UCL School of Life and Medical Sciences


Fourth wave of nation’s largest study on sexual health launched

19 March 2019

The National Survey of Sexual Attitudes and Lifestyles begins its fourth study on sexual health and well-being in Britain, led by UCL with researchers from the London School of Hygiene & Tropical Medicine, the University of Glasgow and NatCen Social Research.


The National Surveys of Sexual Attitudes and Lifestyles (Natsal) are regarded as the world’s largest, most detailed studies of sexual behaviour.

Dr Cath Mercer (UCL Institute for Global Health) and Co-Principal Investigator of the latest Natsal study said, “Improving sexual health remains a key public health challenge in Britain. Last year there were over 420,000 new STI diagnoses in England alone, and teenage pregnancy rates, although reducing, remain among the highest in Europe. There is increasing awareness about sexual violence, but also the importance of a satisfying sex life for our general health and well-being.”

Three Natsal surveys have taken place at the turn of each decade since 1990, with a new wave of data collection (Natsal-4) due to begin in 2021. Combining all four surveys will create a resource that provides a comprehensive picture of the sexual health of the nation and show how this has changed over time and across generations.

For the 2021 survey, interviewers will collect information from nearly 10,000 people aged 15-59 using computerised questionnaires to ensure privacy. People are randomly selected, based on their postcodes to ensure the surveys represent the general British population.

Survey answers will be combined with information from biological samples (e.g. to test for sexually transmitted infections) and routinely-collected data (e.g. health records). Development work for the next wave will start in May 2019 to ensure that the questions asked and the data collected are ‘fit for purpose’ in 2021.

Professor Pam Sonnenberg (UCL Institute for Global Health) and Co-Principal Investigator said, “The three surveys to date have already had a major impact on policy, practice, and the public dialogue about sex. Natsal data have been – and will continue to be - used to plan services and monitor the progress of interventions and national strategies.”

Natsal was initiated in response to the emerging HIV epidemic and has provided the evidence-base for major sexual health interventions and monitoring their impact (including for models on cost-effectiveness). These include the National Chlamydia Screening Programme; enhanced HIV testing; HPV vaccination; and the Teenage Pregnancy Strategy.

The next wave of Natsal is being funded by a grant from Wellcome Trust’s new Longitudinal Population Studies Strategy, reflecting Wellcome’s long-standing support for Natsal since its inception. The National Institute for Health Research (NIHR) and the Economic and Social Research Council (ESRC) as part of UK Research and Innovation are also contributing to funding this latest wave, reflecting the importance of the study for informing policy and practice, as well as its multidisciplinary focus.

Previous waves have been funded by the Medical Research Council and the Department for Health. The initial feasibility study for Natsal was funded by ESRC and the Health Education Authority.

Professor Dame Anne Johnson, who initiated Natsal in the late 1980s, said: “As Principal Investigator on the first three waves of Natsal, I am delighted that funding has been secured to ensure that the Natsal legacy continues to provide essential and novel data on sexual health”.



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