NSW School Students Health Behaviours Survey (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Self-completed data were collected through pen and paper questionnaires administered within secondary schools. Estimates were weighted to adjust for differences in the probability of selection among respondents and benchmarked to the estimated secondary school student population using the latest available Australian Bureau of Statistics estimates.
The 2017 School Students Health Behaviours Survey represents the twelfth survey of a series that commenced in 1984. It captures information on a wide range of health behaviours, including smoking, alcohol consumption, and illicit drug use in New South Wales. This section describes the methods of data collection and analysis.
The target population was all students in Years 7-12 enrolled during the period February to December 2017 in New South Wales. Schools with fewer than 100 students were not included in the survey. Language schools were also excluded from the sampling frame.
The survey used a 2-stage probability sampling procedure: schools were selected first; students within schools were selected second. Schools were stratified by the three sectors (Government, Catholic, and Independent) and randomly selected within each sector. The sampling procedure ensured the distribution of schools among the three sectors was reflected in the sample. Two samples were drawn: junior secondary (Years 7 to 10) and senior secondary (Years 11 and 12).
The target school sample was 126 secondary schools in 2008, 2011, 2014, and 2017. In 2017, to try and achieve this target, 764 schools were approached (437 in 2014) and 94 schools agreed to participate (112 in 2014), giving an overall response rate of 12.3 per cent (26% in 2014). The survey was conducted between May and December 2017.
The questionnaire and survey procedures were approved by the Human Research Ethics Committees of the Cancer Council Victoria, the NSW Population and Health Research Ethics Committee, and the NSW Department of Education and Communities. The survey was also endorsed by the Catholic Education Commission and the Association of Independent Schools of New South Wales.
Principals of selected schools were contacted by the NSW Ministry of Health's Centre for Epidemiology and Evidence to obtain permission to conduct the survey at their schools. If a school refused, they were replaced by the school nearest to them within the same sector. The aim was to survey 80 students from each participating school. For junior secondary, one class of 20 students (and 20 replacements) were randomly selected from each of Years 7-10; for senior secondary, two classes of 20 students (or 40 students and 40 replacements) were randomly selected from each of Years 11-12. A brochure and consent form was sent to the parents of each selected student and replacement. Consent forms were returned to the school and the school held the list of students who had parental consent. Written consent was sought from students with parental consent before the survey.
In 2017, McNair Ingenuity Research Pty Ltd was contracted to administer the pencil-and-paper questionnaire on the school premises. If a student from the sample list was not present at the time of the survey, a student from the replacement list for that year was surveyed. Students from different years were surveyed together. Students answered the questionnaire anonymously.
The survey instrument was a written self-completion questionnaire, which included questions on alcohol, demographics, height and weight, injury, nutrition, physical activity, psychological distress, sedentary behaviour, substance use, sun protection (including sunburn experience and solarium use), and tobacco use.
Responses were coded and the data entered onto a database by the Centre for Behavioural Research in Cancer at The Cancer Council Victoria. After data entry, the data were cleaned and prepared for data analysis. Students whose questionnaires had a large amount of missing data or whose responses were extreme were removed from the dataset before analyses started. In the analysis, responses were excluded if the respondent gave contradictory or multiple responses or did not answer the question. However, these respondents remained in the analysis for the questions that they had validly completed. Cleaning of data relating to questions about the use of alcohol, tobacco, or other substances involved checking for inconsistencies in reported use across time periods (lifetime, year, month, and week). This cleaning procedure ensured maximum use of data and operated on the principle that the student's response about personal use in the most recent time period was accurate.
School students aged 12-17 years were included in the analysis. To ensure that disproportionate sampling of any school type, age level, and gender grouping, did not bias the prevalence estimates, data were weighted to bring the achieved sample into line with the population distribution. Reported prevalence estimates are based on these weighted data. Information about the enrolment details of male and female students in each age group at Government, Catholic and Independent schools was obtained from the Australian Bureau of Statistics (ABS Cat no. 4221.0, 2017)
Data were analysed using SAS version 9.4 (SAS Institute 2012). The SURVEYMEANS procedure in SAS was used to analyse the data and calculate point estimates and 95 per cent confidence intervals for the estimates. The SURVEYMEANS procedure calculates standard errors adjusted for the survey's design. It uses the Taylor expansion method to estimate sampling errors of estimators based on the stratified random sample (SAS Institute 2009). Estimates are presented for each response or indicator and by age group, sex, Local Health District (LHD) group and year where possible. Although figures are provided in every instance in the tables, if the estimates are not reliable because of small sample sizes the estimate is not shown in the graph. Where possible, indicators have been aligned with those collected previously, so that trends can be examined. Analysis of change over time is compared across two time periods, between the base survey year and current survey year, and between the previous survey year and the current survey year. The base survey year for particular indicators may vary, as the survey instrument has changed over time.
The 95 per cent confidence interval provides a range of values that should contain the actual value 95 per cent of the time. In general, a wider confidence interval reflects less certainty in the estimate for that indicator. The width of the confidence interval relates to the differing sample size for each indicator. A wider confidence interval reflects less certainty in the estimate. 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, where appropriate (HealthStats NSW, 2015).
The Local Health District (LHD) was derived from the student's residential postcode. Although it was not possible to report on all indicators by LHD because of the survey's design, it was however possible to report by LHD groups by grouping some LHDs (i.e Central Coast and Northern Sydney; South Eastern Sydney, Sydney and Illawarra Shoalhaven; Western Sydney and Nepean Blue Mountains; Mid North Coast and Northern NSW; Murrumbidgee and Southern NSW; and Western NSW and Far West).
A total of 3,700 students in Years 7-12 were surveyed between May and December 2017. Just over half (52.7 per cent) were from Government schools, 24.4 per cent were from Catholic schools, and 22.9 per cent were from Independent schools. The final sample's sex distribution was 47.2 per cent male and 52.8 per cent female and the age distribution was 57.2 per cent aged 12 to 15 years and 42.8 per cent were aged 16-17 years. When the sample were weighted to the secondary school student population in NSW by age and sex, 51.0 per cent were male and 49.0 per cent were female, 69.8 per cent were aged 12-15 years and 30.2 per cent were aged 16-17 years. Information about the enrolment details of male and female students in each age group at Government, Catholic and Independent schools was obtained from the Australian Bureau of Statistics (ABS Cat no. 4221.0).
In 2017, the sample also consisted of 6.3 per cent Aboriginal or Torres Strait Islander students, which was similar to the NSW proportion of Aboriginal or Torres Strait Islander students in 2017 of 5.8 per cent (ABS Cat no. 4221.0). The main language spoken at home in the final sample was English (72.5 per cent), followed by English and another language (24.0 per cent), and another language only (3.4 per cent).
As this Survey was only answered by a sample of secondary students in New South Wales, it is important to note that estimates of health behaviours are subject to a margin of error.
Furthermore, self-reports of certain health behaviours are known to be subject to social desirability bias, which is a term used to describe the tendency for people to present a favourable image of themselves when responding to surveys. This may lead to the prevalence of certain positive behaviours being overstated, with undesirable or negative behaviours being understated. While an anonymous self-complete questionnaire, such as that used for this survey, provides respondents with the greatest level of privacy when responding to sensitive questions, it is possible that certain health behaviours may be under or over-estimated in this report.
Australian Bureau of Statistics. Schools, Australia 2017. Catalogue no. 4221.0. Canberra: ABS, 2017. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/4221.0
Centre for Epidemiology and Evidence. NSW School Students Health Behaviours Survey Methods. CEE, NSW Ministry of Health. Available at http://www.health.nsw.gov.au/surveys/student/Pages/default.aspx
Centre for Epidemiology and Evidence, NSW Ministry of Health. Confidence intervals method paper. Available at http://www.healthstats.nsw.gov.au/Resources/Confidence_Intervals.pdf
SAS Institute 2012. The SAS version for Windows version 9.4. Cary, NC: SAS Institute Inc., 2012.
Adequate physical activity: the indicator includes children who achieve 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.
- 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: