The aim of this study was to examine the association between watching pornography and poor mental health in three repeated cross-sectional surveys in Sweden (2004, 2009, 2014) among high school seniors (13,277 students) with an average age of 18 years. The same index questions concerning ever having watched pornography and the frequency of watching pornography during the last year were combined with three different measures of psychological health and background control variables in multiple logistic regression and forward stepwise logistic regression models. The repeated cross-sectional surveys did not find any consistent associations across years between poor mental health and ever having watched pornography or the frequency of watching pornography. Having watched deviant pornography (containing violence, children and/or animals) was associated with poor mental health among boys in two surveys but only in one survey among girls. Other characteristics, such as mothers unemployment (especially boys), parenting style (especially high controlling parents among boys) and experiences of sexual abuse (especially penetrating abuse among girls), were more consistently and strongly associated to poor mental health across the three surveys. This study stresses the importance of controlling for multiple background variables when studying the association between watching pornography and mental health, since the association might primarily be explained by underlying confounding variables.

To view destructive sexual behaviors as a form of self-injury is a new concept in the research field that needs further exploration and conceptualization. The aim of this study was to explore experiences of sex as self-injury to identify motives and manifestations of the behavior. An anonymous self-selected open-ended questionnaire was used for the study, and qualitative content analysis was used to identify patterns and themes in the text. A total of 199 informants participated in the study (M = 27.9, SD = 9.3 years), all of whom were recruited via a range of websites of Swedish nongovernmental organizations. Sex as self-injury was described as voluntary exposure to sexual situations including psychological and/or physical harm. Affect regulation and receiving positive or negative confirmation emerged as important motives for the behavior. Respondents described sex as self-injury as difficult to stop when it felt compulsive and addictive, with ever-higher risk-taking and self-harming described. Our findings indicate that sex as self-injury often includes deliberate sexual violence, and is similar to other self-injurious behaviors, including non-suicidal self-injury. Sex as self-injury needs to be addressed in healthcare, such as in psychiatry and gynecology departments, to prevent further traumatization.

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.

PURPOSE: To compare experiences for adverse events, especially sexual abuse, and mental health in a group of high school students in out-of-home care with a representative sample of peers of the same age and similar educational attainment living with their parents.

MATERIALS AND METHODS: A sample of 5839 students in the third year of Swedish high school, corresponding to a response rate of 59.7%, answered a study specific questionnaire. Data from 41 students living in out-of-home care were compared with data from peers not in out-of-home care in a cross-sectional analyze.

RESULTS: Students in out-of-home care had more often an immigrant background and a non-heterosexual orientation, had more often experienced physical and penetrative sexual abuse, and more often sought healthcare for mental problems. Disclosure of sexual abuse was less common, and acts of persuasion or adults' use of their social position was more common among students in out-of-home care.

CONCLUSIONS: Even where the protective factor 'senior educational attainment' is present, risks for abuse and poor mental health are evident for adolescents in out-of-home care. Disclosure of adversity, when it has occurred, ought to be higher among these adolescents with regular contact with social services, but our findings indicate tendencies for the opposite. We therefore suggest routines to be established to screen for adverse life events and mental health actively, along with general and systematic assessments of adversity and mental health during care.

Background

The current study aimed at exploring adolescents’ experiences of online sexual contacts leading to online sexual abuse by a perpetrator whom the victim had first met online. Associations with socio demographic background, experience of abuse, relation to parents, health and risk behaviors were studied.

Methods

The participants were a representative national sample of 5175 students in the third year of the Swedish high school Swedish (M age = 17.97). Analyses included bivariate statistics and stepwise multiple logistic regression models.

Results

In total 330 (5.8%) adolescents had gotten to know someone during the preceding 12 months for the purpose of engaging in some kind of sexual activity online. Thirty-two (9.7%) of those, the index group, had felt that they had been persuaded, pressed or coerced on at least one occasion. Sexual interaction under pressure was seen as constituting sexual abuse. These adolescent victims of online sexual abuse, the index group, did not differ with respect to socio-demographic background from the adolescents without this experience, the reference group. The index group had significantly more prior experiences of different kind of abuse, indicating that they belong to a polyvictimized group. More frequent risk behavior, poorer psychological health, poorer relationships with parents and lower self-esteem also characterized the index group. Online sexual abuse, without experiences of offline abuse, was associated with a poorer psychological health, at least at the same level as offline sexual abuse only.

Conclusions

The study made clear the importance of viewing online sexual abuse as a serious form of sexual abuse. Professionals meeting these children need to focus not only on their psychological health such as symptoms of trauma and depression but also need to screen them for online behavior, online abuse and other forms of previous abuse.

Differences and similarities were studied in the functions of two different self-injurious behaviors (SIB): nonsuicidal self-injury (NSSI) and sex as self-injury (SASI). Based on type of SIB reported, adolescents were classified in one of three groups: NSSI only (n = 910), SASI only (n = 41), and both NSSI and SASI (n = 76). There was support for functional equivalence in the two forms of SIB, with automatic functions being most commonly endorsed in all three groups. There were also functional differences, with adolescents in the SASI only group reporting more social influence functions than those with NSSI only. Adolescents reporting both NSSI and SASI endorsed the highest number of functions for both behaviors. Clinical implications are discussed, emphasizing the need for emotion regulation skills.

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.

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.

Avdelningen för barn och ungdomspsykiatri vid Linköpings universitet fick i uppdrag av Stiftelsen Allmänna Barnhuset att tillsammans med Statistiska Centralbyrån (SCB) genomföra en kvantitativ studie bland unga i gymnasieskolans år 3. Avtalets huvudfokus var att samla in kunskap om ungdomars sexualitet, erfarenheter av övergrepp, sexuell exponering, sexuell exponering via digitala medier i enlighet med Regeringsbeslut S2013/8825/FST. Inom ramen för uppdraget skulle samråd med Ungdomsstyrelsen och Folkhälsomyndigheten tas och undersökningen skulle ske i samarbete med Lunds Universitet.

Samtidigt med detta gavs ett uppdrag från socialförvaltnings utvecklingsenhet i Stockholms stad, om en komplettering genom en vidgad datainsamling i Stockholms stad. Detta uppdrag skulle framför allt fokusera på barn och ungdomar i sexhandel/prostitution samt de som skadar sig själva med sex. Då de två studierna använt en identisk enkät och det i analyserna av materialet visat sig vara väldigt små skillnader mellan de två dataseten så redovisas i denna rapport det sammanlagda materialet.

Detta är den tredje stora nationella studien på området om ungdomars sexualitet och utsatthet för sexuella övergrepp och sexuell exploatering. Den första studien Ungdomars sexualitet –attityder och erfarenheter (Svedin &Priebe, 2004) var ett uppdrag inom ramen för den statliga utredningen Sexuell exploatering av barn i Sverige (SOU, 2004:71). Den andra undersökningen Unga, sex och internet (Svedin & Priebe, 2009) genomfördes på uppdrag av Ungdomsstyrelsen i avsikt att genomföra en kvantitativ studie bland unga i gymnasieskolans år 3 samt bland Riksförbundet för homosexuella, bisexuella och transpersoners rättigheters (RFSL) medlemmar i relevant ålder. Dessa två studier, vars vetenskapliga publikationer presenteras i bilaga 1, har inom centrala områden använt samma enkät vilket möjliggör en jämförelse med den aktuella studien men också att studera trender över tid. Att just kunna jämföra olika undersökningar med varandra och över tid är tämligen unikt vilket ofta rekommenderas från olika håll. Samtidigt som centrala frågeområden som t.ex. sexuella övergrepp och sexuell exploatering behållits så har andra områden bytts ut. I denna rapport är områden som själskadebeteende, sex som självskadebeteende, människohandel för sexuella syften samt mobbing nya (enkäten bilaga 2).

Det här är den tredje stora undersökningen som gjorts om av samma forskargrupp. De tidigare undersökningarna genomfördes 2004 och 2009. Det gör att vi kan jämföra svaren och se utveckling över tid. Undersökningen har genomförts av forskare från Linköpings och Lunds universitet på uppdrag av Stiftelsen Allmänna Barnhuset och har finansierats av regeringen. Den här skriften sammanfattar delar av undersökningen från 2014. Den som är intresserad av att läsa mer om resultaten eller om hur undersökningen är upplagd, kan ta del av den fullständiga rapporten, Unga, sex och internet - i en föränderlig värld, via Stiftelsen Allmänna Barnhusets hemsida www.allmannabarnhuset.se eller via Linköpings universitet www.barnafrid.se.

Statistiska Centralbyrån har gjort ett urval av skolor som är representativt. Några av de utvalda skolorna föll bort för att de lagt ned, inte ville delta eller inte svarade. Det var frivilligt att delta, och det fanns elever som valde att avstå, eller helt enkelt inte var i skolan den dag som undersökningen genomfördes.

Sammanlagt medverkade 5 873 elever från 171 skolor. Eleverna besvarade enkäten under lektionstid, med en av skolan utvald, ansvarig person i klassrummet. Elever, ansvariga lärare och rektor fick information om studien i form av ett informationsbrev. Där fanns också uppgifter om vart eleverna kunde vända sig för att få stöd och hjälp.

Vi ställde frågor på en rad olika områden. Det gör att vi vet mycket om de elever som svarade. Frågorna handlade om sociodemografi (bakgrundsfaktorer som till exempel ålder, kön, födelseland, ekonomi eller föräldrarnas utbildningsnivå), sport/idrottsutövande, sexualitet, erfarenhet av frivilligt sex, alkohol och droganvändning, antisocialt beteende, fysiska, psykiska och sexuella övergrepp, erfarenheter av vård för psykiatriska besvär, självskadebeteende, självskada genom sex, sälja sex, människohandel, kontakt med socialtjänsten, mobbning samt användande av internet, mobiler och pornografi.

Enkäten innefattade även ett antal standardiserade mätinstrument som mäter hur eleverna uppfattar relationen till sina föräldrar, deras självkänsla, symtom på posttraumatisk stress och självskadebeteende. De ungdomar som svarat gick tredje året på gymnasiet 2014. Åldern varierade mellan 16 och 23 år med en medelålder på knappt 18 år. Något fler tjejer än killar deltog och en grupp på 0,9 procent tyckte inte att indelningen kille/tjej passade dem. Vad den grupp som inte tycker att könsindelningen passar dem har svarat på frågorna redovisas på några områden.