Objectives : To raise middle school student awareness, attitudes, and proactive behaviors about immunization, and to increase immunization rates among middle school students through implementation of a comprehensive integrated immunization promotion curriculum ( Immunization Plus! ) Methods: Evaluation used a quasi-experimental non-equivalent comparison- groups design conducted in a sample of 40 classrooms in 22 schools in California. Results: Sixth-grade students exposed to the curriculum developed more positive knowledge and attitudes, and were more likely to be immunized, to intend to obtain newly required immunizations, and to tell parents about immunizations. Conclusion: Infectious disease control and immunizations are under-developed subject areas within school-based health promotion in the United States that can be effectively taught to middle school students.