Summary Background Sexual behaviour and relationships are key components of wellbeing and are affected by social norms, attitudes, and health. We present data on sexual behaviours and attitudes in ...Britain (England, Scotland, and Wales) from the three National Surveys of Sexual Attitudes and Lifestyles (Natsal). Methods We used a multistage, clustered, and stratified probability sample design. Within each of the 1727 sampled postcode sectors for Natsal-3, 30 or 36 addresses were randomly selected and then assigned to interviewers. To oversample individuals aged 16–34 years, we randomly allocated addresses to either the core sample (in which individuals aged 16–74 years were eligible) or the boost sample (in which only individuals aged 16–34 years were eligible). Interviewers visited all sampled addresses between Sept 6, 2010, and Aug 31, 2012, and randomly selected one eligible individual from each household to be invited to participate. Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview. We analysed data from this survey, weighted to account for unequal selection probabilities and non-response to correct for differences in sex, age group, and region according to 2011 Census figures. We then compared data from participants aged 16–44 years from Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3. Findings Interviews were completed with 15 162 participants (6293 men, 8869 women) from 26 274 eligible addresses (57·7%). 82·1% (95% CI 81·0–83·1%) of men and 77·7% (76·7–78·7%) of women reported at least one sexual partner of the opposite sex in the past year. The proportion generally decreased with age, as did the range of sexual practices with partners of the opposite sex, especially in women. The increased sexual activity and diversity reported in Natsal-2 in individuals aged 16–44 years when compared with Natsal-1 has generally been sustained in Natsal-3, but in men has generally not risen further. However, in women, the number of male sexual partners over the lifetime (age-adjusted odds ratio 1·18, 95% CI 1·08–1·28), proportion reporting ever having had a sexual experience with genital contact with another woman (1·69, 1·43–2·00), and proportion reporting at least one female sexual partner in the past 5 years (2·00, 1·59–2·51) increased in Natsal-3 compared with Natsal-2. While reported number of occasions of heterosexual intercourse in the past 4 weeks had reduced since Natsal-2, we recorded an expansion of heterosexual repertoires—particularly in oral and anal sex—over time. Acceptance of same-sex partnerships and intolerance of non-exclusivity in marriage increased in men and women in Natsal-3. Interpretation Sexual lifestyles in Britain have changed substantially in the past 60 years, with changes in behaviour seeming greater in women than men. The continuation of sexual activity into later life—albeit reduced in range and frequency—emphasises that attention to sexual health and wellbeing is needed throughout the life course. Funding Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.
Summary Background Despite its importance to sexual health and wellbeing, sexual function is given little attention in sexual health policy. Population-based studies are needed to understand sexual ...function across the life course. Methods We undertook a probability sample survey (the third National Survey of Sexual Attitudes and Lifestyles Natsal-3) of 15 162 individuals aged 16–74 years who lived in Britain (England, Scotland, and Wales). Interviews were done between Sept 6, 2010, and Aug 31, 2012. We assessed the distribution of sexual function by use of a novel validated measure (the Natsal-SF), which assessed problems with individual sexual response, sexual function in a relationship context, and self-appraisal of sex life (17 items; 16 items per gender). We assess factors associated with low sexual function (defined as the lowest quintile of distribution of Natsal-SF scores) and the distribution of components of the measure. Participants reporting one or more sexual partner in the past year were given a score on the Natsal-SF (11 690 participants). 4122 of these participants were not in a relationship for all of the past year and we employed the full information maximum likelihood method to handle missing data on four relationship items. Findings We obtained data for 4913 men and 6777 women for the Natsal-SF. For men and women, low sexual function was associated with increased age, and, after age-adjustment, with depression (adjusted odds ratio 3·70 95% CI 2·90–4·72 for men and 4·11 3·36–5·04 for women) and self-reported poor health status (2·63 1·73–3·98 and 2·41 1·72–3·39). Low sexual function was also associated with experiencing the end of a relationship (1·52 1·18–1·95 and 1·77 1·44–2·17), inability to talk easily about sex with a partner (2·36 1·94–2·88 and 2·82 2·28–3·48), and not being happy in the relationship (2·89 2·32–3·61 and 4·10 3·39–4·97). Associations were also noted with engaging in fewer than four sex acts in the past 4 weeks (3·13 2·58–3·79 and 3·38 2·80–4·09), having had same sex partners (2·28 1·56–3·35 and 1·60 1·16–2·20), paying for sex (in men only; 2·62 1·46–4·71), and higher numbers of lifetime sexual partners (in women only; 2·12 1·68–2·67 for ten or more partners). Low sexual function was also associated with negative sexual health outcomes such as experience of non-volitional sex (1·98 1·14–3·43 and 2·18 1·79–2·66) and STI diagnosis (1·50 1·06–2·11 and 1·83 1·35–2·47). Among individuals reporting sex in the past year, problems with sexual response were common (41·6% of men and 51·2% of women reported one or more problem) but self-reported distress about sex lives was much less common (9·9% and 10·9%). For individuals in a sexual relationship for the past year, 23·4% of men and 27·4% of women reported an imbalance in level of interest in sex between partners, and 18·0% of men and 17·1% of women said that their partner had had sexual difficulties. Most participants who did not have sex in the past year were not dissatisfied, distressed, or avoiding sex because of sexual difficulties. Interpretation Wide variability exists in the distribution of sexual function scores. Low sexual function is associated with negative sexual health outcomes, supporting calls for a greater emphasis on sexual function in sexual health policy and interventions. Funding Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.
Summary Background Unplanned pregnancy is a key public health indicator. We describe the prevalence of unplanned pregnancy, and associated factors, in a general population sample in Britain (England, ...Scotland, and Wales). Method We did a probability sample survey, the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), of 15 162 men and women aged 16–74 years in Britain, including 5686 women of child-bearing age (16–44 years) who were included in the pregnancy analysis, between Sept 6, 2010, and Aug 31, 2012. We describe the planning status of pregnancies with known outcomes in the past year, and report the annual population prevalence of unplanned pregnancy, using a validated, multicriteria, multi-outcome measure (the London Measure of Unplanned Pregnancy). We set the findings in the context of secular trends in reproductive health-related events, and patterns across the life course. Findings 9·7% of women aged 16–44 years had pregnancies with known outcome in the year before interview, of which 16·2% (95% CI 13·1–19·9) scored as unplanned, 29·0% (25·2–33·2) as ambivalent, and 54·8% (50·3–59·2) as planned, giving an annual prevalence estimate for unplanned pregnancy of 1·5% (1·2–1·9). Pregnancies in women aged 16–19 years were most commonly unplanned (45·2% 30·8–60·5). However, most unplanned pregnancies were in women aged 20–34 years (62·4% 50·2–73·2). Factors strongly associated with unplanned pregnancy were first sexual intercourse before 16 years of age (age-adjusted odds ratio 2·85 95% CI 1·77–4·57, current smoking (2·47 1·46–4·18), recent use of drugs other than cannabis (3·41 1·64–7·11), and lower educational attainment. Unplanned pregnancy was also associated with lack of sexual competence at first sexual intercourse (1·90 1·14–3·08), reporting higher frequency of sex (2·11 1·25–3·57 for five or more times in the past 4 weeks), receiving sex education mainly from a non-school-based source (1·84 1·12–3·00), and current depression (1·96 1·10–3·47). Interpretation The increasing intervals between first sexual intercourse, cohabitation, and childbearing means that, on average, women in Britain spend about 30 years of their life needing to avert an unplanned pregnancy. Our data offer scope for primary prevention aimed at reducing the rate of unplanned conceptions, and secondary prevention aimed at modification of health behaviours and health disorders in unplanned pregnancy that might be harmful for mother and child. Funding Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.
In the UK, people of black Caribbean (BC) ethnicity continue to be disproportionately affected by bacterial sexually transmitted infections (STIs) and Trichomonas vaginalis (TV). We systematically ...reviewed evidence on the association between bacterial STIs/TV and ethnicity (BC compared to white/white British (WB)) accounting for other risk factors; and differences between these two ethnic groups in the prevalence of risk factors associated with these STIs, sexual healthcare seeking behaviours, and contextual factors influencing STI risk.
Studies presenting relevant evidence for participants aged ≥14 years and living in the UK were eligible for inclusion. A pre-defined search strategy informed by the inclusion criteria was developed. Eleven electronic databases were searched from the start date to September-October 2016. Two researchers independently screened articles, extracted data using a standardised proforma and resolved discrepancies in discussion with a third researcher. Descriptive summaries of evidence are presented. Meta-analyses were not conducted due to variation in study designs. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed.
Of 3815 abstracts identified, 15 articles reporting quantitative data were eligible and included in the review. No qualitative studies examining contextual drivers of STI risk among people of BC ethnicity were identified. Compared to the white/WB ethnic group, the greater STI/TV risk among BCs was partially explained by variations in socio-demographic factors, sexual behaviours, and recreational drug use. The prevalence of reporting early sexual debut (<16 years), concurrency, and multiple partners was higher among BC men compared to white/WB men; however, no such differences were observed for women. People of BC ethnicity were more likely to access sexual health services than those of white/WB ethnicity.
Further research is needed to explore other drivers of the sustained higher STI/TV prevalence among people of BC ethnicity. Developing holistic, tailored interventions that address STI risk and target people of BC ethnicity, especially men, could enhance STI prevention.
Summary Background Population-based estimates of prevalence, risk distribution, and intervention uptake inform delivery of control programmes for sexually transmitted infections (STIs). We undertook ...the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) after implementation of national sexual health strategies, and describe the epidemiology of four STIs in Britain (England, Scotland, and Wales) and the uptake of interventions. Methods Between Sept 6, 2010 and Aug 31, 2012, we did a probability sample survey of 15 162 women and men aged 16–74 years in Britain. Participants were interviewed with computer-assisted face-to-face and self-completion questionnaires. Urine from a sample of participants aged 16–44 years who reported at least one sexual partner over the lifetime was tested for the presence of Chlamydia trachomatis , type-specific human papillomavirus (HPV), Neisseria gonorrhoeae , and HIV antibody. We describe age-specific and sex-specific prevalences of infection and intervention uptake, in relation to demographic and behavioural factors, and explore changes since Natsal-1 (1990–91) and Natsal-2 (1999–2001). Findings Of 8047 eligible participants invited to provide a urine sample, 4828 (60%) agreed. We excluded 278 samples, leaving 4550 (94%) participants with STI test results. Chlamydia prevalence was 1·5% (95% CI 1·1–2·0) in women and 1·1% (0·7–1·6) in men. Prevalences in individuals aged 16–24 years were 3·1% (2·2–4·3) in women and 2·3% (1·5–3·4) in men. Area-level deprivation and higher numbers of partners, especially without use of condoms, were risk factors. However, 60·4% (45·5–73·7) of chlamydia in women and 43·3% (25·9–62·5) in men was in individuals who had had one partner in the past year. Among sexually active 16–24-year-olds, 54·2% (51·4–56·9) of women and 34·6% (31·8–37·4) of men reported testing for chlamydia in the past year, with testing higher in those with more partners. High-risk HPV was detected in 15·9% (14·4–17·5) of women, similar to in Natsal-2. Coverage of HPV catch-up vaccination was 61·5% (58·2–64·7). Prevalence of HPV types 16 and 18 in women aged 18–20 years was lower in Natsal-3 than Natsal-2 (5·8% 3·9–8·6 vs 11·3% 6·8–18·2; age-adjusted odds ratio 0·44 0·21–0·94). Gonorrhoea (<0·1% prevalence in women and men) and HIV (0·1% prevalence in women and 0·2% in men) were uncommon and restricted to participants with recognised high-risk factors. Since Natsal-2, substantial increases were noted in attendance at sexual health clinics (from 6·7% to 21·4% in women and from 7·7% to 19·6% in men) and HIV testing (from 8·7% to 27·6% in women and from 9·2% to 16·9% in men) in the past 5 years. Interpretation STIs were distributed heterogeneously, requiring general and infection-specific interventions. Increases in testing and attendance at sexual health clinics, especially in people at highest risk, are encouraging. However, STIs persist both in individuals accessing and those not accessing services. Our findings provide empirical evidence to inform future sexual health interventions and services. Funding Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.
Importance Sexual relationships are important for well-being and health. Recent trends in sexual activity among US adults are unknown. Objectives To examine trends in reported frequency of sexual ...activity and number of sexual partners by sex and age and the association between measures of sexual activity and sociodemographic variables. Design, Setting, and Participants In this survey study, repeat, cross-sectional analyses of participants aged 18 to 44 years from 10 rounds of the General Social Survey (2000-2018), a US nationally representative survey, were performed for men and women separately. Main Outcomes and Measures Sexual frequency in the past year (sexual inactivity, once or twice per year, 1-3 times per month, or weekly or more) and number of sexual partners in the past year (0, 1, 2, or ≥3 partners). The association between measures of sexual activity and sociodemographic variables were assessed using logistic regression. Results The study population included 4291 men and 5213 women in the analysis of sexual frequency and 4372 men and 5377 women in the analysis of number of sexual partners (mean SD age, 31.4 7.6 years; survey response rate, 59.5%-71.4%). Between 2000-2002 and 2016-2018, the proportion of 18- to 24-year-old individuals who reported having had no sexual activity in the past year increased among men (18.9% vs 30.9%; age-adjusted odds ratio aOR for trend across survey periods, 1.20; 95% CI, 1.04-1.39) but not among women (15.1% vs 19.1%; aOR for trend, 1.03; 95% CI, 0.89-1.18). Smaller absolute increases in sexual inactivity were observed among those aged 25 to 34 years for both men (7.0% vs 14.1%; aOR for trend, 1.23; 95% CI, 1.07-1.42) and women (7.0% vs 12.6%; aOR for trend, 1.17; 95% CI, 1.01-1.35) but not among those aged 35 to 44 years. The increase in sexual inactivity coincided with decreases in the proportion reporting weekly or more sexual frequency (men aged 18-24 years: 51.8% vs. 37.4%; aOR for trend, 0.88 95% CI, 0.79-0.99; men aged 25-34 years: 65.3% vs 50.3%; aOR for trend, 0.87 95% CI, 0.81-0.94; women aged 25-34 years: 66.4% vs. 54.2%; aOR for trend, 0.90 95% CI, 0.84-0.96) or 1 sexual partner (men aged 18-24 years: 44.2% vs. 30.0%; aOR for trend, 0.88 95% CI, 0.80-0.98; women aged 25-34 years: 79.6% vs 72.7%; aOR for trend, 0.91 95% CI, 0.84-0.99) and occurred mainly among unmarried men (unmarried men aged 18-44 years: 16.2% vs 24.4%; aOR for trend, 1.14 95% CI, 1.04-1.25). Among married men and women, weekly or more sexual frequency decreased (men: 71.1 % vs 57.7%; aOR for trend, 0.86 95% CI, 0.79-0.93; women: 69.1% vs 60.9%; aOR for trend, 0.92 95% CI, 0.86-0.99). Men with lower income (aOR for men with an annual income of ≥$50 000 vs $0-$9999, 0.37 95% CI, 0.15-0.90) and with part-time (aOR vs full-time employment, 2.08; 95% CI, 1.48-2.93) and no employment (aOR vs full-time employment, 2.08; 95% CI, 1.48-2.93) were more likely to be sexually inactive, as were men (aOR vs full-time employment, 2.94; 95% CI, 2.06-4.21) and women (aOR vs full-time employment, 2.37; 95% CI, 1.68-3.35) who were students. Conclusions and Relevance This survey study found that from 2000 to 2018, sexual inactivity increased among US men such that approximately 1 in 3 men aged 18 to 24 years reported no sexual activity in the past year. Sexual inactivity also increased among men and women aged 25 to 34 years. These findings may have implications for public health.
Sexual orientation encompasses three dimensions: sexual identity, attraction and behaviour. There is increasing demand for data on sexual orientation to meet equality legislation, monitor potential ...inequalities and address public health needs. We present estimates of all three dimensions and their overlap in British men and women, and consider the implications for health services, research and the development and evaluation of public health interventions.
Analyses of data from Britain's third National Survey of Sexual Attitudes and Lifestyles, a probability sample survey (15,162 people aged 16-74 years) undertaken in 2010-2012.
A lesbian, gay or bisexual (LGB) identity was reported by 2·5% of men and 2·4% of women, whilst 6·5% of men and 11·5% of women reported any same-sex attraction and 5·5% of men and 6·1% of women reported ever experience of same-sex sex. This equates to approximately 547,000 men and 546,000 women aged 16-74 in Britain self-identifying as LGB and 1,204,000 men and 1,389,000 women ever having experience of same-sex sex. Of those reporting same-sex sex in the past 5 years, 28% of men and 45% of women identified as heterosexual.
There is large variation in the size of sexual minority populations depending on the dimension applied, with implications for the design of epidemiological studies, targeting and monitoring of public health interventions and estimating population-based denominators. There is also substantial diversity on an individual level between identity, behaviour and attraction, adding to the complexity of delivering appropriate services and interventions.
Understanding sexual lifestyles and how they change over time is important for determining the likelihood of sexual health outcomes. Standard descriptive and regression methods are limited in their ...ability to capture multidimensional concepts such as sexual lifestyles. Latent Class Analysis (LCA) is a mixture modelling method that generates a categorical latent variable to derive homogenous groups from a heterogeneous population. Our study investigates (1) the potential of LCA to assess change over time in sexual lifestyles and (2) how quantifying this change using LCA compares to previous findings using standard approaches.
Probability-sampled data from three rounds of the National Survey of Sexual Attitudes and Lifestyle (Natsal) were used, restricted to sexually active participants (i.e., those reporting sexual partners in the past year) aged 16-44 years (N
= 11,738; N
= 9,690; N
= 8,397). An LCA model was built from four variables: number of sexual partners (past year), number of partners without a condom (past year), age at first sex and self-perceived HIV risk. Covariates included age, ethnicity, educational attainment, same-sex attraction, and marital status. Multinomial regression analyses and Chi-Squared tests were used to investigate change over time in the size of each class.
We successfully used a LCA approach to examine change in sexual lifestyle over time. We observed a statistically significant increase between 1990 and 2010 in the proportion of men (χ
= 739.49, p < 0.01) and women (χ
= 1270.43, p < 0.01) in a latent class associated with reporting 2 or more partners in the last year, relatively high probabilities of reporting condomless sex partners, greater self-perceived HIV risk, and a high probability of first sex before age 16 years, increasing from 19.5% to 31.1% (men) and 9.9% to 22.1% (women).
Our results indicate the viability of LCA models to assess change over time for complex behavioural phenomena. They align with previous findings, namely changing sexual lifestyles in Britain in recent decades, partnership number driving class assignment, and significant sex differences in sexual lifestyles. This approach can be used to extend previous LCA models (e.g., to investigate the impact of COVID-19 on sexual lifestyles) and to support empirical evidence of change over time, facilitating more nuanced public health policy.
In a closed population and defined time period, the mean number of opposite-sex partners reported by men and women should be equal. However, in all surveys, men report more partners. This ...inconsistency is pivotal to debate about the reliability of self-reported sexual behavior. We used data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability sample survey of the British population, to investigate the extent to which survey sampling, accounting strategies (e.g., estimating versus counting), and (mis)reporting due to social norms might explain the inconsistency. Men reported a mean of 14.14 lifetime partners; women reported 7.12. The gender gap of 7.02 reduced to 5.47 after capping the lifetime partner number at the 99th percentile. In addition, adjusting for counting versus estimation reduced the gender gap to 3.24, and further adjusting for sexual attitudes narrowed it to 2.63. Together, these may account for almost two-thirds of the gender disparity. Sampling explanations (e.g., non-U.K.-resident partners included in counts; sex workers underrepresented) had modest effects. The findings underscore the need for survey methods that facilitate candid reporting and suggest that approaches to encourage counting rather than estimating may be helpful. This study is novel in interrogating a range of potential explanations within the same nationally representative data set.
Digital technology offers good opportunities for HIV prevention. This systematic review assesses the effectiveness of interactive digital interventions (IDIs) for prevention of sexually transmitted ...HIV.
We conducted a systematic search for randomized controlled trials (RCTs) of IDIs for HIV prevention, defining 'interactive' as producing personally tailored material. We searched databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, grey literature, reference lists, and contacted authors if needed.Two authors screened abstracts, applied eligibility and quality criteria and extracted data. Meta-analyses used random-effects models with standardized mean differences (SMD) for continuous outcomes and odds ratios (OR) for binary outcomes, assessing heterogeneity using the I2 statistic.
We included 31 RCTs of IDIs for HIV prevention. Meta-analyses of 29 RCTs comparing IDIs with minimal interventions (e.g. leaflet, waiting list) showed a moderate increase in knowledge (SMD 0.56, 95% CI 0.33 to 0.80), no effect on self-efficacy (SMD 0.13, 95% CI 0.00 to 0.27), a small improvement in intention (SMD 0.16, 95% CI 0.06 to 0.26), improvement in HIV prevention behaviours (OR 1.28, 95% CI 1.04 to 1.57) and a possible increase in viral load, but this finding is unreliable.We found no evidence of difference between IDIs and face-to-face interventions for knowledge, self-efficacy, intention, or HIV-related behaviours in meta-analyses of five small RCTs. We found no health economic studies.
There is good evidence that IDIs have positive effects on knowledge, intention and HIV prevention behaviours. IDIs are appropriate for HIV prevention in a variety of settings.Supplementary Video Abstract, http://links.lww.com/QAD/B934.
PDF
