south australian monitoring and surveillance system surveillance system (samss) the health status of...

South Australian Monitoring and Surveillance System (SAMSS)

The Health Status of People Living in the Mid North Health Region: Overweight and Obese, Physical Activity and Nutrition July 2002 to June 2005 Population Research and Outcome Studies Department of Health South Australia

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This work is copyright. It may be reproduced and the Population Research and Outcome Studies (PROS) welcomes requests for permission to reproduce in the whole or in part, for work, study or training purposes subject to the inclusion of an acknowledgment of the source and not commercial use or sale. PROS will only accept responsibility for data analysis conducted by PROS staff or under PROS supervision.

This document can be found online at: http://www.dh.sa.gov.au/pehs/PROS.html Further enquiries: Anne Taylor Manager Population Research and Outcome Studies SA Department of Health 08 8226 6323 or Eleonora Dal Grande Senior Epidemiologist Population Research and Outcome Studies SA Department of Health 08 8226 0789

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TABLE OF CONTENTS

TABLE OF CONTENTS.................................................................................................... 3

EXECUTIVE SUMMARY................................................................................................... 5

CHAPTER 1: INTRODUCTION ......................................................................................... 7

CHAPTER 2: OVERWEIGHT AND OBESITY, PHYSICAL ACTIVITY AND NUTRITION ...... 9 OVERWEIGHT AND OBESE ................................................................................................. 9 PHYSICAL ACTIVITY ........................................................................................................ 20 NUTRITION ................................................................................................................... 23

APPENDIX 1: SOUTH AUSTRALIAN HEALTH REGIONS BY POSTCODE..................... 25

APPENDIX 2: MAP OF SOUTH AUSTRALIAN HEALTH REGIONS................................ 27

APPENDIX 3: BACKGROUND AND METHODOLOGY................................................... 29

APPENDIX 4: DEMOGRAPHIC PROFILE ...................................................................... 33

REFERENCES............................................................................................................... 38

EXECUTIVE SUMMARY The purpose of this report is to provide evidence-based information about the prevalence of overweight and obesity, sufficient physical activity, and the consumption of recommended daily serves of fruit and vegetables of children aged 4 to 7 years for people living the Mid North region. The following summarises the findings from the analyses in this report. Overweight

• The prevalence of people aged 18 years and over for the Mid North region who were classified as overweight was 41.8% (95% CI 36.2 – 47.6).

• The prevalence of people who are overweight in this region has declined over the last four years.

• The proportion of overweight people in the Mid North region did not differ compared to the rest of the South Australian regions.

• The prevalence of overweight for people living in the Mid North region was higher in among

o people at low risk of harm from alcohol in the long term; and o people with at least one health related risk factors.

• People living in the Mid North region had a lower prevalence of people classified as overweight among

o people at high risk of harm from alcohol in the long term. Obese

• The prevalence of people aged 18 years and over for the Mid North region who were classified as obese was 19.8% (95% CI 15.6 – 24.8).

• The prevalence of people who are obese in this region has remained constant over the last four years.

• The proportion of obese people in the Mid North region did not differ compared to the rest of the South Australian regions.

• People living in the Mid North region had a higher prevalence of people classified as obese among

o high risk of harm from alcohol in the long term; and o people with at least three or more health related risk factors.

• The prevalence of people who are obese in this region was statistically significantly lower among

Mid North Region

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o people who are at low risk of harm from alcohol in the long term. Physical activity

• The prevalence of people aged 16 years and over in the Mid North region who have undertaken sufficient physical activity was 46.8% (95% CI 40.3 – 53.4) according to definition 1 (150 minutes of walking, moderate or vigorous exercise, with vigorous activity doubled to account for greater intensity).

• The prevalence of people aged 16 years and over in the Mid North region who have undertaken sufficient physical activity was 34.1% (95% CI 28.1 – 40.6) according to definition 2 (150 minutes of walking, moderate or vigorous exercise, with vigorous activity doubled to account for greater intensity over five or more sessions).

• The prevalence of people in this region undertaking sufficient physical activity has remained constant over the last two years.

• The proportion of people in the Mid North region undertaking sufficient physical activity did not differ compared to the rest of the South Australian regions.

Fruit and vegetable consumption among children aged 4 to 7 years

• The proportion of children aged 4 to 7 years living in the Mid North Region who are consuming at least

o two serves of vegetables per day was 26.0% (95% CI 14.3 – 42.5), o one serve of fruit per day was 100.0% (95% CI 90.0 – 100.0), or o two serves of vegetables and one serve of fruit per day was 26.0%

(95% CI 14.3 – 42.5). • When comparisons were undertaken by region, the proportion of children aged

4 to 7 years living in the Mid North region were less likely to consume the recommended serves of fruit per day as well as the recommended serves of fruit and vegetables per week.

CHAPTER 1: INTRODUCTION This report aims to provide information on overweight and obesity using body mass index (BMI) by socio-demographics characteristics, chronic conditions, and health related risk factors for people living in the Mid North health region. This report presents data from SAMSS for the period July 2002 to June 2005. For planning and service delivery to be undertaken at a regional level, data are required at the regional level. The information will assist forward planning by investigating issues identified by the region and providing reliable population estimates. The data used to explore these issues were obtained from a large representation population health survey, the South Australian Monitoring and Surveillance System (SAMSS). SAMSS is a population health survey surveillance system that commenced in July 2002 and monitors, in a systematic way, the trends of diseases, health related problems, risk factors and other human services issues relevant to the Department of Health, over time. Interviews are undertaken every month in South Australia (approximately 600 people) using Computer Assisted Telephone Interviewing (CATI) technology. In this early stage of SAMSS development only cross-sectional information is provided although trends and time series analyses will be available in future years.

Mid North Region

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CHAPTER 2: OVERWEIGHT AND OBESITY, PHYSICAL ACTIVITY AND NUTRITION

This section reports on the prevalence of one of the South Australian State Strategic Plan indicators for the Mid North region: overweight and obesity for people aged 18 years and over. This section will also report on two other factors that are associated with overweight and obesity: physical activity and fruit and vegetable consumption.

Overweight and obese Respondents were asked their height and weight, and from these body mass index (BMI) was calculated. The formula for calculation of BMI is as follows 1:

weight (kg)/ height (m)2 The criteria for classifying BMI are as follows:

Table 2.1: BMI Criteria Descriptive term BMI

Underweight less than 18.5 Acceptable weight 18.5 to 25 inclusive Overweight greater than 25 and up to and including 30 Obese greater than 30

The percentage in each category of BMI for the Mid North region is reported in Table 2.2.

Table 2.2: Body mass index (BMI) for the Mid North region n % (95% CI) Underweight 6 2.0 ( 0.9 - 4.4) Acceptable weight 102 36.4 (31.0 - 42.2) Overweight 118 41.8 (36.2 - 47.6) Obese 56 19.8 (15.6 - 24.8) Total 282 100.0 Data source: SAMSS July 2002 to June 2005, 18 years and over Note: The weighting of data can result in rounding discrepancies or totals not adding. Data were aggregated to provide sufficient sample size. This may mask changes in prevalence over this time

period.

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The prevalence of people living in the Mid North region classified as underweight, normal and obese has remained constant over the last four years (Table 2.3). However, the prevalence of overweight has statistically significantly declined over the last four years.

Table 2.3: Proportion of people living in the Mid North region who were classified as underweight, acceptable, overweight and obese by year Underweight Normal Overweight Obese Total Year n % n % n % n % 2002/3 1 1.0 # 37 44.8 32 38.4 13 15.8 82 2003/4 2 1.8 # 28 29.2 50 52.4 16 16.6 95 2004/5 3 3.0 # 38 36.3 36 34.9 27 25.9 104

# Insufficient numbers for statistical test. Use caution interpreting this statistic. Note: The weighting of data can result in rounding discrepancies or totals not adding. Data source: SAMSS July 2002 to June 2005, 18 years and over

Overweight or obese by health region

When comparisons were undertaken by region, the proportion of respondents who were overweight or obese in the Mid North region did not differ from the rest of the regions (Table 2.4).

Table 2.4: Overweight or obese by health region, 18 years and over Overweight Obese n % (95% CI) n % (95% CI) Central Northern Adelaide 2540 35.4 (34.3 - 36.5) * 1252 17.4 (16.6 - 18.3) * Southern Adelaide 1238 35.6 (34.0 - 37.2) 596 17.1 (15.9 - 18.4) * Hills Mallee 410 37.1 (34.3 - 40.0) 215 19.5 (17.2 - 21.9) Wakefield 357 39.3 (36.1 - 42.5) 165 18.2 (15.8 - 20.8) Mid North 118 41.8 (36.2 - 47.6) 56 19.8 (15.6 - 24.8) Riverland 123 39.8 (34.5 - 45.4) 76 24.7 (20.2 - 29.8) * South East 237 38.5 (34.8 - 42.4) 154 25.0 (21.8 - 28.6) * Eyre 122 41.2 (35.7 - 46.9) 60 20.2 (16.0 - 25.1) Northern & Far Western 126 35.7 (30.9 - 40.8) 104 29.4 (24.9 - 34.4) * Overall 5271 36.3 (35.5 - 37.1) 2678 18.4 (17.8 - 19.1)

* Statistically significantly higher or lower (p <0.05) than the other categories combined. Data source: SAMSS July 2002 to June 2005, 18 years and over Note: The weighting of data can result in rounding discrepancies or totals not adding. Data were aggregated to provide sufficient sample size. This may mask changes in prevalence over this time

period.

SAMSS July 2002 to June 2005

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When comparisons were undertaken by region, respondents living in the Mid North region were statistically significantly more likely to be overweight and obese than the other regions (Figure 2.1).

Figure 2.1: Overweight and obese by health region, 18 years and over

0 10 20 30 40 50 60 70 80

Northern & Far Western

Eyre

South East

Riverland

Mid North

Wakefield

Hills Mallee

Southern Adelaide

Central Northern Adelaide

South Australia

Hea

lth R

egio

n

Proportion (%)

Data source: SAMSS July 2002 to June 2005, 18 years and over Note: The weighting of data can result in rounding discrepancies or totals not adding. Data were aggregated to provide sufficient sample size. This may mask changes in prevalence over this time

period.

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Overweight or obese by Local Government Areas (LGA)

The proportion of overweight or obese by the Mid North LGA is reported in Table 2.5. When comparisons were undertaken by LGA, the proportion of respondents who were overweight or obese between the LGA in the Mid North region did not differ from the rest of the LGAs (Table 2.5).

Table 2.5: Overweight or obese by LGA in the Mid North region, 18 years and over

Overweight Obese n % (95% CI) n % (95% CI) Barunga West (DC) 9 34.9 (19.5 - 54.3) 8 32.3 (17.5 - 51.8) Mount Remarkable (DC) 15 54.5 (36.3 - 71.6) 3 10.0 # Northern Areas (DC) 21 45.9 (32.2 - 60.3) 12 27.8 (16.8 - 42.3) Orroroo/Carrieton (DC) 4 49.3 # 2 20.0 # Peterborough (DC) 7 42.5 (22.4 - 65.5) 3 17.4 # Port Pirie C, Dists (M) & Bal 59 38.2 (30.9 - 46.1) 26 16.7 (11.6 - 23.4)

Unincorp. Pirie 4 62.5 (26.6 - 88.5) 2 37.5 (11.5 - 73.4) Overall 118 41.8 (36.2 - 47.6) 56 19.8 (15.6 - 24.8)

* Statistically significantly higher or lower (p <0.05) than the other categories combined. # Insufficient numbers for statistical test. Use Caution interpreting this statistic. Data source: SAMSS July 2002 to June 2005, 18 years and over Note: The weighting of data can result in rounding discrepancies or totals not adding. Data were aggregated to provide sufficient sample size. This may mask changes in prevalence over this time

period.


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Overweight and obese by various socio-demographic variables

There were no statistically significant differences in the prevalence of overweight or obesity for people living in the Mid North region (Table 2.6).

Table 2.6: Overweight and obese by socio-demographic variables for people living in the Mid North region Overweight Obese Variable n % (95% CI) n % (95% CI) Sex

Male 61 46.2 (37.9 - 54.7) 30 22.4 (16.1 - 30.3) Female 57 37.9 (30.6 - 45.9) 26 17.5 (12.2 - 24.4)

Age Groups 18 to 29 years 17 43.4 (29.0 - 59.0) 4 11.7 ( 4.8 - 25.5) 30 to 44 years 31 37.0 (27.4 - 47.7) 17 20.8 (13.5 - 30.8) 45 to 59 years 39 47.1 (36.8 - 57.8) 21 24.9 (16.8 - 35.2) 60 years and over 31 40.6 (30.3 - 51.7) 13 17.2 (10.4 - 27.1)

Number of people in household aged 16 years and over

1 16 37.9 (24.9 - 52.9) 7 17.1 ( 8.6 - 30.9) 2 76 42.1 (35.1 - 49.4) 36 20.1 (14.9 - 26.5) 3 or more people 26 43.8 (31.9 - 56.5) 12 21.0 (12.6 - 33.0)

Children aged 15 years or less in household

No 82 43.3 (36.4 - 50.5) 38 20.3 (15.1 - 26.6) Yes 36 38.8 (29.5 - 48.9) 18 18.9 (12.2 - 28.0)

Overall 118 41.8 (36.2 - 47.6) 56 19.9 (15.7 - 25.0) * Statistically significantly higher or lower (p <0.05) than the other categories combined. # Insufficient numbers for statistical test. Use caution interpreting this statistic. Data source: SAMSS July 2002 to June 2005, 18 years and over Note: The weighting of data can result in rounding discrepancies or totals not adding. Data were aggregated to provide sufficient sample size. This may mask changes in prevalence over this time

period.

There were no statistically significant differences in the prevalence of overweight or obesity by demographic profile among people living in the Mid North region (Table 2.7).

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Table 2.7: Overweight and obese by socio-demographic variables for people living in the Mid North region Overweight Obese Variable n % (95% CI) n % (95% CI) Family composition

Couple with/without children 97 41.9 (35.8 - 48.4) 47 20.3 (15.6 - 26.0) Single parent with children / share care parenting 5 67.1 (33.4 - 89.3) - -

Adults (alone, unrelated) 16 36.7 (24.0 - 51.7) 9 20.5 (11.1 - 34.7) Marital status

Married/Living with partner 96 43.9 (37.4 - 50.5) 44 20.0 (15.2 - 25.8) Separated/Divorced 6 43.3 (21.3 - 68.4) 3 19.9 # Widowed 4 26.4 # 3 17.8 # Never Married 13 35.1 (21.7 - 51.5) 7 19.4 ( 9.7 - 35.0)

Highest educational attainment No schooling to secondary 85 41.6 (35.0 - 48.4) 42 20.6 (15.6 - 26.7) Trade, certificate, diploma 25 42.6 (30.8 - 55.3) 13 21.4 (12.8 - 33.4) Degree or higher 7 40.0 (21.3 - 62.2) 1 6.1 #

Country of birth Australia 106 41.8 (35.9 - 48.0) 50 19.9 (15.4 - 25.2) Overseas 12 41.7 (25.5 - 59.9) 5 19.3 ( 8.8 - 37.2)

Speak another language other than English at home

Yes 3 52.3 # 2 35.3 # No 115 41.6 (36.0 - 47.5) 54 19.5 (15.3 - 24.6)

Employment status Full time employed 45 46.6 (36.9 - 56.5) 17 17.4 (11.1 - 26.2) Part time employed 23 40.9 (29.1 - 53.9) 13 22.3 (13.5 - 34.7) Unemployed 2 31.2 # 3 51.6 # Economically inactive (home duties, student, retired, unable to work)

45 46.6 (36.9 - 56.5) 17 17.4 (11.1 - 26.2)


period.


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There were no statistically significant differences in the prevalence of overweight or obesity by socio-demographic profile among people living in the Mid North region (Table 2.8).

Table 2.8: Overweight and obese by socio-demographic variables for people living in the Mid North region Overweight Obese Variable n % (95% CI) n % (95% CI) Money situation

Money left over each week - Can save a lot 82 39.6 (33.2 - 46.5) 34 16.4 (12.0 - 22.1)

Just have enough money to get through to next pay 28 46.4 (34.5 - 58.7) 20 31.9 (21.6 - 44.4)

Spending more money than getting 5 66.9 (34.0 - 88.8) 2 20.4 # Don't know / refused 2 36.9 # 1 13.2 #

Gross annual household income Up to $20,000 28 40.5 (29.7 - 52.3) 16 23.0 (14.7 - 34.2) $20,001-$40,000 33 51.2 (39.3 - 63.1) 13 20.5 (12.4 - 31.9) $40,001-$60,000 16 33.0 (21.3 - 47.3) 9 18.2 ( 9.7 - 31.4) $60,001-$80,000 14 35.7 (22.6 - 51.2) 6 14.5 ( 6.7 - 28.5) $80,000 or more 18 55.3 (38.7 - 70.8) 5 15.9 ( 7.1 - 31.8) Not stated 9 31.5 (17.6 - 49.7) 7 25.2 (12.9 - 43.2)

Home ownership Owned or being purchased 109 43.4 (37.4 - 49.6) 47 18.8 (14.4 - 24.0) Rented from the Housing Trust or privately 8 28.8 (15.4 - 47.3) 8 28.9 (15.4 - 47.5)

Other 1 29.2 # 1 24.4 # Index of relative disadvantage (SEIFA)

1st quintile (lowest) 56 37.3 (30.0 - 45.3) 26 17.4 (12.2 - 24.3) 2nd quintile 15 40.5 (26.4 - 56.2) 12 32.9 (20.1 - 48.8) 3rd quintile 20 43.7 (30.5 - 58.0) 11 24.4 (14.3 - 38.4) 4th quintile 25 53.7 (39.5 - 67.2) 6 12.9 ( 6.0 - 25.5) 5th quintile (highest) - - - -


period.

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Chronic conditions

There were no statistically significant differences in the prevalence of overweight or obese by chronic conditions among people living in the Mid North region (Table 2.9).

Table 2.9: Overweight and obese by chronic conditions for people living in the Mid North region Overweight Obese Variable n % (95% CI) n % (95% CI) Overall Health Status

Excellent 11 30.0 (17.7 - 45.9) 6 16.5 ( 7.9 - 31.3) Very good 49 42.3 (33.8 - 51.4) 21 18.1 (12.1 - 26.0) Good 26 40.7 (29.6 - 52.9) 15 23.2 (14.6 - 34.8) Fair 26 53.4 (39.6 - 66.7) 8 15.6 ( 8.0 - 28.3) Poor 5 34.7 (15.9 - 59.8) 6 40.9 (20.3 - 65.3)

Diabetes No 108 41.8 (35.9 - 47.9) 48 18.4 (14.2 - 23.6) Yes 10 42.2 (24.8 - 61.7) 8 34.5 (18.8 - 54.6)

Current asthma No 99 42.4 (36.3 - 48.8) 45 19.2 (14.7 - 24.7) Yes 18 38.8 (26.3 - 53.0) 11 22.7 (13.1 - 36.4)

Cardiovascular disease (heart attack, angina, heart disease, stroke)

No 106 41.7 (35.8 - 47.8) 50 19.8 (15.3 - 25.1) Yes 12 43.2 (26.6 - 61.5) 5 20.0 ( 9.2 - 38.3)

Arthritis No 87 42.5 (35.9 - 49.3) 36 17.6 (13.0 - 23.3) Yes 30 40.0 (29.8 - 51.3) 20 25.9 (17.3 - 36.7)

Osteoporosis No 115 41.8 (36.1 - 47.7) 55 20.1 (15.8 - 25.2) Yes 3 44.4 # - -


period.


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There were no statistically significant differences in the prevalence of overweight or obese by number of chronic conditions among people living in the Mid North region (Table 2.10).

Table 2.10: Overweight and obese by chronic conditions for people living in the Mid North region Overweight Obese Variable n % (95% CI) n % (95% CI) Psychological distress (K10)

No 105 41.8 (35.8 - 48.0) 49 19.3 (14.9 - 24.7) Yes 13 42.2 (26.6 - 59.5) 7 23.5 (12.0 - 40.9)

Current diagnosed mental health No 96 40.4 (34.4 - 46.8) 49 20.8 (16.1 - 26.4) Yes 22 49.1 (35.1 - 63.2) 6 14.4 ( 6.9 - 27.4)

Number of chronic conditions (excl. mental health)

None 62 41.5 (33.9 - 49.5) 26 17.4 (12.1 - 24.3) 1 41 42.6 (33.3 - 52.6) 20 20.2 (13.4 - 29.3) 2 12 48.9 (30.5 - 67.7) 6 25.9 (12.6 - 45.9) 3 or more 3 24.5 # 4 34.6 #

At least one chronic condition (excl. mental health)

No 62 41.5 (33.9 - 49.5) 26 17.4 (12.1 - 24.3) Yes 56 42.2 (34.1 - 50.7) 30 22.5 (16.2 - 30.3)


period.

Health-related risk factors

The prevalence of overweight for people living in the Mid North region was statistically significantly higher among people who were classified as low risk of harm from alcohol in the long term, and statistically significantly lower among people classified as high risk of harm from alcohol in the long term (Table 2.11). The prevalence of obesity for people living in the Mid North region was statistically significantly higher among people who were classified as high risk of harm from alcohol in the long term, and statistically significantly lower in people who were classified as low risk of harm from alcohol in the long term.

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Table 2.11: Overweight and obese by health-related risk factors for people living in the Mid North region Overweight Obese Variable n % (95% CI) n % (95% CI) Smoking status

Non- or Ex-smoker 102 44.2 (38.0 - 50.6) 45 19.6 (15.0 - 25.2) Smoker 15 30.8 (19.8 - 44.5) 10 20.8 (11.9 - 33.9)

Household smoking environment Smoke free home (incl outside) 103 43.8 (37.6 - 50.2) 42 18.1 (13.7 - 23.5) Smoking in home occasionally or frequently 15 31.8 (20.3 - 46.0) 13 28.4 (17.6 - 42.5)

Risk of harm from alcohol in the short term

Non-drinker, low risk 85 42.2 (35.5 - 49.1) 35 17.6 (13.0 - 23.5) Risky, high-risk 33 41.0 (30.9 - 51.8) 20 25.2 (17.1 - 35.7)

Risk of harm from alcohol in the long term

Non-drinker, low risk 116 43.6 (37.8 - 49.6) * 49 18.2 (14.1 - 23.3) * Risky, high-risk 2 10.5 # 7 47.0 (25.3 - 70.0) *

Number serves of vegetables usually eaten each day

1 or less serves per day 21 37.2 (25.9 - 50.1) 9 15.5 ( 8.3 - 26.9) 2 to 4 serves per day 75 41.2 (34.3 - 48.4) 34 18.8 (13.8 - 25.1) 5 or more serves per day 21 52.5 (37.7 - 66.9) 12 28.6 (17.1 - 43.8) None/Don't eat vegetables - - 1 69.2 #

Number serves of fruit usually eaten each day

1 or less serves per day 58 40.5 (32.8 - 48.6) 32 22.2 (16.2 - 29.7) 2 or more serves per day 51 45.3 (36.4 - 54.5) 21 18.7 (12.6 - 26.8) None/Don't eat fruit 8 33.8 (18.6 - 53.4) 3 11.0 #


period.


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The prevalence of overweight for people living in the Mid North region was statistically significantly higher among people with at least one health related risk factor (Table 2.12). The prevalence of obesity for people living in the Mid North region was statistically significantly higher among people with at least three or more health related risk factors.

Table 2.12: Overweight and obese by health-related risk factors for people living in the Mid North region Overweight Obese Variable n % (95% CI) n % (95% CI) Current high blood pressure and/or on antihypertensive treatment

No 70 44.4 (36.9 - 52.2) 32 20.0 (14.5 - 27.0) Yes 16 38.7 (25.4 - 53.8) 11 26.8 (15.7 - 41.9)

Current high cholesterol and/or on medication

No 72 43.3 (36.0 - 50.9) 33 19.8 (14.5 - 26.5) Yes 14 43.1 (27.8 - 59.8) 10 29.7 (16.9 - 46.8)

Physical activity – definition 1 Not physically active 21 39.0 (27.3 - 52.3) 13 24.2 (14.8 - 37.0) Active but not sufficient 20 38.7 (26.6 - 52.3) 12 22.8 (13.5 - 35.9) Sufficiently active 43 47.3 (37.3 - 57.4) 18 19.4 (12.6 - 28.7)

Physical activity – definition 2 Not physically active 21 39.0 (27.3 - 52.3) 13 24.2 (14.8 - 37.0) Active but not sufficient 31 39.9 (29.7 - 51.1) 19 24.5 (16.3 - 35.2) Sufficiently active 32 50.3 (38.3 - 62.2) 10 16.4 ( 9.3 - 27.4)

Number of health-related risk factors (excl obesity)

0 42 51.8 (41.0 - 62.4) 12 15.5 ( 9.2 - 25.0) 1 24 35.7 (25.3 - 47.7) 15 22.7 (14.3 - 34.0) 2 16 43.6 (29.1 - 59.4) 9 22.8 (12.3 - 38.4) 3 or more 2 19.6 # 7 51.6 (27.1 - 75.3) *

At least one health-related risk factors (excl obesity)

No 42 51.8 (41.0 - 62.4) * 12 15.5 ( 9.2 - 25.0) Yes 43 36.5 (28.3 - 45.5) * 30 25.9 (18.8 - 34.5)


period.

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Physical activity A number of short questions, adopted from the Active Australia Survey2, were asked to monitor physical activity levels. These questions related to walking, moderate activity and vigorous activity including the number of times per week that these activities had been undertaken, and the time spent doing these activities. From descriptions of physical activity type and time, it was determined whether in the past week respondents had achieved a sufficient level of physical activity. The definitions of sufficient physical activity used in this report are as follows:

• 150 minutes total of walking, moderate or vigorous physical activity with vigorous activity weighted by a factor of two to account for its greater intensity. (Definition 1).

• 150 minutes total of walking, moderate or vigorous physical activity with vigorous activity weighted by a factor of two, over at least five separate sessions a week. (Definition 2).

These definitions do not include gardening or housework, however vigorous they are perceived to be, due to limited research regarding the energy expenditure of these activities. The percentage in each category of physical activity for people aged 16 years and over using the two definitions for the Mid North region is reported in Table 2.13.

Table 2.13: Level of physical activity for the Mid North Region

n % (95% CI) Sufficient physical activity, definition 1 Sedentary 59 27.1 (21.6 - 33.4) Insufficient physical activity 56 26.1 (20.7 - 32.4) Sufficient physical activity 101 46.8 (40.3 - 53.4) Total 216 100.0 Sufficient physical activity, definition 2 Sedentary 59 27.3 (21.8 - 33.6) Insufficient physical activity 83 38.7 (32.4 - 45.3) Sufficient physical activity 73 34.1 (28.1 - 40.6) Total 215 100.0 Data source: SAMSS July 2003 to June 2005, 16 years and over Note: The weighting of data can result in rounding discrepancies or totals not adding. Data were aggregated to provide sufficient sample size. This may mask changes in prevalence over this time

period.


21

The prevalence of people living in the Mid North region undertaking sufficient physical activity has remained constant over the last two years (Table 2.14).

Table 2.14: Proportion of people living in the Mid North region who had undertaken sufficient physical activity by yearly quarter Sufficient physical activity,

definition 1 Sufficient physical activity,

definition 2 Quarter n % n % 2003 Jul-Sep 9 40.9 6 27.5 2003 Oct-Dec 16 58.7 11 41.3 2004 Jan-Mar 16 55.7 10 35.4 2004 Apr-Jun 13 49.0 11 43.7 2004 Jul-Sep 8 34.2 5 22.9 2004 Oct-Dec 15 43.1 9 27.5 2005 Jan-Mar 14 48.9 12 41.8 2005 Apr-Jun 10 40.9 7 30.8 Note: The weighting of data can result in rounding discrepancies or totals not adding. Data source: SAMSS July 2003 to June 2005, 16 years and over

Sufficient physical activity by health region

When comparisons were undertaken by region, the proportion of respondents undertaking sufficient physical activity living in the Mid North region did not differ from the rest of the regions (Table 2.15).

Table 2.15: Overweight or obese by health region, 16 years and over

Sufficient physical activity, definition 1


n % (95% CI) n % (95% CI) Central Northern Adelaide 2799 51.0 (49.7 - 52.4) 2184 39.9 (38.6 - 41.2) Southern Adelaide 1435 54.6 (52.7 - 56.5) * 1124 42.8 (40.9 - 44.7) * Hills Mallee 413 45.5 (42.3 - 48.7) * 316 34.9 (31.8 - 38.0) * Wakefield 313 45.8 (42.1 - 49.6) * 232 34.0 (30.6 - 37.6) * Mid North 101 46.8 (40.3 - 53.4) 73 34.1 (28.1 - 40.6) Riverland 109 49.0 (42.5 - 55.6) 74 33.3 (27.4 - 39.7) South East 215 45.2 (40.8 - 49.7) * 171 36.0 (31.8 - 40.4) Eyre 109 47.9 (41.5 - 54.4) 90 39.5 (33.4 - 46.0) Northern & Far Western 101 38.9 (33.2 - 45.0) * 85 33.0 (27.5 - 38.9) * Overall 5594 50.4 (49.5 - 51.3) 4350 39.2 (38.3 - 40.1)

* Statistically significantly higher or lower (p <0.05) than the other categories combined. Data source: SAMSS July 2003 to June 2005, 18 years and over Note: The weighting of data can result in rounding discrepancies or totals not adding. Data were aggregated to provide sufficient sample size. This may mask changes in prevalence over this time

period.

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Sufficient physical activity by Local Government Areas (LGA)

The percentage of people undertaking sufficient physical activity using the two definitions by the Mid North LGA is reported in Table 2.16. When comparisons were undertaken by region, the proportion of people living in the Mid North region undertaking sufficient physical activity did not differ from the rest of the LGAs.

Table 2.16: Sufficient physical activity by definition 1 and 2 by LGA in Mid North, 16 years and over



n % (95% CI) n % (95% CI) Barunga West (DC) 10 56.6 (34.4 - 76.4) 6 34.9 (17.2 - 57.9) Mount Remarkable (DC) 11 44.5 (26.8 - 63.7) 11 44.5 (26.8 - 63.7) Northern Areas (DC) 15 48.2 (31.6 - 65.1) 11 37.4 (22.6 - 55.2) Orroroo/Carrieton (DC) 4 57.1 # 4 57.1 # Peterborough (DC) 5 37.4 # 3 23.9 # Port Pirie C, Dists (M) & Bal 101 46.8 (40.3 - 53.4) 73 34.1 (28.1 - 40.6) Overall 97 45.7 (39.1 - 52.4) 69 32.7 (26.7 - 39.3)

* Statistically significantly higher or lower (p <0.05) than the other categories combined. # Insufficient numbers for statistical test. Use caution interpreting this statistic. Data source: SAMSS July 2003 to June 2005, 16 years and over Note: The weighting of data can result in rounding discrepancies or totals not adding. Data were aggregated to provide sufficient sample size. This may mask changes in prevalence over this time

period.


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Nutrition The proportion of children aged 4 to 7 years living in Mid North Region who are consuming the recommended daily intake of vegetables and fruit3,4 are shown in Table 2.17.

Table 2.17: Vegetable and fruit consumption of children aged 4 to 7 years for the Mid North Region n % (95% CI) Daily vegetable consumption 0 to 1 serves per day 25 74.0 (57.5 - 85.7) 2 or more serves per day 9 26.0 (14.3 - 42.5) Total 34 100.0 Daily fruit consumption 0 serves per day - - 1 or more serves per day 34 100.0 (90.0 - 100.0) Total 34 100.0 Recommended daily intake of at least two serves of vegetables and one serve of fruit per day

Not meeting recommendation 25 74.0 (57.5 - 85.7) Consuming recommended serves of fruit and vegetables 9 26.0 (14.3 - 42.5) Total 34 100.0 Data source: SAMSS July 2002 to June 2005, 4 to 7 years Note: The weighting of data can result in rounding discrepancies or totals not adding. Data were aggregated to provide sufficient sample size. This may mask changes in prevalence over this time

period.

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Fruit and vegetable consumption by health region

When comparisons were undertaken by region, children aged 4 to 7 years living in the Mid North region were statistically significantly less likely to consume two or more serves of vegetables per day and to consume the recommended serves of fruit and vegetables per week (Table 2.18).

Table 2.18: Vegetable and fruit consumption of children aged 4 to 7 years by health region

Daily vegetable consumption Daily fruit consumption Recommended daily intake of at least two serves of

vegetables and one serve of fruit per day

n % (95% CI) n % (95% CI) n % (95% CI) Central Northern Adelaide 199 42.0 (37.6 - 46.5) * 430 90.8 (87.8 - 93.1) 186 39.3 (35.0 - 43.8) *

Southern Adelaide 107 50.2 (43.5 - 56.9) 197 92.8 (88.5 - 95.6) 104 49.0 (42.3 - 55.7) Hills Mallee 50 52.2 (42.3 - 61.9) 92 96.5 (90.7 - 98.7) 50 52.2 (42.3 - 61.9) Wakefield 37 55.5 (43.6 - 66.9) 61 91.7 (82.6 - 96.3) 37 55.5 (43.6 - 66.9) * Mid North 9 26.0 (14.3 - 42.5) * 34 100 (90.0 - 100) 9 26.0 (14.3 - 42.5) * Riverland 16 65.5 (46.1 - 80.9) * 21 81.9 (63.0 - 92.3) 13 51.8 (33.3 - 69.7) South East 20 45.7 (31.9 - 60.1) 40 90.2 (78.0 - 96.0) 19 42.6 (29.2 - 57.2) Eyre 13 38.3 (23.9 - 55.1) 30 90.8 (76.4 - 96.8) 13 38.3 (23.9 - 55.1) Northern & Far Western 5 31.2 (14.0 - 56.0) 15 94.0 (71.5 - 99.0) 5 31.2 (14.0 - 56.0)

Overall 455 45.5 (42.5 - 48.6) 919 91.9 (90.1 - 93.5) 435 43.5 (40.4 - 46.6) * Statistically significantly higher or lower (p <0.05) than the other categories combined. Data source: SAMSS July 2002 to June 2005, 4 to 7 years Note: The weighting of data can result in rounding discrepancies or totals not adding. Data were aggregated to provide sufficient sample size. This may mask changes in prevalence over this time

period.

APPENDIX 1: SOUTH AUSTRALIAN HEALTH REGIONS BY POSTCODE

Table 1A: South Australian Health Regions by postcode

Central Northern Adelaide 5000 5006 5007 5008 5009 5010 5011 5012 5013 5014 5015 5016 5017 5018 5019 5020 5021 5022

5023 5024 5025 5031 5032 5033 5034 5035 5037 5040 5061 5063 5064 5065 5066 5067 5068 5069

5070 5072 5073 5074 5075 5076 5081 5082 5083 5084 5085 5086 5087 5088 5089 5090 5091 5092

5093 5094 5095 5096 5097 5098 5106 5107 5108 5109 5110 5111 5112 5113 5114 5115 5117 5120

5121 5125 5126 5127 5134 5136 5137 5138 5140 5141 5142 5144 5151 5152 5154 5155 5156

Southern Adelaide 5038 5039 5041 5042 5043 5044 5045

5046 5047 5048 5049 5050 5051 5052

5062 5150 5157 5158 5159 5160 5161

5162 5163 5164 5165 5166 5167 5168

5169 5170 5171 5172 5173 5174

Hills Mallee 5131 5132 5133 5139 5153 5201 5202 5203 5204 5210 5211 5212

5213 5214 5220 5221 5222 5223 5231 5232 5233 5234 5237 5238

5240 5241 5242 5243 5244 5245 5250 5251 5252 5253 5254 5255

5256 5259 5260 5261 5264 5265 5266 5301 5302 5303 5304 5307

5308 5309 5320 5321 5354 5356 5357 5236 5306 5310

Wakefield 5116 5118 5235 5350 5351 5352 5353 5355 5360 5371 5372 5373

5374 5381 5400 5401 5410 5411 5412 5413 5414 5415 5416 5417

5419 5451 5452 5453 5460 5461 5462 5464 5501 5502 5510 5520

5550 5552 5554 5556 5558 5570 5571 5572 5573 5575 5576 5577

5580 5581 5582 5583 5418 5420 5421 5455

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Table 1A: South Australian Health Regions by postcode (continued) Mid North 5422

5431 5432 5440 5454

5470 5471 5472 5473 5480

5481 5482 5483 5485 5491

5493 5495 5522 5523 5540

5555 5560 5490 5521

Riverland 5311 5322 5330

5331 5332 5333

5340 5341 5342

5343 5344 5345

5346 5312

South East 5263 5273 5269 5278

5279 5270 5262 5272

5276 5277 5267 5275

5268 5291 5271 5280

5290

Eyre 5653 5661 5602 5603 5604 5605

5606 5607 5620 5630 5631 5632

5633 5640 5641 5642 5650 5651

5652 5654 5655 5660 5670 5671

5680 5690

Northern and Far Western 872 5601 5724 5730 5734

5433 5434 5600 5608 5609

5700 5710 5720 5722 5723

5725 5731 5732 5733

APPENDIX 2: MAP OF SOUTH AUSTRALIAN HEALTH REGIONS

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APPENDIX 3: BACKGROUND AND METHODOLOGY

Background

Aims of SAMSS

The main objectives of SAMSS are to monitor, in a systematic way, the trends of diseases, health related problems, risk factors and other health service issues relevant to the South Australian Department of Health, over time. The aim of this system is to address the needs of the whole of the Department and to monitor key risk factor and population trends in priority chronic disease areas so that programs and policies can respond to these changes. These data monitor state and national health priority areas and will contribute to the evaluation of the effectiveness of the Department of Health programs, interventions and strategic plans. The system collects ongoing data at the population level on the priority health areas and main indicators pertinent to the Department of Health policies. The risk factors included in the system are those critical to national and state health priority areas. These data will ensure that appropriate, timely and valid population health information will be available to monitor health status, respond to population changes and support planning, implementation and evaluation of health services and programs. Trend and time series analyses will allow changes over time to be detected. SAMSS will address these needs on the whole South Australian population and interviews (or surrogate interviews) will be conducted with people of all ages. Other objectives are to: • Provide high quality, representative data; • Characterise health problems or topics by time; • Detect epidemics or changes in the topic occurrence; • Identify high risk groups or risk factors associated with health problems or topics

and suggest hypotheses for further investigation; • Estimate the burden of health problems or topics; • Evaluate health service initiatives, prevention and control programs including the

effectiveness of these programs (directly or indirectly); • Highlight gaps in information and services that affect South Australians’ general

health and wellbeing;

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• Disseminate findings to professionals and administrators within the Department of Health, and other health service professionals or organisations in South Australia and Australia;

• Project future health care needs; • Set priorities for allocation of resources; and • Strengthen the network for surveillance and monitoring of issues relevant to the

Department of Health to improve information gathering and exchange.

Methodology

Questions

Issues included in the questionnaire were based on the Department of Health and national/state priority areas and indicators with the intention of gathering appropriate data on key indicators. Topics that are included in SAMSS were developed by the Population Research and Outcome Studies (PROS) Unit in consultation with key personnel within the Department of Health, including relevant experts. Questions relating to children were developed in consultation with the SAMSS Children’s Committee that consists of state experts on childrens issues. A core set of questions is asked every month with additional questions asked in alternate months. These questions are based on previous work undertaken in Australian states and territories. Where possible, questions that had previously been included in other surveys, and are perceived to ascertain reliable and valid data, were used or modified5,6. The full list of questions asked in SAMSS can be obtained at http://www.health.sa.gov.au/pehs/PROS/samss.html.

Sample Selection

All households in South Australia with a telephone number listed in the Electronic White Pages (EWP) were eligible for selection in the sample. Each month, 1000 South Australian residential telephone numbers were randomly selected from the Electronic White Pages.

Introductory letter

A letter introducing SAMSS was sent to the household of each selected telephone number. Within each household the person who had their birthday last was selected


31

for interview. There was no replacement for non-contactable persons. The letter informed people of the purpose of the survey and indicated that they can expect a telephone call within the time frame of the survey.

Data collection

Data was collected every month by a contracted agency and interviews were conducted in English.

CATI

The CATI III (Computer Assisted Telephone Interview) system was used to conduct the interviews. This system allows immediate entry of data from the interviewer’s questionnaire screen to the computer database. The main advantages of this system are the precise ordering and timing of call backs and correct sequencing of questions as specific answers are given. The CATI system enforces a range of checks on each response with most questions having a set of pre-determined response categories. In addition, CATI automatically rotates response categories, when required, to minimise bias. When open-ended responses are required, these are transcribed exactly by the interviewer.

Call backs

At least ten call backs were made to the telephone number selected at random from the Electronic White Pages to interview household members. Different times of the day or evening were scheduled for each call back. If a person was not able to be interviewed immediately the interview was re-scheduled for a time suitable to them. Where a refusal was encountered, another interviewer (at the discretion of the supervisor) called later, in an endeavour to obtain the interview(s). Replacement interviews for persons who were not able to be contacted or interviewed were not permitted.

Validation

Of each interviewer’s work, 10% was selected at random for validation by the supervisor. The contracted agency is a member of Interviewer Quality Control Australia (IQCA).

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Data Processing

After each occurrence of data collection, the raw data from the CATI system was imported into SPSS for analysis. Open-ended responses were saved in Excel format and the responses were either coded numerically and brought into the main SPSS database, or brought into SPSS as a string variable if necessary.

Weighting

The data presented in this report were weighted by age, sex, area (metro/rural) and probability of selection in the household to the most recent ABS census data. Probability of selection in the household was calculated on the number of adults in the household and the number of listings in the White Pages. Weighting was used to correct for the disproportionality of the sample with respect to the populations of interest. The weights reflect unequal sample inclusion probabilities and compensate for differential non-response. The data were weighted using the ABS data so that the health estimates calculated would be representative of the adult populations of those areas. The weighting of the data results in occasional rounding effects for the numbers. In all instances the percentages should be the point of reference rather than the actual number of respondents as the percentages presented in this report have been processed on the figures pre-rounding.

APPENDIX 4: DEMOGRAPHIC PROFILE

Table 4A shows the proportion of respondents by South Australian Health Regions.

Table 4A: Proportion of respondents by the South Australian Health Regions, 18 years and over

n % Central Northern Adelaide 7594 49.2 Southern Adelaide 3695 23.9 Hills Mallee 1184 7.7 Wakefield 969 6.3 Mid North 302 2.0 Riverland 335 2.2 South East 674 4.4 Eyre 315 2.0 Northern & Far Western 371 2.4

South Australian Health Regions

Total 15439 100.0 Data source: SAMSS July 2002 to June 2005, 18 years and over

The demographic profile of respondents is shown in Table 4A to Table 4E for the Mid North health region (appropriately weighted to reflect population proportions). The Accessibility/Remoteness Index of Australia7 (ARIA) was developed to define rural and remote Australia using the Geographical Information Systems (GISCA) methodology. Remoteness was defined as accessibility to the four categories of the 201 service centres across Australia and road distances of 11,340 population localities to these service centres. Socio-economic, urban/rural and population size factors were not included in the definition. For each localities, a continuous value was given where 0 means highly accessible and 12 mean highly remote. The scores were applied at postcode level to the data and grouped into five categories for analyses. The Australian Bureau of Statistic Socio-Economic Index for Areas (SEIFA) Index of Relative Socio-economic Disadvantage (IRSD)8 is a score given to a locality (ie collector’s district, postcode, suburb, local government area) and is composite measure based on income, educational attainment, employment status, occupation type, family structure, dwellings, house ownership, marital status and ethnicity. The IRSD scores were applied at postcode level to the data, and grouped into quintiles for analysis. Based on locality, the quintiles are based on equal populations using the

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2001 census data, where the highest quintile comprises of postcodes with the highest IRSD scores (most advantaged areas).

Table 4B: Demographic profile - sex, age, accessibility /remoteness index of Australia (ARIA) and Socio-Economic Index of Advantage (SEIFA) Index of Relative Socio-economic Disadvantage (IRSD)

n % Male 141 46.8 Sex of respondent Female 161 53.2 16 to 24 years 23 7.6 25 to 34 years 34 11.4 35 to 44 years 69 22.9 45 to 54 years 55 18.2 55 to 64 years 52 17.1 65 to 74 years 41 13.6

Age groups

75 years and over 28 9.2 Highly accessible - - Accessible 253 83.8 Moderately accessible 48 15.9 Remote - -

ARIA (Accessibility / Remoteness Index of Australia)

Very remote 1 .3 1st (most disadvantaged) 162 53.7 2nd 39 13.1 3rd 52 17.2 4th 48 16.0 5th (most advantaged) - -

Index of Relative Socio-Economic Disadvantage quintiles)

Total 302 100.0

Note: The weighting of data can result in rounding discrepancies or totals not adding while greater variation in totals is due to non-response to question. Data source: SAMSS July 2002 to June 2005, 18 years and over


35

Table 4C: Demographic profile – Number of people living in household, children living in household, family structure, marital status and educational attainment and employment status

n % 1 49 16.2 2 191 63.1 3 51 16.8

Number of people in household, 16 years and over

4 or more people 12 3.9 No 204 67.6 Children aged less than

16 years in household Yes 98 32.4 Family with child(ren) (biological or adoptive parents)

106 35.0

A step or blended family 10 3.3 A sole parent family 7 2.5 Shared care parenting - - Adult living alone 44 14.7 Adult living with partner and no children 111 36.9

Related adults living together 18 5.9

Unrelated adults living together 2 .6

Other 3 1.1

Family structure

Refused - - Married/Living with partner 231 76.5

Separated/Divorced 14 4.7 Widowed 19 6.3 Never Married 38 12.5

Marital status

Refused - - Never attended school - - Some primary school 4 1.4 Completed primary school 24 7.8

Some high school 152 50.3 Completed high school 44 14.4 TAFE or trade certificate or diploma 60 19.8

University, CAE or some other tertiary institute degree

18 6.1

Other 1 .2 Not stated - -

Highest education attained

Total 302 100.0


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Table 4D: Demographic profile - Country of birth, language spoken at home other than English and Aboriginal Torres Strait Islander origin

n % Australia 272 90.2 New Zealand - - United Kingdom 19 6.2 Western Europe 5 1.7 Northern Europe - - Southern Europe 5 1.6 Eastern Europe 1 .2 North Africa and the Middle East - -

South East Asia - - North East Asia - - Southern and Central Asia - -

America (Northern, Central & Southern) - -

Sub-Saharan Africa 1 .2

Country of birth

Other - - Yes 5 1.7 No 297 98.3

Speak another language, other than English, at home

Not stated - - No 301 99.7 Aboriginal or Torres Strait Islander 1 .3

Not stated - -

Aboriginal or Torres Strait Islander

Total 302 100.0



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Table 4E: Demographic profile - employment status, family's money situation, household income and dwelling status

n % Full time employed 104 34.4 Part time employed 57 19.0 Unemployed 6 2.1 Engaged in home duties 44 14.6 Student 6 1.9 Retired 68 22.4 Unable to work 17 5.5

Current employment status

Other 1 .2 Spending more money than getting 9 3.0

Have just enough to get through to next pay 65 21.5

There's some money left each week but just spend it

14 4.8

Can save a bit every now and then 156 51.5

Can save a lot 50 16.7 Don't know 7 2.5

Current money situation

Refused 0 .1 Up to $12,000 17 5.5 $12,001 - $20,000 61 20.3 $20,001 - $40,000 68 22.5 $40,001 - $60,000 48 15.9 $60,001 - $80,000 42 14.0 $80,001 - $100,000 17 5.8 More than $100,000 17 5.5 Not stated/refused 3 1.0

Approximate annual gross household income

Don't know 29 9.5 Owned or being purchased 268 88.8

Rented from the Housing Trust 13 4.2

Rented privately 18 6.1 Other 3 .9

Dwelling status

Total 302 100.0


REFERENCES 1 World Health Organization. Obesity: preventing and managing the global epidemic. Report of a

WHO consultation on obesity. 1997, World Health Organization: Geneva. 2 NSW Health. The Active Australia International Year of Older Persons public education campaign

to promote physical activity among older people: NSW evaluation report. 2000. NSW Health Department

3 NHMRC. Dietary Guidelines for children and adolescents in Australia: incorporating the Infant Feeding Guidelines for Health Workers. Commonwealth of Australia 2003. [Online] Available at http://www.nhmrc.gov.au/publications/nhome.htm.

4 NHMRC. Dietary Guidelines for Australia Adults. Commonwealth of Australia 2003. [Online] Available at http://www.nhmrc.gov.au/publications/nhome.htm.

5 Department of Health, Population Research & Outcome Studies. SERCIS (Social, Environmental and Risk Context Information System). http://www.dh.sa.gov.au/pehs/SERCIS.html

6 Department of Health Population Research & Outcome Studies. The Health Omnibus Survey. http://www.dh.sa.gov.au/pehs/HOS.html

7 Measuring Remoteness: Accessibility/Remoteness Index of Australia (ARIA). Information and Research Branch, Department of Health and Aged Care, and the National Key Centre for Social Applications of Geographical Information Systems (GISCA), University of Adelaide. Department of Health and Aged Care Occasional Papers: New Series No. 6, August 1999. Online [accessed: October 2000] http://www.health.gov.au/ari/aria.htm

8 Australian Bureau of Statistics. Census of Population and Housing. Socio-economic Indexes for Areas. Information paper. ABS Catalogue no. 2039.0. 1996.

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