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apple schools comprehensive school health csh project started schools socioeconomically disadvantaged areas dietary habits poor physical activity pa levels low obesity rates high earlier research showed program effects whereby energy intake pa weight status students apple schools reached similar levels students schools however unknown whether effects csh sustained children grow adolescents effects apple schools healthrelated knowledge attitudes selfefficacy diet pa weight status seven years start project students junior high high school assessed hypothesised apple school graduates comparison school graduates remain similar levels indicators 201516 school year junior high high school graduates grades 712 northern alberta canada participated youth health survey participants included graduates apple elementary schools n 202 comparison elementary schools n 338 healthrelated knowledge attitudes selfefficacy diet 24h dietary recall pa pedometer step count weight status assessed mixed effects regression employed assess differences outcomes apple school graduates comparison school graduates comparisons elementary school 200809 junior highhigh school 201516 selfefficacy pa weight status also conducted apple school graduates significantly differ comparison school graduates outcomes ie knowledge attitudes selfefficacy diet pa weight status additionally significant differences existed comparisons 200809 201516 findings difference apple school graduates comparison school graduates suggest effects apple schools may continue adolescence new school environment may equalizing effect students since lifestyle practices adopted throughout childhood adolescence school environment important influence development extension csh initiatives junior highhigh schools considered help consolidate support continuance healthy lifestyle messages practices throughout childhood adolescence