individual well-being. Familism declines across Hispanic generations, especially among Mexicans and Puerto Ricans, the two groups with the greatest generational depth; other groups will likely follow suit. While new family forms could emerge in which family support remains high, it is more likely that acculturation will weaken familism by fostering the individualism that drives many changes in family behavior. The decline of familism and the shift to nuclear family forms will likely erode the protective functions of extended families and kin networks for future generations. Second and later generations face a higher risk of divorce, and youths reared in single-parent families must contend with the myriad deleterious consequences of parent absence.

Acculturation is also associated with worsening health for Hispanics—as it is for all immigrant groups. This trend poses special risks for the Hispanic population because the phenomenon is experienced most extensively by the swelling second generation. In general, U.S.-born Hispanics report the poorest health and the highest levels of risk behaviors; among those born abroad, negative health outcomes and the propensity to engage in risky behaviors increase with length of residence in the United States.

The worsening health status of Hispanic children and adolescents is of particular concern for three major reasons: their large numbers and rapid growth; their lower insurance coverage levels; and the fact that several health indicators—particularly obesity and the resulting abnormalities of glucose metabolism—point to vulnerabilities that will pose formidable health challenges in the future. If unchecked, these trends portend high rates of premature morbidity and mortality as Hispanic youth, particularly those born in the United States, reach adulthood. Averting those health risks will require strategies that both target obesity among Hispanic youths and attempt to preserve the positive health behaviors of Hispanic immigrants.

Trends in Hispanics’ utilization of quality health care services also raise several issues for policy makers, health care providers, and the health care system in general. Continued immigration of Hispanics from Mexico and from Central and South America, coupled with their dispersal to new areas unaccustomed to providing care for diverse populations, will challenge providers responsible for delivering health care to low-income Hispanics, and to recent immigrants in particular. Current trends in employer-sponsored health insurance also signal rising numbers of uninsured Hispanic adults and youths over the next few years. Expansion of federally subsidized programs, such as Medicaid and SCHIP, appears unlikely in an era of



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