BACKGROUND: The preponderance of evidence suggests that smokers do not engage in health-promoting lifestyles compared to nonsmokers. Few studies, however, have considered possible differences in health behaviors among smokers at different stages of intention to change. In this paper we examined the relationship of smoking stage of change to health behaviors in an HMO population. METHODS: Data were obtained from a baseline health status and preventive service evaluation survey mailed to 8000 HMO members over the age of 40. The sample was stratified based on the presence of one or more chronic diseases. Regression analyses were performed adjusting for covariates and weighting based on the stratification. RESULTS: Smokers appear to vary by stage of change in their practice of health-promoting behaviors. After controlling for age, gender, professional advice, chronic disease, and education, smokers classified in early stages of change demonstrated significantly fewer positive health practices compared to never smokers. A consistent pattern emerged across health behaviors. CONCLUSIONS: Smokers in the earliest stages of change appear to have the most room for improvement compared to ex-smokers and never smokers. Behavior change other than smoking could be an opportunity to engage early stage smokers.