behaviors of Hispanics impose serious limitations. One frequent and noteworthy problem is the lack of detailed data for subgroups of Hispanics defined by national origin and generation in the United States. Most studies group Hispanics into a single category or focus on Hispanics of Mexican origin, who are by far the most numerous. Another problem is the relative lack of detailed epidemiological data on the incidence and prevalence of common and important diseases, such as cardiovascular disease. Moreover, for many conditions, data are unavailable to assess incidence or prevalence according to immigrant status or, among the foreign-born, by length of residence in the United States and degree of acculturation.

Despite these limitations, researchers have learned a great deal about the health status and health behaviors of Hispanics over the past 25 years. The story that has emerged is a complex one, with some findings that warrant optimism and others that merit serious concern. The picture of both advantage and disadvantage that has surfaced must be appreciated and understood in order to develop interventions and design policies to improve Hispanic health.

In this chapter, we provide an overview of the health status and health behaviors of Hispanics in the United States. The chapter is divided into sections, as follows. The next section discusses mortality rates among Hispanics and compares them with rates for non-Hispanic whites and non-Hispanic blacks. This section also illustrates the variation in mortality across Hispanic national-origin groups. The three sections that follow cover, in order, the health status and health behaviors of Hispanic adults, the health status and health behaviors of Hispanic children and adolescents, and birth outcomes. The sixth section discusses the so-called epidemiological paradox, one of the most fascinating findings regarding the health of Hispanics and a source of controversy since it was first described. Finally, we conclude with a summary of our findings and what they mean for the health and health care needs of future generations of Hispanics in the United States.

Our objective is not to be comprehensive. Rather, our goal is to summarize research findings that have an especially strong bearing on future trends in Hispanic health. Accordingly, a major portion of the chapter is devoted to reviewing selected aspects of the health and health behaviors of Hispanic children and adolescents. We have chosen today’s Hispanic youth as a major focus because their health has enormous implications for the future health and health care needs of all Americans.

MORTALITY

As Table 9-1 shows, Hispanics in the United States have lower age-adjusted mortality rates than both non-Hispanic whites and non-Hispanic



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