Youngsters are, on average, 16 years old and sober when they make their sexual debut with somebody they have known for a while. However, condoms feature in just half of sexual encounters with new or casual partners, reveals a major survey on the sexual habits, attitudes and knowledge of young people carried out by the University of Gothenburg on behalf of the Swedish Institute for Communicable Disease Control.

"We have to get young people to view condoms as an essential part of having sex," says Ronny Heikki Tikkanen, one of the researchers behind the study which polled 15,000 young people between the ages of 15 and 29 right across Sweden. "The fact that so many don't use condoms, even though they know that they offer protection against both STIs and unwanted pregnancies, shows how important it is to work on attitudes and behaviour."

The survey clearly demonstrates that those who start having sex at a young age and are generally inclined to take risks with alcohol and drugs are also likely to do so with sex. It is also more common for risk-takers to have accepted payment for sex. Those identified by the study as having exposed themselves to sexual risks have generally encountered HIV prevention initiatives without them having impacted notably on their behaviour.

"We've got to get better at identifying youngsters who take risks," says Margareta Forsberg, R&D manager at the Swedish Institute for Communicable Disease Control. "We also need to be more aware of the link between sexual risks, drugs and social exclusion. If we can come up with support structures at an early stage, we stand a better chance of promoting sexual health, self-esteem and wellbeing."

The researchers behind the study are now calling for new methods and strategies for preventive work on sexuality and health for young people.

"Young people want sexual health clinics to be readily accessible, condoms to be distributed at various meeting places and the Internet to be used more widely for advice and support," says Jonna Abelsson, assistant researcher at the University of Gothenburg. "The study offers guidance on the types of initiative that are viable for youngsters. We need to think about whether we're going about things the right way when it comes to reaching those who most need advice and support."

The Ung KAB09 study is the largest of its kind in Sweden and the large number of respondents means that it has huge potential for increasing our knowledge and for investigating the links between different types of experience. As it was carried out partly through an online questionnaire, the study is not entirely representative, but it still makes an important contribution to preventive work on account of its size.