AbstractSpiritual health is a topic of emergent interest; however, lack of a clear distinction between spiritual health and religious involvement makes it difficult to understand the potential role of spiritual health as a determinant of health. Analyses of such relationships that cross countries and cultures are rare. We therefore assessed whether differences exist between spiritual health and religious involvement and their respective associations with general indicators adolescent health. The study was based on the 2013/2014 Health Behaviour in School-aged Children study conducted in Canada (n = 10 761) and the Czech Republic (n = 4411). In both countries, we failed to identify strong or statistically significant associations between self-reported religiosity and adolescent health. In contrast, adolescents with higher spiritual health scores consistently reported enhanced levels of general health status. Study findings point to the importance of a strong sense of spiritual health as a protective determinant of adolescent health, and raise questions about religious involvement as protective to adolescent health outcomes.