Norwegian adolescents’ exposure to violence- results from the Youth Health Survey from six counties in Norway.

Summary

The purpose of this report is to estimate the prevalence of exposure to violence and sexual abuse among Norwegian 15 – 16 year olds and assess the need for further research through analysis of existing data and a review of available literature. During 2000–2004 in all 15930 adolescents aged 15 – 16 years participated in the Youth Health Surveys in six counties in Norway. Data from these surveys have been used to estimate the prevalence of exposure to violence and sexual abuse, and to analyse the associations of violence and sexual abuse with socioeconomic, geographic and individual characteristics. The following items from the questionnaire measured exposure to violence and sexual abuse:

“Have you been subject to violence (e.g. been hit, kicked etc.) during the last 12 months?”

“Have you during the last 12 months experienced sexual abuse (e.g. flashing, fondling, forced intercourse etc.)”

 Prevalence of violence exposure and sexual abuse

• Violence committed by adolescents during the last year was reported by 23.6 percent of boys and 11.8 percent of girls, while 3.3 percent of boys and 4.6 percent of girls were exposed to violence from adults.
• Sexual abuse during the last year was noted by 1.6 percent of boys and 6.1 percent of girls.
• The prevalence of exposure to violence or sexual abuse was highest in Oslo, Finnmark, Troms and Nordland. Exposure to violence by adolescents was highest in Oslo (around 27 percent for boys), while the highest prevalence of violence committed by adults (around 6 percent for girls) and of sexual abuse (around 9 percent for girls) was reported in Finnmark.

Associations of violence exposure and sexual abuse with socio-economic and  individual characteristics
Adolescents with diverse socioeconomic backgrounds reported violence and sexual abuse in this study. However, some social and individual factors showed significant associations with exposure to violence and sexual abuse:

• Poor family economy (versus good or very well of )
• Parents on disability pension, sick leave, social benefits or unemployment benefits (versus working)
• Living with a single parent, with a step-parent or with foster parents (versus both biological parents)
• Having a physical handicap, and in particular impaired hearing
• Repeated binge drinking
• Being bullied at school
• Low educational achievements
• Poor health in general, mental distress and pain in the head, neck, shoulders, back or stomach
• Having parents with a non-western background (violence from adults only)

Violence committed by adults and sexual abuse showed stronger associations with the above listed factors, while violence by other adolescents showed weaker association.

Reports of two or three types of victimization
Sexual abuse, violence from other adolescents and also violence from adults was reported by 0.4 percent (n = 70), while 2.9 percent (n = 458) reported violence from both youth and adults or one kind of violence and sexual abuse (multiple exposure). Girls reported two or three of these different victimizations more often than boys.

Young people exposed to two or three of these types of victimizations were more likely to report health problems, and mental distress in particular, compared to adolescents who had experienced one kind of victimization only. Among adolescents who had experienced violence and/or sexual abuse, substantial proportions (21 percent of girls and 11 percent of boys) had experienced two or three different types of victimization.

Methodological issues
The Youth Health Surveys included a large sample of adolescents in a narrow age range, and the response rate was very high. The setting of school classes, together with survey personnel rather than teachers giving instructions, provided a relatively neutral arena for answering. The adolescents were informed that participation was voluntary and that the information they gave could not be traced back to them. Some limitations should be noted:

• The six counties covered in this study did not provide a nationally representative sample of Norwegian youth, although the north and south, urban and rural areas were covered.
• A cross-sectional survey does not allow conclusions with respect to causal relationships.
• The survey did not include questions on number or frequency of incidents of violence and sexual abuse, so respondents who suffered repeated episodes of the same type of victimization could not be discriminated from those with a single incident. The questions were limited to violence and abuse during the last 12 months, and the total exposure to violence is unknown.
• The questions regarding violence and sexual abuse did not go into details, and the violence and abuse reported rely to some degree on the respondents’ own definitions, although some examples were given.
• All information on social factors, individual behaviour and health was self-reported and thereby relying on subjective definitions.
• Personal characteristics of respondents tend to exaggerate the associations of self-reported problems, as some people tend to affirm and some to deny problems in general. 

Conclusions and implications
This study showed that around 22 percent of 15 – 16-year olds in Norway were exposed to violence and/or sexual abuse in the course of one year. Among the adolescents exposed to violence, 11 percent of boys and 21 percent of girls were exposed to more than one type of victimization. Being exposed to violence and sexual abuse were associated with a number of other factors known to represent vulnerability. These results show that future research efforts in large scale health studies need to focus more on exposure to violence and sexual abuse. Longitudinal studies should be conducted to define possible risk factors and evaluate the aetiology of health problems in adolescents exposed to violence and abuse. Moreover knowledge about the prevalence and the possible consequences of violence and sexual abuse is crucial in planning prevention and clinical interventions in the field.