The objectives of this study were to: evaluate the effectiveness of school-based health promotion interventions through: – a systematic review of primary studies of the effectiveness of the health promoting schools approach – a systematic review of existing reviews of the effectiveness of other health promoting interventions in schools in the following areas: nutrition, exercise, safety, psychological aspects of health, sexual health, substance use, personal hygiene, environmental issues and family life education; indicate areas where further research is needed; make recommendations for practice in the UK, if research findings permit. The health promoting schools approach: The health promoting schools initiative is a new, complex, developing initiative, and the optimum method of evaluation is currently under debate. There are indications that this approach is promising. The development of programmes to promote mental and social well-being would be likely to improve overall effectiveness and the impact of staff health and well-being needs more consideration. The development of measures of mental and social well-being is important for future evaluation. Continued investment, and ongoing evaluation are necessary to provide evidence about the effectiveness of this approach. Health promotion in schools: This review of reviews has shown that school health promotion initiatives can have a positive impact on children's health and behaviour but do not do so consistently. It would appear that most interventions are able to increase children's knowledge but that changing other factors which influence health, such as attitudes and behaviour, is much harder to achieve, even in the short-term. Overall, a multifaceted approach is likely to be most effective, combining a classroom programme with changes to the school ethos and/or environment and/or with family/community involvement. This is consistent with the health promoting schools approach.