A conceptual approach to school-based health promotion.

Health and health promotion have become salient topics in American society in the 1980's. Still there is little consensus on what is meant by the term "health promotion," in what ways children and adolescents should be a targeted group, or whether such activities are appropriate for schools. This paper proposes a concept of health promotion as an intervention modality, based on a clarification of the notion of health and the efforts needed to foster improved health. The relevance of health promotion efforts to the school setting is argued from three perspectives. Three levels of analysis for conceptualizing school health promotion programs are then proposed and involve the school environment, student personality characteristics, and student behavior. The question of accomplishing changes in health-related behavior through the schools is addressed through changes that are accomplished at each of these three levels. The exploration of this change process through particular theoretical attributes at each of these levels forms the basis for designing and evaluating strategies for effective school health promotion programs. Finally, the relationship between the school and the extra-school environment is proposed as a final area for research in school health promotion.