ADOLESCENT HEALTH: Many Teens ‘Fall Through the Cracks’

      The lack of health insurance and discomfort with pediatricians is causing teenage patients to "fall through the cracks" when it comes to preventive medical care, and doctors should step in and offer health guidelines on sexual behavior, diet and smoking, according to a study published in the current issue of Pediatrics. A survey of 2,426 U.S. doctors revealed that teens ages 11-21 represented 9% of the doctor visits in 1994, but comprised 15% of the population, USA Today reports. Study co-author Gail Slap said, "Doctors should be talking to teens about substance abuse, diet and fitness, sexual behavior and birth control." The gap in care may be attributed to a dearth of physicians specializing in adolescent care, said Dr. Mohammed Akhter, executive director of the American Public Health Association. "You can't treat these people like children, and you can't treat them like adults. The doctor has to appear cool and be approachable so the youngster feels comfortable talking to him," he said. Many teens simply "outgrow their pediatricians and fall through the cracks medically until they start seeing adult doctors years later," said study co-author Amitai Ziv of the University of Pennsylvania Medical School. Although federal health guidelines recommend that teens visit doctors annually, doctors reported significantly fewer visits and said they provided counseling or education in only half their visits with adolescents. An additional barrier to care is a lack of insurance, as in "about one-fifth of office visits with adolescents, the youngster is not insured" -- leading teens to visit emergency rooms for colds, headaches and stomachaches (Elias, 7/7).