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Methods: Local Health Districts
Local Health Districts (LHDs) are health administrative areas constituted under Section 17 of the NSW Health Services Act, 1997 which became effective from January 2011 and were initially called Local Health Networks.
There are 15 geographically-based LHDs (8 covering the Sydney metropolitan region and 7 rural and regional NSW) and two specialist networks focussing on Children's and Paediatric Services and Forensic Mental Health. A third network operates across the public health services provided by three Sydney facilities operated by St Vincent's Health: these include St Vincent's Hospital and the Sacred Heart Hospice at Darlinghurst and St Joseph’s at Auburn.
LHDs replaced the former Area Health Services and have their own budgets, management and accountabilities. Geographically-based LHDs are overseen by Governing Boards. Please refer to the NSW Health website for a list of Local Health Districts and the membership of Boards.
Local Health Districts are:
Metropolitan NSW: Central Coast, Illawarra Shoalhaven, Nepean Blue Mountains, Northern Sydney, South Eastern Sydney, South Western Sydney, Sydney, Western Sydney.
Rural & regional NSW: Far West, Hunter New England, Mid North Coast, Murrumbidgee, Northern NSW, Southern NSW, Western NSW
Smoothing of estimates for rare conditions analysed by Local Health District in this report
The term ‘small area’ refers to a small geographical area and a small population. Data from a small area are characterised by considerable variability. Smoothing is a general term for statistical methods used to reduce the random variability of data. Examples include rounding, moving averages, extending the period of time in which cases are counted or increasing the size of the areas. In addition, Bayesian statistical smoothing can be used to adjust raw estimates in small areas by taking into account information from adjacent areas (local or spatial variability) and from the whole state (global or non-spatial variability).
In this report, extending the period of time, in which cases in the Local Health Districts are counted, was the most frequently used smoothing technique. Results for some Local Health Districts were completely suppressed in few indicators due to very low numbers and privacy concerns. Refer to Notes under the graphs or Methods tabs for confirmation of suppression and the smoothing technique used.
NSW Health. Home page. Last updated 1 July 2011. Available at http://www.health.nsw.gov.au/services/pages/default.aspx
Methods for indicator: Recommended fruit and vegetable consumption
The New South Wales Population Health Survey includes a dietary questionnaire on usual consumption of fruit, vegetables, breads, cereals, red meat, and usual consumption of foods high in fat, salt, and sugar. The Dietary Guidelines for Australian Adults stress the importance of eating plenty of fruit and vegetables. The Go for 2 & 5 fruit and vegetable campaign website provides information on why adults should eat at least 2 serves of fruit and 5 serves of vegetables each day to maintain good health and healthy weight.
For fruit, the indicator includes those who consumed 2 or more serves of fruit a day. The recommended fruit intake is at least 2 serves a day for persons aged 19 years and over, depending on their overall diet. For simplification, this recommendation is applied to 16-18 year olds. One serve is equivalent to 1 medium piece or 2 small pieces of fruit. The question used to define the indicator was: How many serves of fruit do you usually eat each day?
For vegetables, the indicator includes those who consumed 5 or more serves of vegetables a day. The recommended vegetable intake is at least 5 serves a day for persons aged 16 years and over, depending on their overall diet. One serve is equivalent to 1/2 cup of cooked vegetables or 1 cup of salad vegetables. The question used to define the indicator was: How many serves of vegetables do you usually eat each day?
NSW Population Health 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. 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. The 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. 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.
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 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 SAS version 9.2 (SAS). The Taylor 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 www.acma.gov.au/webwr/_assets/main/lib410148/report2-convergent_comms.pdf
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. 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. 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 www.sampleworx.com.au.html
SAS Institute. The SAS System for Windows version 9.2 (software). Cary, NC: SAS Institute Inc., 2009. Available at www.sas.com
United Directory Systems. Australia on Disk (software). UDS: version 2004. Available at www.uniteddirectorysystems.com
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Key points: Fruit and vegetable consumption
Latest available information
Latest available data for adults in NSW:
• 51.8% of adults aged 16 years and over (47.3% of men and 56.2% of women) consumed 2 or more serves of fruit daily and 9.4% of adults aged 16 years and over (7.2% of men and 11.6% of women) consumed 5 or more serves of vegetables daily, as estimated from the 2013 NSW Population Health Survey (self reported using Computer-Assisted Telephone Interviewing or CATI).
• 50.6% of adults aged 18 years and over (44.8% of men and 56.3% of women) consumed 2 or more serves of fruit and 8.2% of adults aged 18 years and over (6.8% of men and 9.6% of women) consumed 5 or more serves of vegetables, as estimated from the 2011-12 Australian Health Survey (self reported using Computer-Assisted Personal Interviewing or CAPI).
Latest available data for secondary school student in NSW:
• 45.5% of students aged 12-17 years (45.0% of boys and 46.0% of girls) consumed the recommended daily fruit intake and 25.7% of students aged 12-17 years (26.9% of boys and 24.5% of girls) consumed the recommended daily vegetable intake, as estimated from the 2011 NSW School Students Health Behaviours Survey (self completed questionnaire).
Latest available data for children in NSW:
• 73.2% of children aged 2-15 years (72.6% of boys and 73.8% of girls) consumed the recommended daily fruit intake and 43.4% of children aged 2-15 years (40.6% of boys and 46.4% of girls) consumed the recommended daily intake of 5 or more serves of vegetables, as estimated from the 2012 NSW Population Health Survey (parent-reported using CATI).
Latest available data for adult Aboriginal persons in NSW:
• 40.6% of Aboriginal adults aged 16 years and over consumed 2 or more serves of fruit daily and 7.8% of Aboriginal adults aged 16 years and over consumed 5 or more serves of vegetables daily, as estimated from the 2013 NSW Population Health Survey (self reported using Computer-Assisted Telephone Interviewing or CATI).
Overall trends in NSW
Self reported data on fruit and vegetable consumption have been collected for adults in NSW since 1997 through the NSW Population Health Survey, since 1977-78 through the National Health Survey and from 2011 through the Australian Health Survey.
Self reported data on fruit and vegetable consumption have been collected for students in NSW since 2005 through the NSW School Students Health Behaviours Survey.
Parent reported data on fruit and vegetable consumption have been collected for children in NSW since 2007 through the NSW Population Health Survey. Although serves of fruit and vegetable are collected on children through the Australian Health Survey, whether they are meeting the recommended daily intake is not routinely reported.
Prevalence estimates, although differing slightly between surveys because of different sampling frames, participation rates and modes of collection (telephone v self completed questionnaires v face to face personal interview) have all been increasing over time for recommended fruit intake and recommended vegetables intake in children. In secondary school students and adults, recommended vegetables intake has remained the same.
Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW Adult Population Health Survey. Available at http://www.health.nsw.gov.au/publichealth/surveys/index.asp
Australian Bureau of Statistics. Australian Health Survey: First Results (4364.0); NSW Tables, 2011-12. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012011-12?OpenDocument
Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW School Students Health Behaviours Survey. Available at http://www.health.nsw.gov.au/publichealth/surveys/index.asp
Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW Child Population Health Survey. Available at http://www.health.nsw.gov.au/publichealth/surveys/index.asp
Introduction: Fruit and vegetable consumption
Fruit and vegetable consumption as a health risk factor
Fruit and vegetable consumption is strongly linked to the prevention of chronic disease and to better health. Vegetables and fruit are sources of antioxidants, fibre, folate, and complex carbohydrates. The fibre and low-energy content of fruit and vegetables may benefit weight control.
Healthy eating is important at any age, but establishing healthy eating habits in childhood and adolescence is an important basis for long term health. Although an adequate intake of fruit and vegetables has a protective influence on health but most population groups eat less than the recommended amounts of these foods.
Definition of adequate consumption of fruit and vegetables
As nutritional needs differ at different stages of life, the National Health and Medical Research Council has developed dietary guidelines for babies, children, adolescents and adults in Australia. A guide for healthy eating supports these guidelines.
For adults, the dietary guidelines recommend consuming on average at least 2 helpings of fruit and 5 of vegetables each day, selected from a wide variety of types and colours and served cooked or raw, as appropriate.
For children aged 4-7 years, the dietary guidelines recommend daily consumption of at least 1 serving of fruit and 2 of vegetables; children 8-11 years should eat 1 serving of fruit and 3 of vegetables for children; and adolescents (12-18 years) should consume 3 servings of fruit and 4 of vegetables.
The guidelines do not provide recommendations for children aged 2-3 years and the NSW Health Survey applied the recommendations for 4-7 year olds in the analysis of survey results however these intake levels could be too high a target for the very young children.
The helpings or serves are defined as follows: 1 serve of vegetables is equivalent to 1/2 cup of cooked vegetables or 1 cup of salad vegetables, and 1 serve of fruit is equivalent to serve is equivalent to 1 medium piece or 2 small pieces of fruit.
Burden of disease in Australia due to low consumption of fruit and vegetables
Inadequate fruit and vegetable consumption was estimated to be responsible for 2.1% of the total burden of disease in Australia in 2003 and is associated with coronary heart disease, some cancers, Type 2 diabetes, overweight and obesity, osteoporosis, dental caries, gall bladder disease, and diverticular disease.
Interventions: Preventive health
National Partnership Agreement on Preventive Health
Initiatives for children
• NSW Health has in place a broad range of programs which support parents and carers in schools, child care and other settings, to help children get off to the best start in terms of their eating habits and activity levels.
• The Children’s Healthy Eating and Physical Activity program aims to support teachers in early childhood services and primary schools to improve their knowledge of childhood healthy eating and physical activity and to support positive changes to policy and practice with in these settings.
• The Targeted Family Healthy Eating and Physical Activity Program - In addition to population measures, NSW Health is targeting at-risk children who are already overweight. The targeted program promotes ‘healthy weight’ and active lifestyles for children from 7 to 13 years of age who are overweight or obese. The program encourages children and their parents to work together to follow a healthier lifestyle.
Initiatives for adults
• NSW Healthy Workers initiative:
• Get Healthy Information and Coaching Service - a free, confidential telephone-based coaching service which provides information on healthy eating, physical activity and weight control.
• Fast Choices initiative:
NSW Overweight and Obesity Strategy 2012-2016
The NSW Ministry of Health is leading the development of a new cross-government overweight and obesity prevention strategy which will set out the key actions, across relevant portfolios, that government will undertake in partnership with industry and communities to promote healthy weight in children, young people and their families.
For more information: Health-related behaviours