Health behaviours

Risk behaviours influence health and wellbeing and contribute to preventable morbidity and premature mortality. This chapter reports: risk alcohol drinking, breast screening, cervical screening, hysterectomy, immunisation (influenza and pneumococcal), smoke alarms in the home, nutrition (fruit consumption, vegetable consumption, lower fat or skim milk consumption, and food insecurity), physical activity, and smoking (current smoking, smoke-free homes, and smoke-free cars.

Risk alcohol drinking

Excessive alcohol consumption is associated with a variety of adverse health consequences including cirrhosis of the liver, mental illness, several types of cancer, pancreatitis, and fetal growth retardation. Adverse social effects include aggressive behaviour, family disruption, and reduced productivity. In general, higher levels of consumption are associated with higher levels of harm; however, high rates of harm have been found among low to moderate drinkers on the occasions they drink to intoxication. The risk drinking indicator in this report includes those who exceeded Guideline 1 of the 2001 NHMRC Australian Alcohol Guidelines prior to 2009 and those who exceeded Guideline 1 of the 2009 NHMRC Australian Alcohol Guidelines from 2009 onwards.[1-4]

In 2006-2009, just over 4 in 10 Aboriginal adults (43.5 per cent) engage in risk alcohol drinking. There was no significant difference between males and females. Among males, a significantly lower proportion of those aged 35-44 years (29.1 per cent) engaged in any risk drinking behaviour, compared with the overall Aboriginal adult male population. Among females, a significantly lower proportion of those aged 55-64 years (18.8 per cent) and 65 years and over (9.5 per cent), engaged in any risk drinking behaviour, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas or among area health services.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who engaged in any risk drinking behaviour.

Breast cancer screening

Breast cancer is the second most common cancer in the world and the most common cancer in females. The prevalence of breast cancer is higher in more developed countries, compared with less developed countries.[5] BreastScreen NSW provides free 2-yearly screening mammograms for females aged 50-69 years of age.[6]

A screening mammogram differs from a diagnostic mammogram in that screening is conducted on females who have no history of breast cancer and no breast problems or symptoms at the time the mammogram is taken. To establish the proportion of Aboriginal females who had a screening mammogram, those who had a breast problem, or had breast cancer in the past, were excluded from the analysis.

The NSW Population Health Survey collects self-reported data on breast cancer screening to complement the data collected through screening registries. The most complete source of data for breast cancer screening is the BreastScreen Register managed by the Cancer Institute NSW.[7] The NSW Cancer Plan 2007-2010 outlines the NSW Government's commitment to further reducing the effects of breast cancer through screening.[7]

In 2006-2009, just over 7 in 10 Aboriginal females aged 50-69 years (70.2 per cent) had a screening mammogram in the last 2 years.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal females aged 50-69 years who had a screening mammogram in the last 2 years.

Cervical cancer screening

Cervical cancer is the seventh most common cancer in the world and the second most common cancer in females after breast cancer. The prevalence of cervical cancer is lower in more developed countries, compared with less developed countries, largely due to population screening programs.[5] As cervical cancer is largely preventable if detected early and treated appropriately, females aged 20-69 who have ever had sex, and who have not had a hysterectomy, are recommended to have a Pap test every 2 years.[5,8]

The NSW Population Health Survey collects self-reported data on cervical cancer screening to complement the data collected through screening registries. The most complete source of data for cervical cancer screening is the Pap Test Register managed by the Cancer Institute NSW.[7] The NSW Cancer Plan 2007-2010 outlines the NSW Government's commitment to further reducing the effects of cervical cancer through screening.[7]

In 2006-2009, just over 7 in 10 Aboriginal females aged 20-69 years (72.6 per cent) had a Pap test in the last 2 years.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal females who had a Pap test in the last 2 years.

Hysterectomy

In 2006-2009, just under 1 in 10 Aboriginal females aged 20-69 years (9.2 per cent) ever had a hysterectomy.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal females who ever had a hysterectomy.

Influenza vaccination

Influenza (flu) is characterised by abrupt onset of fever, myalgia, headache, sore throat, acute cough, and can cause extreme malaise lasting several days. Because immunisation against the influenza virus has been shown to significantly reduce morbidity and preventable mortality, it is recommended for Aboriginal people aged 15 years and over.[9]

In 2006-2009, just under 5 in 10 Aboriginal adults aged 50 years and over (48.3 per cent) were immunised against influenza in the last 12 months. There was no significant difference between males and females, between urban and rural health areas, or among area health services.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults aged 50 years and over who were immunised against influenza in the last 12 months.

Pneumococcal vaccination

Invasive pneumococcal disease is an isolation of Streptococcus pneumoniae from a normally sterile site, most commonly the blood. It is a major cause of pneumonia, meningitis, and bacteraemia without focus. The 23-valent pneumococcal polysaccharide vaccine is recommended for Aboriginal people aged 50 years and over and those 15-49 years who have underlying chronic illnesses that place them at increased risk.[9]

In 2006-2009, just over 3 in 10 Aboriginal adults aged 50 years and over (34.8 per cent) were immunised against pneumococcal disease in the last 5 years. There was no significant difference between males and females.

There was no significant difference between urban and rural health areas or among area health services.

Since 2002-2005, there has been no significant change in the proportion of Aboriginal adults aged 50 years and over who were immunised against pneumococcal disease in the last 5 years; however, there has been a significant increase in rural health areas (26.7 per cent to 38.4 per cent).

Home smoke alarms

In New South Wales, a high proportion of the mortality and morbidity caused by house fires happens at night while people are sleeping. Functional and correctly situated smoke alarms detect low levels of smoke and sound an alarm before the smoke becomes too dense for people to escape.[10] The NSW Building Legislation Amendment (Smoke Alarms) Act 2005 commenced on 1 May 2006. This legislation requires that 1 or more smoke alarms are installed in residential buildings where people sleep, smoke alarms are maintained in functional order, and people do not remove these alarms or interfere with their operation.[11]

In 2006-2009, 93.1 per cent of Aboriginal adults lived in homes with a smoke alarm or detector, whether battery operated or hard wired or both. There was no significant difference among age groups, or between urban and rural health areas.

A significantly higher proportion of Aboriginal adults in the Hunter & New England (99.3 per cent) and North Coast (99.4 per cent) Area Health Services lived in homes with a smoke alarm or detector, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been a significant increase in the proportion of Aboriginal adults living in homes with a smoke alarm or detector (66.3 per cent to 93.1 per cent). The increase has been significant in urban and rural health areas.

Two or more serves of fruit a day

The Dietary Guidelines for Australian Adults and Australian Guide to Healthy Eating stress the importance of eating plenty of fruit.[12,13] The Go for 2 & 5 fruit and vegetable campaign website provides information on why adults should eat at least 2 serves of fruit each day to maintain good health and a healthy weight.[14]

In 2006-2009, just under 5 in 10 Aboriginal adults (46.9 per cent) consumed 2 or more serves of fruit a day. There was no significant difference between males and females. Among males, there was no significant difference among age groups. Among females, a significantly higher proportion of those aged 65 years and over (71.4 per cent) consumed 2 or more serves of fruit a day, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas, or among area health services.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who consumed 2 or more serves of fruit a day.

Five or more serves of vegetables a day

The Dietary Guidelines for Australian Adults and Australian Guide to Healthy Eating stress the importance of eating plenty of vegetables.[12,13] The Go for 2 & 5 fruit and vegetable campaign website provides information on why adults should eat at least 5 serves of vegetables each day to maintain good health and a healthy weight.[14]

In 2006-2009, just over 1 in 10 Aboriginal adults (12.3 per cent) consumed 5 or more serves of vegetables a day. There was no significant difference between males and females. Among males, a significantly lower proportion of those aged 55-64 years (3.5 per cent) consumed 5 or more serves of vegetables a day, compared with the overall Aboriginal adult male population. Among females, a significantly higher proportion of those aged 35-44 years (26.3 per cent), and a significantly lower proportion of those aged 16-24 years (2.5 per cent), consumed 5 or more serves of vegetables a day, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas. A significantly lower proportion of Aboriginal adults in the Hunter & New England (6.6 per cent) Area Health Services consumed 5 or more serves of vegetables a day, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who consumed 5 or more serves of vegetables a day.

Three or more serves of vegetables a day

To monitor trends in vegetable consumption below the recommended levels, the New South Population Health Survey reports Aboriginal adults who consume 3 or more serves of vegetables a day.

In 2006-2009, just under 4 in 10 Aboriginal adults (38.5 per cent) consumed 3 or more serves of vegetables a day. There was no significant difference between males and females. Among males, a significantly higher proportion of those aged 35-44 years (60.2 per cent) consumed 3 or more serves of vegetables a day, compared with the overall Aboriginal adult male population. Among females, a significantly lower proportion of those aged 16-24 years (21.7 per cent), and a significantly higher proportion of those aged 65 years and over (63.0 per cent), consumed 3 or more serves of vegetables a day, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas or among area health services.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who consumed 3 or more serves of vegetables a day.

Usually consumes lower fat or skim milk

The Dietary Guidelines for Australian Adults and Australian Guide to Healthy Eating stress the importance of including reduced fat varieties of milks and/or dairy alternatives in the diet, limiting saturated fat intake, and moderating total fat intake.[12,13]

In 2006-2009, just over 3 in 10 Aboriginal adults (32.9 per cent) usually consumes lower fat or skim milk. There was no significant difference between males and females. Among males, a significantly lower proportion of those aged 16-24 years (14.9 per cent), and a significantly higher proportion of those aged 35-44 years (51.3 per cent) and 45-54 years (51.6 per cent), usually consumes lower fat or skim milk, compared with the overall Aboriginal adult male population. Among females, a significantly higher proportion of those aged 45-54 years (50.0 per cent) and 55-64 years (51.3 per cent) usually consumes lower fat or skim milk, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas. A significantly higher proportion of Aboriginal adults in the South Eastern Sydney & Illawarra Area Health Service (52.0 per cent), and a significantly lower proportion of adults in the Sydney West (20.8 per cent) and Greater Southern (19.9 per cent) Area Health Services, usually consumes lower fat or skim milk, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who usually consumes lower fat or skim milk.

Food insecurity

Despite the good quality of the food supply, there are some population groups who lack food security: that is, who do not have access at all times to sufficient food for an active and healthy life. Food insecurity is associated with socioeconomic disadvantage and is a likely contributor to ill health.[12]

In 2006-2009, just over 1 in 10 Aboriginal adults (11.7 per cent) experienced food insecurity in the last 12 months. A significantly lower proportion of males (8.2 per cent) than females (14.7 per cent) experienced food insecurity in the last 12 months. Among males, a significantly lower proportion of those aged 16-24 years (2.7 per cent) experienced food insecurity in the last 12 months, compared with the overall Aboriginal adult male population. Among females, a significantly lower proportion of those aged 65 years and over (5.4 per cent) experienced food insecurity in the last 12 months, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas. A significantly lower proportion of Aboriginal adults in the South Eastern Sydney & Illawarra Area Health Service (4.6 per cent) experienced food insecurity in the last 12 months, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who experienced food insecurity in the last 12 months.

Adequate physical activity

Adults who regularly participate in moderate-to-vigorous levels of physical activity have lower rates of preventable mortality than those who are physically inactive; also, regular physical activity decreases risk of cardiovascular disease, some cancers, some mental illness, type-2 diabetes, overweight and obesity, and preventable injury.[15] To maintain good health, the National Physical Activity Guidelines for Adults, Choose Health, Be Active: A physical activity guide for older Australians, and the Recommendations on physical activity for health for older Australians is at least 30 minutes of moderate activity on most, and preferably all, days of the week.[16-18]

In the New South Wales Population Health Survey, adequate physical activity is calculated from questions asked in the Active Australia Survey,[19] and is defined as undertaking physical activity for a total of 150 minutes per week over 5 separate occasions. The total minutes are calculated by adding minutes in the last week spent walking continuously for at least 10 minutes, minutes doing moderate physical activity, plus minutes doing vigorous physical activity multiplied by 2.

In 2006-2009, just over 5 in 10 Aboriginal adults (50.3 per cent) undertook adequate levels of physical activity. A significantly higher proportion of males (64.0 per cent) than females (40.1 per cent) undertook adequate levels of physical activity. Among males, a significantly lower proportion of those aged 55-64 years (45.0 per cent) undertook adequate levels of physical activity, compared with the overall Aboriginal adult male population. Among females, a significantly lower proportion of those aged 65 years and over (20.1 per cent) undertook adequate levels of physical activity, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas, or among area health services.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who undertook adequate levels of physical activity.

Current smoking

Tobacco smoking is the leading cause of preventable mortality and morbidity in New South Wales. While the relationship between tobacco smoking, lung cancer, and cardiovascular disease has long been evidenced, a number of other diseases are now known to be associated with smoking. According to the US Surgeon General's Report (2004), tobacco smoking is associated with: cancer, including cancer of the lung, mouth, throat, larynx, esophagus, pancreas, kidney, bladder, stomach, and acute myeloid leukemia; cardiovascular disease, including atherosclerosis, strokes, abdominal aortic aneurysm, hardening and narrowing of the arteries, damage to the cells lining the blood vessels and heart, and blood clots; respiratory disease, including emphysema, chronic obstructive pulmonary disease, and upper and lower respiratory tract infections; reproductive problems, including difficulty becoming pregnant, a higher risk of never becoming pregnant, risk of complications during pregnancy, risk of premature birth, low birthweight infants, stillbirth, and infant mortality including increased risk of sudden infant death syndrome; other health effects, including increased risk of eye diseases, loss of bone mass, and peptic ulcers. Smokers are generally less healthy than nonsmokers. Smoking affects the immune system. Illnesses in smokers last longer and smokers are more likely to be absent from work. Smokers also use more medical services, both outpatient and inpatient services.[20]

In 2006-2009, just over 3 in 10 Aboriginal adults (33.9 per cent) were current (daily or occasional) smokers. There was no significant difference between males and females. Among males, a significantly lower proportion of those aged 16-24 years (19.2 per cent) and 65 years and over (18.3 per cent), and a significantly higher proportion of those aged 25-34 years (69.3 per cent) were current smokers, compared with the overall Aboriginal adult male population. Among females, a significantly lower proportion of those aged 55-64 years (20.7 per cent) and 65 years and over (10.3 per cent) were current smokers, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas. A significantly lower proportion of Aboriginal adults in the South Eastern Sydney & Illawarra Area Health Service (19.7 per cent) were current smokers, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who were current smokers; however, there has been a significant decrease in Aboriginal females (44.2 per cent to 34.2 per cent) and urban health areas (45.8 per cent to 30.7 per cent).

Since 2002-2005 there has been a significant decrease in the proportion of Aboriginal adults who were current smokers (41.3 per cent to 33.9 per cent).

Smoke-free homes

Exposure to environmental tobacco smoke (passive smoking) is a significant cause of preventable mortality and morbidity in New South Wales. Passive smoking causes lung and nasal and sinus cancer, stroke and ischemic heart disease in adults, lower respiratory infections (croup, bronchitis, bronchiolitis and pneumonia), onset of asthma and worsening of asthma, respiratory symptoms, reduced lung function, middle-ear disease and eye and nasal irritation in children, reduced birthweight, and increased risk of sudden infant death syndrome in infants. There is also a causal association between passive smoking and cervical cancer, decreased pulmonary function and exacerbation of cystic fibrosis in adults, and cardiovascular health and the development of neurodevelopmental and behavioural problems in children. The risk of breast cancer appears to increase with passive smoking during puberty but not with overall lifetime exposure. Most of the evidence of harm caused by passive smoking is based on studies in the home environment; however, passive smoking is harmful wherever it takes place.[21]

In 2006-2009, 76.3 per cent of Aboriginal adults lived in smoke-free homes. A significantly higher proportion of Aboriginal adults aged 65 years and over (88.5 per cent), and a significantly lower proportion of Aboriginal adults aged 45-54 years (62.2 per cent), lived in smoke-free homes.

There was no significant difference between urban and rural health areas or among area health services.

Since 1997-1998, there has been a significant increase in the proportion of Aboriginal adults who lived in smoke-free homes (49.7 per cent to 76.3 per cent). The increase has been significant in urban and rural health areas.

Bans smoking in their car

In 2006-2009, 79.2 per cent of Aboriginal adults with cars banned smoking in their car. A significantly higher proportion of Aboriginal adults aged 65 years and over (89.7 per cent), and a significantly lower proportion of Aboriginal adults aged 45-54 years (65.0 per cent), banned smoking in their car, compared with the overall Aboriginal adult population.

There was no significant difference between urban and rural health areas. A significantly higher proportion of Aboriginal adults in the Northern Sydney & Central Coast (93.2 per cent) and Greater Western (87.4 per cent) Area Health Services, and a significantly lower proportion of Aboriginal adults in the North Coast Area Health Service (62.6 per cent), banned smoking in their car, compared with the overall Aboriginal adult population.

Since 2002-2005, there has been a significant increase in the proportion of Aboriginal adults with cars who banned smoking in their car (71.0 per cent to 79.2 per cent). The increase has been significant in urban health areas.

References

Ministerial Council on Drug Strategy. National Alcohol Strategy 2006-2009. Canberra: Australian Government Department of Health and Aged Care, 2006. Available online at www.alcohol.gov.au (accessed 19 May 2010).
Mental Health and Drug and Alcohol Office. NSW Health Drug and Alcohol Plan 2006-2010 Sydney: NSW Department of Health 2007. Available online at www.health.nsw.gov.au/pubs/2007/drug_alcohol_plan.html (accessed 19 May 2010).
Australian Government Department of Health and Aged Care. 2001 Australian Alcohol Guidelines. Canberra: Australian Government Department of Health and Aged Care, 2006.
Australian Government Department of Health and Aged Care. Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Canberra: Australian Government Department of Health and Aged Care, 2009. Available online at www.nhmrc.gov.au/publications/synopses/ds10syn.htm (accessed 19 May 2010).
Tracey E, Alam N, Chen W, Bishop J. Cancer in New South Wales: Incidence and Mortality 2006. Sydney: Cancer Institute NSW, November 2008. Available online at www.cancerinstitute.org.au (accessed 19 May 2010).
The BreastScreen NSW website at www.bsnsw.org.au (accessed 19 May 2010).
The Cancer Institute NSW. NSW Cancer Plan 2007-2010. Sydney: The Cancer Institute NSW, 2006. Available online at www.cancerinstitute.com.au (accessed 19 May 2010).
The NSW Cervical Screening Program website at www.csp.nsw.gov.au (accessed 19 May 2010).
National Health and Medical Research Council. The Australian Immunisation Handbook, 9th Edition, Canberra: National Health and Medical Research Council, 2009. Available online at www.immunise.health.gov.au (accessed 19 May 2010).
NSW Fire Brigades. Smoke Alarm web page at www.nswfb.nsw.gov.au (accessed 19 May 2010).
NSW Fire Brigades. What Does The Legislation Mean? web page at www.nswfb.nsw.gov.au (accessed 19 May 2010).
National Health and Medical Research Council. Dietary Guidelines for Australian Adults. Canberra: NHMRC, 2003. Available online at www.nhmrc.gov.au (accessed 19 May 2010).
National Health and Medical Research Council. Australian Guide to Healthy Eating. Canberra: NHMRC, 2003. Available online at www.health.gov.au (accessed 30th March 2009).
The Go for 2 & 5 fruit and vegetable campaign website at www.gofor2and5.com.au (accessed 19 May 2010).
Bull F, Bauman A, Bellew B, and Brown W. Getting Australia Active II: An update of evidence on physical activity for health. Melbourne: National Public Health Partnership, 2004. Available online at www.nphp.gov.au/publications/a_z.htm (accessed 19 May 2010).
Australian Government Department of Health and Aged Care. National Physical Activity Guidelines for Australians. Canberra: Australian Government Department of Health and Aged Care, 2005. Available online at www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-active-index.htm (accessed 19 May 2010).
Commonwealth of Australia and the Repatriation Commission in collaboration with Australian Sports Federation Limited. Choose Health: Be Active. A physical activity guide for older Australians. Canberra: Commonwealth of Australia and the Repatriation Commission, 2008. Available online at www.health.gov.au/internet/main/publishing.nsf/Content/phd-physical-choose-health (accessed 19 May 2010).
Australian Government Department of Health and Ageing. Recommendations on physical activity for health for older Australians. Canberra: Australian Government Department of Health and Ageing, 2009. Available online at www.health.gov.au/internet/main/publishing.nsf/Content/phd-physical-rec-older-guidelines (accessed 19 May 2010).
Australian Institute of Health and Welfare. The Active Australia Survey: A guide and manual for implementation, analysis and reporting. Canberra: AIHW, 2003. Available online at www.aihw.gov.au/publications/index.cfm/title/8559 (accessed 19 May 2010).
United States Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta: United States Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 2004. Available online at www.surgeongeneral.gov/library/smokingconsequences (accessed 19 May 2010).
Commonwealth Department of Health and Ageing and the National Drug Strategy. Environmental Tobacco Smoke in Australia. Canberra: Commonwealth Department of Health and Ageing, 2002. Available online at www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-publicat-document-env_ets-cnt.htm (accessed 19 May 2010).

Graphs

Source:	New South Wales Population Health Survey 2006-2009 (HOIST). Centre for Epidemiology and Research, NSW Department of Health.
Print version:	Although this page can be printed directly from your web browser, a higher quality version is available as a PDF file that can be printed or viewed on screen.
Produced by:	Centre for Epidemiology and Research, Population Health Division, NSW Department of Health.
Last updated on:	1 August 2010

Health behaviours

Risk alcohol drinking

Breast cancer screening

Cervical cancer screening

Hysterectomy

Influenza vaccination

Pneumococcal vaccination

Home smoke alarms

Two or more serves of fruit a day

Five or more serves of vegetables a day

Three or more serves of vegetables a day

Usually consumes lower fat or skim milk

Food insecurity

Adequate physical activity

Current smoking

Smoke-free homes

Bans smoking in their car

References

Graphs

Aboriginal Adult Report

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