In Central-Eastern European countries, a large proportion of adult morbidity and mortality can be attributed to tobacco and alcohol use behaviors that begin in early adolescence. Consequently, it is unfortunate that studies examining these behaviors among youth have rarely been undertaken in Central-Eastern European countries. The objective of this study was to examine tobacco and alcohol use among a sample of approximately 2,000 secondary students that included youth from four Central-Eastern European countries: Hungary, Slovakia, Czech Republic, and Romania. A cross-sectional school-based survey was administered in 2005 to collect information about the prevalence of cigarette smoking, smokeless tobacco use, cigar use, alcohol use, and episodic heavy drinking. Information was also collected about the normative perceptions of cigarette smoking and alcohol use among schoolmates and friends. During the 30 days preceding the survey, cigarette smoking was reported by 30.6% of boys and 35.0% of girls and episodic heavy drinking (5 or more drinks of alcohol in a row within a couple of hours) was reported by 37.8% of boys and 24.1% of girls. By comparison, current smoking rates among U.S. youth were substantially lower; 21.8% for boys and 21.9% of girls (2003 Youth Risk Behavior Survey). The prevalence of alcohol use among Central-Eastern European students was also higher than among U.S. youth. However, smokeless tobacco and cigar use was lower by comparison. Cigarette smoking and alcohol use was also found to be highly associated with perceptions of the prevalence of these behaviors among schoolmates and close friends. A majority of the students reported that half or more of their friends smoked cigarettes and the same was true of friends when it comes to drinking alcohol. In conclusion, there is a high prevalence of cigarette smoking, alcohol use, and episodic heavy drinking among Central-Eastern adolescents comprising this sample. These behaviors place them at risk for serious health problems both in the short and long-term. Thus, there is a clear need for health education programs and other interventions that adequately address tobacco and alcohol use in order to reduce subsequent morbidity and mortality in Central-Eastern European youth. The results also suggest the need to take into account the normative perceptions of these youth when designing interventions.