In 1993 the Massachusetts Department of Public Health (MDPH) began defining essential components of school health service programs, consistent with the public health model. The MDPH designed and funded the Enhanced School Health Service Programs to develop 4 core components of local school health services: (a) strengthening the administrative infrastructure; (b) promoting health education, including tobacco control activities; (c) linking school health services with health care providers; and (d) implementing management information systems. Funds were appropriated in 1992 from the tobacco excise tax. With additional funding appropriated in 1999 and 2000 from the Tobacco Settlement Fund, these school nurse-managed programs have increased in number. The goal is to develop a statewide system of high-quality school health service programs responsive to the specific needs of students in each community. To be effective, these programs must be recognized as essential components of the primary health care delivery system serving children. (Contains 2 tables.)