This study examined the school performance, suicidal involvement, disordered eating behaviors, pregnancy risk and chemical use of teenagers with a history of sexual abuse or parental alcohol misuse and found that they had higher rates of these adverse outcomes than among a comparison group of teenagers without such background risk factors. Adolescents with dual-risk background reported higher levels of suicide risk, disordered eating, sexual behaviors and chemical abuse than teenagers with only one background risk factor. Among index group members, protective factors against these adverse outcomes included a high degree of religiosity and the ability to discuss problems with family or friends. Risk factors that increased the likelihood of adverse outcomes included depression, perceived substance use in school and worries about family financial security.