More than 90 % of all accidents on ski slopes are caused by falls without other skiers involved. Only little information is available about causes of falling. Recently, we identified several risk factors and triggers, including alcohol consumption and smoking, associated with an increased fall risk. The main goal of the present study was to focus on gender-specific effects of smoking and alcohol consumption on the risk of falling in downhill skiers. Randomized inquiries were performed on five occasions in five ski areas where 1607 downhill skiers, 928 males and 679 females, were interviewed by a standardized questionnaire. Data were collected on demographic characteristics, smoking habits, regular physical activity, skiing skills, preferred slopes, alcohol consumption, snow and weather conditions, and the number of preceding falls on the day of the inquiry. Conditional logistic-regression analysis was used to estimate adjusted odds ratios for fall outcome. Logistic-regression analysis revealed that the fall risk during skiing was increased only in males that are 30 years of age or older: 1.6-fold when they were non-smokers but drank alcohol and 2.2-fold when they were smokers and drank alcohol on the skiing day. In female skiers, this risk was increased in the age groups below 30 and those 30 years and older: 1.9- and 2.2-fold for smokers who did not drink alcohol, 2.2- and 2.8-fold when they were non-smokers but consumed alcohol, and 3.4- and 5.1-fold when they were smokers and drank alcohol on the skiing day. These findings demonstrate that being a smoker or drinking alcohol on the skiing day increases the risk of falling especially in female downhill skiers. The combination of both factors results in an additive risk increase. The avoidance of these risk factors could help to reduce the frequency of falls and probably also that of injuries particularly in female skiers.