Introduction: Late-night alcohol trading hours are generally associated with increased alcohol-related harm. Since 2018, two Scottish cities have allowed extensions in late-night alcohol trading hours with the aim of revitalising the night-time economy. This is the first study to directly observe whether and how bars and nightclubs use these extensions, and collect rich qualitative data about venue environment and staff behaviour. Methods: Trained, paired fieldworkers, behaving as customers, completed semi-structured observation schedules on mobile devices during repeated visits to 15 purposively sampled venues in 2023-24 (5 venues in Glasgow and 10 in Aberdeen: total of 313 h of observation). In-depth qualitative fieldnotes were completed within 48 h of visits. Results: Half of the venues closed early on at least one fieldworker visit without using all of their later trading hours. Venues using their extended hours were observed to be at low occupancy on at least one visit. Fieldworkers observed bar staff serving alcohol to intoxicated customers in every venue. In half of the venues, 'shot girls' were observed persistently approaching customers, including those who appeared intoxicated. Conclusions: Extensions in late-night alcohol trading hours granted in two Scottish cities were not used consistently by venues due to lack of demand by customers. The late-night sale of alcohol to intoxicated customers was routine. Our findings challenge the assumption that later trading hours benefit the night-time economy and highlight the likelihood of associated alcohol-related harms.

Introduction Alcohol-related harms are prevalent late at night, especially on weekends, when high levels of intoxication contribute to increased rates of injury and violence. Reducing or increasing alcohol trading hours late at night in bars and clubs is generally associated with reduced and increased harms, respectively. This study evaluates the impact of later alcohol trading hours in the Scottish cities of Aberdeen and Glasgow on alcohol-related ambulance call-outs and crimes. Under local policy changes, 38 bars in Aberdeen had trading hours extended between 1 and 3 h up to 3am, and 10 nightclubs in Glasgow had a 1-h extension to 4am.Methods Following a natural experiment evaluation framework, we used a controlled interrupted time series design to compare outcomes before and after policy changes, from May 2015 to March 2020. The primary outcome was a count of total weekend night-time alcohol-related ambulance call-outs. Secondary outcomes included weekend night-time crimes.Results In Aberdeen, the policy led to a significant relative increase of 11.4% (effect size=4.643; 95% CI 0.292 to 8.994; p=0.036) in alcohol-related ambulance call-outs, and 8.5% (effect size=3.442; 95% CI 0.239 to 6.645; p=0.035) in reported crimes, at weekend night-times compared with Edinburgh (control). Findings were not significant and robust across analyses for Glasgow.Conclusion Later alcohol trading hours had a significant negative impact on alcohol-related ambulance call-outs and reported crimes in Aberdeen (where more premises had longer extensions) but not in Glasgow, suggesting the number, capacity and type of premises moderated outcomes. This is important for the design of future national and local licensing policies and regulations.

Background: Late-night opening of alcohol venues is associated with increased intoxication, social disorder and burden on public services. From 2017, two Scottish cities—Aberdeen and Glasgow—extended venue trading hours, to 3am and 4am, respectively. This study aimed to explore (i) public perceptions of harms and benefits of later trading hours, and (ii) how related public health evidence is assessed and used by the public. Methods: Eight groups of residents and venue-goers (n = 42) participated in two deliberative focus groups over a two-week period. Evidence on the pros and cons of later hours was presented and discussed. Reflexive thematic analysis was used to analyze data. Results: Participants associated later hours with increased alcohol consumption and increased harms such as violence, antisocial behavior, crime and public disturbance. Harms were discussed more frequently than benefits. Venue-goers highlighted cultural and social benefits and suggested staggered closing times might reduce harms. Following consideration of public health evidence, participants’ focus shifted from individual to societal impacts, such as increased burden on police, ambulance, and hospital services. Conclusion: Exposing lay participants to public health evidence fostered more reflection on societal impacts of later trading hours, potentially providing policy-makers with strategies to increase public support for alcohol policies.

INTRODUCTION:High alcohol availability is related to increased alcohol consumption and harms. Existing quantitative research provides potential explanations for this relationship but there is little understanding of how people experience local alcohol availability. This is the first review to synthesise qualitative research exploring the relationship between alcohol availability and other factors in local alcohol environments. METHODS:The scoping review includes qualitative studies exploring community-level alcohol availability and other factors, facilitating the purchase and consumption of alcohol. We included studies focusing on children and adolescents as well as adults. Study findings were brought together using thematic analysis and the socio-environmental context model, which explains how certain environments may facilitate drinking. RESULTS:The review includes 34 articles. The majority of studies were conducted since 2012. Most studies were conducted in the United Kingdom, Australia and South Africa. The physical availability of alcohol and proximity to local amenities and temporal aspects, like late night opening hours, may be linked to social factors, such as normalisation of drinking and permissive drinking environments. The review highlights the importance of social and cultural factors in shaping interactions with local alcohol environments. DISCUSSION AND CONCLUSION:This qualitative scoping review advances understanding of the pathways linking alcohol availability and alcohol harms by showing that availability, accessibility and visibility of alcohol may contribute towards permissive drinking environments. Further research is needed to better understand how people experience alcohol availability in their local environment and how this can inform alcohol control policies.

Government controls over intimate relationships, imposed to limit the spread of Sars-CoV-2, were unprecedented in modern times. This study draws on data from qualitative interviews with 18 participants in Natsal-COVID, a quasi-representative web-panel survey of the British population (n = 6,654 people), reporting that they had sex with someone from outside their household in the preceding four weeks; a period in which contact between households was restricted in the UK. Whilst only 10% of people reported sexual contact outside their household, among single people and those in non-cohabiting relationships, rates were much higher (Natsal-COVID). Our findings show that individuals did not take decisions to meet up with sexual partners lightly. Participants were motivated by needs-for connection, security, intimacy and a sense of normality. People balanced risks-of catching COVID-19, social judgement and punishment for rule-breaking-against other perceived risks, including to their mental health or relationships. We used situated rationality and social action theories of risk to demonstrate that people weighed up risk in socially situated ways and exhibited complex decision-making when deciding not to comply with restrictions. Understanding motivations for non-compliance is crucial to informing future public health messaging which accounts for the needs and circumstances of all population members.

Sexual wellbeing is an important aspect of population health. Addressing and monitoring it as a distinct issue requires valid measures. Our previous conceptual work identified seven domains of sexual wellbeing: security; respect; self-esteem; resilience; forgiveness; self-determination; and comfort. Here, we describe the development and validation of a measure of sexual wellbeing reflecting these domains. Based on the analysis of 40 semi-structured interviews, we operationalized domains into items, and refined them via cognitive interviews, workshops, and expert review. We tested the items via two web-based surveys (n = 590; n = 814). Using data from the first survey, we carried out exploratory factor analysis to assess and eliminate poor performing items. Using data from the second survey, we carried out confirmatory factor analysis to examine model fit and associations between the item reduced measure and external variables hypothesized to correlate with sexual wellbeing (external validity). A sub-sample (n = 113) repeated the second survey after 2 weeks to evaluate test-retest reliability. Confirmatory factor analysis indicated that a "general specific model" had best fit (RMSEA: 0.064; CFI: 0.975, TLI: 0.962), and functioned equivalently across age group, gender, sexual orientation, and relationship status. The final Natsal-SW measure comprised 13 items (from an initial set of 25). It was associated with external variables in the directions hypothesized (all p < .001), including mental wellbeing (0.454), self-esteem (0.564), body image (0.232), depression (-0.384), anxiety (-0.340), sexual satisfaction (0.680) and sexual distress (-0.615), and demonstrated good test-retest reliability (ICC = 0.78). The measure enables sexual wellbeing to be quantified and understood within and across populations.

Objective: This study explores the choices and constraints affecting timing of parenthood among those who became parents in their mid-thirties and early forties and how their fertility decisions were both affected by and negotiated within the interplay of different temporal frameworks. Background: Recent decades have seen a trend towards postponement of parenthood in many countries. Explanations for this delay include structural factors, changing social norms and the influence of the social meanings of age. The study assesses the influence of these factors on perceptions of the ‘right’ time to become parents. Method: The study draws on qualitative interviews with 23 women and men who participated in the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) survey and had a first child when they were aged between 33 and 46. Results: Prerequisites for parenthood were seen as financial security, a suitable home and a steady relationship. Educational attainment and the achievement of personal and lifestyle goals affected the age at which parenthood was considered as were individual circumstances. Age was less influential than life stage as a criterion for readiness although, for women, chronological age was a decisive factor. Conclusions: Choice in shaping personal biographies was greater among participants than it would have been for previous generations but its consequences acted to constrain options regarding the timing of parenthood. Time taken to fulfil personal and professional ambitions, changing social norms regarding the appropriate age for parenthood as well as individual and structural factors resulted in less predictable life trajectories.

IntroductionAccess to quality sexual and reproductive health (SRH) services remains imperative even during a pandemic. Our objective was to understand experiences of delayed or unsuccessful access to SRH services in Britain during the early stages of the COVID-19 pandemic.MethodsIn October and November 2020 we conducted semi-structured telephone interviews with 14 women and six men reporting an unmet need for SRH services in the Natsal-COVID survey, a large-scale quasi-representative web-panel survey of sexual health and behaviour during COVID-19 (n=6654). We purposively sampled eligible participants using sociodemographic quotas. Inductive thematic analysis was used to explore service access and quality and to identify lessons for future SRH service delivery.ResultsTwenty participants discussed experiences spanning 10 SRH services including contraception and antenatal/maternity care. Participants reported hesitancy and self-censorship of need. Accessing telemedicine and ‘socially-distanced’ services required tenacity. Challenges included navigating changing information and procedures; perceptions of gatekeepers as obstructing access; and inflexible appointment systems. Concerns about reconfigured services included reduced privacy; decreased quality of interactions with professionals; reduced informal support; and fewer preventive SRH practices. However, some participants also described more streamlined services and staff efforts to compensate for disruptions. Many viewed positively the ongoing blending of telemedicine with in-person care.ConclusionThe COVID-19 pandemic impacted access and quality of SRH services. Participants’ accounts revealed self-censorship of need, difficulty navigating shifting service configurations and perceived quality reductions. Telemedicine offers potential if intelligently combined with in-person care. We offer initial evidence-based recommendations for promoting an equitable restoration and future adaption of services.

Sexting has generated considerable public and professional interest with concerns centring on young people, and potential harms to mental and sexual health. Little research thus far has explored the practice among adults and none has focused on the cultural norms relating to the emotional experience of sexting across different ages and genders. We conducted 40 semi-structured interviews with a diverse sample of adults aged 18-59 years in Britain on the role of digital technologies in participants' sexual lives. In this paper, we draw on the accounts of 34 people with experience of sexting. We identified three main themes in participants' accounts related to the emotional aspects of sexting: (1) trust, (2) desire/intimacy and (3) shame. Under each theme, we identified motivations, 'feeling rules', and examples of 'emotion work' relating to the self, the other and the dyad. We conclude that there are shared cultural norms that constitute what appropriate sexting should feel like. Interventions aiming to minimise harms arising from sexting need to build on commonly held cultural conventions regarding the 'rules of the game' concerning feelings as well as behaviours.

Sexual wellbeing is an important aspect of population health and addressing it as a distinct issue requires a validated measure. Our previous conceptual work identified seven domains of sexual wellbeing: security; respect; self-esteem; resilience; forgiveness; self-determination; and comfort. Here we describe the development and validation of a measure capturing these domains. We build on analysis of 40 semi-structured interviews (reported elsewhere). We operationalised domains into items, and refined them via seven cognitive interviews, workshops and expert review. We then tested the items via two web-based surveys (n=590; n=814). Using data from the first survey we did exploratory factor analysis to assess and eliminate poor performing items. Using data from the second we did confirmatory factor analysis to examine model fit and associations between the item reduced measure and external variables hypothesised to correlate with sexual wellbeing (external validity). A sub-sample (n=113) repeated the second survey after two weeks to evaluate test-retest reliability. Confirmatory factor analysis indicated that a ‘general specific model’ had best fit (RMSEA: 0.064; CFI: 0.975, TLI: 0.962), and functioned equivalently across age groups, genders, sexual orientations and relationship statuses. The final measure comprised 13 items (from an initial set of 25). It was associated with external variables in the directions hypothesised (all p<0.001), including mental wellbeing (0.454), self-esteem (0.564), body image (0.232), depression (-0.384), anxiety (-0.340), sexual satisfaction (0.680) and sexual distress (-0.615) and demonstrated good test-retest reliability (ICC = 0.78). Our 13-item measure enables sexual wellbeing to be quantified and understood within and across populations.

ObjectivesPhysical distancing as a non-pharmaceutical intervention 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 aimed to explore whether intimacy needs impacted adherence to physical distancing following lockdown in Britain in March 2020.MethodsThe Natsal-COVID web-panel survey (July–August 2020) used quota-sampling and weighting to achieve a quasi-representative population sample. We estimate reporting of IPCOH with a romantic/sexual partner in the 4 weeks prior to interview, describe the type of contact, identify demographic and behavioural factors associated with IPCOH and present age-adjusted ORs (aORs). Qualitative interviews (n=18) were conducted to understand the context, reasons and decision making around IPCOH.ResultsOf 6654 participants aged 18–59 years, 9.9% (95% CI 9.1% to 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 (eg, condomless sex, higher alcohol consumption). IPCOH was less likely among those reporting bad/very bad health (aOR 0.54; 95% CI 0.32 to 0.93) but more likely among those with COVID-19 symptoms and/or diagnosis (aOR 1.34; 95% CI 1.10 to 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.ConclusionsGiven 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.

laboratories). The non-treponemal Venereal Disease Research Laboratory (VDRL) assay was used to screen patients previously-treated for syphilis. An in-house PCR assay tested ulcerderived DNA extracts for TP. The study received Ethics Committee approval. Results 93 primary syphilis cases (92 with ulceration, 1 with inguinal lymphadenopathy) were diagnosed in the study period. TP PCR was performed in 84/92 (91%) cases and positive in 76/84 (90%) cases. Overall, syphilis serology detected 79/93 (85%) primary syphilis cases. 75/93 (81%) cases had no laboratory evidence of prior syphilis; 18 cases (19%) had previous reactive treponemal serology. Treponemal antibodies were present in 63/75 (84%) first-episode syphilis cases; 12/75 (16%) had non-reactive treponemal serology. Most cases with previously-treated syphilis had reactive VDRL tests (16/18, 89%). There were 64 PCR positive/serology reactive cases, 12 TP PCR positive/serology non-reactive cases, 7 PCR negative/serology reactive cases and one clinically-diagnosed case (negative TP PCR/non-reactive serology). Serology was reactive in all 9 cases where TP PCR was not performed (8 EIA reactive, 1 VDRL reactive). Conclusion Primary syphilis is best diagnosed using a combined approach with TP PCR and syphilis serology.

Background Physical distancing as a non-pharmaceutical intervention (NPI) to prevent SARS-CoV-2 transmission aims to reduce interactions between people, including between different households. We explored whether sexual intimacy needs impacted on compliance with physical distancing at a population level in Britain following the initial national lockdown on 23 March 2020. Methods We undertook the Natsal-COVID web-panel survey between 29 July-10 August 2020. Quota-based sampling and weighting were used to obtain a quasi-representative sample of the British population. We estimated reporting of physical contact outside of the household (PCOH) with a romantic/sexual partner in the four weeks prior to interview, described the type of contact, identified demographic and behavioural factors associated with PCOH and present age-adjusted odds ratios (aORs). Results Of the 6,654 participants aged 18–59 years, 9.9% (95%CI:9.9–10.6%) reported PCOH. Of these, 86.1% reported oral/anal/vaginal sex or genital contact, while the remaining reported kissing (10.4%) or only holding hands/hugging/cuddling (3.4%). PCOH varied by age and gender and was highest in those aged 18–24 (20.6% of women and 15.6% of men). PCOH was more likely in participants identifying as gay/lesbian (aOR 2.5; 1.82–3.45) or bisexual (aOR 1.52; 1.12–2.05) and those reporting >1 partner (aOR 1.71; 3.77–5.88) or condomless sex with a new partner (OR 5.03; 1.07–6.21) in the past year. PCOH was less likely in those reporting a steady or cohabiting relationship (aOR 0.66; 0.55–0.79 and aOR 0.11; 0.08–0.14 respectively), and in those reporting bad/very bad health (aOR 0.54; 0.32–0.93). Conclusion The intimate nature of sexual contact is high-risk for SARS-CoV-2 transmission and PCOH may expand transmission networks by connecting households. Mathematical models of NPIs might consider age- and gender-specific PCOH in the context of other mixing patterns. Public health messaging needs to recognise the importance of sexual and romantic contact in people's decision-making and adherence to control measures.

Background COVID-19 restrictions led to widespread disruption of SRH services in Britain following the first national lockdown (23/3/2020). One-in-ten people who tried to access SRH services during reported being unable to do so (Natsal-COVID). We used mixed-methods research to quantify unmet need and explore its context and impact. Methods 6,657 participants aged 18–59 years completed a web-panel survey (29/07–10/08/20). Quota-based sampling and weighting enabled a quasi-representative population sample to be achieved. Quantitative analysis focused on participants' challenges accessing contraception and STI-related services since lockdown. We conducted 23 in-depth interviews with participants, 15 who reported not receiving an SRH service and eight who discussed this in a different topic interview. Results Reasons for not receiving STI-related (n=103) or contraception services (n=144) despite need included that appointments were unavailable (STI-related services: 28.6% (95%CI:19.5–39.8)/Contraception services 36.3% (28.1% – 45.4%)), were cancelled (22.8% (14.9%- 33.3%)/23.9% (16.8%-32.8%) or services were closed (21.2% (13.7%-31.4)/26.1% (19.1%-34.5%). Discomfort with using online/telephone services was more common amongst those not receiving STI-related services 26.0% (17.4%-36.9%) than for contraception services 6.7% (3.4%-12.8%). Interviewees described how some services were unavailable, while others were disrupted. Many were offered and received alternatives to in-person service (e.g. telephone/online) and some had to use different contraceptive methods. Most understood attempts to limit SARS-CoV-2 transmission and found alternatives convenient, though others saw them as inferior due to interaction limitations. Tenacity was required to access some services. Several participants described how they had avoided or deprioritised their own needs. Fears of contracting COVID-19 and of judgement for having sex against restrictions deterred help-seeking. Conclusion While some people were unable to access an anticipated service, many were offered alternatives with varied consequences. Services may need to adapt further to improve access by offering efficient face-to-face and remote provision while emphasising lack of judgement and validating help seeking.

BackgroundWorldwide, efforts to control SARS-CoV-2 transmission have included lockdowns and restrictions on contact with others, including sexual partners. Our research (Natsal-COVID) indicates that in the UK, 10% of people aged 18–59 had physical or sexual contact with a romantic or sexual partner outside their household (PCOH) during a period in which contact was limited. We explored motivations and decision-making among people reporting PCOH in the four months following the initial national lockdown on 23rd March 2020.MethodSemi-structured interviews were conducted with 18 individuals reporting PCOH during a period in which physical distancing measures were in place. Participants were recruited through a large, quasi-representative survey investigating sexual behaviour in the UK during the COVID-19 pandemic (Natsal-COVID). Interviews were analysed thematically.ResultsParticipants were single (n=8) or in long-term, non-cohabiting, relationships (n=10). While participants in the two groups differed in their reported motivations for PCOH, all demonstrated complex and individualised decision-making, weighing up risks such as SARS-CoV-2 transmission, judgement of peers, and benefits, including feelings of security and improved mental health. For those in relationships, the primary motivation was continuity: participants expected to continue seeing their romantic partner. Participants rationalised this contact as ‘low risk’ in relation to other ‘risks’ of COVID-19 exposure, and reduced other activities (such as shopping, seeing friends) to maintain this contact. For single participants, loneliness and boredom were reported as the primary motivators for PCOH, with dating apps often used to facilitate contact. For both groups, evidence of considered decision-making was clear, with participants referencing government guidance, personal situations, and risk when describing their deliberations.ConclusionIndividuals did not make decisions about PCOH lightly. However, physical contact with partners was considered important and thus rationalised. Public health policy-makers must therefore consider sexual behaviour and needs for physical contact in designing effective future public health messaging.

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 preexisting 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..

This essay examines key aspects of social relationships that were disrupted by the COVID-19 pandemic. It focuses explicitly on relational mechanisms of health and brings together theory and emerging evidence on the effects of the COVID-19 pandemic to make recommendations for future public health policy and recovery. We first provide an overview of the pandemic in the UK context, outlining the nature of the public health response. We then introduce four distinct domains of social relationships: social networks, social support, social interaction and intimacy, highlighting the mechanisms through which the pandemic and associated public health response drastically altered social interactions in each domain. Throughout the essay, the lens of health inequalities, and perspective of relationships as interconnecting elements in a broader system, is used to explore the varying impact of these disruptions. The essay concludes by providing recommendations for longer term recovery ensuring that the social relational cost of COVID-19 is adequately considered in efforts to rebuild.

The idea that how you were parented is key to how you parent your own children is widely recognisable. It is present in popular cultural references, underpins much policy on families and parenting in the UK, and is supported by a substantive body of academic literature. We explore this concept of intergenerational transmission of parenting, understanding it as the context in which parenting interventions have been implemented. We draw on interview data from three Scottish samples of marginalised parents (n = 54) to explore how participants think their own parenting behaviours have been shaped by their experience of being parented and how they talk about participation in a parenting intervention in relation to this. We find that how these parents have been parented is salient in considering their own parenting behaviour, and is a key context for their engagement with the intervention. We make the case for parenting interventions targeted at marginalised parents, arguing that they are acceptable to, and useful for, these parents and may, potentially, be effective in breaking cycles of negative parenting. Policy-makers should not shy away from implementing targeted parenting programmes as part of endeavours to address negative parenting.