Schools have a great influence on the health status of young people and health education programs have existed in schools for many years. A lack of evidence for positive long-term impact of these programs has led to the development of a new approach to school-based health promotion - Health Promoting Schools. This is a comprehensive whole-school approach which incorporates the principles of the Ottawa Charter and has attracted a great degree of interest and commitment at international, national and state levels. However, it is not clear whether or how this approach is being adopted and implemented at the school level and what the current state of research in the field is. This paper reviews the current state of research and the nature of past and present school health promotion programs targeting three health risk behaviours - smoking, alcohol consumption and skin protection. A series of computer database searches were conducted for January 1983 to March 1995, identifying 600 relevant citations. These were, firstly, classified into types of publications using the framework of the Staged Approach, the majority of publications focusing on descriptive research of smoking and alcohol use. Secondly, those articles classified as intervention trials were examined for incorporation of the principles of the Health Promoting Schools concept. Most programs utilised only a curriculum/social skills approach. No programs were identified which had attempted to implement and evaluate the Health Promoting Schools approach in its entirety for any of the three health risk behaviours. Given the increasing interest and investment in the approach, this review highlights a need for well-designed intervention trials which implement and evaluate the Health Promoting Schools approach.
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