Background: The aim of the present study was to examine the impact of professional preparation and class structure on health content delivery and time spent delivering content among required health education classes in the United States. Methods: Data from the classroom-level file of the 2006 School Health Policies and Programs Study were utilized. A series of multivariable logistic regression models were employed to determine if instruction of content was dependent on professional preparation and/or class structure. Years of teaching health topics and size of the school district were included as covariates in the multivariable logistic models. We also conducted a multivariable logistic regression model to examine if time spent teaching each topic area was dependent upon professional preparation and/or class structure. Results: Findings indicated that professionally prepared teachers were significantly more likely to deliver content in 6 of 12 health topic areas when compared to untrained teachers. Class structure was also an important predictor of content delivery among many topic areas. Teachers who taught classes that were devoted to health instruction were significantly more likely to deliver content in the following topic areas: alcohol/drug prevention, tobacco prevention, sexuality, pregnancy, human immuno virus and sexually transmitted disease prevention, emotional/mental health and suicide, and violence prevention. Conclusions: Research concerning the relationship between professional preparation and teaching outcomes is scant. The present study indicates that health content coverage and time spent on instruction are associated with both professional preparation and class structure for many health content areas. (Contains 4 tables.)