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Study design

– UngKAB09

Methodological considerations regarding the 2009 youth and

sexuality survey in Sweden

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Study design – UngKAB09

Methodological considerations regarding the 2009 youth and sexuality

survey in Sweden

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Do quote our reports, but do not forget to state the source. Pictures, photographs and illustrations are protected by copyright. This means you must have the author’s permission to use them.

Original Swedish title: UngKAB09 – Kunskap, attityder och sexuella handlingar bland unga. Published by: The Swedish Institute for Communicable Disease Control

(Smittskyddsinstitutet) SE-171 82 Solna, Sweden. Tel: +46(0)8 457 23 00, fax: +46(0)8 32 83 30, smi@smi.se, www.smittskyddsinstitutet.se, February, 2011. Article number: 2011-15-7

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Foreword

Several initiatives are being carried out in Sweden aimed at reducing sexual risks. The risks considered are infection with HIV and other sexually transmitted infections (STIs), unwanted pregnancy, and other problems with sexuality. All initiatives in the area of prevention must, however, be based on knowledge. How do youths experience their sexual lives? What do they think about various STIs and the risk of getting them? How do they view sexual risk taking and what risks do they take? Is it possible to distinguish specific groups that are exposed to higher risks than other groups?

The National Board of Health and Welfare commissioned the Department of Social Work at the University of Gothenburg, to carry out a survey of youths (aged 15–19) and young adults (aged 20–29) in order to obtain answers to these questions.1 The working team principally consisted of Ronny Heikki Tikkanen, PhD, and Jonna Abelsson, BA, in Gothenburg, and Margareta Forsberg, PhD, at SMI.

The overall aim of the study was to generate a scientific basis for the drafting of various types of action plans concerning sexual health and directed at youths and young adults. The survey took a broad socio-sexual perspective, but

focused particularly on HIV, other sexually transmitted infections and unwanted pregnancies.

UngKAB09 was conducted with a mixed mode design. The respondents were of two types: a representative sample of the general population of the relevant age groups in Sweden, and a self-selected sample from online communities. This enabled us to compare the two samples. 15,278 youths between the ages of 15 and 29 years participated in the study.

The distribution between men and women was equal. Unfortunately, only 24 percentages of the persons in the representative sample responded to the survey. The low response frequency in this sample makes it difficult to generalise the results to people in this age group in Sweden. Nevertheless, this is the largest study of its kind so far conducted in Sweden and the large number of respondents provides excellent possibilities to explore knowledge, attitudes and sexual experiences among young people.

This study has contributed further knowledge in this important area and the results provide inspiration for development of work with sexual health among young people in Sweden and elsewhere. In this document you will find four chapters of the Swedish report translated into English, in order to provide greater opportunities to discuss the methodology for future surveys.

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These chapters are: Background, The conduct of the study, Summary of the complete survey and the questionnaire. Several scientific articles will be written bydifferent researchers under the coordination of Ronny Heikki Tikkanen. For those interested: ronny.tikkanen@socwork.gu.se.

Stockholm, January 2012

Monica Ideström

Head of Unit, HIV Prevention and Sexual Health Swedish Institute for Communicable Disease Control

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Contents

Foreword . . . 5

Contents . . . 7

Summary . . . 8

The survey and the respondents. . . 8

Sexual debut . . . 8

Most recent sexual intercourse and sexual risk taking . . . 9

Pornography . . . 10

Contraception . . . 11

Sexual activities against one’s will . . . 11

Sex for money . . . 11

Attitudes . . . 12

Taking preventive measures . . . 12

Background to the study. . . 16

The problem area . . . 16

The aim of the study and the questions explored . . . 17

The principal questions explored were:. . . 17

One year of preparation . . . 18

Carrying out UngKAB09 . . . 21

Letter sent to a representative sample of young people . . . 21

Self-selected sample . . . 22

Activities to make the survey known . . . 23

The questionnaire . . . 24

Analysis . . . 26

Ethical issues . . . 28

Can the results of the study be generalised? . . . 30

References . . . 35

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Summary

The survey and the respondents

A questionnaire survey – UngKAB09 – on sexuality was conducted at the end of 2009 amongst youths and young adults.2 The survey focused on the knowledge, attitudes and behaviour of sexuality of the respondents. The survey is scheduled to be repeated after four years. The survey results will be used as a basis for identifying and reinforcing health-promotion work in matters of sexuality amongst youths and young adults.

The survey was conducted partly as an overview of representative samples of persons aged 16, 20, 24 and 28 years in Sweden, and partly via various online communities (a self-selected sample). Only 24% of the persons in the representative sample responded to the survey after having received two letters sent to their home address. The low response frequency in the representative sample makes it difficult to generalise the results people in this age group in Sweden. Persons who replied to the survey online (the self-selected sample) are somewhat more sexually experienced than people in the representative sample.

15,278 youths and young adults between ages 15 and 29 participated in the study. The distribution between men and women was equal, but a few respondents (46 respondents) did not disclose their sex. Several percent of the respondents considered themselves to be homosexual. A significantly higher percentage of women than men considered themselves to be bisexual.

The majority of the people who responded to the survey have had vaginal

intercourse. Just under half of them have had anal intercourse. The average number of sex partners did not differ between the sexes. A small group of men have had a large number of sex partners, while this was not the case for women. The 10 percentages most sexually active in the study had had six (6) or more sexual partners during the preceding 12 months.

Men had had more experience in sexual and love-making activities on the internet than women. It was relatively unusual for men to use the internet for more explicit sexual activities such as sexual advertisements and nude photographs. The

difference between men and women regarding publishing nude photographs of themselves was not great.

Sexual debut

The average age of sexual debut of the respondents was 16 (respondents were asked to define their “sexual debut” in the questionnaire). There was a small difference between the sexes, with women having made their debut somewhat earlier than men. Approximately 24% of the respondents had had their sexual

2 “Youths” refers to persons between 15 and 20 years of age. “Young adults” refers to persons between 20 and 29

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debut before age 15. The majority had their sexual debut with someone of the opposite sex; while a very small percent had had their sexual debut with someone of the same sex. Most people first had sex with someone with whom they had a relationship. Finger sex/rubbing sexual organs and vaginal intercourse were common modes of sexual debut amongst men. Anal intercourse and the use of sex toys were not common for the sexual debut.

Nearly 70 percentages of the respondents used some kind of protection the first time they had vaginal intercourse. A condom was used in most cases. It was relatively uncommon for respondents to rely on interrupted intercourse or to so called “safe periods”.

The majority of respondents were sober the first time they had sex. Unprotected sex was common amongst those who stated that they were drunk or under the influence of drugs during their first sexual act. Most respondents were positive about their sexual debut. More men had had positive experiences in the sexual debut than women. Most respondents stated that the second time they had sex was within one year of their debut. Men waited somewhat longer before the next sexual contact than women. Also those whose debut had been before age 15, waited longer before their second sexual contact than those who had had an older debut.

Most recent sexual intercourse and sexual risk taking

Most respondents had most recently had sex with someone they knew. In most cases it was someone they had a relationship with. Only 10 percentages had had sex with a stranger. Another 10 percentages had had sex with a “sex buddy”. It was just as common to meet a new sex partner on the internet as in a club/bar or at a private party.

The most common sexual activities amongst respondents were finger sex/rubbing organs and vaginal intercourse. Approximately 10 percentages stated that they used sex toys or had had anal sex. As compared to the sexual debut, the percentage stating that they had oral sex, anal sex or used sex toys increases when it comes to the most recent sexual intercourse. This applies in particular for the women in the study.

Most respondents had been sober during their most recent sexual intercourse, while younger respondents were more often drunk than older respondents. Twice as many of those under the age of 20 had been very drunk when they had most recently had sex than was the case among older respondents. The same is true for persons with low self-esteem and persons with an early sexual debut. Some respondents had taken drugs in connection with sex. As is the case for alcohol consumption, the percentage was somewhat larger among respondents under 20, among persons with low self esteem and among those who had had an early sexual debut.

Most people chose to describe their most recent sexual intercourse in positive words. Those with low self-esteem described their most recent sexual intercourse more negatively than others.

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Approximately 70 percentages of completed intercourses involved unprotected vaginal or anal intercourse (intercourse without a condom). A few variables differentiate respondents whose most recent intercourse involved unprotected sex: a somewhat higher percentage of respondents aged 20 to 25, and high consumers of alcohol, cannabis or other drugs. It was also much more likely that unprotected sex had taken place at the most recent intercourse if the sex partner was a boyfriend/ girlfriend/partner.

About half of those whose most recent sexual intercourse had involved sex with a partner/one-night stand whom they did not know from before did not use a condom during the vaginal or anal intercourse. The ones whose most recent sexual activity had involved unprotected vaginal or anal intercourse with a new partner/ one-night stand were overrepresented among high consumers of alcohol, cannabis or other drugs, among respondents who had had their sexual debut at an early age, and among respondents who had been forced to have sex. Furthermore these respondents had had more sex partners during the previous year compared to those who used a condom at their most recent sexual intercourse with a new partner/ one-night stand whom they had not known from before. The respondents who did not use a condom believed that the risk of contracting Chlamydia was much greater than other respondents believed it to be, but they did not consider contracting chlamydia to be as serious.

When the sexual intercourse involved a new partner/one-night stand whom the respondent did not know from before, the respondent was more likely to have been under the influence of alcohol.

Approximately 25 percentages of the respondents whose most recent intercourse had been vaginal sex stated that they had used a condom during the entire intercourse. The most common reasons given for using a condom when having vaginal sex were to avoid pregnancy and to avoid sexually transmitted infection (STI). The most common reasons given for not wearing a condom during vaginal intercourse were that another means of protection was used and that the respondent thought it was more pleasant and more intimate to have sex without a condom. Approximately 25 percentages of the respondents whose most recent intercourse had been anal sex stated that they had used a condom during the entire intercourse. A lubricant that did not destroy the condom, such as a water-based or silicon-based lubricant, was used on more than half of these occasions. The most common reasons given for using a condom during anal intercourse were to avoid sexual transmitted infections and because it was more “clean” and hygienic. The most common reasons for not wearing a condom during anal intercourse were that it was more pleasant and more intimate without a condom, and that the respondent was confident that the partner did not have any sexually transmitted infections.

Pornography

Men were generally more positive towards pornography than women. A much higher percentage of women than men regarded porn as a turn off and as something disgusting. More men than women regarded porn as instructive. Neither men nor

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women were unequivocally positive or negative towards porn. The ones who did not disclose their sex had a relatively positive attitude towards porn. Men in the study watched porn more often than the women, and over 30 percentages of the men reported that they watched porn every day.

Contraception

Approximately half of the respondents who had had vaginal intercourse had taken emergency contraceptive pills on some occasion. Men were less certain than women about whether such pills had been taken. The use of emergency contraceptive pills was more common among those who lived in big cities, those who had their sexual debut at an early age, and those who were high consumers of alcohol, cannabis or other drugs. The percentage of respondents who had had experience of emergency contraceptive pills increased with age.

Approximately 25 percentages of the women who had had vaginal intercourse had become pregnant at least once. Less than 10 percentages had been pregnant more than once, and this number increases with age. The majority of those who had become pregnant had had an abortion. Most of those who had become pregnant had not used contraception, but over 30 percentages of them stated that they had used contraceptives unsuccessfully.

Sexual activities against one’s will

Approximately 20 percentages of the respondents stated that they have been forced into sexual activities during the previous year. The definition of “sexual activity” included everything from being touched on their sex organs or breasts to vaginal and anal intercourse. Those who had been forced into sexual activity at any time in their life were 46 percentages. The women in the study had been much more exposed to sexual activities against their will than the men.

Sex for money

A small percentage of the respondents had paid for sex on some occasion; more of the men (5.4%) had paid for sex than of the women (0.5%). It was more common for persons born outside Sweden, second-generation immigrants, people outside the labour market/unemployed, people who had had their sexual debut at an early age and high consumers of alcohol, cannabis or other drugs to have paid for sex on some occasion. It was more common for women (4.6%) than for men (3.6%) to have received money for sex. During the previous year, 1 percent of the respondents had received money for sex. Persons who had received money for sex were overrepresented among those outside the labour market/unemployed, those who had had their sexual debut at an early age, and those with low self-esteem. Furthermore, sex sellers were overrepresented among gay and bisexual men and women, and among high consumers of alcohol, cannabis or other drugs.

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Attitudes

Most respondents agreed that a sexual relationship between two persons of the same sex is completely acceptable. However, men believed this to a much smaller degree than women. Also people born outside Sweden, people living in small towns or in the countryside, and those who stated that religion played a vital role in their everyday lives believed this to a much smaller degree than others.

Respondents judged women harsher than men as far as sexual rumours were concerned, and thus women (much more than men) acquired a bad reputation if they had many sex partners. Younger respondents, people born outside Sweden, and people who stated that religion played a vital role in their everyday life drew, much more often, a connection between the number of sex partners and respectability both concerning men and women.

Sexual activities amongst respondents were strongly associated with love. Women in the study tended to make this association to a much higher extent than men. The connection between sex and love was strong among young respondents, amongst people living in smaller towns and in the countryside, people born outside Sweden, and those who stated that religion played a vital role in their everyday life.

Most of the respondents considered the risk of contracting HIV to be small, given their sexual life. Gay and bisexual individuals, however, and those who consumed large quantities of drugs considered the risk of contracting HIV to be greater. The most common explanation for considering the risk to be small was having a trusted partner.

Respondents in the study considered the risk of contracting chlamydia to be greater than the risk of contracting HIV. Approximately a fifth of the respondents stated that they ran a risk of contracting Chlamydia, given their sexual life. This can be considered to be a small number given that most respondents regarded Chlamydia to be a common infection in Swedish society. Persons whose sexual debut was at an early age and high consumers of alcohol, cannabis or other drugs believed to a greater extent than others that they ran such a risk. The risk was considered to be small if one had a steady partner and if one believed that the partner would talk about an infection.

Most people considered contracting HIV to be very serious. Far fewer, amongst men in particular, regarded contracting Chlamydia to be very serious. On the other hand, genital herpes was considered to be much more serious than Chlamydia. Persons with low self-esteem and high consumers of alcohol, cannabis or other drugs regarded contracting chlamydia to be less serious than other respondents.

Taking preventive measures

Most respondents knew whom to turn to in order to get tested for Chlamydia. Persons under 20 and persons older than 25 knew to a smaller extent than those in the 20–25 age group whom to turn to. Also people born outside Sweden, people who stated that religion played a vital part in their everyday life, and people who had not disclosed their sex knew whom to turn to, to a lesser extent.

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A small percentage of respondents had been denied or dissuaded from taking an HIV test. Women had had such an experience to a much higher degree than men. Also high consumers of alcohol, cannabis or other drugs and those who considered themselves gay or bisexual had had this experience to a higher degree than others. Approximately 30 percentages of the respondents had been tested for HIV, and 10 percentages of respondents had been tested during the preceding year. More women than men stated that they had been tested for HIV. The majority of respondents had been tested for Chlamydia, and more women than men had been tested. A relatively large number had been tested for gonorrhoea or genital herpes.

It was more common that people living in small towns or in the countryside, people who had immigrated to Sweden and people who stated that religion played a vital part in their everyday life had not had a chlamydia test.

Seven out of ten respondents had been offered a consultation in connection with their most recent test; men were offered a consultation less often than women. Approximately 20 percentages of respondents had taken fewer risks in their continued sexual contacts as a result of the consultation. Men and younger

respondents were more liable to change their behaviour after the consultation than others. It was more common that older respondents and women had considered a change in behaviour before the consultation. Information about using condoms was given in approximately half of the consultations that took place. Persons older than 25 years stated to a lower extent than younger persons that they had been well informed about condom use. Women and persons who had not disclosed their sex also stated the same. Women were more satisfied with the information they received than men.

Approximately 10 percentages of the respondents had had chlamydia at some time, and a few percent had had it during the preceding year. Only a few persons had had Chlamydia several times, and 75 percentages had been infected once. Thirteen people said that they were HIV-positive. Sixty persons had had gonorrhoea. A few percent had experience with genital herpes. The number of people who had had an sexually transmitted infection increased to more than 10 percentages if a period longer than 12 months was considered. Women had had more experience of sexually transmitted infections than men. We would like to emphasise, however, that women are tested more often. It is thus possible that a greater fraction of men have an STI without knowing about it.

It was more common for people whose sexual debut had been at an early age, people who had been forced to have sex, and for those who had been paid or received money for sex to have had a sexually transmitted infection (usually Chlamydia) during the previous year. This was also more common for high consumers of alcohol, cannabis or other drugs. In addition, persons whose most recent intercourse involved unprotected sex with a new partner/one-night stand whom they did not know from before were overrepresented among persons who had had a sexually transmitted infection during the previous year.

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A large number were satisfied with the teaching on sex and interpersonal

relationships (sex education) they had received in school. Some people, however, felt that they had received little – or none – instruction in sex and social life. Women and the persons who had not disclosed their sex generally felt that they had received little instruction.

More than 30 percentages of the respondents had visited a website dealing with HIV, STIs or safe sex and approximately half of the respondents had read printed information materials about HIV, STI or safe sex during the preceding year. Approximately half of the respondents had received free condoms during the same period.

Gays, bisexuals and those aged under 20 has experienced health-promoting work (such as visiting preventive websites, reading brochures, received free condoms and talking to counsellors) much more than other respondents. However, this experience was much less common among certain groups: people living in small towns or in the countryside, people outside the labour market/unemployed, and people who stated that religion played a vital role in their everyday life.

The measures that most respondents requested were easily accessible sexual health clinics, distribution of condoms at various meeting places, and the availability of information about STI prevention on the internet. Furthermore, many respondents would like to be able to chat with a counsellor online. Many more respondents preferred to chat with a counsellor than to go to a personal meeting or to talk on the phone. A relatively large percentage, almost 25 percentages, would like to talk with a professional or to be able to discuss issues/problems in a group.

The greatest need for information amongst respondents concerned relationships. Approximately half stated that they needed more information about how to make a relationship work. A considerable percentage would like more information on what it is like to live with HIV. A relatively large number would also like more information about how HIV and other STIs are transmitted.

The results of UngKAB09 show that certain sub-groups of youths are

overrepresented when it comes to sexual risk taking. Such groups are persons with an early sexual debut (before the age of 15) and persons who often drink alcohol or use cannabis or other drugs. Persons who have received or paid money for sex form another group that takes more sexual risks than others, as it does for persons who have six or more sexual partners in a year. Here we would like to remind readers that this should not be interpreted as a causal relationship; but these groups tend to take more sexual risks than others.

The results show that there is no major difference between the needs stated among those who have taken sex-related risks than others. A somewhat larger percentage of the persons who have had an STI during the past year want to be able to chat with a counsellor online. Other needs are the same – they are equal between persons who have had and those who have not had an STI during the past year. When it comes to persons whose most recent intercourse had involved unprotected sex with a new partner/one-night stand whom they did not know from before,

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there are more differences. They state more often than others that they need more information and education about safe sex, how HIV are transmitted, how to talk about risks with a sex partner, and how to find someone to start a relationship with. In all other respects their needs are similar to the needs of other respondents. Persons who have taken sexual risks have more experience with health-promoting and preventive work than others. This gives prerequisites to strengthen and intensify the preventive work directed to persons at risk, since these persons state that they are already in contact with prevention workers in different ways.

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3 The commissioning agency is now the Swedish Institute for Communicable Disease Control.

4 UngKAB is an abbreviation of Ungdomar och sexualitet: kunskap, attityder och beteende (Young People and

Sexuality: Knowledge, Attitudes and Behaviour).

Background to the study

The National Board of Health and Welfare commissioned the Department of Social Work at the University of Gothenburg to carry out a survey of youths (aged 15–19) and young adults (aged 20–29) regarding knowledge, attitudes and behaviour in the area of sexuality.3 The study, denoted “UngKAB09”, was first carried out in the

autumn of 2009, and it is intended to repeat it every four years.4

There are several reasons for the study: first of all, measures for HIV/STI prevention aimed at young people, as well as other types of preventive efforts in the area of youth sexuality, need to be based on objective knowledge of the true situation. Secondly, the government’s “National strategy for HIV/AIDS and other communicable diseases” (Government Bill 2005/6:60) must be followed up. The strategy requires that action plans and strategies should be drawn up in various areas and the results of these needs to be followed up. The results of UngKAB09 constitute a basis for such a follow up with regard to youths and young adults. The results of UngKAB09 are significant also at an international level. Sweden signed the United Nations General Assembly Special Session on HIV and AIDS (UNGASS) Declaration of Commitment on HIV/AIDS in 2001. One component of the declaration concerns reporting data on youths and young adults. Such data has been collected through UngKAB09.

The sexuality of young people is often a matter of public debate, as are measures taken by various government institutions. Such measures need to be planned and implemented on the basis of relevant knowledge in the area. UngKAB09 is intended to constitute a source of such relevant knowledge.

Despite the needs described above, no repeated youth study has been carried out in Sweden that makes it possible to follow the development of youths’ and young adults’ knowledge, attitudes and behaviour over time. There is thus a great need for a recurring scientific study that can follow the development of youths’ and young adults’ knowledge, attitudes and behaviour regarding sexuality. It is planned that UngKAB will be repeated, and this will enable it to begin to address this need.

The problem area

People’s – in this case youths’ and young adults’ – approach (knowledge, attitudes and behaviour) to sexuality is closely linked to broader societal conditions. Today there are evident changes happening both to these conditions and to the approach of young people to sexual relationships.

The development of the Western world, from pre-modernity to late modernity, has had a considerable influence on our ways of looking at and acting in sexual relationships. Discourses in sexual relations have reflected three stages

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corresponding, approximately, to a marriage paradigm, a romantic love complex

and to a pure relationship. The romantic love complex, which in Sweden has long been the dominant paradigm for how we perceive intimate relationships, contains two central components: love ideology and heteronormativity. Love ideology is the norm that says that sexuality primarily belongs within the framework of a love-based relationship. Heteronormativity is the norm that says that one of the basic aspects of a love-based or sexual relationship is that it is heterosexual. The romantic love complex is still powerful as a norm setter, but we are seeing signs that suggest that it is subject to changes and that it is weakening. There is also a shift today towards pure relationships. The pure relationship, briefly, represent a sexual relationship stripped of various types of romantic notion, and this is a relationship that will only last as long as the parties involved reap any benefit from it. A development towards more pure relationships opens the way for more liberal sexual relations, in the form of, for example, more partners, more “one-night stands” and more “sex buddies”. Current research indicates that such a development is underway (Herlitz, 2008). These changes, which are most clearly visible among the younger generations, are very likely to have an impact on various types of risk taking in sexual relationships. A consequence of sexual risk taking is reflected in the sharp increase in the occurrence of chlamydia in Sweden that has occurred since the mid-1990s.

In order for society to be able to meet the needs of young people for knowledge about and reflection on these issues, knowledge is required about how young people themselves think and act. A regularly recurring study such as UngKAB is an important basis for such knowledge.

The aim of the study and the questions explored

The overall aim of the study is to generate a scientific basis to formulate and plan various types of action concerning sexual health directed at youths and young adults. The study emanates from a broad socio-sexual perspective, but focuses particularly on HIV, other STIs (sexually transmitted infections) and unwanted pregnancies. The primary aim of the study is to explore the knowledge, attitudes behaviour and practices among youths and young adults in Sweden in relation to sexuality.

The principal questions explored were:

• What knowledge about sexuality does youths and young adults have? What knowledge do they need?

• What knowledge about how to protect themselves against STIs and unwanted pregnancies do youths and young adults have? What knowledge do they need? • To what extent does behaviour and practices of youths and young adults

involve sexual risk?

• Is it possible to identify specific groups of youths and young adults that take greater risks than others?

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• Is it possible to identify specific groups of youths and young adults with special needs in terms of knowledge and/or health promotion measures? • What are the experiences of youths and young adults with regard to testing

for HIV and other STIs?

The study was also intended as a basis for reporting on the various issues above. It was intended to be a planning template for both national and regional initiatives to counter various types of problem associated with sexuality, for initiatives to prevent unwanted pregnancies, and for the educational programmes in sex and interpersonal relationships given by schools.

One year of preparation

Work on UngKAB09 began more than a year before the survey was carried out. Preparation focussed on two main areas: the content of the questionnaire and the conduct of the survey. It was important to make use of earlier experiences from similar studies.

The ambition in formulating the questionnaire was to create a modern survey tool that builds on and advances earlier research. One important factor was the desire to maximise the possibilities for comparisons with earlier Swedish research and international studies. The content was therefore based on several other questionnaires that have been used in sexuality research. The Swedish questionnaires studied, and from which certain questions were used, were SAM 73/90 (Edgardh, 2001), HIV och AIDS i Sverige (Herlitz, 2008), Ungdom, kön och sexualitet i gränslandet (Hammarén & Johansson, 2001 and 2002; Forsberg, 2005), and Ungdomars sexualitet – attityder och erfarenheter (Svedin & Priebe, 2004). Norwegian and British questionnaires were also studied, and certain formulations from them were used in the new questionnaire. The questionnaire was further discussed with a group of just over 25 Swedish researchers and persons working in the field of sexuality and health, during a two-day seminar in August 2008. Questions that received particular attention during these discussions included:

• How can a questionnaire be drawn up that doesn’t assume normative notions of sexuality?

• How to pose questions whose responses can capture different, and new, types of relational pattern that may emerge as a result of the development towards pure relationships?

• What is the best way to capture instances of various types of risk-filled sexual behaviour?

The decision to carry out UngKAB09 in the form of a digital questionnaire was based on experiences of similar studies. During the year of preparation we systematically examined and reviewed experiences from similar studies both in Sweden and abroad. What follows is a brief description of these experiences.

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A large number of quantitative and qualitative studies of youth and sexuality have been carried out in Sweden since the end of the 1980s (for overviews see Forsberg, 2000; 2006). Most of the quantitative studies were carried out in schools, and were directed towards Year 9 pupils and upper secondary pupils (Years 10–12). Some were directed towards students in higher education. The number of pupils included ranged from just over 300 (Edgardh, 2002) to just over 5,600 (Svedin & Priebe, 2004). Response rates in these school-based studies have generally been high, from just under 70 percentages (Edgardh, 2002) to just under 100 percentages (Hammarén & Johansson, 2001 and 2002; Forsberg, 2005).

A larger, population-based study of sexual habits in Sweden, Sex i Sverige (Lewin et al., 1998), was carried out in 1996. This was to a large extent a continuation of a 1967 study (Zetterberg, 1969), and thus provided the opportunity to carry out comparisons over time. Sex i Sverige was directed at 4,781 randomly selected individuals aged 18–74 years, of which 2,810 (59%) took part in the study. One study, HIV och AIDS i Sverige, has been carried out on repeated occasions and therefore offers the possibility of comparisons over time (Herlitz, 2008). The purpose of this study, which has been distributed in the form of a postal questionnaire, is to monitor the knowledge, attitudes and behaviour of the Swedish general public with respect to HIV and AIDS. Some of the questions asked make it possible to follow the development of such aspects as number of sex partners and condom use. The study was first carried out in 1987 and has been repeated on a further six occasions since then. The study was directed at 4,000 randomly selected persons in the Swedish population, aged between 16 and 44, on five occasions, and at 6,000 such persons on two occasions. Response rates were around 70 percentages during the 1980s. Response rates for the 1994, 1997, 2000 and 2003 studies ranged between 60 and 64 percentages while it dropped to 51 percentages in 2007, with the greatest response reduction among young men. Only 39

percentages of men aged 16 to 17 responded to the questionnaire (Herlitz, 2008). The National Board of Health in Denmark (Sundhedsstyrelsen) commissioned a study, Ung2006, in the southern part of the country in the early autumn of 2006. A population-based random sample of 6,000 young people aged 15 to 24 was selected. These people received a letter requesting that they participate in the study, with instructions for how to respond to the questionnaire via the internet. The researchers were keen to compare young people with a Danish background with young people with a foreign background, and thus the study population contained 3,700 young people with a Danish background and 2,300 with a foreign background. A reminder was distributed, but the response rate was too low for useful results to be obtained. It was concluded that the response rate would not be improved sufficiently by a second reminder, and the sample was instead increased by a further 4,000 young people in the chosen age groups. This second selection did not receive a reminder. The number of correctly completed responses was 3,695, corresponding to a response rate of just under 37 percentages.

A broad-based study, Ung i Norge, was carried out in Norway in 1992 and 2002. This was in the form of a questionnaire in 2002 that was distributed to 12,923

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pupils in schools, of which 11,928 participated, giving a response rate of just over 92 percentages. Norway has also carried out population studies in 1987, 1992, 1997 and 2002 (Træen et al., 2003). On each occasion, a questionnaire was sent out to a random selection of 10,000 persons in the adult population. In 1987, 63 percentages of the recipients responded to the questionnaire. Response rates have subsequently declined: 48 percentages in 1992, 38 percentages in 1997 and 36 percentages in 2002. A large study of sexual habits was carried out by the Norwegian Institute of Public Health (Folkehelseinstituttet) and the University of Tromsø in 2008. The response rate was less than 20 percentages and it was decided that the results of the study would not be analysed further.

A country-wide study Health in School has been carried out regularly in Finland over the past 14 years. The study separates those aged 14 to 16 into one group, with a response rate of 85 percentages and those aged 16 to 18 into another, with a response rate of 75 percentages. The questionnaire is distributed via schools and has a high level of acceptance, which is why response rates are high. Three larger, population-based studies of sexual habits were carried out in Finland in the 20th

century, in 1971, 1992 and 1999. The sample studied in the 1999 study consisted of 3,300 individuals, of which 1,496 (45.8%) responded. This was a considerably lower response rate than that of the 1992 study, in which 2,250 persons out of a selection of 3,049 (75.9%) responded (Haavio-Mannila & Kontula, 2003). The Swedish and foreign studies described above allow us to conclude that studies carried out using traditional methods (postal questionnaires) suffer from progressive decrease in response rates. A downward trend in response rate and difficulties in reaching a representative selection of the population under study are thus major challenges in planning quantitative studies in the area of young people and sexuality. It was therefore decided that UngKAB09 would be in the form of a digital questionnaire, in which some of the data collection would be carried out via

various internet communities.

The National Board of Health and Welfare commissioned an overview of the methodology available for internet-based research from Kristian Daneback at the University of Gothenburg (Daneback, 2008). Daneback states that the results of web questionnaires, with which one reaches a self-selected sample, cannot be generalised to apply to a larger population. He discusses also the difficulties of using classical quantitative methods. He describes how decreasing response rates make it difficult, and sometimes impossible, to generalise from results achieved by such means. Daneback concludes that a golden mean is to use “what are known as mixed mode designs”, which combine different types of data collection. UngKAB09 was carried out using such a mixed mode design. The next chapter describes in greater detail how the study was carried out and how the results were analysed.

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Carrying out UngKAB09

UngKAB09 was carried out using a mixed mode design. We used the same questionnaire for the two modes but two different methods of recruiting

respondents. The first method gave a representative sample and the second gave a self-selected sample. The use of two selection methods enabled us to compare the results of the two methods. Analysis of the correspondence between them may imply new possibilities for the development of data collection methods. A low degree of correspondence would be important knowledge for the evaluation of future studies in which data collection is carried out by means of self-selecting samples via the internet. We will return to this matter later in this chapter.

The same digital questionnaire was used for both samples (Appendix 1). This chapter describes the procedure used for the two samples, details of the analysis and how we dealt with ethical issues.

Letter sent to a representative sample of young people

UngKAB09 was directed at youths and young adults aged between 15 and 29. We selected a representative sample in the following age groups: 16, 20, 24 and 28-year-olds.5 The sample consisted of 24,000 individuals, 6,000 in each age group.

These particular ages were chosen since that they are evenly distributed within the age range and they may represent different phases of life in terms of sexual experiences and experiences of intimate relations.

We sent out a letter of the traditional postal survey type to a random sample in each of the age groups mentioned above on 4 November 2009.6 The letter described the

purpose of the research project, the voluntary nature of participation and how the collected material would be handled. The letter included a link to a web page with the questionnaire and a unique login code. A reminder was sent on 26 November to 20,117 persons who had not responded. We had previously eliminated 340 individuals in the intervening period, either because the first letter to them had been returned or because they had contacted the research team and asked not to be sent a reminder. Thus, 3,543 persons had begun to answer the questionnaire when the reminder was sent. Data collection ended on 4 January 2010, on which date 5,673 responses had been received, a response rate of just less than 24 percentages.7 This

is a low rate, which makes it problematic to consider the sample we obtained to be

5 Among 20, 24 and 28-year-olds, the sample was drawn from all individuals born in the year in question. Among

16-year-olds, the sample was drawn from those who had turned 16 before 27 November 2009.

6 We employed an external supplier with experience of data collection for the purely technical design (and

collection) of the questionnaire. Their services were procured in accordance with external procurement regulations of the University of Gothenburg, and external suppliers were asked to present tenders based on a written specification of requirements. The procurement process began in November 2008 and was completed in May 2009.

7 28% among the 16-year-olds, 22% among the 20-year-olds, 23% among the 24-year-olds and 21% among the

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representative. We will return to this matter later in this chapter. The response rate is, however, not lower than that of other postal studies carried out in, for example, Norway.

Self-selected sample

A second sample constituted the second arm of our mixed mode design. This sample can be described as a “self-selected sample”, since the respondent her- or himself chose whether or not to be part of the sample. The self-selected sample was recruited from all ages within the 15-29 age range, (which contrasts with the representative sample in which we only recruited 16, 20, 24 and 28-year-olds). Recruitment to the self-selected sample was done through various internet communities.

Using an internet survey, in which the sample is self-selected, is an attempt to overcome the problem of decreasing response rates from which traditional research methods (postal surveys) suffer. The method has been tested for various purposes in sexuality research, including that of reaching hidden populations, such as men who have sex with men (MSM). This has been done via an internet community (see, for example, Tikkanen, 2008; 2010). The method is also used by commercial actors. The Youth Barometer (Ungdomsbarometern) is an example of this (Ungdomsbarometern, 2009). This is a yearly, internet-based study of how young people think and act in a number of different issues. Data from the study is used by many entities, both private and public (including various universities, municipalities and county councils), for various types of planning. Results from the Youth Barometer were included in the report presented by Sweden to UNGASS in 2008.

Using an internet-based survey in which the sample is self-selected introduces some problems that must be considered. One obvious problem is that the results cannot be used to make generalisations about a larger population. A second problem is that there is no way of knowing that a respondent who claims to be, say, a 19-year-old female, really is a 19-year-old female. However, the problem of decreasing response rates in surveys obtained by traditional methods means that such surveys, with response rates well below 50% in some cases (24% in UngKAB09, for example), can no longer be considered to be reliable bases for generalisations.

Recruitment to the self-selected sample took place via various internet communities. Our ambition was that the communities we selected should be representative of the age range. A panel of young people around 18 years old helped us in identifying and selecting suitable communities and advising us on how to communicate with potential respondents from them.

The table below shows the different communities we used to recruit respondents. We used different means for different communities to make the study known and to create trust among the users. For example, a news story about the study was published on the website of some communities, while information about the study and its purpose was sent by e-mail to members of other communities.

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Table1. Internet communities from which respondents were recruited Community Type of advertising/recruitment

facebook.com Advertisement whoa.nu Advertisement helgon.net Advertisement bilddagboken.se Advertisement

umo.se News item

rfsu.se News item rfsl.se News item

rfslungdom.se News item and e-mail

lafa.nu News item

devote.se News story and e-mail happypancake.se E-mail

ungdomar.se Advertisement and e-mail youtube.com Film clip

jesper.nu Advertisement

The main method used to recruit respondents for the self-selected sample was banner advertisements. We sent e-mails to all community members in some cases, and these e-mails included the banner.

The banner contained the following texts, which were shown in rotation with a few seconds’ delay: “So what’s really up with sex?”, “Answer questions about sex and health”, “You can participate too, and win a notebook!”, “Click here! Sweden’s largest study of sex and health carried out by the University of Gothenburg”. Clicking on the banner redirected the user to our website (www.ungkab.se). This site contained a link to the questionnaire, and information about the researchers, the aim of the study and about the competition in which respondents could take part after having completed the questionnaire.

Recruitment of the self-selected sample began on 1 December 2009 and finished on 4 January 2010. During this period, 9,942 self-selected persons responded to the questionnaire.8

Activities to make the survey known

We carried out a number of activities before and during the data collection period designed to make the study known and to increase interest to participate. We held a press conference in October 2010 to which we invited others who work with sexual health among young people. They described how important it is to have a continuously running study of young people’s sexual health, and how they planned to use the results obtained by UngKAB09 in health promotion initiatives. The press conference led to articles about the study in several daily newspapers and to a radio report about it.

We also used various advocates before and during the data collection period who explained why it was important to participate in the study. These advocates came from various fields of popular culture. They contributed an image and a brief message, and the messages were then spread via Facebook and YouTube.

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The questionnaire

We had studied both Swedish and foreign questionnaires when we constructed UngKAB09. A seminar was held at the beginning of May 2009 to critical exam and discuss the content of the questionnaire and the method of data collection in greater detail. Professor Bente Træen from Tromsø University in Norway led the seminar. Other participants at the seminar included researchers with experience of the research area and various experts working in the field of sexuality and health. The questionnaire was subsequently distributed to a number of senior researchers in various areas of knowledge to obtain their comments. The questions have also been scrutinised by experts from Statistics Sweden (SCB, Statistiska Centralbyrån). The questionnaire contained 63 questions, of which most had fixed multiple choice answers (see Appendix 1). The number of questions a respondent received depended on the number of follow-up questions he or she was led past.9 The

questions in the study dealt with the following areas: social and demographic aspects, body and health, love and sexual experiences, the first time you had sex, the most recent time you had sex, experiences of condoms and other

contraceptives, knowledge and attitudes, pornography, and the internet. A number of questions were included to study experiences of such phenomena as sexual acts that happened against one’s will, and experiences of buying and selling sex. The emphasis of the questionnaire, however, was on sexual experiences, and the questions were designed mainly to provide important knowledge for the shaping of strategies in relation to various types of sexual risk taking.

How can sexual experiences be explored in a questionnaire? One commonly used approach is to ask respondents to state what they have done sexually and how many partners they have had during a certain period of time, such as the past twelve months. This approach suffers from the limitations that the information given is an estimate of the experiences of the respondent, and that it gives an overall picture of an individual’s sexual experience. In other words, the results usually contain little information about the various sexual situations or the persons with whom the respondent has had sex.

Catania et al. (1993) argue that the length of the retrospective period affects the respondent’s possibilities for correctly reporting what he/she has done sexually, to what extent and with whom. This might be the case, for instance, if a respondent has had a steady partner over the previous year with whom he/she has regularly had unprotected sex. In a study of risk taking among MSM carried out in 1998, there was a clear tendency for men to round off the number of times they had had intercourse into even tens (see the discussion in Tikkanen and Månsson, 1999). This observation can be interpreted to mean that the men estimated the number of times they had had intercourse during the past twelve months. The fact that

9 The digital questionnaire had a built-in function by which respondents who had answered “No” to a certain

question were led past the follow-up questions that would have been relevant if the respondent had answered “Yes”. For example, respondents who had not yet made their sexual debut were led past questions about the most recent time they had sex, etc. In this way, the questionnaire was experience-based and the same form could be used for the entire age range.

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several respondents included the word “approximately” in front of their answers in the paper questionnaire strengthens this interpretation. One way of dealing with this problem is to use a shorter retrospective period, such as three months. This, however, introduces the risk that respondents who have not had sexual contacts during the past three months become categorised as sexually inactive, despite the fact that they may have had sex during the rest of the year.

In addition to difficulties remembering, there is also the risk that a person does not want to remember certain actions. This can lead to respondents remembering sexual experiences that have had a positive significance and “forgetting” other experiences (Catania et al., 1993). Further, respondents can over-report socially and sexually acceptable actions with the aim of creating a positive image or compensating for “unacceptable” actions. Despite the problems associated with questionnaires, however, they are a very suitable method for obtaining information about actions that may be perceived as sensitive. Siegel et al. (1994) studied MSM, and compared the reliabilities in reporting risk behaviours of questionnaires and interviews. The researchers found that the men were more inclined to describe risky sexual actions in a questionnaire than in an interview. In the interviews, in contrast, the men provided more detailed information about the situations in which they had practised safer sex.

Tikkanen et al. asked questions in MSM studies conducted in 2006 and 2008 about the latest occasion on which the respondent had had sex with a man (Tikkanen, 2008; 2010). Thirty questions were posed to obtain information about how the respondents had met their most recent partners, where they had sex and what kind of sex they had. The advantage of this approach is that it provides a cross section of sexual experiences within a group. The cross section also gives an indication of development over time.

One advantage of asking questions about the most recent sexual encounter is that the answers provide detailed information about the situation and the action as well as the partner – knowledge that is important in understanding, for example, sexual risk taking. Another advantage is that it becomes easier for the respondent to remember and to relate what happened in the most recent sexual encounter than it is for one to summarise what has happened over the past year. Most respondents in the 2006 MSM study had had their most recent sexual encounter during the month before completing the questionnaire (Tikkanen, 2008). This supports the idea that it is easier to remember and relate what happened in the most recent sexual encounter.

The considerations described above led us to include questions in UngKAB09 both about sexual experiences over the preceding twelve months, about the first sexual encounter, and about the most recent sexual encounter.

An important aspect of formulating the UngKAB09 questionnaire was to create a modern research instrument that was not based on normative conceptions of gender and sexuality. We decided, therefore, that the question about the respondent’s

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gender should be an open question.10 We also reminded the respondent that “having

sex” does not necessarily mean penetrative vaginal or anal intercourse. The UngKAB09 questionnaire included a number of questions that had been specified in the guidelines for reporting within UNGASS. The answers to these are to be used as the basis for Sweden’s reporting in conformity with the UNGASS declaration. The questionnaire included also a number of questions that had been formulated in such a way that they could be used in the follow up of the National action plan on sexual health and chlamydia prevention targeting youths and young adults published by the National Board of Health and Welfare, at the Government’s request, in 2009. The UngKAB survey was first carried out in 2009, and results from it will be considered when drafting the measures to be implemented as part of the action plan.

Those respondents who completed the questionnaire were invited to take part in a competition. There was no connection between the answers given in the survey and those of the competition. The respondents were required to answer a number of general knowledge quiz questions (with no link to their own sexual experiences), and to compose a slogan promoting increased condom use – a central theme of HIV/STI prevention, and one that was compatible with the aims of the study. A jury made up of representatives from the National Board of Health and Welfare, RFSL (the Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights). The RFSL youth federation and RFSU (the Swedish Association for Sexuality Education) chose the best contributions. Three people won computers and 100 people won MP3 players.

Analysis

The reliability of the data was examined before the data was analysed, and 377 of the completed questionnaires were rejected. Firstly, we removed those who had answered only the socio-demographic background questions (40 respondents). Secondly, we looked closely at the answers we had received. This led to the elimination of 337 questionnaires. Of these, 45 respondents had provided

inconsistent answers. The other 292 respondents had completed the questionnaire in less than seven minutes. We made the assessment that it would not have been possible to answer all the questions on the form properly in that time, no matter how few one’s sexual experiences had been. The final material thus consists of 15,278 respondents. Table 2 shows the gender distribution of the two samples. The table also includes the 397 respondents who did not state their sex as male, female or other but just left the field blank.

The statistical analysis was carried out using SPSS (Statistical Package for the Social Sciences) software. The results are presented as simple frequency tables and cross tabulations. Simple cross tables are often sufficient to show interesting

10 The replies were then re-coded into three categories: Men, Women and Other. The category Other includes

those who expressly stated that they did not want to be categorised, and those who stated that they are transgender persons. There were only 46 individuals in this category. 397 responses could not be placed in any of the three categories.

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similarities and differences in the data. The cross tables compare responses between genders, since many factors regarding sexuality are different for men and women. There is no biological explanation for this: it is mainly a consequence of the norms that surround sexuality. The “Other” category in the tables includes transgender persons and respondents who expressly stated that they did not want their gender categorised. This category is a small category (only 46 individuals), and it is not possible to make any generalisations from the results from such a small group.

Table 2. Number of respondents, given as percentage (number)

Non-response

Women Men Other gender

Representative sample 41 (3,135) 35 (2,467) 4 (2) 1 (1) Self-selected sample 59 (4,562) 65 (4,671) 96 (44) 99 (396) TOTAL 100 (7,697) 100 (7,138) 100 (46) 100 (397) We carried out Pearson’s chi-squared tests when calculating cross tabulations. These are based on the difference between the observed and expected values for a given variable. The chi-squared test examines the way in which variables depend on each other, but says nothing about the strength of any correlations that may exist. In other words, this test shows the probability that any differences between variables in our material are due to random variation. Some of the variables are quantitative (interval variables). We have compared averages between various groupings of these variables using t-tests or analysis of variance (ANOVA). We have tried to express ourselves in a way that allows those who do not have a deeper understanding of statistics to follow our reasoning. This means, among other things, that the text is not burdened with complex statistical reasoning. We should point out, however, that the conclusion that there are differences (between genders, for example) is based on statistical significance testing (chi-squared tests, t-tests or ANOVA). This is emphasised in certain parts of the report by the use of the term “significant differences”.

We have used factor analysis for certain analyses. This is a multivariate analysis method that is suitable for revealing any underlying patterns among a larger number of variables (Barmark, 2009). Put simply, factor analysis searches for correlations between different variables. We have included dichotomous variables in the factor analyses we carried out, and use principal component analysis (PCA) as rotation method.11

The data allows for regional and specific analyses (such as “young adults in Skåne” or “young people who have immigrated to Sweden”). The data will therefore be broken down into smaller, specific sets for in-depth analysis, in order to meet the needs of, for example, regional stakeholders.

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Ethical issues

The research plan was vetted and approved by the Regional Ethical Review Board in Gothenburg. Respondents’ participation in the study was based on the principle of informed consent. Information about the study, including information about individuals’ legal right to anonymity, etc., was included in the letter sent to those in the representative sample and in a document that all internet respondents saw when they opened the online questionnaire. Those who consented to participate in the study did so by completing the questionnaire and sending it digitally to the researchers. Since all respondents were over 15 years of age, no consent was needed from parents or guardians.

The researchers could be contacted by e-mail and telephone during the data-collection period. Real-time communication was possible during specified hours every day during this period.

We suspected that surveys about sexuality would give rise to reactions in some respondents and that these may need to be dealt with in consultation with a

professional. The questionnaire, therefore, included contact details for professional counsellors in the school healthcare system, youth counselling centres and

psychiatric care centres, and contact details for volunteer organisations such as RFSU, RFSL and Noaks Ark (an HIV service organisation based in Sweden). The questionnaire provided information to all respondents who answered that they had experienced sex against their will about where they could obtain counselling and support. One advantage in UngKAB09 was that the researchers on this project were behaviour scientists and trained counsellors who have previously worked at Youth clinics and within the social services.

Surveys of young people on sensitive topics are always subject to a discussion about respondents’ discomfort. Information about various types of support centres and organisations is often included in studies of sexuality to help respondents with any questions that may have arisen. However, little is known about the extent to which respondents find surveys about intimate subjects unpleasant. A recent article describes and addresses this issue (Priebe, Bäckström & Ainsaar, 2010). The authors studied a particularly sensitive area in sexuality research: sexual exploitation, experiences of sexual abuse and of selling and buying sexual services. This survey, thus, contained a considerably greater number of sensitive questions than UngKAB09. The study was directed at pupils in the third year of upper secondary education. Further questions about how respondents had felt about answering the questionnaire were included at its end. Priebe et al. (2010) found that a clear majority had not felt that the questions caused discomfort. Asked whether they had felt discomfort at the questions, 80 percentages chose response options 1-3 on a scale where 1 represented “I don’t agree at all” and 5 “I agree fully”. Asked for their position on the statement “I don’t think you should ask people such questions”, 90 percentages chose response options 1–3 on the same scale. An analysis of differences between different categories of respondent showed a slightly higher incidence of discomfort at the questions among people with experience of sexual abuse and among sexually inexperienced respondents. These differences were, however, relatively small.

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We asked similar questions in UngKAB09, and the results are shown in Table 3.

Table 3. How did you feel about answering this questionnaire? Averages and standard deviations on a scale from 1 (“Don’t agree at all”) to 5 (“Agree fully”)

Women Men Other

The questions were important (n=13,956) 4.3±0.9 4.0±1.0 3.9±1.0 The questions were unpleasant (n=13,931) 1.5±1.0 1.5±0.9 1.8±1.1 It was fun answering the questions (n=13,917) 3.6±1.1 3.4±1.1 3.3±1.1 The questions were difficult to answer (n=13,885) 2.1±1.1 2.1±1.0 2.3±1.2 I answered the questions truthfully (n=13,991) 4.9±0.3 4.9±0.4 4.8±0.5 The questions were generally perceived as important and answers were truthful. A relatively small number of respondents felt that the questions were unpleasant. A slightly larger number found them difficult to answer. Gender differences were small. Further analysis (data not shown) showed that there was a difference between those who had made their sexual debut and those who hadn’t, in which the latter find the questions unpleasant to a slightly higher degree. The survey questionnaire was digital and experience-based. This means that sexually inexperienced respondents were not presented with questions about sexual

experiences they had not yet had. It is probable that these respondents would have felt the questionnaire to be even more unpleasant if they had been exposed to all the questions.

Results from those who had experienced sex against their will agreed with the findings of Priebe et al. (2010): such respondents tended to find the survey questions unpleasant to a slightly higher degree. The differences were, however, small.

The data collected by UngKAB09 concerned sensitive areas such as sexual activity and health, and it was vital that stringent requirements for confidentiality were imposed during the collection, processing and presentation of the research material. The participants in the survey received information about the purpose of the project either in the letter sent to their home address or in the document respondents had to pass before obtaining access to the questionnaire itself.

The respondents in the representative sample were given a personal login code. This was necessary in order to be able to determine who had responded to the survey, and to send reminders to those who had not. This information was known only by the person doing the actual data collection.12

The level of IT security of the project was high. One important security measure was pointing out to respondents that they should choose a suitable time for answering the questions. We felt that it was important to remind young people about this, particularly if they were in environments with many other people. We also informed respondents about how to remove all traces of their activities on the computer after they had finished. No information was saved on the computer on

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which respondents completed the questionnaire. The questionnaire was closed after five minutes of inactivity and there was no possibility of answering any further questions. We even removed the “Back” function in the questionnaire. This was to protect the respondent against the possibility that someone else could use this function to see the respondent’s answers to previous questions.

Can the results of the study be generalised?

UngKAB09 is the largest study of its kind in Sweden but do the results tell us anything about Swedish young people in general? As mentioned earlier, it is difficult to draw general conclusions about young people based on the results obtained from the representative sample, since only 24 percentages responded. Generalisations drawn from answers to the self-selected sample also suffer from limitations, because this is not a random sample. The only thing we can note is that the gender distribution among them who answered the survey is even. Also the fraction of respondents who lack upper secondary education is lower among those who responded to UngKAB09 than in the population as a whole,

Then, can anything be said about the 76 percentages who did not respond to the survey? It is difficult to carry out a more profound classical non-response analysis because the non-response figure is so large. Further, there are reasons to assume that any uneven distribution in the response pattern can be due to other factors than the fundamental background variables that are known such as gender, age and place of residence. The fundamental background variables that are usually the basis for non-response analyses are often, gender, age, education, occupation and place of residence. The explanation could just as well be sought in background factors such as class background, social vulnerability and self-esteem.

Another way of evaluating the material is to compare it with similar studies, such as “Ungdomsbarometern” (the Youth Barometer) (Ungdomsbarometern, 2009). This study has mapped young people’s attitudes, values and behaviour in a number of different areas since 1991.13

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Table 4. The percentages of men: comparison between Ungdomsbarometern and the two UngKAB09 samples

Letter sent to

Ungdoms- representative sample Self-selected barometern UngKAB09 sample UngKAB09

16-year-olds 41 42 48

20-year-olds 46 43 45

24-year-olds 42 43 55

Table 4 shows the percentages of men in Ungdomsbarometern and the two UngKAB09 samples.14 We have only included 16, 20 and 24-year-olds, since

only these three age groups are present in all three samples. Differences between the three samples are relatively small. What can be seen is that the group of respondents to the self-selected sample includes a slightly greater percentage of men than respondents to the letter sent to the representative sample. Differences between Ungdomsbarometern and the two UngKAB09 samples are small. Table 5 presents the percentages of jobseekers in the three samples.

There are clear differences. The two UngKAB09 samples do not differ when it comes to 16 and 20-year-olds, while the self-selected UngKAB09 sample contained a higher percentage of jobseekers among the 24-year-olds in contrast to the sample obtained from the representative sample and respondents to Ungdomsbarometern.

Table 5. Percentages of jobseekers: comparison between Ungdomsbarometern and the two UngKAB09 samples

Letter sent to

Ungdoms- representative sample Self-selected barometern UngKAB09 sample UngKAB09

16- year-olds 0 0 1

20-year-olds 8 15 17

24-year-olds 6 9 14

Table 6 presents the percentages of respondents born abroad in the three samples

Table 6. Respondents born abroad: comparison between Ungdomsbarometern and the two UngKAB09 samples

Letter sent to

Ungdoms- representative sample Self-selected barometern UngKAB09 sample UngKAB09

16- year-olds 4 4 4

20-year-olds 7 7 5

24-year-olds 12 10 6

Table 6 shows that the percentages for the 24-year-olds differ. Here the percentage of respondents born abroad is smaller in the self-selected sample than it is in the representative sample and in Ungdomsbarometern.

14 UngKAB is an abbreviation of Ungdomar och sexualitet: kunskap, attityder och beteende (Young People and

Figure

Table 2. Number of respondents, given as percentage (number)

Table 2.

Number of respondents, given as percentage (number) p.27
Table 3. How did you feel about answering this questionnaire? Averages and  standard deviations on a scale from 1 (“Don’t agree at all”) to 5 (“Agree fully”)

Table 3.

How did you feel about answering this questionnaire? Averages and standard deviations on a scale from 1 (“Don’t agree at all”) to 5 (“Agree fully”) p.29
Table 5 presents the percentages of jobseekers in the three samples.

Table 5

presents the percentages of jobseekers in the three samples. p.31
Table 4. The percentages of men: comparison between Ungdomsbarometern and  the two UngKAB09 samples

Table 4.

The percentages of men: comparison between Ungdomsbarometern and the two UngKAB09 samples p.31
Table 4 shows the percentages of men in Ungdomsbarometern and the two  UngKAB09 samples

Table 4

shows the percentages of men in Ungdomsbarometern and the two UngKAB09 samples p.31
Table 7 presents the percentages of respondents with sexual debut before the age of  15 in the three samples.

Table 7

presents the percentages of respondents with sexual debut before the age of 15 in the three samples. p.32
Table 8. Comparisons in percentages between the two UngKAB samples

Table 8.

Comparisons in percentages between the two UngKAB samples p.33

References

Related subjects : How did you get the job?