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is estimated that 18 percent of drivers 16 to 20 years old--a total of 2.5 million adolescents-drive under the influence of alcohol. According to the Youth Risk Behavior Surveillance System conducted by the CDC, which monitors health risk behaviors among youths and young adults, unintentional injuries, including motor vehicle accidents, are by far the leading cause of death in adolescents, causing 29 percent of all deaths. An estimated 50 percent of these deaths are related to the consumption of alcohol (CDC, 1998). Sexually Risky Practices Adolescents are at higher risk than adults for acquiring STDs for a number of reasons. They are more likely to have multiple (sequential or concurrent) sexual partners and to engage in unprotected sexual intercourse. They are also more likely to select partners who are at higher risk for STDs. Among females, those 15 to 19 years old have the highest rates of gonorrhea, while 20- to 24-year-olds have the highest rate of primary and secondary syphilis (CDC, 1996). Adolescents who use alcohol and illicit drugs are more likely than others to engage in sexual intercourse and other sexually risky behaviors. A positive correlation has been demonstrated between alcohol use and frequency of sexual activity. In a 1990 Massachusetts survey of adolescents 16 to 19 years old, two-thirds reported having had sexual intercourse, 64 percent reported having sex after using alcohol, and 15 percent reported having sex after using drugs (MacKenzie, 1993). Substance use among adolescents is associated with early sexual activity, an important factor in the prevalence of STDs and HIV infection. The use of substances combined with sexual activity significantly decreases the likelihood that a condom will be used during sex. Substance use also can decrease an individual's discrimination in the selection of sexual partners and can increase the number of partners and the likelihood of risky sexual practices (including anal intercourse), thereby heightening the risk of STDs (MacKenzie, 1993).