1. The Use of Surveys to Measure ‘lifestyle’ in Public Health Intelligence Nick Cavill Cavill Associates/ National Obesity Observatory nick@cavill.net

2. Thanks to... Carol Davies, EMPHO Andrew Hughes, SEPHO Cathy Mulhall, NOO

3. Objectives To increase awareness of the use of ‘lifestyle’ surveys in Public Health Intelligence To increase awareness of large national surveys (and mandatory local surveys) To discuss the implications for our work…

5. Lifestyle? Smoking Physical activity Diet Obesity Alcohol consumption Use of drugs Sexual behaviour Sexually transmitted infections Teenage pregnancy Breastfeeding Blood pressure Cholesterol levels

6. The need for local lifestyle data Use: General prioritising, planning, targeting and evaluating local services and lifestyle change initiatives data at LA/PCT-level AND below for... –comparison with other LAs/PCTs –within-area comparisons by age, gender, ethnicity, ward, practice, etc –analysis of trends over time and progress towards local targets –measuring the outcomes/impacts of services Specific Local Operational Plans (LOPs) Local Area Agreement (LAAs) Needs Assessments

7. Lifestyle in LOPs and LAAs Local Operational Plans (LOPs) –based on the “Vital Signs” indicators Local Area Agreement (LAAs) –based on the National Indicator Set (NIS) Vital Signs and NIS lifestyle indicators restricted to: –child obesity –smoking quitters –hospital admissions for alcohol-related harm –adult physical activity levels –school sport –breastfeeding

8. The need for local lifestyle data (cont.) helps to communicate important public health messages...... to the public/local communities... to decision makers/commissioners/funders

12. Some relevant national surveys Health Survey for England General Household Survey Psychiatric Morbidity Surveys ONS Omnibus Survey National Survey of NHS Patients Adult Dental Health Infant Feeding Survey Food & Expenditure Survey National Diet & Nutrition Survey National Survey of Sexual Attitudes & Lifestyles (NATSAL) Drug use, Smoking and Drinking among Young People in England Active People Survey Taking Part Survey Citizenship Survey

13. Health Survey for England Annual since 1991 Adults age >16 living in private households Children’s data from 1995 onwards (2-15) Approx. 16,000 people interviewed annually Clinical examination - height, weight, BP, blood sample - as well as self report data Special topic-based reports well researched Regional breakdowns - rarely anything sub-region Not much on underlying determinants of health and lifestyle Recent (2008) inclusion of ‘attitudes’

14. YearSpecial population focus Modules 2001 Disability, Asthma, Accidents 2002Children & young adults & maternal health Asthma, Accidents, Physical activity, Eating habits, Oral health 2003 Ethnic minoritiesCVD, Physical activity, Eating habits, Oral health, Accidents (serious), Asthma (children) 2004 CVD, Physical activity, Eating habits 2005 Elderly + elderly in institutionsDisability, Accidents, Social exclusion 2006 Disability, Asthma, Accidents Health Survey for England 2001-06

15. HSE in 2008 Focus on physical activity Included accelerometer data n=3,600 Step test for cardiovascular fitness Incorporated into broader Health and Social Care Survey from 2011

17. General Household Survey - ‘ Living in Britain ’ multi-purpose continuous survey since 1971 face to face interviews all adults in 13,000 addresses annually (72% response) regular health-related lifestyle topics –smoking – prevalence, consumption, dependency –drinking - amount & frequency occasional lifestyle topics –e.g. sport & leisure extensive socio-economic data –household composition, education, employment, housing tenure

19. Active People Survey ‘Sponsored’ by Sport England/DCMS Run by Ipsos Mori 1,000 per LA (APS1) 500 per LA (APS2)

21. Cycling in APS

22. (NB: data are illustrative only)

23. ONS Omnibus Survey Multi-purpose survey for non-profit organisations 3000 private households per month in GB Adults >16 interviewed

24. new developments ONS Integrated Household Survey GHS, Labour Force Survey, Expenditure & Food Survey, English Housing Survey, Omnibus Surveys n=160,000 in 2008, 240,000 in 2009 PCT level estimates IC Survey Consultation - a new HSCSfE

25. accessing the reports Health Survey for England http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-related-surveys/health-survey-for-england Health Survey for England 2006: CVD and risk factors adults, obesity and risk factors children Health Survey for England 2006 Latest Trends Health Survey for England 2005: Health of Older People General Household Survey http://www.statistics.gov.uk/downloads/theme_compendia/GHS06/GHS2006overview.pdf GHS 2006 Overview Report Smoking and drinking among adults, 2006 Active People Survey Sport England website

26. accessing and using the raw data UK Data Archive –http://www.data-archive.ac.uk holds all of: –Health Survey for England, General Household Survey, Psychiatric Morbidity Surveys, ONS Omnibus Survey, National Survey of NHS Patients, Adult Dental Health, Infant Feeding Survey, Food & Expenditure Survey, National Diet & Nutrition Survey, National Survey of Sexual Attitudes & Lifestyles (NATSAL), Drug use, Smoking and Drinking among Young People in England, Active People Survey... and more! time lag between survey and access

29. Mandatory Local Surveys Place Surveys NHS Patient Surveys NCMP TellUs

30. Place Surveys Replacement for “Best Value” survey Local Authority led Views, experiences and perceptions of local people Support new National Indicator set Consultation ended February 2008 Guidance issued June 2008, fieldwork September 2008

31. NHS Patient Surveys purpose the in-house option the standard methodology core and optional questions

32. NCMP Every year, children in Reception and Year 6 are weighed and measured during the school year Parents receive child’s results Generates local-level population surveillance data for trends in obesity. Many areas now incorporating child obesity within their LAAs

33. TellUs2 (2007) Online survey to gather views of children and young people n = 111,325 (across 141 LAs) School years 6, 8 and 10 (ages 10-15) Every Child Matters outcomes: Be healthy, Stay safe, Enjoy and achieve, Make positive contribution, Achieve economic well-being Evidence for National Indicator set TellUs3 2008 (results not yet published) www.ofsted.gov.uk

34. Data from commercial organisations e.g. CACI, Claritas, Experian, Acxiom, Dr Foster large volumes of household survey and consumer data modelled to provide estimates for all areas of the country e.g.: –expenditure on tobacco, food and drink –prevalence of smoking and obesity

35. Acxiom smoking prevalence estimates based on the “National Shoppers Survey” large national sample - some coverage in your area updates available annually adjusted for known biases in the sample e.g. undersampling of young people. relatively cheap 2005 data gave a national prevalence of 17% compared to 23-24% from 2004-5 GHS and 2004 HSE

36. The analysis looked at two surveys (The Health Survey for England and the British Market Research Bureau's TGI quarterly survey of 25,000 Britons) which ask people their Body Mass Index (BMI)*. By linking the postcodes of these respondents to the lifestyle categorisation (MOSAIC**) it was possible to show which types of people tend to have high and low BMIs. Dr Foster Obesity Data

37. Data from commercial organisations The main problem is that detailed methodologies are often not available

38. In conclusion… Much survey data available Use it creatively Do not duplicate Be critical