ObjectiveTo report the prevalence and comparison of cancer-linked health behaviors and identify risk factors associated with unhealthy behavior among adolescent siblings and cancer survivors.MethodsThe Child Health and Illness Profile -Adolescent Edition (CHIP -AE) was completed by 307 survivors and 97 sibling controls 14-20 years of age.ResultsRisky behavior ranged from 0.7 to 35.8 for survivors and 1.0 to 41.2 for siblings. Comparisons of sexual behavior, tobacco, alcohol, or illicit drug use utilizing continuous data revealed no differences between groups. Categorically, survivors were less likely to report past smokeless tobacco use or current use of beer/wine or binge drinking (p-values range from. 01 to. 04). Survivors with better mental health were at lower risk for poor behavioral outcomes.Conclusions Adolescent survivors engage in risky health behaviors at rates generally equivalent to their siblings. Aggressive health education efforts should be directed toward this high-risk population. © The Author 2012. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved.