Background: A sizeable percentage of Hispanic youth are affected by alcohol use. Research is needed to identify specific factors placing Hispanic youth at elevated risk. Purpose: This study examined whether recent alcohol use (past 30 days) and frequent episodic heavy drinking among 7th - 12th grade Hispanic students (N = 946) in Greater Cincinnati schools differed based on perceived harm of use, ease of access and parent/peer disapproval of use. Methods: The PRIDE national survey for grades 6-12 was administered to youth in their school classrooms. Results: One-in-four (24.5%) recently used alcohol and one-in-seven (15.2%) frequently (often/a lot) engaged in episodic heavy drinking. Students at highest risk for recent alcohol use and frequent episodic heavy drinking were those who felt use was not harmful/somewhat harmful, felt alcohol access was fairly easy/very easy and had parents/peers who did not disapprove of use. Discussion: These results should be considered when developing and implementing alcohol prevention efforts for Hispanic youth. Ongoing parent-child communication, rule-setting and rule enforcement should be encouraged. Translation to Health Education Practice: Findings can assist health educators to more thoroughly understand how perceived harm, ease of access and parent/peer disapproval affect recent alcohol use and episodic heavy drinking among Hispanic youth. (Contains 7 tables.)