The Accessibility/Remoteness Index of Australia Plus (ARIA plus) is a remoteness index value (or score) based on road distance to major service centres (GISCA). In 2001, the Australian Bureau of Statistics (ABS) applied ARIA  cut-off scores to define the Australian Statistical Geography Standard (ASGS) Remoteness Areas (ABS). 

The service centre categories are based on population size, with the smallest centres in ARIA having populations of 1,000-4,999. Localities with populations greater than 1000 persons are considered to contain at least some basic level of services (e.g. health, education, or retail) (GISCA). Service centres with larger populations are assumed to contain a greater level of service provision. ARIA scores are based over 20,000 such localities throughout Australia.

 In the report, remoteness areas are classified as Major cities; Inner regional or Outer regional areas (these two are referred to as regional when taken together); Remote and Very remote areas (remote when the last two are taken together). The term rural and remote is used when referring generally to areas outside Major Cities.

Amalgamating ARIA categories to reduce variability associated with small numbers

In this report, increasing the size of areas considered is used for estimates in analysis by remoteness from service centres. Very remote areas are often amalgamated with Remote areas and occasionally Very remote, Remote and Outer regional areas are amalgamated. Notes under the graphs confirm the extent of amalgamation. Extending the period of time in which cases are counted is also used in some indicators presenting health data by ARIA.

Analysis of NSW Population Health Survey data by remoteness from service centres in this report

Postal areas are grouped according to the Australian Statistical Geographical Standard (ASGS) remoteness categories on the basis of Accessibility/Remoteness Index for Australia (ARIA+  version) score. For reporting purposes, outer regional, remote and very remote areas are aggregated in order to report reliable estimates of a range of health behaviours for non-metropolitan areas.

References

Australian Bureau of Statistics (ABS). 1270.0.55.005 - Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July%202011?OpenDocument

National Centre for Social Applications of Geographic Information Systems (GISCA). About ARIA (Accessibility/Remoteness Index of Australia). Available at http://gisca.adelaide.edu.au/projects/category/about_aria.html

Definitions of risky alcohol drinking

In 2009, the NHMRC published new guidelines to reduce the health risks from drinking alcohol. These guidelines focus on the effects of alcohol during, and immediately after drinking, and introduce the concept of lifetime risk of alcohol related disease or injury. Guideline 1 states that the lifetime risk of harm from alcohol-related disease or injury is reduced by drinking no more than two standard drinks on any day when drinking alcohol and drinking less frequently. To reduce the immediate risk of injury on a single occasion of drinking the guidelines state that healthy men and women should drink no more than four standard drinks on a single occasion (Guideline 2). Not drinking alcohol is the safest option for children and young people under 18 years of age (Guideline 3), and for women who are pregnant or planning a pregnancy, or who are breastfeeding (Guideline 4) (National Health and Medical Research Council 2009).

In HealthStats NSW, the measure of lifetime risk of harm is defined as more than 2 standard drinks on a day when usually drinking, and is referred to as "long-term risk of harm" from alcohol consumption. As this definition is based on usual alcohol consumption, therefore representing an overall pattern of drinking, it reflects alcohol use related to health risk over the long-term.

References

National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC, 2009. Available at http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/ds10-alcohol.pdf

In February 2009, the 2001 Australian Alcohol Guidelines were replaced with the Australian Guidelines to Reduce Health Risks from Drinking Alcohol, which are based on modelling of the lifetime risk of harm from drinking.

To assist monitoring lifetime risk of harm, as defined by Guideline 1 of the 2009 Guidelines, this indicator provides information on the proportion of adults who consume more than 2 standard drinks on a day when they consume alcohol, which is referred to as "long-term risk of harm" from alcohol consumption. In HealthStats NSW, the measure of lifetime risk of harm is defined as more than 2 standard drinks on a day when usually drinking, and is referred to as "long-term risk of harm" from alcohol consumption. As this definition is based on usual alcohol consumption, therefore representing an overall pattern of drinking, it reflects alcohol use related to health risk over the long-term.

The questions used to define the indicator were: How often do you usually drink alcohol? On a day when you drink alcohol, how many standard drinks do you usually have? A standard drink is equal to 1 middy of full-strength beer, 1 schooner of light beer, 1 small glass of wine, or 1 pub-sized nip of spirits.

The NSW Ministry of Health has conducted the Adult Population Health Survey (since 1997) and the Child Population Health Survey (since 2001) through the New South Wales Population Health Survey, an ongoing survey of the health of people in NSW using computer-assisted telephone interviewing (CATI). The main aims of the surveys are to provide detailed information on the health of adults and children in NSW and to support planning, implementation and evaluation of health services and programs in NSW.

Survey instrument

The survey instruments include question modules on health behaviours, health status, and other associated factors. The methods and all questions are approved for use by the NSW Population and Health Services Research Ethics Committee. While some questions are collected annually, other questions are collected less frequently. The instrument is translated into 5 languages: Arabic, Chinese, Greek, Italian and Vietnamese.

Survey sample

The target population for the survey is all state residents living in private households. The target sample was approximately 1,000 persons in each of the health administrative areas (total sample 8,000-16,000 depending on the number of administrative areas).

From 1997 to 2010 the random digit dialling (RDD) landline sampling frame was developed as follows. Records from the Australia on Disk electronic white pages (phone book) were geo-coded using MapInfo mapping software. The geo-coded telephone numbers were assigned to statistical local areas and area health services. The proportion of numbers for each telephone prefix was calculated by area health service. All prefixes were expanded with suffixes ranging from 0000 to 9999. The resulting list was then matched back to the electronic phone book. All numbers that matched numbers in the electronic phone book were flagged and the number was assigned to the relevant geo-coded area health service. Unlisted numbers were assigned to the area health service containing the greatest proportion of numbers with that prefix. Numbers were then filtered to eliminate continuous non-listed blocks of greater than 10 numbers. The remaining numbers were then checked against the business numbers in the electronic phone book to eliminate business numbers.

From 2011 onwards the RDD landline sampling frame was developed as follows: Australian Communications and Media Authority exchange district and charge zone prefixes were generated for each of the strata (that is Local Health Districts introduced in January 2011) using “best fit” postcode (ACMA 2011). All prefixes were expanded with suffixes ranging from 0000 to 9999. The sample was then randomly ordered within each stratum. The estimated numbers required for each stratum was then forwarded to Sampleworx, who used proprietary software to test each numbers current status (valid, invalid or unknown and business, non-business or unknown). The resulting valid non-business and valid unknown numbers were used for the survey.

From 2012 onwards mobile only phone users were included into the surveys using an overlapping dual-frame design, which incorporates three groups of respondents: landline only users, mobile only users and landline and mobile users.

The RDD mobile sampling frame was developed by Sampleworx and included using all known Australian mobile prefixes. Sampleworx used proprietary software to test each number to identify valid and invalid numbers. A random sample of valid mobile numbers was then provided for use for the survey.

The introduction of this design was prompted by the increasing numbers of mobile-only phone users in the general population. Because this design increases the representativeness of the survey sample the production of unbiased estimates over time is also improved. This improvement has been confirmed by an analysis of unweighted estimates, which indicated that a greater proportion of younger people, of males, and of people born overseas participated in the mobile sample compared with the landline sample. Further, comparison of the demographic characteristics of the survey sample for the first quarter of 2012 with the NSW population showed that the NSW Population Health Survey was more representative of the NSW population than the previous sample (Barr et al. 2012).

Due to this change in design, the 2012 NSW PHS estimates reflect both changes that have occurred in the population over time and changes due to the improved design of the survey.

When considering significant differences over time excluding the 2010 and 2011 data points ensures that all of the estimates are from sampling frames that had adequate coverage of the population, that is 85% or more.

When the Australia on Disk electronic white pages became available, reliable introductory letters were sent to the selected households (1997 to 2008). Households were contacted using random digit dialling. Depending on the frame either one person from the household was randomly selected or the mobile phone holder was selected for inclusion in the survey.

Interviews

Interviews are carried out continuously between February and December each year. An 1800 freecall contact number and website details are provided to potential respondents, so they can verify the authenticity of the survey and ask any questions regarding the survey. Trained interviewers at the Health Survey Program CATI facility carried out interviews until the end of 2014. For 2015, the NSW Population Health Survey was outsourced to McNair Ingenuity Research Pty Ltd, which is a social and market research company. All protocols related to the collection of respondent data have been implemented by McNair.

Up to 7 calls are made to establish initial contact with a household, and up to 5 calls are made in order to contact a selected respondent. Respondents reached by a landline phone number undergo a within-household selection process, where each member of the household has an equal chance of selection for interview. Respondents reached via mobile phone do not undergo this household selection process. Where a child under the age of 16 has been chosen within the household, the parent or main carer for that child completes the interview on their behalf. When an adult respondent that lives in a household with a child or children is selected for interview, at the end of their interview, they are offered to opportunity to complete a secondary interview about one of their children. In 2015, approximately 41% of all primary adult respondents living in households with at least one child under the age of 16 took up this option. If a parent completing an interview about their children is unsure of their child’s height and/or weight, the respondent is offered the opportunity to be contacted at a later date for this information. 

Data analysis

For analysis, the survey sample was weighted to adjust for differences in the probabilities of selection among respondents. Post-stratification weights were used to reduce the effect of differing non-response rates among males and females and different age groups on the survey estimates. These weights were adjusted for differences between the age and sex structure of the survey sample. Population data based on Australian Bureau of Statistics estimates and population projections based on data from the NSW Department of Planning and Infrastructure have been used to calibrate weights to the population within each health administrative area. and the Australian Bureau of Statistics latest mid-year population estimates (excluding residents of institutions) for each health administrative area.

Call and interview data were manipulated and analysed using SAPHaRI and SAS version 9.4 (SAS). The Taylor series expansion method was used to estimate sampling errors of estimators based on the stratified random sample. The 95 per cent confidence interval provides a range of values that should contain the actual value 95 per cent of the time.

Estimates were smoothed using least-squares spline transformation (CEE, Adult survey methods: web page).

Further information on the methods and weighting process is provided elsewhere (CEE, Child survey methods: web page).

References

Australian Communications and Media Authority (ACMA). Communications report 2010-11 series: Report 2 – Converging communications channels: Preferences and behaviours of Australian communications users. Commonwealth of Australia, 2011. Available at www.acma.gov.au/webwr/_assets/main/lib410148/report2-convergent_comms.pdf

Barr ML, Ritten JJ, Steel DG, Thackway SV. ‘Inclusion of mobile phone numbers into an ongoing population health survey in New South Wales, Australia: design, methods, call outcomes, costs and sample representativeness’. BioMed Central: Medical Research Methodology 2012, 12:177 (22 November 2012). Available at www.biomedcentral.com/1471-2288/12/177.

Centre for Epidemiology and Evidence. NSW Adult Population Health Survey Methods. CEE, NSW Ministry of Health. Available at http://www.health.nsw.gov.au/surveys/adult/Pages/default.aspx

Centre for Epidemiology and Evidence. NSW Child Population Health Survey Methods. CEE, NSW Ministry of Health. Available at http://www.health.nsw.gov.au/surveys/child/Pages/default.aspx

Software used

PitneyBowes Software. MapInfo (software). PBS as MapInfo Corporation: version 1997. Available at www.pbinsight.com.au

Sampleworx Pty Ltd. Available at http://www.sampleworx.com.au

SAS Institute. The SAS System for Windows version 9.3 (software). Cary, NC: SAS Institute Inc., 2011. Available at www.sas.com

United Directory Systems. Australia on Disk (software). UDS: version 2004. Available at www.uniteddirectorysystems.com