Kaye Wellings

• Professor (Full) at London School of Hygiene and Tropical Medicine

Background Most surveys examining health professionals’ knowledge, attitudes and practices around abortion have used convenience samples and have targeted doctors. Our goal in the SACHA Study, drawing on evidence-based strategies to maximise response rates, was to achieve a representative sample of a wider range of health professionals, working in...

Objectives To gather views of healthcare professionals on the regulation and provision of abortion in Britain. Methods Cross-sectional, stratified cluster sample survey of healthcare professionals working in a range of healthcare services including abortion services. Measures included knowledge of and attitudes towards the regulation and provision...

Introduction Use of telemedicine in abortion care is safe and effective. Patient satisfaction with telemedically supported abortion is high, but as use expands in Britain, little is known about patients’ or health professionals’ views on how it is best used. We sought the views of both groups on telemedicine's role in abortion provision and how its...

Background Models of abortion care have changed significantly in the last decade, most markedly during the COVID-19 pandemic, when home management of early medical abortion with telemedical support was approved in Britain. Objective Our study aimed to examine women’s satisfaction with abortion care and their suggestions for improvements. Design Q...

Objectives: Therapeutic, regulatory and technological changes have contributed to new directions in abortion care. We aimed to gather views of healthcare professionals on current and future regulation and provision of abortion in Britain. Design: Cross sectional, stratified cluster sample survey with additional free text comments. Setting: Healthca...

Patient and public involvement (PPI) is limited within abortion-related research. Possible reasons for this include concerns about engaging with a stigmatised patient group who value confidentiality and may be reluctant to re-engage with services. Structural barriers, including limited funding for abortion-related research, also prevent researchers...

Background Knowing levels and determinants of partnership acquisition will help inform interventions that try to reduce transmission of sexually transmitted infections (STIs) including HIV. Methods We used population-based, cross-sectional data from 47 Demographic and Health Surveys to calculate rates of partner acquisition among men and women (15...

Objective: In 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion,...

Studies into decline in sexual activity among women in midlife produce equivocal findings, some implicating hormonal and physiological changes, others psycho-social and environmental factors. Women's perspectives rarely inform interpretation of the data. Associations between sexual satisfaction, activity and function, and health and lifestyle facto...

Background The prevalence of genital chlamydia and gonorrhoea is higher in the 16–24 years age group than those in other age group. With users, we developed the theory-based safetxt intervention to reduce sexually transmitted infections. Objectives To establish the effect of the safetxt intervention on the incidence of chlamydia/gonorrhoea infecti...

Objective To inform UK service development to support medical abortion at home, appropriate for person and context. Design Realist review Setting/participants Peer-reviewed literature from 1 January 2000 to 9 December 2021, describing interventions or models of home abortion care. Participants included people seeking or having had an abortion. I...

Objective To quantify the effects of a series of text messages (safetxt) delivered in the community on incidence of chlamydia and gonorrhoea reinfection at one year in people aged 16-24 years. Design Parallel group randomised controlled trial. Setting 92 sexual health clinics in the United Kingdom. Participants People aged 16-24 years with a dia...

Objectives To synthesise evidence on user experience of medical abortion at home To develop a realist programme theory to explain what interventions improve user experience for whom and in what context. To use this programme theory to develop recommendations for service providers and those having medical abortions at home Background Changes in the...

Background: During the COVID-19 pandemic, the British governments issued temporary approvals enabling the use of both medical abortion pills, mifepristone and misoprostol, at home. This permitted the introduction of a fully telemedical model of abortion care with consultations taking place via telephone or video call and medications delivered to w...

Objectives To assess the impact of the December 2018 approval of home administration of misoprostol in England on access to medical abortion. Design Time series analysis Setting British Pregnancy Advisory Service (BPAS), independent-sector abortion provider in England Participants 145,529 abortions carried out by BPAS across England between 2018...

Background During the COVID-19 pandemic, the British governments issued temporary approvals enabling the use of both pills for medical abortion at home. This permitted the introduction of a fully telemedical model of abortion care with consultations taking place via phone or video call and medications delivered to women’s homes. The approvals in En...

Introduction Sex education has been shown to improve the sexual health of adolescents. However, many countries, including Saudi Arabia, still lack formal, school-based sex education programmes. Methods We examined the views of 28 stakeholders on anticipated barriers and facilitators to formulating and implementing a school-based sex education prog...

Background: The narrative surrounding women’s reproductive health has shifted from a medical model to an emphasis on reproductive well-being over different life-stages. We developed and piloted a tracker survey for monitoring women’s reproductive health and well-being in England, recruiting respondents online. This paper reports on the success of t...

Using data from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) we examined associations between salivary testosterone (Sal-T) and sexual function and behavior. Single morning saliva samples were self-collected from a subsample of participants aged 18-74 years and analyzed using mass spectrometry. 1,599 men and 2,123...

Purpose To describe medium-term physical and mental health and social outcomes following adolescent sexual assault, and examine users’ perceived needs and experiences. Method Longitudinal, mixed methods cohort study of adolescents aged 13–17 years recruited within 6 weeks of sexual assault (study entry) and followed to study end, 13–15 months post...

Although sex education has been found to improve young people’s sexual and reproductive health, no formal programmes exist in Saudi Arabia. This study aims to assess the views of stakeholders on the need for sex education programmes for adolescents in Saudi Arabia, suggested forms of provision, and views on the information provided in Science and R...

Introduction Over-the-counter provision of emergency contraception pills (ECP) has increased since deregulation of progestogen-only formulations and is now the most common public health service provided by UK pharmacists. Important questions relate to women’s perceptions of their experience of receiving ECPs from pharmacists. Methods Qualitative s...

Introduction Young people aged 16 to 24 have the highest prevalence of genital chlamydia and gonorrhoea compared with other age groups and re-infection rates following treatment are high. Long-term adverse health effects include subfertility and ectopic pregnancy, particularly among those with repeated infections. We developed the safetxt intervent...

Background A quarter of a century ago, two global events—the International Conference on Population and Development in Cairo, and the Fourth World Conference on Women in Beijing—placed gender equality and reproductive health and rights at the centre of the development agenda. Progress towards these goals has been slower than hoped. We used survey d...

Objective Despite increases in STIs among those over 40, little is known about the social context of STI transmission among people experiencing relationship transition in midlife, and few sexual health promotion initiatives are targeted at this group. This study sought to identify factors shaping STI risk perceptions and practices among midlife ind...

Purpose: Pregnancy rates among adolescents have declined in the U.S. and Britain but remain high compared with other high-income countries. This comparison describes trends in pregnancy rates, recent sexual activity, and contraceptive use among women aged 16-19 years in the U.S. and Britain to consider the contribution of these two behavioral fact...

Aim To describe prevalence and trends in contraceptive method use in Britain through a comparison of the second and third National Surveys of Sexual Attitudes and Lifestyles (Natsal-2 and Natsal-3). Methods Cross-sectional probability sample surveys. General population sample of women aged 16–44 years, resident in Britain, with ever-experience of...

Background: Despite known associations between different aspects of sexual health, it is not clear how patterning of adverse sexual health varies across the general population. A better understanding should contribute towards more effective problem identification, prevention and treatment. We sought to identify different clusters of sexual health...

Aims Pregnancy rates among adolescents have declined in the US and Britain, but remain high compared to other high-income countries. This comparison examines trends in pregnancy rates, recent sexual activity and contraceptive use among women aged 16-19 in the US and Britain to consider the behavioural drivers of the decline in pregnancy rates in th...

This study elicited views of key stakeholders on the need for adolescent sex eudcation and the appropriate model to adopt in Saudi Arabia. Semi-structured interviews were conducted in Riyadh, Saudi Arabia, with 28 stakeholders: policy-makers; social and healthcare providers; teachers and school staff; and religious scholars. Interviews were recorde...

Objectives Quantify non-attendance at sexual health clinics and explore help-seeking strategies for genitourinary symptoms. Design Sequential mixed methods using survey data and semistructured interviews. Setting General population in Britain. Participants 1403 participants (1182 women) from Britain’s Third National Survey of Sexual Attitudes an...

Infertility represents a very peculiar area of medicine. Contrary to other areas, where signs and symptoms lead to a diagnosis, which in turn leads to a specific treatment, in reproduction the lack of signs and symptoms for more than 12 months suggests the diagnosis of 'unexplained subfertility', and if this condition has lasted for some years, cou...

Background Abortions are known to be underreported in surveys. Previous research has found a number of ways in which survey methodology may affect respondents’ willingness to disclose abortions. The social and political climate surrounding abortion may also create stigma affecting abortion reporting, and this may vary between countries and over tim...

Associations have been shown between father’s absence and menarcheal age, but most studies have focused on absence resulting from divorce, abandonment or death. Little research has been conducted to evaluate the effect on menarcheal age of paternal absence through migrant work. In a sample of 400 middle school students, this study examined the asso...

Objectives To examine changes over time in the reported frequency of occurrence of sex and associations between sexual frequency and selected variables. Design Repeat, cross sectional, population based National Surveys of Sexual Attitudes and Lifestyles (Natsal-1, Natsal-2, and Natsal-3). Setting British general population. Participants 18 876 m...

Aims To describe medium-term health and social outcomes in young people 13–15 months post-sexual assault. Method Longitudinal mixed methods study examining the trajectories of adolescents presenting to the Sexual Assault Referral Centres (SARCs) serving a large, diverse city soon after assault. Data were collected within 6 weeks (T0), 4–5 months (...

Aims The study aims were to 1) assess the feasibility, acceptability and effectiveness of a new model of centralized health service provision (the CSAservice) for children under 13 years disclosing recent child sexual abuse (CSA) and 2) evaluate non-offending carer’s views of how effectively multi-agency services address the needs of these children...

Background Men and women are increasingly likely to stay sexually active into later life, but research shows that sexual activity and satisfaction decrease with increasing age. Ill health and medical treatments may affect sexual activity but there is little research on why some older people with a health problem affecting their sexual activity are...

Background A greater understanding of the circumstances of first sexual intercourse, as opposed to an exclusive focus on age at occurrence, is required in order that sexual health and well-being can be promoted from the onset of sexual activity. Methods We used data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) condu...

Introduction Repeated induced abortion (RIA) is a challenging public health issue. Although many studies have investigated the characteristics of women who experience multiple abortions, most have focused only on limited intrapersonal variables. To frame the analysis, this study used an ecological model integrating intrapersonal, interpersonal and...

In a closed population and defined time period, the mean number of opposite-sex partners reported by men and women should be equal. However, in all surveys, men report more partners. This inconsistency is pivotal to debate about the reliability of self-reported sexual behavior. We used data from the third National Survey of Sexual Attitudes and Lif...

Background: Young people are disproportionately affected by sexual assault, yet longitudinal data are sparse. This paper examines the characteristics of adolescents presenting to sexual assault services and mental and sexual health outcomes after an assault. Methods: This was a prospective cohort study in adolescents aged 13-17 years attending t...

Background One in six pregnancies in Britain are unplanned. An understanding of influences on contraceptive method choice is essential to provision compatible with users’ lifestyles. This study describes contraceptive method use by age, and relationship status and duration, among women in Britain. Methods Data from women participating in the third...

Introduction To estimate the prevalence of use of different sources of contraceptive supplies in Britain and its variation by key demographic and behavioural characteristics. Methods Cross-sectional probability sample survey of women and men aged 16–74 years, resident in Britain, interviewed between 2010 and 2012. Analyses reported here were of 45...

Background: The Global Programme to Eliminate Lymphatic Filariasis has set 2020 as a target to eliminate lymphatic filariasis (LF) as a public health problem through mass drug administration (MDA) to all eligible people living in endemic areas. To obtain a better understanding of compliance with LF treatment, a qualitative study using 43 in-depth...

Sexually transmitted infection (STI) stigma persists and can delay or prevent seeking care at sexual health clinics but help-seeking in response to genito-urinary symptoms is not well-understood and often clinically framed. I explore perceptions and social representations of STIs and how these influence lived experiences of genito-urinary symptoms...

Background Sexual orientation encompasses three dimensions: sexual identity, attraction and behaviour. There is increasing demand for data on sexual orientation to meet equality legislation, monitor potential inequalities and address public health needs. We present estimates of all three dimensions and their overlap in British men and women, and co...

Sexual attraction and experience among men and women aged 16–74 years, Britain, 2010–12. (DOCX)

Sexual identity, same-sex attraction and recent opposite-sex sex among men and women reporting same-sex sex ever, by recency of same-sex sex and age, Britain, 2010–12. (DOCX)

THIS ARTICLE IS AVAILABLE OPEN ACCESS HERE: http://www.sciencedirect.com/science/article/pii/S1054139X17303300 Purpose To describe time trends and current patterns in sexual practices with opposite-sex partners among men and women aged 16–24 years in Britain. Methods Complex survey analyses of cross-sectional probability survey data from three Bri...

Introduction To estimate the prevalence of use of different sources of contraceptive supplies in Britain and its variation by key demographic and behavioural characteristics. Methods Cross-sectional probability sample survey of women and men aged 16–74 years, resident in Britain, interviewed between 2010 and 2012. Analyses reported here were of 45...

Objectives Socioeconomic status has been shown to be associated with sexual activity, contraceptive-use, pregnancy and abortion among young people. Less is known about whether the strength of the association differs for each outcome, between men and women, or cross-nationally. We investigate this using contemporaneous national probability survey da...

Objectives To investigate factors associated with reporting lacking interest in sex and how these vary by gender. Setting British general population. Design Complex survey analyses of data collected for a cross-sectional probability sample survey, undertaken 2010–2012, specifically logistic regression to calculate age-adjusted OR (AOR) to identif...

Background Despite effective and accessible treatments, many sexually transmitted infections (STIs) in high-income countries go untreated, causing poor sexual health for individuals and their partners. Research into STI care has tended to focus on biomedical aspects of infections using patient samples and prioritised attendance at healthcare servic...

Introduction Trial recruitment is one of the most important trial tasks as full recruitment provides trials with sufficient power to detect intervention effects. Yet, two thirds of randomised controlled trials fail to fully recruit. The NIHR safetxt trial is a single blind randomised controlled trial to evaluate the effect of a safer sex interventi...

Objectives: Online venues might facilitate sexual encounters, but the extent to which finding partners online is associated with sexual risk behaviour and sexual health outcomes is unclear. We describe use of the internet to find sexual partners in a representative sample in Britain. Methods: The third National Survey of Sexual Attitudes and Lif...

Objectives Breakdown of marriage and cohabitation is common in Western countries and is costly for individuals and society. Most research on reasons for breakdown has focused on marriages ending in divorce and/or have used data unrepresentative of the population. We present prevalence estimates of, and differences in, reported reasons for recent br...

Objective: To estimate the prevalence of painful sex among women in Britain, and to explore associated sexual, relationship and health factors that should be considered in assessment. Design: Multi-stage, clustered and stratified population probability sample survey, using computer-assisted self-interview. Sample frame was the British Postcode A...

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 populati...

Objective: To test the procedures proposed for a main trial of a safer sex intervention for young people delivered by mobile phone text message ('safetxt'). Design and setting: Pilot randomised controlled trial. Participants were recruited through sexual health services in the UK. An independent online randomisation system allocated participants...

CONTEXT: Salivary testosterone (Sal-T) measurement by LC-MS/MS resents the opportunity to examine health correlates of Sal-T in a large-scale population survey. OBJECTIVE: To examine associations between Sal-T and health-related factors in men and women aged 18-74 years. DESIGN & SETTING: Morning saliva samples were obtained from participants in a...

Objective To describe actual and preferred contraceptive sources among young people in Britain and whether discordance between these is associated with markers of sexual risk behaviour or poor sexual health. Design Cross-sectional probability sample survey. Setting British general population. Participants 3869 men and women aged 16?24?years inte...

Context: Salivary testosterone (Sal-T) measurement by LC-MS/MS resents the opportunity to examine health correlates of Sal-T in a large-scale population survey. Objective: To examine associations between Sal-T and health-related factors in men and women aged 18-74 years. Design & setting: Morning saliva samples were obtained from participants...

Background Partnership type is a determinant of STI risk; yet, it is poorly and inconsistently recorded in clinical practice and research. We identify a novel, empirical-based categorisation of partnership type, and examine whether reporting STI diagnoses varies by the resulting typologies. Methods Analyses of probability survey data collected fro...

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 ob...

Purpose: Concern about young people's sexuality is focused on the need to prevent harmful outcomes such as sexually transmitted infections and unplanned pregnancy. Although the benefit of a broader perspective is recognized, data on other aspects of sexuality, particularly sexual function, are scant. We sought to address this gap by measuring the...

Background Social understandings of sexually transmitted infections and associated symptoms and care-seeking behaviour continue to lag behind advancements in biomedical diagnostics and treatment, perpetuating the burden of disease. There is a lack of research linking perceptions, experiences and care-seeking for sexual health issues, especially res...

Background: To date, research on men who have sex with men (MSM) has largely focused on their sexual health needs and on men recruited from gay-orientated venues. National probability survey data provide a rare opportunity to examine the broader sociodemographic, behavioural, and health profiles of MSM, defined as men who reported ≥1 male sexual p...

Background: Younger people bear the heaviest burden of sexually transmitted infections (STIs). Partner notification, condom use and STI testing can reduce infection but many young people lack the knowledge, skills and confidence needed to carry out these behaviours. Text messages can provide effective behavioural support. The acceptability and fea...

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 hel...

Objectives Travelling away from home presents opportunities for new sexual partnerships, which may be associated with sexually transmitted infection (STI) risk. We examined the prevalence of, and factors associated with, reporting new sexual partner(s) while overseas, and whether this differed by partners’ region of residence. Methods We analysed d...

Background Health risk behaviours are prominent in late adolescence and young adulthood, yet UK population-level research examining the relationship between drug or alcohol use and sexual health and behaviour among young people is scarce, despite public health calls for an integrated approach to health improvement. Our objective was to further our...

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)/o...

Background/introduction Younger people bear the heaviest burden of sexually transmitted infections (STIs). The acceptability and feasibility of conducting a randomised controlled trial of safer sex support delivered by text message are not known. Aim(s)/objectives To develop a safer sex intervention delivered by text messages for people aged 16–24...

Background/introduction There are both individual and public health benefits in people responding to genito-urinary symptoms effectively. Sexual health clinics are best equipped for managing symptoms but not everyone with symptoms chooses to attend. Aim(s)/objectives To examine the prevalence and meanings of genito-urinary symptoms and the impact...

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. In this observational study...

To examine the changes in the prevalence of, and the factors associated with, the use of emergency contraception (EC) in Britain between 2000 and 2010, spanning the period of deregulation and increase in pharmacy supply. Cross-sectional probability sample surveys. British general population. Data were analysed from the second and third Britis...

Objective To examine associations between sexual behaviour, sexual function and sexual health service use of individuals with depression in the British general population, to inform primary care and specialist services. Setting British general population. Participants 15 162 men and women aged 16–74 years were interviewed for the third National Sur...

The timing of first sexual intercourse is often defined in terms of chronological age, with particular focus on "early" first sex. Arguments can be made for a more nuanced concept of readiness and appropriateness of timing of first intercourse. Using data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), conducted in 201...

Interviewer-administered surveys are an important method of collecting population-level epidemiological data, but suffer from declining response rates and increasing costs. Web surveys offer more rapid data collection and lower costs. There are concerns, however, about data quality from web surveys. Previous research has largely focused on selectio...

Background Those who go online regarding their sexual health are potential users of new Internet-based sexual health interventions. Understanding the size and characteristics of this population is important in informing intervention design and delivery. Objective We aimed to estimate the prevalence in Britain of recent use of the Internet for key s...

Establishing the clinical significance of symptoms of sexual dysfunction is challenging. To address this, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced two new morbidity criteria (duration and symptom severity) to the existing criteria of distress. This study sought to establish the impact of thes...

Background: There are currently no large general population epidemiological studies of Mycoplasma genitalium (MG), which include prevalence, risk factors, symptoms and co-infection in men and women across a broad age range. Methods: In 2010--12, we conducted the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability s...