The purpose of this paper is to add to the growing body of knowledge regarding the clustering or covariation of health behaviors in adolescents. Patterns of smoking, healthy eating and activity levels were examined through a self-report survey using serial cross-sectional samples of students over 7 years (sixth to 12th grade). The students represented were participants in the Class of 89 study, a component of the Minnesota Heart Health Program. Comparisons are made between males and females as well as by reference and intervention communities. Bi-variate and multivariate results suggest that not only do associations exist between health behaviors, but the associations strengthen over time. After the eighth grade, students reporting lower activity patterns as well as those making fewer healthy food choices also exhibit a higher weekly smoking prevalence. The multivariate analyses point to a risk profile where smoking, poor food choices and lower activity patterns cluster. The results point to the importance of early health education in order to foster the development of a positive health profile prior to consolidation of unhealthful behaviors. Comprehensive school-based health education is also recommended as a way to promote the importance and development of a healthy lifestyle across multiple behaviors.