NSW School Students Health Behaviours 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 males aged 12-17 years who consumed at least 5.5 serves of vegetables a day, and females aged 12-17 years who consumed at least 5 serves per day.
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 Behaviour Survey represents the twelveth survey of a series that commenced in 1984. The Survey 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 3 sectors (Government, Catholic, and Independent) and randomly selected within each sector. The sampling procedure ensured the distribution of schools among the 3 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, 1 class of 20 students (and 20 replacements) were randomly selected from each of Years 7-10; for senior secondary, 2 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 (ie 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 were 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. 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. http://www.health.nsw.gov.au/surveys/student/Pages/default.aspx
HealthStats NSW 2017, Centre for Epidemiology and Evidence, NSW Ministry of Health. http://www.healthstats.nsw.gov.au/Resources/Confidence%20intervals.pdf
SAS Institute 2012. The SAS version for Windows version 9.4. Cary, NC: SAS Institute Inc., 2012.
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 do you usually eat each day? How many serves of vegetables do you 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: