This study examines trends in adolescent suicide methods in the US from 1999 to 2020, focusing on firearm, poisoning, hanging and asphyxiation, and other methods, by age, sex, and race and ethnicity. The study analyzed data from 47,217 adolescent suicide decedents, using national death certificate data. The results show that suicide rates by all methods increased over the study period. Firearm suicide rates increased by 1.0% annually, with the most rapid increases among Black, Asian and Pacific Islander, American Indian and Alaska Native, and Hispanic or Latino adolescents. Poisoning suicide rates increased by 2.7% annually, with the most rapid increase among female adolescents. Hanging and asphyxiation suicide rates increased by 2.4% annually, with the highest increase among female adolescents. Other methods of suicide also showed increasing trends. The study highlights the need for targeted prevention strategies, particularly for racial and ethnic minority youth. The findings underscore the importance of addressing social determinants of health, structural racism, and systemic inequities in reducing adolescent suicide rates. The study also emphasizes the need for improved mental health services and policies to address disparities in suicide rates among different demographic groups.This study examines trends in adolescent suicide methods in the US from 1999 to 2020, focusing on firearm, poisoning, hanging and asphyxiation, and other methods, by age, sex, and race and ethnicity. The study analyzed data from 47,217 adolescent suicide decedents, using national death certificate data. The results show that suicide rates by all methods increased over the study period. Firearm suicide rates increased by 1.0% annually, with the most rapid increases among Black, Asian and Pacific Islander, American Indian and Alaska Native, and Hispanic or Latino adolescents. Poisoning suicide rates increased by 2.7% annually, with the most rapid increase among female adolescents. Hanging and asphyxiation suicide rates increased by 2.4% annually, with the highest increase among female adolescents. Other methods of suicide also showed increasing trends. The study highlights the need for targeted prevention strategies, particularly for racial and ethnic minority youth. The findings underscore the importance of addressing social determinants of health, structural racism, and systemic inequities in reducing adolescent suicide rates. The study also emphasizes the need for improved mental health services and policies to address disparities in suicide rates among different demographic groups.