Trend and change analysis in an Australian surveillance system Associate Professor Anne Taylor South Australian Department of Health University of Adelaide Eleonora Dal Grande, Tiffany Gill, Zumin Shi Population Research & Outcome Studies, SA Health Michele Herriot Health Promotion, SA Health

2 Background The importance of evidence to Health Promotion – Range of sources – Health surveys risk factor surveillance Flexibility Addition of time Seasonal trends Trends over time Difference between surveys and surveillance - The ways things were vs the way things are changing

3 Outline of presentation Surveillance in Australia Examples/results from South Australia What challenges we face

4 History of surveillance in Australia South Australia Northern Territory Western Australia Queensland New South Wales Victoria Tasmania Surveillance system No surveillance system Adaptation

5 Surveillance in Australia COAG (Council of Australian Governments) – Laying the foundations for healthy behaviours in the daily lives of Australians – ($A448.1m over 4 yrs) – reward payments National Partnership Agreement on Preventive Health

6 Surveillance in Australia CATI infrastructure ($A10m over 4 yrs) – National consistency Questions Measurement Sampling frame – Minimum sample sizes Indicators (adults & children) -Fruit & vegetables -Physical activity -Healthy weight -Smoking

7 South Australian Monitoring & Surveillance System (SAMSS) Commenced July 2002 – Continuous chronic disease and risk factor surveillance system – CATI (Computer Assisted Telephone Interviews) – n = 600 per month – Random selection of South Australians of all ages (0+ years)

8 Sampling Australia – Electronic White Pages 2004 privacy legislation – Random Digit Dialling All telephone numbers included in IPND (Integrated Public Number Database) – (fixed line, mobile, public/private payphone, freecall) included in 1 database (listed and unlisted)

9 Data use Prevalence, change in estimates, trends Description of at risk populations Geographic distribution of illness/risk factors Detecting epidemics Generating hypotheses Facilitating planning

10 Data use Importance of continuous data collection – Provide trends – Timeliness – Aggregation over time

11 Fruit and vegetable consumption

12 Mean Serves of Mean serves of fruit per day – Adults aged 18 years and over Data Source: SAMSS

13 Mean serves of fruit per day – Children aged 5 to 17 years Data Source: SAMSS

14 Mean Serves of Mean serves of vegetables per day – Adults aged 18 years and over Data Source: SAMSS

15 Mean serves of vegetables per day – Children aged 5 to 17 years Data Source: SAMSS

16 Fruit and vegetable consumption campaign Go for 2&5 Campaign® – Awareness raising and educating – Comprehensive media campaign May-June 2005 – National and State based activities – $A100,000 in SA; Nationally $A4.75 million – Go for 2&5 Fruit and Vegetable man events

17 Fruit & vegetable consumption campaign

18 Proportion eating 5+ serves vegetables/day (pre and post campaign) Data Source: SAMSS

19 Proportion eating 5+ serves vegetables/day (pre and post campaign) by gender Data Source: SAMSS

20 Proportion eating 5+ serves vegetables/day (pre and post campaign) by BMI Data Source: SAMSS

21 Proportion eating 2+ serves fruit/day (pre and post campaign) Data Source: SAMSS

22 Proportion eating 2+ serves fruit/day (pre and post campaign) by gender Data Source: SAMSS

23 Proportion eating 2+ serves fruit/day (pre and post campaign) by BMI Data Source: SAMSS

24 Physical Activity

25 Sufficient physical activity – Adults 18 years and over Data source: SAMSS, age 18 years and over

26 60 minutes of physical activity per day – Children 5 to 15 years Data source: SAMSS, age years

27 Proportion undertaking sufficient physical activity (adults) Data Source: SAMSS

28 Proportion undertaking sufficient physical activity by BMI (adults) Data Source: SAMSS

29 Proportion undertaking sufficient physical activity by gender (adults) Data source: SAMSS, age 16 years and over

30 Proportion undertaking sufficient physical activity by SEIFA (adults) Data source: SAMSS, age 16 years and over

31 Proportion undertaking sufficient physical activity by overall health status (adults) Data source: SAMSS, age 16 years and over

32 Proportion undertaking sufficient physical activity by smoking status (adults) Data source: SAMSS, age 16 years and over

33 Smoking

34 Data source: SAMSS, age 16 years and over Smoking – Adults aged 16 years and over

35 Proportion of adults smoking Data source: SAMSS, age 16 years and over

36 Proportion of adult smokers by gender Data source: SAMSS, age 16 years and over 2002 to 2010

37 Smoking policy and legislation Dec 2004 – Smoke-free workplaces and public areas except licensed hospitality venues May 2007 – Ban on smoking in cars with children under 16 years Nov 2007 – All public areas smoke-free, including hospitality venues – Current policy targeting retail sales displays

38 Proportion of adults reporting smoking undertaken in the home Data source: SAMSS, age 16 years and over

39 Healthy Weight

40 Data source: SAMSS, age 18 years and over Unhealthy weight – Adults aged 18 years and over

41 Unhealthy weight – Children aged years Data source: SAMSS, age 5-17 years

42 Proportion of adults reporting overweight/obese (BMI >25) Data source: SAMSS, age 16 years and over

43 Proportion of adults reporting overweight/obese (BMI > 25) by gender Data source: SAMSS, age 16 years and over

44 Proportion of adults reporting overweight/obese (BMI > 25) by age Data source: SAMSS, age 16 years and over

45 Proportion of adults reporting overweight/obese (BMI > 25) by income Data source: SAMSS, age 16 years and over

46 What challenges do we face? In Australia - continued harmonization – State-based system – Conflicting goals Aim of all surveillance systems – Improvement on health outcomes – Value for money – Use of data An effective risk factor surveillance system will provide the evidence for change

47 Challenges - Sampling Scientific Known probability of selection Random Power System approach Population framework Limited by : – Needs/resources available

48 Challenges - Questions Standards Best practice guidelines Question development – Cognitive testing – Field testing Use of modules Flexibility but consistency Reliability/validity

49 Challenges In Australia -Too many different systems Harmonization -Questions (SNAPS) No national conference No governing committee -Informal vs formal

50 Challenges - Data collection Telephones Mixed mode Regular & sustained Issues – Response rates – Cultural differences Importance of quality assurance in all aspects

51 Challenges Dissemination – We have room for improvement – The use of the media & relationship with media – Explore more options The power of collaboration – Partners

52 Challenges - Sustainability/continuity Long term commitment - cost Show a difference/make a difference Be useful as an evidence provider

53 Contact Details Anne Taylor Population Research & Outcome Studies (PROS) South Australian Department of Health University of Adelaide PROS Website: