School-Based Health Centers and School Attendance in Rural Areas.

Importance: School-based health centers (SBHCs) provide students with convenient access to physical, mental, and dental health services, which is particularly important in rural areas with long travel distances and limited availability of primary care. Objective: To examine the association between SBHCs and school attendance in a rural region. Design, Setting, and Participants: This cross-sectional study compared attendance rates among students in school districts with and without SBHCs in rural upstate New York. Student attendance data from the 2015 to 2016 through the 2018 to 2019 school years were obtained for 52 schools in 32 districts within a regional education service area. Analysis included students in kindergarten through 12th grade from 18 schools in 14 districts with SBHCs and 34 schools in 18 districts without SBHCs. Multivariable logistic regression was used to model the association between SBHC access and risk of chronic absenteeism. Statistical analysis was performed from May 2024 to February 2025. Exposure: Access vs no access to an SBHC based on which district a student was enrolled in. In districts with SBHCs, all schools had SBHCs. Main Outcomes and Measures: Absenteeism was calculated as the number of days absent divided by the total days enrolled and classified by federal and state chronic absenteeism categories: not at risk (0%-4.99% absent), at risk of chronic absenteeism (5%-9.99% absent), and chronically absent (≥10% absent). Results: Attendance data were available for 66 303 students (kindergarten through 12th grade; 49.4% female) during 4 years: 30 046 from SBHC districts and 36 257 from non-SBHC districts. Across all but 1 school year, non-SBHC students were significantly more likely than SBHC students to be classified as chronically absent or at risk for chronic absenteeism. Students in SBHC districts had 12% greater odds of being not at risk for chronic absenteeism after accounting for grade, sex, school year, economic disadvantage, and community characteristics of wealth and district size (odds ratio, 1.12; 95% CI, 1.08-1.16). Evidence of a stronger association was found between SBHC access and reduced absenteeism among elementary school students and among children attending schools with higher student poverty and higher community wealth. Conclusions and Relevance: This cross-sectional study of rural students in kindergarten through 12th grade found that students in SBHC districts had significantly fewer absences than students in non-SBHC districts in the same region. These findings suggest that by providing primary care services at school, SBHCs may help decrease absenteeism among students in rural communities.