<p>In Cambodia, the majority of the population is rural and reliant on subsistence agriculture, with cattle raised by smallholder farmers using traditional practices, resulting in low productivity and vulnerability to foot-and-mouth disease (FMD). As FMD causes deleterious impacts on rural livelihoods, known FMD risk factors were reviewed, using knowledge, attitudes and practice (KAP) surveys of smallholders(<i>n</i>=240) from four regions. The study aimed to understand current biosecurity threats to smallholder livelihoods and investigate the hypothesis that small holder farmers practising FMD risk management should be associated with higher incomes from cattle. Descriptive data were examined to demonstrate trends in KAP and a multivariable linear regression model developed to identify cattle income predictors. Results showed that baseline mean knowledge scores were low at 28.4% across all regions and basic biosecurity practices, including quarantine of new cattle, isolation of sick cattle and FMD vaccination, were lacking. As farmers purchase and sell cattle from and to various administration levels (including export), there is high risk of FMD transmission into and from smallholder communities. The final multivariable linear regression model identified significant explanatory parameters for annual cattle income, including region, number of calves born, forage plot size (ha), vaccination of cattle and the number of cattle purchased (F pr.<0.001,R²=29.9). Individual biosecurity practices including FMD vaccination were not significant predictors of income. With the current focus of farmers on treatment of FMD with inappropriate antibiotics leading to potential anti-microbial residue issues, yet receptivity to payment for vaccine in most regions, there is an urgent need for a coordinated national biosecurity and FMD management public awareness campaign. Further, to enhance the association between improved cattle health and rural livelihoods, it is recommended that livestock development programmes implement a systems approach to enhance farmer KAP in biosecurity, nutrition, reproduction and marketing of cattle.</p>