STONY BROOK, N.Y. -- Dr. Robin McFee, who teaches a course in adolescent health to medical students at State University of New York at Stony Brook, points out an interesting paradox: While adolescence is the time of greatest "inherent health," the overall health of adolescents, unlike other age groups, has declined during the past several decades.
The reason for this is that the years from age 10 to the early 20s are a time marked by a tendency to engage in risky behavior with serious consequences. About three-quarters of deaths among 10- to 24-year-olds in the United States are caused by car crashes (29 percent), murders (20 percent), suicides (12 percent) and unintentional injuries such as drowning or poisoning (11 percent), according to the U.S. Centers for Disease Control and Prevention.
Although the unintentional pregnancy rate among American teens has dropped slightly in the past several years, it is still among the highest in the world. And every year, 3 million teens -- about one in four who are sexually active -- get a sexually transmitted disease.
About 5 percent of adolescent females have a full-blown eating disorder, according to the Society for Adolescent Medicine; the percentage with disordered eating has been estimated to be much higher.
According to the CDC, more than one-third of high school students are smokers, and college-age smoking also has risen dramatically.
And a 1997 CDC survey found that close to 40 percent of high school students had ridden in the previous 30 days with a driver who had been drinking alcohol. The National Institute on Drug Abuse reports that in the Class of 1997 more than half had used an illegal drug.
Despite the prevalence of risky behavior and despite the lip service paid to preventive medicine, adolescents are among the most underserved groups medically. Although adolescents represent 17 percent of the U.S. population, they represent only 11 percent of medical visits, and less than 20 percent receive routine or preventive care annually, according to the National Adolescent Health Information Center at the University of California, San Francisco. About 15 percent of adolescents have no health insurance.
Part of the reason adolescents don't go to the doctor is that many are uncomfortable with the doctor who took care of them as babies and toddlers. And, experts say, while pediatricians have the technical expertise for medical problems, some may be uncomfortable with the psychosocial issues that dealing with teens presents.
According to Dr. McFee, 33 percent of visits to doctors included counseling recommendations from The Guidelines for Adolescent Preventive Services, a program developed by the American Medical Association and backed by the American Academy of Pediatrics and Society for Adolescent Medicine.
Yet, doctors can be important, nonjudgmental sources of information for kids unable or unwilling to ask their parents for information or help, she said. And kids want information. A Kaiser Family Foundation survey, released this week, found that young adolescents -- 10 to 12 years old -- wanted more information on issues ranging from HIV to what to do if someone brings a gun to school, to how to handle pressures to have sex.
For more information on adolescent health care:
The American Society for Adolescent Health provides names of health care providers, at (816) 224-8010.
Kaiser Family Foundation has a Web site to help parents talk with kids: http://www.talking withkids.org.