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Adolescents Selling Sex and Sex as Self-Injury
Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There are today only a few population-based studies in the world investigating the prevalence of and associated risk-factors with adolescents selling sex and so far no earlier population-based study has been found investigating adolescents motives for selling sex. Further, to use sex in means of self-injury (SASI) is a behaviour that has been highlighted in Sweden the last years but it is a new field of research and a behaviour in need of conceptualization.

The aim of this thesis was to investigate the prevalence of, associated risk factors with, motives for and manifestations of adolescents selling sex and the use of sex as self-injury (SASI). For the thesis, two nationally representative cross-sectional population surveys with third year students at Swedish high schools were collected in 2009 (n = 3498, mean age 18.3 +/- 0.6 years, response rate 60.4%) and in 2014 (n = 5839, mean age 18.0 +/- 0.6 years, response rate 59.7%). Further, the motives and manifestations of SASI were investigated in an anonymous self-selected, open-ended questionnaire published on websites of non-governmental organizations offering help and support to women and adolescents (n = 199, mean age 27.9 +/- 9.3 years). Quantitative and qualitative methods were used for data analyses.

In the 2009 population-based survey, 1.5% (n = 51) of the adolescents reported having sold sex on at least one occasion, but in 2014 the prevalence was slightly lower at 0.9% (n = 51). SASI was reported by 3.2% of girls (n = 100) and 0.8% of boys (n = 20). Both selling sex and SASI were associated with various adverse factors such as experience of sexual abuse, emotional and physical abuse, poor mental health and self-injury. Adolescents selling sex had sought help and support for different problems and worries to a greater extent compared to peers. Contact with healthcare for various psychiatric problems such as suicide attempts, depression and eating disorders was common for adolescents using SASI. Further analysis showed that adolescents selling sex are a heterogeneous group in regard to underlying motives for selling sex, which included emotional and material reasons as well as pleasure. Depending on their underlying motives, adolescents selling sex were found to differ in regard to compensation received, age of the buyer, means of contact with the buyer, sexual orientation, experience of sexual abuse and the use of SASI. By using data from an open-ended questionnaire, SASI was described as deliberate or self-inflicted sexual situations that could include psychological and physical harm. SASI was used as a way to regulate negative feelings, such as anxiety, or to get positive or negative confirmation and the behaviour could be hard to stop.

In conclusion, selling sex and SASI occurs among Swedish adolescents and the behaviours are associated with sexual, physical and emotional abuse and poor mental health, including trauma symptoms. In regard of the motives and manifestations of SASI, the behaviour could be compared to direct self-injurious behaviours. Data from this thesis suggest that more attention should be paid in healthcare to recognizing adolescents selling sex and SASI in order to prevent further traumatization and victimization.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. , p. 76
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1645
Keywords [en]
Adolescents, Selling sex, Sex as self-injury, Child sexual exploitation, Sexual abuse
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology Substance Abuse Psychology (excluding Applied Psychology) Geriatrics
Identifiers
URN: urn:nbn:se:liu:diva-153569DOI: 10.3384/diss.diva-153569ISBN: 9789176852040 (print)OAI: oai:DiVA.org:liu-153569DiVA, id: diva2:1272828
Public defence
2019-01-18, Berzeliussalen, ingång 65, Campus US, Linköping, 09:00 (Swedish)
Supervisors
Available from: 2018-12-21 Created: 2018-12-20 Last updated: 2018-12-21Bibliographically approved
List of papers
1. Adolescents selling sex: Exposure to abuse, mental health, self-harm behaviour and the need for help and support - a study of a Swedish national sample
Open this publication in new window or tab >>Adolescents selling sex: Exposure to abuse, mental health, self-harm behaviour and the need for help and support - a study of a Swedish national sample
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2013 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 67, no 2, p. 81-88Article in journal (Refereed) Published
Abstract [en]

Selling sex is not uncommon among adolescents and we need to increase our knowledge of how this affects them. The aim of this study was to investigate adolescents who sell sex regarding sexual, mental and physical abuse, mental health as estimated by using the Hopkins Symptom Check List-25 (HSCL-25), self-harm behaviour and the adolescents' experience of receiving help and support. The study was carried out on a national representative sample of adolescents (mean age 18.3 years) in Swedish high schools in the final year of their 3-year programme. The study had 3498 participants and a response rate of 60.4%. Of the adolescents, 1.5% stated that they had sold sexual services. The selling of sex was associated with a history of sexual, mental and physical abuse. Poorer mental health and a higher degree of self-harm behaviour were reported among the adolescents who had sold sex. Help and support was sought to a greater extent by adolescents who had sold sex but these adolescents were not as satisfied with this help and support as the other adolescents. Adolescents that sell sex are a group especially exposed to sexual, mental and physical abuse. They have poorer metnal health and engage in more self-harm behaviour than other adolescents. They are in need of more help and support than other adolescents ant it is reasonable to assert that more resources, research and attention should be directed to this group to provide better help and support in the future.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
adolescents, child abuse, help and support, mental health, self-harm behaviour, selling sex
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:liu:diva-91850 (URN)10.3109/08039488.2012.679968 (DOI)000316956800001 ()
Available from: 2013-05-03 Created: 2013-05-03 Last updated: 2018-12-21Bibliographically approved
2. Adolescents motives for selling sex in a welfare state - A Swedish national study
Open this publication in new window or tab >>Adolescents motives for selling sex in a welfare state - A Swedish national study
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2018 (English)In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 81, p. 286-295Article in journal (Refereed) Published
Abstract [en]

In addition to money or other compensation, other motives for selling sex may be important in a welfare country such as Sweden. The aim of this study was to carry out an exploratory investigation of adolescents motives for selling sex in a population-based survey in Sweden. A total of 5839 adolescents from the third year of Swedish high school, mean age 18.0 years, participated in the study. The response rate was 59.7% and 51 students (0.9%) reported having sold sex. Exploratory factor analysis and hierarchical cluster analysis were used to identify groups of adolescents according to underlying motives for selling sex. Further analyses were carried out for characteristics of selling sex and risk factors. Three groups of adolescents were categorized according to their motives for selling sex: Adolescents reporting; 1) Emotional reasons, being at a greater risk of sexual abuse, using sex as a means of self-injury and having a non-heterosexual orientation. 2) Material but no Emotional reasons, who more often receive money as compensation and selling sex to a person over 25 years of age, and 3) Pleasure or no underlying motive for selling sex reported, who were mostly heterosexual males selling sex to a person under 25 years of age, the buyer was not known from the Internet, the reward was seldom money and this group was less exposed to penetrative sexual abuse or using sex as a means of self-injury. In conclusion, adolescents selling sex are a heterogeneous group in regard to underlying motives.

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD, 2018
Keywords
Selling sex; Adolescent; Child sexual exploitation; Motives; Prostitution
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-149697 (URN)10.1016/j.chiabu.2018.04.030 (DOI)000436375800026 ()29775872 (PubMedID)
Note

Funding Agencies|Ministry of Health and Social Affairs/the Childrens Welfare Foundation Sweden; County of Stockholm, Sweden

Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2019-05-01
3. Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health
Open this publication in new window or tab >>Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health
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2017 (English)In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 11, no 1Article in journal (Refereed) Published
Abstract [en]

Sex as self-injury has become a concept in Swedish society; however it is a largely unexplored area of research, not yet conceptualized and far from accepted in the research field. The use of sex as a way of affect regulation is known in the literature and has, in interviews with young women who sell sex, been compared to direct self-injury, such as cutting or burning the skin. The aim of this study was to investigate the self-reported frequency of sex as self-injury and the association to sociodemographic factors, sexual orientation, voluntary sexual experiences, sexual risk-taking behaviors, sexual, physical and mental abuse, trauma symptoms, healthcare for psychiatric disorders and non-suicidal self-injury.

Place, publisher, year, edition, pages
BioMed Central, 2017
National Category
Neurosciences Rheumatology and Autoimmunity Psychiatry
Identifiers
urn:nbn:se:liu:diva-134927 (URN)10.1186/s13034-017-0146-7 (DOI)000395328600001 ()
Available from: 2017-03-02 Created: 2017-03-02 Last updated: 2018-12-21Bibliographically approved

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Fredlund, Cecilia

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