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BLOOMINGTON, Illinois (AP) -- More teenagers are heeding warnings about drinking and driving, but they routinely face behind-the-wheel distractions from cell phones to passengers that contribute to thousands of fatal crashes every year, according to a study released Thursday.

Teens often take the wheel amid commotion, angst or fatigue that would be challenging even for older drivers, said Dr. Flaura Winston, chief investigator for the study.

"We need to go beyond the message of drinking and driving and also talk about the message of distractions," said Winston, a pediatrician with the Children's Hospital of Philadelphia. (Watch teens talk about how drivers get distracted )

The study by the children's hospital and State Farm Insurance Co., the nation's largest auto insurer, asked high school students what happens when their peers drive that makes them unsafe.

The 2006 survey of more than 5,600 students was a scientific sampling of the 10.6 million students in public high schools across the U.S.

Ninety percent of teens said they rarely or never drive after drinking or using drugs, reflecting a trend that has seen teen traffic deaths involving alcohol drop by about 35 percent from 1990 to 2005, according to National Highway Traffic Safety Administration data.

But teens reported a host of other in-car distractions that researchers say help make traffic accidents the No. 1 killer of U.S. teens, with a fatality rate four times higher than drivers aged 25-69, based on miles driven. About 5,600 teens died in traffic accidents in 2005, and about 7,500 were driving cars involved in fatal accidents.

Researchers found that one teenage passenger with a teen driver doubles the risk of a fatal crash, while the risk is five times higher when two or more teens ride along. Most states have laws restricting passengers when teens drive, but 15 states do not.

Nearly 90 percent of teens reported seeing peers drive while talking on cell phones and more than half spotted drivers using hand-held games, listening devices or sending text messages.

About 75 percent said they see teens driving while tired or struggling with powerful emotions, such as worries about grades or relationships. More than nine of 10 teens also reported seeing teen drivers speeding and half said they sometimes drive at least 10 mph over posted speed limits themselves.

"The environment for a teen driver is much more challenging and demanding than most of us adults thought. They're trying to manage all of that while trying to navigate the vehicle at the same time and they're pretty inexperienced at that," said Laurette Stiles, vice president of strategic resources at Bloomington-based State Farm.

Researchers say they will use the study to push for legislation such as stricter requirements for graduated drivers licenses, which can include mandated supervised driving with parents, night driving curfews and passenger restrictions.

The study's conclusions also will be shared with schools and parents, who can use them to warn teens about the potential hazards of driving, said Winston, who founded the hospital's Center for Injury Research and Prevention.