Does the psychosocial school environment matter for health? : a study of pupils in Swedish compulsory school from a gender perspective

Sammanfattning: Despite the fast-growing evidence of the importance of the psychosocial work environment for the health of adults there is a lack of research about the possible health effects of the work environment among pupils, that is, their school environment. This is especially true for the psychosocial aspects of the pupils' school situation.The overall aim of this thesis was to analyse the importance of the psychosocial school environment for the health of pupils in Swedish compulsory school from a gender perspective.Both quantitative and qualitative methods were used. A cluster sampling technique was used in order to select six different schools in three medium- sized industrial towns in the north of Sweden. The schools were chosen to represent different socio-economic areas. A three-year prospective study was started in 1994, including a cohort of 533 pupils (261 girls, 272 boys) in grade three and grade six. With age-adjusted questionnaires self-perceived health and psychosocial school environmental factors were measured at the baseline study as well as three years later. The total non-response rate was 0.9%.For the qualitative study, two classes (one from grade 2 and one from 5) were selected and followed with focus group interviews once a year for five years. Twenty-nine single-sex focus group interviews were conducted with themes such as: What they feel good and bad about at school; Strategies for enhanced well-being; What it means to have influence at school.High control in combination with low demands in the school situation was associated with the best health and feelings of self-worth. Multiple regression analyses showed that problems in relations with classmates was the most recurrent psychosocial factor at school pardy explaining ill healthdevelopment and decreased self-worth. Girls had a more negative ill health development than boys between grades six and nine. A study of factors associated with ill health in grade nine showed that sexual harassment among girls and lack of classmate support among both boys and girls were significant risk factors for a high degree of psychological symptoms. Generally, social background factors were less important for pupils' health in this study than the psychosocial environment at school.The best predictors for health behaviour among boys and girls in grade nine were factors related to earlier health/health behaviour. The results also indicated that school-related factors could predict future health behaviour, especially in relation to low physical activity among girls.The qualitative study showed that the girls used 'alliance-building' and 'resistance', in order to increase their power, while 'responsibility-taking' and 'withdrawal' could mean maintained subordination. The boys used mastering techniques (various types of abuse, claiming to be the norm, acting-out behavior, blaming the girls, choosing boys only) to maintain their dominance. The girls' active actions for increased power could be of significant importance for their health. An interpretation of the boys' mastering techniques was that the boys' health would benefit if they gave up striving for power over others.Thus, the psychosocial school environment in regard of demand, control, classmate relations and sexual harassment seemed to matter for pupil's health. School health promotion need to be more gender sensitive, through increasing the awareness of the gender regimes at school and addressing the asymmetric and gendered distribution of power between pupils. Democratic strategies for increased power among pupils in subordinate positions should be encouraged and methods need to be developed in order to encourage health promoting femininities and masculinities at school.