NSW Population Health Survey (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
The indicator includes those whose level of physical activity was insufficient, sufficient or who did not undertake any moderate physical activity in a typical week. The national guidelines apply different criteria for different age groups. The guidelines relating to physical activity and sedentary behaviour were updated in 2014 and the new definition has been applied to the entire time series shown.
The 2014 guideline for adults aged 18 to 64 years recommends a combination of moderate and vigorous activities on most or all days of the week, as well as strength training on at least 2 days and minimising sedentary behaviour especially prolonged sitting.
In order to capture the intent of the 2014 guideline, for adults aged 18-64 years, sufficient physical activity is defined in this report as undertaking moderate intensity physical activity for a total of at least 150 minutes per week over 5 separate occasions. Insufficient physical activity includes either those undertaking no moderate intensity physical activity or less than 150 minutes of moderate intensity physical activity per week or the moderate intensity physical activity was undertaken over fewer than 5 separate occasions per week. The Methods tab describe the questions and calculation method used for this indicator.
Current guidelines for older Australians aged 65 years and over recommend 30 minutes of moderate physical activity on most, or preferably all days. This report applies the same questions and calculation method to all those aged 16 years and over, despite some differences in the guidelines for different adult age groups.
The indicator shows self-reported data collected through Computer Assisted Telephone Interviewing (CATI). Estimates were weighted to adjust for differences in the probability of selection among respondents and were benchmarked to the estimated residential population using the latest available Australian Bureau of Statistics mid-year population estimates. Adults are defined as persons aged 16 years and over in the NSW Population Health Survey.
In order to address diminishing coverage of the population by landline telephone numbers (<85% since 2010), a mobile phone number sampling frame was introduced into the 2012 survey.
Postal Areas (POAs) were grouped according to the Australian Statistical Geographical Standard (ASGS) remoteness categories on the basis of Accessibility/Remoteness Index for Australia (ARIA version) score. Data prior to 2016 are based on the 2011 ARIA version and data for 2016 and onwards are based on the 2016 ARIA version.
Remote* includes very remote.
LL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate.
Department of Health. Choose health: Be active. A physical activity guide for older Australians. Australian Government, 2008.
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 1,000 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 HealthStats NSW, 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.
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.
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.
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
The indicator includes those whose level of physical activity was insufficient, sufficient or who did not undertake any moderate physical activity in a typical week.
The national guidelines relating to physical activity and sedentary behaviour were updated in 2014 and the new definition has been applied to the entire time series for reporting indicators in HealthStats NSW. Different criteria for physical activity are defined by national guidelines for different age groups. National reporting on physical activity is focused on 'insufficient' levels of physical activity (see reports from the Australian Institute of Health and Welfare at https://www.aihw.gov.au/reports/biomedical-risk-factors/risk-factors-to-health/contents/insufficient-physical-activity ).
The 2014 guideline for adults aged 18 to 64 years recommends a combination of moderate and vigorous activities on most or all days of the week, as well as strength training on at least two days and minimising sedentary behaviour, especially prolonged sitting. In order to capture the intent of the 2014 guideline, for adults aged 18-64 years in NSW, sufficient physical activity is defined as undertaking moderate intensity physical activity for a total of at least 150 minutes per week over five separate occasions. Insufficient physical activity includes either those undertaking no moderate intensity physical activity or undertaking less than 150 minutes of moderate intensity physical activity per week or the moderate intensity physical activity was undertaken over fewer than five separate occasions per week.
Current guidelines for older Australians aged 65 years and over recommend 30 minutes of moderate physical activity on most, or preferably all, days. This report applies the same questions and calculation method to all those aged 16 years and over, despite some differences in the guidelines for different adult age groups.
The total minutes of physical activity are calculated by adding minutes in the last week spent walking continuously for at least 10 minutes, minutes doing moderate physical activity, and minutes doing vigorous physical activity multiplied by two. This calculation corresponds with the definition and questions asked in the Active Australia Survey (AIHW 2003).
The questions used to define the indicator were: In the last week, how many times have you walked continuously for at least 10 minutes for recreation or exercise or to get to or from places? What do you estimate was the total time you spent walking in this way in the last week? In the last week, how many times did you do any vigorous physical activity that made you breathe harder or puff and pant? What do you estimate was the total time you spent doing this vigorous physical activity in the last week? In the last week, how many times did you do any other more moderate physical activity that you have not already mentioned?
Australian Institute of Health and Welfare. The Active Australia Survey: a guide and manual for implementation, analysis and reporting. Canberra: AIHW, 2003.
Department of Health. Australia's Physical Activity and Sedentary Behaviour Guidelines: Adults. Australian Government, 2014.
Department of Health. Choose health: Be active. A physical activity guide for older Australians. Australian Government, 2008.
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.
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.
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 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.
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).
A proportional hazard regression model with time equal to one unit using PROC SURVEYREG in SAS software was fitted. PROC SURVEYREG produces relative risks while taking into account the complex survey design; the strata and weights. The strata are a combination of Local Health District and year. The weights are based on the probability of selection in the survey and the age and sex structure of the population each year. For trend analysis, the weights are recalibrated to te 2001 Australlian Standard Population by five year age groups to age standardise the analysis. Age-sex standardisation was implemented across the complete survey file (both adult and child records). Separate models were fitted for each sex, and each model had year as the independant variable and the binary indicator as the dependant variable.
Estimated annual rates of change for health indicators (and associated 95% confidence intervals) were calculated from these models as relative differences. If the confidence intervals for the relative difference did not overlap a value of 1, the change was considered statistically significant.
In the reporting of trend analysis results on the topic landing page data summary tables (such as http://www.healthstats.nsw.gov.au/IndicatorGroup/ChildObesityTopic ), up and down arrows are used to show statistically significant increasing and decreasing annual rates of change. If the rate of change is not statistically significant, the trend is considered stable as illustrated by horizontal arrows. For statistically significant trends, the percentage point difference between modelled prevalence for the most recent year of data and that for 5 (short term trend) or 10 years (long term trend) prior. The short term percentage point difference is based on the model incorporating the 5 most recent years of data. The long term trend analysis is based on the model incorporating yje 10 most recent years of data. For context, the raw prevalence (and associated 95% confidence interval) estimated from the survey for the most recent year is also reported in the data summry tables.
Australian Bureau of Statistics. Standard Population for Use in Age-Standardisation Table (Cat. no. 3101.0), 2013
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 http://www.acma.gov.au/
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
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 Enterprise Guide version 7.15 (software). Cary, NC: SAS Institute Inc., 2017. Available at www.sas.com
United Directory Systems. Australia on Disk (software). UDS: version 2004. Available at www.uniteddirectorysystems.com
- In New South Wales, 38.5% of adults aged 16 years and over (35.5% of men and 41.4% of women) undertook insufficient levels of physical activity (less than 150 minutes of moderate or vigorous activity a week, or 150 minutes of activity, or more, over fewer than five sessions a week), as estimated from the 2019 NSW Population Health Survey (self-reported using Computer-Assisted Telephone Interviewing or CATI).
- Nationally, 17.8% of persons aged 18 years and over (19.8% of males and 15.8% of females) in NSW were sufficiently active in the last week (more than 300 minutes of physical activity over five sessions), as estimated from the 2017-18 National Health Survey (interviewer-administered questionnaire).
- Depending on the design, implementation, achieved response rates and target population, different surveys purporting to measure the same outcome can arrive at different conclusions. However, most surveys will generally produce broadly consistent estimates when comparing sub-groups, such as sex or age, within each survey. For measurements that are reliant on activities undertaken "in the last week", continuous surveys provide a means of capturing consistent data over the year without being subject to seasonal influences.
- 18.6% of students aged 12-17 years (21.8% of boys and 15.5% of girls) undertook adequate levels of physical activity, as estimated from the 2017 NSW School Students Health Behaviours Survey (self-completed questionnaire).
- 12% of adolescents aged 13-18 years (15% of boys and 8% of girls) met the recommended daily physical activity level of at least 60 minutes in moderate to vigorous intensity physical activity on every day of the week, as estimated from the 2015 NSW School Physical Activity and Nutrition Survey (SPANS).
- 23.0% of children aged 5-15 years (26.1% of boys and 19.6% of girls) achieved adequate levels of physical activity, as estimated from the 2018-2019 NSW Population Health Survey (parent-reported using CATI).
Australian Bureau of Statistics, National Health Survey: First Results (4364.0.55.001); NSW Tables, 2017-18. Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/F6CE5715FE4AC1B1CA257AA30014C725?opendocument
Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW Adult Population Health Survey. Available at: http://www.health.nsw.gov.au/surveys/adult/Pages/default.aspx
Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW School Students Health Behaviours Survey. Available at: http://www.health.nsw.gov.au/surveys/student/Pages/default.aspx
Hardy L. SPANS 2015 - NSW Schools Physical Activity and Nutrition Survey (SPANS) - Full Report, University of Sydney, 2016. Available at: https://www.health.nsw.gov.au/heal/Publications/spans-2015-full-report.PDF
Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW Child Population Health Survey. Available at: http://www.health.nsw.gov.au/surveys/child/Pages/default.aspx
Physical activity is defined as any bodily movement produced by skeletal muscles, that requires energy expenditure. Physical inactivity has been identified as the fourth leading risk factor for global mortality causing an estimated 3.2 million deaths globally (WHO 2012).
Physical activity is an important factor in maintaining good health at any age. People with sufficient physical activity have lower rates of preventable morbidity and mortality than those who are physically inactive. Regular moderate intensity physical activity – such as walking, cycling, or participating in sports – has significant benefits for health. For instance, it can reduce the risk of cardiovascular diseases, diabetes, colon and breast cancer, and depression. Moreover adequate levels of physical activity will decrease the risk of a hip or vertebral fracture and help control weight (WHO 2012).
There is strong evidence for the beneficial effects of moderate to vigorous physical activity on children and adolescents musculoskeletal and cardiovascular health, adiposity, blood lipid levels, social and mental health, and academic performance (Strong et al., 2005).
To maintain good health, the National physical activity guidelines for adults recommend at least 30 minutes of moderate activity on most, and preferably all, days of the week. Moderate intensity activity includes brisk walking, dancing, swimming, or cycling, which can be undertaken in shorter bursts such as 3 lots of 10 minutes (AGDHA, 1999 and 2005).
Australian recommendations for levels of physical activity in young people are at least 60 minutes of moderate to vigorous intensity physical activity every day (AGDHA, 2004).
Physical inactivity was responsible for 2.5% of the total burden of disease in Australia in 2015 (AIHW, 2019), contributing significant burden to breast cancer, coronary heart disease, diabetes, bowel cancer and stroke (Begg et al, 2007). Physical activity is a preventive factor for cardiovascular disease, cancer, mental illness, diabetes mellitus and injury.
It is increasingly difficult for children and adolescents to participate in a physically active lifestyle in Australia. An increase in sedentary recreational activities, such as watching television and videos and playing computer games, coupled with a culture of driving children to school and other activities instead of walking or cycling have all contributed to creating an environment that encourages more sedentary pursuits (Booth, 2000).
The NSW Healthy Eating and Active Living Strategy 2013-2018 provides a whole of government framework to promote and support healthy eating and active living in NSW and to reduce the impact of lifestyle-related chronic disease.
The Strategy has four key strategic directions: