4715.0 - National Aboriginal and Torres Strait Islander Health Survey, 2018-19 Quality Declaration 
Latest ISSUE Released at 11:30 AM (CANBERRA TIME) 11/12/2019   
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ASSESSING HEALTH RISK FACTORS


This appendix provides information about the guidelines and measures used to assess some specific lifestyle and related factors that impact on health.

ALCOHOL CONSUMPTION

Alcohol consumption risk levels were assessed using the single occasion and lifetime risk guidelines from the National Health and Medical Research Council (NHMRC) 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol.

    • These two guidelines are for people aged 18 years and over and recommend a maximum number of standard drinks per day. A standard drink contains 12.5 millilitres (mLs) of alcohol.
    • A separate guideline advises that, for people aged 15–17 years, the safest option is to delay the initiation of drinking alcohol for as long as possible. In this survey, people aged 15–17 years are assessed against the single occasion and lifetime risk guidelines to provide an estimate of the level of risk for this age group.

Alcohol consumption is likely to be under-reported. Some people who drank alcohol may not have reported it, and some may have reported it but understated the quantity consumed. The extent to which under-reporting has occurred is not able to be quantified.

Single occasion risk guideline

The single occasion risk guideline advises healthy males and females to drink no more than four standard drinks on a single occasion to reduce the risk of alcohol-related injury arising from that occasion.

In this survey, a person was considered to have exceeded the single occasion risk guideline if they had consumed more than four standard drinks on at least one day in the last 12 months.
    • This was assessed using a person’s response to questions about the number of times in the last 12 months they had consumed five or more standard drinks in one day.
    • The number of standard drinks was as reported by the person. This is different to the lifetime risk guideline, where the number of standard drinks was derived from information about the number, type, brand, and serving size of drinks consumed.

Lifetime risk guideline

The lifetime risk guideline advises healthy males and females to drink no more than two standard drinks per day to reduce the risk of harm from alcohol-related disease or injury over their lifetime.

In this survey, a person was considered to have exceeded the lifetime risk guideline if they had consumed more than two standard drinks per day on average in the last week. It was assumed the level of alcohol consumption in the last week was typical.

The average number of standard drinks per day was derived from information provided by the person about:
    • the number, type, brand, and serving sizes of alcoholic drinks consumed on (up to a maximum of) the three most recent days alcohol was consumed in the week prior to interview, and
    • the total number of days alcohol was consumed that week.

It was derived by:
    • calculating the total amount of alcohol consumed (in mLs) for each drink type by multiplying the alcohol content (%) by the volume (mL), based on the type (e.g. light beer, red wine), brand and number of drinks reported on the maximum of three most recent days alcohol was consumed in the previous week
    • summing the drink type results to derive the total alcohol consumption for the maximum of three most recent days alcohol was consumed
    • dividing that result by the number of days on which alcohol consumption was reported (that is, by one, two or three) to derive average daily alcohol consumption for those days
    • multiplying that daily average by the total number of days alcohol was consumed that week, and
    • dividing the result by seven to arrive at the average number of standard drinks consumed per day.

Where the precise type and/or brand of the drink was not known, the following default alcohol content values were used:
    • light beer — 2.7%
    • mid-strength beer — 3.5%
    • full-strength beer — 4.9%
    • wine coolers — 3.5%
    • low alcohol wines — 0.9%
    • fortified wines — 17.8%
    • white wine — 12.4%
    • red wine — 13.3%
    • sparkling wine/champagne — 13.3%
    • spirits — 40.0%
    • liqueurs — 20.0%
    • pre-mixed spirits (e.g. UDL) — 5.0%
    • alcoholic cider — 4.7%
    • cocktails — 31.5%
    • other alcoholic drinks — 27.4%.

Particular types or brands may contain more or less alcohol than this. However, the default values were considered sufficiently representative for the purposes of assessing lifetime risk and single occasion risk.

People who did not consume any alcohol

People who did not consume any alcohol in the week prior to interview were categorised as:
    • last consumed more than one week to less than 12 months ago
    • last consumed 12 months or more ago, or
    • never consumed.

Further information about measuring alcohol consumption

For a detailed explanation of the method used to measure alcohol consumption in ABS health surveys, see Alcohol Consumption in Australia: A Snapshot, 2007–08 (cat. no. 4832.0.55.001).

BLOOD PRESSURE (MEASURED)

People aged 18 years and over were asked to provide a blood pressure reading, voluntarily taken by the interviewer at the time of interview. Readings were categorised as:
    • normal — less than 120/80 mmHg (millimetres of mercury)
    • normal-high — from 120/80 to less than 140/90
    • high — from 140/90 to less than 160/100
    • very high — from 160/100 to less than 180/110
    • severe — from 180/110.

People were placed in the highest of the categories that either the systolic or diastolic reading fell into.

A reading of 140/90 mmHg or higher does not necessarily indicate a person has hypertension. In this survey, hypertension is defined as a condition that has lasted, or which the respondent expects to last, for six months or more.

The reading also does not take into account whether a person might have had a high blood pressure reading if they were not managing it through the use of medication.

BODY MASS INDEX (BMI)

Body Mass Index (BMI) is a simple index of weight-for-height, commonly used for defining whether a person is underweight, normal weight, overweight or obese.

A BMI score is calculated using the formula weight (in kilograms) divided by the square of height (in metres). For example, a person who weighs 70 kilograms and whose height is 1.75 metres will have a BMI of 22.9 (70/(1.75m2) = 70/3.06 = 22.9).

There were two measures of BMI in this survey:
    • self-reported (for people aged two years and over) — based on a person reporting their height and weight
    • measured (for people aged two years and over) — based on a measure of the person’s height and weight, voluntarily taken by the interviewer at the time of interview.

Interviewers used digital scales to measure weight (maximum 200 kilograms) and a stadiometer to measure height (maximum 210 centimetres). Women who advised they were pregnant were not measured. For more information see Physical measurements (appendix).

BMI classification for persons aged 18 years and over

People aged 18 years and over were classified as underweight, normal weight, overweight or obese based on their BMI score as recommended by the World Health Organization’s BMI Classification:
    • underweight Class 3 — 15.99 or less
    • underweight Class 2 — 16.00–16.99
    • underweight Class 1 — 17.00–18.49
    • normal range — 18.50–24.99
    • overweight — 25.00–29.99
    • obese Class 1 — 30.00–34.99
    • obese Class 2 — 35.00–39.99
    • obese Class 3 — 40.00 or more.

BMI classification for children aged 2–17 years

BMI categories for children aged 2–17 years were:
    • underweight — Class 3, Class 2, and Class 1
    • normal range
    • overweight
    • obese Class 1.

The BMI scores for each category take into account the age and sex of the child. For a detailed list of the cut-offs see Appendix 4 in the National Health Survey: Users’ Guide, 2017–18 (cat. no. 4363.0).

BREASTFEEDING

Breastfeeding of children aged three years and under was assessed using the National Health and Medical Research Council's 2012 Infant Feeding Guidelines. The guidelines recommend infants:
    • be exclusively breastfed to around six months of age (the six month guideline)
    • continue to be breastfed with appropriate complementary foods until at least 12 months of age (the 12 month guideline).

The six month guideline was considered to have been met if a child had been exclusively breastfed for at least six months. Children under the age of six months were excluded.

The 12 month guideline was considered to have been met if a child was exclusively breastfed for at least six months and then continued to be breastfed to 12 months of age. Children under the age of 12 months were excluded.

If unable to determine whether a child was exclusively breastfed for six months, or exclusively breastfed for six months then continued to be breastfed to 12 months of age, they were classified as not known.

For further information about collection methods and data quality see Explanatory notes.

FRUIT AND VEGETABLE CONSUMPTION

Fruit and vegetable consumption was assessed using the National Health and Medical Research Council (NHMRC) 2013 Australian Dietary Guidelines.
    • The guidelines recommend a minimum number of serves of fruit and vegetables each day, depending on a person's age and sex.
    • Several age recommendations include half servings. In this survey, only whole serves were collected, so half serves in the guidelines were rounded up to the nearest whole serve for the purpose of assessing whether a person met the relevant guideline.

Usual daily intake of fruit

Both males and females were considered to have met the guideline for fruit consumption if they usually consumed at least the following number of serves per day:
    • one serve for those aged 2–3 years
    • two serves for those aged four years and over.

One serve is approximately 150 grams of fresh fruit or 30 grams of dried fruit.

Usual daily intake of vegetables


Children were considered to have met the guideline for vegetable consumption if they consumed at least the following number of serves per day:
    • three serves for those aged 2–3 years
    • five serves for those aged 4–8 years
    • five serves for those aged 9–11 years
    • six serves for boys aged 12–17 years
    • five serves for girls aged 12–17 years.

People aged 18 years and over were considered to have met the guideline if they usually consumed at least the following number of serves per day:
    • six serves for males aged 18–70 years
    • five serves for males aged 71 years and over
    • five serves for females aged 18 years and over.

One serve is approximately half a cup of cooked vegetables or one cup of salad vegetables — equivalent to approximately 75 grams.

PHYSICAL ACTIVITY (NON-REMOTE)

Physical activity undertaken by people living in non-remote areas was assessed based on an interpretation of Department of Health guidelines.
    • For the pre-2014 guidelines, the National Physical Activity Guidelines for Australian Adults were used for all people aged 18 years and over.

To meet either set of guidelines, people needed to do varying combinations of some or all of the following physical activities:
    • walking for transport
    • walking for fitness, recreation or sport
    • moderate intensity exercise
    • vigorous intensity exercise
    • strength or toning activities.

2014 guidelines for people aged 15–17 years

In this survey, people aged 15–17 years were considered to have met the guidelines if, in the last week, they did:
    • one or more of the following for at least 60 minutes every day: ­walking for transport, walking for fitness, recreation or sport, moderate intensity exercise, or vigorous intensity exercise, and
    • some vigorous intensity exercise, and
    • strength or toning activities on at least three days.

2014 guidelines for people aged 18–64 years

In this survey, people aged 18–64 years were considered to have met the guidelines if, in the last week, they:
    • did one or more of the following at least five days: walking for transport, walking for fitness, recreation or sport, moderate intensity exercise, or vigorous intensity exercise, and
    • accumulated at least 150 minutes of any combination of the above (vigorous intensity exercise time is multiplied by two), and
    • did strength or toning activities on at least two days.

2014 guidelines for people aged 65 years and over

In this survey, people aged 65 years and over were considered to have met the guidelines if, in the last week, they did:
    • one or more of the following every day: walking for transport, walking for fitness, recreation or sport, moderate intensity exercise, or vigorous intensity exercise, and
    • any combination of the above for at least 30 minutes on five or more days.

Pre-2014 guidelines for people aged 18 years and over

There were two guidelines for people aged 18 years and over. In this survey, people were considered to have met:
    • the first guideline if, in the last week, they had accumulated 150 minutes of physical activity from any combination of the following: walking for transport, walking for fitness, recreation or sport, moderate intensity exercise, or vigorous intensity exercise
    • the second guideline if, in the last week, they met the first guideline and undertook any of those activities on at least five occasions.

For more information about the pre-2014 guidelines, see Australian Aboriginal and Torres Strait Islander Health Survey: Users’ Guide, 2012–13 (cat. no. 4727.0.55.002).

SMOKING

People aged 15 years and over were asked about the extent to which they were regularly smoking tobacco products and using e-cigarettes/vaping at the time of interview.

Tobacco products include:
    • manufactured (packet) cigarettes
    • roll-your-own cigarettes
    • pipes, cigars or other tobacco products.

Tobacco products exclude:
    • chewing tobacco
    • smoking of non-tobacco products (such as marijuana).

A person’s smoker status for tobacco products was categorised as:
    • current daily smoker — a person who reported they regularly smoked one or more cigarettes, pipes, cigars or other tobacco products per day
    • current smoker less than daily — a person who reported they smoked cigarettes, pipes, cigars or other tobacco products less frequently than daily
    • ex-smoker — a person who reported they did not currently smoke but had previously either regularly smoked daily, smoked at least 100 cigarettes in their lifetime, or smoked pipes, cigars or other tobacco products at least 20 times in their lifetime
    • never smoked — a person who reported they had never regularly smoked daily, smoked less than 100 cigarettes in their lifetime, and smoked pipes, cigars or other tobacco products less than 20 times in their lifetime.

An e-cigarette user/vape smoker was a person who uses or has ever used an electronic cigarette, a battery operated device that resembles tobacco cigarettes, pipes or cigars to inhale nicotine and/or other chemicals in a vapour form rather than smoke.
    • For e-cigarettes/vapes containing nicotine, people were asked if they had used them in the previous 12 months and, if so, how often.
    • For e-cigarettes/vapes excluding nicotine, people were asked whether they had ever used them and, if currently using them, how often.

Smoking is likely to be under-reported. Some current smokers may not have identified as such due to social pressures, especially where other household members were present at the interview. The extent to which under-reporting has occurred is not able to be quantified.

WAIST CIRCUMFERENCE

Waist circumference is a measurement, in centimetres (cm), of a person’s waist. Measurements were voluntarily taken:
    • by the interviewer at the time of interview using a tape measure (maximum 200 cm)
    • from people aged two years and over, excluding women who had volunteered that they were pregnant.

The waist circumferences of people aged 18 years and over were classified by sex as recommended by the World Health Organization’s 2008 Waist Circumference and Waist-Hip Ratio: Report of a WHO Consultation as:
    • not at risk — less than 94 cm for males, or less than 80 cm for females
    • increased risk — 94 cm to less than 102 cm for males, or 80 cm to less than 88 cm for females
    • substantially increased risk — 102 cm or more for males, or 88 cm or more for females.