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The objective of this study was to examine the factors contributing to healthy behaviour in young adult long-term survivors of childhood cancer.Young adult childhood cancer survivors can adopt more healthy behaviour than the general population as a way to minimize the adverse consequences, that is, late effects of cancer and its treatment. Knowledge about the predictors of healthy behaviour in childhood cancer survivors can help providers assist young adult survivors with minimizing late effects.A cross-sectional correlational design and convenience sampling were used. Data were collected by mailed survey. Study measures included an investigator-developed demographic and disease form, the Mishel Uncertainty in Illness Scale-Community, the Post-traumatic Stress Disorder Index and the Health Promoting Lifestyle Profile II. Fifty-one per cent (N = 46) of eligible survivors responded to the survey. Data from 45 participants were used in the analyses.43·3% of variance in healthy behaviour was explained by a model that included uncertainty (β = −0·37, p = 0·007), post-traumatic stress symptoms (β = −0·10, p = −0·44), interactions with primary care providers (β = 0·33, p = 0·01) and a history of special educational assistance (β = −0·23, p = 0·06).Young adult childhood cancer survivors who have higher levels of uncertainty, higher levels of symptoms of post-traumatic stress, lower frequency of primary healthcare interaction and poorer cognitive resources were more likely to report lower levels of healthy behaviour.The findings can guide the clinical assessment of young adult survivors with regard to their health behaviours and needs they may have for education and supportive care. Findings also help inform the design of health promotion interventions for this specific group of cancer survivors.