Introduction Due to their linkages in the social ecology of adolescents, adolescents’ cigarette smoking involvement is correlated with other health risk behaviours such as unsafe sexual behaviour and nonsexual risk behaviours, which can damage their health and well-being. This study focuses on examining whether socio-demographic factors and health risk and problem behaviours explain the prevalence of cigarette smoking among Chinese adolescents.

Methods Based on the data from 1st National Youth Reproductive Health Survey in 2009, using binominal and ordered probit models with a Heckman’s two-stage estimation procedure, this study examines the socio-demographic and health risk and problem behaviours explaining both cigarette smoking and its frequency, respectively.

Results The results indicate that both the occurrence of cigarette smoking and the frequency of cigarette smoking are mainly associated with health risk and problem behaviours covering other nonsexual risk behaviours and sexual behaviour. The prevalence of smoking was highest among male, rural adolescents, and who had lower education, from one-child family, broken family, or lived in the west. When we adjusted for socio-demographic factors and health risk and problem behaviours, smoking was associated with having premarital sex, having multiple sexual partners, binge drinking, and porn-reading addiction among Chinese adolescent.

Conclusion Unsafe sexual behaviours, binge drinking, and porn-reading addiction are correlates of cigarette smoking suggest clustering to form a risk behaviour syndrome among Chinese adolescents. It reflects an urgent need for further exploring the relationship between cigarette smoking and other health risk behaviours will be helpful for designing further tobacco control interventions among Chinese youth.