Background Back pain is one of the most important public health problems. It is on rise among adolescent and pupils’ population. The aim of this study was to assess the relationship between cognitive factors (skills, knowledge, self-efficacy, and expectation beliefs) and back care behavior among pupils.Methods A cross sectional study was conducted on a random sample of students attending public elementary schools in Tehran, Iran from October 2018 to March 2019. They completed a questionnaire containing items on cognitive abilities and a checklist to assess their skills on back care behaviors. Stepwise multiple regression analysis was performed to find out the contribution of cognitive factors on outcome.Results In all, 204 students were entered into the study. The results revealed that 95.3% of the variance in the back behavior was explained by self-efficacy (β=0.586, t=12.08, P<0.001), expectation beliefs (β=0.232, t= 5.08, P<0.001), and skills (β=0.181, t=4.46, P<0.001).Conclusion These results showed that the pupils who had more confident, skills, and expectation beliefs were more likely to do proper back behavior. In this regard, school-based back pain prevention interventions should be addressed using key cognitive factors that consider the potential change strategies.