1. Lifestyle data and surveys Irina Holland irina.holland@somerset.nhs.uk

2. Aims of session Consider why we need lifestyle data and how we can find it Find out about the main national surveys Overview of the use of national data to create local models Hear about an example of a local lifestyle survey Understand the pros and cons of different types of survey

3. Introduction Lifestyle is one of the wider determinants of health Recent National Policies – E.g. Choosing Health and Healthy Weight, Healthy Lives Factors include physical activity, smoking, alcohol and drug use, as well as attitudes towards behaviour

4. Health and wellbeing Also look at wider determinants which may affect health and wellbeing e.g. levels of education, employment, housing, access to services, family and friends, etc.

5. Why do we need to know? Monitor health of population Likely future health needs (incidence and prevalence of disease or determinants) Plan and commission services relevant to our local population – Joint Strategic Needs Assessments (JSNA) – Local Area Agreements (LAA) Monitor performance of services/programmes Reduce Health Inequalities

6. Sources of lifestyle data Commercial sector / market research organisations Primary Care (e.g. QOF) National Surveys Synthetic estimates from national surveys Local surveys

7. Commercial organisations – Pros and cons E.g. Experian (MOSIAC), Dr Foster Positives – Large volume of household survey and consumer data Negatives – Modelled to provide for all areas – Detailed methods often not available

8. What is a survey? A survey is a way of gathering information from a sample population of interest They are a planned method of data collection Data is collected in the same way from everyone The sample should represent the population of interest Surveys can be one-off, repeated in the same population, or repeated in a different population

9. Why are surveys useful? Can measure populations that don’t come into contact with services Can measure issues that are not routinely recorded, e.g. healthy eating, physical activity levels Can help us to understand the link between disease and determinant, e.g. income and mental health

10. What surveys have you heard of? Have you used the data from any of these?

11. Main national surveys relevant to Public Health Census* Health Survey for England (being replaced by the Health and Social Care Survey in 2010) General LiFestyle Survey (GLF), formerly known as the General Household Survey (GHS) ONS Omnibus Survey *The Census is unique in that it measures ALL population, not just a sample

12. Other national surveys Psychiatric Morbidity Survey Adult Dental Health Infant Feeding Survey Living Costs and Food Survey Active People Survey National Diet & Nutrition Survey National Survey of Sexual Attitudes & Lifestyles (NATSAL) Smoking, Drinking and Drug use among Young People in England Taking Part Survey Citizenship Survey

13. The Census in England and Wales A census is a count of all people and households in the country. It provides population statistics from a national to neighbourhood level for government, local authorities, business and communities. The last census for England and Wales was on 29 April 2001. The next will take place on 27 March 2011 and will involve around 25 million households.

14. Census – Pros and cons Positives – Biggest cross-sectional survey in England – Best checked Census ever Negatives – Old! – Under-estimation of households and people Can you think who might be missed? – Data suppressed if small numbers

15. General LiFestyle Survey (GLF) Formerly known as the General Household Survey (GHS) Run since 1971 The GLF is a module of the Integrated Household Survey (IHS), run by ONS Adults 16+ 13,000 involved annually Regular lifestyle topics Extensive socio-economic data

16. GHS/GLF – Pros and cons Positive – General patterns of living – Trends 30 years data – Much data analysed by socio-economic status – Easily accessible data Negative – Little regional breakdown – Time lag

17. Health Survey for England Part of an overall programme of surveys commissioned by DH and designed to provide regular information on various aspects of the nation's health Annual since 1991, Adults aged 16+ living in private households, about 16,000 interviewed annually Children included since 1995 Core topics include: general health, smoking, drinking and fruit and vegetable consumption, height, weight, blood pressure measurements and blood and saliva samples. Each year focuses on a different demographic group and looks at such health indicators as cardio-vascular disease, physical activity, eating habits, oral health, accidents, and asthma. Will be replaced with the Health and Social Care Survey

18. HSE – Pros and cons Positive – Contains useful data on many risk factors for major conditions, e.g. CHD, diabetes, cancer – Not just self reported – Trend data – Regional breakdown – Special reports from yearly topics well-researched Negative – Not much on underlying determinants

19. ONS Omnibus Survey Since 1990 Carried out by the Office for National Statistics Multi-purpose survey based on interviews with a sample of about 1,800 adults per survey month, with one adult selected from each household. The ONS Omnibus is used for a number of purposes, for example: – to provide quick answers to questions of immediate interest – to provide information on topics that do not require a full survey – to develop and pilot questions for other surveys

20. Information Centre Health Surveys Programme Network Informs users of current programme of health surveys – HSE (HSCS) – Adult Dental Health Survey – Carers Survey – Smoking, Drinking and Drug use in young people – Omnibus – Infant Feeding Survey – Elements of the GLF and Integrated Household Survey (IHS) delivered by ONS

21. National surveys delivered locally National method but carried out locally Place Survey NHS Patient Surveys National Child Measurement Programme (NCMP) TellUs

22. Place Survey The National Indicator Set launched by the government in April 2008 contains 25 indicators which are informed by citizens' views and perspectives. In order to minimise the number of surveys that local authorities need to undertake, 18 of these indicators are collected through a single Place Survey administered by, or on behalf of, each local authority. The Survey takes place every two years.

23. NHS Patient Surveys Gathers feedback from patients about care they have recently received All services / settings included

24. National Childhood Measurement Programme (NCMP) Since 2005 Weighs and measures children in Reception (age 5-6) and Year 6 (age 10-11) Population surveillance Data shared with parents to engage them about the importance of healthy weight

25. TellUs Survey of children and young people Linked to five Every Child Matters outcomes Some lifestyle data, smoking, drink/drugs Sample of schools selected in each Local Authority TellUs1 started 2006 TellUs3 available now, TellUs4 due March 2010

26. Model based estimates (synthetic estimates) Demand for information at a range of geographical levels, not always collected locally National surveys designed to provide reliable estimates at national or sometimes regional levels Sample size usually too small to provide direct estimates for smaller areas, e.g. Local Authority Therefore need another technique...

27. Example of use – Health Profiles (1) http://www.apho.org.uk/default. aspx?QN=P_HEALTH_PROFIL ES

28. Example of use – Health Profiles (2) Model-based estimates using Health Survey for England data 2003-2005 for: – Adults who smoke – Binge drinking adults – Healthy eating adults – Obese adults

29. How does it work (briefly!) There is a relationship between national survey estimate and another sources of information related to behaviour, e.g. demographic information Census data often used for this Logistic regression technique used Identifies characteristics most strongly related to the behaviour Adjust for each area based on these characteristics to develop local estimates

30. Full technical description available from http://www.dh.gov.uk/en/Publicationsandstat istics/Statistics/StatisticalWorkAreas/Statistica lworkareaneighbourhood/DH_4116713

31. Limitations of modelled estimates NOT an estimate of actual prevalence – this measures expected prevalence Cannot be used to monitor performance Cannot usually compare between two sets of model-based estimates in two different time periods Does not reflect local initiatives

32. Local lifestyle Survey (1) Why.... – Prioritise local services – Evaluate local initiatives – Compares smaller geographies, e.g. wards (if sample size large enough) – Informs targets and plans, e.g. Local Area Agreements (LAAs) and Joint Strategic Needs Assessments (JSNAs)

33. Local Lifestyle Survey (2) Real local data Flexibility and control over: – Population to be surveyed (area, age, sex, etc) – Sample size (statistical power vs cost) – Design (cross-sectional/longitudinal, census/sample) – Method (phone, internet, face to face, postal) – Subject matter – anything you like!

34. Local Lifestyle Survey (3) Difficulties May not be able to compare with other areas May be difficult to get permission, e.g. names and addresses Takes a lot of time Can be expensive Is it really representative... ?

35. Example of a bespoke local Lifestyle Survey (Somerset Lifestyle Survey 2009) Survey previously done in 1987, 1992, 1998, 2002 7,500 sample, registered adults 16-74 11-page postal questionnaire In house Produced using package called Formic

36. What was difficult Public! (Translations, complaints) – Dedicated phone line with answerphone Volume of paper involved (33 boxes A4) Logistics of franking 7,500 envelopes And posting them! Storage Cleaning data

37. What survey method to use? MethodProsCons Postal Face-to-face Telephone Web

38. Some criteria for assessing and comparing different sources Validity Reliability Bias Timeliness Cost