Hispanic adolescents engage in many health-compromising behaviors, such as use of alcohol and illicit drugs and early sex, at rates comparable to those of white teens, although their tobacco use is lower. Cuban-origin youths have the highest levels of tobacco, alcohol, and drug use, followed by those of Mexican and Puerto Rican origin. By comparison, youths from other Hispanic subgroups have low rates of drug use—probably because larger shares of these subgroups are first-generation immigrants, which means they are less acculturated. In general, acculturated youths engage in such health-compromising behaviors more often than the less acculturated. Hispanic young people also experience poor mental health, exhibiting the highest prevalence of depression of any ethnic group. Although Hispanic adolescent girls are as likely as white adolescents to consider suicide, they are twice as likely to attempt it. Their suicide completion rate, however, is lower than that of other ethnic groups.

The significance of these and other health-compromising behaviors among adolescents transcends their own physical well-being. In 2003, Hispanics had the highest teen birthrate, with 82.2 births per 1,000 adolescent females ages 15-19. In comparison, the birthrate for teens of all backgrounds was 41.7, while that for white teens was 27.5 and for black teens was 64.8.92 Such statistics bode ill for the educational prospects of Hispanic adolescents, who are more likely than either blacks or whites to withdraw from school if they become mothers.93 Indeed, all health conditions and behaviors that affect scholastic performance—including not only adolescent childbearing, but also drug and alcohol use and exposure to lead and other environmental contaminants—are especially worrisome because of the life-long consequences of educational underachievement discussed above.

Access to Quality Care

Hispanics face a variety of financial and nonfinancial obstacles to obtaining appropriate health care. Low rates of insurance coverage are perhaps most notable, but limited access to providers, language barriers, and uneven quality of care exacerbate inequities in health outcomes between Hispanics and whites and between native- and foreign-born Hispanics.

The lack of insurance coverage is greater among foreign-born compared with U.S.-born Hispanics, Spanish compared with English speakers, recent compared with earlier immigrants, and noncitizens compared with citizens. Undocumented immigrants are least likely to be insured; one estimate of their uninsured rates ranges between 68 and 84 percent.94 Owing

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