This study proposes and tests a new model that seeks to explain associations between religion, spirituality and health outcomes among adolescents. Specifically, we test for mediating effects of perceived spirituality on religion–health relations. Using data from the 4-H Study of Positive Youth Development, we find that perceived spirituality mediates religion–health relations, but that varies based on youths’ conceptualisation of spirituality. With findings confirming that perceived spirituality potentially promote youths’ psychosocial health, we offer some future research directions and implications regarding relations between youths’ spirituality, religion and health behaviours.