The study shows that 31 percent of adolescent smokers in Canada between grades 9 and 12 use contraband tobacco and indicates that teens who smoke contraband tobacco are more likely to use illicit drugs.

"The rate of illicit drug use among the contraband smokers is higher than that among teenagers who smoke non-contraband cigarettes - sometimes double or triple the rate," said Professor Mesbah Sharaf, a health economics lecturer at Alberta.

According to the study, 22 percent of all adolescent smokers in Canada used cocaine. Among those who smoked contraband cigarettes, 31 percent reported using cocaine, whereas only 18 percent of non-contraband smokers reported using cocaine.

Use of MDMA (ecstasy) was also more prevalent among contraband smokers (45 percent) than among non-contraband smokers (33 percent).

The rate of ketamine and amphetamine use among the contraband-smoking teens was almost three times as high as the rate among non-contraband-using teens - and more than six times as high for heroin.

This is the first published study to specifically examine the potential connection between contraband cigarette smoking and drug use among adolescents, researchers said.

"If, as we believe this study shows, contraband cigarette use is associated with illicit drug use, then intensive effort needs to be made to avoid this - by both government and tobacco companies," said Sharaf.

"Adolescence is a critical period, and most unhealthy habits are developed at an early age," Sharaf added.

Researchers used a national sample of 2,136 current smoker students in grades 9 to 12 from the 2010-2011 Youth Smoking Survey conducted by Statistics Canada.

The survey assessed students' past-year use of the following drugs (including some street names for each type of drug): amphetamines, cocaine, hallucinogens, heroin, MDMA and ketamine.

The study also showed a significant relationship between truancy and drug use, as well as binge drinking and drug use.

The study was published in The Journal of Primary Prevention.

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