Objective: To determine health risk behaviors and cluster patterns among adolescents from four minorities in rural of Wuling mountainous area, and to provide a reference for health education for adolescents in ethnic minority areas. Methods: Totally 4 162 teenagers from 8 rural middle schools of Xiangxi Tujia and Miao Autonomous Prefecture, Dong Autonomous County of Tongdao, Huaihua, Bai Minority Village of Sangzhi County, Zhangjiajie, were selected with multi-stage stratified random cluster sampling and surveyed with a questionnaire to collect information on health risk behaviors from September to October, 2018. Cluster patterns of health risk behaviors were analyzed by sex by two-step cluster method. Results: The occurrence rates of the behaviors of the adolescents from four minorities of smoking, drinking, walking violations, unsafe swimming, fighting, suicide idea, feeling lonely constantly, frequent sleeplessness, depression, internet addiction were 18.9%, 31.0%, 49.6%, 32.3%, 28.6%, 18.3%, 16.3%, 12.4%, 16.3%, 6.7% respectively, among which the highest occurrence rates were Tujia teenagers’ fight(31.4%), Miao teenagers’ unsafe swimming(45.1%), Dong teenagers’ drinking(34.8%), Bai teenagers’ walking violation(52.9%). And the differences were statistically significant(P<0.05). Among the lowest risk group, there were 322 male students (16.4%) and 496 female students (22.5%); Among the moderate low group, there were 377 male students (19.3%) and 536 female students (24.3%); Among the implicit behavior high risk group, there were 518 male students (26.5%) and 758 female students(34.4%);Among the explicit behavior high risk group, there were 741 male students (37.8%) and 414 female students(18.8%). 23.1% of teenagers engaged in four or more types of health risk behaviors, with male higher than that of female(χ2=183.52, P<0.01), and the rate of Miao teenagers (28.2%) was the highest. Conclusion Health risk behaviors among minority adolescents in Wuling rural areas are prevalent and varied in ethnicity. Clustering of explicit risk behaviors in boys and implicit risk behaviors in girls were obvious. The hierarchical guidance and comprehensive intervention should be carried out on the basis of the characteristics of different minority teenagers’ health risk behaviors.