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This book represents a second effort to place between two covers a comprehensive and integrated review of the health and health status of Latinos living in the United States. Our earlier book, Latino Health in the United States: A Growing Challenge (1994), was and continues to be the first effort of its kind. Since that time, several developments have occurred. These developments provide the basis for a book that provides current analyses of events affecting the health of Latinos.

Among recent developments are

• The increase in data sources that include ethnic identifiers and enable the inclusion of more and accurate data in this book.
• Changes in the health care market and the strong presence of managed care, which are affecting Latinos.
• Changes in federal immigration and welfare policies that have implication for the health and well-being of Latinos.
• Demographic changes that result in Latinos becoming the largest ethnic or racial group in the nation.

The purpose of the book is to

• Provide a profile--demographic and health status--of Latino populations in the United States by subgroup.
• Describe and analyze key issues affecting the health and health care of Latinos.
• Identify research needs, policy issues, and/or implications for programs and practice.
• Stimulate thinking on viable actions to address the needs of Latinos.

Very often books on Latino health focus on one aspect of their condition, such as mental health, women's health, drug abuse, and so on. While these efforts make important contributions to an understanding of the community's health needs, they often do not provide the reader with the "whole picture" or complete profile of Latinos. This book strives toward that end. It addresses key and critical health issues that affect Latinos' health so as to inform practice, program planning, research, and policy--good health policy and programs evolve from good information.

The book is divided into six parts. The first part, Latino Populations in the United States, defines Latinos and summarizes key health status indicators. Chapter One provides sociodemographic information and describes changes within the Latino community as it raises critical questions for the reader's consideration. It also provides an economic and demographic profile of Latinos by subgroups, with analyses of changing demographic patterns and their implications for the health and health care systems. The second chapter provides an overview of current available data sets as well as a discussion of the persistent lack of data on Latinos. The data on morbidity and mortality indicators (for children and adults) are summarized and the factors that influence their health status presented (including socioeconomic status, insurance coverage, and behavioral risk factors). Chapter Three looks at the changes in the health care market that are affecting consumers in numerous ways with regard to access to care and the quality of care rendered. This chapter describes and analyzes these changes as they affect Latinos. Special attention is given to issues such as the effects of managed care, devolution, insurance rates among Latinos, health care for immigrants, and so on.

Part Two, entitled Latino Life Stages and Health, reviews the special health needs of Latinos from birth through the golden years. In Chapter Four the authors review the available data on the health of Latino children and youth, ages zero to eighteen. They include an overview of access to care, preventive care (such as immunization), acute and chronic illnesses, intentional and unintentional injury, and infant health issues. Morbidity and mortality indicators for infants, children, and youth by subgroup and gender are also presented. The following chapters address the health status of Latinas with a focus on maternal and child health. Chapter Five examines behaviors during the prenatal period across groups and the influence of a number of socioeconomic variables, cultural factors, and the systems of care used by Latinas. The sixth chapter examines the health and social status of elderly Latinos with a particular emphasis on risk and protective factors, as well as the socioeconomic and sociocultural factors that affect their well-being. The last chapter in Part Two reviews and analyzes the empirical data on the mental health of Latinos. The authors review sociocultural factors, migration, and acculturation, among others, and their influence on diagnostic and treatment processes. They also present the limitations of existing research and identify areas in need of inquiry.

Part Three, Patterns of Chronic Diseases Among Latinos, reviews chronic conditions as they affect Latinos. The four chapters deal independently with cancer, cardiovascular disease, diabetes, and HIV/AIDS. Each chapter compares morbidity and mortality patterns across ethnic racial groups and describes their corresponding risk factors. The socioeconomic and sociocultural factors that play a role in each disease are also presented.

The two chapters in Part Four, Occupational Health and the Latino Workforce, examine data on the rates of occupational disease among urban and rural Latino workers who are employed in various industries and work settings. Chapter Thirteen on rural health goes beyond the health of workers in rural settings and examines the overall conditions of Latinos living in rural communities.

The fifth part, Alcohol, Tobacco, and Other Drug Use Among Latinos, contains three chapters that provide a comprehensive review of empirical studies describing patterns of alcohol, tobacco, and other drug use among Latinos. Each chapter examines the social, cultural, and other risk factors that influence specific drug use among Latinos. Chapter Fourteen presents public policy and other programmatic interventions for addressing alcohol problems. Chapter Fifteen analyzes the recent tobacco settlements and how it might affect Latinos. Drug use and its effect on Latino adults and youth is the focus of Chapter Sixteen.

Part Six brings the book to a close with a discussion of policy and programmatic interventions that are needed to address the needs of the Latino community.

Please note that the term "Latino" is used throughout this book instead of "Hispanic." Nevertheless, the reader should be aware of the fact that much epidemiological data have been collected using "Hispanic" as the operational label. For a discussion of these issues see Hayes-Bautista and Chapa (1987) and Treveno, 1987.

As we progress into the new millennium, our nation is on the cusp of a massive demographic transformation. Latinos are central to these changes. If our nation is to remain a productive leader of industrialized nations, then it cannot ignore the health and well-being of one of its largest and youngest population groups. If Latinos are not healthy, participating members of American society, then we all suffer as a nation. It is the humble desire of the editors of this publication that the materials contained herein serve to guide the formation of policies, programs, and research to ensure a healthy Latino citizenry.