Background: Using data from the 2006 Health Behavior in School-aged Children (HBSC) survey, the prevalence of 6 forms of bullying (physical, verbal, relational, sexual, cyber, and racist), and the role of smoking and drinking in bullying was examined among Italian adolescents for this study. Methods: The sample was composed of 2667 Italian middle and secondary school students (49.9% girls) randomly selected. The revised Olweus Bully/Victim Questionnaire was used to measure physical, verbal, relational, sexual, cyber, and racist forms of bullying. For each form, 3 categories were created and compared with students "not involved in bullying": bully, victim, and bully-victim. Logistic regressions were applied to test the connections among the 3 forms of involvement in different types of bullying and smoking and drinking. Results: Prevalence of having been bullied or having bullied others at school at least once in the last 2 months was 11.6% for physical, 52% for verbal, 47.9% for relational, 18.5% for sexual, 19.4% for cyber, and 9.4% for racist bullying. Compared to girls, boys were more likely to be involved in physical bullying; moreover, boys were more involved as bullies in verbal, sexual, cyber, and racist bullying. In contrast, girls were more likely to be victims of verbal, relational, sexual, and cyber bullying than were boys. Logistic regressions showed the connection between the different forms of involvement in bullying and smoking and drinking. Conclusions: Our results indicate that all forms of bullying behavior are associated with legal substance use. Implication for prevention program was discussed. (Contains 3 tables.)