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Health Survey for England Newsletter (2018)

Trauma and abuse


Welcome to the first Health Survey for England newsletter of 2018. It is also our first paperless newsletter. We hope you like this more interactive format, which enables us to include links to articles referencing HSE surveys (as per your request) and the 2016 HSE report.

First of all, though, from everyone in the HSE team, we would like to wish all our interviewers and nurses, a belated but very Happy New Year. We are very excited to start this new year, as this means a whole new HSE survey year!

2018 is the 28th year of the HSE and without your hard work and dedication, it would not be possible. The survey continues to provide an invaluable wealth of data on a many number of topics including general health, mental health, obesity and cholesterol.


2016 HSE Report published

Something to remember

Response rates in 2017

Your feedback

HSE in the media

HSE in research

Top tips for top interviewers

Update from the research team

The incentive experiment continues in 2018


2016 HSE Report published

In December 2017, NHS Digital published the 2016 HSE report based on the data you all collected. It is available for download on the NHS Digital website. An interactive website showing some of the key findings is available on the HSE website.


The report contains some interesting demographics on obesity and the use of weight management tools, consumption of prescribed medicines, and the impact of deprivation on a number of health and wellbeing related factors.

BBC News provides a nice overview of some of the highlights of the report in their article “Is England a healthy nation?” (BBC Online)


Key findings

Obesity levels remain high but stable in 2016

Over a quarter of men (26%) and women (27%), and 16% of children were obese according to the height and weight measurements you collected. Almost half of our participants (47%) were trying to lose weight. More than a third of adults (39%) reported using at least one weight management aid to help them lose weight. The most popular aids were going to the gym or doing exercise (29%), websites or mobile phone apps (8%), activity trackers/fitness monitors (6%), and dieting clubs (4%). Only a small percentage used NHS services (1%).

Prescribed medicine use is high particularly in those aged 75 and over:

In 2015/2016, nearly half the adult population in England (48%) had taken at least one prescribed medicine in the previous week and 24% had taken three or more. This was largely driven by adults aged 75+. In this group over 90% had taken at least one prescribed medicine and 56% of those aged 85 and over had taken 5 or more prescribed medicines.

Links between health and deprivation:

The report points to links between deprivation and well-being, smoking levels, physical activity, prescribed medicine use and obesity. For instance, women and children in more deprived areas were more likely to be obese than those living in less deprived areas. Well-being scores and physical activity were lower and prescribed medicine use was higher in more deprived areas.  


Something to remember

IT Support has passed on a number of issues raised by interviewers to our survey programmer Sandra recently. For example, when working on a September and October point, an interview was carried out using an October serial number when it should have been a September serial number.

Fixing errors like this is quite a lengthy process and it can have a knock-on effect on the subsequent nurse visit. So please make sure before you start the interview that you are in the right month and are using the right serial number for the household.


Response rates in 2017

We are absolutely delighted to announce that in 2017 we achieved our overall target response rate of 60%. This equates to just over 5,000 households and nearly 8,000 adults and 2,000 children. In a climate where response rates in general are falling, this is a fantastic achievement and we would like to thank you all for your hard work and dedication.

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The good news continues: in 2017, a total of 4,945 adults and 1,141 children had a nurse visit with 98% agreeing to have their blood pressures measured, 95% agreeing to have saliva samples taken and 81% agreeing to a blood sample being taken. A big thank you also to our fantastic team of nurses.

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Response rates by region:



Your feedback

As part of briefings, we like to get your feedback to find out what you think works and what we could improve on. Thank you for your constructive feedback and comments. Below are some of your questions and our responses.

"Can we have a ‘Sorry I missed you’ card or letter for HSE?"

In 2018 interviewers can use a ‘Follow Up’ letter or a multi-purpose postcard which is left blank so you can write a message to the participants. Similarly, we have a re-contact letter and calling card for nurses which are included in your starter pack. All documents can be requested from the Equipment team ( or leave a message on the Equipment answer phone: 01277 690006). 

"Can we have the data linkage and gambling videos on our devices?"

We are looking into whether these videos can be installed on your laptops for HSE 2019. In the meantime, you can access the data linkage video via the NatCen YouTube channel:

Why don’t we provide cotinine results? Couldn’t we at least do this for adults?

The cotinine sample in itself is a snapshot test because cotinine is transient. A non-smoker could inhale smoke while walking down the street behind someone who is smoking. If we took a saliva sample within 24-48hrs (when cotinine may still be in their system), we may get a positive result. If we took a sample on a different day, it may be clear.

While the lab can distinguish between active and passive smoking from the level of cotinine, there is also a question about what constitutes risky levels of cotinine (which is why measuring cotinine as part of HSE 2018 is so important). Unless there is regular exposure to nicotine through (passive) smoking, a positive result says very little about long-term risk for individual health.

Sending out a positive cotinine result may therefore be ethically questionable, as it does not in itself provide conclusive information about personal health and may cause more concern than not knowing would. It is fine for researchers to use the data to assess cotinine levels at a population level, but we have been advised not to provide individual feedback.

Can we have two sets of show cards in our starter packs?

Everyone should already have two sets of respondent show cards in their starter packs. We will make sure this is made clearer in future briefings.

Can we have links to journal and other articles in which HSE data is used?

We have included a section titled ‘HSE in the media’ in this newsletter, where we give you a round-up of news articles and academic research articles that use or make reference to HSE data. In this section we also provide links to the articles where available so you can read the full story.

There are other issues you raised that we could not change at this stage, such as the sending out of advance letters which some of our interviewers would like to do themselves. We have not forgotten about these points, and we have passed them on to the relevant teams for consideration.


HSE in the media

In December 2017, the HSE 2016 report was published. 566 news items, which reached 30 million people, made reference to HSE:

The Drum – Underage drinking records down by 67% since 2003 in UK, reports NHS Digital

Men’s Health – 5 surprising benefits of exercise

Nursing Times – Call for nurses to help keep older people active and healthy

WiredGov – Household survey shows more men than women meet physical activity guidelines

Yahoo – Pill nation: half of us take at least one prescription drug

Health Business – More men than women get physical activity guidelines

Diabetes Times – Survey uncovers major health findings in England

The Telegraph – Half of us take at least one prescription drug daily

BBC Online – Is England a healthy nation?

The Guardian – Social care postcode gap widens for older people

i News - We are an obese, sedentary, pill-popping nation, NHS figures reveal

The Sun – Women get happier by the age of 85 ‘once their partners are dead’.

The Mirror – A quarter of young women are suffering with their mental health and experts blame social media

Daily MailWomen are more miserable that men until their mid-80s when they are widowed and begin enjoying retirement

Daily Mail – A nation of pill poppers: HALF of all adults in England are on prescription drugs for depression and heart disease, damning report reveals

Pharmaceutical Journal - NHS Survey reports almost half of adults in England on prescription medicines

Huffington Post - Nation failing its health MoT – high levels of drinking, obesity and unhappiness (in women)


HSE in research

Here's a selection of research articles that have used HSE data in their analyses:

High psychological distress (depression, anxiety) is associated with increased rates of death from selected cancers.

HSE data used: GHQ-12 (interview), self-reported cancer (interview), height, weight, smoking, drinking, physical activity, socio-economic and demographic data

Batty, G. D., Russ, T. C., MacBeath, M., Stamatakis, E., & Kivimäki, M. (2017). Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies. BMJ 2017;356:j108

Alcohol consumption and the prevalence of heavy episodic drinking were higher among HSE participants who required more extended efforts to contact.

HSE data used: number of contact attempts, demographics, socio-economic status, question on drinking

Boniface S, Scholes S, Shelton N, Connor J (2017) Assessment of Non-Response Bias in Estimates of Alcohol Consumption: Applying the Continuum of Resistance Model in a General Population Survey in England. PLoS ONE 12(1): e0170892.

Social inequalities in the prevalence of diagnosed and undiagnosed diabetes (by demographics and socio-economic status).

HSE data used: questions on diabetes (interview), prescribed medications (nurse), EDTA blood sample - glycated haemoglobin (nurse)

Moody A, Cowley G, Ng Fat L, et al. (2016). Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series. BMJ Open 2016;6:e010155. doi: 10.1136/bmjopen-2015-010155

79% decline in children’s exposure to second-hand smoke between 1998 and 2012

HSE data used: questions on children’s and parents’ smoking (interview), smoking in the house (interview), saliva sample – cotinine (nurse)

Jarvis, M.J. and Feyerabend, C. (2015). Recent trends in children's exposure to second-hand smoke in England: cotinine evidence from the Health Survey for England. Addiction, 110: 1484–1492. doi: 10.1111/add.12962

Individuals in the United States have higher rates of most chronic diseases and markers of disease than their same-age counterparts in England across all age groups

HSE data used: a range of health indicators from interview and nurse

Martinson ML, Teitler JO, Reichman NE. (2011). Health Across the Life Span in the United States and England. American Journal of Epidemiology. ;173(8):858-865. doi:10.1093/aje/kwq325


Top tips for top interviewers

We have asked Kerry Hobson, one of our experienced interviewers, for her top tips to secure an interview. We have summarised Kerry’s tips and tricks below. Her keywords are: SMILE - POSITIVE- CONFIDENT - ENTHUSIASTIC - PASSIONATE- ENGAGING - PROFESSIONAL.

Be positive and smile

It seems obvious but a positive mind set and a smile go a long way. Assume that you are going to get the interview and show the participant that you will go the extra mile to give them a chance to participate.

Emotions are contagious. Good and bad. Making the initial encounter a positive experience through a smile or a compliment (maybe they have a lovely garden or car), may be met with a positive response from the participant. Often people decide to take part because they like the interviewer and they want to help them. Your positivity, enthusiasm and passion can be key to winning over a participant.

And there is a lot to be passionate about…

Be proud of the study

This is an internationally recognised Gold Standard study! We have been collecting data on the health of the population for 25 years. And all this data feeds straight back into policy and planning: think 5-a-day – HSE is the government’s only source of data to monitor fruit and veg consumption and obesity levels in the population. It feeds back into healthcare too: when HSE found high levels of undiagnosed high blood pressure in the population, doctors responded by carrying out more regular blood pressure checks.

Your work is therefore really important. So are the answers of our participants. So much so that you are out at any time and day of the week working hard to give them an opportunity to contribute to this important research.

Be professional and prepared

A high level of professionalism helps to underline the seriousness and high quality of HSE.

In addition to giving your credentials (name and company name), Kerry suggests reminding participants of the advance letter and the incentive. This is also a chance to check the address to ensure you are contacting an eligible household. Most importantly though, be prepared. When the door opens, you often have to think on your feet to secure an interview. Not all participants are won over by science and you often need to judge quite quickly what this particular participant will respond to.

Before going out, it may be useful to spend some time going over different scenarios to make sure you are ready to explain the research fully and confidently in the right words, have the right leaflets at hand, and maybe even the right opening line (Kerry has a whole repertoire of one-liners for different scenarios). Finding the right opening or a common ground such as the NHS (most people use the NHS, most have an opinion and most want to feed back) can turn a soft refusal into an appointment or even a walk in.

Guarded participants may feel reassured to know that they can pass if there are questions they do not want to answer and that HSE is not a test: there are no right or wrong answers just their experience.

Interviewers can also play a huge part in setting up the nurse visit. Kerry suggests that introducing the nurse by name and mentioning how lovely s/he is, that the nurse visit is much shorter and that, without the nurse visit, it is like hearing only half the story may all help to encourage participants to agree to a nurse visit.

Be persistent

In the context of securing an interview or nurse appointment, a ‘no’ is not always a ‘no’. Don’t give up on a soft refusal.  This is important research, so it is worth going back: sometimes a refusal may turn into a ‘yes’ because you get a different person, or the participant is having a better day. You all know how rewarding it is to get an unexpected interview. Try to get a walk-in as appointments look great in a full diary but don’t always come to fruition.

In a perfect world all residents can be interviewed at the same time but more often than not, this is not the case. It always pays off to make a special effort and go back as many times as it takes to get the whole family.


Update from the research team

There have been a few changes in the HSE research team. Franziska Marcheselli, Hollie Jones and Kate Earl have moved on to other teams and two new researchers, Byron Davies and Nikki Heinze, have joined the HSE team. They look forward to meeting you in the future.


The incentive experiment continues in 2018

In February 2017 we introduced the incentive experiment to see whether increasing the value of an unconditional incentive sent to participants increases response rates. Half of the points we issued received the usual £10 incentive voucher in their advance letter and the other half received the increased £15 incentive.


Interestingly, the preliminary results for 2017 are so far inconclusive. The response rate for the £15 incentive (59.6%) was fractionally higher than for the £10 incentive (59.3%). The current difference is certainly not sufficient to say it is indeed improving response rate.

In order to obtain enough data to show conclusively whether the £15 incentive is making a difference to response rates, NHS Digital have decided to continue the incentive experiment programme into 2018. Your point will again be entirely made up of only one of the voucher amounts (£10 or £15). The incentive value will also be denoted on the ARF. We will keep you updated on the results of the extended experiment.