Adolescents and young adults continue to have the highest rates of most STDs of any age group. Recent data indicate that teen births are on the rise for the first time in over a decade. The majority of adolescents initiate sex by the time they graduate from high school, with a substantial proportion initiating before age 13. We are challenged by persistent questions and controversy regarding the most effective and appropriate means to address these issues. Further, our work is complicated and complemented by our more recent understanding of the role that cognitive and neurological development plays in adolescent decisions regarding sexual activity and risk. We have effective behavioral interventions for young people; the challenge is how to make them appropriate to and available in the settings where we are most likely to access adolescents. Traditional public health approaches to STD prevention have predominantly centered on screening and treatment of infected individuals, however, little impact has been seen in reducing sexual risk behavior or STD rates. How do we move from STD screening and treatment specifically toward sexual and reproductive health more generally? Family planning clinics provide more comprehensive reproductive health services, however, they primarily reach sexually experienced young women. School and community-based health education has increasingly focused on promoting abstinence, with little information on protective measures for sexually active youth or connection to STD prevention or family planning services. We must find a way through these challenges to provide a comprehensive set of interventions, translated appropriately for the populations we most need to reach and for the venues where they will be most effective. This session has several foci: to present an overview of the most pertinent issues in improving adolescent reproductive health, including STD prevention; to put those issues into greater context by discussing what we know about adolescent brain development and its impact on STD prevention efforts; to present the current most effective approaches to STD prevention among adolescents; and finally to provide an example of effective adolescent health programming within an STD prevention setting.