How can primary concerns of school district superintendents guide school health efforts?

School-based research and health promotion interventions typically require upper administration support and acceptance to succeed. This paper focuses on a recently completed Delphi survey of the majority of school district superintendents in a frontier state. The survey examined superintendent district-level concerns at the elementary, middle/junior high, and high school levels. Primary concerns revolved around school funding, classroom education and student achievement, and teacher-centered issues. Implications for this research are discussed as are the importance of these data to those interested in working with schools to improve student health. The importance of this information for implementation of coordinated school health programs also is discussed.