Violence and sexual risk taking reported by young people at Swedish youth clinics

  • Sofia Hammarström Region Västra Götaland, Knowledge Center for Sexual Health, Gothenburg, Sweden; and Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
  • Siw Alehagen Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
  • Helena Kilander Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Obstetrics and Gynaecology, Eksjö Hospital, Jönköping, Sweden; Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden; and Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
Keywords: Gender identity, transgender youth, violence, risk taking, sexual health, re-victimisation, poly-victimisation, cumulative violence


Background: Early identification of sexual risk taking and exposure to violence is fundamental when seeking to strengthen young people’s health. The purpose of this study was to study factors associated with sexual risk taking and ill health, as well as to study gender differences, and the associations amongst exposure to multiple forms of violence, sexual risk taking and ill health.

Methods: This was a cross-sectional study based on data from 3,205 young people answering a questionnaire belonging to the Sexual health Identification Tool (SEXIT 2.0), during consultations at 12 youth clinics in Sweden. The analyses are based on descriptive statistics and nominal multiple regression analysis.

Results: Male, transgender and non-binary youths reported significantly more events of sexual risk taking and ill health compared to women. Those who reported sexual initiation before the age of 15 (OR 2.87, CI 1.81–4.56), three or more sexual partners in the past 12 months (OR 2.68, CI 1.70–4.22) and to have ever experienced an unintended pregnancy (OR 2.29, CI 1.32–3.97) were more than twice as likely to report exposure to physical, emotional and sexual violence. Transgender, non-binary youths and women were more exposed to multiple violence (OR 3.68, 13.50) compared to men.

Conclusions: Transgender and non-binary youths are exposed to significantly more violence compared to women and men. Experiences of sexual risk taking and ill health demonstrated strong associations with exposure to multiple violence.


Download data is not yet available.


  1. UNFPA, Guttmacher Institute. Contraception for adolescents and youth – being responsive to their sexual and reproductive health needs and rights. 2019. Available from: [cited 13 January 2022].

  2. World Health Organization. Violence info. 2017. Available from: [cited 13 January 2022].

  3. Aho N, Proczkowska-Björklund M, Svedin CG. Victimization, polyvictimization, and health in Swedish adolescents. Adolesc Health Med Therap. 2016;7:89–99. doi: 10.2147/ahmt.s109587

  4. Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, et al. Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission. Lancet. 2018;391:2642–92. doi: 10.1016/S0140-6736(18)30293-9

  5. Falasinnu T, Gilbert M, Hottes TS, Gustafson P, Ogilvie G, Shoveller J. Predictors identifying those at increased risk for STDs: a theory-guided review of empirical literature and clinical guidelines. Int J STD AIDS. 2015;26:839–51. doi: 10.1177/0956462414555930

  6. Niccolai LM, Hochberg AL, Ethier KA, Lewis JB, Ickovics JR. Burden of recurrent Chlamydia trachomatis infections in young women: further uncovering the ‘hidden epidemic’. Arch Pediatr Adolesc Med. 2007;161:246–51. doi: 10.1001/archpedi.161.3.246

  7. Aztlan EA, Foster DG, Upadhyay U. Subsequent unintended pregnancy among US women who receive or are denied a wanted abortion. J Midwifery Womens Health. 2018;63:45–52. doi: 10.1111/jmwh.12723

  8. Blom H, Högberg U, Olofsson N, Danielsson I. Strong association between earlier abuse and revictimization in youth. BMC Public Health. 2014;14:715. doi: 10.1186/1471-2458-14-715

  9. Kjellgren C, Priebe G, Svedin CG, Langstrom N. Sexually coercive behavior in male youth: population survey of general and specific risk factors. Arch Sex Behav. 2010;39:1161–9. doi: 10.1007/s10508-009-9572-9

  10. Strandberg A, Skoglund C, Gripenberg J, Kvillemo P. Alcohol and illicit drug consumption and the association with risky sexual behaviour among Swedish youths visiting youth health clinics. Nord Stud Alcohol Drugs. 2019;36:442–59. doi: 10.1177/1455072519845970

  11. Kastbom ÅA, Sydsjö G, Bladh M, Priebe G, Svedin CG. Sexual debut before the age of 14 leads to poorer psychosocial health and risky behaviour in later life. Acta Paediatr. 2015;104:91–100. doi: 10.1111/apa.12803

  12. Niccolai LM, Livingston KA, Laufer AS, Pettigrew MM. Behavioural sources of repeat Chlamydia trachomatis infections: importance of different sex partners. Sex Transm Infect. 2011;87:248–53. doi: 10.1136/sti.2010.045484

  13. Zemlak JL, Bryant AP, Jeffers NK. Systematic review of contraceptive use among sex workers in North America. J Obstet Gynecol Neonatal Nurs. 2020;49:537–48. doi: 10.1016/j.jogn.2020.08.002

  14. Holmes K, Sher L. Dating violence and suicidal behavior in adolescents. Int J Adolesc Med Health. 2013;25:257–61. doi: 10.1515/ijamh-2013-0059

  15. Khadr S, Clarke V, Wellings K, Villalta L, Goddard A, Welch J, et al. Mental and sexual health outcomes following sexual assault in adolescents: a prospective cohort study. Lancet Child Adolesc Health. 2018;2:654–65. doi: 10.1016/s2352-4642(18)30202-5

  16. Decker MR, Peitzmeier S, Olumide A, Acharya R, Ojengbede O, Covarrubias L, et al. Prevalence and health impact of intimate partner violence and non-partner sexual violence among female adolescents aged 15-19 years in vulnerable urban environments: a multi-country study. J Adolesc Health. 2014;55:S58–67. doi: 10.1016/j.jadohealth.2014.08.022

  17. Miranda-Mendizabal A, Castellví P, Parés-Badell O, Alayo I, Almenara J, Alonso I, et al. Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. Int J Public Health. 2019;64:265–83. doi: 10.1007/s00038-018-1196-1

  18. Danielsson I, Blom H, Nilses C, Heimer G, Högberg U. Gendered patterns of high violence exposure among Swedish youth. Acta Obstet Gynecol Scand. 2009;88:528–35. doi: 10.1080/00016340902846056

  19. Palm A, Danielsson I, Skalkidou A, Olofsson N, Högberg U. Violence victimisation – a watershed for young women’s mental and physical health. Eur J Public Health. 2016;26:861–7. doi: 10.1093/eurpub/ckv234

  20. Turner HA, Finkelhor D, Ormrod R. Poly-victimization in a national sample of children and youth. Am J Prev Med. 2010;38:323–30. doi: 10.1016/j.amepre.2009.11.012

  21. Finkelhor D, Ormrod RK, Turner HA. Poly-victimization: a neglected component in child victimization. Child Abuse Negl. 2007;31:7–26. doi: 10.1016/j.chiabu.2006.06.008

  22. Simmons J, Wijma B, Swahnberg K. Lifetime co-occurrence of violence victimisation and symptoms of psychological ill health: a cross-sectional study of Swedish male and female clinical and population samples. BMC Public Health. 2015;15:979. doi: 10.1186/s12889-015-2311-3

  23. Blom H, Hogberg U, Olofsson N, Danielsson I. Multiple violence victimisation associated with sexual ill health and sexual risk behaviours in Swedish youth. Eur J Contracept Reprod Health Care. 2016;21:49–56. doi: 10.3109/13625187.2015.1089227

  24. Chew D, Tollit MA, Poulakis Z, Zwickl S, Cheung AS, Pang KC. Youths with a non-binary gender identity: a review of their sociodemographic and clinical profile. Lancet Child Adolesc Health. 2020;4:322–30. doi: 10.1016/s2352-4642(19)30403-1

  25. Newcomb ME, Hill R, Buehler K, Ryan DT, Whitton SW, Mustanski B. High burden of mental health problems, substance use, violence, and related psychosocial factors in transgender, non-binary, and gender diverse youth and young adults. Arch Sex Behav. 2020;49:645–59. doi: 10.1007/s10508-019-01533-9

  26. Bouris A, Everett BG, Heath RD, Elsasesser CE, Neilands TB. Effects of victimization and violence on suicidal ideation and behaviors among sexual minority and heterosexual adolescents. LGBT Health. 2016;3:153–61. doi: 10.1089/lgbt.2015.0037

  27. Price-Feeney M, Green AE, Dorison S. Understanding the mental health of transgender and nonbinary youth. J Adolesc Health. 2020;66:684–90. doi: 10.1016/j.jadohealth.2019.11.314

  28. Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:214–22. doi: 10.1016/s1473-3099(12)70315-8

  29. Lindroth M, Zeluf G, Mannheimer LN, Deogan C. Sexual health among transgender people in Sweden. Int J Transgend. 2017;18:318–27. doi: 10.1080/15532739.2017.1301278

  30. National Organisation for Swedish Youth Clinics. ‘Keep up the good work’ 2012–2013. Young people’s experiences and perceptions of visits and contact with 33 youth clinics. 2015. Available from: [cited 13 January 2022].

  31. Wagenius CM, San Sebastián M, Gustafsson PE, Goicolea I. Access for all? Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden. Scand J Public Health. 2019;47:1–8. doi: 10.1177/1403494818774965

  32. Hammarström S, Nilsen P, Lindroth M, Stenquist K, Bernhardsson S. Identifying young people exposed to or at risk of sexual ill health: pilot implementation of an evidence-informed toolkit (SEXIT) at Swedish youth clinics. Eur J Contracept Reprod Health Care. 2019;24:45–53. doi: 10.1080/13625187.2018.1564815

  33. Petersson C, Swahnberg K, Peterson U, Oscarsson M. Experience of violence and self-rated health: do youths disclose their experiences when visiting a Youth Centre in Sweden. Scand J Public Health. 2021;49:277–84. doi: 10.1177/1403494820921690

  34. Lalor K, McElvaney R. Child sexual abuse, links to later sexual exploitation/high-risk sexual behavior, and prevention/treatment programs. Trauma Violence Abuse. 2010;11:159–77. doi: 10.1177/1524838010378299

  35. Steel JL, Herlitz CA. The association between childhood and adolescent sexual abuse and proxies for sexual risk behavior: a random sample of the general population of Sweden. Child Abuse Negl. 2005;29:1141–53. doi: 10.1016/j.chiabu.2004.10.015

  36. Miron LR, Orcutt HK. Pathways from childhood abuse to prospective revictimization: depression, sex to reduce negative affect, and forecasted sexual behavior. Child Abuse Negl. 2014;38:1848–59. doi: 10.1016/j.chiabu.2014.10.004

  37. Public Health Agency of Sweden. Sexuality and health among young people in Sweden: UngKAB15 - a survey on Knowledge, Attitudes and Behaviour among young people 16-29 years old. Stockholm (Sweden), 2017. Available from: [cited 13 January 2022].

  38. Palm A, Hogberg U, Olofsson N, Skalkidou A, Danielsson I. No differences in health outcomes after routine inquiry about violence victimization in young women: a randomized controlled study in Swedish youth health centers. J Interpers Violence. 2020;35:77–99. doi: 10.1177/0886260516681878

  39. Krumpal I. Determinants of social desirability bias in sensitive surveys: a literature review. Qual Quan. 2013;47:2025–47. doi: 10.1007/s11135-011-9640-9

  40. Kattari SK, Walls NE, Atteberry-Ash B, Klemmer C, Rusow JA, Kattari L. Missing from the conversation: sexual risk factors across young people by gender identity and sexual orientation. Int J Sex Health. 2019;31:394–406. doi: 10.1080/19317611.2019.1667938

  41. Public Health Agency of Sweden. Sexual and reproductive health and rights (SRHR) in Sweden 2017. Available from: [cited 13 January 2022].

How to Cite
Hammarström S., Alehagen S., & Kilander H. (2022). Violence and sexual risk taking reported by young people at Swedish youth clinics. Upsala Journal of Medical Sciences, 127(1).
Original Articles