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Smoking and harmful drinking dramatically increase health risks but little is known about their cooccurrence and factors that influence this co-habit, limiting development and implementation of appropriately targeted prevention interventions. This study was conducted among youth aged 10-24 years old in the Chi Linh Demographic - Epidemiological Surveillance System (CHILILAB DESS). The total numbers in the first, second and third rounds in 2006, 2009 and 2013 were 12,406, 10,211, and 7,654, respectively. A random-effects logit model controlling for both time-variant and time-invariant variables was applied to explore factors associated with current smoking, harmful drinking, and occurrence of smoking and harmful drinking together. We found dramatically increasing trends in current smoking, harmful drinking and co-occurrence among youth. Our results indicate similar health problems among youth in peri-urban areas in Vietnam. Demographic characteristics (older age, being male, being unmarried, and having informal work) appeared to be predictors for smoking and drinking behaviour. Besides, peer and family members had significant influence on smoking, whereas having a close-friend who was smoking was the most important variable. The results suggested that smoking and harmful drinking should not be solved with separate, stand-alone interventions but rather with integrated efforts.