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Since 2002, the NSW Ministry of Health, in conjunction with the administration of local health services in NSW, has conducted 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 NSW Population Health Survey are to provide detailed information on the health of the people of NSW and to support the planning, implementation and evaluation of health services and programs in NSW. Prior to the introduction of the continuous survey in 2002, the Centre for Epidemiology and Research conducted adult health surveys in 1997 and 1998, an older people's health survey in 1999, and a child health survey in 2001.
Survey instrument
The survey instrument for 2010 included question modules on demographics, health behaviours, health status, and health services. Most of the survey questions have been used in previous surveys. All questions not previously used were submitted to the NSW Population and Health Services Research Ethics Committee for approval prior to use. New questions were also field tested before inclusion. The instrument was translated into 5 languages: Arabic, Chinese, Greek, Italian and Vietnamese.
Survey sample
The target population for the continuous survey is all state residents living in households with private telephones. In 2010, the target sample was approximately 1,500 people in each of the 8 area health services which existed at that time (a total sample of 12,000). The survey results were analysed and reported for the 15 geographical local health districts which came into existence in January 2011.
The sampling frame was developed as follows. Records from the Australia on Disk electronic white pages (phone book) were geo-coded using MapInfo mapping software.[1,2] 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 nonlisted 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. Finally, numbers were stratified by area health service and randomly selected by area health service. Households were contacted using random digit dialling. One person from the household was randomly selected for inclusion in the survey.
Interviews
In 2010, interviews were carried out continuously between February and December. An 1800 freecall contact number was provided to potential respondents, so they could 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. Up to 7 calls were made to establish initial contact with a household, and up to 5 calls were made in order to contact a selected respondent.
Definition of local health district, metropolitan, and rural-regional
Respondents were allocated to a local health district (LHD) by postcode. Where a respondent's postcode crossed LHD boundaries, an LHD concordance was used to randomly allocate the respondent to 1 of the LHDs crossing the postcode. The concordance was constructed using the 2010 G-NAF (Geocoded National Address File) and QuickLocate Geocoding SDK.[3] For the small number of respondents did not provide their postcode, other information on suburb, local government area, and area health service were used to allocate the respondent to an LHD. Respondents have all been allocated to 1 of the 15 geographical LHDs, or to the Albury Local Government Area.
In this report, the term metropolitan means the respondent lived in 1 of the 8 geographical LHDs designated greater metropolitan: Central Coast, Illawarra Shoalhaven, Nepean Blue Mountains, Northern Sydney, South Eastern Sydney, South Western Sydney, Sydney, and Western Sydney. The term rural-regional means the respondent lived in 1 of the 7 geographical LHDs designated rural or regional: Far West, Hunter New England, Mid North Coast, Murrumbidgee, Northern NSW, Southern NSW, and Western NSW.
Indices of remoteness and disadvantage
The Accessibility-Remoteness Index of Australia Plus (ARIA ) is the standard Australian Bureau of Statistics (ABS) endorsed measure of remoteness.[4] It is derived using the road distances from populated localities to the nearest service centres across Australia. For each locality, the accessibility to services is expressed as a continuous measure from 0 (high accessibility) to 15 (high remoteness) and grouped into 5 categories: major cities, inner regional, outer regional, remote, and very remote.
The Socio-Economic Indexes for Areas (SEIFA) describe the socioeconomic aspects of geographical areas in Australia, using a number of underlying variables such as family and household characteristics, personal educational qualifications, and occupation.[5] The SEIFA index used to provide breakdowns of the New South Wales Population Health Survey data in 2010 is the Index of Relative Socio-Economic Disadvantage. This index is calculated on attributes such as low income and educational attainment, high unemployment, and people working in unskilled occupations. The SEIFA index values are grouped into 5 quintiles, with quintile 1 being the least disadvantaged and quintile 5 being the most disadvantaged.
Both the ARIA and SEIFA indexes were assigned on respondents' postcode of residence. To enable socioeconomic copmparisons, prevalence estimates for each SEIFA quintile were calculated for most health indicators in this report.
Data analysis
For analysis, the survey sample was weighted to adjust for differences in the probabilities of selection among respondents. These differences were due to the varying number of people living in each household, the number of residential telephone connections for the household, and the varying sampling fraction in each health area.
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 and the Australian Bureau of Statistics 2010 mid-year population estimates (excluding residents of institutions) for each area health service. This enables calculation of prevalence estimates for the state population rather than for the respondents selected. Further information on the methods and weighting process is provided elsewhere.[6-7]
Call and interview data were manipulated and analysed using SAS version 9.2.[8] The Taylor expansion method was used to estimate sampling errors of estimators based on the stratified random sample.[8]
The 95 per cent confidence interval provides a range of values that should contain the actual value 95 per cent of the time. The width of the confidence interval relates to the differing sample size for each indicator. In general, a wider confidence interval reflects less certainty in the estimate for that indicator. If confidence intervals do not overlap then the observed estimates are significantly different. If confidence intervals overlap slightly the observed estimates may be significantly different but further testing needs to be done to establish that significance. For a pairwise comparison of subgroup estimates, the P value for a two-tailed test was calculated using the t-test for differences in means from independent samples and a modified form of t-test, which accounts for the dependence of the estimates, to test for differences between sub-group estimates and total estimates.[8]
The indicators in this report are presented in graphical form (in the PDF and HTML versions) and in graphical and tabular form (in the HTML version). For each indicator, where data are available, the report includes bar charts of the indicator by age group, socioeconomic status, and local health district, and a line chart of trend by sex. In most cases, trend data are presented from the base year; that is, from the first year data were collected for that indicator. In the HTML version, the table below the chart presents further information, including a link to a downloadable CSV file, which contains an estimate of the number of people in the population corresponding to the prevalence estimates for the indicator. Both the PDF and HTML versions can be obtained from the New South Wales Population Health Survey website at www.health.nsw.gov.au/publichealth/surveys/index.asp.
In this report, separate statistics for Albury are not presented because of their small sample size. Respondents in Albury have been included in the analysis for the total population of NSW. Caution needs to be taken when interpreting estimates for Far West LHD, due to the small sample size. Results for any group with less than 30 respondents are treated as less reliable and have been suppressed from this report with the label 'n/a' displayed in related graphs.
In the online HTML version of the report, the bottom of each table contains links to downloadable CSV files which contain the population estimates and trends for that indicator.
References
- Australia on Disk [software]. Sydney: Australia on Disk, 2004.
- MapInfo [software]. Troy, NY: MapInfo Corporation, 1997.
- QuickLocate 3 Geocoding SDK [software]. Greenwich, NSW: MapData Services, 2011. Further information available from www.mapds.com.au (accessed 28 April 2011).
- Australian Bureau of Statistics. ASGC Remoteness Classification: Purpose and Use. Census Paper No. 03/01. Commonwealth of Australia, 2003.
- Australian Bureau of Statistics. 1996 Census of Population and Housing: Socio-Economic Indexes for Areas, Information Paper, Catalogue no. 2039.0. Canberra: ABS, 1998.
- Barr M, Baker D, Gorringe M, and Fritsche L. NSW Population Health Survey: Description of Methods. Available online at www.health.nsw.gov.au/resources/publichealth/surveys/health_survey_method.asp (accessed 2 March 2011).
- Steel D. NSW Population Health Survey: Review of the Weighting Procedures. Available online at www.health.nsw.gov.au/pubs/2006/review_weighting.html (accessed 2 March 2011).
- SAS Institute. The SAS System for Windows version 9.2. Cary, NC: SAS Institute Inc., 2009. Further information available from www.sas.com (accessed 2 March 2011).
The indicator includes those who are overweight or obese: that is, with a Body Mass Index (BMI) of 25.0 or higher. The questions used to define the indicator were: How tall are you without shoes? How much do you weigh without clothes or shoes?
For 18 years and over, BMI is calculated as follows: BMI = weight(kg)/height(m)². Categories for this indicator include overweight (BMI from 25.0 to 29.9) and obese (BMI of 30.0 and over). For 16-17 year olds, the same categories are used but are linked to international cut off points defined by sex to pass through a BMI of 16, 17, and 18.5 for underweight, 25 for overweight, and 30 for obesity at age 18 years (Cole et al. 2000; Cole et al. 2007).
The validity of self-reported height and weight has been investigated in adult, adolescent, and young adult populations. While many studies have observed a high correlation (96 per cent agreement) between BMI calculated from self-reported and measured height and weight, there is ample evidence that self-reported height and weight is not as exact as measured height and weight but is adequate for conducting epidemiological research.
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Related Indicators
• Among adults, 54.3% (60.7% of men and 48.0% of women) were overweight or obese in NSW in 2010.
• Among secondary school students aged 12-17 years, 21.4% (26% of boys and 15% of girls) were overweight or obese in NSW in 2008.
• Among children aged 2-8 years, 30.3% were overweight or obese and among children aged 9-15 years 27.3% were overweight or obese in NSW in 2009-2010.
High body weight as a health risk factor
There are health problems associated with being either underweight or over weight. Although underweight can be a serious risk to health (leading to malnutrition and other health problems such as osteoporosis), public health focus is on excess body weight, as this is a much greater problem in the Australian population (AIHW Cat. no. AUS 122 2010)
Excess weight, especially obesity, is a risk factor for cardiovascular disease, Type 2 diabetes, some musculoskeletal conditions and some cancers. As the level of excess weight increases, so does the risk of developing these conditions. In addition, being overweight can hamper the ability to control or manage chronic disorders (AIHW Cat. no. AUS 122 2010)
Excess weight in children increases the risk of poor health, both during childhood and later in adulthood. Children who are overweight or obese are at greater risk of developing chronic conditions such as asthma and Type 2 diabetes; and may experience negative social and mental wellbeing (AIHW Cat. no. AUS 122 2010).
Body Mass Index (BMI)
Body mass is derived from a person's weight and height. The Body Mass Index (BMI) is the weight in kilograms divided by the square of the height in metres (kg/m2). A person considered overweight or obese has a BMI of at least 25 kg/m2. For more details on the BMI, see the Methods section.
Burden of disease due to overweight and obesity in the world and in Australia
Previously considered a problem in high-income countries, overweight and obesity are now also on the rise in low- and middle-income countries, especially in urban areas. The World Health Organization has estimated that by 2015 there will be 2.3 billion adults who are overweight, and more than 700 million who will be obese (World Health Organization 2006).
In Australia in 2003, high body mass was responsible for 7.5% of the total burden of disease with Type 2 diabetes and ischaemic heart disease accounting for almost three-quarters of this burden (Begg et al. 2007)
Prevalence of overweight and obesity in Australia
In the 2007–08 National Health Survey, the majority of Australian adults (61%) had a BMI (based on measured data) that indicated they were either overweight or obese. A larger proportion of males than females were overweight or obese (68% compared with 55%) (ABS Cat. no. 4364.0 2009).
Based on self reported data from the same National Health Survey, the proportion of Australians who were classified as overweight or obese has increased from 50% in 2001 to 54% in 2004-05 and 56% in 2007-08 (ABS Cat. no. 4364.0 2009).
References
Australian Bureau of Statistics. National Health Survey: Summary of Results, 2007-2008 (Reissue). Cat. no. 4364.0. Canberra: ABS, 2009. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0/
Australian Institute of Health and Welfare. Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW, 2010. Available at http://www.aihw.gov.au/publication-detail/?id=6442468376
Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007. Available at http://www.aihw.gov.au/publications/index.cfm/title/10317
World Health Organization. Obesity and overweight. Fact sheet no. 311. Geneva: WHO, 2006. Available at http://www.who.int/mediacentre/factsheets/fs311/en/index.html
National Health Priority Area
In 2008, obesity was announced as a National Health Priority Area. Since then, the National Preventative Health Taskforce has developed a strategy to tackle the burden of chronic disease caused by risk factors such as obesity, tobacco, and excessive consumption of alcohol (National Preventative Health Strategy 2009); (Obesity Working Group, National Preventative Health Taskforce 2009).
Healthy People NSW
Healthy People NSW: Improving the health of the population incorporates the priorities of the NSW State Plan and the NSW State Health Plan 2006–2010 (Population Health Division 2007). NSW Health plans to prevent obesity by increasing physical activity and encouraging healthy eating habits. Strategies include social marketing of healthy lifestyles, risk factor management programs delivered in primary health care settings, strategies to improve the food supply and promotion of physical activity through healthy urban design (Population Health Division 2007).
The NSW State Plan has set a target to stop the growth in childhood obesity by holding childhood obesity at the 2004 level of 25% by 2010, and then reduce levels to 22% by 2016 (NSW Premier's Department 2006).
NSW Government Plan for Preventing Overweight and Obesity in Children, Young People and their Families 2009-2011
The NSW Government Plan for Preventing Overweight and Obesity in Children, Young People and their Families 2009-2011 focuses on the prevention of overweight and obesity through behaviour change.
The provision of community information, promotion of healthy food, active lifestyles, sport and recreation infrastructure and prevention and early intervention are the underlying principles for the suite of 34 actions presented in the Plan. Key behaviours targeted in the Plan to address the prevalence of overweight and obesity include:
increased consumption of fruit and vegetables
increased physical activity, walking and incidental activity
the reduced consumption of energy-dense nutrient-poor (EDNP) foods
reduced consumption of sugar-sweetened beverages and
reduced sedentary and small screen behaviours
Good for Kids. Good for Life
A child obesity prevention program, Good For Kids. Good For Life (NSW Government website 2010), started in 2005 is conducted by the Hunter New England Area Health Service. With funding of $7.5 million for 2005-2010 period, it was Australia's largest obesity prevention trial, focusing on promoting physical activity and healthy eating in children and young people up to 15 years of age. The trial explores the effectiveness of a range of intervention strategies targeting children, parents and carers and general community across six settings, including schools, childcare, community health services, media and Aboriginal communities.
Live Life Well @ School
The Live Life Well @ School program (NSW Department of Education and Training & NSW Department of Health website 2010), involves government primary schools participating in a series of professional learning workshops focusing on nutrition education, fundamental movement skills and physical activity.
Go4Fun
Go4Fun is a program that provides services to children aged 7-13 who are already overweight or obese. The program is delivered over a ten week period with both caregivers and children attending. The program is being rolled out across NSW.
Munch and Move
Munch and Move (NSW Government website 2010), a program in preschools, will help prevent children from becoming overweight later in life by creating good habits while they are young. The program is being expanded to include Long Day Care and Family Day Care.
References
National Preventative Health Strategy. Australia: The Healthiest Country by 2020 – National Preventative Health Strategy – Overview. Canberra: Commonwealth of Australia, 2009. Available at http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/nphs-roadmap/$File/nphs-roadmap.pdf
NSW Department of Education and Training and NSW Department of Health. Live Life Well @ School. NSW Department of Education and Training & NSW Department of Health website. Cited on 1 October, 2010). Available at http://www.curriculumsupport.education.nsw.gov.au/live_life/index.htm
NSW Government. Good for kids. Good for life. NSW Government website. Cited on 1 October, 2010). Available at http://www.goodforkids.nsw.gov.au/Parents
NSW Government: NSW Department of Health, NSW Department of Education and Training, Sport and Recreation, a division of Communities NSW and the Heart Foundation. Munch and Move. NSW Government website. Cited on 1 October, 2010). Available at http://www.healthykids.nsw.gov.au/campaigns-programs/about-munch-move.aspx
NSW Premier's Department. A new direction for NSW. State Plan. Sydney: NSW Premier's Department, 2006. Available at http://www.nsw.gov.au/stateplan/index.aspx?id=8f782cbd-0528-4077-9f40-75af9e4cc3e5
Obesity Working Group, National Preventative Health Taskforce. Australia: the healthiest country by 2020. Technical Report No 1. Obesity in Australia: a need for urgent action. Including addendum for October 2008 to June 2009. Canberra: Commonwealth of Australia, 2009. Available at http://www.health.gov.au/internet/preventativehealth/publishing.nsf/Content/tech-obesity
Population Health Division. Healthy people NSW. Improving the health of the population. Sydney: NSW Department of Health, 2007. Available at http://www.health.nsw.gov.au/pubs/2007/pdf/healthy_people.pdf
Useful websites include:
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
HealthInsite at http://www.healthinsite.gov.au
NSW Department of Education and Training and NSW Department of Health. Live Life Well @ School. NSW Department of Education and Training & NSW Department of Health website. Cited on 1 October, 2010). Available at http://www.curriculumsupport.education.nsw.gov.au/live_life/index.htm
NSW Government. Good for kids. Good for life. NSW Government website. Cited on 1 October, 2010). Available at http://www.goodforkids.nsw.gov.au/Parents
NSW Government: NSW Department of Health, NSW Department of Education and Training, Sport and Recreation, a division of Communities NSW and the Heart Foundation. Munch and Move. NSW Government website. Cited on 1 October, 2010). Available at http://www.healthykids.nsw.gov.au/campaigns-programs/about-munch-move.aspx