Neighborhood context appears to be modestly associated with the sexual initiation of adolescents. However, little support was found for neighborhood influence on contraceptive use, suggesting that other factors may play a more important role in shaping adolescents' contraceptive behaviors.

Ideal studies of acculturation would stratify analyses by gender and country of origin, and would include time measures related to acculturation. When feasible, studies should be population-based and longitudinal, and should build on existing theories of the relationship between acculturation and the sexual behavior, norms and beliefs that are unique to Latino culture.

The peer provider model appears to be a promising addition to the mix of service delivery models, particularly for certain subgroups of clients. The findings underscore the importance of tailoring programs on the basis of clients' risk profiles.

This study investigates how community characteristics can protect adolescents from the negative effects of poverty. Using economic predictors, eight communities with low or high birthrates for 15- to 17-year-old Latinas were identified. Quantitative data on birth-rates, demographics, and the physical environment were obtained from government, hospital, and local sources. Qualitative data on the physical environment and social processes in the community were collected by interviews and observations in these eight communities. The low- and high-birthrate communities differed in their physical environment, the characteristics of the population, social capital, and cultural norms. The zip codes with low adolescent birthrates had a higher percentage of residents of Latino descent, stronger social networks, and more ties to their countries of origin. The findings support a model of community building that focuses on strengthening informal social networks and supporting protective cultural norms.

This study demonstrates the critical importance of health insurance as a determinant of access to and use of health services among adolescents. It also shows that little progress has been made during the past 15 years in reducing the size of the uninsured adolescent population. The new State Children's Health Insurance Program could lead to substantial improvements in access to care for adolescents, but only if states implement effective outreach and enrollment strategies for uninsured adolescents.adolescents, health insurance, access, Medicaid, SCHIP.

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