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Background: By regulating behaviour at household level, COVID-19 restrictions drastically altered relationships. Given strong links between intimate relationships and health, we investigated how the pandemic impacted relational and sexual aspects of steady relationships in Britain in the 4-months following first national lockdown (23/3/2020). Methods: 6,657 participants aged 18–59 years completed a web-panel survey questionnaire between 29/7–10/8/20. A quasi-representative population sample was achieved via quotas and weighting. We analysed sexual activity by age, gender and cohabitation status, and used descriptive statistics and logistic regression to explore self-perceived changes in sex and relationship quality among those in steady relationships (n=4,271). Results: Of the full sample, 64.2% were in a steady relationship, mostly cohabiting (88.8%). Following lockdown, 48.9% of those in cohabitating relationships and 36.4% in non-cohabiting relationships reported sex (anal/vaginal/oral) at least weekly. Frequency of sexual activity varied by age, gender and cohabitation status. The majority reported no change in their sex life and relational quality compared with the months pre-lockdown. Among those perceiving change, quality of sex life was more commonly reported to deteriorate, whereas quality of relationship was more commonly reported to improve. Change – both positive and negative – was more commonly reported by younger people. Overall, 7% reported deterioration to a ‘lower quality’ relationship, with deterioration more commonly reported by those: in mid-life (35–44 vs. 45–59) (men, AOR:2.31; 95%CI:1.45–3.66; women, AOR=1.63; 95%CI:1.03–2.56); living in an urban area (among men) (AOR:2.61; 95%CI:1.15–5.90); and not living with a partner (among women) (AOR:2.01; 95%CI:1.28–3.16). Deterioration was associated with poor health and with decline in sexual aspects of the relationship. Conclusion: COVID-19 led to an early net gain in relationship quality but net loss in quality of sex lives in steady relationships in UK. A sizeable minority of steady relationships were adversely affected with implications for sexual – and wider – wellbeing.

COVID-19 related restrictions have impacted the dynamics of romantic relationships, with many cohabiting partners spending more time together and non-cohabiting partners much less. We explored qualitatively, the vulnerabilities (characteristics that decreased resilience) and stressors that impacted intimate relationships following the initial COVID-19 lockdown. 45 semi-structured interviews were undertaken with participants who had completed a national web-panel survey (Natsal-COVID) and agreed to follow-up. Here we draw on the accounts of 19 participants in steady relationships who reported relationship difficulties. Analysis drew on Karney and Bradbury’s ‘Vulnerability-stress-adaptation’ model. The sample comprised 12 women and 7 men, 13 were living with their partner and 6 were not. Participant’s pre-existing attachment, coping, and communication styles shaped their susceptibility to relationship difficulties. The stress of COVID-19, amplified by financial strain and health issues, affected couple’s ability to adapt. In live-in relationships, childcare, divisions of housework, and a lack of space in which to unwind and escape from negative behaviours intensified pressures on relationship quality. One participant described these in the context of a violent relationship that worsened during lockdown, which she had managed to leave. Participants who did not live with their partners described struggling with phone/digital communication, physical distance, and a lack of certainty in the future of their relationship. In adapting to ‘pandemic life’, tensions arose over how much time to spend together. Those in non-cohabiting relationships were torn between balancing risks of COVID-19 against those of not seeing each other, with many reporting feeling they had placed their relationship on hold. For some, their sex life improved their adaptation, while for others it was a further source of stress. Understanding how existing vulnerabilities interact with a stressful event to shape adaptive processes in couples’ relationships might provide insights for counsellors and healthcare providers to better support couples through COVID-19.

Background: Rapid development and uptake of digital technologies have influenced sexual lives. As part of development research for the decennial British National Survey of Sexual Attitudes and Lifestyles (Natsal–4), we aimed to understand the practices of adults in Britain using digital technologies to meet sexual and romantic partners. Methods: We conducted 40 semi-structured interviews with adults in Britain on the role digital technologies played in their sexual lives. Here we draw on the accounts of 22 of those who had direct experience of online partner seeking. Informed by Social Practice Theory, we developed thematic codes encompassing the materials, skills and meanings that constitute online partner-seeking as a social practice. Findings: Online partner seeking is a social practice normalised in contemporary culture, enmeshed within broader online cultures of image presentation. It is associated with multiple goals and imbued with possibilities as well as risks. Material elements we identified related to the technology, its affordances, and how these shape interactions. We found that technological, interpersonal, and self-care skills were together required to seek and progress to various relationship forms and protect the self. Distinct linguistic, sexual, harm/damage limitation and exit strategies also drew on a range of skills. Participants reflected on how they presented themselves online, on their intentions, and on the skills required to ‘read’ situations and act authentically. Conclusion: While online partner seeking has often been considered individualistic, outcomes can be read through a lens of Social Practice Theory. Successful partner selection, communication and avoidance of harm depend on a complex learned constellation of the skills, materials and meanings associated with dating choices. Our findings have potential to inform survey questionnaire design and effective, nuanced health promotion interventions which consider intersecting dimensions of this social practice to build skills, develop goals and assess strategies to respond to unwanted interaction.

Background: Intimate relationships are ubiquitous and exert strong influence on health. Widespread disruption to them may impact wellbeing at a population level. We investigated the extent to which the first COVID-19 lockdown (March 2020) affected steady relationships in Britain. Methods: 6,654 participants aged 18-59 years completed a web-panel survey between 29/7-10/8/2020. Quasi-representativeness was achieved via quota sampling and weighting. We explored changes in sex life (5 dimensions) and relationship quality (6 dimensions) among participants in steady relationships (n=4,271) by age, gender, and cohabitation status, and examined factors associated with deterioration to a lower quality relationship. Results: 64.2% of participants were in a steady relationship, mostly cohabiting (88.8%). 22.1% perceived no change in their sex-life quality, and 59.5% no change in their relationship quality. Among those perceiving change, sex-life quality was more commonly reported to decrease and relationship quality to improve. There was significant variation by age, but less often by gender or cohabitation. Overall, 10.6% reported sexual difficulties that started or worsened during lockdown. 6.9% reported deterioration to a ‘lower quality’ relationship, more commonly those: aged 18-24 (women only OR 2.38;1·39-4·08) and aged 35-44 (women OR1.63;1.03-2.56, men OR 2.31;1.45-3.66) compared with those aged 45-59; not living with partner (women only aOR 2.01;1.28-3.16); and reporting depression/anxiety (e.g., depression (women aOR 2.56;1.79-3.64, men aOR 3.06;2.02–4.63). Interpretation: Intimate relationship quality is yet another way in which COVID-19 has led to divergence in experience, with age a key determinant of impact. Funding Information: Natsal (Wellcome Trust/ESRC/NIHR), MRC/CSO, UCL COVID-19 Rapid Response Fund. Declaration of Interests: The authors have no interests to declare. Ethics Approval Statement: Ethical approval was obtained from the University of Glasgow MVLS College (20019174) and LSHTM research ethics committees (22565).

Cyberbullying is associated with considerable negative mental and psychosocial consequences in children and young people, making it a serious public health concern. To review the highest level of available evidence, a systematic mapping review was conducted to identify systematic reviews that investigated the relationship between cyberbullying and mental and psychological outcomes in young people. Topic-relevant bibliographic databases and online resources were searched to identify reviews published since 2007. Data were extracted using a coding tool developed for this study. Methodological quality of included reviews was assessed using AMSTAR criteria. Nineteen systematic reviews satisfied the inclusion criteria and they reported a strong negative association between cyberbullying and mental health outcomes in young people. Meta-analysis was performed in 11 reviews and narrative synthesis in 8 reviews. Data were derived from predominantly cross-sectional studies and a clear causal relationship between cyberbullying and mental outcomes cannot be established. Two-third of the included reviews were classified to be of low or unclear quality, due to the lack of quality assessment of the primary studies included in individual reviews. This systematic map consolidates available evidence at review level and confirms the existing gaps in longitudinal and qualitative evidence synthesis. Closer examination of the moderating factors influencing cyberbullying behaviors in future research can advance our understanding and inform the development of tailored programs of intervention to mitigate the negative impact of this phenomenon.

Background: Physical distancing aims to reduce interactions between people to prevent SARS-CoV-2 transmission. Intimate physical contact outside the household (IPCOH) may expand transmission networks by connecting households. We explored whether intimacy needs impacted adherence to physical distancing following lockdown in Britain in March 2020. Methods: The Natsal-COVID web-panel survey (July-August 2020) used quota-sampling and weighting to achieve a quasi-representative population sample. We estimated IPCOH with a romantic/sexual partner in the four weeks prior to interview and identified associated factors. Qualitative interviews (n=18) were conducted to understand the context, reasons, and decision-making around IPCOH. Findings: Of 6,654 participants aged 18-59 years, 9.9% (95%CI:9.1-10.6%) reported IPCOH. IPCOH was highest in those aged 18-24 (17.7%), identifying as gay or lesbian (19.5%), and in steady non-cohabiting relationships (56.3%). IPCOH was associated with reporting risk behaviours (e.g., condomless sex, higher alcohol consumption). IPCOH was less likely among those reporting bad/very bad health (aOR 0.54;0.32-0.93) but more likely among those with COVID-19 symptoms and/or diagnosis (aOR 1.34;1.10-1.65). Two-thirds (64.4%) of IPCOH was reported as being within a support bubble. Qualitative interviews found that people reporting IPCOH deliberated over, and made efforts to mitigate, the risks. Interpretation: Given 90% of people did not report IPCOH, this contact may not be a large additional contributor to SARS-CoV-2 transmission, although heterogeneity exists within the population. Public health messages need to recognise how single people and partners living apart balance sexual intimacy and relationship needs with adherence to control measures. Funding Information: Natsal (Wellcome/ESRC/NIHR), MRC/CSO, and UCL COVID-19 Rapid Response Fund. Declaration of Interests: The other authors declare that they have no conflicts of interest. Ethics Approval Statement: Ethical approval was obtained from the University of Glasgow MVLS College (reference 20019174) and LSHTM research ethics committees (reference 22565). An anonymised dataset will be deposited with the UK Data Archive.

Background Accurate information on a nation’s sexual health is essential to plan and evaluate services, inform prevention, and contribute to societal understanding. In Britain, sexual health data arise from surveillance systems, convenience surveys of key populations, and the decennial National Surveys of Sexual Attitudes and Lifestyles (Natsal). Natsal has employed ‘gold-standard’ population survey methods: probability sampling, trained fieldworkers conducting detailed computer-assisted-personal-interviewing, and biosampling. However, this approach is resource-intensive and limitations include declining response rates and concerns about non-response bias. In designing Natsal-4, we reviewed whether alternative methods could meet the needs of data-users and the wider community. Methods We evaluated methods used by major UK general population surveys and sexual health surveys internationally. Key considerations were: general population representativeness; sample size; breadth and depth of information collected; data quality; biosampling; the possibility for sub-group ‘boost’ sampling, and data linkage. Results Five alternative methods were assessed (1) random-digit dialling phone surveys: considered unsuitable due to inadequate sample frame and response rate; (2) inviting participants from existing probability surveys to a follow-up sexual health interview: unsuitable because of additional non-response bias, difficulty achieving required sample size, and minimal cost-saving; (3) adding a sexual health module to existing probability survey(s), and (4) conducting a probability survey with fieldworker-selected individuals asked to self-complete a sexual health web-survey: both considered unsuitable due to much-reduced questionnaire; (5) ‘web-first’ mixed-mode survey, involving postal invitations to complete a web-survey with non-responding addresses followed-up by post and/or fieldworker visit: unsuitable due to concerns about response rate, unmeasurable and measurable response bias, and selection bias. Conclusion Given major drawbacks of the alternatives examined, the design used for previous waves of Natsal is still considered the best option for achieving a representative sample, enabling detailed data collection, enhancing survey data with biological and routine data, and retaining Natsal’s time-series; together maximising Natsal’s utility and impact. Disclosure No significant relationships.

We would like to follow up our 2014 publication in this journal by submitting further validation data to support the measurement of salivary testosterone (T), highlighting its independence from variations in circulating sex hormone-binding globulin (SHBG), unlike serum total T which is positively correlated with SHBG. All analyses were performed as previously described. In addition, further samples were collected from, 48 males and 38 females, healthy volunteers (mean age 32 y, range 18–66). Ethical committee approval was granted from Ghent University Hospital. These samples were analysed for salivary T, total T and equilibrium dialysis using liquid chromatography-tandem mass spectrometry. Figure 1 shows that: (i) serum total T is significantly and positively correlated with SHBG in both men (n1⁄4 93) and women (n1⁄4 86); (ii) serum calculated free T is not correlated with SHBG in men but negatively correlated with SHBG in women; (iii) salivary T is not correlated with SHBG in either men or women; (iv) serum-free T measured using equilibrium dialysis is not correlated with SHBG in men (n1⁄4 48) but, like calculated free T, is inversely correlated with SHBG in women (n1⁄4 38). These results demonstrate that salivary T is not influenced by variations in serum SHBG, unlike the analogue serum free T direct assay. The sexually dimorphic relationship between free T, whether calculated or measured by equilibrium dialysis, and SHBG, is an interesting observation which, to the best of our knowledge, has not been previously reported.

PURPOSE: To evaluate the uptake, feasibility and acceptability of a general practice-based optometrist-led glaucoma check service. The service targeted people of black Caribbean and black African descent aged 40-65 years, resident in Hackney, London, United Kingdom. METHODS: The study used a mixed-method design, including analysis of service data, prospective audit of secondary care referrals patient survey, cost-consequence analysis, and interviews with staff involved in developing and implementing the service. RESULTS: A total of 3040 patients were invited to undergo the free check; 595 (19.6%) booked an appointment and 461 (15.2%) attended. Overall, 31 patients (6.8%) were referred to secondary care, of whom 22 attended and were assessed for glaucoma. Four were diagnosed with glaucoma and eight with suspected glaucoma, i.e. 2.6% of patients who underwent the check. The cost per patient identified with suspected or confirmed glaucoma was £9,013. Staff who were interviewed suggested that patients who attended might be those who routinely attended optometrist appointments, however only 62.4% of survey respondents reported having had an eye examination in the previous two years, and 11.4% of women and 16.0% of men reported never having had an eye examination. CONCLUSION: This study represents one possible configuration for a glaucoma case-finding service, and it contributes to a wider debate about whether screening, targeted or otherwise, should be offered in the UK. Our findings suggest that general practice is an acceptable setting and that such a service may reach some people not previously engaged with primary eye care services.

Introduction: Measurement of salivary testosterone (Sal-T) to assess androgen status offers important potential advantages in epidemiological research. The utility of the method depends on the interpretation of the results against robustly determined population distributions, which are currently lacking. Aim: To determine age-specific Sal-T population distributions for men and women. Methods: Morning saliva samples were obtained from participants in the third National Survey of Sexual Attitudes and Lifestyles, a probability sample survey of the British general population. Sal-T was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Linear and quantile regression analyses were used to determine the age-specific 2.5th and 97.5th percentiles for the general population (1675 men and 2453 women) and the population with health exclusions (1145 men and 1276 women). Results: In the general population, the mean Sal-T level in men decreased from 322.6 pmol/L at 18 years of age to 153.9 pmol/L at 69 years of age. In women, the decrease in the geometric mean Sal-T level was from 39.8 pmol/L at 18 years of age to 19.5 pmol/L at 74 years of age. The annual decrease varied with age, with an average of 1.0% to 1.4% in men and 1.3% to 1.5% in women. For women, the 2.5th percentile fell below the detection limit (, Précis: We studied the population distribution of salivary testosterone (Sal-T) levels using liquid chromatography-tandem mass spectrometry and found that the mean Sal-T level was approximately 6 times greater in men than in women and decreased with age in both sexes.

STUDY QUESTION: What is the prevalence of infertility and of help seeking among women and men in Britain? SUMMARY ANSWER: One in eight women and one in ten men aged 16-74 years had experienced infertility, defined by unsuccessfully attempting pregnancy for a year or longer, and little more than half of these people sought medical or professional help. WHAT IS KNOWN ALREADY: Estimates of infertility and help seeking in Britain vary widely and are not easily comparable because of different definitions and study populations. STUDY DESIGN, SIZE, DURATION: A cross-sectional population survey was conducted between 2010 and 2012 with a sample of 15 162 women and men aged 16-74 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants completed the Natsal-3 questionnaire, using computer-assisted personal interviewing (CAPI) and computer-assisted self-interview (CASI). MAIN RESULTS AND THE ROLE OF CHANCE: The reported prevalence of infertility was 12.5% (CI 95% 11.7-13.3) among women and 10.1% (CI 95% 9.2-11.1) among men. Increased prevalence was associated with later cohabitation with a partner, higher socio-economic status and, for those who had a child, becoming parents at older ages. The reported prevalence of help seeking was 57.3% (CI 95% 53.6-61.0) among women and 53.2% (CI 95% 48.1-58.1) among men. Help seekers were more likely to be better educated and in higher status occupations and, among those who had a child, to have become parents later in life. LIMITATIONS, REASONS FOR CAUTION: These data are cross-sectional so it is not possible to establish temporality or infer causality. Self-reported data may be subject to recall bias. WIDER IMPLICATIONS OF THE FINDINGS: The study provides estimates of infertility and help seeking in Britain and the results indicate that the prevalence of infertility is higher among those delaying parenthood. Those with higher educational qualifications and occupational status are more likely to consult with medical professionals for fertility problems than others and these inequalities in help seeking should be considered by clinical practice and public health. STUDY FUNDING/COMPETING INTERESTS: Funding was provided by grants from the Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health. AMJ is a Governor of the Wellcome Trust. Other authors have no competing interests.

Summary Background In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals. Methods In this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994–98 to 2009–13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3 (2010–12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18–24 years; and the prevalence of participation in education, work, and training in young mothers. Findings Conception rates in women younger than 18 years declined steadily from their peak in 1996–98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994–98 and had greater declines to 2009–13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11·4 conceptions (95% CI 9·6–13·2; p

PurposeThis paper aims to examine whether greater consideration should be given to the timing of sexual health interventions within the calendar year.Design/methodology/approachThe paper uses a review of the literature.FindingsThe evidence points to seasonality in a number of areas of sexual health among young people, including: the timing of first intercourse and conceptions, both of which peak in the summer and over Christmas; abortions which peak approximately two months later in February and late summer and sexually transmitted infections, which peak over the summer and autumn. In the case of conceptions there is evidence that the seasonal pattern among young people is different from that of adults. Potential explanations fall into four main categories: biological; behavioural; social, and service‐related.Research limitations/implicationsMany of the studies included in this review are from the USA, and some are based on either small samples or specific risk groups, which raises questions of representativeness and generalisability. Further, it is notable how little research there has been regarding seasonal variations in other aspects of sexual behaviour, such as risk reduction practice and other potential explanatory factors such as health‐seeking behaviour and availability of services.Practical implicationsThe findings consistently point to periods of heightened sexual activity among young people in the summer and over Christmas, and suggest that greater consideration should indeed be given to the timing of sexual health interventions within the calendar year.Originality/valueTo the best of the authors' knowledge, no other review of this kind has yet been found.

Objectives To describe the prevalence of medication use to assist sexual performance in Britain and to identify associated factors. Methods Cross-sectional probability sample, undertaken in 2010–2012, of 15 162 people aged 16–74 years, resident in Britain, of whom, 5617 men and 8095 women reported sexual experience (ever) and 4817 men were sexually-active (reported sex in the last year). Results Ever use of medication to assist sexual performance (medicated sex) was more commonly reported by men than women (12.9% (95% CI 11.9% to 13.9%) vs 1.9% (95% CI 1.7% to 2.3%)) and associated with older age in men and younger age in women. It was associated with reporting smoking, and use of alcohol and recreational drugs, as well as unsafe sex (≥2 partners and no condom use in the last year) in both men and women. Among men, the proportion reporting medicated sex in the last year was higher among those reporting erectile difficulties (ED) than those not doing so (28.4% (95% CI 24.4% to 32.8%) vs 4.1% (95% CI 3.4% to 4.9%)). In all men, medicated sex was associated with more frequent sexual activity, meeting a partner on the internet, unsafe sex and recent sexually transmitted infections diagnosis; associations that persisted after adjusting for same-sex behaviour and ED. However, there were significant interactions with reporting ED, indicating that among men with ED, medicated sex is not associated with same-sex behaviour and ever use of recreational drugs. Conclusions A substantial minority of people in Britain report medicated sex, and the association between medicated sex and risky sexual behaviour is not confined to high-risk groups.

Objectives To examine variation in source of information about sexual matters by sociodemographic factors, and associations with sexual behaviours and outcomes. Design Cross-sectional probability sample survey. Setting British general population. Participants 3408 men and women, aged 17–24 years, interviewed from 2010–2012 for third National Survey of Sexual Attitudes and Lifestyles. Main outcome measures Main source of information (school, a parent, other); age and circumstances of first heterosexual intercourse; unsafe sex and distress about sex in past year; experience of sexually transmitted infection (STI) diagnoses, non-volitional sex or abortion (women only) ever. Results Citing school was associated with younger age, higher educational level and having lived with both parents. Citing a parent was associated, in women, with lower educational level and having lived with one parent. Relative to other sources, citing school was associated with older age at first sex (adjusted HR 0.73 (95% CI 0.65 to 0.83) men, 0.73 (0.65 to 0.82) women), lower likelihood of unsafe sex (adjusted OR 0.58 (0.44 to 0.77) men, 0.69 (0.52 to 0.91) women) and previous STI diagnosis (0.55 (0.33 to 0.91) men, 0.58 (0.43 to 0.80) women) and, in women, with lower likelihood of lack of sexual competence at first sex; and experience of non-volitional sex, abortion and distress about sex. Citing a parent was associated with lower likelihood of unsafe sex (0.53 (0.28 to 1.00) men; 0.69 (0.48 to 0.99) women) and, in women, previous STI diagnosis. Conclusions Gaining information mainly from school was associated with lower reporting of a range of negative sexual health outcomes, particularly among women. Gaining information mainly from a parent was associated with some of these, but fewer cited parents as a primary source. The findings emphasise the benefit of school and parents providing information about sexual matters and argue for a stronger focus on the needs of men.

Objectives: Our objective was to compare data on contraceptive use in relation to reported sexual activity in women from different minority ethnic groups.Design: We analyzed the National Survey of Sexual Attitudes and Lifestyles 2000.Subjects: Women aged 16-44 years, numbering 6932 and residing in Britain, participated in this study.Main Outcome Measures: Our main outcome measures are as follows: percentage of women reporting sexual activity, use of contraception and type of contraception (hormonal, barrier or permanent methods).Results: Overall, fewer women from the LTK's four main ethnic minority groups reported recent sexual activity, compared with white women. Among sexually active women, contraceptive use was significantly lower in all ethnic minority groups than in white women, but this pattern differed according to marital status. In ever-married or cohabiting women, lower contraceptive use was reported by Indian (78%) and Pakistani women (74%) than by other groups. Among single women, black Caribbean (88%) and black African (82%) women reported using less contraception compared with white (95%) and Indian (100%) women. Women from all ethnic minority groups were less likely than white women to report using hormonal contraception and permanent methods and were more likely to use barrier methods. The differences between ethnic groups remained significant after adjusting for educational achievement and parity. Deprivation and acculturation did not account for the use of contraception or the type of contraceptive method used.Conclusion: Sexually active married Pakistani and Indian women reported the lowest overall use of contraception. Among sexually active single women, black African and black Caribbean women reported levels of contraceptive use that were lower than those reported by white women. Sexually active women from all four minority ethnic groups were less likely than white women to use reliable methods of contraception. (c) 2006 Elsevier Inc. All rights reserved.

Purpose: To describe variations in age differences (ADs) between partners at first heterosexual intercourse and to examine associations between this AD, sociodemographic characteristics, and circumstances of first heterosexual intercourse, by gender.Methods: A total of 3277 men and 4734 women aged 25-44 years who reported ever having heterosexual intercourse in a probability survey of the British population to obtain an unbiased sample of ADs at first intercourse. Face-to-face interviews collected sociodemographic data and information on first intercourse. Gender-specific cumulative distributions of ADs categorized respondents reporting relatively younger first partners (below fifth percentile) and those reporting relatively older first partners (above 95th percentile).Results: Relatively older first partners were six years older than men and 10 years older than women. Relatively younger first partners were three years younger than men and one year younger than women. Men and women with relatively older first partners were more likely to have just met their partner (odds ratios adjusted for sociodemographic characteristics [AOR] 1.8, 95% confidence interval [CI] 1.2-2.7, and 3.1, 95% CI 2.1-4.6, respectively); had a more willing first partner (AOR 2.1, 95% CI 1.2-3.8, and 1.6, 95% CI 1.2-2.2, respectively); not used condoms at first sex (AOR 1.9, 95% CI 1.2-3.0, and 1. 5, 95% CI 1. 1-2.0, respectively); and reported a non-autonomous reason for first sex (AOR 1.6, 95% CI 1.1-2.4, women only). Men with relatively younger first partners were more likely to regret the timing of the first occasion (AOR 2.1, 95% CI 1.0-4.5).Conclusions: First partnerships involving relatively older or younger partners are associated with adverse circumstances of first intercourse. Condoms and other reliable contraception are less likely to be used, and age differences may reflect unequal power relations. Promoting effective communication and negotiation skills may be particularly important for those with relatively older or younger first partners. (c) 2006 Society for Adolescent Medicine. All rights reserved.

Objectives: To assess changes between 1990 and 2000 in the circumstances of women who became mothers before the age of 18. Design: Two cross sectional probability sample surveys of the general population carried out in 1989–1991 (Natsal 1990) and 1999–2001 (Natsal 2000). Setting: British households. Participants: Women aged 18 to 27 years at time of survey (Natsal 1990: 2575, Natsal 2000: 1757). Main outcome measures: Educational attainment, participation in education/work or training, living in social housing, social class, living as lone adult, parity, ill health, and health related behaviours at the time of the interview. Results: The proportion of women who were sexually active before 18 increased between 1990 and 2000 from 58.9% to 71.3% (p

Objective: To identify sociodemographic, sexual, and health behavioural and attitudinal factors associated with reporting sexual function problems. Methods: A probability sample survey of 11 161 men and women aged 16–44 years resident in Britain in 2000. Data collected by a combination of computer assisted face to face and self interviewing. Outcomes were self report of a range of sexual function problems, considered as “any problems” (1+ lasting 1+ months in the past year) and “persistent problems” (1+ lasting 6+ months in the past year), and associations with sociodemographic, behavioural, and attitudinal variables. Results: Both “any” and “persistent” sexual function problems were more commonly reported by women than men. A variety of sociodemographic factors were associated with both measures but differed by gender. For example, the adjusted odds ratio (AOR) for reporting any problems for married v single respondents was 0.70 (95% confidence interval (CI) 0.57 to 0.87) v 1.31 (95% CI 1.10 to 1.56) for men and women, respectively. Sexual behaviours significantly associated with reporting sexual function problems included competence at first sex, paying for sex in the past 5 years, number of occasions of sex and masturbation, both in the past 4 weeks. For men (only), reporting STI diagnosis(es) was significantly associated with reporting “any” problems (AOR 2.1, 95% CI 1.4 to 3.2) and “persistent” problems (AOR 2.1, 95% CI 1.1 to 3.9). Both measures were significantly more likely among men and women who reported communication difficulties with their partners, with AORs in excess of 1.9. Conclusions: Sexual fulfilment is an important part of sexual health. Understanding factors associated with reporting sexual problems, and recognising that such factors maybe partnership specific, is an important step towards improving our understanding of sexual function and thus improving the provision of care and support available.

BACKGROUND: We examined attendance at sexually transmitted disease (STD) clinics and the prevalence, distribution, and associated demographic and behavioral factors of self-reported sexually transmitted infections (STIs) in a population survey of sexual attitudes and lifestyles. METHODS: We analyzed data from stratified probability sample surveys obtained through the British National Surveys of Sexual Attitudes and Lifestyles (Natsal), which was undertaken in 1990 (n=13,765) and 2000 (n=11,161) among men and women aged 16-44 years. National STD surveillance data for 1999 were used to determine disease- and risk factor-specific proportionate population burden (PPB). RESULTS: Between 1990 and 2000, the number of subjects who reported having attended an STD clinic during the past 5 years increased from 4.3% to 7.6% among men and from 3.3% to 6.6% among women. In 2000, 3.0% of men and 4.0% of women reported having received a diagnosis of an STI during the past 5 years; 77.6% of men and 60.3% of women with an STI had attended an STD clinic. Reported STI acquisition was independently associated with age, increasing numbers of sex partners, male homosexual partners, and partners from abroad (for women only). Of all reported STIs during the past 5 years (PPB, 10.2%), 10.2% were reported by the 2.9% of men who reported having had homosexual partners during the past 5 years. Of all reported STIs in the past 5 years (PPB, 41.6%), 41.6% were reported by the 4.0% of women who reported having > or =10 sex partners during that time. Analysis of national STI surveillance data showed that the PPB for new episodes of Chlamydia trachomatis diagnosed among homosexual men was 2.8%, that for gonorrhea was 17.4%, and that for syphilis was 32.1%. CONCLUSIONS: Numbers and types of sexual partnerships remain the dominant individual and population risk factors for STI acquisition. Combined population behavior and surveillance data demonstrate the high PPB for STIs attributable to key risk factors. PPB may be a useful indicator of epidemic "phase" and may help target resources and guide prevention strategies.

Objectives: To estimate the prevalence and timing of homosexual experience among British men; to explore the patterns of sexual practices and partnerships in 2000, and behavioural and attitudinal changes between 1990 and 2000 among men who have sex with men (MSM).Design: Two large, stratified probability sample surveys of the general population.Methods: Trained interviewers administered a combination of face-to-face and self-completion questionnaires to men aged 16 to 44 years resident in Britain (n = 6000 in 1990 and n = 4762 in 2000).Results: in 2000, 2.8% of British men reported sex with men in the past 5 years. 46.0% of MSM reported five or more partners in the past 5 years, and 59.8% reported unprotected anal intercourse in the past year. A total of 33.0% of MSM reported one or more female partner(s) in the past year. In comparison with 1990, there was a significant increase in the proportion of MSM in the population in 2000, and among these men, in the proportion reporting receptive anal intercourse in the past year [age-adjusted odds ratio (OR), 2.08; 95% confidence interval (CI), 1.08-4.00], but no significant change in self-perceived HIV-risk (age-adjusted OR, 1.11; 95% Cl, 0.49-2.51) or HIV testing in past 5 years (age-adjusted OR, 1.14; 95% Cl, 0.57-2.25).Conclusions: Evidence of increasing prevalence of homosexual intercourse among the British male population coupled with increases in some HIV-risk behaviours among MSM suggests overall increasing numbers at risk in the population. Although these changes may partly reflect an increased willingness to report these behaviours, our results are consistent with increasing incidence of sexually transmitted infections and behavioural surveillance data. (C) 2004 Lippincott Williams Wilkins.

Background The need to improve the quality and availability of information on sexual health is identified as a key element in achieving the aims set out in the National Strategy for Sexual Health and HIV. Providing information about sexual health to young people poses particular challenges because of the sensitive nature of the issues and because of the difficulties that young people may face in sourcing information and asking questions of professionals. Objective To explore the views of young people attending sexual health services on several aspects of service delivery, including provision of information. Method Twenty-five in-depth qualitative interviews were conducted with a purposive sample of young people attending a range of different outlets for sexual health care. Results This research revealed important information about the ways in which the type, format, tone and design of health promotion materials and the methods used to impart information to young people has a strong impact on client satisfaction during visits to sexual health services. Conclusions Young people vary greatly in their needs for sexual health information in terms of level, extent and manner of provision. Passive acceptance of information should not be taken to indicate tacit satisfaction with level and complexity. Written information needs to be used in conjunction with face-to-face discussion. Effective provision of sexual health information impacts notably on client satisfaction. Pitched at the right level, sexual health information has considerable potential to enhance sexual health status.

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 11 161 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 mast strongly associated with risk behaviour and adverse outcomes have considerable potential for preventive intervention.

Summary 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 11 161 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.

Aims to show that audit and feedback could improve the prescribing of hormone replacement therapy (HRT) to women with a history of hysterectomy. Describes a randomised controlled trial involving 28 practices and covering a total of 3,169 women with a baseline coded history of hysterectomy. In addition to data extraction and feedback, intervention practices were given educational material and audit support. A rise in prescribing was evident in both younger and older women. There was also evidence of significant improvement in the appropriate prescribing of HRT. Concludes that prescribing feedback linked with educational material and audit can improve the prescribing of HRT in primary care in women with a history of hysterectomy and that this technique has wider application in the new era of clinical governance.

Broad spectrum approaches to health promotion, using mass media techniques to reach the general population, have potential value in raising the profile of health issues, providing legitimacy to efforts at community level and providing the impetus for other activities. Their cost‐effectiveness, however, is difficult to assess and has been questioned by some. This paper makes the case for a systematic approach to the evaluation of mass media health promotional interventions. Formative evaluation is needed to ensure the optimally effective design of such interventions, followed by process evaluation to identify factors which have enhanced or hindered implementation, followed by outcome evaluation, to assess the extent to which desired effects have been achieved, and adverse effects avoided. An eclectic approach to outcome evaluation is recommended including the use of experimental approaches wherever possible, but also ensuring that non‐experimental methods are rigorous and comprehensive. This review is aimed at practitioners using mass media interventions in health promotion as well as students of health promotion and its evaluation.

Background Salivary testosterone (Sal-T) may be a useful surrogate of serum free testosterone. The study aims were to use a novel liquid chromatography tandem mass spectrometry (LC-MS/MS) assay to determine whether Sal-T concentrations accurately reflect Sal-T concentrations in both sexes and to investigate practical aspects of sample collection. Methods Saliva and serum samples were collected in 104 male and 91 female subjects. A more sensitive LC-MS/MS assay was developed to enable Sal-T quantitation in the low concentrations found in females. Saliva (200 µL) was extracted with 1 mL of methyl- tert-butyl ether following the addition of D5-testosterone. Quantitation was performed using a Waters TQ-S mass spectrometer. Results The assay achieved a lower limit of quantification of 5 pmol/L, sufficiently sensitive to measure testosterone in female saliva. Sal-T showed a diurnal variation but samples taken at weekly and monthly intervals showed no significant differences. Sal-T was stable at ambient temperature for up to 5 days, after freeze-thawing and 3 years frozen storage. Reference intervals for Sal-T were 93–378 pmol/L in males and 5–46 pmol/L in females. Sal-T correlated significantly with serum calculated free-T in males ( r = 0.71, P Conclusions These results confirm that testosterone can be reliably and accurately measured by LC-MS/MS in both adult male and female saliva samples. These results lay the foundation for further exploration of the clinical application of Sal- T as a reliable alternative to serum testosterone in the diagnosis and management of androgen disorders and assessment of androgen status in clinical research.

Background/introduction Sexual function is largely absent from the policy discourse on young people’s sexual health. The omission is troubling, given the link between low sexual function and indicators of risk (including higher partner numbers, paying for sex, non-consensual sex and STI diagnosis). An absence of data permits this silence. Aim(s)/objectives To address the gap in empirical data on sexual function problems in young people aged 16 to 21 in Britain. Methods Descriptive statistics from a national probability survey of 15,162 British men and women (Natsal-3), undertaken from 2010–2012 using computer-assisted self-interviews (CASI). Complex survey analyses of data from participants aged 16–21 (854 men and 1021 women sexually active in the last year; 262 men and 255 women sexually experienced but not active in the last year). Results Distressing sexual function problems (>3months in last year) were reported by 9.1% of men and 13.4% of women. Most common among men was reaching a climax too quickly (4.5%) and among women, difficulty reaching climax at all (6.3%). The majority of young people experiencing problems did not seek help, and those that did rarely sought out professionals. Around 6% of those currently sexually active, and 10% of those not so, reported avoiding sex because of sexual function problems. Discussion/conclusion Sexual function problems are common among young people and are largely unaddressed. Addressing these clear needs will have benefits for other aspects of sexual health. Reassurance in clinical settings and information/advice in educational settings are inexpensive and potentially effective strategies.

To the Editor: Our laboratory has extensive experience in developing liquid chromatography–tandem mass spectrometry (LC-MS/MS)1 methods for routine use in the clinical laboratory. We previously developed an LC-MS/MS assay for serum testosterone and androstenedione (1). In collaboration with the National Survey of Sexual Attitudes and Lifestyles (NATSAL) working group, we have now developed an LC-MS/MS assay for salivary testosterone (Sal-T). Sal-T is a filtrate of plasma containing only the free fraction. Free testosterone (FT) is considered the physiologically active form and more accurately reflects androgen exposure in target tissues than serum total testosterone. Methods to measure serum FT are unsuitable for the routine clinical laboratory, and the reliability of mathematical algorithms to derive serum FT are questionable, with no consensus. Direct measurement of Sal-T therefore offers a potentially more accurate and convenient alternative to measuring serum FT, particularly in conditions affecting sex hormone–binding globulin. Our method used samples collected via an unstimulated passive-drool technique. Volunteers rinsed their mouth with water, refrained from eating, and did not brush their teeth 30 min before sampling. Samples were collected by drooling down a plastic straw into a collection vial; the saliva sample was then frozen at −80 °C. Samples were thawed, mixed, and centrifuged; the clear supernatant was then used for analysis. Sample preparation involved …

Objective To develop and pilot a communication aid aimed at increasing the frequency with which sexual health issues are raised proactively with young people in primary care. Methods Group interviews among primary health care professionals to guide development of the tool, simulated consultations to pre-test it, and a pilot study to assess effectiveness. Results We developed an electronic consultation aid: Talking of Sex and piloted it in eight general practices across the UK. 188 patients and 58 practitioners completed questionnaires pre-intervention, and 92 patients and 45 practitioners post-intervention. There was a modest increase in the proportion of consultations in which sexual health was raised, from 28.1% pre-intervention to 32.6% post-intervention. In consultations with nurses the rise was more marked. More patients reported discussing preventive practices such as condom use post-intervention. Patients unanimously welcomed the opportunity to discuss sexual health matters with their practitioner. Conclusion The tool has capacity to increase the frequency with which sexual health is raised in primary care, particularly by nurses, to influence the topics discussed, and to improve patient satisfaction. Practice implications The tool has potential in increasing the proportion of young people whose sexual health needs are addressed in general practice.

Background: Noninvasive molecular tests for bacterial sexually transmitted infections (STIs) provide new opportunities for testing in nonclinical settings. Little information is available on the outcomes when applied to asymptomatic sex survey participants. Objective: The objective of this study was to examine patient treatment preferences and partner notification outcomes among Chlamydia trachomatis-positive cases identified in the 2000 national survey of sexual attitudes and lifestyles (Natsal 2000), and factors associated with providing a urine sample. Methods: The authors conducted a stratified probability sample survey of 11,161 men and women aged 16 to 44 years residing in Britain using computer-assisted self-interviews. Urine testing was performed for C. trachomatis offered to a random half of sexually active respondents aged 18 to 44 using ligase chain reaction. Notification, treatment, and follow up of ligase chain reaction-positive respondents were undertaken. Results: A total of 5105 respondents were invited to provide a urine sample. A total of 3628 (71%) agreed and 3608 samples were successfully tested. Willingness to provide a urine sample was significantly higher among those reporting previous homosexual experience, heterosexual anal sex, and STI diagnosis. Seventy-three respondents (31 men and 42 women) were diagnosed with genital chlamydial infection. Sixty-five (89%) responded to notification of their infection and were recommended for treatment and partner notification. Fifty (77%) respondents preferred to be seen by their general practitioner and 15 (23%) by their local genitourinary medicine clinic. Although physician feedback on treatment and partner notification outcomes was obtained for only half (n = 34) of respondents, follow-up respondent interviews confirmed that a total of 49 (75%) respondents underwent this process. Interpretation: In this community-based survey, the rate of provision of urine samples was high, and those who provided samples were found to be at somewhat greater risk of infection on average. This was accounted for in estimating population chlamydia prevalence. The authors found that treatment and partner notification of newly diagnosed infections can be successfully achieved in STI prevalence studies.

Summary Background Ethnic variations in the rate of diagnosed sexually transmitted infections (STIs) have been reported in many developed countries. We used data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) to investigate the frequency of high-risk sexual behaviours and adverse sexual health outcomes in five ethnic groups in Great Britain. Methods We did a stratified probability sample survey of 11161 men and women aged 16–44 years, resident in Great Britain, using computer-assisted interviews. Additional sampling enabled us to do more detailed analyses for 949 black Caribbean, black African, Indian, and Pakistani respondents. We used logistic regression to assess reporting of STI diagnoses in the past 5 years, after controlling for demographic and behavioural variables. Findings We noted striking variations in number of sexual partnerships by ethnic group and between men and women. Reported numbers of sexual partnerships in a lifetime were highest in black Caribbean (median 9 [IQR 4–20]) and black African (9 [3–20]) men, and in white (5 [2–9]) and black Caribbean (4 [2–7]) women. Indian and Pakistani men and women reported fewer sexual partnerships, later first intercourse, and substantially lower prevalence of diagnosed STIs than did other groups. We recorded a significant association between ethnic origin and reported STIs in the past 5 years with increased risk in sexually active black Caribbean (OR 2·74 [95% CI 1·22–6·15]) and black African (2·95 [1·45–5·99]) men compared with white men, and black Caribbean (2·41 [1·35–4·28]) women compared with white women. Odds ratios changed little after controlling for age, number of sexual partnerships, homosexual and overseas partnerships, and condom use at last sexual intercourse. Interpretation Individual sexual behaviour is a key determinant of STI transmission risk, but alone does not explain the varying risk across ethnic groups. Our findings suggest a need for targeted and culturally competent prevention interventions.

The need for estimates of the extent of sexual function problems in the general population has become more urgent given recent debates surrounding the identification and definition of “sexual dysfunction,” the increased availability of pharmacological interventions, and possible changes in our expectations of what constitutes sexual function and fulfilment.1 We report results from the national survey of sexual attitudes and lifestyles (Natsal 2000). Natsal 2000 was a stratified probability sample survey done between May 1999 and February 2001 of 11 161 men and women aged 16-44 years resident in Britain.2 3 The response rate was 65.4%. A computer assisted self interview asked participants about their sexual lifestyles and attitudes. We asked questions about their experience of sexual problems based on those used in the US national health and social life survey,4 which measured the main dimensions of sexual dysfunction, …

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.

Summary 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 11 161 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.

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.

Although low dose aspirin reduces risk in patients with heart disease, many such patients do not receive daily prophylactic aspirin.1 We report a trial of feedback of general practitioners' data on aspirin prescribing aimed at increasing coded aspirin prescribing in patients with heart disease. Computerised practices were randomised to receive feedback on their prescribing, either of aspirin for patients with ischaemic heart disease or of hormone replacement therapy for women who had had hysterectomies. We approached 48 practices in north London; nine refused, and 11 were excluded. Of the 28 (58%) practices in the study, seven were single handed and six had five or more partners. All participating practices used the emis computer system except two that used Paradoc; both systems yielded sufficiently reliable and comparable data. Eligible practices had to have computerised information on hysterectomies and ischaemic heart disease and use their systems for repeat prescribing. Practices were then randomised by using sealed envelopes to …

Background The Third British National Survey of Sexual Attitudes & Lifestyles (Natsal 3) builds upon groundbreaking research undertaken for Natsal 1 and Natsal 2 in 1990 and 2000, respectively. Natsal 3 aims to interview 15 000 men and women aged 16–74 years during 2010–2012. However, the first pilot (Pilot 1) for Natsal 3 achieved a response rate of only 38.4%, leading us to explore ways to maximise survey participation. Methods Following Pilot 1, we consulted widely with interviewers, survey methodologists and communications experts to improve documents sent to households in advance of the interviewer calling, and the survey branding. This included simplifying the advance letter language and removing specific references to “sex”; developing a more detailed information leaflet to send with the letter; developing a study logo and respondent website. In Pilot 2, households were randomised to be sent the leaflet with the advance letter or to be given it when the interviewer called. We also examined the effect of the token of appreciation on participation rates by randomising households to receive either a £15 or a £30 voucher for participation. Results The overall response rate increased to 50.3% (218/434 eligible addresses) in Pilot 2. This did not vary by whether or not households received the information leaflet in advance (50.8% and 49.6%, respectively), but interviewers felt that households sent the leaflet were more informed about the study and they were more confident approaching these households. Interviewers preferred the improved advance letter and some respondents reported that the website was a key factor encouraging them to participate. Pilot 2 response rates differed by token of appreciation (47.1% vs 53.4% for £15 vs £30) but the sample size was too small to conclude that the difference was significant, so randomisation continued during the first wave of fieldwork. Response rates in wave 1 before reissuing were 48.4% vs 50.6% for £15 and £30, respectively (p=0.2). Conclusions Despite survey response rates declining generally, Natsal 3 development work has shown that it is possible to attain an adequate response in a population-based survey of sexual behaviour. Careful wording of participant documents, attractive survey branding and a participant website all contributed to increasing response rates. Response rates were slightly higher for the larger token of appreciation but increasing the value was not considered cost-effective.

Erratum to bEthnic variations in sexual activity and contraceptive use: national cross-sectional surveyQ [Contraception 74 (2006) 224–233] Sonia Saxena4, Andrew J. Copas, Catherine Mercer, Anne M. Johnson, Kevin Fenton, Bob Erens, Kiran Nanchahal, Wendy Macdowall, Kaye Wellings Division of Epidemiology Public Health and Primary Care, Department of Primary Care and Social Medicine, Imperial College, London Charing Cross Campus, W6 8RP London, UK Centre for Sexual Health and HIV Research, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Mortimer Market, off Capper Street, WC1E 6AU London, UK National Centers for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA National Centre for Social Research, EC1V 0AX London, UK Centre for Sexual and Reproductive Health Research, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK