BACKGROUND: This study examined the prevalence of level 3 (pathological) gambling and a variety of other health risks among casino employees. METHODS: A sample of 3841 full-time casino employees representing four geographic sites was surveyed about gambling, drinking, smoking, and other health risk behaviors. In addition, respondents were asked about their use of the employee assistance program (EAP) and perceived obstacles towards using the EAP. RESULTS: This study found that casino employees have a higher prevalence of past-year level 3 (pathological) gambling behavior than the general adult population, but a lower prevalence of past-year level 2 (problem) gambling than the general adult population. In addition, casino employees have higher prevalence of smoking, alcohol problems, and depression than the general adult population. Furthermore, these risk behaviors tend to cluster. The majority of non-smoking respondents in this sample were exposed to second-hand smoke. Employees reported low participation in the company's EAP. CONCLUSIONS: The results of this study suggest that casino management should consider (1) improving problem gambling screening for employees who visit EAPs, even if employees present other problems (e.g., alcohol problems) as their primary concern, (2) increasing employees' awareness of EAPs, (3) increasing health promotion and education through channels other than company EAPs, and (4) creating smoke-free working areas.