Spouse concordance of smoking patterns and other lifestyle factors was examined in data provided by 560 married couples from the Minnesota Heart Survey. Married pair concordance was measured against a standard of concordance based on the frequencies in surrogate spouse pairs. Smoking patterns are found to be significantly concordant for married pairs. More married pairs than surrogate pairs tended to both smoke or both not smoke. Among smokers, married pairs are more similar than surrogate pairs in daily number of cigarettes smoked. Among ex-smokers, married pairs are more similar than surrogate pairs in the year they quit smoking. Younger couples with the least amount of education were most concordant and showed the greatest smoking rate. Five additional lifestyle factors showed an increased level of concordance for married over surrogate pairs. Concordance in these factors was not correlated with smoking concordance. It is suggested that married couples respond similarly to a shared environment made up of daily practices, social life, and leisure activities. Further, smoking intervention directed toward the married couple should be considered.