Relatively little is known about risk behaviors of elementary school children. A recent evaluation of a comprehensive school health education curriculum provided an opportunity to survey elementary school children about their perceived health status, knowledge, attitudes, health self-efficacy, and health and risk behaviors. For the evaluation, a total of 4273 surveys were completed by 2 cohorts of school children, grades 2 and 4, in 24 schools in a large urban school district during the spring semesters of 2002; the cohorts were surveyed a second time when they were in third and fifth grade in spring 2003. Older children scored higher than younger ones on factors generally associated with improved health behaviors (such as health knowledge and refusal skills); yet, they scored lower than younger children on healthy behaviors, especially risk behaviors and those things presumed to be associated with later adolescent risk taking. The interrelationships among behavior, knowledge, age, and school-level attributes are explored. As health knowledge, refusal skills, and other protective factors increase, health behaviors improve slightly, but the most important factor in explaining health behaviors is grade level. This article points to the need to study the development of risk behaviors throughout elementary school and the need for additional work on the measurement of risk behaviors during the elementary school years.