Serious Health Problem Seen for 1 in 5 U.S. Teen-Agers : Medicine: The Office of Technology Assessment suggests that Congress back school-linked or community-based centers to care for adolescents.

Perhaps one of every five of America’s 31 million adolescents has at least one serious health problem and many often face “formidable” barriers in trying to obtain basic health care, according to a federal report released Monday.

Teen-agers who are poor or minorities are at special risk because they are most likely to be “without the necessary safety nets that help many adolescents through the second decade of life,” said a study conducted by the Office of Technology Assessment, which conducts research for Congress.

But white, middle-class adolescents also lack access to needed services and support for health services, the study said.

“Unique income, insurance, informational, legal, physical and social-psychological barriers all can interfere. . . ,” the report said.

For example, requirements that teens have parental consent or notification discourage them from obtaining health care, particularly abortion and contraceptive services, the report said.

The agency urged Congress to find ways to improve the status of adolescent health and increase youths’ access to health care because “today’s adolescents are America’s future work force.”

“We don’t do very well by our adolescents,” said Rep. Patricia Schroeder (D-Colo.), who chairs the Select Committee on Children, Youth and Families.

Many teen-agers, she said, “stop seeing a pediatrician when they’re too embarrassed to sit out in the waiting room--and then they don’t see a doctor again until they’re in their 20s.”

“We must . . . recognize the health risks our adolescents face, and make sure that we prepare a plan that addresses American teens’ health problems,” Schroeder added. “Parents and policy-makers cannot afford to let our teens fall through the cracks of the pediatric and adult health care system.”

OTA said that adolescent health “involves much more than the absence of physical disease” and is greatly influenced by family, school and other social and environmental factors.

The majority of adolescents who die, for example, die from injuries in motor vehicle accidents, suicide or homicide, the report said. These often stem from “risk-taking” behaviors, such as drinking alcohol, taking drugs or engaging in unprotected sex.

OTA suggested that Congress support the development of school-linked or community-based centers that can provide comprehensive health and related services for adolescents.

These centers provide confidential services without cost to teen-agers after the adolescents obtain a “blanket” parental consent. Included are early intervention services that may not be covered by health insurance, evening and weekend hours of operation, adolescent involvement in the design and management of services and staff members who are experienced in working with adolescents.

These centers are based in schools or elsewhere in the community, “although their location in schools makes them immediately accessible to the largest number of adolescents,” the OTA said.

While there have been few studies on the effectiveness of such centers, “there is clear evidence that (they) can improve adolescents’ access to the health and related services that they are most likely to need,” OTA said.

Congress could also expand Medicaid to include all poor adolescents, or find ways to discourage private health insurers from eliminating or limiting dependent coverage or coverage of certain services important to adolescents, OTA said.

About 4.6 million adolescents overall--or one of seven--were without any health insurance in 1988 and one-third of poor adolescents were not covered by Medicaid, OTA said.

The study noted that half of all black, Latino, and American and Alaskan Indian adolescents live in poor or near-poor families. By comparison, one-third of Asian adolescents and 17% of white non-Latino adolescents are in such families.

The agency said that there are very few health care professionals trained to deal with the special problems of adolescents. Only about 1,400 primary-care physicians in the United States specialize in adolescent medicine, OTA said. There are about the same number of mental health professionals trained to treat teen-agers, the agency said.