NSW Population Health Survey (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Parent-reported data collected through Computer Assisted Telephone Interviewing (CATI). Estimates weighted to adjust for differences in the probability of selection among respondents and benchmarked to the estimated residential population using the latest available Australian Bureau of Statistics mid-year population estimates. Estimates are based on aggregated data for the defined time periods.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.
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).
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 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
Adequate physical activity: the indicator includes children who ahcieve adequate physical activity. It is defined as 1 hour or more of vigorous or moderate physical activity outside of school hours each day.
Sedentary behaviour: the indicator includes children who spent more than 2 hours per day on sedentary leisure activities.
The questions used to define adequate physical activity were: On about how many days during the school week does child usually do physical activity outside of school hours? On those days, about how many hours does child usually do physical activity? On about how many weekend days does child usually do physical activity? On a typical weekend day, about how many hours does child usually do physical activity?
The questions used to define sedentary behaviour were: On about how many days, during the school week and on a typical week day, does child usually watch TV, videos or DVDs at home? On those days, about how many hours does child usually spend watching TV, videos or DVDs?
On about how many weekend days does child usually watch TV, videos or DVDs at home? On those days, about how many hours does child usually spend watching TV, videos or DVDs?
On about how many days, during the school week does child usually play video or computer games or work on the computer? On those days, about how many hours does child usually spend playing video or computer games or work on the computer?
On about how many weekend days does child usually play video or computer games or work on the computer? On those days, about how many hours does child usually spend playing video or computer games or work on the computer?
Department of Health. Australia's Physical Activity and Sedentary Behaviour Guidelines: Children 5-12 years. Australian Government, 2014.
Department of Health. Australia's Physical Activity and Sedentary Behaviour Guidelines: Young people 13-17 years. Australian Government, 2014.
- 39.8% of adults aged 16 years and over (36.0% of men and 43.4% 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 2018 NSW Population Health Survey (self-reported using Computer-Assisted Telephone Interviewing or CATI).
- 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).
- 24.2% of children aged 5-15 years (29.6% of boys and 18.4% of girls) achieved adequate levels of physical activity, as estimated from the 2017-2018 NSW Population Health Survey (parent-reported using CATI).
Australian Bureau of Statistics, National Health Survey: First Results (4364.0.55.001); NSW Tables, 2014-15. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?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, 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: