National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey methodology

The 2023 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS) is a component of the wider Intergenerational Health and Mental Health Study (IHMHS) funded by the Australian Government Department of Health, Disability and Ageing. It was conducted from January 2023 to March 2024. Data was collected from approximately 2,100 households around Australia, in both non-remote and remote areas, including discrete Indigenous communities.

The main aim of the NATSINPAS is to provide information about Aboriginal and Torres Strait Islander people throughout Australia on the following key topics:

• general health (including selected health conditions, disability and smoking status)
• nutritional intake
• dietary supplements
• physical activity and inactivity
• sedentary behaviour
• sleep characteristics.

Self-reported health status, height, and weight were also collected. Respondents could voluntarily provide blood pressure, height, weight and waist measurements. 

Some topics were included for the first time in the 2023 NATSINPAS, including main type of oils and fat used when cooking, barriers to accessing healthy and nutritious foods, key influences on dietary choices, consumption of tap water at home and food security. Information about physical activity, inactivity and sleep was also measured using an accelerometer for the first time. Accelerometers are wearable devices that detect change in speed.

The survey also collected information on a standard set of demographic topics about respondents including age, sex at birth, main language, employment, education and income.

The food and nutrient data for the 2023 NATSINPAS is generally comparable with the 2012–13 NATSINPAS. However, data items relating to self-reported physical activity, sedentary behaviour and sleep are generally not considered to be comparable to the 2012–13 NATSINPAS. Key differences from the 2012–13 NATSINPAS are detailed in the Comparability with previous surveys in the General considerations section. 

The survey was possible thanks to the high level of cooperation from our Aboriginal and Torres Strait Islander peoples and their communities. Without their continued support of ABS surveys, the collection of data and the wide range of information available for Aboriginal and Torres Strait Islander peoples published by the ABS would not be possible.

The survey was developed following extensive consultation to identify priority data requirements and data gaps. In addition to consulting with key stakeholders from government, research sector and community organisations, workshops were held with Aboriginal and Torres Strait Islander community members to capture their thoughts about issues that are critical to Aboriginal and Torres Strait Islander people, their families and communities.

Key consultation included:

• establishing advisory and reference groups to assist the ABS in determining the content of the survey and to advise on data output requirements.
• establishing expert advisory panels to advise the ABS on selected topics. These panels comprised key researchers from the Aboriginal and Torres Strait Islander community, as well as government and non-government agencies.
• testing new questions with Aboriginal and Torres Strait Islander people and communities to ensure concepts would be understood by respondents, and to refine the questions and associated procedures.

A dress rehearsal was also conducted in April–May 2022 to test survey content and procedures. 

The range of topics identified for possible inclusion exceeded the capacity of the survey. With the assistance of the advisory and reference groups, topics were prioritised, then shortlisted. Topics ultimately selected for inclusion in the survey were those identified as highest priority which could be appropriately collected in a survey of this type. 

The scope of the survey was all Aboriginal and Torres Strait Islander people aged 2 years and over living in private dwellings.

The following people were not included in the survey:

• non-Indigenous persons
• visitors to private dwellings staying for less than 6 months
• people in households where all usual residents were less than 18 years of age
• people who usually lived in non-private dwellings, such as hotels, motels, hostels, hospitals, nursing homes and short-stay caravan parks
• students at boarding school
• non-Australian diplomats, diplomatic staff and members of their household
• members of non-Australian defence forces stationed in Australia and their dependants
• overseas visitors.

Coverage exclusions apply to those people who were in scope for the survey, but who were not included in the sampling frame. The following coverage exclusions were applied:

• mesh blocks with no or very few Aboriginal and Torres Strait Islander households
• some discrete Indigenous communities and outstations with a small number of Aboriginal and Torres Strait Islander households
• long-stay caravan parks and marinas.

The overall coverage of the 2023 NATSINPAS was approximately 24% of Aboriginal and Torres Strait Islander persons in Australia. The final sample has been weighted to population benchmarks, which align with the scope of the survey, to account for undercoverage. For more information, see the How the data is processed section.

The survey was designed to produce reliable estimates for the whole of Australia and for remoteness areas. The sample was designed to achieve a Relative Standard Error of less than 25% for key variables.

The survey sample had two parts:

• a community sample, comprising discrete Indigenous communities, including any outstations associated with them; and
• a non-community sample, comprising persons within areas outside Indigenous communities. 

Each part used a multi-stage sampling process to ensure the representativeness of the final sample. The community sample allocation was a random selection of discrete Indigenous communities and outstations in remote areas.

• Selections were made using the Dwelling Register for Aboriginal and Torres Strait Islander Communities (DRATSIC). The DRATSIC was constructed from counts from the 2021 Census of Population and Housing. See the ABS address register page for further details on DRATSIC.
• Communities in Victoria, Tasmania and the ACT were excluded from coverage entirely, consistent with the 2022–23 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), as there were no community addresses found.
• Communities in New South Wales were also excluded from coverage entirely, consistent with the 2012–13 NATSINPAS.
• Non-remote communities were excluded from sample allocation.

Dwellings in the non-community sample were selected using a stratified multi-stage area sample.

• Mesh blocks with no Aboriginal and Torres Strait Islander households, as identified in the 2021 Census, were excluded from coverage.
• Areas in remote Victoria and very remote Tasmania were excluded, consistent with the 2022–23 NATSIHS.
• For each randomly selected dwelling within the selected mesh block, one usual resident aged 18 years or over was asked whether anyone in the household was of Aboriginal and/or Torres Strait Islander origin. This screening question was used to identify Aboriginal and Torres Strait Islander households, from which the sampling process was undertaken for participants in the survey.

Within each identified Aboriginal and Torres Strait Islander household in both the community and non-community sample, up to one adult (aged 18 years and over) and one child (aged 2–17 years) was randomly selected.

The sample design had an expected number of 4,131 fully responding persons. The final survey data file had 2,879 fully responding persons, the calculation of which is explained below.

A total of 4,791 households were selected in the sample. These were identified by screening households in non-community areas and through selections of discrete Indigenous communities. The sample was then reduced to 4,223 households after excluding those unable to be contacted after screening.

Of the 4,223 households in the final sample, 2,097 (49.7%) were fully or adequately responding households. These are households where at least one person selected to complete the survey had either completed it fully or to a point where their data could still be used.

From the 2,097 fully or adequately responding households, there were 2,879 people included in the final sample.

Interviews were conducted on all days of the week; however, the proportion of people who responded varied across each day. Monday was the most common day of interview and Saturday was the least common day of interview. 

The 24-hour dietary recall consumption was of the day prior to interview (from midnight to midnight). For example, if an interview was conducted on Monday, the dietary recall tool would collect consumption for Sunday. The distribution of each interview day is shown in the table below. 

Many data items are impacted by the day of the week, such as food types collected in the 24-hour dietary recall and sleep. This impact was not controlled for and should be noted during analysis or interpretation.

Of the 2,879 respondents aged 5 years and over, 817 were fully/adequately responding (met the minimum wear threshold of 48 hours or more), an opt-in rate of 28.4%.

Interviewer training

Information was collected by trained ABS interviewers using a computer-based questionnaire. Prior to enumeration, interviewers:

• participated in cultural awareness training which described cultural considerations and sensitivities around conducting surveys with the Aboriginal and Torres Strait Islander population
• completed training and exercises to gain an understanding of the survey content and procedures.

Face-to-face interviews

Interviewers conducted face-to-face interviews in all selected households.

A person aged 18 years or over was asked to provide basic information for all usual residents of the household, including Indigenous status, age, sex and relationships. A usual resident of the household aged 18 years or over, known as the household spokesperson, then answered financial and housing questions, such as income, tenure arrangements, household facilities and food security.

Personal interviews were then conducted with selected Aboriginal and Torres Strait Islander persons aged 15 years and over. Some people were unable to be interviewed because:

• of injury or illness (a proxy interview may have been arranged)
• of cultural considerations, such as mourning the death of a family member (sorry business) or
• an interpreter was required and unable to be arranged.

For selected persons aged 15–17 years:

• a personal interview was conducted if a parent or guardian provided consent, or
• their interview was completed by a proxy (that is, by a parent or guardian).

A parent or guardian was required to be present for any personal interviews conducted with persons aged 15–17 years.

An adult was asked to respond on behalf of children aged less than 15 years.

Dietary intake data was collected using a 24-hour dietary recall instrument called Intake24. One day of data was collected for 24 hours, from midnight to midnight, on the day prior to interview.

Respondents could volunteer to wear a device called an accelerometer, which collected detailed physical activity information (using acceleration). Accelerometers had to be physically returned to the ABS to enable the data to be extracted. 

• For the non-remote sample and remote non-community sample, respondents were asked to wear the accelerometer for 7 days, then post back using a pre-paid envelope.
• For the remote discrete Indigenous community-based sample, respondents were asked to wear the accelerometer for 4 days. The accelerometer was collected by an ABS Engagement Manager, who posted them back to the ABS. 

The shorter wear time for the remote community sample enabled the accelerometers to be collected by ABS Engagement Managers while they were still in community. Before making this change, ABS sought advice from accelerometry experts on the minimum amount of data that could be collected to produce reliable daily estimates. This procedure reduced respondent burden while maximising the likelihood of a successful return of the accelerometers. More information is available in the Measured Physical Activity and Sleep section.

Use of local Aboriginal and Torres Strait Islander advisors

In communities and in some regional areas, interviewers were accompanied, where possible, by local Aboriginal and Torres Strait Islander advisors who assisted in conducting interviews. The advisors:

• explained the purpose of the survey
• introduced the interviewers, and
• assisted in identifying usual residents of a household and in locating residents who were not at home.

Variations in data collection and survey questions in remote areas

To take account of language and cultural differences, the collection method and survey questions sometimes varied in remote areas.

• Some questions were reworded to enhance a person’s ability to understand concepts.
• Some topics were excluded if they were not suitable to collect or not applicable.

This means some data items are not available for the total Aboriginal and Torres Strait Islander population. For more information on the availability of data items, see the Data Item List.

Content

The survey collected the following content:

• Demographics – age, sex, language, social marital status
• Household details – type, size, household composition, tenure, Socio-Economic Indexes for Areas (SEIFA), geography
• Proxy status
• Food security and financial stress
• Work details, including labour force status
• Defence force service
• Educational attainment
• Access to working household appliances and structural problems with the dwelling
• Personal and household income
• Self-assessed health status
• Disability and long-term health conditions, including detailed questions on cardiovascular diseases, diabetes and high sugar levels, kidney disease and mental health conditions
• Smoking
• Fruit and vegetable consumption
• Physical activity
• Social and emotional wellbeing
• 24-hour dietary recall
• Specific dietary information such as food avoidance, consumption of oils, fats, salt, and dietary supplements
• Sources of tap water
• Barriers to healthy and nutritious foods
• Key influences on dietary choices
• Physical and sedentary activity
• Barriers to physical activity
• Sleep behaviours
• Self-reported height and weight
• Physical Measures – blood pressure, height, weight and waist.

The 2023 NATSINPAS uses the Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables, 2020. Data from this survey are typically presented using the Sex at birth variable. When a small number of responses are recorded in any output category, outputs may be suppressed or combined into other categories due to confidentiality and statistical issues. A small number of people in the survey reported having a term other than male or female recorded as their sex at birth. Estimates for people whose sex at birth is neither male nor female cannot be output as a separate category, but are included in the estimates for total persons.

For a full list of content collected, see the Data Item List.

As part of the IHMHS, respondents aged 5 years and over were asked if they would like to participate in the National Aboriginal and Torres Strait Islander Health Measures Survey (NATSIHMS). This involved voluntarily providing blood and/or urine samples (urine samples only for children aged 5–11 years) at a pathology collection centre. For some communities, visiting pathology services were arranged.

Survey materials

A copy of the questionnaire, prompt cards and measurements card are available on request by emailing client.services@abs.gov.au or calling 1300 135 070.

As only a sample of people in Australia were surveyed, results needed to be converted into estimates for the whole population. This was done through a process called weighting:

• Each person or household is given a number (known as a weight) to reflect how many people or households they represent in the whole population.
• A person or household’s initial weight is based on their probability of being selected in the sample. For example, if the probability of being selected in the survey was one in 45, then the person would have an initial weight of 45 (that is, they would represent 45 people).

The person weights are then calibrated to align with independent estimates of the in-scope population, called ‘benchmarks’. The benchmarks use additional information about the population to ensure that:

• people in the sample represent people that are similar to them, and
• the survey estimates reflect the distribution of the whole population, not the sample.

For this survey, person weights were simultaneously calibrated to the following population benchmarks:

• state/territory by remoteness area
• state/territory by age by sex
• Torres Strait Islander status by Torres Strait Islander region by adult/child status
• remoteness area by age by sex
• state/territory by discrete Indigenous community.

The survey was benchmarked to the estimated Aboriginal and Torres Strait Islander resident population living in private dwellings at 30 June 2023 which was 946,233 persons. As people in non-private dwellings (for example, hotels) are excluded from the scope of the survey, they were also excluded from the survey benchmarks. The 2023 estimates do not, and are not intended to, match estimates for the total resident Aboriginal and Torres Strait Islander population obtained from other sources. This approach is consistent with the 2022–23 NATSIHS.

For household weights, the ABS does not produce counts of Aboriginal and Torres Strait Islander dwellings so household level benchmarks are not available. Instead, a household composition benchmark was calculated using the weighted person level data. 

Initial household weights were the average of the final person level weights of the respondents in the household, with an adjustment for the number of Aboriginal and Torres Strait Islander persons in the household.

Estimates of the number of households by household composition (number of adults and number of children) were produced using the weighted person level dataset. These estimates were used as household benchmarks. 

The household weights were then calibrated to the following benchmarks, derived from the weighted person dataset:

• state/territory by discrete Indigenous community by household composition
• state/territory by remoteness area by household composition

The sum of the household weights provides an estimate of the number of Aboriginal and Torres Strait Islander households.

Undercoverage is a potential source of non-sampling error. It is the shortfall between the population represented by the achieved sample and the in-scope population. It can introduce bias into the survey estimates; however, the extent of any bias depends on the size of the undercoverage as well as the difference in the characteristics of those people in the coverage population and those of the in-scope population.

Undercoverage rates can be estimated by calculating the difference between the sum of the initial weights of the sample and the population count. If a survey has no undercoverage, then the sum of the initial weights of the sample would equal the population count (ignoring small variations due to sampling error).

In the 2023 NATSINPAS, there was an increase in the undercoverage rate compared with previous Aboriginal and Torres Strait Islander surveys. The overall undercoverage rate was approximately 76% of the in-scope population at the national level. The estimated undercoverage in the 2022–23 NATSIHS was 75%, while in the 2012–13 NATSINPAS it was 63%.

The undercoverage rate for non-community areas was approximately 78% and for community areas was approximately 47%. The undercoverage rate varied across the states and territories.

Given the high undercoverage rate, extensive analysis was undertaken to ensure the results were consistent with other data sources. Potential bias due to undercoverage was addressed by adjusting the initial weights and using population benchmarks.

Undercoverage may occur due to several factors, including:

• frame exclusions (areas being removed from the sampling frame)
• non-response
• people not identifying as being of Aboriginal and/or Torres Strait Islander origin
• issues arising in the field.

Each of the factors is explained in more detail below.

Similar to the 2012–13 NATSINPAS and 2022–23 NATSIHS, frame exclusions were incorporated to make the sample design more efficient. Part of the frame exclusion that could be contributing to undercoverage are people who may have moved since the 2021 Census of Population and Housing.

Non-response may occur when people cannot or will not participate, or they cannot be contacted. The loss of information on persons and households reduces the sample and increases both sampling error and the likelihood of incurring response bias.

Non-response in this survey includes non-response to:

• the screening question
• the survey after identification of an Aboriginal and Torres Strait Islander household.

To reduce non-response, the following methods were used:

• face-to-face interviews with respondents
• employment of local Aboriginal and Torres Strait Islander advisors to assist with interviewing in communities and some regional areas
• follow up of respondents if there was initially no response
• aligning the estimates with population benchmarks to ensure the weighted file was representative of the population.

Of those households who were approached for screening in non-community areas, 4.0% were identified as having an Aboriginal or Torres Strait Islander usual resident. Of these identified households, 57.1% then responded to the survey.

In discrete Indigenous communities, 77.1% of approached in-scope households responded to the survey.

Some Aboriginal and Torres Strait Islander households may not have been identified during the screening process due to:

• Aboriginal and Torres Strait Islander people not identifying themselves as being of Aboriginal and/or Torres Strait Islander origin
• the household spokesperson being unable to provide the Indigenous status of other residents.

There was a large increase in the number of people identifying as being of Aboriginal and/or Torres Strait Islander origin between the 2016 and 2021 Censuses of Population and Housing, and these people may not have chosen to identify in the same way for the 2023 NATSINPAS for various reasons. Data from the 2021 Census is part of the population benchmarks used in this survey. For more information about the change across the Censuses, please refer to Understanding change in counts of Aboriginal and Torres Strait I Islander Australians: Census, 2021. 

Known undercoverage due to issues arising in the field include sample being excluded due to:

• occupational, health and safety issues, including natural disasters
• time constraints, particularly in Aboriginal and Torres Strait Islander communities and their associated outstations.

This release presents nutrition, physical activity and sleep estimates for the Aboriginal and Torres Strait Islander population for 2023. Commentary presents analysis of national data by remoteness and other demographics.

Data cubes (spreadsheets) present proportions and their associated measures of error at a national level, by remoteness and other demographic variables. A Data Item List is also available.

The ABS supports a strengths-based approach when disseminating data about the Aboriginal and Torres Strait Islander population. No comparisons with the non-Indigenous population are included in this release. For advice on making comparisons, see Non-Indigenous comparisons under the General considerations section. 

Additional data from the survey will be available via a range of other products and services.

The ABS is committed to supporting Aboriginal and Torres Strait Islander communities to achieve better outcomes through well-informed policy and decisions. The ABS will promote and disseminate results from the 2023 NATSINPAS primarily through its Engagement Managers – see Engagement resources.

The Census and Statistics Act 1905 authorises the ABS to collect statistical information and requires that information is not published in a way that could identify a particular person or organisation. 

To minimise the risk of identifying individuals in aggregate statistics, a technique called perturbation is used to randomly adjust cell values. Perturbation involves small random adjustment of the statistics which have a negligible impact on the underlying pattern. This is considered the best technique for avoiding the release of identifiable data while maximising the information that can be released. After perturbation, a given published cell value will be consistent across all tables. However, adding up cell values in Data Cubes to derive a total may give a slightly different result to the published totals.  

The ABS previously conducted the NATSINPAS in 2012–13 as part of the Australian Aboriginal and Torres Strait Islander Health Survey. The 2023 NATSINPAS is generally comparable to the 2012–13 survey. However, due to the time between the two NATSINPAS surveys, there have been numerous changes to the content. These changes are mostly due to updates to relevant nutrition and physical activity guidelines, updates to demographic standards and the addition of content based on user needs.

Based on Census data, between 2011 and 2021, the Aboriginal and Torres Strait Islander population increased by 48.2% or 264,358 people. When comparing estimates from the 2023 NATSINPAS with previous surveys, users should be aware of the large increase in the Aboriginal and Torres Strait Islander population and consider the impact this may have when interpreting change over time.

The following table summarises the main content changes applied in the 2023 NATSINPAS compared with the 2012–13 survey. For full details of available data items, refer to the Data Item List.

Care has been taken to ensure that the results of this survey are as accurate as possible. The following factors should be considered when interpreting these estimates.

• Information recorded in the survey is ‘as reported’ by respondents and may differ from information available from other sources or collected using different methodologies.
• Results from previous surveys have shown a tendency for people to under-report when asked about certain topics, such as alcohol consumption and smoking.
• Different data items were collected for different time periods. The reliability and accuracy of data are dependent on the respondent's recall.
• Seasonal effects (for example, inability to access healthy and nutritious foods when wanted to in the 4 weeks prior to interview due to roads being impassable) may have impacted questions that specify time periods.
• Some people may have provided responses they felt were expected, rather than those that accurately reflect their own situation.

For some survey data items, some people were unwilling or unable to provide the requested information.

• Where responses for a particular data item were missing for a person or household they were recorded in a ‘not known’, ‘not stated’ or ‘refusal’ category.
• 'Not stated’ categories have either been included in the data cubes as part of the total, or they appear as a separate category. This allows users to determine the suitability of the data for their purposes.

‘Family composition’ is created through the relationships that exist between a single ‘responsible adult’ and each other member of that family living in the household. Family composition is then allocated based on whether the types of relationships given below are present or not in the family, in the following order of precedence.

• A couple relationship is defined as a registered or de facto marriage, including same-sex relationships.
• A parent-child relationship is defined as a relationship between two persons usually resident in the same household. The child is attached to the parent via a natural, adoptive, step, foster or child dependency relationship.
• A child dependency relationship is defined as including all children under the age of 15 years (whether related or unrelated to the family reference person) and those natural, step, adopted or foster children who are full-time students aged 15–24 years.
• Other relationship is defined as including all those persons related by blood or by marriage who are not covered by the above relationships.

The definition of family used for the 2023 NATSINPAS is a more restrictive definition than the ordinary notion of the term ‘family’ which generally includes relatives whether they live together or not. This reflects the need to place some physical bound on the extent of family for the purposes of being able to collect family data in surveys.

Information was collected using the short-form version of the questions used in the ABS’ monthly Labour Force Survey.

Questions in the 2023 NATSINPAS employment module referred to the Community Development Program (CDP). The labour force status of a person on the CDP depended on who paid for the work they did.

• If they reported they were paid by an employer or another source, they were considered employed.
• If they reported they were paid by Centrelink or were unpaid, they were considered either unemployed or not in the labour force. They were asked further questions to determine their final labour force status.

Differences in household types and compositions, and their requirements relative to income, can be taken into account by the application of equivalence scales. These scales are a set of ratios which, when applied to the income of different household or income unit types, produce standardised estimates of income which reflect the households' relative well-being. The modified Organisation for Economic Co-operation and Development (OECD) equivalence scale (1994) was used.

Equivalised income is derived by calculating an equivalence factor and then dividing income by that factor. The equivalence factor is built up by allocating points to each person in the household unit and summing those points. One point is allocated to the first adult in the unit, 0.5 points for each other person aged 15 years and over, and 0.3 points for each person aged less than 15 years. For example:

• a single person household has a factor of one, so equivalised income is therefore the same as reported income
• a household comprising 2 adults and a child aged less than 15 years would have a factor of 1.8, so equivalised income for this household is therefore the household income divided by 1.8.

Equivalised income is available in dollar amounts and deciles.

Income deciles

In the 2023 NATSINPAS, the deciles for both household and personal income were not taken from the deciles within the survey. Instead, a national figure which includes both non-Indigenous and Aboriginal and Torres Strait Islander households was used, meaning each decile may not necessarily contain 10% of the in-scope population. The income decile boundaries from the 2023 NNPAS were used for household income, however, as the 2023 NNPAS did not collect personal income, the decile boundaries from the 2022 NHS were used. These were adjusted for inflation using the Consumer Price Index to account for the enumeration period difference between the 2022 NHS and the 2023 NATSINPAS.

The dollar amount cut-offs for the household and personal income deciles are available in the Data Item List in the Data downloads section. 

Income quintiles were created by combining deciles, meaning each quintile may not contain 20% of the in-scope population.

The ABS supports a strengths-based approach when disseminating data about the Aboriginal and Torres Strait Islander population. No comparisons with the non-Indigenous population are included in releases from this survey.

However, the ABS acknowledges some users may want to compare the NATSINPAS data for the Aboriginal and Torres Strait Islander population with data for the non-Indigenous population from other surveys, such as the 2023 National Nutrition and Physical Activity Survey.

The Aboriginal and Torres Strait Islander population has a younger age structure than the non-Indigenous population. Age is strongly related to many population characteristics, such as energy requirements and employment patterns. To account for this, the ABS uses a technique called age standardisation to produce proportions that can be used for comparison purposes. Age standardised estimates of prevalence are those rates that ‘would have occurred’ should both the Aboriginal and Torres Strait Islander and non-Indigenous populations have the same age composition.

The ABS recommends any comparisons between the Aboriginal and Torres Strait Islander population and the non-Indigenous population for characteristics which are associated with age are done using age standardised estimates. Age standardised estimates are not required when making comparisons by age group (for example, 18–24 years).

Age standardised estimates can be produced on request by the ABS as a paid consultancy – see Consultancy request form for more information.

Fruit and vegetable consumption was assessed using the National Health and Medical Research Council’s (NHMRC) 2013 Australian Dietary Guidelines . The guidelines recommend consumption of a minimum number of serves of fruit and vegetables each day, depending on a person's age and sex. Consumption was assessed using a respondent's reported usual daily intake in serves of fruit and vegetables. All drinks, beverages and juices were excluded. 

A serve of fruit is approximately 150 grams of fresh fruit or 30 grams of dried fruit. A serve of vegetables is approximately half a cup of cooked vegetables (including legumes) or one cup of salad vegetables – equivalent to approximately 75 grams. Tomatoes were included as vegetables.

The main type of oil or fat used to cook dishes containing vegetables, meat, chicken or seafood was asked of respondents 18 years and over. Persons in the household aged 2–17 years were then given the responses of the selected adult respondent in the household. Oils and fats used in baking were excluded.

Responses to these questions are used to determine the oil and fat content of home-prepared foods consumed in the 24-hour dietary recall. More information is available in the Intergenerational Health and Mental Health Study: Concepts, Sources and Methods.

Respondents aged 2 years and over were asked questions about the main source of their tap water at home, whether they consume tap water at home, and whether they had experienced any barriers to drinking tap water at home in the last 12 months. Respondents who had experienced barriers were asked for the reasons why (for example, taste, safety concerns).  

Water intake was also recorded during the 24-hour dietary recall.

Since the 2012–13 survey, there has been a change in the way the frequency of salt used for cooking or preparing food was collected. In 2023, respondents aged 18 years and over were asked how often salt is used in cooking and preparing meals, the type of salt used and if it is iodised. Persons in the household aged 2–17 years were then given the responses of the selected adult respondent in the household. This differed from 2012–13, where the questions were asked of all respondents aged 2 years and over.

Like the 2012–13 survey, all selected persons aged 2 years and over were asked if salt is added to food at the table and, if yes, the type of salt added (for example, ordinary salt or salt substitute) and whether it is iodised. 

For information on how overall salt consumption is estimated in the 24-hour dietary recall, see Intergenerational Health and Mental Health Study: Concepts, Sources and Methods.

Respondents aged 18 years and over were asked how often they were able to access healthy and nutritious foods when they wanted to in the last 4 weeks. Respondents who indicated they could not always access healthy and nutritious foods when they wanted to were asked the reasons why (for example, cost, availability).

There are many factors that influence what people choose to eat or drink. Respondents aged 18 years and over living in non-remote areas were asked about the reasons they choose the food and drinks they usually consume, such as cost, taste and availability.

Respondents were also able to respond that they do not usually choose their food or drinks. 

In this survey, a household’s food security status was based on whether one or more members of the household had enough food, or money to buy the food, needed for an active, healthy life at all times in the last 12 months. This was assessed using a set of 10 questions, known as the Adult Food Security Survey Module, developed by the United States Department of Agriculture (USDA). 

• The questions were asked of a household spokesperson aged 18 years or over, on behalf of all members of the household.
• The specific experiences of children in the household do not form part of this measure.
• Minor modifications were made to the wording used in some questions to improve their ability to be understood and interpreted in the Australian context.

Households were asked 3 questions to establish whether there were any indicators of food insecurity. If at least one question was answered in the affirmative, households were asked more questions to establish the severity of food insecurity. Households were scored 1 for each affirmative response to give a total score between 0 and 10.

Around 9.1% of households had at least one missing response and required responses to be imputed. Missing values were imputed based on the household’s responses to other questions using the USDA’s direct imputation method. An affirmative response was imputed only if a household indicated it had experienced all of the less severe types of food insecurity and also experienced a more severe type of food insecurity. A small proportion of households (0.5%) that did not answer all of the first 3 questions did not have missing values imputed and were unable to be classified.

Households were then classified as having experienced food security or marginal, moderate or severe food insecurity based on their total score. Following consultation with Australian food security experts, the ABS adopted Statistics Canada’s approach to classifying households. This differs from the USDA approach by:

• classifying a score of 2 as moderate food insecurity instead of marginal food insecurity, and
• classifying marginal food insecurity as food insecure instead of food secure. 

The food security status assigned to a household may not reflect the experience of all individuals within the household.

A long-term health condition is defined as a medical condition (illness, injury or disability) that was current at the time of the interview and has lasted, or is expected to last, for 6 months or more.

For the 2023 NATSINPAS, information on health conditions was collected from only four individual modules, namely, cardiovascular, diabetes, kidney disease and mental health conditions. Questions varied to take into account differences between non-remote and remote populations and demographic characteristics. Respondents could report multiple health conditions.

Some reported conditions were assumed to be long-term, including diabetes mellitus, rheumatic heart disease, heart attack, angina, heart failure and stroke. Diabetes, rheumatic heart disease, heart attack, angina, heart failure and stroke were also assumed to be current.

The classification hierarchy used in the 2023 NATSINPAS has been updated since the 2012–13 NATSINPAS. It is based on the 10th revision of the International Classification of Diseases and Related Health Problems (ICD-10). New COVID-19 codes have been included in the classification, in line with the World Health Organization's adaptation of the ICD. The conditions classification used in the 2023 NATSINPAS is consistent with other ABS surveys, including the 2023 NNPAS and 2022–23 NATSIHS. For more information about the conditions classification used, see the Data Item List. 

A person is considered to have a disability if they have an impairment which restricts their everyday activities and has lasted, or is expected to last, for at least 6 months. A person with disability is classified by whether they have:

• a specific limitation with any core activities (mobility, communication and self-care)
• a specific restriction when participating in schooling or employment activities, or
• no specific limitation with core activities or restriction with schooling or employment activities.

A person has a specific limitation with a core activity if they need help from another person, have difficulty or use an aid or other equipment to perform at least one selected task. The level of limitation for each core activity is based on the amount of help a person needs with a selected task:

• profound — unable to do or always needs help with a core activity task
• severe — sometimes needs help or has difficulty with a core activity task
• moderate — does not need help but has difficulty with a core activity task
• mild — does not need help and has no difficulty, but uses aids or equipment or has other limitations with a core activity task.

A person's overall level of core activity limitation is determined by their highest level of limitation in any of these activities. For example, if a person has a profound limitation with a communication task and a moderate limitation with a self-care task, the person is categorised as having profound disability.

A person has a schooling restriction if they are aged between 5 and 20 years and, because of their disability, they:

• are not attending school/undertaking further study
• need time off school or study
• attend special classes or a special school, or
• have other related difficulties.

Specifying that a schooling restriction only applies to those aged between 5 and 20 years is new for the 2023 NATSINPAS and brings the data into alignment with the ABS standard. 

A person has an employment restriction if, because of their disability, they:

• are restricted in the type of job they could do
• are restricted in the number of hours they can work
• have difficulty finding suitable work
• need time off work, or
• are permanently unable to work.

A person with a "schooling/employment restriction only" is someone who reported no limitations with any of the core activities but reported having difficulty with schooling and/or employment activities.

Physical activity, sedentary behaviour and sleep data collected as part of the 2023 NATSINPAS are assessed against Australia’s Physical Activity and Sedentary Behaviour Guidelines, which differ by age group. These guidelines also include sleep recommendations for children. For more information about the guidelines, see Australia's Physical Activity and Sedentary Behaviour Guidelines.

Additional information about how data from the 2023 NATSINPAS was assessed against the guidelines will be available in the Intergenerational Health and Mental Health Study: Concepts, Sources and Methods in mid–2026.

As was the case in the 2012–2013 NATSINPAS, the collection of this data was different depending on the respondent’s age. 

The age groups in 2012–2013 were:

• Pre-school aged children (2–4 years old)
• School-aged children (5–17 years old)
• Adults (18 years and over).

The age groups in 2023 were:

• Pre-school aged children (2–4 years old and 5 years old not attending primary school)
• School-aged children (6–17 years old and 5 years old attending primary school)
• Adults (18 years and over).

In 2012–13, children aged 5 years old were treated as school-aged children, even if they were not yet attending school. In 2023, for respondents who were 5 years old, a parent/guardian was asked if the child attended school. Children attending school were treated as school-aged children, while those not attending were treated as pre-school aged children. This is in line with Australia's Physical Activity and Sedentary Behaviour Guidelines.

Self-reported physical activity

Information about physical activity for people living in remote areas is collected differently to the way it is collected for people living in non-remote areas. 

Remote respondents aged 5 years and over are asked about any sports, exercise or physical activities that they did the day before the survey. 

If any activity was reported, respondents aged 18 years and over were asked whether they undertook these activities for less than half an hour or more than half an hour. Respondents aged 5–17 years were asked whether they undertook these activities for less than an hour, or more than an hour.

Respondents aged 18 years and over were then asked whether this was about the same amount of physical activity that they do on most days. If the amount of activity was not the same as most days, respondents were asked whether they usually do more or less than that on most days. 

Self-reported sedentary behaviour

Respondents aged 5 years and over are asked about the types of sedentary behaviour they did the day before the survey (for example, watch TV, eat meals, work or study) as a multiple response question. 

Respondents were also asked to think about all the things they did ‘yesterday’ and respond whether they were mostly sitting, mostly standing, mostly walking, mostly running or mostly doing physical labour or hard work when they did them.

Acceleration cut-point thresholds are applied to the raw data to classify the level of activity at each moment in the day, such as inactivity, or light, moderate or vigorous activity. A statistical model is then used to determine whether the respondent is asleep (the main sleep period) or awake at the time of the day. 

Estimates presented in NATSINPAS 2023 are calculated based on an average of seven 24-hour periods for people living in non-remote areas, and four 24-hour periods for people living in remote areas. This is due to a difference in collection methodologies. 

The analysis considers several time periods, including: 

• midnight to midnight (calendar day)
• midday to midday (to analyse overnight sleep)
• wake-up time to wake-up time (different for each respondent).

The chart below shows average hours per day by activity type for adults. Spending more time in one type of activity means spending less time in others. 

The accelerometer data was processed with GGIR (version 3.2-6)[2], and R (version 4.4.1)[3]. GGIR is a software package designed to process multi-day raw accelerometer data for physical activity, inactivity and sleep[4-6]. As the accelerometer moves, the average acceleration (or speed) of the device can be calculated. This is measured in milligravity (mg) units. 

Outputs were later combined with survey data (e.g. age, sex, geography) and survey weights to produce estimates. Population estimates for the accelerometer data were not weighted separately. They represent a sub-sample of the NATSINPAS. Analysis with the survey weights indicate that some bias is likely present, but it is small and within the margin of error. This bias is mainly caused by different participation rates by age group. The ABS suggests taking care when looking at differences by age, especially when comparing children and adults.

Further information about how the analytical software models each activity type is noted in the section below. A full list of the parameters used in GGIR will be published mid–2026 in IHMHS: Concepts, Sources and Methods. Researchers wishing to analyse the data using different parameters may do so in the DataLab.

Most respondents did not wear the device for the entire duration, although most had met the minimum wear threshold to be included in estimates.

• 89.3% of respondents living in non-remote areas wore the device for 48 hours
• 71.4% of respondents living in remote areas wore the device for 48 hours
• 79.1% of all respondents wore the device for at least 48 hours. 

Estimates presented in NATSINPAS 2023 are calculated based on an average of seven 24-hour periods for people living in non-remote areas, and four 24-hour periods for people living in remote areas. 

Graphs below show the proportion of the sample by age, remoteness and the number of hours or number of nights the device was worn. 

The amount of time respondents wore the device was analysed to ensure the estimates produced were as accurate as possible, while still representing the Australian population. 

Average daily physical activity estimates were relatively stable using data from 48 hours of wear time or greater. See Graphs below.

Among participants who had already met the minimum 48-hour wear time requirement, the average amount of sleep changed very little when different sleep‑threshold rules were applied - see graph below.

Missing data were imputed to ensure that each respondent had a complete 7-day (168 hours) record in the microdata. When data were missing for a particular time point, an average value from the same time point on other valid wear days was calculated. Imputation rates for each age group are shown below.

For people living in remote areas, only the first 4 days of wear was used for estimates in NATSINPAS 2023. For persons living in non-remote areas, all 7 days of wear time was used. Researchers using microdata in the DataLab who apply different minimum‑wear rules should exercise caution when interpreting results.

As explained earlier in the Device wear time rates section, ABS uses minimum wear time criteria to make sure results are reliable and representative. Researchers using microdata should be careful when interpreting results if using different minimum wear time criteria. To support this, flag variables have been included in the microdata so users can identify and exclude imputed values if needed.

Physical activity and sleep data measured by wrist-worn devices, and physical activity and sleep data that people report for themselves are not comparable. 

• Accelerometers record all movement, while questionnaires depend on what people remember and choose to report.
• Self-reported physical activity data are based on survey questions about activities such as walking for exercise, recreation or sport or to get to places, moderate or vigorous physical activity (including at work) and strength or toning activities.

The reliability and accuracy of self-reported data is affected by:

• what people remember (e.g. they may not remember to include time spent running upstairs or what time they went to bed)
• their ability to estimate total time per day spent doing an activity at each level of intensity across a 24-hour period (e.g. moderate physical activity may occur for 30 minutes in the morning, 10 minutes at lunch time, 45 minutes in the afternoon)
• their assessment of the intensity of their physical activity (moderate or vigorous)
• some people providing responses they felt were expected, rather than those that accurately reflect their own situation. 

For adults, measured moderate and vigorous physical activity was higher than the respondents’ self-reported estimates. The gap was substantially higher for females than males, suggesting females may under-report their moderate and vigorous physical activity more than males. Self-reported estimates were also closer to measured data on weekdays than weekends.

For children, self-reported estimates of moderate and vigorous physical activity were substantially higher on average than the measured value. This may be due to over-reporting of moderate and vigorous physical activity by parents or guardians if they answered on behalf of their child. It may also be due to the accelerometer being removed for safety reasons during contact sports and other activities.

Self-reported length of sleep was generally higher than the measured main sleep period. This is likely due to how the different methods are used to define sleep. Questionnaire responses capture the time a person reported going to bed and turning the lights out to go to sleep. Accelerometer measures classify sleep once movement falls below a defined threshold. This difference should also be considered when interpreting estimates of sleep efficiency. The difference between self-reported and measured sleep is smaller for adults than for children.

There is no self-reported data that corresponds to inactivity or light physical activity.

The non-response rate for waist measurements in 2023 was 43.7% for adults and 55.4% for children. The non-response rate for blood pressure measurements (taken for adults only) in 2023 was 43.5%.

The higher non-response rates in 2023 could in part be due to the trend of declining participation in physical measurements. The COVID-19 pandemic may also have had an effect. The procedures for collecting physical measurements in the 2023 NATSINPAS were adapted to include increased hygiene and social distancing measures, and respondents needed to take their own measurements rather than ABS interviewers taking the measurements.

Self-reported height and weight

In addition to the voluntary measured items, respondents in the 2023 NATSINPAS were also asked to self-report their height and weight measurements (respondents who advised that they were pregnant were not asked to self-report as they are not applicable to the BMI population for analysis). This provides valuable information about height and weight which can be used in assisting in the imputation for those with missing values.

How imputation works

In the 2023 NATSINPAS , missing values were imputed using the 'hot decking' imputation method. In this method, a record with a missing response (the 'recipient') receives the response of another similar record (the 'donor'). Several characteristics were used to match recipients. For adults, they were:

• age group
• sex
• part of state (capital city and balance of state)
• whether or not has high cholesterol (as a long-term health condition)
• self-reported BMI category (calculated from self-reported height and weight).

For example, a female recipient aged 35–39 years who lives in a capital city, has a self-reported BMI category of overweight (calculated using self-reported height and weight) and has high cholesterol will match to a donor record who has the same profile (female, 35–39, self-reports as overweight, etc.).

For children aged 2–14 years, the following variables were used:

• single year of age
• sex
• part of state
• self-reported BMI category. 

For children aged 15–17 years, the same imputation variables were used as for children aged 2–14 years, in addition to level of exercise for non-remote respondents. Cholesterol data was not collected for persons under 18 years of age so could not be used as an imputation variable.

For BMI, 59.3% of imputed records matched a donor record using all variables. The remaining 40.7% were matched using fewer variables.

Basal metabolic rates (BMR) are the amount of energy needed for a minimal set of functions necessary for life over a defined period. BMR is expressed as kilojoules (kJ) per 24-hours and is calculated using age, sex and weight (kg). 

BMR can be used to estimate the amount of energy a person needs to maintain a healthy body weight. The amount of physical activity a person does impacts the amount of energy their body requires. Active people will require larger amounts of energy, and people with a more sedentary lifestyle will require less. No adjustment has been made to BMR for activity levels or health status, which can have an impact on BMR.

The ratio of energy intake to BMR (EI:BMR) is used for determining low and high energy reporters in persons aged 10 years or more. 

There are several accepted methods for estimating BMR. The ABS used the Mifflin-St Jeor method to estimate BMR, which replaced the Schofield method used in the 2012–13 NATSINPAS. For further information see Intergenerational Health and Mental Health Study: Concepts, Sources and Methods.

Waist circumference is a measurement, in centimetres (cm), of a person’s waist. Measurements were voluntarily provided by people aged 2 years and over at the time of interview. Respondents took their own measurements using a tape measure (maximum 150cm). People who advised they were pregnant were not asked to provide measurements.

The waist circumferences of people aged 18 years and over were classified by level of risk of developing chronic disease as recommended by the World Health Organization’s 2008 Waist Circumference and Waist-Hip Ratio: Report of a WHO Consultation.

Dietary intake information was collected using a 24-hour dietary recall tool called Intake24 which was adapted for use in Australia in conjunction with Monash University and Food Standards Australia New Zealand. The tool captured information on the food and beverage intakes for all respondents on the day prior to interview, from midnight to midnight. 

The purpose of the 24-hour dietary data collection is to estimate total amounts of food, beverages, food energy, nutrients and non-nutrient food components consumed by the Australian population, to assess dietary behaviours and the relationship between diet and health. Data were merged with the Australian Food and Nutrient (AUSNUT) Files to produce estimates of energy, macronutrients, vitamins, minerals and Australian Dietary Guideline (ADG) food group serves per 100 grams.

The food and nutrient release provides an estimate of energy and nutrient intake based on a single day of food consumption only. This should be considered when interpreting results.

Further information on the 24-hour dietary recall methodology is available in the Intergenerational Health and Mental Health Study: Concepts, Sources and Methods.

Interviewers recorded the Australian Register of Therapeutic Goods Administration (TGA) identification number of each dietary supplement taken by the respondent in the 24-hours prior to interview.  The AUST-L number was assigned to listed medicines including vitamins, minerals, and herbal and homoeopathic products.

For dietary supplements without an AUST L code, interviewers were able to record details of the supplement which were coded. Up to 15 different supplements were recorded. Data were merged with the Australian Food and Nutrient (AUSNUT) Database to produce estimates of macronutrients, vitamins and minerals for each supplement.

Further information on dietary supplement collection and processing can be found in the Intergenerational Health and Mental Health Study: Concept, Sources and Methods.

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