4363.0.55.001 - National Health Survey: Users' Guide, 2001  
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Contents >> Chapter 5 - Health Risk Factors

CONTENTS


Introduction

Smoking

Alcohol consumption

Exercise

Height and weight

Dietary habits

Sun protection

Breastfeeding

Adult immunisation

Children's immunisation

Supplementary women’s health topics:


Contraception/protection


INTRODUCTION

Note: Except where indicated, or in reference to the Indigenous data item list, respondents from the 2001 NHS(I) provided the same information as the 2001 NHS(G) although sparse NHS(I) had less content. Data in this chapter only refer to the 2001 NHS(G) sample and do not include the 2001 NHS(I) sample.

A range of social, economic and environmental factors are recognised as affecting the risk of ill-health i.e. the chance an individual has of developing a particular illness or injury. Specific lifestyle and related factors which have been identified as (positively and/or negatively) impacting health include diet and nutrition, use of medicines, overweight and obesity, physical activity, high blood cholesterol, inadequate sun protection, high blood pressure, oral hygiene, smoking, alcohol use, lack of or incomplete immunisation and use of illicit drugs.

It is clearly not possible, and in some cases inappropriate in a survey such as the 2001 NHS, to attempt to address the whole range of factors likely to affect health. The approach taken in this survey was to focus on selected lifestyle -related health risk factors identified through consultations with health professionals, administrators, policy makers, etc. as major issues of concern and considered appropriate for inclusion in an interview survey of this type.

Health risk factor topics included in the 2001 NHS(G) and non-sparse NHS(I) were:
  • smoking
  • alcohol consumption
  • exercise
  • height, weight and body mass
  • dietary habits
  • breastfeeding
  • sun protection
  • childhood and adult immunisation
  • supplementary women's health topics, and
  • contraception/protection.

Health risk factor topics included in sparse NHS(I) were:
  • smoking
  • alcohol consumption
  • height, weight and body mass
  • breastfeeding
  • adult immunisation
  • supplementary women's health topics, and
  • contraception/protection

In addition, other aspects of health risks may be indicated through information obtained in the survey about other health and related characteristics, such as the presence of particular long-term conditions. The collection of information about health risk factors and behaviours in conjunction with other health and population characteristics enables all these elements to be analysed together. However, while data from the survey may suggest apparent associations between particular risk factor(s) and certain illness condition(s), the data should not be interpreted as indicating causal relationships.

Some caution should be used in drawing together data for the different risk factors covered as the reference periods used differ e.g. smoking - at time of interview, alcohol consumption - in the last week, exercise - in the last two weeks, etc.

Most of the specific risk factors covered have been addressed in previous ABS surveys, either at the national or State or Territory level. Where appropriate to the survey vehicle and consistent with the data requirements of users, similar methodologies were employed in the 2001 NHS to those used in previous surveys (particularly the 1995 NHS) to enhance comparability and enable use of the data for time-series analysis.


SMOKING

Definition

This topic refers to smoking of tobacco, including manufactured (packet) cigarettes, roll-your-own cigarettes, cigars and pipes, but excludes chewing tobacco and smoking of non-tobacco products. The topic focused on ‘regular smoking’, where regular was defined as one or more cigarettes (or pipes or cigars) per day as reported by the respondent.

The topic primarily describes smoking status (current smokers, ex-smokers and those who had never smoked regularly) at the time of interview.


Methodology

Adult respondents were asked whether they currently smoke (and if so whether they smoke regularly), or have ever smoked regularly. In addition, respondents were asked whether anyone else in the household smoked regularly, and if so, the number of people. See Q220 to Q225 in 2001 NHS(G) Adult form.


Population

Information was collected for all persons aged 18 years and over.


Data items
  • current smoker status - occasional smoker, regular smoker, non-smoker
  • smoker status - current smoker/daily, current smoker/other, ex-smoker, never smoked regularly
  • number of regular smokers in household.


Although this is a household level characteristic, it is recorded on each person's record (including children age under 18 years).

Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


Interpretation

Points to be considered in interpreting data from this survey include:
  • some under-reporting of persons identifying as current smokers is expected to have occurred due to social pressures (particularly in cases where other household members were present at the interview). The extent to which under-reporting has occurred and hence its effects on the accuracy of survey estimates are unknown
  • concepts such as ‘regular’ are open to different interpretation by respondents and hence may not have been consistently applied in reporting information in this survey, despite a prompt to respondents that regular meant ‘at least once a day’
  • the selected adult respondent may not have known the smoker status of all other members of the household. For example, if another member only smoked when away from home, or if children kept their smoking hidden from parents. As a result, some undercounting may have occurred. Estimates of the prevalence of smoking in the population should therefore be based on person level data rather than household level data
  • The categories of smoker status, and the concepts on which they are based differ from those in the National Health Data Dictionary (NHDD) as summarised below. For this reason estimates from this survey may differ from other population survey data which use the NHDD definitions.

TABLE 5.1: Smoker status

2001 NHSNHDD

Current smokerDaily smoker
DailyWeekly smoker
OtherIrregular
Ex-smoker (self-reported; ever smoked regularly)Ex-smoker (100+ cigarettes in lifetime)
Never smoked (never smoked regularly)Never smoked (Less than 100 cigarettes in lifetime)



Comparability with 1995

Data on smoking status are considered directly comparable between the 2001 and 1995 NHSs. However, in making comparisons, care should be taken to ensure the same items ( i.e. based on current smoker or daily smoker concepts) are being compared.

In the 1995 NHS, the number of smokers in the household was derived from reported smoker status of each adult in the household. Information was collected in the 2001 NHS using a different methodology (as described above) and may include persons aged less than 18 years. As a result, this item is not considered directly comparable between the two surveys.

The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


ALCOHOL CONSUMPTION

Definition

This topic refers to consumption of alcoholic drinks, and focuses on the intake of alcohol derived from information reported by respondents about the types and quantities of alcoholic drinks they had consumed on the three most recent days on which they consumed alcohol, in the week prior to interview. Homemade wines and beers were included.

Note that the intake of alcohol refers to the quantity of alcohol contained in the drinks consumed, not the quantity of the drinks themselves.

Methodology

Adult respondents were asked how long ago they last had an alcoholic drink. Those who reported they had a drink within the previous week were asked the days in that week on which they had consumed alcohol (excluding the day on which the interview was conducted), and for each of the last 3 days on which they drank, the types and quantities of drinks they had consumed. They were further asked whether their consumption in that week was more, about the same, or less than their usual consumption.

At the beginning of the interview, respondents in the 2001 NHS(G) and non-sparse NHS(I) were told "Some people may drink more or less than others, depending on their lifestyle and individual choices" before being asked about how long ago they had a drink, whereas in sparse NHS(I) respondents were told "I am asking these questions as drinking alcohol can affect people's health".

Information was collected separately in respect of seven categories of alcoholic drinks:
  • light beer
  • mid-strength beer
  • full-strength beer
  • wine/champagne
  • spirits/liqueurs
  • fortified wine, and
  • other alcoholic drinks (including alcoholic cider and coolers).

In sparse NHS(I), light beer and mid-strength beer were combined into one category.

Interviewers were provided with a card showing the types of drinks to be included in each of these categories (see Appendix 13). If interviewers were unsure as to which of these categories a reported drink belonged, details were recorded in ‘other alcoholic drinks’ for checking/reclassifying as appropriate during office processing.

Respondents were asked to report the types of drink consumed, the number of drinks, the size of the drinks, and where possible the brand name(s) of the drink(s) consumed on each of the last 3 days on which they had consumed alcohol. In some cases interviewers were asked to record further details of drink types beyond the broad category level, to enable more precise coding of alcohol content. For example, this occurred for beer where the brand name alone may have been insufficient to enable categorisation as light, mid-strength or full-strength, and for wine where the alcohol content differs according to whether a white, red, sparkling or low alcohol wine was involved.

It was recognised that the collection of accurate data on quantity consumed is difficult, particularly in a recall situation, and bearing in mind the nature and possible circumstances of consumption. Interviewers were provided with extensive documentation and training covering the recording of amounts consumed. Where possible, information was collected in terms of standard containers or measures i.e. 10 oz glass, stubbie, nip, etc. In other cases interviewers were asked to record as much information as necessary to clearly indicate quantity.

Reported quantities of drinks were converted during office processing to millilitres of alcohol present in those drinks. For this purpose, a computer assisted coding system was developed. Coders could access the system via brand name or drink type and by entering the quantity and size of drinks, the system would calculate the quantity of alcohol consumed. This system covered common drinks (including common mixed drinks and cocktails) and common quantity measures.

Where precise brand x type information was not recorded, the coding system used default alcohol content values based on drink type. These values are shown below:

  • light beer
    0.027
  • mid-strength beer
    0.035
  • full-strength beer
    0.049
  • stout
    0.058
  • wine coolers
    0.035
  • low alcohol wines
    0.090
  • fortified wines
    0.179
  • white wine
    0.124
  • red wine
    0.133
  • sparkling wine/champagne
    0.119
  • spirits
    0.385
  • liqueurs
    0.200
  • pre-mixed spirits (e.g. UDL)
    0.050
  • alcoholic cider
    0.047
  • extra-strong cider
    0.075
  • cocktails
    Various, as per special listing by cocktail name; and
  • other alcoholic beverage
    0.274

It is recognised that particular types or brands of beverage within each of these categories may contain more or less alcohol than indicated by the conversion factor e.g. full-strength beers are usually in the range 4% to 6% alcohol by volume. The factors are considered to be sufficiently representative of each category as a whole for the purposes of indicating relative health risk as appropriate to the aims of this survey. However, it should be noted that these categories, defined by the conversion factors used, may not reflect legal definitions.


Population

Information was collected for all persons aged 18 years and over.

Data items
  • day of week of interview
  • period since last consumed alcohol
  • number of days last week on which consumed alcohol
  • days of week on which consumed alcohol

For each of the last (up to) three most recent days on which alcohol was consumed:
  • type(s) of alcoholic beverage consumed
  • quantity of alcohol consumed
  • day of week.

For the reference period:
  • number of days of week that consumed alcohol
  • estimated total quantity of alcohol consumed in reference week
  • average daily consumption on days for which data were recorded (maximum of 3 days)
  • average daily consumption on days on which consumed alcohol
  • average daily consumption over reference week
  • main type of drink consumed
  • day of week of heaviest alcohol consumption
  • amount consumed on day of heaviest consumption
  • alcohol risk level (consumed in last week at low risk, risky, high risk level), last consumed more than 1 week to less than 12 months ago, last consumed 12 months or more ago, never consumed)
  • whether consumption in reference week more, less, same as usual.

Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.

    Interpretation

    Points to be considered in interpreting data on alcohol consumption from this survey include:
    • some under-reporting of consumption, both in terms of persons identifying as having drank alcohol in the reference week, and in the quantities reported, is expected to have occurred. Investigations in relation to previous NHSs showed possible under-reporting to be as high as 50% for some types of drink. However, the under-reporting which has occurred does not invalidate the survey results as indicators of relative consumption levels (current and over time), and of the relative health risks of the consumption levels identified.
    • As noted in methodology, the leading statement for non-sparse differed to sparse NHS(I). The extent that the context set for the questions impacted on reporting is not known but may have contributed to the issue outlined above.
    • details of consumption were recorded for the 3 most recent days in the previous week on which respondents had consumed alcohol. Because fewer interviews are conducted on Fridays (10%) and Saturdays (7%) than other days of the week, and virtually none on Sundays (less than 1%) the methodology used has resulted in some under-representation of those who drank mid-week; see table below.

    TABLE 5.2: Alcohol consumption

    Day on which consumed alcohol
    % of adults who drank in reference week who drank on that day
    Of those who drank on that day % for which consumption details were recorded.

    Monday
    39.5
    71.7
    Tuesday
    39.5
    60.0
    Wednesday
    40.3
    50.9
    Thursday
    40.4
    40.9
    Friday
    55.8
    62.9
    Saturday
    65.3
    77.1
    Sunday
    52.7
    83.2


    Although consumption levels are highest at weekends, which as shown above are also the days of highest coverage in the data, the impact of the methodology used should be considered in interpreting the data. ABS analysis has indicated that while there is some impact of the 3 day methodology at the individual respondent level (for example in terms of the level of health risk), at the population level the impact is considered to be relatively minor.
    • two indicators of alcohol risk level were derived from the average daily amount of alcohol consumed:
      - average over the 1 to 3 days for which consumption details were recorded, and
      - average over the 7 days of the reference week
      i.e. Average consumption over 3 days x number of days consumed alcohol / 7.

      Published data are compiled using the 7 day average, which is also the basis for assessing risk level; see point below. Results compiled using the 3 day average are available on request.
    • according to average daily intake over the 7 days of the reference week, respondents were grouped into three categories of relative risk level. Risk levels are based on the National Health and Medical Research Council (NHMRC) risk levels for harm in the long-term, and assume the level of alcohol consumption in the week recorded was typical. The average daily consumption of alcohol associated with the risk levels is as follows:

    TABLE 5.3: Alcohol risk level

    Relative risk level
      Male
      Female

    Low risk
      Less than or equal to 50ml
      Less than or equal to 25ml
    Risky
      More than 50 - 75ml
      More than 25 - 50ml
    High risk
      More than 75ml
      More than 50ml


    It should be noted that whereas the NHMRC risk levels assume ongoing consumption at the levels reported, indicators derived in the 2001 NHS relate to consumption only during the reference week and take no account of whether or not consumption in that week was more, less or similar to usual consumption levels. In addition, this indicator takes no account of other factors related to health status, other lifestyle behaviours, etc. which may influence the absolute level of personal health risk from drinking alcohol; and
    • as noted previously, reported quantities of alcoholic drinks consumed were converted to quantities of alcohol consumed. While brand/drink specific conversions were used where possible, some conversions were based on factors representing the alcohol content of each type of drink category as a whole. To the extent that individuals consumed particular brands/types of drink within each group with an alcohol content higher or lower than that represented by the default factor, the derived intake may over or under-state actual intake.

    Comparability with 1995

    The methodology used in the 2001 survey was essentially the same as that used in the 1995 survey. Results for the two surveys are therefore considered directly comparable. However, it should be noted that:
    • the system used to derive alcohol content in the 2001 survey catered for more specific drink information (e.g. down to individual brand level) and as a result the accuracy of the derivation of alcohol consumed is expected to be marginally higher than that in 1995. At the population level however this is expected to have minimal impact on the comparability of the 2001 and 1995 data sets.
    • the categories of beer have been changed between surveys, as shown below; this change reflects a change in product availability between the surveys. Although these categories are used primarily for convenience and to assist more accurate reporting, because a standard conversion factor applies to each category, a change of category and hence conversion factor used may impact the overall quantity of alcohol derived for that drink type.

    TABLE 5.4: Alcohol conversion factors

    1995
    2001


    Category
    Default conversion factor
    Category
    Default conversion factor

    Extra/special light beer
    0.009
    Light beer
    0.027
    Low alcohol beer
    0.027
    Mid-strength beer
    0.035
    Full strength beer
    0.049
    Full strength beer
    0.049


    • In drawing comparisons, consideration should also be given to the social factors and general changes in health awareness which have occurred in the period between surveys and which may have influenced the levels of reporting.

    The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


    EXERCISE

    Definition

    This topic refers to physical exercise undertaken for recreation, sport or health/fitness purposes during the two weeks prior to interview. The topic excludes physical activity undertaken in the course of work and activity undertaken for reasons other than recreation, sport or health/fitness.


    Methodology

    Respondents aged 15 years and over were asked whether, during the previous two weeks, they did any:
    • walking for sport, recreation or fitness
    • moderate exercise (apart from walking)
    • vigorous exercise.

    For each of these categories of exercise, respondents were asked:
    • the number of times they had done that exercise in the previous two weeks, and
    • the total amount of time spent (hours and minutes) doing that exercise over that two weeks.

    For the purposes of the survey, moderate exercise was defined as exercise (undertaken for recreation, sport or fitness) that caused a moderate increase in the heart rate or breathing of the respondent. Vigorous exercise was defined as exercise (undertaken for recreation, sport or fitness) that caused a large increase in the respondent’s heart rate or breathing.

    The application of these definitions reflected the respondent’s perception of moderate or vigorous exercise or walking, and the purpose of that activity. Responses may have varied according to the type of activity performed, the intensity with which it was performed, the level of fitness of the participant, and their general health and other characteristics (e.g. age). For example, some respondents may consider a game of golf to be moderate exercise while others may consider it walking.

    Information was not recorded in the survey about the type of activities undertaken and reported against each of the three categories above. See Q207 to Q215 in 2001 NHS(G) Adult form.

    From the information recorded about the frequency, duration and intensity of exercise an exercise level was derived for each respondent. The aim was to produce a descriptor of relative overall exercise level, and to indicate the quality of the activities undertaken in terms of maintaining heart, lung and muscle fitness. The level is based on a score, derived from:


    No. of times
    activity undertaken

    X

    Average time
    per session

    X

    Intensity

    where intensity is a measure of the energy expenditure required to carry out the exercise, expressed as a multiple of the resting metabolic rate. Because the 2001 NHS did not collect details of the types of activities undertaken an intensity value was estimated for each of the three categories of exercise identified in the survey. A score was derived for each of the three categories of exercise and then summed to provide a total for the respondent for that two week period. Respondents were grouped into exercise levels according to their score.

    Exercise level was derived using intensity values of:
    3.5 for walking,
    5.0 for moderate exercise, and
    7.5 for vigorous exercise.
    Score ranges were grouped and labelled as follows:

    TABLE 5.5: Exercise level

    Exercise levelCriteria


    Sedentary Scores less than 100 (including no exercise)
    Low exercise levelScores of 100 to less than 1 600
    Moderate exercise levelScores of 1 600 to 3 200 or more than 3 200 but less than 2 hours vigorous exercise
    High exercise levelScores greater than 3 200 and 2 hours or more of vigorous exercise.



    Population

    Information was collected for all persons aged 15 years and over. This information was not collected in the sparse NHS(I).

    Data items
    • whether walked for sport, recreation or fitness
    • number of times walked
    • total time spent walking
    • average length of walking session
    • whether did any moderate exercise
    • number of times moderate exercise undertaken
    • total time spent in moderate exercise
    • average length of moderate session
    • whether did any vigorous exercise
    • number of times vigorous exercise undertaken
    • total time spent in vigorous exercise
    • average length of vigorous session
    • summary types of exercise undertaken
    • total time spent exercising
    • exercise level.

    Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists.


    Interpretation

    Points to be considered when interpreting these data include:
    • the topic conceptually excludes physical activity undertaken at work, and for reasons other than exercise, sport or recreation (e.g. household duties). As a result the data should not be interpreted as necessarily indicative of overall activity levels of persons, or of their fitness
    • although conceptually excluded, activities at work appear to have been reported by respondents in some cases, contributing to apparently very high levels of exercise. However, because information was not available to confirm this had occurred, the data were not amended and so remain as reported. The possibility that this had occurred in some cases should be considered in interpreting the data
    • the information is ‘as reported’ by respondents and reflects the respondent’s perception of the activity undertaken, the intensity of their participation, their level of fitness, etc. Information about exercise undertaken by persons aged 15 to 17 years was reported by an adult within the household, usually a parent. The child may or may not have been consulted. As a result, data for this age group should be interpreted with particular care
    • in general the use of a two-week reference period was not considered to pose significant recall problems for respondents. For many people, participation in exercise is regular and/or for a set period each session. However, to the extent that persons undertook exercise in less formal circumstances or that the reference period was atypical of usual exercise patterns, the accuracy of the information provided may have been affected
    • recent developments in the area of statistics on exercise or physical activity have tended to move away from the use of METS values in deriving exercise level, and have placed more emphasis on measures of time spent exercising. Retention of the exercise level approach as described above was primarily for the purpose of consistency and comparability with data from the 1995 NHS. However, measures of time exercising are also available as outputs from this survey.


    Comparability with 1995

    Data on exercise were collected in the 2001 NHS using the same methodology and questions as in the 1995 survey, and therefore comparable data from these surveys (and the 1989-90 NHS) can be obtained. However, as several different derivations of exercise level have been used over the NHS series some care needs to be taken to ensure the data being compared have been compiled on the same basis.

    TABLE 5.6: Exercise comparability - 1989-90, 1995 and 2001

    2001
      1995
      1989/90

    Intensity values:

    3.5 walking,
    5.0 moderate,
    7.5 vigorous

    3.5 walking,
    5.0 moderate,
    9.0 vigorous

    3.2 walking,
    5.7 moderate,
    8.5 vigorous
    Published output



    Can be compiled on request



    Can be compiled on request
      Can be compiled on request



      Can be compiled on request



      Published output
      Can be compiled on request



      Can be compiled on request



      Published output
    Threshold scores for exercise levels:
    0 = No exercise
    1 < 1500 = Low
    1500-3250 = Medium
    > 3250 = High

    < 100 = Sedentary
    100 < 1600 = Low
    1600 - 3200 = Moderate
    >3200 & < 2 hrs of vigorous = Moderate
    >3200 and 2 hours or more of vigorous = High
    Can be compiled on request




    Published output
      Published output




      Can be compiled on request
      Published output




      Can be compiled on request


    An effect of calculating exercise level using the 2001 NHS method is to reduce the number of respondents classified to the high exercise level category relative to the methodology used for published data in 1995, and increase the number classified to the medium level, with small increases in the remaining categories.

    The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


    HEIGHT, WEIGHT AND BODY MASS

    Definition

    This topic refers to:
    • the height and weight of respondents as reported during interview, and to
    • self-reported and derived body mass.

    Information was collected for all respondents aged 15 years and over. No measurements of height and weight were taken as part of this survey, except in sparse NHS(I), where an offer was made to measure or weigh respondents if they were unsure of their weight or height. These questions were asked at the end of the survey, and it was made clear that being measured or weighed was voluntary and optional.


    Methodology

    Respondents were first asked whether they considered themselves to be of an acceptable weight, underweight or overweight. They were then asked to report their weight and height without shoes. Women who were pregnant at the time of the interview were asked to provide their usual weight before pregnancy. Answers provided in imperial measurements were recorded by interviewers and converted into metric measurements. If respondents rounded their weight or height (e.g. about 6 feet) interviewers prompted for a more exact measure where possible. See Q204 to Q206 in 2001 NHS(G) Adult form.

    Body mass index (BMI) was derived using Quetelet’s body mass index which is calculated as weight (kg) divided by the square of height (m). A BMI score is created which is then commonly grouped for output. There are two main classifications of BMI in common use, one recommended by the NHMRC and the other by the World Health Organisation (WHO). The standard output classification defined for this survey provides data to meet both NHMRC and WHO standards:

    TABLE 5.7: BMI ranges

    LabelBMI Score

    UnderweightLess than 18.5
    Normal range18.5 to less than 20.0
    20.0 to less than 25.0
    Overweight25.0 to less than 30.0
    Obese30.0 or more


    Population

    Information was collected for all persons aged 15 years and over.


    Data items
    • reported height (cm)
    • reported weight (kg)
    • self-assessed body mass
    • derived body mass index (BMI).

    Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.

    Reported height and weight and body mass index scores are stored on the data file and can be grouped in output to suit individual user needs.


    Interpretation

    In interpreting data for this topic users should bear in mind that:
    • the data are ‘as reported’ by respondents and hence may differ from those which might be obtained by measurement. A comparison of reported height and weight measures recorded in the 1995 NHS with measured height and weight in the 1995 National Nutrition Survey (NNS) was published in 1998 in How Australians Measure Up, 1995 (cat. no 4359.0). This showed that:
      - overall people tend to overstate their height; 24% of males and 29% of females reported their height to within 1 cm of their measured height. 64% of males and 51% of females overstated their height by 1 cm or more. .
      - overall people tended to understate their weight; 22% of both males and females reported their weight within 1 kg of their measured weight. 57% of males and 68% or females understated their weight by 1 kg or more.
      - the net result of differences in reporting height and weight was that 27% of males and 28% of females would be classified to a different body mass index group (usually a heavier group) if measured rather than reported height and weight data were used.
    • information about height, weight and reported body mass for persons aged 15 to 17 years was reported by an adult within the household, usually a parent. The child may or may not have been consulted. As a result, data for this age group should be interpreted with particular care.
    • while BMI is a useful tool to assess and monitor changes in body mass at the population level, it may be an inappropriate measure of the body fatness of certain populations and particularly of certain individuals. For example those whose high body mass is due to muscle rather than fat, those with osteoporosis who have lower than usual BMI or those who have a different body build or different body fat distribution.


    Comparability with 1995

    Data collected on height and weight in the 2001 NHS used the same methodology and questions as in the 1995 survey, and therefore directly comparable estimates can be compiled from the 1995 survey. However, it should be noted that categories in published output from the 1995 survey were defined differently from those in 2001 NHS output. Data in published output from the 1995 survey are therefore not directly comparable.

    The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


    DIETARY HABITS

    Definition

    This topic covers selected dietary indicators relating primarily to usual intake of fruit and vegetables and deliberate intake of folate enriched foods or supplements. This information was collected in the 2001 NHS(G) and non-sparse NHS(I) but was excluded in the sparse NHS(I) because testing showed that good quality and reliable information could not be obtained. Data indicative of nutritional intake were not collected in the 2001 NHS.


    Methodology

    Following a question on type of milk usually consumed, respondents aged 12 years and over were asked to report the number of serves of vegetables and of fruit they usually eat each day, excluding drinks and beverages. For the purposes of this survey:
    • a serve of vegetables was defined as a half a cup of cooked vegetables or one cup of salad vegetables - approximately equivalent to 75 grams. All types of vegetables were included (tomatoes were included as a vegetable rather than a fruit) but legumes were excluded.
    • a serve of fruit was defined as one medium piece or two small pieces of fruit, or one cup of diced fruit, or one quarter cup of sultanas, or four dried apricot halves - approximately 150 grams of fresh fruit or 50 grams of dried fruits.

    Picture prompt cards were used to assist respondents in understanding the concept of a serve; one prompt card showed 6 examples of single serves of different vegetables and another card showed 6 single serves of fruit; if respondents had difficulty in reporting, interviewers were encouraged to prompt in terms of asking respondents about their usual consumption of vegetables and fruit at breakfast, lunch and dinner and for snacks. Grouped response categories were provided: 1 or less, 2-3, 4-5, 6 or more, does not eat vegetables or fruit.

    These respondents were further asked how often they added salt to food after cooking.

    Two further groups of questions on diet related issues were asked;
    • adults were asked whether they had run out of food in the previous 12 months and couldn't afford to buy more, and
    • female respondents aged 18 to 49 years were asked if in the previous 2 weeks they had consumed foods or drinks because they had added folate, or consumed vitamin or mineral supplements because they contained folate.

    See Q301 to Q309 in 2001 NHS(G) Adult form.


    Population

    The populations differed for particular items within this topic, as shown under 'data items' below. This information was not collected in the sparse NHS(I).


    Data items

    TABLE 5.8: Dietary items and populations

    ItemPopulation

    Type of milk usually consumedPersons aged 12 yrs and over
    Usual daily serves of vegetablesPersons aged 12 yrs and over
    Usual daily serves of fruitPersons aged 12 yrs and over
    Frequency of adding salt to food after cookingPersons aged 12 yrs and over
    Food securityPersons aged 18 yrs and over
    Deliberate intake of folate enriched foods/drinks or supplementsFemales aged 18 - 49 years



    Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists.


    Interpretation

    Points to be considered in interpreting data for this topic include:
    • Data on type of milk usually consumed was obtained as an indicator of fat intake. Data recorded are based on the information provided by respondents against a defined classification of milk type categories. The variety of milk products available, and the various terminologies used to label milk products may have led to some misreporting and incorrect classification.
    • Questions on intake of fruit and vegetables are based on short questions used in the 1995 National Nutrition Survey (NNS). An analysis of data collected in the 1995 NNS which compared data collected using short questions with data collected from the detailed recall methodology concluded that "the responses to the short questions on fruit and vegetable intake can provide reliable information on fruit and vegetable intake across a range of population sub-groups which is generally consistent with group level differences in fruit and vegetable intake as determined by 24-hour recall" (1).

      The questions however are complex for respondents, as they needed to understand the inclusions/exclusions, understand the concept of a serve and assess their consumption levels accordingly, and think about their total consumption in what would constitute an average day. The questions were subject to cognitive testing, and were a particular focus in pilot tests. As a result the methodology was refined to include picture prompt cards, and interviewers were instructed to prompt/assist respondents in a standard way if necessary.

      Based on testing and results from the 1995 NNS it is considered that indicators of vegetable and fruit intake from the 2001 NHS(G) and non-sparse NHS(I) are sufficiently reliable for assessing broad intake levels for population groups.
    • Studies have shown that consumption of folate by women who are pregnant or trying to become pregnant reduces the risk of neural tube defects in babies. Questions in this survey aim to indicate the intentional consumption of folate fortified foods or supplements. Data from this survey do not provide a measure of the extent to which women of child-bearing age consume folate.
      (1) Ingrid Coles-Rutishauser, Australian Food and Nutrition Monitoring Unit, 2/3/2000.


      Comparability with 1995

      Information on diet was not collected in the 1995 NHS, but as noted above, information was obtained in the 1995 NNS, which was conducted in association with the NHS. In the NNS information covering four main areas was collected by trained nutritionists:
      • detailed food and beverage consumption, using a 24 hour recall approach, which enabled nutrient intake to be derived;.
      • usual frequency of consumption of selected foods and vitamin and mineral supplements (collected via a self-completion food frequency questionnaire);
      • selected physical measures, covering height, weight, waist and hip circumference and blood pressure; and
      • eating habits and patterns.

      For additional information see National Nutrition Survey: Users' Guide, Australia 1995 (cat. no. 4801.0).

      Apart from folate intake, all items on dietary habits in the 2001 NHS were included in the 1995 NNS. The questions on adding salt to cooked food and food security are exactly the same as the 1995 NNS and are expected to be comparable. However, the question on type of milk usually consumed in the 2001 NHS includes a new category for soy milk and therefore the category 'None of the above' is not comparable between the 1995 NNS and the 2001 NHS.

      In the 1995 NNS, the questions on usual fruit and vegetable intake were included at the end of the Food Frequency Questionnaire (FFQ) which was a self-completion questionnaire given to respondents aged 12 years and over at the end of the face-to-face interview. This placement ensured that the respondent had been introduced to the definitions of fruit and vegetables and other dietary concepts through the earlier FFQ questions and the face to face interview. However, in the 2001 NHS, these questions needed to be supported by prompt cards containing colour photographs of single serves of different fruits and vegetables. Respondents were also encouraged to look at the pictures of serves and count the equivalent number of serves they usually consumed. If necessary, the interviewer would prompt the respondent to recall the usual numbers of serves of fruits/vegetables by eating occasion (breakfast, lunch, dinner, in-between meals).

      The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


      SUN PROTECTION

      Definition

      This topic refers to measures taken for protection from the sun by children and adolescents under 18 years of age, and focussed on measures taken in the month prior to interview.


      Methodology

      Respondents (mostly via proxy) were asked whether in the last month they had taken any measures to protect themselves from the sun, and if so which ones. A protective measure was considered to be a deliberate action taken to reduce exposure to sunlight. A prompt card with the following categories was shown to the respondent as a guide:

      sunscreen,
      umbrella,
      hat,
      clothing,
      sunglasses,
      avoided sun/ limited the time spent in the sun,
      other

      In addition, a question was asked of all respondents whether they had their skin regularly checked for changes in freckles and moles. See Q226 to Q228 in 2001 NHS(G) Child form.


      Population

      Information about sun protection behaviours was collected for persons aged 0-17 years only. An adult (usually a parent) provided the information on behalf of the children.

      Data about checks for changes to freckles and moles were collected for all ages.

      This information was not collected in the sparse NHS(I).


      Data items
      • whether in last month taken sun protection measures
      • types of protective measures taken
      • whether skin regularly checked for changes in freckles or moles.

      Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists.


      Interpretation

      When interpreting these data it should be kept in mind that:
      • issues relating to safe sun protection behaviours have been widely promoted in the community, and therefore some respondents may tend to report towards the recommended practices rather than actual practices.
      • the information reflects the adult's (usually a parent's) understanding or knowledge of the protective measures taken by their children, which may differ from actual measures taken.


      Comparability with 1995

      Data collected in this survey use the same methodology and most of the same questions as in the 1995 NHS and therefore results for items common to both surveys are regarded as directly comparable for children; data relating to adults which was collected in 1995 were not collected in 2001.

      The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


      BREASTFEEDING

      Definition

      This topic refers to the breastfeeding of infants and focuses on the duration of breastfeeding and the ages at which substances other than breastmilk have been introduced into the regular diet of the child.

      Information about the breastfeeding history of women was also collected in the survey; see Supplementary women’s health topics, in this Chapter.


      Methodology

      Questions on breastfeeding were asked in respect of children aged three years and under at the time of the survey. For most children, questions were answered on their behalf by a parent, usually the mother (83% for children aged 0 to 3 years). Initially questions were asked to establish whether the child had ever been breastfed and was currently being breastfed.

      For children who had ever been breastfed information was collected to determine if foods other than breastmilk had been introduced into the diet and at what age regular consumption of these had started. These foods were:
      • infant formula,
      • cow’s milk,
      • other milk substitutes (soya bean milk, goat's milk, evaporated milk, other milk), and
      • solid food.

      Regular was defined as at least once per day; occasional use was excluded. For those children previously but not currently breastfed, the main reason for stopping breastfeeding was also collected.

      For those children who had never been breastfed, the same series of questions established the type of food (other than breastmilk) the child was given initially and the age at which the other foods listed had been introduced (if at all). The introduction of a food was defined to be the age at which the infant first started taking the food on a regular basis, as opposed to the age at which it was first offered.

      See Q151 to Q166 in 2001 NHS(G) Child's form. In sparse NHS(I), information collected was limited to just whether the child had ever been breastfed and whether it was currently being breastfed.


      Population

      Information was collected for all children aged 0-3 years.


      Data items
      • breastfeeding status
      • whether breastfed when came home from hospital
      • whether ever regularly given -
        Infant formula
        cow's milk
        other milk substitutes
        solid food (if under 6 months of age)
      • age (months) first given regularly -
        infant formula
        cow's milk
        other milk substitutes
        solid food
      • type(s) of milk substitutes
      • main reason for stopping breastfeeding
      • age (months) first regularly given anything other than breastmilk
      • type of product first given
      • age (months) first given breastmilk substitute
      • type of substitute given
      • total time breastfed
      • total time fully breastfed.

      Age in months and duration of breastfeeding in weeks are stored on the main data file, and can be grouped for output to suit individual requirements.

      Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


      Interpretation

      Points to be considered in interpreting data for this topic:
      • Information is ‘as reported’ by respondents. No analysis has been undertaken regarding the accuracy of these reported data and whether the accuracy of recall declines as the child gets older. Respondents may not have interpreted the concept of "regular" consistently, where they did not seek clarification from the interviewer.
      • In addition, the accuracy of the data may be reduced in cases where an adult other than the child’s mother, responded for the child; this occurred for around 17% of children aged 0-3 years.
      • Issues relating to the benefits of breastfeeding have been widely promoted in the community and some respondents may have tended to report recommended practices rather than to actual practices.
      • Data from this survey cannot be compiled using the concepts of "exclusively breastfed" or "predominantly breastfed" which have been recently adopted for national monitoring purposes in Australia. Data to support these concepts were not obtained in the survey; based on reported period breastfed, and the ages at which other foods were introduced into the regular diet of children, children are classified by breastfeeding status. This refers to the level of breastfeeding at a given age;
          1. Fully breastfed = receiving only breastmilk on a regular basis.
          2. Partially breastfed = breastfed and receiving breastmilk substitutes (but not solids) on a regular basis.
          3. Complementary breastfeeding = breastfed and receiving solids on a regular basis (with or without other breastmilk substitutes)
          4. Not breastfed.


      Comparability with 1995

      The methodology and questions used in the 2001 NHS were the same as those used in the 1995 survey, and therefore data are available which are considered directly comparable between surveys. However, due to tabulation design features, published data from these surveys cannot be directly compared.
      In making comparisons care should be taken to ensure consistent definitions (e.g. of breastfeeding status) have been used in compiling the particular estimates being compared.

      The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


      ADULT IMMUNISATION

      Definition

      This topic refers to the immunisation status of adults aged 50 years and over against influenza and pneumococcal disease.

      Influenza vaccinations are available free of charge to:
      • persons aged 65 years and over under the Older Australians Program,
      • Aboriginal and Torres Strait Islander people aged 50 years and over, and
      • others with predisposing risk factors.

      Annual vaccinations are recommended to retain coverage.

      Pneumococcal disease is a major cause of death and morbidity, being linked with meningitis, pneumonia and other upper respiratory tract infections such as otitis media and sinusitis. The NHMRC recommend routine pneumococcal vaccination, at least every 5 years. Populations most at risk include the elderly (aged 65 years and over), Aboriginal and Torres Strait Islander people of all ages, and people with predisposing risk factors such as diabetes, cardiopulmonary, renal or liver disease, immunosupression and alcohol misuse.


      Methodology

      Respondents aged 50 years and over were asked whether they had ever had an influenza vaccination, whether they had that vaccination in the last 12 months, whether they had to get a prescription to obtain the vaccination, and whether the vaccine was obtained free of charge. Vaccinations at consultations for which the respondents were bulk billed are recorded as free of charge, as are consultations where the respondent was charged for the consultation but received the vaccine free of charge. Respondents in sparse NHS(I) were not asked questions regarding whether a prescription was obtained for vaccination or whether the vaccination was free of charge.

      Respondents were further asked if they had ever had a pneumococcus or pneumovax vaccinations, and whether they had received a vaccination in the last 5 years. Respondents who reported having a pneumonia vaccination were included.

      See Q231 to Q236 in 2001 NHS(G) Adult form.


      Population

      Information was obtained from all persons aged 50 years and over.


      Data items
      • Influenza vaccination status
      • Whether influenza vaccine obtained by prescription
      • Whether influenza vaccination obtained free of charge
      • Pneumococcus vaccination status

      Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


      Interpretation

      Points to be considered in interpreting data for this topic:
      • During early testing it was found that some respondents were unfamiliar with the term 'pnuemoccocal' and some were confused between the influenza and pneumoccocal vaccinations. However, it was also found these difficulties were mainly among those who had not had either vaccination and that those who had been vaccinated could generally report with surety. Less than 1% of respondents aged 50 years and over reported they did not know if they had an influenza vaccination and less than 2% a pnuemoccocal vaccination. Nevertheless the possibility that some misreporting may have occurred should be considered in interpreting the data. Where this occurred, the order of the questions, influenza first then pneumoccocal, would most likely have led to over-reporting of influenza vaccinations and under-reporting of pneumoccocal vaccinations.
      • Items relating to whether or not the respondent obtained a prescription for the influenza vaccine, and whether or not it was administered free of charge should be interpreted with care. Persons who were vaccinated under the Older Australians Program were entitled to receive their vaccination free of charge, without the necessity of obtaining a prescription. However, the circumstances under which a vaccination was received could differ significantly such that various combinations of responses to these items could legitimately apply. Whether or not the vaccine was free of charge may, for some respondents, have been difficult to accurately report; for example where a consultation was bulk billed the respondent may not be aware of the charges levied or where a fee was charged for a consultation at which a vaccination was received, but it was not clear what that fee related to; i.e. the consultation, the vaccine, and/or the vaccination.
      • For many older people the influenza vaccination is a well publicised and a regular (annual) occurrence, such that the 12 month recall period is considered to have posed few problems. However it may have posed more problems for those who have irregular influenza vaccinations. The five year recall period used for pneumoccocal vaccinations, while appropriate to the recommended frequency of vaccination, may have posed recall difficulties for some respondents.


      Comparability with 1995

      Information on this topic was not covered in the 1995 NHS. However, similar questions were contained in two small-scale surveys conducted by the ABS in 1999. Summary results from these surveys were published in Population Survey Monitor, August 1999 and November 1999 (cat. no. 4103.0). While similar questions were used, data are not considered directly comparable due to differences in the survey methodologies; for example the 1999 surveys sought information about influenza vaccinations received during 1999 - the August survey therefore covered a 7-8 month period while the November survey covered a 10-11 month period compared to a 12 month reference period used in the 2001 NHS.

      The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


      CHILDREN'S IMMUNISATION

      Definition

      This topic refers to the immunisation status of children aged 0-6 years against Diphtheria, Pertussis (whooping cough), Tetanus, Hepatitis B, Poliomyelitis, Measles, Mumps, Rubella and Haemophilus Influenzae Type B. Some vaccines for these conditions are separate while others are combined, such as the Diphtheria/Tetanus/Pertussis vaccine (DTP).

      Recommended schedules for childhood vaccinations are issued by the NHMRC and are periodically updated in response to advances in medical research and as new vaccines or combinations of vaccines become available. For the age group covered in this survey (children aged 0-6 years at the time of the survey) three different recommended schedules have applied; 1996, 1998 and 2000. Details of the schedules are contained in the table shown under Interpretation below.

      The schedule appropriate for each child depends on the date the child was born. For example, if a child was born after the 30 April 2000, that child would be on the 2000 schedule. Any child born before that date would be on the 1996 or 1998 schedule as appropriate. However, in some cases children may receive additional vaccinations appropriate to a later version of the schedule under 'catch-up' programs or may otherwise voluntarily receive vaccines applicable to later schedules.

      Immunisation status refers to the number and type of vaccinations a child has received relative to the number and type of vaccinations a child of that age should have received under the recommended schedule. From this survey, immunisation status (essentially whether fully or partly immunised or not immunised) is available derived in terms of:
      • the schedule which the children started, and
      • the current (i.e. 2000) schedule,

      and can be compiled both in terms of each of the diseases covered by immunisation, each of the particular vaccines and overall in terms of all vaccines/diseases covered by the recommended schedules.

      Immunisation status relative to the schedule started is the indicator used in published output from the survey; it is the most appropriate indicator of the level of compliance with the recommended immunisation schedules.


      Methodology

      A nominated adult reported on behalf of children. Information about childhood immunisation was collected for all children aged 0-6 years.

      Respondents were encouraged to refer to immunisation records (e.g. Baby Book) or other information to assist them in accurately answering the immunisation questions. Data were obtained about the type of record consulted (if any), the reported immunisation status of the child, the reasons not immunising and about factors which influence decisions regarding children's immunisation.

      Respondents were then asked a series of questions about specific vaccinations, including the number (including boosters) and types (including brand name for some types) received, from which immunisation status was derived separately for each vaccine, disease and overall for the schedules (as discussed above). Overall immunisation status is defined as follows:

      Fully immunised - includes only children that have received every vaccination appropriate to their age as indicated on the appropriate schedule.

      Partially immunised - includes children that have received some vaccinations appropriate to their age but not all as indicated on the appropriate schedule.

      Not known if fully or partly immunised - includes children who had received some vaccinations appropriate to their age but the number was not known.

      Not immunised - includes those children that have not received any vaccinations.

      Not known if immunised - includes children for whom no immunisation data were recorded.

      The way derivations were designed gave each child time to 'catch up' to the relevant schedule. This 'catch up' allowance was one month after the age at which the vaccination was due, according to the appropriate schedule they were following. For example, under the 2000 Schedule, a child should receive a Diphtheria/Tetanus/Pertussis (DTP) vaccination at 2, 4 and 6 months of age. A child aged 5 months (or more) would not be regarded as fully immunised unless they had at least 2 DTP vaccinations, but a child aged less than 5 months (e.g. 4 months and 27 days) would be deemed to be fully vaccinated with at least 1 DTP vaccination - see diagram below. Although for survey output age of children is available in months only, for the purposes of deriving children's immunisation status, exact age was derived from date of interview and date of birth information.

      TABLE 5.10: Immunisation status

      Age of child (months)

      01234567
      DTP Vaccination dueXXX

      Immunisation status
      No of vacc'ns rec'd
      NoneFully immunisedFully immunisedFully immunised Not immunisedNot immunisedNot immunisedNot immunisedNot immunised
      OneFully immunisedFully immunisedFully immunisedPartially immunisedPartially immunisedPartially immunisedPartially immunisedPartially immunised
      TwoFully immunisedFully immunisedFully immunisedFully immunisedFully immunisedPartially immunisedPartially immunisedPartially immunised
      ThreeFully immunisedFully immunisedFully immunisedFully immunisedFully immunisedFully immunisedFully immunisedPartially immunised

      It should be noted that, as shown in the diagram above, children who have not yet reached the age at which the first vaccination is required under the Schedule are deemed to be fully immunised.

      Population
      All persons aged 0 to 6 years. This information was not collected in the sparse NHS(I).

      Data items
      • Reported immunisation status
      • Immunisation status for the 2000 schedule
      • Immunisation status for the 1998 amended schedule
      • Immunisation status for Diphtheria
      • Immunisation status for Whooping cough
      • Immunisation status for Tetanus
      • Immunisation status for Diphtheria/Whooping Cough/Tetanus (DTP)
      • Immunisation status for Diphtheria/Tetanus (CDT)
      • Immunisation status for Hepatitis B
      • Immunisation status for Poliomyelitis
      • Immunisation status for Measles/Mumps/Rubella (MMR)
      • Immunisation status for Haemophilus Influenzae Type B (Hib)
      • Reasons not immunised
      • Reasons did not continue with immunisation
      • Reasons immunised
      • Type of records used to answer questions
      Immunisation status items are available derived at specific ages and for age ranges.

      Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists.

      Points to be considered in interpreting data for this topic:
      • Respondents were asked to refer to the child's immunisation records whenever possible, to assist them in providing complete and accurate data. Overall, 82% of respondents had some type of immunisation record they referred to. However, the use of records did not necessarily ensure accurate reporting since some records were incomplete or poorly completed. Interviewers were instructed that if there was at least a date in the relevant section of the record then it should be considered that the child received that particular vaccine.
      • As noted above, the age group covered in the survey spanned 3 editions of the recommended childhood immunisation schedule. Taking account of all Schedule changes in the survey output is both complex to do and complex for users in interpreting the data. Several key changes of note:
          - There was a national campaign in 1998 to vaccinate children with the last MMR booster at ages over 4 years rather than at ages 10 to 16 years as previously. This effectively constituted an amendment to the schedule in that children were then required to have received two MMR vaccines by the time they were 6 years old.
          - Hep B was included in the recommended schedule for the first time in 2000. This change meant that children born before 1 May 2000 would be classified as fully immunised if they received all other vaccines except HepB, but that children born on 1 May 2000 or later would be fully immunised only if they had HepB vaccinations in addition to the others from the schedule.

      TABLE 5.11: Immunisation schedules

      Age
      2000 schedule
      1998 Schedule
      1996 Schedule

      Birth
      HepB
      N/A
      N/A
      2 months
      DTP, Hib, OPV, HepB
      DTP, Hib, OPV
      DTP, Hib, OPV
      4 months
      DTP, Hib, OPV, HepB
      DTP, Hib, OPV
      DTP, Hib, OPV
      6 months
      DTP, OPV, HepB
      DTP, Hib(HbOC), OPV
      DTP, Hib(HbOC), OPV
      12 months
      MMR, Hib
      MMR, Hib(PRP-OMP)
      MMR, Hib(PRP-OMP)
      18 months
      DTP
      DTP, Hib(HbOC)
      DTP, Hib(HbOC)
      4-6 years
      DTP, MMR, OPV
      DTP, OPV, MMR
      DTP, OPV
      10-16 years
      HepB
      MMR, HepB


      • While results from this survey are broadly consistent with statistics available from the Australian Childhood Immunisation Register (ACIR) the data are not directly comparable, due to the different coverage of the collections, and the different sources of information, methodologies used to obtain/compile the data and points in time to which the data relate.

      Comparability with 1995
      Children's immunisation was not covered in the 1995 NHS, but was covered in a separate survey also conducted in 1995; the Children's Immunisation and Health Screening Survey (CIHSS). Immunisation results from that survey were published in Children's Immunisation, Australia, April 1995 (cat. no. 4352.0).

      The methodology used in the CIHSS was similar to that used in the 2001 NHS; some questions were identical while other had been updated to reflect changes to the recommended schedule which had occurred since the 1995 survey. Therefore results from the two surveys are considered comparable, except for Hib and HepB. As noted above HepB was introduced with the 2000 immunisation schedule and hence was not represented at all in the 1995 survey. Prior to 1994 Hib vaccinations could be purchased and given to children by a health professional but were not part of the recommended immunisation schedule. When Hib was introduced with the 1994 schedule a variety of vaccines were available, with different brands requiring different numbers of boosters to complete the course of vaccinations.

      During the latter 1990's, increasing the proportion of children who are vaccinated was adopted as a specific government policy objective. Campaigns were conducted to raise public awareness of childhood immunisation, and the Australian Childhood Immunisation Register (the ACIR) was established as a national database to record and monitor immunisation details for children aged less than 7 years. The ACIR recall and reminder scheme is a facility to remind parents/providers when further vaccinations are due. Also in that period education authorities tightened vaccination requirements as part of school enrolments and there was greater public debate about the pros and cons of immunisation.

      While these factors would have contributed to changes in immunisation levels they will also have impacted on the comparability of data in other ways; greater awareness among parents of recommended childhood immunisation, more accessible and better quality immunisation records, greater pressure to report "desirable" immunisation details rather than actual details, etc. These factors should be considered in comparing the 1995 and 2001 survey results.

      The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.

      SUPPLEMENTARY WOMEN'S HEALTH TOPICS

      Aspects of women’s health are addressed in most topics included in the 2001 NHS. This section outlines additional topics covered in the survey which relate specifically to women. Topics covered were:
      • screening for breast and cervical cancer
      • use of hormone replacement therapy
      • hysterectomy
      • breastfeeding history

      Although not specifically a women's health topic, contraception/protection is also included in this section, because the methodology used to collect the information was the same as that used to collect information on the supplementary women's health topics.

      Each topic is discussed separately in this section, but all share a common methodology outlined below:

      General methodology

      At the completion of the survey interview, female respondents aged 18 years and over were invited to complete an additional women’s health questionnaire relating to the specific women’s health issues outlined above. Women who agreed to participate were asked to complete the questionnaire themselves and return it to the interviewer in a sealed envelope provided. This methodology was adopted in recognition of the potential sensitivity of some of the questions asked; it has been used successfully in the previous two national health surveys.

      Information from each form was key data entered to create an electronic record, which was then matched and combined with the main health survey record for each respondent. This enables cross-classification of data from this supplementary questionnaire with all data items from the main survey questionnaire, as appropriate.

      Approximately 92% of adult female respondents agreed to complete this questionnaire. The questionnaire contained a maximum of 32 questions, depending on age and responses provided, and was designed and refined through testing to be as simple and straightforward as possible. Questionnaires were made available in a number of languages to assist respondents who had difficulty in reading English (see Chapter 2: Data Collection - Interviews). However, some language problems may have persisted. For example, if the respondent only read a language other than one in which the form was available, if the respondent had difficulty reading English but chose not to request a foreign language form, or if some of the terms (e.g. Pap smear test) were not familiar. Overall less than 1% of females who completed a supplementary women's health form used a non-English language form. These language problems, together with more general literacy factors, may have affected the reliability of information reported.

      The table below, showing selected demographic characteristics of women respondents by whether or not they completed this questionnaire, indicates there were some differences in response rates, particularly the lower response among older women (which may underlie some of the differences observed in some other characteristics) and country of birth. While there is no reason to suspect that the health characteristics of women (and particularly those health characteristics addressed by this questionnaire) who completed the questionnaire differed from those who did not, this cannot necessarily be assumed to be the case.

      The table below shows the % of adult women respondents in the population groups described who completed/did not complete a Womens Health Questionnaire (WHQ):

      TABLE 5.12: Women's Health Form response status

      Women who completed WHQ
      Women who did not complete WHQ

      Number of respondents
      8933
      821

      Age (yrs) -
      18 - 24
          25 - 34
          35 - 44
          45 - 54
          55 - 64
          65 and over
        Marital status -
          Never Married
          Married
          Other
      Birthplace -
      Australia
      NZ & other Oceania
      UK and Ireland
          Southern & Eastern Europe
      Middle East
      Southeast Asia
      All other
      Income unit weekly income -
      Less than $500
      $500 to less than $1000
        $1000 to less than $1500
        $1500 or more
        Not stated
        Work -
          Employed
        Unemployed
        Not in labour force
      Education -
      Post-school qualification
      No post-school qualification
      Household composition -
      Single person
      Couple only
      Single with children
      Couple with children
      Other
      %

      94
      93
      93
      93
      92
      86

      93
      92
      90

      93
      94
      93
      80
      77
      94
      88

      89
      94
      96
      95
      89

      94
      93
      88

      93
      90

      90
      92
      92
      91
      93
      %

      6
      7
      7
      7
      8
      14

      7
      8
      10

      7
      6
      7
      20
      23
      6
      12

      11
      6
      4
      5
      11

      6
      7
      12

      7
      10

      10
      8
      8
      9
      7



      As the questionnaire was a self-completion form which the interviewers did not inspect at the time of the interview, it may have contained errors or omissions which under the interviewer administered methodology used for the main survey, would not have occurred. While some of these were corrected in processing (by reference to other responses in the survey), other errors and inconsistencies in the data have survived in final output for these topics. As a result, discrepancies occur in populations between topics covered in this questionnaire, and between items within topics.

      In sparse NHS(I) a subset of the women's health topics was collected through personal interview with adult female respondents who were informed of the potential sensitivity and voluntary nature of these additional questions.

      Comparability with 1995

      Information on supplementary women’s health topics was collected in the 1995 NHS using the same self-completion methodology to that used in the 2001 survey. New items were included in the 2001 survey, and the questionnaire was redesigned to make it easier for respondents to follow. These changes may have impacted on comparability, but for most topics data are considered broadly comparable for common items. Topic specific comparability issues are discussed below.

      The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.

      Screening for breast and cervical cancer

      Definition
      This topic refers to breast examinations and Pap smear tests by women to detect breast and cervical cancer or the presence of pre-cancerous cells, and focusses on the regularity and frequency of screening practices.

      The term "screening' is used in the following description to include all tests/actions, regardless of the purpose or reason for the test/action.

      Methodology
      Women respondents were asked a series of questions about their breast examination practices, including self-examination, examination by a doctor or medical assistant and mammograms. Information was collected about the regularity of these practices, and usual frequency of tests. Similar questions were asked about Pap Smear tests.

      Women who reported having had a mammogram were asked the reasons for their most recent mammogram.

      In sparse NHS(I), women were not asked about breast exams or how long ago they had their last mammogram or Pap Smear test.

      Population
      Women aged 18 years and over

      Data items
        • Types or regular breast exams
        • Whether ever had breast exam by doctor or medical assistant
        • Whether have regular breast exams by doctor or medical assistant
        • Frequency of regular breast exams by doctor or medical assistant
        • Whether regularly examines own breasts
        • Frequency of regular breast self-examinations
        • Whether know what mammogram is
        • Whether ever had mammogram
        • Whether have regular mammograms
        • Usual time between mammograms
        • Time since last mammogram
        • Reason for last mammogram
        • Whether know what Pap test is
        • Whether ever had Pap test
        • Whether have regular Pap tests
        • Usual time between Pap tests
        • Time since last Pap test.

        Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.

        Interpretation
        Points to be considered in interpreting data for this topic include:
          • breast and cervical cancer have been the focus of major public health education programs in recent years. Despite the confidential nature of the questionnaire there may have been a tendency for some respondents to report recommended or desirable screening patterns rather than actual practices.


          Breastfeeding history

          Definition

          Information about the current or recent breastfeeding of children aged 0 to 3 years at the time of the survey is provided earlier in this Chapter under 'Breastfeeding'. This topic refers to the breastfeeding history (number of children breastfed and duration) of women aged 18 to 64 years.


          Methodology

          Women respondents aged 18 to 64 years were asked questions for this topic. Women were asked to report the number of babies they had ever had (live births only), and whether they had breastfed any of their children (including currently breastfeeding and/or expressing milk) and the number of children breastfed. For each child breastfed (to a maximum of 8 children), respondents were asked to record the number of months the child had been breastfed. Although the response boxes were numbered, respondents did not necessarily report their breastfed children in age order.


          Population

          Women aged 18 to 64 years


          Data items
          • number of babies ever had
          • whether has breastfed any children
          • number of children breastfed
          • time (months) breastfed each child
          • total time breastfed (all children)
          • average time breastfed each child.

          Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


          Interpretation

          Points to be considered in interpreting data for this topic include:
          • breastfeeding has been the focus of public health education programs in recent years. Despite the confidential nature of the questionnaire there may have been a tendency for some respondents to report recommended or desirable breastfeeding history rather than actual history.
          • as the questions require respondents to report information, usually about previous breastfeeding occurrences, the ability of respondents to accurately recall and report information on duration of feeding for each child, could be expected to decline the longer the period since breastfeeding and the more children breastfed.
          • the interpretation of period breastfed each child could be expected to vary between respondents, particularly in regard to whether periods partly breastfed, or only periods fully breastfed were counted. Given the recall issues noted above, it was not appropriate to seek to clarify these periods.
          • the period recorded was at the date of interview. Women who were breastfeeding at the time of the survey were asked to report the period breastfed to that date. Cases where breastfeeding was current are not separately identifiable in output from this items; however cross referencing with items from the breastfeeding topic (outlined previously in this Chapter) may be a useful approach to identifying those cases.
          • in a very small number of cases, women reported they had breastfed more babies than they reported they had ever had. Although possibly errors, these cases have not been amended and hence remain on the survey data file.
          • as a result of the points above, data from this topic should not be interpreted as inferring breastfeeding rates or patterns in the past, but rather only to indicate the breastfeeding experience of women.


          Comparability with 1995

          With the exception of an additional question in the 2001 survey about number of children ever had (asked to establish a benchmark against which breastfeeding experience can be interpreted), the questions used in the 2001 survey were almost identical with those used in the 1995 NHS. As a result the data are considered to be generally comparable, but the following points should be noted:
          • in the 2001 NHS, the sequencing meant that women were asked to respond in respect of babies they ever had; in the 1995 survey conceptually the question could have included breastfeeding another's baby, although this is likely not to be a common occurrence
          • the question on number of babies ever had in the 2001 NHS may have been sensitive or disturbing for some respondents. This may have impacted their responses to subsequent questions
          • the 2001 NHS questionnaire included a prompt for respondents to include expressing milk and current breastfeeding. These were not specifically mentioned in the 1995 NHS questionnaire, and as a result may not have been reported.

          The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.
            Hysterectomy and Hormone Replacement Therapy

            Definitions

            As these topics each comprise two questions, they have been combined in this section for convenience. Details of each topic are provided below.


            Methodology

            Women respondents were asked whether they had a hysterectomy, and their age when this occurred, and whether they were currently using a hormone replacement treatment (HRT) prescribed by a doctor, and how long they had been using HRT (with provision for women to record details in months or years as they preferred). The questionnaire provided a very brief definition of a hysterectomy, to assist respondents.


            Population

            Women aged 18 to 64 years. This information was not collected in the sparse NHS(I).


            Data items
            • Whether had a hysterectomy
            • Age at hysterectomy
            • Whether currently use prescribed HRT
            • Time using HRT.

            Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists.


            Interpretation

            Points to be considered in interpreting data for this topic include:
            • results of this survey do not provide a measure of women taking hormone replacement medication. Excluded are women using a medication not prescribed by a doctor
            • although the question was asked about medications prescribed by a doctor, the results should not necessarily be interpreted as relating solely to the use of prescribed medication. For example some respondents may have included over the counter medications and natural and herbal medications if used on the advice of a doctor
            • the survey provides a measure of the prevalence of use of hormone replacement medication; women who previously used HRT but no longer did so are not identified in the survey.


            Comparability with 1995

            The methodology and questions about hysterectomy used in the 2001 survey were almost identical with those used in the 1995 NHS. As a result, those data are considered to be directly comparable.

            However, for HRT the data are not considered comparable. The 2001 survey asked about HRT prescribed by a doctor, whereas the 1995 survey asked about HRT with no qualifications. It is probable that some respondents would have included non-prescribed medications (e.g. herbal and natural medications) when answering this question in the 1995 survey. As a result, it could be expected that the number of women reporting HRT use in the 1995 survey was inflated relative to the number which would have been identified using the 2001 approach.

            The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


            Contraception/protection

            Definition

            This topic refers primarily to the current use of contraceptive methods. Although it includes items which may be indicative of some protective or safe-sex practices, the data are not designed for this purpose, and any inferences drawn about sexual behaviours or use of safe sexual practices should be done with care.


            Methodology

            Questions on contraception were included on the Women’s Supplementary Health Form. Data were therefore collected only from women, but applied to the respondent and partner where appropriate. The self-completion methodology was adopted in recognition of the potential sensitivity of the topic.

            Women aged 18 to 49 years were asked whether they had ever taken the oral contraceptive pill for any reason, whether they were currently taking the contraceptive pill and their age when they first started taking the pill.

            All women were asked a general question which covered contraceptive practices, aspects of fertility and aspects of sexual behaviours, as shown below. Women were asked to mark all the categories which applied.

            Use condoms as protection against sexually transmitted diseases (STDs)
            Use condoms as contraception
            Take a contraceptive pill
            Use an IUD
            Use a diaphragm
            Use Natural, Rhythm or Billings method
            Use withdrawal method
            Had a contraceptive injection
            Take the morning after pill
            Had a tubal ligation/tubes tied
            Partner has been sterilised (including vasectomy)
            Had a hysterectomy
            Currently experiencing menopause
            Gone through menopause
            Infertile - self
            Infertile - partner
            Have a female partner
            Not sexually active
            None of these (above) apply

            In sparse NHS(I), women were asked to mark all the following categories which applied:
              Use condoms
              Have a baby needle (DepoProvera)
              Take the pill (contraceptive pill)
              Use the loop (IUD)
              Anything else to stop having babies
              Can't have babies (eg, infertile, tubes tied, menopause)
              Don't have partner/not sexually active
              None of these apply
            This was the only question regarding contraception asked in sparse NHS(I).
              Women in the NHS(G) and non-sparse NHS(I) who reported that they or their partner did not use contraception were asked for all the reasons they did not. Multiple categories could be selected from the following:

              Trying to get pregnant
              Currently pregnant
              Currently breastfeeding
              Had a recent pregnancy
              Had a tubal ligation/tubes tied
              Partner has been sterilised (including vasectomy)
              Had a hysterectomy
              Gone through menopause
              Infertile - self
              Infertile - partner
              Other medical reason limiting likelihood of pregnancy
              Take the morning after pill
              Have a female partner
              Not sexually active
              Don't like to use or believe it's not good for health or for religious reasons
              Other

              These questions were asked in a less structured form than most questions in the survey, to encourage and enable respondents to report their situation/practices without implying any judgements about the purposes or combinations of contraceptive practices, which may occur through formal questions. This approach was tested in the lead up to the survey and was found to be acceptable to respondents, and to yield data required by users.


              Population

              Information was collected for all women aged 18 to 49 years.


              Data items
              • whether ever taken the oral contraceptive pill
              • age when first started taking the oral contraceptive pill
              • whether currently taking the oral contraceptive pill
              • current condom use
              • type of contraceptive practice currently used (by self and/or partner).
              • combined contraception practices.

              Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


              Interpretation

              Points that should be kept in mind when interpreting data on this topic include:
              • space and time constraints on the survey resulted in questions on this topic only being asked of adult female respondents. Although these respondents were asked to report practices used by themselves and their partners (where applicable), the data recorded may differ from those recorded if males had also been asked these questions. The methodology may also have resulted in a tendency for the data to reflect practices in ongoing relationships
              • the data relate to contraceptive practices and should not be interpreted as necessarily indicative of sexual patterns
              • the data relate primarily to the contraceptive practices/situation current at the time of the survey, which may differ from the respondent's usual practices/situation. As a result, the data provide a point in time picture of practices/situation in the adult population, but care should be taken in relating those characteristics with other health characteristics described in the survey for individual respondents
              • the self-completion questionnaire ensured respondents privacy in reporting this information, although this may have been effected by the presence of other household members at interview. However, the potentially sensitive and personal nature of these questions may have impacted on respondents willingness to respond, and on the nature of those responses
              • some discrepancies occurred between answers provided in response to the general question about current practices outlined above, and the specific questions about current use of the contraceptive pill, and whether had a hysterectomy. By reference to other data sources, responses to the direct questions were deemed to be more accurate overall than responses to the general question. As a result, in published output data from the direct questions on current use of the contraceptive pill, and whether had a hysterectomy has replaced data from the general question for these two components.
              • data from the question regarding reasons for non-use of contraception is considered too unreliable for general use. Analysis of responses to this question indicated discrepancies with other data, and suggested that some respondents did not understand the question, or chose to respond in ways other than those anticipated (and required). The data from this question can be made available on request, but are not available in general survey outputs.


              Comparability with 1995

              Questions about use of the oral contraceptive pill are the same in the 2001 NHS(G) and 1995 surveys, and those data items are considered directly comparable.

              The questions on the use of, or reasons for non-use of, other contraceptive practices differ significantly between the surveys in approach, the underlying concepts and in the level of detail. Considerably more detail was collected in 2001 NHS(G) than in the 1995 survey. As a result, data for these items are not considered directly comparable between the surveys.

              The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


              Chapter 1 - Introduction

              Chapter 2 - Survey Design and Operation

              Chapter 3 - Health Status Indicators

              Chapter 4 - Health Related Actions

              Chapter 5 - Health Risk Factors

              Chapter 6 - Population Characteristics

              Chapter 7 - Data Quality and Interpretation of results

              Chapter 8 - Data Output and Dissemination
              Appendix 1 - Glossary of Terms Used

              Appendix 2 - Sample Counts and Weighted Estimates

              Appendix 3 - Classification of Long-term Medical Conditions: Based on ICD-10

              Appendix 4 - Classification of Long-term Medical Conditions: Based on ICD-9

              Appendix 5 - Classification of Long-term Medical Conditions: ICPC Based

              Appendix 6 - Classification of Type of Medication

              Appendix 7 - Classification of Country of Birth

              Appendix 8 - Classification of Language Spoken at Home
              Appendix 9 - Classification of Occupation

              Appendix 10 - Classification of Industry of Employment

              Appendix 11 - Classification of Types of Alcoholic Drinks

              Appendix 12 - Standard Errors

              Appendix 13 - Content of the 2001 National Health Survey (Indigenous)

              Appendix 14 - List of Abbreviations



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