encouraging masking beyond mandates.

Conclusions

Adapting health messaging to the local context, partnering with trusted community champions, and building trust across governmental, school, and public health entities can improve the effectiveness of public health messaging.

背景：虽然在2019冠状病毒病卷土重来或另一种重大呼吸道疾病激增的情况下，不太可能恢复对口罩的强制要求，但自愿口罩仍然显示出希望。这项民族志研究旨在了解圣地亚哥不同地区（包括美墨边境学区和军事住房学校社区）父母和儿童的掩蔽决策过程。方法：我们用英语和西班牙语对父母及其幼儿进行了19次访谈，重点关注他们孩子学校的COVID-19工作，并从2021年12月至2022年5月在圣地亚哥县小学进行的60多次系统观察中收集了详细的掩蔽文化现场记录。我们使用Dedoose进行分析，包括多轮编码和研究人员之间正在进行的共识会议。结果：在社会生态模型（SEM）的指导下，我们将结果分为以下几类：儿童的态度和行为，父母的信念和影响，学校文化和地区/学校面具的要求。扫描电镜的每个层次都影响个人和家庭的掩蔽行为。在我们的数据中，学校文化特别区分了学校的口罩依从性，并鼓励在州命令结束后戴口罩。对学校卫生政策、实践和公平的影响：掩蔽不需要以命令结束。掩蔽已被证明可以减少COVID-19的传播，学校卫生政策应考虑在规定之外鼓励掩蔽。结论：根据当地情况调整卫生信息传递，与值得信赖的社区倡导者合作，并在政府、学校和公共卫生实体之间建立信任，可以提高公共卫生信息传递的有效性。

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引用次数: 0

Opportunities for Policy Progress: The Role of Schools in Minimizing, Mitigating, or Perpetuating Weight-Based Stigma 政策进步的机会：学校在减少、减轻或延续基于体重的污名方面的作用。

IF 1.8 4区医学 Q2 EDUCATION & EDUCATIONAL RESEARCH

Journal of School Health

Pub Date : 2025-06-04 DOI: 10.1111/josh.70034

Samantha Turner, Emma D'Arpino

Weight stigma profoundly impacts the mental, emotional, and physical well-being of children and adolescents in larger bodies. As pivotal social environments, schools may unintentionally reinforce weight stigma via policies and practices. This paper examines three key policy strategies to mitigate weight stigma in school settings: adopting weight-neutral approaches in nutrition and physical education, implementing equitable screening and referral for eating disorders, and de-implementing body mass index (BMI) screenings. A review of existing evidence highlights the potential of these strategies to reduce stigma, promote inclusive health practices, and improve student outcomes. Weight-neutral education can minimize biases in health curricula and foster healthier perceptions of body image. Universal screening for eating disorders addresses diagnostic disparities, particularly for youth in larger bodies, who are often overlooked despite significant health risks. Removal of BMI screenings emerges as the most impactful and feasible approach, given its association with increased body dissatisfaction and limited efficacy in improving health outcomes. By implementing these evidence-based practices, schools can foster an equitable and supportive environment for all students, emphasizing holistic health over weight-centric metrics. As trusted institutions, schools have the unique capacity to lead systemic efforts to combat weight stigma and promote inclusivity across broader societal contexts.

体重耻辱感深刻地影响着儿童和青少年的心理、情感和身体健康。作为关键的社会环境，学校可能会通过政策和实践无意中加强对体重的歧视。本文探讨了减轻学校环境中体重耻辱感的三个关键政策策略：在营养和体育教育中采用体重中性方法，实施公平的饮食失调筛查和转诊，以及取消实施体重指数（BMI）筛查。对现有证据的审查强调了这些战略在减少污名、促进包容性卫生做法和改善学生成绩方面的潜力。体重中性教育可以最大限度地减少健康课程中的偏见，并培养更健康的身体形象观念。饮食失调的普遍筛查解决了诊断差异，特别是对于体型较大的年轻人，尽管存在重大健康风险，但他们往往被忽视。考虑到BMI筛查与身体不满增加和改善健康结果的有效性有限相关，取消BMI筛查成为最有效和最可行的方法。通过实施这些循证实践，学校可以为所有学生营造一个公平和支持性的环境，强调整体健康而不是以体重为中心的指标。作为值得信赖的机构，学校具有独特的能力，可以领导系统性的努力，消除体重歧视，并在更广泛的社会背景下促进包容性。

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引用次数: 0

The Promise of School-Based Health Centers to Enhance Youth Mental Health Equity 以学校为基础的健康中心对提高青少年心理健康公平的承诺。

IF 1.8 4区医学 Q2 EDUCATION & EDUCATIONAL RESEARCH

Journal of School Health

Pub Date : 2025-06-03 DOI: 10.1111/josh.70024

Anne E. Bowen, S. Andrew Garbacz, Ellen C. Anderson, Madeline Wadington, Katie Eklund

Youth mental health needs are of high concern nationwide [1, 2]. Amplifying these concerns, traditionally medically underserved groups are at elevated risk of lacking access to mental healthcare and experiencing poor mental health outcomes. For instance, Black and Latine/Hispanic children are less likely to be seen by mental health specialists than White children [3]. Psychiatric emergency department use, a proxy measurement for lack of access to preventative care, is highest among Black children [4] and is increasing more rapidly among Latine/Hispanic youth compared to their White peers [5]. Black youth aged 5–12 years are twice as likely to die by suicide as same-aged White youth [4]. In 2020, more than half of sexual and gender minority youth who sought access to mental healthcare were unable to receive services [6]. Social drivers of health (SDOH; e.g., living conditions, traumatic exposures) are root causes of disparities; inequitable distributions of SDOH lead to lower healthcare access and higher disease burden among marginalized communities [7]. The effects of SDOH, in combination with long-standing societal inequities and interpersonal biases, have perpetuated poor mental health outcomes for disadvantaged social groups [8].

If left untreated, mental illness is likely to persist into adulthood, leading to long-term consequences [9]. Parent mental illness is associated with an increased lifetime risk of mental illness for their children and negative effects on child development [10]. This cascade can lead to disparities that persist across generations. Yet, childhood health prevention and intervention services protect against negative health, educational, and economic outcomes for adults [8]; thus, early healthcare for traditionally underserved youth may have the potential to alleviate generational disparities [11].

Public health programs that reduce racial, ethnic, and socioeconomic health disparities typically achieve this goal by addressing SDOH for medically underserved groups, through programs such as early childhood education, parental support, and income assistance [8]. The structural nature of these interventions leverages community partnerships and emphasizes collaboration to alter social, physical, economic, and/or political environments to advance health equity [12, 13].

One such structural intervention is the provision of healthcare within schools to reduce access barriers, such as high costs, lack of transportation, and difficulty navigating the healthcare system [14]. School-based health centers (i.e., school and community health or hospital partnerships; SBHCs) provide comprehensive healthcare, including primary healthcare and often specialty care, delivered by multidisciplinary healthcare teams, to students in s

青少年心理健康需求在全国范围内受到高度关注[1,2]。传统上医疗服务不足的群体缺乏获得精神保健的机会和经历不良精神健康结果的风险更高，这加剧了这些担忧。例如，黑人和拉丁裔/西班牙裔儿童比白人儿童更不容易接受心理健康专家的治疗。精神科急诊科使用率（缺乏预防性护理的替代衡量标准）在黑人儿童中最高，与白人儿童相比，拉丁裔/西班牙裔青少年的使用率上升得更快。5-12岁的黑人青年死于自杀的可能性是同龄白人青年的两倍。2020年，寻求获得精神保健服务的性和性别少数群体青年中，有一半以上无法获得服务。健康的社会驱动因素；例如，生活条件、创伤性暴露)是差异的根本原因；SDOH的不公平分配导致边缘化社区获得医疗服务的机会减少，疾病负担加重[b]。SDOH的影响，再加上长期存在的社会不平等和人际偏见，使弱势社会群体的心理健康状况长期不佳[10]。如果不及时治疗，精神疾病很可能会持续到成年，导致长期后果。父母的精神疾病与他们的孩子一生中患精神疾病的风险增加以及对儿童发展的负面影响有关。这种级联可能导致代际间持续存在的差距。然而，儿童健康预防和干预服务保护成年人免受健康、教育和经济方面的负面影响[10]；因此，对传统上得不到充分服务的青年进行早期保健可能有可能减轻代际差距。减少种族、民族和社会经济健康差异的公共卫生项目通常通过早期儿童教育、父母支持和收入援助等项目来解决医疗服务不足群体的SDOH问题，从而实现这一目标。这些干预措施的结构性质是利用社区伙伴关系，并强调合作改变社会、物质、经济和/或政治环境，以促进卫生公平[12,13]。其中一种结构性干预措施是在学校内提供医疗保健服务，以减少获取障碍，例如高成本、缺乏交通和难以利用医疗保健系统bbb。以学校为基础的保健中心（即学校和社区保健或医院伙伴关系）；中小学校卫生保健中心（shhcs）为学校学生提供全面的卫生保健服务，包括初级卫生保健，通常还包括由多学科卫生保健小组提供的专科卫生保健服务[b]。大约80%的小健康中心服务于一级学校，大多数小健康中心解决诸如粮食不安全、就业、移民和人际关系等问题，从而提供了通过减少障碍来提高公平的途径。精神卫生保健是精神卫生保健中心最常见的专科护理形式，2022年由83%的精神卫生保健中心提供，最常见的形式是由持牌社会工作者或咨询师提供的个别治疗。精神卫生保健中心采用综合保健模式，在同一环境中提供身心健康服务，并在各提供者之间进行协调。研究表明，综合模式促进了青少年获得医疗保健服务并改善了心理健康结果[16,17]。有证据表明，与社区诊所相比，小卫生保健中心提供了更好的医疗服务，这突出表明，小卫生保健中心有潜力向传统上医疗服务不足的人群提供更多的医疗服务，这些人群越来越缺乏获得医疗服务的机会。例如，与传统的社区卫生保健中心相比，小卫生保健中心有更多的初级保健就诊和更低的急诊护理使用。类似的模式也存在于shbhc的心理健康服务中。与同龄人相比，进入精神健康中心的青少年接受心理咨询和与专业人士讨论心理健康问题的几率更高。准实验研究的结果显示，与没有获得精神卫生服务中心的学生相比，获得精神卫生服务中心的学生对精神卫生服务的利用率更高，精神卫生保健费用更低。这些发现表明，精神卫生中心可以提供可获得的低成本精神卫生服务[20,21]。小卫生保健中心的使用者保险不足、无保险和生活在贫困线以下的比例不成比例，这突出表明小卫生保健中心如何覆盖传统上医疗服务不足和脆弱的青年。在能够获得家庭健康中心的学生中，那些有公共医疗保险或没有医疗保险的学生比那些有私人医疗保险的学生更有可能利用家庭健康中心的服务。 shhcs还以不成比例的高比率为种族和民族少数群体的青年提供服务；在几项研究中，美国印第安人、黑人和拉丁/西班牙裔学生在shbhc的使用中所占比例过高[19,23 -25]。类似的模式也反映在对shbch心理健康服务的使用上。例如，种族和少数民族青年比白人青年更有可能在shbhc寻求心理健康服务[23,26]。这些结果说明了精神卫生中心如何有效地为传统上服务不足的群体提供护理，强调了精神卫生中心在缓解这些群体获得精神卫生服务的差距方面的潜力。定性调查结果描绘了一幅青年对shbhcs看法的美好图景。主要是黑人和拉丁裔/西班牙裔青年的样本认为shbhc心理健康服务可靠、支持、有效、方便、可获得和保密[27-29]。青少年对精神健康中心提供的综合护理表示赞赏，并表示如果没有精神健康中心，他们可能不会得到任何精神健康服务。这些发现为青年报告对shbhc心理健康服务的积极看法提供了见解。除了对青少年心理健康中心的积极评价外，目前文献的研究结果表明，青少年心理健康中心的心理健康服务对青少年心理健康结果有直接的积极影响。对1528名主要为黑人和拉丁裔/西班牙裔青年的样本中提供者报告的结果进行的分析表明，许多心理健康问题（如焦虑、抑郁、悲伤、行为）在三次或更多次的shbhc心理健康访问中显著改善[10]。与没有增加心理健康服务的学校相比，拥有shbhcs的学校在2年内增加了心理健康服务，在全校范围内，青少年报告的抑郁发作、自杀意念和自杀企图率的下降幅度明显更大（优势比从0.82-0.88）。心理健康中心的心理健康服务可能对心理健康结果存在差异的群体产生特别积极的影响。例如，在有shbhc的学校上学的性少数青少年报告最近抑郁发作、自杀意念和自杀企图的可能性分别比在没有shbhc的学校上学的性少数学生低30%、34%和43%。因此，有证据表明，shbhc心理健康服务与改善青少年心理健康结果有关，包括那些经历心理健康问题风险较高的性少数青年。精神卫生保健中心通过改善传统上得不到医疗服务的青年（例如，参加公共健康保险的青年）获得医疗保健的机会，为解决心理健康差距提供了一条途径；黑人、西班牙裔/拉丁裔和美洲印第安人青年)和改善青年，特别是弱势青年的心理健康结果。除了这些好处之外，青年还描述了通过精神卫生保健中心提供的精神卫生服务的积极看法。以下，我们为实施和维持shbhc心理健康服务提供建议。研究强调多学科合作是shbhc长期维持的关键驱动因素[33-35]。学校专业人员和儿科医生很少参与多学科护理协调，尽管报道它是有益的，尽管有证据表明护理协调直接改善了儿童的预后[36-39]。许多学校专业人员缺乏关于身体健康如何影响学业和心理健康结果的培训，医疗专业人员对学校系统和学校专业人员的复杂角色的了解有限。专家们建议，在shhcs的背景下，应提供关于跨学科合作的职前培训，并纳入以团队为基础、以客户为中心的护理的最佳实践。儿科医生报告说，在跨学科合作中自我效能和能力低下是护理协调的障碍，这可能会通过充分的培训得到加强。儿科医生也认为合作时间有限是一个障碍。专家建议通过护理协调会议促进合作，这为学校专业人员和医护人员提供了一个相互接触的常规机会[35,40]。缺乏资金和收入是实施、维持和纳入精神卫生服务的主要障碍[34,40]。一位shbhc的出资人提供了一些策略，这些策略在历史上成功地维持了shbhc的财务状况：尽早申请医疗补助账单，为学校至少500名符合医疗补助条件的潜在人群提供服务，并在shbhc开放的每天保持两次健康儿童检查和6到8次其他检查的建议。缺乏完整的同意书可能

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