According to a survey of Michigan high school students, binge drinking is strongly associated with higher rates of smoking and tobacco use. Binge drinkers were nearly twice as likely to have smoked in the past month compared to non-drinkers and non-binge drinkers. The survey also found that binge drinkers were more likely to have used smokeless tobacco or cigarillos. To reduce youth alcohol and tobacco use, the document recommends that parents talk to their children about refusing substances, schools provide prevention education programs, and retailers follow restrictions on youth access.