ABSTRACT Background Alcohol, tobacco, and other drug use (ATOD) and sexual risk-taking are contributors to the health and welfare of adolescents and a significant percentage engage in these behaviors. These behaviors may contribute to other risk-taking such as driving while impaired (DWI) or riding with an impaired driver (RWI). The purpose of this study was to assess the relationship between DWI and RWI and ATOD use, sexual risk-taking, and physical fighting among adolescents. Methods Date for this study were derived from the 2017, 2019, 2021 Youth Risk Behavior Survey (YRBS) (n = 45,132). Logistic regression models were used to estimate the association between DWI and RWI and ATOD use, sexual risk-taking, and physical violence. Results Heavy smoking, binge drinking, prescription pain medication without a prescription, sexual intercourse with four or more people, and being in a fight on school property were associated with DWI. Binge drinking, prescription pain medication without a prescription, alcohol or drug use before last sexual intercourse, and being in a fight in or out of school were associated with RWI. Conclusions The results seem to suggest that risk behaviors are intertwined with DWI and RWI. There may be a combined effect of engaging in one risk behavior, influencing engagement in other risk behaviors.