PURPOSE: Differences in prostate specific antigen awareness may contribute to differences in the frequency of prostate specific antigen testing. We investigated the association of health risk behaviors, including smoking, physical inactivity, obesity and excessive alcohol consumption, with awareness of the prostate specific antigen test in men in California at risk for prostate cancer. MATERIALS AND METHODS: Using 2003 data from the California Health Interview Survey, a population based, random digit dial telephone survey, the records of 7,297 men 50 years or older without a history of prostate cancer were identified. The outcome was self-reported awareness of the prostate specific antigen test. The main independent variables were smoking status, physical activity level, body mass index and alcohol consumption. The prevalence, OR and 95% CI for prostate specific antigen awareness were calculated using SUDAAN to account for the complex sampling design. RESULTS: The overall prevalence of prostate specific antigen awareness was 73.0%. After controlling for potential confounders the odds of being aware of the prostate specific antigen test was lower in current smokers (vs never smoked OR 0.53, 95% CI 0.41-0.68), physically inactive men (vs physically active OR 0.77, 95% CI 0.63-0.93) and obese men (vs normal weight OR 0.77, 95% CI 0.62-0.95). CONCLUSIONS: Health risk behaviors are associated with lower prostate specific antigen awareness. Our findings suggest opportunities for focused health education interventions and quality improvement programs tailored to men who engage in unhealthy behaviors to improve their prostate specific antigen test awareness.