Summary Availability of health-promoting interventions (HPIs) may vary across schools serving students with different socioeconomic backgrounds. Our objectives were to describe social inequalities across elementary schools in: (i) level of importance that school principals attribute to 13 common health-related issues among students in their school; (ii) availability of HPIs within their school addressing eight health topics and (iii) (mis)alignment between perceived importance and HPI availability. Data were collected in telephone interviews with school principals in a convenience sample of 171 elementary schools (59% of 291 schools contacted). Schools were categorized as serving very advantaged, moderately advantaged or disadvantaged students. Principals reported how important 13 health issues were among students in their schools and provided data on HPI availability for 8 health issues, 4 of which required school action under government mandates. Higher proportions of principals in schools serving disadvantaged students (36% of all 171 schools) perceived most health issues as important. The mean number of HPIs in the past year was 12.0, 12.1 and 11.7 in schools serving very advantaged, moderately advantaged and disadvantaged students, respectively. Only availability of mental health HPIs differed by school deprivation (60, 43 and 30% in very, moderately and disadvantaged, respectively). Although most schools offered oral health HPIs, dental problems were not perceived as important. Smoking was perceived as not important and smoking-related HPIs were relatively rare (9%). Given rapid evolution in public health priorities, (mis)alignment between perceived importance of specific health issues and HPI availability in elementary schools warrants ongoing reflection.

Introduction School-based health-promoting interventions (HPIs) aim to support youth development and positively influence modifiable lifestyle behaviours. Identifying factors that contribute to or hinder the perceived success of HPIs could facilitate their adaptation, improve implementation and contribute to HPI sustainability. The objective of this study was to identify factors in three domains (school characteristics, characteristics of the HPI and factors related to planning and implementing the HPI) associated with perceived success of HPIs among school principals in elementary schools. Methods Data were drawn from Project PromeSS, a cross-sectional survey of school principals and/or nominated staff members in a convenience sample of 171 public elementary schools in Quebec, Canada. School board and school recruitment spanned three academic school years (2016–2019). Data on school and participant characteristics, HPI characteristics, variables related to HPI planning and implementation and perceived success of the HPI were collected in two-part, structured telephone interviews. Descriptive statistics were used to characterize schools and study participants. Twenty-eight potential correlates of perceived HPI success were investigated separately in multivariable linear regression modelling. Results Participants generally perceived HPIs as highly successful. After controlling for number of students, language of instruction, school neighbourhood and school deprivation, we identified five correlates of perceived success, including lower teacher turnover, higher scores for school physical environment, school/teacher commitment to student health, principal leadership and school being a developer (vs. adopter) of the HPI. Conclusion If replicated, these factors should be considered by HPI developers and school personnel when planning and implementing HPIs in elementary schools.