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Background According to Taiwan health promoting school (HPS) accreditations program, the school was recognized with a gold award, silver award, bronze award, participation award, and non-awards. Previous studies have foci on the effectiveness of the HPS from the perspective of students' health behaviors. The main purpose of this study is to compare the students' health and social outcomes in different HPS award levels to assess the effectiveness of the HPS program. Methods This cross-sectional survey was conducted to 121 schools registering HPS accreditation program in 2018. Overall, a total of 8812 elementary, junior and senior high school students completed the questionnaire. The accredited schools were classified into four categories according to the award level: excellent (5 schools with gold), good (32 schools with silver), fair (23 schools with bronze and 18 schools with participation), and poor (44 schools with non-award). The outcome variables included perceived health status, well-being, and quality of life. The descriptive statistics and ANOVA were analysed using SPSS 20.0 software. Results There were awards level differences of students' health (F = 10.66, p&amp;lt;.001) and social outcomes (e.g. well-being: F = 3.76, p&amp;lt;.01; quality of life: F = 11.58, p&amp;lt;.001). From the perspective of health outcomes, the results found that schools with excellent level (Mean=3.59), good level (Mean=3.52), and fair level (Mean=3.47) were better in students' perceived health status than schools with poor level (Mean=3.38). Similarly, the results showed that schools with excellent level were better in students' well-being (Mean=7.63) and quality of life (Mean=34.56) than schools with poor level (Mean=7.25; 33.56). Conclusions Students from schools with excellent levels exhibited better health and social outcomes. The finding suggests that future studies evaluate and track the effectiveness to conduct the longitudinal study, and the HPS program should be effectively implemented and sustained. Key messages To explore the effectiveness of the health promoting school program in health and social outcomes. Note: This work was funded by the Health Promotion Administration, Ministry of Health and Welfare. Health promoting schools award level is related to students’ perceived health status, well-being, and quality of life.

Effectiveness of health promoting school program: The relationship of HPS award level and outcome