This study analyzed factors associated with utilization of needle exchange programs (NEPs) by young injection drug users (IDUs). Between 1997-1999, 700 IDUs 18-30 years of age were surveyed in Chicago. The majority of study participants (65%) had not used an NEP in the 6 months preceding baseline. Frequent NEP users were least likely to share needles (odds ratio [OR] = 0.32; 95% CI = 0.19-0.54) or other injection equipment (OR = 0.51; CI = 0.30-0.85), or to reuse their own needles (OR = 0.25, CI = 0.13-0.45), and were most likely to use condoms with steady sex partners (OR = 2.95; CI = 1.56-5.56). This study found that while frequent NEP use was associated with less risk behavior, young IDUs used NEPs infrequently or not at all.