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.
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. Each LHD has its own budget, 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
The term ‘small area’ refers to a sub-state geographical area with a small population. Data analysed for small areas may result in estimates that display considerable variability from year to year, particularly for rare conditions or events. Smoothing is a general term for statistical methods used to reduce the random variability of data in small populations. Examples of smoothing include rounding, moving averages, extending the period of time in which cases are counted or increasing the size of the areas. In addition, 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 HealthStats NSW, the most frequently used smoothing technique for data presented by Local Health District is the aggregation of several years of data together followed by the calculation of a rolling average across the aggregated years. For some indicators, data for particular Local Health Districts may be suppressed due to very low numbers and privacy concerns. Please refer to Notes under the graphs or Methods tabs for confirmation of suppression and the smoothing technique used.
In HealthStats NSW, the total population used for each Local Health District when calculating age-standardised rates are the Estimated Resident Populations produced by the Australian Bureau of Statistics (ABS) and projections produced by the NSW Department of Planning, Industry, and Environment. As sub-state projections based on the 2016 Census are not yet available, population projections for Local Health Districts (estimated population for 2017 and onwards) are based on Estimated Resident Populations produced by the ABS prior to the 2016 Census.
NSW Health. Local Health Districts and specialty networks. Available at https://www.health.nsw.gov.au/lhd/Pages/default.aspx
In 2009 and 2010, the NSW Ministry of Health, in conjunction with the area health services, completed the eighth and ninth years of the New South Wales Population Health Survey, an ongoing survey of the health of people of New South Wales using computer assisted telephone interviewing (CATI). The main aims of the survey are: to provide detailed information on the health of the people of New South Wales; and to support the planning, implementation, and evaluation of health services and programs in New South Wales.
Prior to the inclusion of the child component in the New South Wales Population Health Survey in 2003, the Centre for Epidemiology and Evidence conducted a child health survey in 2001. The reporting plan for the continuous survey includes a biennial report on child health for the whole state. The first report on child health from the continuous survey reported data from 2003-2004; a second report was produced for data from 2005-2006; a third report was produced for data from 2007-2008.
This section describes the methods used for the 2009-2010 Report on Child Health, which includes information on the health of residents aged 0-15 years.
The content of the survey was developed by the NSW Health Survey Program in consultation with key stakeholders, area health services, other government departments, and a range of experts. The survey included questions used in previous surveys and new questions developed specifically for 2009 and 2010. All new questions not previously used were submitted to NSW Health's Population and Health Services Research Ethics Committee for approval prior to use. New questions were also field-tested prior to inclusion in the survey. The instrument was translated into 5 languages: Arabic, Chinese, Greek, Italian and Vietnamese.
In 2009 and 2010, the target population for the child component of the New South Wales Population Health Survey was all children aged 0-15 years living in households with private telephones. For each year, the target sample comprised approximately 475 children in each of the 8 area health services which existed at that time (a total sample of 7,600 over 2 years). 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..
In 2009 and 2010, interviews were carried out continuously between February and December. An 1800 freecall contact number was provided for potential respondents to verify the authenticity of the survey and to 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 5 calls were made in order to contact a selected respondent. If the selected respondent was a child under the age of 16 years, a parent or carer was selected as a proxy respondent.
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. 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.
The Accessibility-Remoteness Index of Australia Plus (ARIA ) is the standard Australian Bureau of Statistics (ABS) endorsed measure of remoteness. 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. 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.
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. 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. 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.
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.
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://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n55_australian_dietary_guidelines_130530.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
• 40.9% of adults aged 16 years and over (38.0% of men and 43.7% of women) consumed 2 or more serves of fruit daily and 5.9% of adults aged 16 years and over (2.9% of men and 8.8% of women) consumed at least the minimum recommended number of serves of vegetables daily, as estimated from the 2018 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.
• 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
• 61.8% of children aged 2-15 years (58.9% of boys and 62.9% of girls) consumed the recommended daily fruit intake, and 5.4% of children aged 2-15 years (4.3% of boys and 5.5% of girls) consumed the recommended daily intake of vegetables, as estimated from the 2017-2018 NSW Population Health Survey (parent-reported using CATI).
Latest available data for adult Aboriginal persons in NSW
• 24.9% of Aboriginal adults aged 16 years and over consumed 2 or more serves of fruit daily and 3.8% of Aboriginal adults aged 16 years and over consumed the recommended number of serves of vegetables daily, as estimated from the 2018 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 vegetables 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 serve 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: