Purpose

The purpose of the study is to assess associations between exposure to a multilevel, socio-ecological health program administered by local education agencies and changes in health behaviors among high school students.

Methods

This analysis used a multilevel difference-in-differences approach to compare student health experiences and outcomes between schools selected by local education agencies nationwide to implement the program (exposed schools) and schools that were not (unexposed schools). We measured repeated cross-sectional outcomes using the 2015 and 2017 Youth Risk Behaviors Surveys. The final analytic sample comprised 638 schools in total (N = 64,838 students), with 237 exposed schools (n = 30,336 students) and 401 unexposed schools (n = 34,502 students).

Results

Students in exposed schools demonstrated significant reduction in odds compared with those in unexposed schools in ever having sex (adjusted odds ratio [aOR] = .88, 95% confidence interval [CI]: .81–.96), having four or more lifetime sexual partners (aOR = .84, 95% CI: .72–.97), being currently sexually active (aOR = .78, 95% CI: .78–.96), and using effective hormonal birth control (aOR = .7, 95% CI: .56–.88). Exposure to the program was associated with significant reduction in odds of not going to school because of safety concerns (aOR = .87, 95% CI: .78–.97), having experienced forced sex (aOR = .76, 95% CI: .68–.86), ever used marijuana (aOR = .89, 95% CI: .81–.98), and currently using marijuana (aOR = .77, 95% CI: .64–.93).

Conclusions

Exposure to the program was associated with significant decreases in sexual risk behaviors, experience of violence, and substance use.

中文翻译：

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当地教育机构对学校环境的影响，以减少高中生的健康风险行为和经历

目的

该研究的目的是评估当地教育机构实施的多层次社会生态健康计划与高中生健康行为变化之间的关联。

方法

该分析采用多级双重差分法，比较全国地方教育机构选择实施该计划的学校（暴露学校）和未实施该计划的学校（未暴露学校）之间的学生健康经历和结果。我们使用 2015 年和 2017 年青少年危险行为调查重复测量了横截面结果。最终分析样本总共包括 638 所学校（N = 64,838 名学生），其中 237 所暴露学校（n = 30,336 名学生）和 401 所未暴露学校（n = 34,502 名学生）。

结果

与未接触过暴露的学校的学生相比，暴露于接触过的学校的学生在一生中发生过四次或以上性行为的几率显着降低（调整后的比值比 [aOR] = .88，95% 置信区间 [CI]：0.81–.96）性伴侣（aOR = .84，95% CI：.72–.97）、当前性活跃（aOR = .78，95% CI：.78–.96）以及使用有效的激素避孕（aOR = . 7, 95% CI: .56–.88)。接触该计划与因安全问题而不去学校的几率显着降低相关（aOR = .87，95% CI：.78–.97）、经历过强迫性行为（aOR = .76，95% CI： ：.68–.86)，曾经使用过大麻(aOR = .89，95% CI：.81–.98)，目前使用大麻(aOR = .77，95% CI：.64–.93)。

结论

参与该计划与危险性行为、暴力经历和药物使用的显着减少有关。