Objective: To understand cumulative health risk behaviors among college students and the association with adverse childhood experiences, so as to provide a theoretical basis for the prevention and control of health risk behaviors in this population. Methods: From November to December 2022, four universities in Shanghai were selected using convenience sampling, and 3 039 students were selected for a questionnaire survey using random cluster sampling. The questionnaire covered general basic information, adverse childhood experiences and health risk behaviors. A latent class analysis was carried out to explore the latent classes of health risk behaviors among the college students and multivariate Logistic regression was performed to analyze the association between adverse childhood experiences and cumulative health risk behaviors. Results: The health risk behaviors of college students were classified into three latent classes:a low risk group (84.60%), a high risk group for smoking and alcohol consumption ( 10.37 %), and an excessive sugar intake group (5.03%). The proportion of three latent classes of health risk behaviors varied significantly by childhood neglect and abuse, family functioning and other adverse childhood experiences ( χ 2=210.67, 106.55, 104.41 , P <0.01). The results of the multiple Logistic regression analysis revealed that childhood neglect and abuse, poor family functioning, and other adversities increased the risk in the high risk group for smoking and alcohol consumption among college students ( OR =6.24, 3.80, 3.68), as well as an childhood neglect and abuse increased the risk of the excessive sugar intake group among college students ( OR =2.18) ( P <0.01). Conclusions Adverse childhood experiences are associated with clustered health risk behaviors. Proactive measures should be taken to prevent the transmission of negative childhood experiences, which would contribute to reduce the occurrence of health risk behaviors among college students.