Health behaviours

Risk behaviours affect health and wellbeing and contribute to preventable morbidity and premature mortality. This chapter reports: alcohol risk drinking, fruit consumption, vegetable consumption, type of milk consumed, physical activity, immunisation against influenza, immunisation against pneumococcal pneumonia, smoking status, smoke-free households, and homes with a smoke alarm or detector.

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 consumption on the health of others, such as road trauma caused by drink-driving and alcohol-related violence.[1,2] 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?

Overall, 36.0 per cent of New South Wales adults engaged 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.[3] A significantly higher proportion of people born in New Zealand (41.7 per cent) and Australia (38.4 per cent) engaged in risk alcohol drinking. A significantly lower proportion of people born in Italy (26.3 per cent), Germany (25.5 per cent), Greece (14.2 per cent), India (13.4 per cent), the Philippines (12.5 per cent), Hong Kong (8.0 per cent), Lebanon (7.1 per cent), Vietnam (5.0 per cent), and China (4.4 per cent), engaged in risk alcohol drinking.

Nutrition: fruit and vegetable consumption

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.[4]

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]

Overall, 47.5 per cent of New South Wales adults consumed the recommended daily intake of fruit (2 serves or more). A significantly higher proportion of people born in Italy (64.1 per cent) and Germany (62.0 per cent) consumed the recommended daily intake of fruit.

Overall, 8.4 per cent of New South Wales adults consumed the recommended daily intake of vegetables (5 serves or more). A significantly lower proportion of people born in China (4.6 per cent), the Philippines (3.6 per cent), Hong Kong (3.1 per cent), Italy (2.7 per cent), Vietnam (1.9 per cent), and Lebanon (1.9 per cent), consumed the recommended daily intake of vegetables.

Nutrition: use of lower fat milks

A diet high in fat consumption is associated with health risk, which is why it is important to monitor fat consumption in dairy foods.

In the New South Wales Population Health Survey respondents are asked the following questions, as part of a validated short dietary questionnaire: What type of milk do you usually have?

Overall, 44.9 per cent of New South Wales adults consumed low fat, reduced fat or skim milk. A significantly higher proportion of people born in South Africa (55.6 per cent) and the United Kingdom (52.2 per cent) consumed low fat, reduced fat or skim milk. A significantly lower proportion of people born in China (18.6 per cent), Vietnam (18.6 per cent), Greece (30.7 per cent), Lebanon (31.6 per cent), Hong Kong (31.8 per cent), the Philippines (33.4 per cent), India (35.8 per cent), and Germany (37.2 per cent) consumed low fat, reduced fat or skim milk.

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.

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.[11] 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 the New South Wales Population Health Survey the following Active Australia Survey questions are asked: 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?

Overall, 49.2 per cent of New South Wales adults undertook adequate levels of physical activity. A significantly higher proportion of people born in New Zealand (59.0 per cent) undertook adequate levels of physical activity. A significantly lower proportion of people born in China (39.6 per cent), Italy (39.1 per cent), Vietnam (37.5 per cent), Greece (33.2 per cent), and Lebanon (29.8 per cent) undertook adequate levels of physical activity.

Influenza and pneumococcal vaccination

Influenza (flu), caused by the influenza virus, 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 be 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.[12] 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 and Torres Strait Islander people, and young children. The National Health and Medical Research Council recommends immunisation against pneumococcal disease for: all people aged 65 years and over; Aboriginal and Torres Strait Islander 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.[12]

In the New South Wales Population Health Survey the following Active Australia Survey questions were asked of respondents aged 50 years and over: Has a health professional ever advised you to be vaccinated against the flu?; Were you vaccinated or immunised against flu in the past 12 months?; Has a health professional ever advised you to be vaccinated against pneumonia?; When were you last vaccinated or immunised against pneumonia?

Overall, 49.2 per cent of New South Wales adults aged 50 years and over were vaccinated against influenza in the last 12 months. A significantly lower proportion of people born in South Africa (33.2 per cent), the United States (34.3 per cent), and New Zealand (36.2 per cent) were vaccinated against influenza in the last 12 months.

Overall, 24.6 per cent of New South Wales adults aged 50 years and over were vaccinated against pneumococcal disease in the last 5 years. A significantly lower proportion of people born in Lebanon (7.8 per cent), Vietnam (9.2 per cent), Hong Kong (9.4 per cent), the Philippines (9.8 per cent), New Zealand (12.1 per cent), South Africa (12.7 per cent), China (13.6 per cent), and the United States (13.9 per cent) were vaccinated against pneumococcal disease in the last 5 years.

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.[13]

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 regularly, I've never smoked.

Current smoking status includes daily or occasional smoking. Overall, 21.6 per cent of New South Wales adults were current smokers. A significantly higher proportion of people born in Lebanon (35.3 per cent) were current smokers. A significantly lower proportion of people born in China (14.7 per cent), India (14.2 per cent), South Africa (14.1 per cent), Vietnam (13.6 per cent), and Hong Kong (12.4 per cent) were current smokers.

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.[14]

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, 83.1 per cent of New South Wales adults live in a smoke-free home. A significantly lower proportion of people born in Lebanon (63.4 per cent) live in a smoke-free home. A significantly higher proportion of people born in the Philippines (91.8 per cent), Hong Kong (91.3 per cent), India (90.9 per cent), and South Africa (90.6 per cent) live in a smoke-free home.

Smoke alarms or detectors in the home

In New South Wales, on average, 20 deaths and 100 hospitalisations are attributed to house fires each year. Most mortality and morbidity happens at night, while people are sleeping, and is due to smoke inhalation rather than burns. 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. They dramatically reduce fatalities, injuries and damage to property. However, studies have also shown a significant proportion of smoke alarms are not functional.[15–19] The NSW Building Legislation Amendment (Smoke Alarms) Act 2005 commenced on 1 May 2006.[20] This legislation requires that: one or more smoke alarms are installed in residential buildings where people sleep; smoke alarms are maintained in functional order; people do not remove these alarms or interfere with their operation.[19]

In 2005, the New South Wales Population Health Survey asked respondents: Do you have any of the following fire safety measures in your home [Fire Blanket, Fire alarm (hard wired), Fire alarm (battery operated only), Fire sprinkler system, Safety switch or circuit breaker, Fire extinguisher, Fire evacuation plan, External water supply, External sprinkler, Other (specify)]?

Overall, 74.2 per cent of New South Wales adults have a smoke alarm or detector in their home. A significantly lower proportion of people born in Vietnam (60.2 per cent), China (57.7 per cent), Hong Kong (57.2 per cent), Italy (54.4 per cent), and Greece (48.9 per cent) have a smoke alarm or detector in their home.

References

1. 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.

3. World Health Organization. International Guide for Monitoring Alcohol Consumption and Related Harm. Geneva: WHO, 2000.

2. National Health and Medical Research Council. Australian Alcohol Guidelines: Health Risks and Benefits. Canberra: NHMRC, 2001.

4. National Health and Medical Research Council. Dietary Guidelines for Australian Adults. Canberra: NHMRC, 2003.

5. Ness AR, Powles JW. Fruit and vegetables and cardiovascular disease: A review. Int J Epidemiol, 1997, 26; 1–13.

6. 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.

7. 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.

8. 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.

9. National 'Go for 2 Fruits and 5 Vegetables Campaign' website at www.gofor2and5.com.au.

10. 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.

11. Australian Institute of Health and Welfare. The Active Australia Survey: A guide and manual for implementation, analysis and reporting. Canberra: AIHW, 2003.

12. National Health and Medical Research Council. The Australian Immunisation Handbook, 8th Edition, Canberra: National Health and Medical Research Council, 2003.

13. 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.

14. 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.

15. Schmertmann M, Finch C, and Williamson A. NSW Injury Profile: A Review Of Injury Deaths During 1998–2002. Sydney: NSW Injury Risk Management Research Centre, 2004, available online at www.irmrc.unsw.edu.au/documents/injuryprofiledeaths2004.pdf, accessed 16 February 2006.

16. Hayen A, and Mitchell R. NSW Injury Profile: A Review of Injury Hospitalisations During 1989–90 to 2003–04. Sydney: NSW Injury Risk Management Research Centre, 2005.

17. Haddix A, Mallonee S, Waxweiler R, Douglas M. Cost effectiveness analysis of a smoke alarm giveaway program in Oklahoma City, Oklahoma. Injury Prevention 2001; 7: 276–281.

18. Douglas M, Mallonee S, Istre G. Estimating the proportion of homes with functioning smoke alarms: A comparison of telephone survey and household survey results. Am J Public Health 1999; 89(7): 1112–1114.

19. Australasian Fire Authorities Council. Accidental fire fatalities in residential structures: Who's at risk? Melbourne: Australasian Fire Authorities Council, 2005.

20. NSW Fire Brigades. Smoke Alarm website and What Does The Legislation Mean? website at www.nswfb.nsw.gov.au, accessed 16 February 2006.

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 June 2006