Abstract
more symptoms, and lagging behind males in self-esteem and general well-being. An interaction between gender and the intervention was Post-primary school students (n ⍧ 2407) and young adults (n ⍧ 477) participated in a crossidentified among senior pupils. Exposure was especially beneficial for females. However, as sectional evaluation of a health education programme for schools. The Lifeskills proyoung adults, the two main effects of gender and programme participation re-emerged as the gramme is based on a philosophy of student empowerment, and aims to teach knowledge and most important independent variables, and the interaction between them was not significant. skills relevant to health promoting behaviour. School students were recruited in schools, while This pattern has implications for the interpretation of evaluations conducted on short-term young adults were opportunistically recruited in workplaces, training centres and on public interventions as well as for short-term impact evaluations. transport. Those who attended schools where Lifeskills had been taught and who remembered
Introduction
such lessons were conservatively classified as the intervention group, while those who attended other schools and did not remember
Introduction
The Irish public health system divides the country into eight regional Health Boards, each of which such lessons were classified as the comparison group. Participants completed questionnaires is responsible for the development and implementation of regional health strategy. These responsibilitdesigned to collect data on health-related behaviours, indicators, knowledge and psychological ies include health promotion and health education. Historically, liaison between the health and educahealth. School-level factors were employed as covariates in subsequent analyses of covariance.
Introduction
of the North Western Health Board (NWHB) is appropriate methodology, focusing on the use of quasi-experimental designs in evaluating health the Lifeskills programme for schools which is offered to all schools within the region. Introduced promotion [e.g. (McKinlay et al., 1989; Murray et al., 1989) ]. However, no baseline data were to second-level schools (pupils aged 12-18) in 1981 and primary schools (ages 4-11) in 1991, the collected prior to the implementation of the Lifeskills programme. Neither has there been any programme's philosophy is one of empowering young people through equipping them with a simple random or stratified allocation to intervention groups. Each school has been free to customize variety of skills for choosing healthy behavioural options (McLoone and McAuley, 1985) . the programme to its own perceived requirements. As a result it is only possible to conduct an quasiThe main components of the NWHB's promotion of this programme have been the development experimental evaluation (Best, 1989) . Rather than being able to address the question whether this of materials, including lesson plans, and in-service teacher training on educational aspects of health programme can have an influence on pupils (efficacy), it is only possible to ask whether the promotion and personal development. All teachers are offered annual refresher courses immediately programme as implemented has an influence (effectiveness). In addition it has been necessary before the new school year begins. These courses comprise teaching methods, guidelines on manageto compare the intervention group to a comparison rather than a control group and accordingly to ment and administration, and topic-specific input based on curriculum content. In most schools, investigate sources of non-equivalence between the groups. pupils receive one class a week (about 45 min) in Lifeskills. However time-tabling can vary from While gender and social class effects are relatively common factors associated with various four classes per week to none. Nevertheless, Lifeskills is now the most comprehensive schools' health behaviours and attitudes (Friel et al., 1999) , measures of psychological well-being have also health education programme in the country.
Introduction
The policy context of this field has developed been found to vary between socio-demographic groups. Perceived control over life circumstances and changed substantially since the inception of the Lifeskills programme in 1981, resulting in is inversely distributed by social status (Thoits, 1995) . For example, research evidence indicates increasing calls for comprehensive reviews and research into current practice [e.g. (Metcalfe, that females, minority group members, and those of lower education and income exhibit higher 1993)]. Similar appeals for research and development have also come from other countries, fatalism or a lower sense of mastery, personal control or internal locus of control [see reviews in including the US (Corry, 1992) , Canada (Hart-Zeldin, 1990) and Australia (Coonan et al., (Mirowsky and Ross, 1989; Turner and Roszell, 1994) ]. 1990). In addition, the widescale introduction of the health-promoting school (HPS) concept throughout Heath education or school-based health promotion is often assumed to have uniform effects on Europe (Parsons et al., 1997) , which focuses on a more holistic view of the school as a setting for students. Of particular relevance to the present study is the frequent failure in evaluation of specific health promotion, renders it timely to assess as accurately as possible what has already been and comprehensive health education promotion interventions to present findings by gender [e.g. achieved in various contexts. One of the major tenets of the HPS model is the introduction of a (Connell et al., 1985; Moberg and Piper, 1990; Arbeit et al., 1992; Nutbeam et al., 1993 ; Morgan, health education curriculum. The Lifeskills programme contributes just such a curriculum. It is 1997)] or even to control for gender effects (Ashworth et al., 1992; Kooler and Bruvold, 1992 ; in this context that the current evaluation was conceived. Schonfeld et al., 1995; Hausman et al., 1996) . Where gender is included as a variable, findings Numerous authors discuss the importance of are inconsistent. For example, Edmundson et al. post-primary schools in an adjacent Health Board area. The post-primary school students were report on absence of gender interactions in their evaluation of a child and adolescent trial for categorized according to whether they could remember receiving Lifeskills or health education cardiovascular health (Edmundson et al., 1996) ; Duitsman and Cychosz and Snow et al. found no classes. Those from schools where Lifeskills was taught and who recalled such classes were categorgender effects in their evaluations of drug education (Duitsman and Cychosz, 1997; Snow et al., 1997) ; ized as Lifeskillsϩ, those who were from schools where no Lifeskills or health education was taught and Ary et al. found no gender differences in the efficacy of school-based smoking prevention (Ary and who did not recall any such classes were categorized as Lifeskills-. et al., 1990) . Others, however, have reported differential effects on females and males. Arborelius
Introduction
An opportunistic sample of young adults from the region who had experienced the programme and Bremberg reported more significant differences for female pupils than for male pupils on a variety was obtained from several sources as follows. (1) Two centres of the state vocational training agency of outcome measures in a quasi-experimental evaluation of a student-centred model of health FÁ S agreed to assist in data collection, and released trainees from classes and workshops to complete education (Arborelius and Bremberg, 1988) . In contrast, Holcomb et al. reported a greater impact questionnaires in a classroom setting with research staff. (2) Two large factories in the region also on males of a date-rape prevention intervention (Holcomb et al., 1993) and O' Leary et al. found agreed to distribute questionnaires to employees who were under 25. Questionnaires with stamped a stronger influence on males following an AIDS prevention programme (O'Leary et al., 1996) . Such return envelopes were duly sent through internal company mail. Factory respondents were also given differences may be attributable to a variety of factors, including the design and implementation the option of returning completed questionnaires through a post box located close to their respective of the intervention. Nevertheless, they highlight the relevance of including analysis by gender in staff rooms. Posters to encourage returns were placed in various locations throughout the two any evaluation plan.
Introduction
plants and two sets of reminders were also distributed directly to potential participants. (3) Students
Method
in third-level education: there is no university in the NWHB region and young people from the area This paper reports on two research strands in an evaluation of the Lifeskills programme: those frequently attend university or technical college in the nearest large city, which is a 2-3 h drive away. concerned with post-primary school students (aged 12-17) and adult 'graduates' of the Lifeskills Local entrepreneurs provide private buses from this city to various parts of the NWHB region and programme, i.e. young adults (aged 18-25) who had received Lifeskills classes while they were they agreed to allow researchers to travel on these buses with the aim of recruiting participants. in school. Both groups were assessed using a standardized self-completion questionnaires and During a total of 14 bus journeys, researchers approached all passengers individually and were compared to constructed comparison groups.
Method
explained the purpose of the study according to a
Method
Participants and procedure strict research protocol. Although all those aged under 25 from the NWHB were included in this A random sample of classrooms in all post-primary schools in the NWHB were invited to participate. study, they were not all third-level students, and thus the sample also included employed and unThe sampling frame comprised individual class groups. The self-report responses of these students employed young adults. The adult sample was divided into Lifeskillsϩ were compared with those of a comparison group of pupils in randomly selected classrooms from 12
Method
and Lifeskills-groups using the following criteria:
Method
those who had been in schools which reported 30 countries are now involved in this study and the data collected are readily comparable notwithteaching Lifeskills during the time they were in school and who remembered receiving some form standing the usual problems in cross-national interpretation. The core section of the questionnaire of health education were classified as the Lifeskillsϩ group. Those who were at schools is those parts which have remained constant over time and are used in all participating countries, which did not teach the Lifeskills programme and who could not remember receiving any form of and includes demographic questions concerning parental occupation, gender and household comhealth education were classified Lifeskills-. These participants were assessed using a standardized position. Social class was determined from parental occupation according to the Provisional Irish Social questionnaire battery analogous to that employed with the post-primary students.
Method
Class Scale (O'Hare, 1982) . In addition to the HBSC questions on health Two separate pilot studies were undertaken, the first with second year post-primary pupils, aged behaviours, attitudes and symptoms, a number of measures of psychological health were selected for 13-14 (nϭ30) from a third health board area, the second with adult post-graduate students, aged inclusion according to relevance to the original objectives of the Lifeskills programme. McLoone 22-30 (nϭ23). Both were intended to help assess the suitability of the measurement tools for the and McAuley describe Lifeskills teaching as 'education for living ' (McLoone and McAuley, target groups. 1985) , which should enhance students' self-esteem
Measurement
and belief in their capacity to control their own life. In order to assess these aspects of psycholoPrincipals in all schools completed a specially devised short one-page questionnaire containing gical health the following questionnaires were administered to the pilot participants. questions on structural aspects of the school (teacher and pupil numbers, estimated percentage
Measurement
Internal reliability of pupils from rural backgrounds) as well as a series of items relating to the concept of the HPS d The Rosenberg Self-Esteem Scale (Rosenberg, 1965) , which attained α scores in the pilot Kelleher, 1995, 1998 Schooler, 1978, 1981) (α ϭ 0.49 and 0.73, respectively) purpose of the HBSC is to document the behaviours of children so as to inform health promotion d The Social Adjustment Questionnaire (Weissman et al., 1971 (Weissman et al., ,1978 , which has six strategists in the various countries. Every 4 years, random samples of not less than 1500 young people subscales: work, leisure, family unit, partner, children and extended family (partner and aged 11, 13 and 15 year in each collaborating country are taken (Aaro and Wold, 1989) . Over children were omitted for school students). The α values were 0.51-0.68 for the children and any individual pupil has had. It is likely that the level of exposure varies within any individual 0.51-0.84 for the adults. d Finally, a 15-item knowledge questionnaire was classroom as well as within schools and thus amalgamating the class for analysis would mask constructed based on the content of the postprimary Lifeskills curriculum. This questionthis variability. Second, the region is the most rural in the Republic of Ireland and students from naire was also administered to the post-primary school pilot participants, where it attained a many different social backgrounds sit together in classrooms. In rural Ireland, post-primary school Kuder-Richardson coefficient of 0.75. pupils are very rarely educated separately by gender Those which exhibited most adequate internal or social status. Such variables are known or reliability as well as acceptable distributions were hypothesized to have be associated with health subsequently employed with the study participants.
Measurement
status and reported health behaviour on health These comprised: the HBSC core questions, the (Nolan, 1994; McDermott et al., 1997; Riley et al ., Rosenberg Self-Esteem Scale, the Mastery Scale, 1998). Therefore, treating the class as the unit of the General Wellbeing Scale, the Social Adjustment analysis would mask the range of socio-demoQuestionnaire and the Knowledge Questionnaire.
Measurement
graphic strata in the room. Finally, employing the Slightly different versions of the final research individual rather than the class as the analysis unit instrument were developed for adult and youth maximizes statistical power. participants. For example, the adults were asked Multiple analyses of covariance were carried about school in the past tense and the young people out employing gender, social class and group as were not asked about relationships with their independent variables, and the reported healthchildren or partners.
Measurement
related factors as the dependant variables. In addi- tion, educationalists [e.g. (Finlayson, 1991) ] strongly recommend the consideration of 'school As in other situations where data are collected from existing groups, the potential for group effects factors' when interpreting work of this nature. This refers to such variables as school size and type; is present. One response would be to treat the classroom or the school as the unit of analysis.
Analyses
the nature of a school's philosophy or ethos should also be taken into account. Obviously these factors The difference in the number of schools in the comparison and intervention groups is also relevant could have an important effect on students behaviour, attitudes and feelings, but also on the quality to this question, because there are fewer schools (n ϭ 12) in the comparison group, the potential of support given to the programme and hence its level of implementation within the school. The for school effects is greater. In relation to classroom effects, Roberts et al. (Roberts et al., 2000) present data collected from principals regarding the school and the HPS attitudes and policies were employed design factor values calculated on the international HBSC data. These vary by age group, country and to address these issues. Possible effects of school type were controlled by employing gender of variable, e.g. for frequency of exercising they range from 1.09 to 1.41, for eating burgers they range pupils, social class make-up, rurality, HPS attitudes and HPS policies, and school size as covariates from 1.01 to 1.43 and for smoking from 1.20 to 1.71. Thus these should be considered when when they varied significantly between groups. These analyses were conducted according to interpreting the data presented in Table I .
Analyses
The individual students were chosen as the unit guidelines suggested by Tabachnick and Fidell (Tabachnick and Fidell, 1993 ) and Wildt and Ahtola of analysis for three reasons. The potential for individual differences in exposure to Lifeskills is (Wildt and Ahtola, 1978) . For the young adults, age, gender social class, high. Detailed notes on implementation have not been kept by teachers, students or schools, so it is number of years of full-time education, possession of a post-school qualification and rurality were all impossible to ascertain exactly how much exposure a This reflects those school students who reported that they had ever felt 'really drunk' and those adults who reported that they had felt 'really drunk' 10 or more times.
Analyses
explored as sources of non-equivalence between responded positively and a total of 1436 completed groups. These two groups of adults differ significquestionnaires were returned from these pupils. Of antly on only one possible covariate. The these, 795 were classified as Lifeskills-and 825 Lifeskillsϩ group are less likely to report that they as Lifeskillsϩ. had achieved further qualifications after leaving
Young adults
school. Thus receipt of a further qualification was employed as a covariate in subsequent analyses
Young adults
In total, 477 completed questionnaires were for the young adults.
Young adults
returned from young adults as follows. (1) Eightyfive percent of the registered FÁ S trainees were Results present on the day and all agreed to participate. Thus 220 completed questionnaires were returned.
School students
(2) In total, 25 responses were received from the first factory, representing 27% of the under 25s A sample of 971 students from 33 post-primary employed in the factory. Thirty-five responses were schools in the NWHB area returned completed received from the second factory, representing 64% questionnaires. This represents 77% of those of the under 25s employed there. The differences classrooms who were invited to participate. In the comparison group, 92% of selected classrooms in response rate are attributable to various person- nel and industrial relations difficulties in the first being. In years 3 and 4 (ages 13-15), some gender differences remain but most differences are factory during the period of data collection. (3) In between the Lifeskillsϩ and Lifeskills-group, total, 197 completed questionnaires were returned and the interaction between gender and Lifeskills by bus passengers out of 284 distributed (69%).
School students
begins to emerge. Fifty percent of these respondents were female and
School students
In the final year (ages 16-17), there is a clear their mean age was 23.85, 75% were single and interaction between gender and receipt of Life-48% reported that they lived in the countryside, skills. At this stage the Lifeskillsϩ pupils show 53% reported that they had attended post-primary an advantage in relation to reported drunkeness, school in the NWHB with a mean of 14.56 years and the gender differences on self-esteem and of full-time education. These young adults were general well-being are maintained. Although a subsequently classified as Lifeskillsϩ (n ϭ 188) small number of social class differences were and Lifeskills-(n ϭ 129), according to the criteria identified, these were not sustained across dependoutlined above.
School students
ent variables or over years and are therefore not
Descriptive analyses
reported here. An illustration of the gender by Lifeskills interaction for senior pupils is contained The incidence of health behaviours, attitudes and in Figure 1 . The dependent variable in this case is symptoms (percentages) for both the school drinking beer. Figure 1 shows the increase in beer students and young adults are presented in Table I. drinking across age groups and the retardation that Mean scores on the measures of psychological occurs in this increase for Lifeskills females. These health and knowledge for all groups are presented differences are non-significant at Year 1 (F ϭ 3.02; in Table II. d.f. 1,164; P Ͼ 0.05) but the interaction (F ϭ
Inferential analyses
6.98; d.f. 1,132; P Ͻ 0.01) and simple main effects The results indicate different patterns across the of gender and Lifeskills at Year 5 are statistically various age groups (Table III) . In the first 2 significant. years of post-primary school (ages 11-13), most
Inferential analyses
In young adulthood, most Lifeskills by gender significant differences relate to gender irrespective interactions are not significant and three-way of whether students were in Lifeskills classes or (genderϫsocial classϫLifeskills) analyses of not. Although the females report more positive covariance illustrate a number of positive effects health behaviours, they also report more symptoms, related to either gender or Lifeskills. Significant effects are presented in Table III . Substantial gender and lower levels of self-esteem and general well- differences emerge amongst the adults which Discussion mirror those found amongst the younger school students. The main effect of the Lifeskills experience seems to be on participants drinking of beer, The main impact of the Lifeskills programme is related to substance use, specifically alcohol. By wine and coffee.
Inferential analyses
When compared to 15-year-old children in other European countries and Canada (King and Coles, 1992) employing exactly the same HBSC questions, the NWHB 15 year olds in this sample reported less alcohol use than those in other countries and their pattern of use was remarkable. Although fewest of them had ever drunk alcohol (81% of males and 67% females), they were also most likely to report that they were weekly drinkers (47% of all males and 37% of all females), so fewer of them drank, but those that did drank regularly. In addition, the NWHB 15 year olds reported the lowest frequency of 'ever having been really drunk' (23% of all males and 15% of all the time they were 15-16, Lifeskillsϩ children females). It is unlikely that their perception of drank significantly less often and reported lower what 'really drunk' means differs substantially rates of drunkenness. These differences applied from those in all other countries, including across all social classes in both males and females, Northern Ireland, Scotland and Wales, and thereand became more marked as they got older. Given fore this may suggest that although these children that alcohol is the substance most widely abused drink regularly, they do so relatively sensibly. in Irish society (Morgan, 1994) , these results indiOverall, the programme appears to have had a cate an important impact of Lifeskills on drinking differential effect over time on the females, at least behaviour among young people and suggest that during the school years. While large sex differences the programme makes a positive contribution in characterize the responses of younger students, this area. However, the failure to detect the effects with females behaving more positively but feeling on other behaviours, especially smoking, should worse, by the time they reach the senior years, the be noted. It is hypothesized that interventions females seem to be benefiting from exposure to a targeting tobacco behaviour should begin at a greater extent than the males. This benefit is much earlier stage in the development of health identified across a range of behaviours and health behaviours during the primary school years. From indicators. Multiple analyses of covariances reveal a research perspective closer attention should be that females who had received the Lifeskills progiven to the factors hypothesized as influencing gramme reporting higher levels of well-being, both initiation into and maintenance of smoking fewer symptoms and more positive behaviours behaviour in the Irish context. than males who had been similarly exposed and The consistent effect related to alcohol behavifemales who had not. These findings illustrate the ours throughout the age ranges suggest that the importance of taking socio-demographic factors, effect is likely to be real and related to the impact especially gender, into account in any evaluation. of the Lifeskills educational programme. However, They also illustrate the importance of sustained it is possible that reported behaviours do not programming and the possibility of delayed effects. reflect actual behaviours. Nevertheless, the fact School students here did not exhibit substantial that Lifeskillsϩ pupils consistently report in this effects attributable to the intervention until their manner suggests at the very least the success of third year of post-primary school even though most the programme as an educational tool about the had been in receipt of the programme for up to boundaries of appropriate behaviour and sharonlynch@example.com academic years at that stage. This suggests that its efficacy in influencing perceived social norms regarding drinking behaviour.
Inferential analyses
short-term interventions either may not be of measurable benefit or that the effects of such are data on these topics from a wider section of the delayed, or indeed both.
Inferential analyses
school community-teachers, pupils and parents. If school students had been the only participants
Inferential analyses
In conclusion, this study is an example of in this evaluation the gender patterns presented an evaluation of an operational health education would result in a call for more emphasis to be programme rather than one specifically designed placed on males and further investigation of the and eagerly delivered for demonstration purposes. appropriateness of health education methods While the benefits of Lifeskills have shown thememployed for such males. The added value of the selves sustainable at least into early adulthood, the current study lies in the addition of the adult interactions with gender are interestingly short in 'graduate' group. While the evidence presented duration. Health issues remain for females with here suggests a sustained impact of the Lifeskills almost the same advantages and disadvantage as programme on alcohol consumption, it also highindicated over the 10 years or so from early postlights substantial gender differences. With the primary school to early adulthood. This finding exception of exercise, females report more positive illustrates the value of the difficult task of locating health behaviours, more symptoms, and lower programme graduates and implies the potential levels of self-esteem and general well-being. In benefits of employing a true longitudinal design fact, many of the disadvantages and advantages for the evaluation of intervention programmes. females exhibit in early post-primary school are also present among young women. This emphasizes

{'paper_id': '18644375', 'title': 'School health education and gender: an interactive effect?', 's2_url': 'https://api.semanticscholar.org/CorpusID:18644375', 'source': 'S2ORC'}