ABSTRACT
Background: Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) have been undertaken decennially since 1990 and provide a key data source underpinning sexual and reproductive health (SRH) policy. The COVID-19 pandemic disrupted many aspects of sexual lifestyles, triggering an urgent need for population-level data on sexual behaviour, relationships, and service use at a time when gold-standard in-person, household-based surveys with probability sampling were not feasible. We designed the Natsal-COVID study to understand the impact of COVID-19 on the nation's SRH and assessed the sample representativeness. Methods: Natsal-COVID Wave 1 data collection was conducted four months (29/7-10/8/2020) after the announcement of Britain's first national lockdown (23/03/2020). This was an online web-panel survey administered by survey research company, Ipsos MORI. Eligible participants were resident in Britain, aged 18-59 years, and the sample included a boost of those aged 18-29. Questions covered participants' sexual behaviour, relationships, and SRH service use. Quotas and weighting were used to achieve a quasi-representative sample of the British general population. Participants meeting criteria of interest and agreeing to recontact were selected for qualitative follow-up interviews. Comparisons were made with contemporaneous national probability surveys and Natsal-3 (2010-12) to understand bias. Results: 6,654 participants completed the survey and 45 completed follow-up interviews. The weighted Natsal-COVID sample was similar to the general population in terms of gender, age, ethnicity, rurality, and, among sexually-active participants, numbers of sexual partners in the past year. However, the sample was more educated, contained more sexually-inexperienced people, and included more people in poorer health. Conclusions: Natsal-COVID Wave 1 rapidly collected quasi-representative population data to enable evaluation of the early population-level impact of COVID-19 and lockdown measures on SRH in Britain and inform policy. Although sampling was less representative than the decennial Natsals, Natsal-COVID will complement national surveillance data and Natsal-4 (planned for 2022).
ABSTRACT
Background: Britain’s National Surveys of Sexual Attitudes and Lifestyles (Natsal) have been undertaken decennially since 1990 and provide a key data source underpinning sexual and reproductive health (SRH) policy. The COVID-19 pandemic disrupted many aspects of sexual lifestyles, triggering an urgent need for population-level data on sexual behaviour, relationships, and service use at a time when gold-standard in-person, household-based surveys with probability sampling were not feasible. We designed the Natsal-COVID study to understand the impact of COVID-19 on the nation’s SRH and assessed the sample representativeness. Methods: Natsal-COVID Wave 1 data collection was conducted four months (29/7-10/8/2020) after the announcement of Britain’s first national lockdown (23/03/2020). This was an online web-panel survey administered by survey research company, Ipsos MORI. Eligible participants were resident in Britain, aged 18-59 years, and the sample included a boost of those aged 18-29. Questions covered participants’ sexual behaviour, relationships, and SRH service use. Quotas and weighting were used to achieve a quasi-representative sample of the British general population. Participants meeting criteria of interest and agreeing to recontact were selected for qualitative follow-up interviews. Comparisons were made with contemporaneous national probability surveys and Natsal-3 (2010-12) to understand bias. Results: 6,654 participants completed the survey and 45 completed follow-up interviews. The weighted Natsal-COVID sample was similar to the general population in terms of gender, age, ethnicity, rurality, and, among sexually-active participants, numbers of sexual partners in the past year. However, the sample was more educated, contained more sexually-inexperienced people, and included more people in poorer health. Conclusions: Natsal-COVID Wave 1 rapidly collected quasi-representative population data to enable evaluation of the early population-level impact of COVID-19 and lockdown measures on SRH in Britain. Although sampling was less representative than the decennial Natsals, Natsal-COVID will complement national surveillance data and Natsal-4 (planned for 2022).
ABSTRACT
Background The UK's National Surveys of Sexual Attitudes and Lifestyles (Natsal) have been done every 10 years since 1990, and provide a key data source to underpin sexual and reproductive health policy. The COVID-19 pandemic disrupted many lifestyle aspects, triggering an urgent need for population-level data on sexual behaviour, relationships, and service use at a time when gold-standard, in-person, household-based surveys with probability sampling were not feasible. We designed the Natsal-COVID study to understand the effect of COVID-19 on the nation's sexual and reproductive health. Methods Data were collected over 4 months (survey wave one;July 29 to Aug 10, 2020) and 1 year (wave two;March 27 to April 26, 2021) after the announcement of the UK's first lockdown (March 23, 2020). Data were collected online via web-panel surveys administered by Ipsos MORI. Eligible participants were UK residents aged 18–59 years, and the samples included a boost of those aged 18–29 years. Questions covered participants' sexual behaviour, relationships, and sexual and reproductive health service use. Quotas and weighting were used to achieve a quasi-representative sample of the UK general population. Participants meeting criteria of interest and agreeing to be recontacted were selected for qualitative follow-up interviews over the months of October and November, 2020. Comparisons were made with contemporaneous national probability surveys (2019 Annual Population Survey and 2018 Health Survey for England) and Natsal-3 (2010–12) to understand bias in sociodemographic characteristics, general health, and sexual behaviours. We obtained ethical approval from the ethics committees of the University of Glasgow College of Medical, Veterinary & Life Sciences College (reference 20019174) and the London School of Hygiene & Tropical Medicine Research (reference 22565). Findings 6654 participants completed wave one of the study, of which 45 (0·7%) completed qualitative interviews. A further 6658 participants completed wave two, of which 2098 (31·5%) were wave one participants. Compared with probability surveys, the weighted Natsal-COVID participants were more educated, less sexually experienced, and in poorer health. In wave one, we found that 20·8% of respondents (95% CI 19·3–22·3%) reported using sexual and reproductive health services in the first 4 months of lockdown, whereas 9·7% (8·6–10·8%) reported difficulty accessing services. Wave two allowed for the generation of 1-year estimates, including of chlamydia testing (5·4% [4·7–6·2%]), HIV testing (7·2% [6·4–8·1%]), and cervical cancer screening (10·3% [9·2–11·6%]). Qualitative interviews suggested that participants often required repeated attempts to access sexual and reproductive health services. Interpretation Natsal-COVID rapidly collected quasi-representative population data to evaluate the population-level effect of COVID-19 and lockdown measures on sexual and reproductive health in the UK and to inform sexual and reproductive health policy. Although less representative than the decennial Natsals, Natsal-COVID will complement national surveillance data and Natsal-4 (planned for 2022). Funding Natsal is a collaboration between University College London (UK), the London School of Hygiene & Tropical Medicine (UK), the University of Glasgow (UK), Örebro University Hospital (Sweden), and NatCen Social Research (UK). The Natsal Resource, which is supported by the Wellcome Trust (via grant number 212931/Z/18/Z), with contributions from the UK's Economic and Social Research Council and National Institute for Health Research, supports the Natsal-COVID study through funding from the University College London COVID-19 Rapid Response Fund and the MRC/CSO Social and Public Health Sciences Unit (Core funding, grant numbers MC_UU_00022/3 and SPHSU18). The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
ABSTRACT
BackgroundVaccination is crucial to address the COVID-19 pandemic but inequalities in uptake may exacerbate existing health inequalities. We investigate the UK prevalence of COVID-19 vaccine hesitancy, identify which population subgroups are more likely to be vaccine hesitant, and report stated reasons for hesitancy.MethodsNationally representative survey data from 12,035 participants were collected from 24th November to 1st December 2020 for wave 6 of the UK Household Longitudinal Study (‘Understanding Society’) COVID-19 web survey. Participants self-reported ethnicity, highest educational attainment, gender, age, how likely they would be to have a vaccine if offered and their main reason for hesitancy. Weighted cross-sectional analysis assessed the prevalence of vaccine hesitancy and logistic regression models estimated independent associations.ResultsOverall vaccine hesitancy was low (18% unlikely/very unlikely). Vaccine hesitancy was higher in women (21.0% vs 14.7% in men), in younger age groups (26.5% in 16–24 year olds vs 4.5% in 75+) and in those with lower education levels (18.6% no qualifications vs 13.2% degree qualified). Vaccine hesitancy was high in Black (71.8%) and Pakistani/Bangladeshi (42.3%) ethnic groups. Odds ratios for vaccine hesitancy after adjustment for age and gender were 13.42 (95% CI:6.86, 26.24) in Black, 2.54 (95% CI:1.19, 5.44) in Pakistani/Bangladeshi groups, and 1.76 (95% CI:1.10, 2.82) for Other White (including Eastern European) ethnic groups (compared to White British/Irish). Vaccine hesitancy was not higher in all minority ethnic groups;for example, ORs were 1.11 (95% CI:0.64, 1.95) for Indian ethnicity and 0.67 (95% CI:0.24, 1.87) for Other Asian (including Chinese) ethnicity. Lower education was also related to vaccine hesitancy (no qualifications versus degree OR 3.54;95% CI:2.06, 6.09) but ethnic differences largely remained when education was included in the model. For those who were vaccine hesitant the most common stated reason for hesitancy was concerns over unknown future effects (42.7%). However, when compared to the White British/Irish group, Black participants were more likely to state they ‘Don’t trust vaccines’ (29.2% vs 5.7%) and the Pakistani/Bangladeshi ethnic group more frequently cited worries about side-effects (35.4% vs 8.6%).ConclusionVaccine hesitancy is strongly associated with education and ethnicity, with marked ethnic heterogeneity. Black and Pakistani/Bangladeshi participants reported considerably greater vaccine hesitancy than White British/Irish ethnicity, but some minority ethnic groups did not. Educational inequalities did not account for ethnic differences. Vaccine programmes need to understand reasons for vaccine hesitancy within specific population sub-groups and take urgent action to improve uptake.
ABSTRACT
Vaccine hesitancy could undermine efforts to control COVID-19. We investigated the prevalence of COVID-19 vaccine hesitancy in the UK and identified vaccine hesitant subgroups. The 'Understanding Society' COVID-19 survey asked participants (n = 12,035) their likelihood of vaccine uptake and reason for hesitancy. Cross-sectional analysis assessed vaccine hesitancy prevalence and logistic regression calculated odds ratios. Overall vaccine hesitancy was low (18% unlikely/very unlikely). Vaccine hesitancy was higher in women (21.0% vs 14.7%), younger age groups (26.5% in 16-24 year olds vs 4.5% in 75 + ) and those with lower education levels (18.6% no qualifications vs 13.2% degree qualified). Vaccine hesitancy was high in Black (71.8%) and Pakistani/Bangladeshi (42.3%) ethnic groups. Odds ratios for vaccine hesitancy were 13.42 (95% CI:6.86, 26.24) in Black and 2.54 (95% CI:1.19, 5.44) in Pakistani/Bangladeshi groups (compared to White British/Irish) and 3.54 (95% CI:2.06, 6.09) for people with no qualifications versus degree. Urgent action to address hesitancy is needed for some but not all ethnic minority groups.