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The aim of this study was to investigate sexual behavior, contraceptive use, risk factors as well as sources of sex information among first-year high-school students in Sweden. Secondly, to assess differences between genders and study programs as well as changes over a 40-year period. A repeated cross-sectional survey was conducted in two cities. A questionnaire comprising 77 items was used. The study population consisted of 415 students (63.4% females). The median age of sexual intercourse was 15 years. In total, 37% had had sexual intercourse, compared to 56.3% in 2009 and 45% in 1999 (p<0.001), and the proportion of students who had their first sexual intercourse was not influenced by gender. More students in vocational programs (46.3%), compared to theoretical (33.3%), had experience of at least one sexual intercourse (p=0.019). The same extend of contraception use at first and latest intercourse was reported, compared to previous studies. Forty-nine percent were mostly informed about sex from the internet, while in previous years, magazines, family and youth clinics were the main information sources. Comparing over time, students were in general less sexually experienced and less engaged in non-penetrative sex and physical intimacy. These findings call for a new approach, when designing sex and relationship education and health-care counseling in adolescents.

Aims: Health-related behaviours are associated with social relationships. Adolescence is a time when healthy and unhealthy behaviours are established. There is a need to investigate adolescents’ views on how social relationships are related to health-related behaviours of adolescents in the Scandinavian welfare system. This study aimed to explore Swedish adolescents’ experiences and thoughts of how social relationships in different social environments are related to health-related behaviours.

Methods: A total of 36 adolescents aged 15–16 years were interviewed in seven focus-group sessions. Qualitative content analysis was used for analysis of the transcribed interviews.

Results: Two themes – social context and personal management – emerged. Swedish adolescents describe that their health-related behaviours as being partly shaped by their own personal management but mainly by the social contexts that surround them. Social contexts were expressed as playing a role in the adolescents’ health-related behaviours, as they provide fellowship, pressure, dependability and engagement. Fellowship with friends and family was expressed as providing healthy behaviours and high levels of well-being. Fellowship with friends was particularly important for physical activity. Close relationships were stated to influence health-related behaviours. Pressure from friends, teachers and social media were described as mainly influencing unhealthy behaviours and, to some extent, low levels of well-being. However, adolescents’ personal ability illustrated how adolescents shaped their own health-related behaviours.

Conclusions: The study results contribute to the understanding of Swedish adolescents’ views on how social relationships can shape their health-related behaviours. The findings may be useful to school professionals in supporting adolescents to improve well-being and healthy behaviours.

This study investigates boys’ awareness and thoughts about human papillomavirus (HPV) and HPV vaccination, perceived benefits of vaccinating men, information sources and intention to be vaccinated against HPV. We used a qualitative approach and interviews were conducted with 31 upper secondary school male students. Two main themes 1) Promotion of equal health and 2) Increased knowledge facilitates the decision about HPV vaccination emerged from the analysis. The informants believed that it was important and fair to protect boys and girls equally against HPV. If HPV vaccination could prevent both girls and boys against an HPV-related disease, there was nothing to question or to discuss. It was not a matter of sex; it was a matter of equal rights. Moreover, an important reason for vaccinating boys was to prevent the transmission of the virus. However, the boys felt unsure and stated that they needed to know more. The school nurse and the school health were considered suitable both for distributing information and for providing the vaccinations.

In conclusion, the participants were in favor of introducing HPV vaccination also for boys in the national vaccination program. Sex-neutral HPV vaccinations were viewed both as a way to stop the virus transmission and a means to promote equal health for the entire population.

In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolescents' knowledge, beliefs and HPV vaccination status in relation to socioeconomic status and sexual experience. Thus, the aim was to examine HPV catch-up vaccination status in adolescents in relation to 1) socioeconomic factors, 2) beliefs and knowledge about HPV prevention, and 3) sexual behaviour. The Health Belief Model was used as a theoretical framework. Upper secondary school students (n = 832) aged 16, randomly chosen from a larger sample, were invited to participate in conjunction with the general health interview with the school nurse. A total of 751/832 (90.3%), girls (n = 391, 52%) and boys (n = 360, 48%) completed the questionnaire. HPV vaccination was associated with ethnicity and the mothers' education level; i.e. girls with a non-European background and girls with a less educated mother were less likely to have received the vaccine (p<0.01 and p = 0.04 respectively). Vaccinated girls perceived HPV infection as more severe (p = 0.01), had more insight into women's susceptibility to the infection (p = 0.02), perceived more benefits of the vaccine as protection against cervical cancer (p<0.01) and had a higher intention to engage in HPV-preventive behaviour (p = 0.01). Furthermore, boys and girls were almost equally sexually experienced, although fewer girls had used condom during first intercourse with their latest partner (p = 0.03). Finally, HPV vaccinated girls were less likely to have unprotected sex (p<0.01). In summary, catch-up HPV vaccination among young girls was associated with a European background and high maternal education level, as well as more favourable beliefs towards HPV prevention and less sexual risk-taking. Further preventive measures should therefore be directed at the migrant population.

The aim of this study was to determine how patients with head and neck cancer experience changes within their intimate relationships at the end of treatment and detect detrimental and facilitating factors in the process of resuming intimate relationships. Interviews were conducted with 131 patients. A core category - being open versus not sharing the cancer journey - emerged from the patients' narratives and was based on the experiences of engagement/disengagement, openness/fear, and patronizing attitudes/sharing the burden. The findings point to the necessity of patients being open about the disease trajectory and might be understood in the light of theories about potential changes in identity and self-concept.

Background: Unhealthy behaviours during adolescence constitute a major risk for numerous diseases in adulthood.

Aim: To explore the associations between multiple unhealthy behaviours in adolescents and health behaviour information communicated by their parents and teachers, how much the adolescents cared about this information and whether adolescents went to schools with an annual health-themed week or not.

Methods: In this cross-sectional study, a self-reported questionnaire was delivered to pupils aged 15 and 16 (n = 492). The results were analysed using Poisson regression.

Results: The number of unhealthy behaviours was lower in adolescents whose parents encouraged them to adopt healthy behaviours. Adolescents at schools with an annual health-themed week reported more unhealthy behaviours than other adolescents. In addition, attendance at such schools did not compensate for a lack of health behaviour information communicated by parents. Caring about health behaviour information communicated by parents was associated with fewer unhealthy behaviours. In contrast, the opposite was found when adolescents cared about health information communicated by teachers.

Conclusion: It is important for parents to encourage their adolescent children to adopt healthy behaviours because this is particularly effective at lowering the number of unhealthy behaviours in adolescents. It also appears to be important for parents and teachers to develop credibility among adolescents regarding information communicated about health issues. The results also indicate the importance of involving parents in the school health work to influence them to encourage their adolescent children to adopt healthy behaviours.

Objective: To explore parents' views of extending the human papillomavirus (HPV) vaccination programme to also include boys. Design: Explorative qualitative design using individual, face-to-face, interviews and inductive thematic analysis. Setting: 11 strategically chosen municipalities in central Sweden. Participants: Parents (n= 42) who were offered HPV vaccination for their 11-12 years old daughter in the national school-based vaccination programme. Results: The key themes were: equality from a public health perspective and perception of risk for disease. Parents expressed low knowledge and awareness about the health benefits of male HPV vaccination, and they perceived low risk for boys to get HPV. Some parents could not see any reason for vaccinating boys. However, many parents preferred gender-neutral vaccination, and some of the parents who had not accepted HPV vaccination for their daughter expressed that they would be willing to accept vaccination for their son, if it was offered. It was evident that there was both trust and distrust in authorities' decision to only vaccinate girls. Parents expressed a preference for increased sexual and reproductive health promotion such as more information about condom use. Some parents shared that it was more important to vaccinate girls than boys since they believed girls face a higher risk of deadly diseases associated with HPV, but some also believed girls might be more vulnerable to side effects of the vaccine. Conclusions: A vaccine offered only to girls may cause parents to be hesitant to vaccinate, while also including boys in the national vaccination programme might improve parents' trust in the vaccine. More information about the health benefits of HPV vaccination for males is necessary to increase HPV vaccination among boys. This may eventually lead to increased HPV vaccine coverage among both girls and boys.

BACKGROUND: Factors that influence unhealthy behaviours in adolescents may have different impacts in different sociocultural settings. There is lack of research on the association between psychosocial vulnerability and unhealthy behaviours in adolescents, particularly outside the United States. The aim was to investigate both direct and indirect relationships between psychosocial conditions (subjective well-being, social relationships and self-esteem) and four health-related behaviours (smoking, alcohol consumption, meal frequency and physical activity) in Swedish adolescents aged 15-16 years. Socio-demographic variables (socio-economic status, gender and age) were also investigated.

METHODS: To study these associations, a hypothesised model was tested using structural equation modelling. In the hypothesised model, interrelated psychosocial conditions (low well-being, poor social relationships and low self-esteem) and socio-demographic factors (low self-perceived socio-economic status, being female and higher age) together represented a vulnerability underlying smoking, alcohol consumption, irregular meal frequency and low level of physical activity. In this cross-sectional study, self-report questionnaires were used to collect data from 492 adolescents.

RESULTS: Hypothesised pathways between psychosocial conditions, socio-demographic factors and the four unhealthy behaviours were confirmed. Low well-being was strongly associated with unhealthy behaviours, and poor social relationships showed a strong indirect association with the unhealthy behaviours. Low self-esteem, low self-perceived socio-economic status and female gender were also vulnerability factors for the unhealthy behaviours.

CONCLUSIONS: Vulnerability for four common unhealthy behaviours was found in Swedish adolescents. This study presents the interrelationships of psychosocial and socio-demographic factors and how they were related with unhealthy behaviours. The results bring new insight into how psychosocial factors are related to unhealthy behaviours in adolescents living in northern Europe.

The aim was to investigate school nurses' attitudes towards, and experiences of vaccination against human papillomavirus (HPV), and compare the results with a similar study three years earlier. School nurses (n = 736) from all counties in Sweden completed a questionnaire in spring 2016, four years after the implementation of the national HPV vaccination programme, and three years after the previous survey. Overall, the school nurses had more favourable attitudes towards the HPV vaccination programme compared to the study in 2013 (p = 0.015). More than half of the nurses (n = 415, 56%) strongly agreed that boys should also be offered the vaccine (p<0.001). There were no differences in school nurses' perceived knowledge about HPV in order to inform and to answer questions about the vaccine from the girls or from the parents. More than half of the nurses (n = 409, 56%) reported that they needed more education about HPV. Almost all nurses (n = 659, 90%) had been contacted by parents with questions about the vaccine, and most questions were related to vaccine safety. School nurses have a more favourable attitude towards the vaccination programme against HPV compared to three years earlier, although almost all nurses had been contacted by parents with diverse questions and concerns. The nurses believed that they needed more education about HPV. Thus, it is essential to provide ongoing education and training for school nurses who are key healthcare professionals for providing information about HPV and HPV vaccination to parents and to pupils.