title: Asking about Sex in General Health Surveys: Comparing the Methods and Findings of the 2010 Health Survey for England with Those of the Third National Survey of Sexual Attitudes and Lifestyles.
abstract: OBJECTIVE
  Including questions about sexual health in the annual Health Survey for England (HSE) provides opportunities for regular measurement of key public health indicators, augmenting Britain's decennial National Survey of Sexual Attitudes and Lifestyles (Natsal). However, contextual and methodological differences may limit comparability of the findings. We examine the extent of these differences between HSE 2010 and Natsal-3 and investigate their impact on parameter estimates.
  
  
  METHODS
  Complex survey analyses of data from men and women in the 2010 HSE (n = 2,782 men and 3,588 women) and Natsal-3 undertaken 2010-2012 (n = 4,882 men and 6,869 women) aged 16-69y and resident in England, both using probability sampling, compared their characteristics, the amount of non-response to, and estimates from, sexual health questions. Both surveys used self-completion for the sexual behaviour questions but this was via computer-assisted self-interview (CASI) in Natsal-3 and a pen-and-paper questionnaire in HSE 2010.
  
  
  RESULTS
  The surveys achieved similar response rates, both around 60%, and demographic profiles largely consistent with the census, although HSE participants tended to be less educated, and reported worse general health, than Natsal-3 participants. Item non-response to the sexual health questions was typically higher in HSE 2010 (range: 9-18%) relative to Natsal-3 (all <5%). Prevalence estimates for sexual risk behaviours and STI-related indicators were generally slightly lower in HSE 2010 than Natsal-3.
  
  
  CONCLUSIONS
  While a relatively high response to sexual health questions in HSE 2010 demonstrates the feasibility of asking such questions in a general health survey, differences with Natsal-3 do exist. These are likely due to the HSE's context as a general health survey and methodological limitations such as its current use of pen-and-paper questionnaires. Methodological developments to the HSE should be considered so that its data can be interpreted in combination with those from dedicated sexual health surveys, thus improving our ability to monitor trends in sexual health.
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Prah
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Nardone
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom; NatCen Social Research, London, United Kingdom.
authors.forename: Soazig
authors.initials: S
authors.lastname: Clifton
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Mindell
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Copas
authors.affiliation: NatCen Social Research, London, United Kingdom.
authors.forename: Chloe
authors.initials: C
authors.lastname: Robinson
authors.affiliation: NatCen Social Research, London, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Craig
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Woodhall
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Wendy
authors.initials: W
authors.lastname: Macdowall
authors.affiliation: NatCen Social Research, London, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fuller
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Bob
authors.initials: B
authors.lastname: Erens
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Pam
authors.initials: P
authors.lastname: Sonnenberg
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Kaye
authors.initials: K
authors.lastname: Wellings
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004739:England; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011594:Psychometrics / Q000379:methods*; D012309:Risk-Taking; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D055815:Young Adult