Collecting information on marital status: a methodological note.
Explore the source record for details and available documents.
Attitude↗
Biomedical subjects
K Wellings
Publications and source records attributed to K Wellings.
The accuracy of reported sensitive sexual behaviour in Britain: exploring the extent of change 1990-2000.
OBJECTIVES: The 1990-1 British national probability sample survey of sexual attitudes and lifestyles (Natsal 1990) was repeated in 1999-2001 (Natsal 2000) to update population estimates of risk behaviours, and assess change over time. We examine whether changes in prevalence estimates may partly result from changes in measurement accuracy. METHODS: Taking Natsal 2000 (11 161 respondents) and Natsal 1990 (13 765 respondents aged 16-44) we compared the response rate, sample representativeness, reporting of abortion last year (relative to official statistics), and selected attitudes. Among the common birth cohort eligible for both surveys (aged 16-34 Natsal 1990, 26-44 Natsal 2000), we compared reporting of experiences before 1990. RESULTS: The response rate (66.8% Natsal 1990, 65.4% Natsal 2000) and completeness of reporting abortion were unchanged (84% Natsal 1990, 86% Natsal 2000). Attitudes were significantly changed in Natsal 2000 relative to Natsal 1990--for example, increased tolerance of male homosexual sex, OR (95% CI) 2.10 (1.93-2.29) men and 2.95 (2.74 to 3.18) women. In the common birth cohort reporting of heterosexual intercourse before 16 (OR 1.15 (1.02 to 1.29) men, 1.49 (1.31 to 1.69) women), and homosexual experience (OR 1.80 (1.46 to 2.21) men, 2.00 (1.61 to 2.48) women) were significantly increased. CONCLUSIONS: The results are consistent with improved reporting accuracy for some sensitive behaviours in Natsal 2000, in line with greater social tolerance and improved survey methodology. However, the evidence is not conclusive, and may not be generalisable to all such behaviours. The increase found in the reported prevalence of STI risk behaviours between Natsal 1990 and Natsal 2000 is likely to be somewhat overstated.
Adolescent↗
Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours.
BACKGROUND: Sexual behaviour is a major determinant of sexual and reproductive health. We did a National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) in 1999-2001 to provide population estimates of behaviour patterns and to compare them with estimates from 1990-91 (Natsal 1990). METHODS: We did a probability sample survey of men and women aged 16-44 years who were resident in Britain, using computer-assisted interviews. Results were compared with data from respondents in Natsal 1990. FINDINGS: We interviewed 11161 respondents (4762 men, 6399 women). Patterns of heterosexual and homosexual partnership varied substantially by age, residence in Greater London, and marital status. In the past 5 years, mean numbers of heterosexual partners were 3.8 (SD 8.2) for men, and 2.4 (SD 4.6) for women; 2.6% (95% CI 2.2-3.1) of both men and women reported homosexual partnerships; and 4.3% (95% CI 3.7-5.0) of men reported paying for sex. In the past year, mean number of new partners varied from 2.04 (SD 8.4) for single men aged 25-34 years to 0.05 (SD 0.3) for married women aged 35-44 years. Prevalence of many reported behaviours had risen compared with data from Natsal 1990. Benefits of greater condom use were offset by increases in reported partners. Changes between surveys were generally greater for women than men and for respondents outside London. INTERPRETATION: Our study provides updated estimates of sexual behaviour patterns. The increased reporting of risky sexual behaviours is consistent with changing cohabitation patterns and rising incidence of sexually transmitted infections. Observed differences between Natsal 1990 and Natsal 2000 are likely to result from a combination of true change and greater willingness to report sensitive behaviours in Natsal 2000 due to improved survey methodology and more tolerant social attitudes.
Adolescent↗
Sexual behaviour in Britain: early heterosexual experience.
BACKGROUND: Relatively high rates of teenage conception and sexually transmitted infection among young people in Britain have focused attention on early sexual behaviour and its determinants. We report the results of the second National Survey of Sexual Attitudes and Lifestyles (Natsal 2000). METHODS: We did a probability sample survey between 1999 and 2001, of men and women aged 16-44 years in Britain. Participants were interviewed using a combination of computer-assisted face-to-face and self-completion questionnaires, and asked questions regarding first heterosexual intercourse, communication about sex, pregnancy, and sexually transmitted infections (STIs). FINDINGS: We recruited 11161 men and women to the survey (4762 men, 6399 women). The proportion of those aged 16-19 years at interview reporting first heterosexual intercourse at younger than 16 years was 30% for men and 26% for women; median age was 16 years. The proportion of women reporting first intercourse before 16 years increased up to, but not after, the mid-1990s. There has been a sustained increase in condom use and a decline in the proportion of men and women reporting no contraceptive use at first intercourse with decreasing age at interview. Among 16-24 year olds, non-use of contraception increased with declining age at first intercourse; reported by 18% of men and 22% of women aged 13-14 years at occurrence. Early age at first intercourse was significantly associated with pregnancy under 18 years, but not with occurrence of STIs. Low educational attainment was associated with motherhood before 18 years, but not abortion. INTERPRETATION: The increase in the proportion of women reporting first intercourse before age 16 years does not appear to have continued throughout the past decade. Only a small minority of teenagers have unprotected first intercourse, and early motherhood is more strongly associated with educational level than with family background. Factors most strongly associated with risk behaviour and adverse outcomes have considerable potential for preventive intervention.
Adolescent↗
Sexual behaviour in Britain: reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection.
BACKGROUND: Studies of the epidemiology of sexually transmitted infections (STI) are largely based on surveillance data. As part of a national survey of sexual attitudes and lifestyles (Natsal 2000) in Britain, we estimated the frequency of self-reported STIs, and the prevalence of urinary Chlamydia trachomatis infection. METHODS: We did a stratified probability sample survey of 11161 men and women aged 16-44 years in Britain. Computer assisted self-interviews contained items on the nature and timing of previously diagnosed STIs. Half of all sexually experienced respondents aged 18-44 years were invited to provide a urine sample for ligase chain reaction testing for C trachomatis infection. FINDINGS: 10.8% of men and 12.6% of women reported ever having an STI, 3.6% of men and 4.1% of women reported ever being diagnosed with genital warts, and 1.4% of men and 3.1% of women reported previous infection with C trachomatis. 76% of men and 57% of women ever diagnosed with an STI had been to a GUM clinic. C trachomatis was found in 2.2% (95% CI 1.5-3.2) of men and 1.5% (95% CI 1.11-2.14) of women with age-specific prevalence being highest among men aged 25-34 (3.1%) and women aged 16-24 years (3.0%). Non-married status, age, and reporting partner concurrency or two or more sexual partners in the past year were independently associated with infection with C trachomatis. INTERPRETATION: We show substantial heterogeneity in distribution of reported STIs, and the demographic and behavioural determinants of prevalent genital chlamydial infection. The results have potentially wide application for proposed chlamydia screening programmes which, given the demonstrated prevalence, must now proactively seek to involve men.
Adolescent↗
Effect of computer-assisted self-interviews on reporting of sexual HIV risk behaviours in a general population sample: a methodological experiment.
OBJECTIVES: To develop methods to maximize the accuracy of reporting HIV risk behaviours in a general population survey. We assessed the feasibility of using a computer-assisted self-completion interview (CASI) in comparison with pen-and-paper self-completion interview (PAPI). DESIGN: A probability sample survey of residents aged 16-44 years in Britain, with alternate assignment of addresses to interview by CASI (462) or PAPI (439). METHODS: Personal interviews exploring demographic and sexual behaviour variables. Principal outcome measures were the impact of CASI in relation to PAPI on data quality and rates of reporting a range of behaviours. RESULTS: A total of 901 interviews were completed; 829 individuals were eligible for and accepted the self-completion module. Internal consistency of data items was greater with CASI than PAPI and item non-response was lower. Overall, there was no significant difference in rates of reporting between CASI and PAPI. The main effect for CASI compared with PAPI in a generalized estimating equation (GEE) analysis was an OR (95% CI) of 1.04 (0.92-1.17). Variables were also examined individually, including homosexual partnership (adjusted OR 1.26 95%, CI 0.69-2.29), payment for sex (adjusted OR 0.68 95% CI 0.29-1.59), masturbation (adjusted OR 0.89 95% CI 0.66 1.22) and five or more partners in the past 5 years (OR 0.85 95% CI 0.61 -1.19). CONCLUSION: We found no evidence of a consistent effect of CASI on rates of reporting sexual HIV risk behaviours in this sample. CASI resulted in improvement in internal consistency and a reduction in missed questions.
Adolescent↗
The acceptability of urinary LCR testing for Chlamydia trachomatis among participants in a probability sample survey of sexual attitudes and lifestyles.
OBJECTIVES: To examine the factors that influence respondents' willingness to participate in urinary testing for Chlamydia trachomatis in a general population feasibility survey of sexual attitudes and lifestyles. METHODS: 199 sexually experienced, 18-44 year old participants, recruited as part of a larger (n=901) methodological study of sexual attitudes and lifestyles, were invited to provide a urine sample for chlamydial infection testing using ligase chain reaction (LCR) techniques. Analysis of the survey data and in-depth qualitative interviews were undertaken to explore the factors that influenced participants' decisions to participate. RESULTS: 143/199 (72%) participants agreed to provide a urine sample. The likelihood of providing a urine sample was reduced if other individuals were present in the home at the time of interview (OR 0.42, 95% confidence interval 0.20-0.90, p=0.03). Trust and rapport with the interviewer, understanding the aims of the test, sense of obligation, and perceived importance of the test were identified as additional influencing factors in the in-depth interviews. CONCLUSIONS: Survey respondents' uncertainty or embarrassment at participating in urine testing can be overcome if they are well informed, motivated by the potential health gain, and briefed by trained and confident interviewers.
Adolescent↗
Surveys on sexual health: recent developments and future directions.
The increasingly widespread adoption of the term sexual health reflects a move away from the medicalisation of this specialty. The focus has shifted from clinical practice to lifestyle and behaviour; from clinician to client, and from treatment to prevention. This article discusses these themes, identifying their implications for sexual health research. Recent times have seen, for example, a growing number of studies combining biological and behavioural measures conducted by interdisciplinary teams able to combine biomedical measurements of morbidity with insights into the subjective interpretations of symptoms and consequences. Considerable progress has been made, too, in mounting community based studies, and much has been achieved in gaining compliance and refining sampling methods. Integrated sexual health services, encompassing more than contraceptive or prophylactic service provision, have provided the impetus to investigation of the costs and benefits of coordinated family planning and genitourinary medicine services. Despite its broader focus, there remain opportunities for sexual health research to expand its remit. Studies to date may have focused too narrowly on pathological, to the neglect of health enhancing, consequences of sexual behaviour.
Adolescent↗
Post-exposure prophylaxis after occupational and non-occupational exposures to HIV: an overview of the policies implemented in 27 European countries.
The aim of this survey, which was part of an English-French project supported by the Commission of the European Communities, was to compare access to HIV post-exposure prophylaxis (PEP) in the occupational and non-occupational contexts in 27 European countries. A protocol was designed in May 1998 in collaboration with all country consultants. Data were collected at country level by each consultant through interviews, review of local and national recommendations and results of national or local surveys. The final comparative analysis was carried out from the individual country reports and a review of the literature. The large majority of European countries have detailed procedures regarding occupational PEP: 20/27 have produced national guidelines, three have adopted the US CDC recommendations and only four have no official recommendations. Although no standard protocol exists, the more common one is a four-week implementation of a triple combination therapy. In the context of non-occupational exposure to HIV, only five countries have guidelines with specific recommendations and one country has adopted the CDC recommendations. In the majority of cases (13 countries), PEP is never recommended but is only available in a few circumstances, sometimes with major limitations. In the last eight countries, such PEP is not currently available. Although the estimations of HIV transmission risks in occupational and non-occupational contexts are really comparables, easy access to PEP after accidental sexual or blood exposures is not guaranteed for the general population in the majority of European countries.
Anti-HIV Agents↗
Seasonal variations in sexual activity and their implications for sexual health promotion.
Although seasonal variations in births are observed in all human populations, the links between calendar events and sexual activity have received little attention in relation to health promotion and service provision. We have plotted various relevant data--routinely collected data for births within and outside of marriage, abortions, sexually transmitted infections, human immunodeficiency virus tests and condom sales figures--by calendar period. The trends point consistently to an increase in sexual activity and unsafe sex occurring at or around the Christmas period, and a longer but less pronounced subsidiary period of increased sexual activity and unsafe sex coinciding with the summer vacation. We conclude that seasonal patterns of sexual activity have implications for provision of sexual health services and for the timing and targeting of sexual health promotional interventions.
Abortion, Induced↗
Trends in teenage pregnancy in England and Wales: how can we explain them?
Teenage pregnancy is associated with adverse social and physical outcomes for both mother and child. We drew on various sources--birth and abortion statistics from the Office for National Statistics, data from the National Survey of Sexual Attitudes and Lifestyles, and routinely collected data from family planning clinics--to identify trends in England and Wales and their possible determinants. The rate of teenage sexual activity has increased steadily and consistently over the past four decades, whilst the rate of teenage fertility has shown greater variation. When the teenage fertility rate is calculated against the denominator of sexually active women, rather than the total sample of teenage women, the underlying trend in teenage fertility over the past four decades has been downwards, though not consistently so. Fluctuations in the teenage fertility rate seem to track intervention-related factors such as access to, and use of, contraceptive services and the general climate surrounding the sexual health of young people.
Abortion, Induced↗
Teenage fertility and life chances.
Teenage mothers and their children face poorer prospects in life than do women who delay motherhood until later in life. Moreover, patterns of early childbearing tend to be repeated in subsequent generations. Therefore, an understanding of the factors associated with early fertility is important for the prevention of adverse consequences. This paper uses data from the National Survey of Sexual Attitudes and Lifestyles to explore these associations. Early sexual intercourse is an important predictor of early fertility, as is poor educational attainment, although it is not clear to what extent pregnancy acts to thwart academic ambitions, or to what extent poor educational performance leads to a need to seek personal fulfilment in other than academic goals. Thus, interventions designed to influence age at first intercourse and to improve educational performance both have potential in terms of impacting on teenage pregnancy rates. Family background also exerts a powerful influence on teenage fertility. Young people for whom one or both parents are absent are more likely to become parents early in life. However, the most important factor of family life determining the chances of teenage motherhood appear to be the quality of communication about sexual matters with the home. In terms of outcomes, teenage mothers are more likely to live in social housing, are less likely to be in paid employment and have larger than average sized families. Certain areas of the country, notably the older, run-down industrial areas, have higher rates of teenage motherhood than the newer, more prosperous areas. Because most of these effects are independent of one another, there is potential merit in intervening to prevent unintended conception at several points in a young woman's life. Primary preventive efforts are needed to reduce the rates at which teenage pregnancy occurs in this country. Yet, if the cycle of deprivation that means the children of young mothers themselves enter parenthood early is to be broken, then efforts must also be made to mitigate the effects of teenage fertility for both mother and child.
Adolescent↗
First sexual intercourse: anticipation and communication. Interviews with young people in England.
This study investigated anticipation and communication around first sexual intercourse through semi-structured interviews with young people (aged 16 to 29) in England. Ranging from surprise to pre-planning, several different levels of anticipation are explored. The main findings are as follows: communication plays a central role, mediating between the degree of anticipation and the degree to which first intercourse is wanted, protected and enjoyed. First intercourse tends to be characterized by silence, especially during early, spontaneous encounters. Silence does not imply lack of communication-non-verbal communication plays an important role. Where young people are ambivalent, verbal and non-verbal communication may send contradictory messages. The implications of the results for future safer sex campaigns are discussed.
Adolescent↗
Using condom data to assess the impact of HIV/AIDS preventive interventions.
The effective evaluation of preventive activities depends on the identification of indicators and the selection of appropriate outcome measures which reflect the goals of the intervention. An increase in condom use has been seen as a positive sign of the impact of HIV/AIDS public education. This paper examines possible sources of data relating to condom use in the context of assessing public response to the AIDS epidemic, with particular reference to methodological challenges presented by each; issues relating to the validity of data, problems of interpretation and the scope for improvement. A multiple indicator approach, using several types of data in unison, is advocated. Conclusions drawn from the multiple indicator approach are likely to be firmer and sounder than those drawn from the single indicator approach, and are more likely to offer insight into the mechanisms which influence particular outcomes.
Adolescent↗
Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison.
OBJECTIVES: The purpose of this study was to characterize sexual behavior and opinions about sex in the United States and Britain; implications are discussed for effective public health policy regarding sexually transmitted diseases (STDs) in the United States. METHODS: Large-scale national probability surveys conducted in the 2 countries detailed sexual behavior, opinions, and the prevalence of STDs. RESULTS: In comparison with that of Britain, the US population has greater variability in sexual behavior, less tolerant opinions about sexual behavior, and a higher STD prevalence and lower condom usage among men. CONCLUSIONS: The survey data show compelling evidence from both countries of a strong association between number of sex partners and STD risk. In the United States relative to Britain, there is both greater dispersion in sexual behavior and a greater incidence of unconditional opposition to certain sexual practices. The former implies a need for strong public health policy to address the risks of STDs, but the latter implies strong opposition to that policy. This disjuncture between public health need and feasibility may contribute to the high US rate of STDs.
Adolescent↗
Sexual behaviour in young people.
Explore the source record for details and available documents.
Adolescent↗
Geographic variation in sexual behaviour in Britain: implications for sexually transmitted disease epidemiology and sexual health promotion.
OBJECTIVES: To explore geographical variation in sexual behaviour in Great Britain with reference to the prevalence of HIV infection. DESIGN: The National Survey of Sexual Attitudes and Lifestyles comprises a randomly selected, representative sample of almost 19,000 men and women aged 16-59 years living in Great Britain. METHODS: The survey was carried out using a combination of face-to-face interview and self-completion questionnaires and a wide range of data was collected. In this study, data on numbers and sex of sexual partners, condom use, injecting drug use, perception of risk of AIDS and lifestyle change were analysed, and comparisons were made between the different geographical areas in Great Britain. RESULTS: In the last 5 years, men living in Inner London were more likely to have a male partner [odds ratio (OR), 5.6; 95% confidence interval (CI), 3.1-10.0] or to have had 10 or more female partners (OR, 2.4; 95% CI, 1.6-3.6) than men living in other parts of the country. Similar results were observed for women living in Inner London: OR for a female partner in the last 5 years was 4.1 (95% CI, 1.6-10.2) and for five or more male partners in the last 5 years was 2.1 (95% CI, 1.5-2.8). More complex, but less striking patterns of behaviour were seen in different parts of the country. Both men and women living in Inner London were more likely to recognize that they were at some risk of acquiring HIV and were also more likely to report a change in sexual lifestyle. CONCLUSIONS: These analyses highlight the difficulties inherent in extrapolating from sexual behaviour data gathered using purposive samples to the population as a whole. The results are consistent with the known epidemiology of HIV and sexually transmitted diseases in Britain. The data suggest that cases of HIV will continue to be concentrated in Inner London, but Londoners are particularly aware of their risk. Reported behaviour change in response to perception of risk of AIDS underlines the importance of effective health promotion.
Adolescent↗
Who goes to sexually transmitted disease clinics? Results from a national population survey.
OBJECTIVES: To examine the pattern of attendance at sexually transmitted disease (STD) clinics in Britain. To compare the demographic characteristics, behaviours and attitudes of STD clinic attenders with those of non-attenders, and to assess the extent to which STD clinics are used by those with high-risk sexual lifestyles. DESIGN: Random sample general population survey of sexual attitudes and lifestyle. SUBJECTS: 18,876 randomly selected men and women resident in Britain aged 16-59 years. MAIN OUTCOME MEASURES: Demographic characteristics, pattern of homosexual partnerships, heterosexual partnerships, payment for sex, abortion, drug injection in the last five years, and attitudes to sexual behaviours amongst 512 respondents who had attended STD clinic in the last five years compared with those who had not. RESULTS: 8.3% of men and 5.6% of women had attended a clinic in their lifetime and 3.4% and 2.6% respectively in the last five years. Attendance rates varied substantially with area of residence. 11% of Inner London residents had attended in the last five years. In multivariate analysis, STD clinic attendance for men was most strongly associated with increased numbers of heterosexual partners, (OR = 6.01 (4.44-8.15) and homosexual partnerships (OR = 9.59 (5.83-15.8)) and more weakly associated with payment for sex, non-manual social class, age 25-44, unmarried status and smoking. Clinic attendance for women was most strongly associated with numbers of heterosexual partners (OR = 3.74 (2.76-5.08) and injecting drug use (OR = 4.39 (1.73-11.1)). A weaker independent association was found with a history of abortion, anal sex, non-manual social class, non-married status and age 16-24. From the total population, 1 in 6 men and 1 in 7 women in the top 5% of the distribution for numbers of heterosexual partners and 1 in 5 men paying for sex and 1 in 4 of those with a homosexual partner had attended a clinic in the last five years. The probability of attendance increased with multiple risk behaviours. Of women 64.2% and of men 69.7% attending clinics reported major risk markers for STD transmission. CONCLUSIONS: STD clinics in Britain are used by a wide demographic spectrum of the population. The behaviours, but not the attitudes, of attenders differed markedly from those of non-attenders. Clinics are relatively efficient in attracting only those with high-risk lifestyles, but, at a population level, the minority of those reporting risk-markers for STD transmission attend clinics. These findings suggest that STD clinics are an important focus for sexual health promotion, but that community programmes are also important for reaching non-attenders.
Adolescent↗