4363.0.55.001 - National Health Survey: Users' Guide, 2001
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 27/05/2003
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CONTENTS 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:
Health risk factor topics included in sparse NHS(I) were:
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
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:
TABLE 5.1: Smoker status
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:
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:
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
For each of the last (up to) three most recent days on which alcohol was consumed:
For the reference period:
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:
TABLE 5.2: Alcohol consumption
TABLE 5.3: Alcohol risk level
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:
TABLE 5.4: Alcohol conversion factors
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:
For each of these categories of exercise, respondents were asked:
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:
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
Population Information was collected for all persons aged 15 years and over. This information was not collected in the sparse NHS(I). Data items
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:
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
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:
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:
Population Information was collected for all persons aged 15 years and over. Data items
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:
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:
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;
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
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:
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:
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
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:
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:
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
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:
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:
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
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:
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:
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
Population All persons aged 0 to 6 years. This information was not collected in the sparse NHS(I). Data items
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:
TABLE 5.11: Immunisation schedules
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. 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:
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
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
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 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
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:
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:
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. 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
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:
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:
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 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
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:
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.
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