Dimensions of Peer Sexual Harassment Victimization and Depressive Symptoms in Adolescence: A Longitudinal Cross-Lagged Study in a Swedish Sample.

Sexual harassment is commonly considered unwanted sexual attention and a form of gender-based violence that can take physical, verbal and visual forms and it is assumed to cause later depression in adolescents. There is a dearth of research explicitly testing this assumption and the directional pathway remains unclear. The purpose of this study was to use a feminist theoretical framework to test competing models in respect of the direction of the relationships between dimensions of peer sexual harassment victimization and dimensions of depressive symptoms from ages 14 to 16 in adolescents. The study also aimed to investigate gender differences in these pathways. Cross-lagged models were conducted using a three-wave (2010, 2011 and 2012) longitudinal study of 2330 students (51 % females) from Sweden, adjusted for social background. Girls subjected to sexual harassment in grade seven continued to experience sexual harassment the following 2 years. There was weaker evidence of repeated experience of sexual harassment among boys. Depressive symptoms were stable over time in both genders. Sexual name-calling was the dimension that had the strongest associations to all dimensions of depressive symptoms irrespective of gender. In girls, name-calling was associated with later somatic symptoms and negative affect, while anhedonia (reduced ability to experience pleasure) preceded later name-calling. Physical sexual harassment had a reciprocal relationship to somatic symptoms in girls. In boys, name-calling was preceded by all dimensions of depressive symptoms. It is an urgent matter to prevent sexual harassment victimization, as it is most likely to both cause depressive symptoms or a reciprocal cycle of victimization and depression symptoms in girls as well as boys.

What students do schools allocate to a cognitive-behavioural intervention? Characteristics of adolescent participants in Northern Sweden.

BACKGROUND: Adolescents are a vulnerable group when it comes to the risk of developing depression. Preventing the onset of depressive episodes in this group is therefore a major public health priority. In the last decades, school-based cognitive-behavioural interventions have been a common primary prevention approach. However, evidence on what girls actually are allocated to such interventions when no researchers are involved is scarce. OBJECTIVE: To explore how a selective cognitive-behavioural program (Depression In Swedish Adolescents) developed to prevent depression in adolescents, was implemented in a naturalistic setting in schools in northern part of Sweden. The focus was on characteristics of participants allocated to the intervention. DESIGN: Cross-sectional baseline data on depressive symptoms, school environment and socio-economic factors were collected in 2011 by means of questionnaires in schools in a municipality in the northern part of Sweden. Intervention participants were identified in a follow-up questionnaire in 2012. Students (n=288) included in the analyses were in the ages of 14-15. RESULTS: Sixty-six girls and no boys were identified as intervention participants. They reported higher levels of depressive symptoms, lower personal relative affluence, more sexual harassment victimization and less peer support compared to female non-participants (n=222). Intervention participants were more likely to attend schools with a higher proportion of low parental education levels and a lower proportion of students graduating with a diploma. CONCLUSIONS: The developers of the intervention originally intended the program to be universal or selective, but it was implemented as targeted in these schools. It is important for school administrations to adhere to program fidelity when it comes to what students it is aimed for. Implications for effectivenss trials of cognitive-behavioural interventions in the school setting is discussed.

Risk behaviour, parental background, and wealth: a cluster analysis among Swedish boys and girls in the HBSC study.

AIM: To analyse how health risk behaviours (HRB) are clustered and associated with parental background and family wealth among Swedish boys and girls. METHODS: Data were collected from Health Behaviour in School-aged Children (HBSC), a global cross-sectional survey for 1997/98, 2001/02, and 2005/06. A total of 11,972 boys and girls in grades 5, 7, and 9 participated in the study. The pupils were categorised in subgroups according to parental background: Swedish (80.0%), mixed (10.6%), and foreign (9.4%). Cluster analyses were used to identify HRB profiles. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, parental background, and family affluence. RESULTS: In total 11,232 pupils were identified and allocated to five cluster profiles, half of them in the cluster profile of low-risk behaviour. The most disadvantaged cluster was multiple HRB, which was characterised by high prevalence of smoking, drunkenness, low physical activity, and high soft-drink consumption. The cluster profile of multiple HRB was associated with both mixed background and foreign background in girls and with mixed background in boys. The cluster profile of inadequate tooth brushing was associated with foreign background in both boys and girls. The cluster profiles of multiple HRB and inadequate tooth brushing were associated with low family affluence in girls. CONCLUSIONS: The cluster profiles of multiple HRB and inadequate tooth brushing were associated with parental foreign extraction in boys and girls and with low family affluence in girls. Prevention programmes based on identified clusters of HRB, including consideration of impact of socio-demographic indicators, are needed.

Sexual harassment of girls in elementary school: a concealed phenomenon within a heterosexual romantic discourse.

The aim of this study was to enhance the understanding of young girls' experiences of peer sexual harassment in elementary school and of normalizing processes of school-related sexualized violence. Six focus group interviews with girls in Grade 1 through 6 were carried out in an elementary school in the northern part of Sweden. A content analyses showed that young girls experienced verbal, nonverbal, and sexual assault behaviors at school. Sexual harassment as a concealed phenomenon and manifest within a romantic discourse were themes found in the analysis. A conclusion is that schools have to acknowledge behaviors related to sexual harassment as a potential problem even in young ages and develop methods to approach the subject also for this age group.

Physical and psychological symptoms and learning difficulties in children of women exposed and non-exposed to violence: a population-based study.

OBJECTIVES: To analyse the association between violence against mothers and the health of their children as reported by the mothers. METHODS: The data originate from a multistage sampling health-questionnaire survey, distributed to a representative sample of women in Sweden. The health of 283 children (aged 0-18 years), as reported by women who had been exposed to violence at home or outside home during the past 12 months, was compared with that of 4,664 children of non-exposed mothers. RESULTS: Odds ratios regarding most registered physical symptoms showed that children of violence-exposed mothers had a significant higher risk of ill health than children of non-exposed mothers. Regarding psychological symptoms and learning difficulties, the odds were raised for girls for most symptoms, but not for boys. A twofold increase in health-care utilisation and an overall general increase in the risk of pharmaceutical consumption were shown for both girls and boys of exposed mothers. CONCLUSIONS: This population-based study shows an increased risk of poorer health amongst boys and girls aged 0-18 years, as reported by mothers exposed to violence.

Male students' behaviour, knowledge, attitudes, and needs in sexual and reproductive health matters.

OBJECTIVES: To investigate young male students' behaviour, knowledge, attitudes, and needs related to sexual and reproductive health (SRH). Differences between students on vocational and academic study programmes were also investigated. METHOD: A questionnaire consisting of 87 multiple choice questions was distributed to 253 male students attending three upper secondary schools in a single Swedish county. RESULTS: A response rate of 76% (n = 192) was achieved. Vocational students displayed more risk behaviour than those in academic study programmes regarding use of tobacco and sexual behaviour. Eighteen percent of those who were sexually experienced had suggested or provided the emergency contraception pill (ECP) to a girl. Insufficient knowledge of sexually transmitted infections (STIs) was identified, especially among the vocational students. No one reported the upper secondary school as their main source of knowledge and both groups requested more information about both genders' reproductive systems, and STIs. Some discriminatory attitudes regarding gender equality in SRH matters were identified. Both groups stated that male-friendly Youth Health Clinics (YHCs), easier access to condoms and Internet-service for Chlamydia test are important. CONCLUSIONS: Improvements in the quality and quantity of sex education in upper secondary schools are needed; they should be tailored to the spectrum of students' situations and needs. A structure of the YHC adapted to male youths' needs and alternative, easily accessible STI tests are important factors for reaching young men and having them participate in a responsible way in protecting their own and their partners' SRH.

Young students as participants in school health promotion: an intervention study in a Swedish elementary school.

OBJECTIVES: The aim was to analyse if young students could be substantive participants in a health-promoting school project. The specific aims were to analyse the changes the students proposed in their school environment, how these changes were prioritized by a school health committee and to discuss the students' proposals and the changes from a health and gender perspective. STUDY DESIGN: An intervention project was carried out in an elementary school with students (about 150) in Grades 1 through 6. The intervention included small-group discussions about health promoting factors, following a health education model referred to as "It's your decision." At the last of 6 discussions, the students made suggestions for health-promoting changes in their school environment. A health committee was established with students and staff for the purpose of initiating changes based on the proposals. METHODS: A content analysis was used to analyse the proposals and the protocols developed by the health committee. RESULTS: The analysis showed 6 categories of the students' proposals: social climate, influence on schoolwork, structure and orderliness, security, physical environment and food for well-being. Their priorities corresponded to the students' categories, but had an additional category regarding health education. CONCLUSIONS: Principles that guide promoting good health in schools can be put into action among students as young as those in Grades 1 through 6. Future challenges include how to convey experiences and knowledge to other schools and how to evaluate if inequalities in health because of gender, class and ethnicity can be reduced through the focus on empowerment and participation.

Young students as participants in school health in promotion: An intervention study in a swedish elementary school.

OBJECTIVES: The aim was to analyse if young students could be substantive participants in a healthpromoting school project. The specific aims were to analyse the changes the students proposed in their school environment, how these changes were prioritized by a school health committee and to discuss the students' proposals and the changes from a health and gender perspective. STUDY DESIGN: An intervention project was carried out in an elementary school with students (about 150) in Grades 1 through 6. The intervention included small-group discussions about health promoting factors, following a health education model referred to as 'It's your decision.' At the last of 6 discussions, the students made suggestions for health-promoting changes in their school environment. A health committee was established with students and staff for the purpose of initiating changes based on the proposals. METHODS: A content analysis was used to analyse the proposals and the protocols developed by the health committee. RESULTS: The analysis showed 6 categories of the students' proposals: social climate, influence on schoolwork, structure and orderliness, security, physical environment and food for well-being. Their priorities corresponded to the students' categories, but had an additional category regarding health education. CONCLUSIONS: Principles that guide promoting good health in schools can be put into action among students as young as those in Grades 1 through 6. Future challenges include how to convey experiences and knowledge to other schools and how to evaluate if inequalities in health because of gender, class and ethnicity can be reduced through the focus on empowerment and participation.

A possible contributor to the higher degree of girls reporting psychological symptoms compared with boys in grade nine?

BACKGROUND: It is a recurrent finding that adolescent girls report psychological symptoms in a higher degree compared with boys. The explanations for this difference vary, but the psychosocial school environment has never been a focus in these explanations. The aim of this study was to analyse whether psychosocial factors at school were associated with a high degree of psychological symptoms among boys and girls in grade nine, with a special focus on sexual harassment. METHODS: The study was based on a cross-sectional study including 336 pupils (175 girls and 161 boys) in grade nine (about 15 years old), who answered an extensive questionnaire. The non-response rate was negligible (<1%). Logistic regression analysis was used to analyse whether school-related factors (teacher support, classmate support, sexual harassment), body image, and parental support were associated with a high degree of psychological symptoms. RESULTS: Sexual harassment at school was associated with a high degree of psychological symptoms among girls. CONCLUSIONS: Sexual harassment must be acknowledged as a negative psychosocial school environmental factor of importance for the high degree of psychological ill-health symptoms among girls compared with boys.

[Consequences of violence--a public health issue. Strong connection between violence/threat and illness in both women and men]. / Våldets följder--en fråga om folkhälsa. Starkt samband mellan våld/hot och ohälsa hos både kvinnor och män.

Earlier studies have indicated that patients with chronic pain often have experienced physical abuse, but only a small number of population studies have demonstrated an association between abuse and chronic pain. During 1997 a population study was made in northern Sweden. Close to 15,000 people from 18-85 years of age answered a questionnaire about public health issues, including four questions about physical abuse and threats. In the present study the association between answers to these four questions and the other health questions were analyzed for men and women from 18-44 years. Almost 8% of the women and 10% of the men had been subjected to violence or threats during the past year, with higher figures for younger men and women. A strong association between violence/threats and most of the other health issues was found for both men and women. The association remained after controlling for various socioeconomic variables as well as smoking, although with somewhat lower odds ratios.

Do changes in the psychosocial school environment influence pupils' health development? Results from a three-year follow-up study.

AIMS: This study analysed the effects of psychosocial factors at school on pupils' health and self-worth from a longitudinal perspective. METHODS: A three-year prospective study was started in 1994, including 533 pupils (261 girls, 272 boys) from 25 different classes in grades 3 and 6. With age-adjusted questionnaires the changes in self-perceived health were compared with changes in psychosocial school environmental factors. RESULTS: The girls in the older cohort reported a negative health development with decreased self-worth and increased somatic and psychological symptoms. Significant gender differences in ill health, but not in self-worth, developed, especially in the older cohort. A multiple regression analysis showed that a negative development of psychosocial factors at school, measured as control, demand, and classmate problems, was associated with poorer health and self-worth among the pupils. A trichotomization of the psychosocial variables at school indicated a possible causal relationship between psychosocial factors and ill health and self-worth. CONCLUSIONS: The negative development in pupils' health and self-worth could partly be explained by the more unfavourable psychosocial environment that prevails at school at the senior level. The public health implications of our study can be summarized as the need for schools to improve pupils' social situation at school in relation to their work situation as well as to pay special attention to the school situation of girls at senior level.