The just-released Commonwealth Fund Survey of the Health of Adolescent Girls explores the current state of girls' health and the challenges they face navigating the turbulent teenage years. Several findings raise warning signs for the health care system, policymakers, school systems, and parents: an alarming one in five high school girls reported physical or sexual abuse, one in four reported not getting health care when she needed it, and one in four indicated depressive symptoms. The nationwide survey, conducted by Louis Harris and Associates, Inc., from December 1996 to June 1997, included 6,748 girls and boys in grades five through twelve who completed in-class questionnaires in 265 public, private, and parochial schools. The findings build on survey data from the National Longitudinal Study on Adolescent Health released two weeks ago. The Commonwealth Fund survey provides the first national data on the extent of physical and sexual abuse of adolescent girls and the link to risky health behaviors. Unlike the longitudinal survey, the Fund survey focuses on adolescent girls, and contains findings for younger girls (grades five through eight) and older girls (grades nine through twelve) to examine trends as girls mature. In addition, the survey oversampled African American, Latina, and Asian American girls to analyze findings by race and ethnicity. The Commonwealth Fund survey found that health care providers and parents may be missing opportunities to promote the health of adolescent girls and give them support. Though girls say they would like to discuss sensitive health problems with their doctors, they are often reluctant or embarrassed to bring up these topics themselves. Only about a quarter of the girls surveyed discussed sensitive topics, such as drinking, smoking, or sex, with their doctor. In addition, a significant number of girls (36 percent) said they sometimes did not get medical care when they needed it because they did not want to tell their parents about the problem. More effective communication with physicians and parents is necessary, particularly for girls in danger because of abuse or their own risky behaviors. "There is a medical syndrome called 'failure to thrive' when infants do not grow as they should. We are discovering a similar failure among adolescents, a problem that can lead to a difficult future," said Ellen V. Futter, president of the American Museum of Natural History and chair of The Commonwealth Fund Commission on Women's Health. "Girls need more emotional nourishment and support, and we must find ways to give it to them." The survey also found that lack of insurance was a major barrier to girls' getting the health care they need. Forty-four percent of girls who were uninsured said they had gone without care when they needed it, and nearly a third of uninsured girls lacked a regular doctor-more than twice the rate of those with insurance. "At a time when the nation is adding $24 billion to children's health care, the survey underscores that access to care in the years between childhood and adulthood is also critically important," said Karen Davis, president of The Commonwealth Fund. "We now have more funds to invest in our children's futures. That investment should include extending health insurance to all young people, including adolescents." High rates of risky behaviors by girls, including smoking, drinking, and using drugs, indicate a substantial need for counseling and support. The survey found that girls are now engaging in risky behaviors at about the same rate as boys: about a third of older boys and girls reported either smoking, drinking, or using drugs. Eating disorders, however, were much more prevalent among girls: 18 percent of high school girls reported that they had binged and purged, compared with only 7 percent of high school boys. The survey also found that abused girls are more likely than nonabused girls to engage in risky behaviors. Rates of smoking, drinking, and using drugs were twice as high for abused girls, and a third of abused girls reported bingeing and purging. Abused girls' apparent efforts to self-medicate are likely to have further negative effects on their health, making their need for counseling especially crucial.