PURPOSE: To examine prevalence and associations of gambling problems and health risk behaviors among college athletes from the first national survey of gambling among U.S. college student-athletes. METHODS: Conducted by the National Collegiate Athletic Association (NCAA), this self-administered and anonymous survey collected information from a nationally representative sample of 20,739 student-athletes. RESULTS: Males consistently had higher past-year prevalence of gambling than females (e.g., 62.4% of males reported some type of gambling vs. 42.8% of females). Based on DSM-IV Gambling Screen, this study identified 4.3% of males and 0.4% of females as problem/pathological gamblers. A general upward trend existed that as the level of gambling problems increased, so did the prevalence of substance use, gorging/vomiting, and unprotected sex. Cross-group comparisons by gambler type were all significant. Problem and pathological gamblers also experienced significantly more drug/alcohol-related problems than non-gamblers and social gamblers. CONCLUSIONS: Direct associations found between gambling and multiple risk behaviors in college student-athletes support the persistence of the youth problem-behavior syndrome and suggest the need for multi-faceted initiatives to tackle these risk behaviors simultaneously.