Abstract Background Little is known on the co-occurrence and heterogeneity of child sexual abuse (CSA) or health risk behavior (HRB) prevalence nor the associations among the victims. Objectives To detect the prevalence and subgroups of adolescents reporting CSAs or HRBs, and to examine the association between the subgroups. Methods Participants were secondary school students in a national survey in China ( N  = 8746). Self-reported CSA and HRB experiences were collected through a computer assisted questionnaire. Prevalence and confidence intervals were calculated. Multigroup latent class analysis (LCA) was used to examine latent subgroups of CSA and HRB. Dual latent class regression analysis was used to examine the association between CSA and HRB classes. Results A total of 8746 students participated in our study. The prevalence of having ever experienced any of the reported seven CSA items was 12.9%. The preferred LCA model consisted of a three-class CSA latent variable, i.e. “Low CSAs”(95.7% of the total respondents), “Verbal or exhibitionism CSAs”(3.3%), and “high multiple CSAs” (1.1%); and a three-class HRB latent variable, i.e. “Low HRBs”(70.5%), “externalizing HRBs” (20.7%), and “internalizing HRBs” (8.7%). Students in the “Verbal or exhibitionism CSAs” or “high multiple CSAs” classes had higher probabilities of being in “externalizing HRBs” or “internalizing HRBs” classes. The probabilities were higher in “high multiple CSAs” class(male externalizing OR 4.05, 95%CI 1.71–9.57; internalizing OR 11.77, 95%CI 4.76–29.13; female externalizing OR 4.97, 95%CI 1.99–12.44; internalizing OR 9.87, 95%CI 3.71–26.25) than those in “Verbal or exhibitionism CSA”(male externalizing OR 2.51, 95%CI 1.50–4.20; internalizing OR 3.08, 95%CI 1.48–6.40; female externalizing OR 2.53, 95%CI 1.63–3.95; internalizing OR 6.05, 95%CI 3.73–9.80). Conclusions Prevalence of CSA items varies. Non-contact CSAs are the most common forms of child sexual abuse among Chinese school students. There are different latent class co-occurrence patterns of CSA items or HRB items among the respondents. CSA experiences are in association with HRB experiences and the associations between latent classes are dose-responded. Multi-victimization has more significantly negative effects. The results could help identify high-risk subgroups and promote more nuanced interventions addressing adverse experiences and risk behaviors among at-risk adolescents.