NSW Population Health Survey (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Dietary indicators have been changed for the entire time series to comply with the latest Australian Dietary Guidelines (see Methods for more detail).
For fruit, the indicator includes those who consumed 2 or more serves a day (both males and females aged 9 years and over). For children, the recommended intake of fruit is at least 1 serve each day for children aged 2-3 years and 1.5 serves each day for children aged 5-8 years.
For vegetables, the indicator includes those children aged 2-3 years who consumed at least 2.5 serves per day, children aged 4-8 years who consumed at least 4.5 serves per day, children aged 9-11 years who consumed at least 5 serves per day, males aged 12-15 years who consumed at least 5.5 serves per day and females aged 12-15 years who consumed at least 5 serves per day.
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.
LL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate.
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
Nutrition contributes significantly to healthy weight, quality of life and wellbeing, resistance to infection, and protection against chronic disease and premature death. Healthy eating promotes physical growth and cognitive development during childhood. Children are nutritionally vulnerable and their nutrient and energy requirements per kilo of bodyweight are greater than adults. There is a relationship between nutrition in childhood and adolescence and the development of diseases in adulthood.
In 2013, the National Health and Medical Research Council updated the Australian dietary recommendations, these are fully described in the Australian Dietary Guidelines: Educator Guide 2013. Data for the whole time series has been updated according to these latest guidelines.
|Recommended serve size|
|Vegetables and legumes/beans||
½ cup cooked green or brassica or cruciferous vegetables or
½ cup cooked orange vegetables or
1 cup raw green leafy vegetables or
1 small potato or equivalent of sweet potato, taro, sweet corn or cassava or
½ cup cooked dried or canned beans, chickpeas or lentils
1 piece of medium-sized fruit or
2 pieces of small fruit or
1 cup diced, cooked or canned fruit or
½ cup 100% fruit juice (only to be used occasionally as a substitute for other foods in the group) or
30g dried fruit (only to be used occasionally as a substitute for other foods in the group)
|Grain (cereal) foods||
1 slice of bread or ½ medium roll or flat bread (about 40g) or
½ cup cooked rice, pasta, noodles or
½ cup cooked porridge or polenta or 2/3 cup breakfast cereal flakes (30g) or
¼ cup muesli (30g) or
3 crispbreads or1 crumpet (60g) or 1 small English muffin or scone (35g)
½ cup cooked barley, buckwheat, semolina, cornmeal, quinoa or
¼ cup flour
65g cooked lean meats e.g. beef or lamb or pork or venison or kangaroo or
½ cup of lean mince or
2 small chops or
2 slices of roast meat (about 90–100g raw weight) or
80g cooked poultry e.g. turkey or chicken (about 100g raw weight) or
100g cooked fish fillet (about 115g raw weight) or
1 small can of fish (no added salt, not in brine) or
2 large eggs (120g) or
1 cup (150g) cooked beans, lentils, chickpeas, split peas or canned beans (preferably with no added salt) – legumes/beans can be eaten in larger amounts if used as a part of the meats group or
170g tofu or
30g nuts or seeds or nut/seed paste
1 cup milk – fresh, UHT long life, reconstituted dried or calcium enriched soy drink or
½ cup evaporated unsweetened milk or
¾ cup or 1 small carton yoghurt or
40g (2 slices or 4x3x2cm piece) hard cheese e.g. cheddar or
|Unsaturated spreads and oils||
10g monounsaturated or polyunsaturated spread
7g monounsaturated or polyunsaturated oil, for example olive, canola or sunflower oil
10g tree nuts or peanuts or nut pastes/butters
|Age||Vegetables and legumes/beans||Fruit||Grain (cereal) foods*||Lean meat**||Dairy***||Unsaturated spreads and oils****|
|Pregnant||up to 18||5||2||8||3.5||3.5||2|
|Breastfeeding||up to 18||5.5||2||9||2.5||4||2|
*mostly wholegrain and/or high fibre cereal varieties
**including poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
***including milk, yoghurt, cheese and/or alternatives, mostly reduced fat
****includes nuts or seeds
National Health and Medical Research Council (2013). Australian Dietary Guidelines. Canberra: National Health and Medical Research Council. Available at https://eatforhealth.govcms.gov.au/sites/default/files/content/n55_australian_dietary_guidelines.pdf
The questions used to define the indicator were: How many serves of fruit does child usually eat each day? How many serves of vegetables does child usually eat each day?
Latest available data for adults in NSW
• In New South Wales, 40.6% of adults aged 16 years and over (37.5% of men and 43.5% of women) consumed 2 or more serves of fruit daily and 6.3% of adults aged 16 years and over (2.3% of men and 10.2% of women) consumed at least the minimum recommended number of serves of vegetables daily, as estimated from the 2019 NSW Population Health Survey (self-reported using Computer-Assisted Telephone Interviewing or CATI). The recommended number of serves of vegetables is 5 or more each day for females aged 16 years and over and males aged over 70 years, 6 serves or more daily for males aged 19 to 50 years and 5.5 serves or more daily for all other adult males.
• Nationally, 51.4% of adults aged 18 years and over (46.6% of men and 55.8% of women) consumed 2 or more serves of fruit, and 7.5% of adults aged 18 years and over (4.1% of men and 10.9% of women) consumed the recommended intake of vegetables, as estimated from the 2017-18 National Health Survey (self-reported using Computer-Assisted Personal Interviewing or CAPI).
Latest available data for secondary school students in NSW
• 76.5% of students aged 12-17 years (73.5% of boys and 79.6% of girls) consumed the recommended daily fruit intake and 9.1% of students aged 12-17 years (9.1% of boys and 9.1% of girls) consumed the recommended daily vegetable intake, as estimated from the 2017 NSW School Students Health Behaviours Survey (self-completed questionnaire).
Latest available data for children in NSW
• 62.7% of children aged 2-15 years (61.4% of boys and 64.1% of girls) consumed the recommended daily fruit intake, and 5.5% of children aged 2-15 years (5.2% of boys and 5.9% of girls) consumed the recommended daily intake of vegetables, as estimated from the 2018-2019 NSW Population Health Survey (parent-reported using CATI).
Latest available data for adult Aboriginal persons in NSW
• 33.2% of Aboriginal adults aged 16 years and over consumed 2 or more serves of fruit daily and 2.9% of Aboriginal adults aged 16 years and over consumed the recommended number of serves of vegetables daily, as estimated from the 2019 NSW Population Health Survey (self-reported using Computer-Assisted Telephone Interviewing or CATI).
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 versus self-completed questionnaires versus face-to-face personal interview) have all been increasing over time for recommended fruit intake and recommended vegetable intake in children. In secondary school students and adults, recommended vegetable 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/surveys/adult/Pages/default.aspx
Australian Bureau of Statistics. National Health Survey: First Results (4364.0); NSW Tables, 2017-18. Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012017-18?OpenDocument
Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW School Students Health Behaviours Survey. Available at: http://www.health.nsw.gov.au/epidemiology/Pages/nsw-school-students-health-behaviours-survey.aspx
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
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, most population groups eat less than the recommended amounts of these foods.
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 at least 2 serves of fruit per day, and at least 5.5 serves of vegetables a day for males aged 16-18 years; at least 6 serves a day for males aged 19-50 years; at least 5.5 serves per day for males aged 51-70 years; and at least 5 serves per day for males aged over 70, and all females aged 16 years and over.
For children aged 2-3 years, the dietary guidelines recommend daily consumption of at least 1 serving of fruit and 2.5 servings of vegetables; children 4-8 years should eat 1.5 servings of fruit and 4.5 servings of vegetables; children 9-11 years, and adolescent girls (12-18 years) should consume 2 servings of fruit and 5 servings of vegetables; adolescent boys should consume 2 servings of fruit and 5.5 servings of vegetables.
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 1 medium piece or 2 small pieces of fruit.
Inadequate fruit and vegetable consumption were estimated to be responsible for 1.4% and 1.2% of the total burden of disease respectively in Australia in 2015. Low fruit and vegetable intake is associated with coronary heart disease, some cancers, and stroke.
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: