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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 question used was: Which of the following best describes your smoking status: smoke daily, smoke occasionally, do not smoke now but I used to, I have tried it a few times but never smoked regularly, or I have never smoked?
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Related Indicators
• Smoking causes more than 5,200 deaths and just over 44,000 hospitalisations in NSW per year.
• In 2010, just under 16% of adults in NSW smoked (daily or occasionally), 18% of males and 13.5% of females.
• Rates of current (daily or occasional) smoking were highest amongst those aged 25-34 years. The oldest age group reported the lowest rates.
Smoking as a health risk factor
Tobacco smoking is the leading preventable cause of illness and premature death, particularly from cardiovascular disease; cancers of the lung, larynx, and mouth; and chronic obstructive pulmonary disease. It is a major risk factor for coronary heart disease, stroke, peripheral vascular disease, cancer and a variety of other diseases and conditions . Smoking also contributes to the risk of sudden infant death syndrome (SIDS) and low birthweight (U.S. Department of Health and Human Services 2004). Tobacco smoking contributes more drug-related hospitalisations and deaths than alcohol and illicit drug use combined (AIHW Cat. no. AUS 122 2010) and is estimated to kill approximately half (Peto et al. 2004) to two-thirds (Doll et al. 2004 ) of all its long-term users.
The currently reviewed evidence on the mechanisms by which smoking causes disease indicates that there is no risk-free level of exposure to tobacco smoke, which causes adverse health outcomes, particularly cancer and cardiovascular and pulmonary diseases, through mechanisms that include DNA damage, inflammation, and oxidative stress (U.S. Department of Health and Human Services 2010).
Exposure to environmental tobacco smoke (ETS), particularly indoors, carries well documented health risks.
Burden of disease due to smoking and prevalence in Australia
Tobacco smoking was responsible for 7.8% of the total burden of disease in Australia in 2003 (Begg et al. 2007). In 2004-05, the total social costs of tobacco use in Australia were estimated to be $31.5 billion with tangible costs of $12.0 billion (Collins DJ et al. 2008).
In 2007, around 2.9 million Australians aged 14 years and over smoked daily. Males were more likely to be daily smokers (18.0%) than females (15.2%) (AHIW Cat No. PHE 98 2008).
References
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
Australian Institute of Health and Welfare. 2007 National Drug Strategy Household Survey: first results. Drug Statistics Series No 20. Cat No. PHE 98. Canberra: AHIW, 2008. Available at http://www.aihw.gov.au/publications/phe/ndshs07-fr/ndshs07-fr-no-questionnaire.pdf
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
Collins DJ, Lapsley HM. The cost of tobacco, alcohol and illicit drug abuse to Australian society in 2004-05. National Drug Strategy Monograph Series no. 64. Canberra: Department of Health and Ageing, 2008. Available at http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono64
Doll R, Peto R, Boreham J and Sutherland I. "Mortality in relation to their smoking: 50 years' observations on male British doctors ". British Medical Journal 2004. Vol328 1519-28.
Peto R, Lopez AD, Boreham J, Thun M, Heath JC. Mortality from smoking in developed countries 1950-2000. Oxford: Oxford University Press, 2004. Available at http://rum.ctsu.ox.ac.uk/~tobacco
U.S. Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Atlanta, GA: 2010. Available at http://www.surgeongeneral.gov/library/tobaccosmoke/index.html
U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centres for Diseases Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2004/index.htm
Plain packaging
Australia has one of the most comprehensive tobacco control policies and programs in the world and a new National Tobacco Strategy is expected to be developed in 2011. The National Preventative Health Strategy recommends a range of actions aimed at reducing chronic disease burden associated with three lifestyle risk factors: obesity, tobacco and excessive alcohol consumption. The Strategy recommends ending all remaining forms of advertising and promotion of tobacco products, including eliminating promotion of tobacco products through the design of a package, by amending the Tobacco Advertising Prohibition Act 1992 and the Trade Practices CPIS (Tobacco) Regulations 2004 to reduce tobacco consumption and prevalence of smoking within Australian communities. Public consultation on a draft Tobacco Plain Packaging Bill 2010 is underway.
Social marketing and other measures
Other proposed national strategies focus on revenue measures that would reduce the affordability of tobacco products, legislative reforms to address current deficiencies in tobacco regulation, funding for social marketing campaigns, Indigenous tobacco control, other initiatives to reduce social disparities in smoking such as subsidising nicotine replacement therapy for highly disadvantaged people, and health system interventions (Tobacco Working Group 2009).
Smoke-free Environment Act
The Smoke-free Environments Act 2000 protects the community from second-hand smoke by prohibiting smoking in all enclosed public places in NSW (with the exception of the private gaming areas in Star City Casino).
Public Health (Tobacco) Act
The Public Health (Tobacco) Act 2008 strengthen restricts the sale, advertising and display of tobacco products, non-tobacco smoking products and smoking accessories in NSW. Key provisions of the Act include the introduction of a tobacco retailer notification scheme, restricting tobacco sales to a single point of sale in any retail outlet, a ban on smoking in cars with children present, the removal of tobacco products removed from shopper loyalty programs and the introduction of a total display ban for retailers (with the exception of approved specialist tobacconists).
Targeting young people
Recent amendments to the Public Health Act 1991 further strengthen measures already in place to prevent young people from taking up smoking. These include banning the sale of sweet, fruit or confectionery flavoured tobacco products that may encourage young people to smoke, and banning the sale of tobacco products from mobile or temporary premises at events targeted at young people, such as music festivals. The NSW Government introduced a number of reforms to further reduce children and young people's exposure and access to tobacco in amendments to the Public Health (Tobacco) Act 2008.
Support for smoking cessation
Smoking cessation, or quitting, has immediate and important health benefits for individuals of all ages. Ex-smokers have improved life expectancy and reduced risk of smoking-related disease, compared to continuing smokers (Fiore et al. 2000). Dependence on tobacco-delivered nicotine can be characterised as a chronic relapsing disorder. Without assistance, around 95% of quitters will fail on any single attempt and most people make several attempts before they are successful. At least 70% of Australian smokers are believed to be dependent on tobacco-delivered nicotine (Ministerial Council on Drug Strategy 2005).
The Quitline
The correct use of nicotine replacement therapies, such as gum, lozenge, patch, sublingual tablet or inhaler, doubles the chance of successfully quitting smoking (Stead et al. 2008). The Quitline (13 7848) provides expert smoking cessation advice and quitting smokers can enrol in the free callback service, where an advisor will provide ongoing support throughout the quit attempt. The Quitline is accessible for the cost of a local call throughout NSW. A fax referral system is in place for all health services in NSW to refer clients who want to quit smoking to the NSW Quitline.
NSW Health has published a guide to brief intervention for health professionals, titled 'Let's take a moment'. The document outlines clear and practical advice in the provision of smoking cessation interventions for health professionals, based on evidence for best practice (NSW Department of Health Let's take a moment 2005).
References
Fiore MC, Baily WC, Cohen SJ, Dorfman SF, Goldstein MG. Treating tobacco use and dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, U.S. Surgeon General, 2000. Available at http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf
Ministerial Council on Drug Strategy. National Tobacco Strategy 2004-2009. Canberra: Department of Health and Ageing, 2005. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-pub-tobacco-tobccstrat2-cnt.htm
NSW Department of Health . Let's take a moment. Quit smoking brief intervention - a guide for all health professionals. Sydney: NSW Department of Health, 2005. Available at http://www.health.nsw.gov.au/pubs/2005/lets_take_a_moment.pdf
Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Second edition. Cochrane Database of Systematic Reviews, 2008. Available at http://www.ncbi.nlm.nih.gov/pubmed/18253970
Tobacco Working Group. Australia: the healthiest country by 2020. Technical Report No 2. Tobacco control in Australia: making smoking history. Including addendum for October 2008 to June 2009. Canberra: National Preventative Health Taskforce, Commonwealth of Australia, 2009.
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