Mortality from oral cancer has been rising in the young in several areas of the world until the early 1990s. We analysed data from two case-control studies from Italy and Switzerland including 137 cases of oral and pharyngeal cancer below age 46 and 298 hospital controls. The multivariate odds ratios (OR) were 20.7 for heavy smokers and 4.9 for heavy drinkers. The combination of high tobacco and alcohol consumption led to an OR of over 48. Body mass index (OR=0.28, for the highest tertile), high consumption of coffee (OR=0.25), fresh vegetables (OR=0.39), fruit (OR=0.73) and beta-carotene (OR=0.48) were inversely related to risk. Tobacco accounted for 77% of all cancer cases in this population, alcohol for 52%, low vegetable consumption for 52%, and the combination of the three factors for 85%.