The health decision-making dynamics of adolescents in New York and Montana are assessed. Ninth-grade students were asked to make a decision on a hypothetical dilemma scenario. From their choice they were classified as either health-promoting decision makers (HPDM) or health-risky decision makers (HRDM). They were subsequently asked a series of questions dealing with future health choices, degree of reflection, the effect of stress upon choice selection, and type of cognition during decision. Results indicate that HPDM intended not to engage in future, risky sexual behavior or drinking and driving behavior(s). Health-risky decision makers were, however, more reflective in making their initial choice. The variable of stress was not definitive for either group, and significant regional differences were not evident. Implications for the design of school health education program curricula are presented along with suggestions for future investigation