The Use of Surveys to Measure ‘lifestyle’ in Public Health

Intelligence

Nick Cavill Cavill Associates/

National Obesity Observatory

nick@cavill.net

Thanks to...

• Carol Davies, EMPHO • Andrew Hughes, SEPHO • Cathy Mulhall, NOO

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…

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

The need for local lifestyle dataUse: 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

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

The need for local lifestyle data (cont.)

• helps to communicate important public health messages ...

• ... to the public/local communities

• ... to decision makers/commissioners/funders

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

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’

Year Special population focus  Modules

2001   Disability, Asthma, Accidents

2002 Children & young adults & maternal health

Asthma, Accidents, Physical activity, Eating habits, Oral health

2003  Ethnic minorities CVD, Physical activity, Eating habits, Oral health, Accidents (serious), Asthma (children)

2004    CVD, Physical activity, Eating habits

2005  Elderly + elderly in institutions Disability, Accidents, Social exclusion

2006   Disability, Asthma, Accidents

Health Survey for England 2001-06

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

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

Active People Survey • ‘Sponsored’ by Sport

England/DCMS • Run by Ipsos Mori • 1,000 per LA (APS1)• 500 per LA (APS2)

Cycling in APS

(NB: data are illustrative only)

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

new developments

• ONS Integrated Household SurveyGHS, Labour Force Survey, Expenditure & Food Survey, English Housing Survey, Omnibus Surveysn=160,000 in 2008, 240,000 in 2009PCT level estimates

• IC Survey Consultation - a new HSCSfE

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

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

Mandatory Local Surveys

• Place Surveys

• NHS Patient Surveys

• NCMP

• TellUs

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

NHS Patient Surveys

• purpose

• the in-house option

• the standard

methodology

• core and optional

questions

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

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

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

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

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

Data from commercial organisations

The main problem is that detailed methodologies are often not available

In conclusion…

• Much survey data available

• Use it creatively

• Do not duplicate

• Be critical