A variety of reasons have been advanced for the high prevalence of alcohol and drug use among young adolescent American Indians. Research to date has not provided adequate information that would be helpful in the design and implementation of viable prevention programs among adolescents' in ethnic communities. This article focuses on American Indian adolescents' perceptions of risk factors and effects associated with alcohol use during pregnancy, as well as age-related prevention strategies for fetal alcohol syndrome. A focus- group approach was used to elicit perceptions from participants. Results indicated that peer pressure, influences of adult drinking behaviors, stressful family environment, and the acceptance of alcohol use in the Indian community may be risk factors associated with alcohol use among American Indian youth. Participants, however, indicated lack of knowledge about the relationship between Fetal Alcohol Syndrome and alcohol use during pregnancy. Practical prevention approaches are recommended, including: (1) incorporation of alcohol prevention messages with music, posters, and communication technology tools; (2) education in risk factors and effects of alcohol use for young adolescents; (3) prevention of alcohol use through active involvement in social and physical activities; (4) empowerment of youth through peer leadership; and (5) improvement in family relationships and an environment with stronger adherence to Indian cultural traditions.