Guns. Drugs. Tobacco. Obesity. Sex. Eating disorders. Depression. Teen-agers today probably have more reasons to see a doctor regularly than any generation before them.
Studies show that teen-agers are savvy enough to know they need medical care or counseling but have a difficult time finding someone, including parents, whom they feel comfortable talking to about the difficult and often highly personal health issues they face.
Yet many studies in the past decade have shown that adolescents are as out of touch with the health-care system as parents are with the music their kids listen to.
Teen-agers represent 15 percent of the U.S. population but make up only 9 percent of medical visits -- a rate that points to an underuse of services, according to a study published last year in the journal Pediatrics.
That could change, however, if child-health advocates succeed in prodding both the health-care system and parents of teen-agers to take notice of the problem.
This week, Children Now, a child-advocacy organization in Oakland, Calif., is releasing a detailed report that calls on the nation's HMO industry to do a better job of improving health care for adolescents and describes some ways to accomplish those improvements.
The report, ''Partners in Transition,'' details numerous small managed-care programs around the nation that have documented success in improving the health of teen-agers. The report -- endorsed by the American Association of Health Plans, the leading HMO industry organization -- acknowledges that managed care is now a major force in health-care delivery and calls HMOs to step up to the challenge of reducing health risks among teen-agers.
''There is recognition of the gaps in adolescent health care,'' said Lois Salisbury, president of Children Now. ''But implementing adolescent programs needs the kind of road map we've put together. Because getting it done is not so easy.''
Not easy at all. Adolescents are the lost souls of health care, often having outgrown their pediatrician's ability to make them feel comfortable and meet their needs but unwelcomed by practitioners who treat adults. One survey of HMO doctors found that only 31 percent of pediatricians and 34 percent of internal-medicine doctors said they liked working with adolescents. Half of obstetrician-gynecologists and 61 percent of family-practice doctors said they enjoyed teen patients.
Although physicians can obtain board certification in adolescent medicine, only a few hundred nationwide have done so, according to the American Society for Adolescent Medicine, which has about 1,000 physician members.
''We've not done a great job'' with adolescents, said Dr. James Perrin, director of the division of general pediatrics at Massachusetts General Hospital in Boston. ''It's easy to do the ordinary doctoring things. But that is probably not going to meet the needs of many adolescents.''
A study published last year in the journal Pediatrics found that nearly one-half of adolescent office visits included no counseling or education, and only 3 percent of teens received counseling on such crucial issues as smoking cessation, sexually transmitted diseases and weight control.
Parents often assume their teens are in robust health because they rarely come down with a bad cold.
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