The latest CDC data show continued declines in youth substance use.   However, overdose deaths among adolescence are increasing at a fast rate given the illicit marketplace.  Mental health challenges exacerbated by the COVID-19 pandemic further elevate adolescent risk.  As a result, there is a need to modify prevention approaches to meet this current reality. This session will focus on the latest prevalence and trends in youth substance use as well as the relationship between substance use and risk factors such as ACEs and mental health.  The session will end by discussing how to this work can inform new approaches to our youth prevention activities.