television. The Search Institute, in its analysis of 15,000 adolescents, found that the combination of inadequate supervision of children and more than three hours of television daily was directly related to a life-style marked by more health-debilitating behaviors than was the case with youngsters who were more closely supervised (Blythe and Rochlkepartain, 1993).

With increased family stress and the decreased time and direct supervision that parents are able to give to their children, schools are increasingly asked to fill the role of surrogate or supplemental parents.

Access to Health Care

Estimating the number and percentage of children under the age of 18 with no health insurance is difficult, and different models give different figures. For example, estimates range from 8.7 million (12.6 percent) to 11.1 million (16.1 percent) uninsured children in 1993 (Lewit and Schuurmann-Baker, 1995), although a figure as high as 12 million uninsured children has been cited recently (American Medical Association Council on Scientific Affairs, 1990). Millions of other children have inadequate insurance plans that fail to cover even such basic preventive services as immunizations (National Health/Education Consortium, 1992). According to a recent GAO report, 12 million children do not get such basic preventive care as periodic physical examinations or immunizations at the proper intervals, and only about half of all elementary school children routinely receive health care. Although 7.5 children under the age of 18 require mental health services, fewer than one in eight actually receives them (GAO, 1994b). Oral health problems are significant among schoolchildren and often go untreated (National Institute of Dental Research, 1995).

Of major concern is the decline of employer-sponsored health coverage for children. Solloway and Budetti (1995) report that between 1979 and 1986, 1.26 million children lost health insurance coverage because of reductions in their parents' employer-based plans. The largest decline occurred in conventional two-parent, single wage earner families, in which coverage of children decreased by 11.7 percent between 1977 and 1987 (Solloway and Budetti, 1995). Between 1987 and 1992, another 4.5 percent of children lost their employer-based coverage. Even if dependent coverage is available, high cost-sharing requirements for premiums and large co-payments or out-of-pocket expenses are major problems, especially for low- and middle-income wage earners. Further, uninsured children with chronic illnesses may be excluded because of preexisting condition, and lifetime benefit caps are an obstacle for those with insurance. In addition, young families are often the least protected and most



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