ORIGINAL RESEARCH
Michelle Trivedi, MD, MPH; Jorge Kaufmann, ND, MS; Holly Pereira, MD; Brenda M. McGrath, PhD; Miguel Marino, PhD; Michelle Spano MA; Jennifer A. Lucas, PhD; Sarabeth Broder-Fingert, MD, MPH; Michael Arenson, MD; Arvin Garg, MD, MPH; John Heintzman, MD, MPH
Corresponding Author: Michelle Trivedi, MD, MPH; Department of Pediatrics, Child Health Equity Center, UMass Chan Medical School, UMass Memorial Children’s Medical Center.
Email: michelle.trivedi@gmail.com
DOI: 10.3122/jabfm.2025.250321R1
Keywords: Access to Care, Asthma, Child Health, Community Health Centers, Community-Based Research, Cross-Sectional Studies, Electronic Health Records, Health Disparities, Health Policy, Health Promotion, Pediatrics, Retrospective Studies, School Health Services
Dates: Submitted: 08-14-2025; Revised: 10-10-2025; Accepted: 10-27-2025
Status: In production.
PURPOSE: There has yet to be a comprehensive multi-state study describing the children that use school-based health centers (SBHCs). This study seeks to determine sociodemographics, care utilization patterns, and prevalence of asthma and overweight among children seeking care at SBHCs.
METHODS: This retrospective cross-sectional analysis examined electronic health record data of children utilizing SBHCs within a large network of community-based clinics, consisting of 180 SBHCs in 14 U.S. states from 2012-2018. Demographics of exclusive SBHC users (SBHC-only group) were compared to utilizers of SBHCs plus non-SBHC community health centers (SBHC+ group).
RESULTS: Of 179,970 children with ≥1 ambulatory visit at a SBHC, 75.6% received care exclusively at SBHCs. Many SBHC-users reported family income <138% of the federal poverty line (48.9%) and self-identified as Hispanic (45.7%). Among SBHC utilizers, the prevalence of asthma (8%) and overweight (30%) were comparable to national statistics. Overall, 33% of children received well-child care and 24% received influenza vaccinations exclusively at SBHCs. When comparing the two groups within the study, the SBHC-only group were older, and more lacked insurance (13.4%) compared with SBHC+ children (2.6%). The SBHC-only group had fewer total yearly visits, fewer yearly well-child visits, and fewer influenza vaccinations. In age stratified groups, preschool-aged children received the most well-child care and influenza vaccinations in SBHCs.
CONCLUSIONS: SBHCs serve a pediatric population that is disproportionately low-income, uninsured, and Hispanic. Children, particularly preschoolers, receive preventive healthcare at SBHCs. Given the population served, SBHCs have strong potential to address pediatric health inequities if adequately resourced, utilized, and integrated with other facilities including community health centers.