Objective: Adolescence is presented as a vulnerable period for accidental injury, particularly spinal cord injury, given young people's propensity for risky behaviours. School-based health promotion initiatives provide opportunities for education about the risks associated with dangerous behaviours. In this study, we aimed to describe young people's safety beliefs before and after a school-based spinal cord health promotion and awareness presentation. The effect of selected demographic characteristics on safety beliefs was also examined. Design: A pre-post design was used to record group and time point differences on a range of specific safety beliefs before and after the presentation. Setting and method: The Spinal Education and Awareness Team (SEAT) from Spinal Life Australia conducted a health promotion and awareness presentation with 1,410 students aged 14-19 years across 13 secondary schools in Queensland, Australia. Presentations took place in regional, metropolitan and provincial city schools. A survey assessing basic demographic characteristics and specific risk behaviours was completed by students before and after the presentation. Results: T-tests and chi-square analyses were conducted to examine time point and group differences in relation to the SEAT presentation and to determine relative risks between subgroups of young people. A total of 705 pre-surveys (50%) and 735 post-surveys (52%) were analysed. Overall, reported beliefs were significantly safer post-presentation compared to pre-presentation (all t > 6.93, p < 0.001). Rural adolescent boys licensed to drive emerged as a particularly risky sub-group and were over three times (odds ratio [OR] = 3.35, 95% confidence interval [CI] = 1.34, 8.40) more likely than their metropolitan peers to hold less safe beliefs relating to spinal cord injury. Conclusion: Findings indicated that the health promotion and awareness presentation increased awareness of spinal cord injury risk behaviours overall and improved adolescent-related safety beliefs. Licensed adolescent boys from rural areas reported little change in awareness post-presentation, further highlighting the importance of targeted health promotion initiatives in rural areas. Extended research is required to further explore the belief-behaviour interaction in this at-risk population.