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Accurate information about a nation’s sexual health is essential to plan and evaluate services, inform prevention efforts, and contribute to societal discourse on sexuality. In Britain, sexual health data come from a range of sources. There are world-class surveillance data on STIs and reproductive health, although these only represent people attending services and collect limited data.1 2 A number of British surveys draw on convenience samples of populations of particular interest, such as sexual health clinic attendees, men who have sex with men and particular ethnic groups,3–7 and are therefore not generalisable to the wider population. Furthermore, such surveys often focus on specific aspects of sexual health (eg, STIs), and while some nationally representative surveys have included questions on sex and relationships, space limitations mean that questions are restricted to a small number of key behaviours and outcomes.8
Since 1990, the British National Surveys of Sexual Attitudes and Lifestyles (Natsal) have provided a decennial ‘census’ of the sexual health of the nation, capturing detailed data from probability samples of the population (Natsal-1: 1990–1991; Natsal-2: 1999–2001; Natsal-3: 2010–2012). This has involved randomly selecting addresses to which a trained fieldworker calls to randomly select and invite one household member to participate in a detailed structured interview using a combination of computer-assisted face-to-face and self-completion questions, with a subsample of participants invited to provide biological samples. This design seeks to represent the population as …
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