1. 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. 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. 3 Outline of presentation Surveillance in Australia Examples/results from South Australia What challenges we face

4. 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. 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. 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. 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. 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. 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. 10 Data use Importance of continuous data collection – Provide trends – Timeliness – Aggregation over time

11. 11 Fruit and vegetable consumption

12. 12 Mean Serves of Mean serves of fruit per day – Adults aged 18 years and over Data Source: SAMSS 2003-2009

13. 13 Mean serves of fruit per day – Children aged 5 to 17 years Data Source: SAMSS 2003-2009

14. 14 Mean Serves of Mean serves of vegetables per day – Adults aged 18 years and over Data Source: SAMSS 2003-2009

15. 15 Mean serves of vegetables per day – Children aged 5 to 17 years Data Source: SAMSS 2003-2009

16. 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. 17 Fruit & vegetable consumption campaign

18. 18 Proportion eating 5+ serves vegetables/day (pre and post campaign) Data Source: SAMSS 2002-2010

19. 19 Proportion eating 5+ serves vegetables/day (pre and post campaign) by gender Data Source: SAMSS 2002-2010

20. 20 Proportion eating 5+ serves vegetables/day (pre and post campaign) by BMI Data Source: SAMSS 2002-2010

21. 21 Proportion eating 2+ serves fruit/day (pre and post campaign) Data Source: SAMSS 2002-2010

22. 22 Proportion eating 2+ serves fruit/day (pre and post campaign) by gender Data Source: SAMSS 2002-2010

23. 23 Proportion eating 2+ serves fruit/day (pre and post campaign) by BMI Data Source: SAMSS 2002-2010

24. 24 Physical Activity

25. 25 Sufficient physical activity – Adults 18 years and over Data source: SAMSS, age 18 years and over 2003 - 2009

26. 26 60 minutes of physical activity per day – Children 5 to 15 years Data source: SAMSS, age 15 - 15 years 2003 - 2009

27. 27 Proportion undertaking sufficient physical activity (adults) Data Source: SAMSS 2003-2010

28. 28 Proportion undertaking sufficient physical activity by BMI (adults) Data Source: SAMSS 2003-2010

29. 29 Proportion undertaking sufficient physical activity by gender (adults) Data source: SAMSS, age 16 years and over 2003 - 2010

30. 30 Proportion undertaking sufficient physical activity by SEIFA (adults) Data source: SAMSS, age 16 years and over 2003 - 2010

31. 31 Proportion undertaking sufficient physical activity by overall health status (adults) Data source: SAMSS, age 16 years and over 2003 - 2010

32. 32 Proportion undertaking sufficient physical activity by smoking status (adults) Data source: SAMSS, age 16 years and over 2003 - 2010

33. 33 Smoking

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

35. 35 Proportion of adults smoking Data source: SAMSS, age 16 years and over 2002 - 2010

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

37. 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. 38 Proportion of adults reporting smoking undertaken in the home Data source: SAMSS, age 16 years and over

39. 39 Healthy Weight

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

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

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

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

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

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

46. 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. 47 Challenges - Sampling Scientific Known probability of selection Random Power System approach Population framework Limited by : – Needs/resources available

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

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

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

51. 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. 52 Challenges - Sustainability/continuity Long term commitment - cost Show a difference/make a difference Be useful as an evidence provider

53. 53 Contact Details Anne Taylor Population Research & Outcome Studies (PROS) South Australian Department of Health University of Adelaide PROS Website: http://www.health.sa.gov.au/PROS/