A Systematic Review of Consent Procedures, Participation Rates, and Main Findings of Health-Related Research in Alternative High Schools From 2010 to 2015

Abstract

There is a well-established link between educational attainment and health. Alternative high schools (AHSs) serve students who are at risk for school dropout. Health-related research conducted in AHSs has been sparse. Achieving high participation rates is critical to producing generalizable results and can be challenging in research with adolescents for reasons such as using active consent. These challenges become greater when working with vulnerable populations of adolescents. In this systematic review, we examined health-related studies conducted in AHSs between 2010 and 2015. Results indicated that (1) health-related research in AHSs has increased over the past 5 years, (2) AHS students continue to experience significant disparities, (3) active consent is commonly used with AHS students, (4) 42% of studies reported participation rates or provided enough information to calculate participation rates, and (5) school nurses are missing from health-related research conducted in AHSs. Implications for future research and school nursing are discussed.Keywords integrative reviews, high school, alcohol/tobacco/drug use prevention, exercise, mental health, nutrition Each day in the United States, over 2,300 students drop out of high school and over 18,000 are suspended (Children's Defense Fund, 2008;Smaller, 2012). School dropout is increasingly recognized as an important public health issue owing to the link between educational attainment and health (Freudenberg & Ruglis, 2007). Rigorous research documenting disparities and impacts of interventions can play a crucial role in monitoring and addressing health disparities among young people. Alternative high schools (AHSs) frequently serve students who are at risk for dropping out of school. The same factors that place AHS students at risk for school dropout (e.g., adverse childhood experiences and homelessness) also increase their risk for poor mental health outcomes and involvement in health-risk behaviors such as substance use and high-risk sex. Yet the AHS setting has typically been underutilized for health-related research and presents unique challenges to producing rigorous and generalizable results. For example, AHS students are a highly mobile population and have high rates of chronic truancy; this instability can present challenges to obtaining active parental consent for participation in research and determining accurate participation rates. In this article, we present an updated systematic literature review of health-related studies conducted in the AHS setting between May 2010 and June 2015 (the last systematic review covered literature published between 1997 and April 2010; Johnson & Taliaferro, 2012). In addition, we take this review one step further by exploring important methodological issues that may impact the quality and generalizability of research conducted with AHS students. These issues include consent procedures used by researchers (i.e., active vs. passive) and reporting practices for consent rates and participation rates.

The Role of Affect Management for HIV Risk Reduction for Youth in Alternative Schools

“…Three reviews indicate that substance use is often targeted in alternative schools even if they do not enroll youth with substance use disorders, and solely reducing substance use may not reduce HIV risk behaviors. 23–26 Substance use at time of sex, however, can increase the risk of unprotected sex, but there were no differences between interventions. It is possible that a greater emphasis on substance use and additional skills to reduce substance use in sexual situations was needed.…”

Methods Matter: Tracking Health Disparities in Alternative High Schools

“…In addition to facing these structural inequalities in our education system, AHS students face high levels of personal stressors. As compared to peers in traditional schools, AHS students more frequently experience adverse childhood experiences, homelessness, and living in unsafe and/or impoverished neighborhoods (Johnson, Morris, Rew, & Simonton, ). Consequently, AHS students experience higher levels of emotional and behavioral problems and are involved in high levels of health‐risk behaviors (Grunbaum et al., ; Johnson, McMorris, & Kubik, ); in other words, this is the population we most need to monitor to address disparities in adolescence that may progress throughout the life span and cost society billions of dollars.…”

“…Researchers generally report response rates or cooperation rates but do not make it clear which rate they are reporting. In health‐related research in AHSs from 2010 to 2015, only 42% of articles reported student‐level participation rates (Johnson et al., ).…”

Increasing adolescent girls’ ability to identify STI-risk characteristics of sexual partners: a pilot study within an alternative disciplinary school

“…Students attending alternative schools are much more likely than students attending mainstream schools to experience numerous health conditions (e.g., mental health issues, substance use, and violence) and health risk factors (e.g., homelessness and abuse). 6 In particular, girls attending alternative schools are at least twice as likely to report sexual behaviours: ever had sex (48% vs. 86%), sex within the past 3 months (35% vs. 66%), had at least four sex partners (16% vs. 48%), and used alcohol or drugs immediately prior to sex (25% vs. 43%). 5 Yet, compared with mainstream schools, few health interventions, and fewer STI prevention interventions, have been conducted within alternative schools.…”

“…5 Yet, compared with mainstream schools, few health interventions, and fewer STI prevention interventions, have been conducted within alternative schools. 6 We developed an STI primary preventive intervention for adolescent girls attending an alternative disciplinary school (ages 16 to 18 years) that included activities designed to reduce girls' sexual partner risk measured with eight characteristics: age difference, history of jail, recency of sexually transmitted disease (STD), place where they met, drinking alcohol in the two-hours prior to sex, history of sex with men, recent sexual activity, and drug use in the two-hours prior to sex. These eight characteristics were chosen because of their high correlation with STI risk, especially when considered together, and their potential for modification.…”