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Community strategies, including school, child-care, and public recreation area closures, combined with health-protective beliavior (HPB) strategies including increased personal hygiene, wearing protective face masks, and social distancing (e.g., working from [...], Introduction: This study examined the role of family functioning in predicting family adherence to health-protective behaviors (HPBs) aimed at reducing COVID-19 spread. Pre-COVID-19 family functioning, disruptions to family functioning (cohesion, conflict, routines), and family chaos during the COVID-19 pandemic were tested as pathways to HPB adherence. Method: We utilized a sample of N = 204 families, comprising parents who had children ([M.sub.age] = 4.17). Parents ([M.sub.age] = 27.43) completed one survey prior to COVID-19 onset in the United States, and twice during COVID-19, at a 2-week interval. Structural equation modeling was used to test three potential pathways between prepandemic family-level functioning and HPB adherence during the COVID-19 pandemic. Results: Findings indicated that families with higher levels of chaos during COVID-19 demonstrated consistently lower HPB adherence across all three models. Additionally, disruptions in family cohesion from pre-COVID was associated with lower levels of parent and child HPB adherence. Family conflict was indirectly associated with HPB adherence via family chaos during COVID-19; whereas family routines were not associated with HPB adherence at all. Discussion: These findings suggest that family functioning is a meaningful predictor of HPB adherence. Family-based support may be effective in improving HPB adherence by focusing on promoting cohesion and reducing conflict and chaos for families coping with reduced community support and resources. Strategies for family-based supports are discussed. Public Significance Statement Adherence to health-protective behaviors was a critical public health strategy for reducing spread of the COVID-19 virus. Stay-at-home mandates disrupted family functioning, which in turn undermined health-protective behavior adherence. Findings suggest that support efforts to minimize disruptions to family relationships can improve health-protective behavior adherence, potentially reducing virus transmission during early stages of the pandemic. Keywords: COVID-19, health-protective behaviors, family relationships, family processes, social distancing Supplemental materials: https://doi.org/10.1037/fsh0000649.supp