title: Child physical abuse and concurrence of other types of child abuse in Sweden-Associations with health and risk behaviors.
abstract: OBJECTIVE
  To examine the associations between child physical abuse executed by a parent or caretaker and self-rated health problems/risk-taking behaviors among teenagers. Further to evaluate concurrence of other types of abuse and how these alone and in addition to child physical abuse were associated with bad health status and risk-taking behaviors.
  
  
  METHODS
  A population-based survey was carried out in 2008 among all the pupils in 2 different grades (15 respectively 17 years old) in Södermanland County, Sweden (n=7,262). The response rate was 81.8%. The pupils were asked among other things about their exposure to child physical abuse, exposure to parental intimate violence, bullying, and exposure to being forced to engage in sexual acts. Adjusted analyses were conducted to estimate associations between exposure and ill-health/risk-taking behaviors.
  
  
  RESULTS
  Child physical abuse was associated with poor health and risk-taking behaviors with adjusted odds ratios (OR) ranging from 1.6 to 6.2. The associations were stronger when the pupils reported repeated abuse with OR ranging from 2.0 to 13.2. Also experiencing parental intimate partner violence, bullying and being forced to engage in sexual acts was associated with poor health and risk-taking behaviors with the same graded relationship to repeated abuse. Finally there was a cumulative effect of multiple abuse in the form of being exposed to child physical abuse plus other types of abuse and the associations increased with the number of concurrent abuse.
  
  
  CONCLUSIONS
  This study provides strong indications that child abuse is a serious public health problem based on the clear links seen between abuse and poor health and behavioral problems. Consistent with other studies showing a graded relationship between experiences of abuse and poor health/risk-taking behaviors our study shows poorer outcomes for repeated and multiple abuse. Thus, our study calls for improvement of methods of comprehensive assessments, interventions and treatment in all settings where professionals meet young people.
authors.affiliation: Linköping University, Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Linköping, Sweden.
authors.forename: E-M
authors.initials: EM
authors.lastname: Annerbäck
authors.forename: L
authors.initials: L
authors.lastname: Sahlqvist
authors.forename: C G
authors.initials: CG
authors.lastname: Svedin
authors.forename: G
authors.initials: G
authors.lastname: Wingren
authors.forename: P A
authors.initials: PA
authors.lastname: Gustafsson
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D012309:Risk-Taking; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology