Predictors of health-related quality of life (HR-QOL) among inner-city girls and its effect on health care use were evaluated. Adolescent girls aged 14 to 18 years (n = 127) completed a demographic and risk-behavior interview, the Kaufman Brief Intellectual Test, and the Medical Outcomes Study Short Form-36. Medical charts were reviewed for health care use. Two assessments were completed 6 months apart. Participants reported stable and poor HR-QOL compared with norms for similar aged females. HR-QOL was associated with some concurrent risk taking. Lower self-perceptions of mental health were associated with inconsistent condom use, smoking, and alcohol use; lower self-perceptions of physical health were associated with pregnancy and smoking. Predictive associations were not found. There was a trend for poorer physical health to be associated with more clinic visits. This study highlights the need for research aimed at both improving self-perceptions of health and decreasing high-risk behavior among inner-city girls.