Concern about health care and the ability to pay for it hardly get mentioned . Injuries, the leading cause of death among children, doesn't even make the list. Nor does smoking, the leading cause of preventable illness in all Americans. The only disease mentioned by at least 1 percent of adults is AIDS.

When the Harvard School of Public Health reported last week on its nationwide survey, "American Attitudes Toward Children's Health Care Issues," health care was conspicuously absent.

The findings suggest that the "family values" agenda has caught on with the public more than the "health care" agenda" agenda, said Robert J. Blendon, professor of health policy and political analysis at both the Harvard School of Public Health and the Kennedy School of Government, who directed the study.

"Poverty, day care, health insurance -- these are off the radar screen," Blendon said.

He said he was surprised that poverty didn't rank higher as a concern when one out of five American children lives below the poverty line, and surprised as well that concern about crime rose sharply even as crime rates fell.

At a time when states are trying to figure out how -- and whether -- to take advantage of a new federal law aimed at boosting Medicaid coverage of otherwise uninsured children, the results are troubling to health officials.

In the Harvard survey, only 29 percent were aware of the new law or the effort to expand coverage of uninsured children. Adults with uninsured children were no more aware of the new legislation than other adults were.

"We were sort of staggered by that," Blendon said. "What's clear is that people don't even know there's going to be a debate about this. There's just no public following of this legislation."

The nationwide opinion poll was designed by the Harvard School of Public Health and conducted by the Survey Research Center at the University of Maryland in College Park. About 1,500 randomly selected adults were interviewed by telephone during September and October.

When a 1986 Harris poll, using identical language, asked adults to name critical problems facing children, drugs were also far-and-away the top concern. But the other rankings changed sharply in the last 11 years.

Child abuse and sexual abuse, mentioned as a top concern by 28 percent of adults in 1986, plummeted to 1 percent this year. Crime leaped into second place, mentioned by 24 percent, compared with 4 percent in the earlier poll. Concern about breakdown of home and family life remained strong, but dropped from 46 percent to 22 percent. Alcohol fell slightly from 9 percent to 8 percent. Nearly twice as many adults mentioned education as an important concern this year compared with 1986.

Neither health nor poverty made it into the Top Ten list of concerns in either the 1986 or 1997 survey.

"Health care, poverty, alcohol and smoking didn't even make it onto the list," said Ruby H. Hearn, senior vice president of the Robert Wood Johnson Foundation, which funded the survey. "The public agenda as revealed in the survey is much narrower than we think it needs to be."

Hearn expressed concern that the public, although clearly frightened by the dangers of illegal drugs, remained unworried by the related health problems. "Very few kids just start taking drugs," she said. "They start drinking or they start smoking, and that's what leads them to drugs." One in eight sixth-graders, she noted, say they recently have gone on a drinking binge, according to the University of Michigan's latest national survey.

Like Blendon, she also worries that the public misunderstands the new federal initiative on children's health insurance coverage. "The federal legislation did not take care of the problem," Hearn said. "It created an opportunity for states to take care of the problem."

About 11 million American children lack health insurance. The bipartisan Balanced Budget Act passed by Congress and signed into law by President Clinton in August includes a $24 million measure aimed at expanding health coverage for many of those 11 million children. The new law thus encourages states to increase their Medicaid budgets -- and thus take advantage of higher federal matching funds -- to expand coverage to families with annual incomes up to twice the poverty level, or more than $32,000.

"A lot of families in that range are doing without, because they have not a clue that they are eligible," said Sarah C. Shuptrine, founder and president of the Southern Institute on Children and Families, a nonprofit organization focusing on the disadvantages in 17 southern states and the District of Columbia.

"The ball is in the court of the states now," Shuptrine said. "The federal government has acted. It's an incredible opportunity for the states."

But the latest survey suggests that the public still misunderstands Medicaid, the federal-state health program for low-income families. People tend to think of Medicaid as a program only for the poorest families, Shuptrine said, when in fact it may cover children in working-class families well above the poverty line.

"We need to uncomplicate those messages for parents," Shuptrine said.

In Maryland, for example, families with incomes up to 133 percent of the federal poverty level are eligible for Medicaid. An estimated 168,000 in Maryland are uninsured but do not qualify for Medicaid. An estimated 168,000 are uninsured but do not qualify for Medicaid. Gov. Parris N. Glendening (D) has vowed to expand coverage to include families making more than twice the federal poverty level, including families with incomes up to nearly $38,000.

Other states, including Arkansas, Missouri and South Carolina, have made similar moves. But advocates of expanded health coverage for children worry that public unawareness, as documented in the Harvard poll, may doom the effort in other states.

"What this means," Harvard's Blendon said, "is that if a big push isn't made to increase support for children's health care, any hope of extending coverage to the majority of the 11 million uninsured children could fizzle out at the state level."

Other findings in the Harvard survey also have important implications for policymakers, Blendon said. They show that the public is inclined to trust nurses and doctors on these issues more than they would public officials or insurance plans or so-called experts.

"If I were making a big push for children's legislation," Blendon said,"I would start by rounding up all the nurses and pediatricians I could before I'd go after the governors and the commissioners. I'd be rounding up [former surgeon general C. Everett] Koop long before I'd be rounding up Harvard professors."

PROBLEMS FACING CHILDREN

1986 Percent

2. Home life breakdown 46 and related problems*

3. Child and sexual abuse 28

4. Poor quality education 9

4. Alcohol abuse 9

1997 Percent

2. Crime 24

3. Home life breakdown 22 and related problems*

4. Poor quality education 17

* Combined data

Q: What do you think are the two or three most important HEALTH problems facing children in America today?

AIDS 23 percent

Infectious diseases 17 percent (Besides AIDS)

Drugs 15 percent

Smoking 11 percent

Cancer 10 percent

Alcohol 7 percent

Inability to pay for medical care 4 percent

Poverty, injuries 1 percent or less and accidents, child or sexual abuse

NOTE: Percentage of adults who named a given problem.

SOURCES: Harvard University; Robert Wood Johnson Foundation; University of Maryland; Harris Survey