The transition period between elementary and middle school is a high-risk period for smoking initiation. Hence the importance of primary prevention programs in adolescent populations. The development and implementation of appropriate preventive measures requires information on tobacco use among adolescents. The objective of this study was to estimate the prevalence of smoking among middle school students in Casablanca and to describe associated drug use. A cross-sectional study was conducted in 2010 in six collèges (middle schools) in Casablanca. The average age of the students was 16.3 years (SD = 2.1). 55% of the students were female. Overall smoking prevalence was 7.5% (CI 95% = 5.5% - 10.1%) ? 11.4% among boys and 4.6% among girls. 52.5% of the smokers began smoking between the ages of 14 and 18. The reasons for smoking included smoking as a way of escaping from problems (30%), relaxation (16%) and experience (7%). Smoking behavior was associated with drug use in 23.3% of smokers, compared to 0.6% among non-smokers (p < 10?3). These results suggest the need for prevention measures aimed at strengthening tobacco control policies in schools and other gathering places for young people.