Health behaviours

Risk behaviours in adulthood affect health and wellbeing and contribute to premature mortality. This chapter reports: risk alcohol drinking, nutrition, physical activity, smoking status, exposure to environmental tobacco smoke (passive smoking), and imm unisation against vaccine preventable diseases (influenza and pneumococcal disease).

Risk alcohol drinking

Alcohol affects health in a number of ways, including: acute physical effects, such as intoxication and alcohol overdose; chronic physical effects, such as cirrhosis of the liver, heart disease, brain damage, and memory loss; and the effects of alcohol con sumption on the health of others, such as road trauma caused by drink-driving and alcohol-related violence.[1] Alcohol abuse is also associated with crime, social problems, and lost productivity. Alcohol consumption is second only to tobacco consumption as a preventable cause of drug-related morbidity and mortality in Australia.

In the New South Wales Population Health Survey the following questions are asked: How often do you usually drink alcohol?; On a day when you drink alcohol, how many standard drinks do you usually have?; In the past 4 weeks how often have you had more than 4 [if male] or 2 [if female] drinks in a day?; In the past 4 weeks, how often have you had 11 or more [if male] or 7 or more [if female] drinks in a day?; In the past 4 weeks how often have you had 7–10 [if male] or 5–6 [if female] drinks in a day?

Just under one-half (45.9 per cent) of Aboriginal adults engage in risk alcohol drinking, defined by Guideline 1 of the NHMRC Australian Alcohol Guidelines as: consuming alcohol every day, consuming on average more than [4 if male or 2 if female] standard drinks, consuming more than [6 if male or 4 if female] on any one occasion or day.[2] A significantly higher proportion of males (54.2 per cent) than females (37.8 per cent) engage in risk alcohol drinking. Risk alcohol drinking generally d ecreased with age. There was some geographical variation, with a higher proportion of urban residents (47.2 per cent) than rural residents (45.1 per cent) engaging in risk alcohol drinking.

Just under one in 5 (19.5 per cent) of Aboriginal adults engage in high risk alcohol drinking (binge drinking), defined by the NHMRC Australian Alcohol Guidelines as consuming 11 or more standard drinks in any one day if male, and 7 or more standard drinks in any one day if female.[2] The proportion of males (28.2 per cent) reporting high risk alcohol drinking was significantly higher than females (11.1 per cent), with young males aged 16–24 years having the highest level (53.5 per cent ).

Nutrition: fruit and vegetable consumption and food security

Nutrition is an important determinant of health and disease at all stages of life, either as protective influences or as risk factors. Some common diseases and conditions, to which diet contributes substantially to health risk or health protection, include : coronary heart disease, stroke, some cancers, type 2 diabetes, osteoporosis, dental caries, gall bladder disease, and diverticular disease.[4,5,6,7]

An adequate intake of fruit and vegetables decreases the risk of major chronic diseases.[4,6] However, most groups in the New South Wales population eat less than the recommended amounts of these foods.[1] Despite the good qua lity of the food supply, there are some groups who lack food security: that is, who do not have sufficient access at all times to sufficient food for an active and healthy life. Food insecurity is a likely contributor to ill health associated with socioeco nomic disadvantage.

In the New South Wales Population Health Survey respondents are asked the following questions, as part of a validated short dietary questionnaire: How many serves of fruit do you usually eat each day?; and, How many serves of vegetables do you usually eat each day?[8] The national 'Go for 2 Fruits and 5 Vegetables Campaign' is used as the source of recommended numbers of serves of fruits and vegetables.[9] The following question was also asked: In the last 12 months, were there any times you ran out of food and couldn't afford to buy more?

Just over one-third (37.2 per cent) of Aboriginal adults consumed the recommended daily intake of fruit (2 serves or more). More females (40.6 per cent) than males (33.6 per cent) consumed the recommended daily intake of fruit. Consumption of fruit general ly increased with age. There was no significant difference between urban and rural areas.

Just over one in 10 (10.2 per cent) Aboriginal adults consumed the recommended daily intake of vegetables (5 serves or more). A significantly higher proportion of females (14.6 per cent) than males (5.4 per cent) consumed the recommended daily intake of ve getables. Consumption of vegetables was highest in females aged 35–44 years of age (23.6 per cent). There was some geographical variation, with a higher proportion of urban residents (12.7 per cent) than rural residents (8.6 per cent) consuming the r ecommended daily intake of vegetables. The highest proportion was in the Northern Sydney & Central Coast Health Area (21.7 per cent).

Overall, 15.1 per cent of Aboriginal adults had run out of food in the last 12 months and could not afford to buy more. Males and females were similar as were the different age groups. There was no significant difference between urban and rural areas. The lowest proportions were in the North Coast (8.2 per cent) and Greater Southern (10.1 per cent) Health Areas.

Adequate physical activity

Physical activity is an important factor in maintaining good health. It is a preventative factor for cardiovascular disease, some cancers, mental illness, diabetes mellitus, obesity, and injury. [10] The National Physical Activity Guidelines for Adults state the minimum amount of physical activity recommended to maintain good health is at least 30 minutes of moderate activity on most, and preferably all, days of the week.

In the New South Wales Population Health Survey the following Active Australia Survey questions were asked: [11] In the last week, how many times have you walked continuously for at least 10 minutes for recreation or exercise or to get to or from places?; What do you estimate was the total time you spent walking in this way in the last week?; In the last week, how many times did you do any vigorous physical activity that made you breathe harder or puff and pant?; What do you estimate was the total time you spent doing this vigorous physical activity in the last week?; In the last week, how many times did you do any other more moderate physical activity that you haven't already mentioned?; What do you estimate was the total time that you spent doing these activities in the last week?

According to the Active Australia Survey, adequate physical activity 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 walkin g (continuously for at least 10 minutes), minutes doing moderate physical activity, plus minutes doing vigorous physical activity multiplied by 2.

Overall, 51.6 per cent of Aboriginal adults undertook adequate levels of physical activity. A significantly higher proportion of males (58.0 per cent) than females (45.6 per cent) undertook adequate levels of physical activity. Overall, among both males an d females, the proportion decreased with age. There was some geographical variation, with a higher proportion of urban residents (55.5 per cent) than rural residents (49.3 per cent) undertaking adequate levels of physical activity.

Smoking status

Smoking is the leading preventable cause of mortality and morbidity in New South Wales. It is the main cause, or a significant cause, of many diseases including cancer and cardiovascular disease. Of all preventable risk factors, tobacco use is responsible for the greatest burden of premature death and disability.[12]

In the New South Wales Population Health Survey the following question was asked: Which of the following best describes your smoking status? I smoke daily, I smoke occasionally, I don't smoke now but I used to, I've tried it a few times but never smoked re gularly, I've never smoked.

Current smoking status includes daily or occasional smoking. Overall, 43.2 per cent of Aboriginal adults were current smokers. There was no significant difference in the proportion of males and females who currently smoked. For both males and females, rate s of current smoking were highest in young adults, particularly young men aged 16–24 years (58.9 per cent). There was some geographical variation, with a higher proportion of rural residents (44.4 per cent) than urban residents (41.2 per cent) curren tly smoking.

Smoke-free households

The adverse effects of exposure to environmental tobacco smoke (passive smoking) are well documented. In adults, passive smoking has been linked to asthma, lung cancer, cardiovascular diseases, eye irritations, and headaches.[13]

In the New South Wales Population Health Survey the following question was asked: Which of the following best describes your home situation? My home is smoke-free, People occasionally smoke in the house, People frequently smoke in the house.

Overall, 69.4 per cent of Aboriginal adults live in a smoke-free home. There was some geographic variation, with a higher proportion of urban residents (75.3 per cent) than rural residents (65.7 per cent) living in smoke-free homes. The highest proportion of smoke-free homes were in South Eastern Sydney & Illawarra (83.0 per cent) and Northern Sydney & Central Coast (80.9 per cent) Health Areas.

Immunisation: influenza and pneumococcal

In New South Wales, despite substantial progress in reducing the incidence of vaccine preventable diseases, increases in immunisation levels are needed to further reduce and eliminate these causes of illness and death.[14]

Influenza (flu) is caused by the influenza virus and is characterised by abrupt onset of fever, myalgia, headache, sore throat, and acute cough. Infuenza can cause extreme malaise lasting several days. Although usually not life-threatening, influenza can b e complicated by secondary bacterial pneumonia in individuals whose medical condition makes them vulnerable. Under the National Immunisation Program, influenza vaccine is provided free to all people aged 65 years and over and is recommended annually.[14] Under the National Indigenous Pneumococcal and Influenza Immunisation Program, the vaccine is provided free to Aboriginal people aged 50 years and over and to those aged 15–49 years who have chronic conditions or illness, or are heavy d rinkers, or smoke tobacco.[14]

Streptococcus pneumoniae (pneumococcus), a bacterial inhabitant of the upper-respiratory tract, is a major cause of pneumonia, meningitis, and middle-ear infection, particularly in the elderly, Aboriginal people, and young children. The National Hea lth and Medical Research Council recommends immunisation against pneumococcal disease for: all people aged 65 years and over; Aboriginal people aged 50 years and over; people over 5 years who are immunocompromised, suffer from chronic conditions or illness , or smoke tobacco; and people with asplenia, either functional or anatomical.[14]

The New South Wales Population Health Survey asked respondents aged 50 years and over: Has a health professional ever advised you to be vaccinated against the flu?; Were you vaccinated against flu in the past 12 months?; Has a health professional ever advi sed you to be vaccinated against pneumonia?; When were you last vaccinated against pneumonia?

Overall, 44.9 per cent of Aboriginal adults aged 50 years and over had an influenza vaccination in the last 12 months. There was no significant difference in the proportion of males and females who had an influenza vaccination. The proportion generally inc reased with age and was higher in rural areas (48.1 per cent) than urban areas (45.4 per cent).

Just over one in 5 (20.6 per cent) Aboriginal adults aged 50 years and over had a pneumococcal vaccination in the last 5 years. There was no significant difference in the proportion of males and females. The proportion generally increased with age, and the re was no significant difference between rural areas and urban areas.

References

English DR, Holman CDJ, Milne MG, et al. The quantification of drug caused morbidity and mortality in Australia. Canberra: Commonwealth Department of Human Services and Health, 1995.
National Health and Medical Research Council. Australian Alcohol Guidelines: Health Risks and Benefits. Canberra: NHMRC, 2001.
World Health Organization. International Guide for Monitoring Alcohol Consumption and Related Harm. Geneva: WHO, 2000.
National Health and Medical Research Council. Dietary Guidelines for Australian Adults. Canberra: NHMRC, 2003.
Ness AR, Powles JW. Fruit and vegetables and cardiovascular disease: A review. Int J Epidemiol, 1997, 26; 1–13.
World Cancer Research Fund and American Institute for Cancer Research. Food, nutrition and the prevention of cancer: A global perspective. Washington DC: American Institute for Cancer Research, 1997.
Brunner E, Wunsch H, Marmot M. What is an optimal diet? Relationship of macronutrient intake to obesity, glucose tolerance, lipoprotein cholesterol levels and the metabolic syndrome in the Whitehall II study. Int J Obes Relat Metab Disord, 2001, 25: 45–53.
Mark GC, Webb K, Rutishauser IHE, Riley M. Monitoring food habits in the Australian population using short questions. Canberra: Commonwealth Department of Health and Aged Care, 2001.
National 'Go for 2 Fruits and 5 Vegetables Campaign' website at www.gofor2and5.com.au.
Bauman A, Bellew B, Vita P, Brown W, and Owen T. Getting Australia Active: Towards better practice for the promotion of physical activity. Melbourne: National Public Health Partnership, 2002.
Australian Institute of Health and Welfare. The Active Australia Survey: A guide and manual for implementation, analysis and reporting. Canberra: AIHW, 2003.
Mathers C, Vos T, Stevenson C. The burden of disease and injury in Australia. AIHW Catalogue no. PHE18. Canberra: Australian Institute of Health and Welfare, 1999.
National Health and Medical Research Council. The Health Effects of Passive Smoking. Canberra: Publications Production Unit, Commonwealth Department of Health and Family Services, November 1997.
National Health and Medical Research Council. The Australian Immunisation Handbook, 8th Edition, Canberra: National Health and Medical Research Council, 2003.

Graphs

Source:	New South Wales Population Health Survey 2006 (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 July 2007