In its most recent survey of high school students in Indiana, the Centers for Disease Control and Prevention reported that:
• 14 percent were obese
• 22 percent regularly smoked cigarettes and 11 percent used smokeless tobacco
• 38 percent had used marijuana, and more than 15 percent had used inhalants
• 28 percent had participated in binge drinking
• 49 percent had had sexual intercourse, generally without use of a condom.
It’s not only adults who are troubled by these statistics. Stephanie Woodcox, adolescent health coordinator at the Indiana State Department of Health, says youth also are concerned about their own behaviors.
“I think that youth have a really good understanding of what the risky behaviors are. They’re very aware that if they engage in certain activities, it’s going to result in certain consequences,” she said.
But two impediments stand in the way of youth getting the information and care they need to make wise decisions: access to health care and privacy.
Typically, kids get their health insurance through a parent or guardian. But when parents lose their jobs, they often lose their health insurance, too, unless they can continue to pay the premiums.
Chelsea Ratlitt, 17, a junior at Plainfield High School, has seen firsthand how costly health care and insurance can be in a down economy. “About a year ago it was, my dad lost his job, and around the same time he lost his job, his appendix decided it wanted to burst. So we had no insurance and we had to get on something that’s called COBRA insurance and it costs a ton of money a month,” she said.
When money is tight, kids don’t want to ask their parents for anything. But access to care is only the first step. Woodcox said youth also needs to feel comfortable in a health-care setting so that they will be honest and get the information they need to make decisions.
“If an adolescent does want to seek out health care, they may be a little hesitant to do so because they don’t want their parents to find out about it. So specifically when you’re talking about reproductive health care or things of that nature, they may be hesitant to seek out those services even though they feel they need them because they’re afraid that their parents might find out or not approve of the behaviors that they’re engaging in,” she said.
Seeing a doctor through a parent’s health insurance almost always involves telling a parent. But school-based health centers offer both the access and confidentiality that adolescents require.
Indianapolis Public Schools’ Willard J. Gambold Middle School is one of 83 Marion County schools that have clinics on site. Like other school-based clinics, it provides a range of primary care services to students at little or no cost. In the next few years the clinic plans to open its doors to neighborhood residents as well.
Nurse practitioner Jessica Fortunak says she treats students for stomachaches and minor injuries and helps them with scheduled medications and shots. But she also deals with bigger issues, such as drug use, sex and weight gain.
“Here at middle school, it’s especially difficult because these students are trying to find out who they are and trying to follow their peers into different things to show that they’re normal,” she said.
Fortunak takes particular interest in teaching Gambol students how to eat and live healthier, and she stays late every Thursday to lead an exercise and nutrition class. She’s concerned that many of the students are overweight, with body mass indexes (a measure of the amount of fat in a body) exceeding the optimum of 25 percent or less.
“We definitely have a huge population here of students who are over 25 percent BMI, 30 as well. And we just started a Biggest Loser weight-loss challenge. Every Thursday they come in and we do about an hour, hour and a half, of exercise and then an hour of nutritional information to help them out,” she said.
Vanessa Garcia, 14, is a seventh-grader at Gambold and has been coming to the clinic for about two years. She also attends Fortunak’s class on Thursdays.
“She makes sure that we don’t like eat things that we shouldn’t and we talk about it every day, like to make sure we’re eating healthy stuff,” she said.
Eighth-grader Amber Austin, 14, also appreciates all the resources of the clinic, though she said it can be uncomfortable seeing her classmates there.
“I would describe it as a cool place. They've given me my shots that I needed, they give me medicine when I feel sick. It's kind of like going to the doctor but you’re in school, it's less scary,” she said.
Though Fortunak works at the school clinic, she is paid by the Shalom Health Care Center, which offers primary health care services to the underserved. No one at the clinic or center is refused service because they can’t pay.
“Over half of these students don’t have Medicaid or any type of insurance. And if you don’t have any type of insurance, you’re not going to the doctor,” she said.
According to the National Assembly on School-Based Health Care, kids who have access to a school-based clinic receive significantly better care than those who don’t. It’s also been shown that school-based health clinics reduce visits to emergency rooms, saving money and resources.
They also fill a need. On its website, the CDC outlines the care needed for each adolescent: “Government agencies, community organizations, schools, and other community members must work together in a comprehensive approach. Providing safe and nurturing environments for our nation’s youth can ensure that adolescents will be healthy and productive members of society.”
ASSISTANT EDITORS: Eric Chen, 17; Samantha Swan, 15.