Sources: James Button, Ken Wald -- (352) 392-0262; Barbara Rienzo, 392-0583

GAINESVILLE, Fla. --- Conflicts about sex education and reproductive services are creating a cultural divide among communities that have school-based health clinics, a new University of Florida study finds.

On one side are progressive communities and inner-city areas with large numbers of poor minority youth, where school-based clinics are most likely to thrive. On the other are Southern states and conservative Christian strongholds, where the clinics are likely to founder, said Kenneth Wald, a UF political science professor and a study co-author.

"Something like morality politics issues engage people at the gut level," said Wald, who collaborated with Barbara Rienzo, a UF health science professor, and James Button, a UF political science professor. "Whether you talk about needle exchanges, addressing homosexuality in the curriculum, or in this case reproductive services, it tends to bring out people who might not get involved in a more conventional kind of political struggle."

The number of school-based health clinics has risen dramatically from a few dozen in the mid-1980s to more than 1,200 today. Recently, however, the divergent views about morality have forced some to close, the study found.

The UF researchers' findings are based on a random nationwide survey of 226 school-based health clinics, an innovative form of health care that provides youth with everything from sports exams and immunizations to reproductive and mental health services. The study is a continuation of one Rienzo and Button initiated in 1990.

"There is a racial element to this in that minority schools are more likely to have a lot of sexuality services, including condom distribution," Button said. "In many of those communities, there's an understanding that black and Latino youth really need these services because of the high teenage pregnancy rate, even though there are traditional churches that would normally oppose provision of reproductive care services."

Funding is a big problem for those schools, moreover, because white middle-class legislators and others often are reluctant to give money to poor neighborhoods, he said.

One of the biggest hardships for school-based clinics nationwide is that they are run by health-care providers who lack experience building community support, the study found.

"Many of these public health professionals were very naive about the politics of school-based clinics -- how to build coalitions, maintain support and inform the school board and other local political leaders about the clinic and what it's doing," Button said.

School-based clinics began as an effort to fill a void in the nation's health-care system, Rienzo said. In 1998 alone, more than 11 million children -- one in six -- had no medical insurance at all, and millions more were uninsured for part of the year, she said.

In the UF study, 65 percent of the students served by school-based clinics were minorities and 67 percent were on free- or reduced-price lunch programs. Policy-makers consider schools to be ideal places to offer health care because children spend more time in them than in other social institutions, and teachers and staff can identify problems early.

One of the clinics' most important benefits is retaining students who might otherwise drop out of school, Rienzo said. "There's good evidence that providing basic medical care and keeping youth healthy enables them to do well in school," she said.

In the UF study, about two-thirds of the clinics also offer limited reproductive care services, mostly counseling and pregnancy testing, she said.

"Although religious conservatives say clinics encourage teens to engage in sexual behavior by talking about it, research clearly shows they don't promote sexual activity," she said. "What we found is that most parents really want these clinics, including when they offer reproductive services. In communities where health and school officials have mobilized support, clinics are growing and providing vital health services."

Wald believes clinics will catch on as a solution to the nation's health-care crisis. "The tragedy is that they won't be found in communities needing them most," he said, "poor communities in the South with the biggest health problems and highest rates of teen pregnancies."

Note: If no author is given, the source is cited instead.

• Health Policy
• Teen Health
• Children's Health

• Sex education
• Athletic training
• Adolescence
• Occupational therapy
• Sports medicine
• Pediatrics