Report on the Tasmanian Population Health Survey 2016 ... Web viewThese are modifiable lifestyle...

Report on the Tasmanian Population Health Survey 2016March 2017

Acknowledgements

The Epidemiology Unit gratefully acknowledge the permission provided by the Victorian Department of Health to use questions from the annual Victorian Population Health Survey.

The data collection for this survey, and the preparation of the associated technical report, was undertaken by the Social Research Centre Pty Ltd, Melbourne. We specifically acknowledge the contributions of their Director for Data Processing and Analytics, Dr Dina Neiger in developing a tailored weighting methodology.

Suggested citation:Department of Health and Human Services Tasmania 2016, Report on the Tasmanian Population Health Survey 2016, Hobart.

Prepared by the Epidemiology Unit

Enquiries about this publication or requests for data should be directed to:

Michael LongEpidemiology UnitDepartment of Health and Human ServicesGPO Box 125Tasmania 7001

© Department of Health and Human Services, Tasmania, 2016This work is copyright. It may be reproduced in whole or in part for study and training purposes subject to the inclusion of an acknowledgment of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicate above requires written permission from the Department of Health and Human Services, Tasmania.

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Report on the Tasmanian Population Health Survey 2016

This publication can be downloaded at: http://www.dhhs.tas.gov.au/publichealth/epidemiology

Table of Content

Acknowledgements................................................................................................. iTable of Content................................................................................................. iiTables................................................................................................................ ivFigures............................................................................................................... ixIntroduction........................................................................................................1Interpretation.....................................................................................................2Key Findings.......................................................................................................3Chapter 1: Physical and mental health.......................................................6

Self-assessed health........................................................................................6Psychological distress......................................................................................9Financial stress and food insecurity..............................................................12

Chapter 2: Lifestyle risk factors................................................................14Smoking........................................................................................................14Alcohol consumption.....................................................................................18Body Mass Index...........................................................................................25Fruit and vegetable consumption..................................................................30Folate/folic acid.............................................................................................35Type of drinks consumed..............................................................................37Type of diet and food satisfaction.................................................................40Physical activity levels...................................................................................42Sedentary behaviour (sitting)........................................................................45Active transport.............................................................................................47

Chapter 3: Indicators of health literacy....................................................49Understanding health information.................................................................49Engaging with health care providers.............................................................52

Chapter 4: Chronic Diseases.......................................................................54Chronic disease prevalence...........................................................................54

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http://www.dhhs.tas.gov.au/publichealth/epidemiology

Chronic disease management.......................................................................56Preventive chronic disease screening...........................................................59

Chapter 5: Oral Health.................................................................................62Self-assessed oral health status....................................................................62Oral health problems.....................................................................................64Oral hygiene - adults.....................................................................................65Oral hygiene - children..................................................................................67Use of dental services and barriers...............................................................68

Chapter 6: Environmental health and wellbeing....................................73Wood heating................................................................................................73Home cooling................................................................................................76Bushfire risk and evacuation triggers............................................................78

Chapter 7: Public Health Service Use and Satisfaction..........................81Public Hospitals.............................................................................................81Community Health Centres...........................................................................83Child Health and Parenting Services (CHaPS)................................................85

Chapter 8: Risk factor prevalence in Local Government Areas...........87Appendix A: Survey methodology.....................................................................94

Survey design and sampling.........................................................................94Data collection..............................................................................................96Survey sample weighting..............................................................................96Profile of survey respondents........................................................................98Statistical analysis and interpretation of results...........................................98

Appendix B – Glossary....................................................................................101Appendix C – TPHS 2016 questionnaire data items........................................104Appendix D – Tasmania’s regional structure..................................................106

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Tables

TABLE 1: SELF-ASSESSED HEALTH, AGE STANDARDISED, 18 YEARS AND OVER, TASMANIA 2009 TO 2016...................................6

TABLE 2: SELF-ASSESSED HEALTH, AGE STANDARDISED, ABORIGINAL AND TORRES STRAIT ISLANDERS, 18 YEARS AND OVER, TASMANIA 2009-2016.....................................................................................................................................6

TABLE 3: SELF-ASSESSED HEALTH STATUS BY REGION, AGE STANDARDISED, 18 YEARS AND OVER, TASMANIA 2016......................7

TABLE 4: SELF-ASSESSED HEALTH BY AGE, TASMANIA 2016...............................................................................................7

TABLE 5: SELF-ASSESSED HEALTH BY SEIFA QUINTILES, AGE STANDARDISED, 18 YEARS AND OVER, TASMANIA 2016....................8

TABLE 6: HIGH/VERY HIGH LEVEL OF PSYCHOLOGICAL DISTRESS BY SEX, 18 YEARS AND OVER, TASMANIA 2009 TO 2016.............9

TABLE 7: LEVEL OF PSYCHOLOGICAL DISTRESS BY REGION, 18 YEARS AND OVER, TASMANIA 2016.............................................9

TABLE 8: HIGH/VERY HIGH LEVELS OF PSYCHOLOGICAL DISTRESS, ABORIGINAL AND TORRES STRAIT ISLANDERS, 18 YEARS AND OVER, TASMANIA 2009 TO 2016...............................................................................................................................10

TABLE 9: HIGH/VERY HIGH LEVEL OF PSYCHOLOGICAL DISTRESS BY AGE, TASMANIA 2009 TO 2016........................................10

TABLE 10: HIGH/VERY HIGH LEVELS OF PSYCHOLOGICAL DISTRESS BY SEIFA QUINTILES^, 18 YEARS AND OVER, TASMANIA 2009 TO 2016............................................................................................................................................................11

TABLE 11: FINANCIAL STRESS AND FOOD INSECURITY, 18 YEARS AND OVER, TASMANIA 2009 TO 2016..................................12

TABLE 12: RAN OUT OF FOOD AND COULD NOT AFFORD TO BUY ANY MORE WITHIN LAST 12 MONTHS, TASMANIA 2009 TO 2016....................................................................................................................................................................13

TABLE 13: SMOKING STATUS, 18 YEARS AND OVER, TASMANIA 2009 TO 2016..................................................................14

TABLE 14: SMOKING STATUS BY REGION, 18 YEARS AND OVER, TASMANIA 2016................................................................14

TABLE 15: CURRENT SMOKERS BY AGE, TASMANIA 2009 TO 2016..................................................................................15

TABLE 16: CURRENT SMOKERS BY SEX AND AGE, TASMANIA 2013 AND 2016...................................................................15

TABLE 17: CURRENT SMOKERS BY AGE AND REGION, TASMANIA 2016..............................................................................16

TABLE 18: CURRENT SMOKERS AMONG ABORIGINAL AND TORRES STRAIT ISLANDERS, 18 YEARS AND OVER, TASMANIA 2009 TO 2016............................................................................................................................................................16

TABLE 19: CURRENT SMOKERS BY SEIFA QUINTILES, 18 YEARS AND OVER, TASMANIA 2009 TO 2016...................................17

TABLE 20: FREQUENCY OF SMOKING INSIDE A HOME, 18 YEARS AND OVER, TASMANIA 2009 TO 2016..................................17

TABLE 21: ALCOHOL CONSUMPTION CAUSING SINGLE OCCASION RISK OF HARM^ BY FREQUENCY AND SEX, TASMANIA 2016.......18

TABLE 22: ALCOHOL CONSUMPTION CAUSING RISK OF HARM ON A SINGLE OCCASION ^ BY SEX AND AGE, TASMANIA 2016.........19

TABLE 23: ALCOHOL CONSUMPTION CAUSING RISK OF HARM ON A SINGLE OCCASION^ BY AGE AND REGION, TASMANIA 2016....20

TABLE 24: ALCOHOL CONSUMPTION CAUSING RISK OF HARM ON A SINGLE OCCASION^ BY SEIFA QUINTILES, 18 YEARS AND OVER, TASMANIA 2016.............................................................................................................................................20

TABLE 25: ALCOHOL CONSUMPTION CAUSING RISK OF HARM ON A SINGLE OCCASION^, ADULTS WITH DEPENDENT CHILDREN, TASMANIA 2016.............................................................................................................................................21

TABLE 26: ALCOHOL CONSUMPTION CAUSING RISK OF LIFE-TIME HARM^ BY SEX, TASMANIA 2016.........................................22

TABLE 27: ALCOHOL CONSUMPTION CAUSING RISK OF LIFE-TIME HARM AT LEAST WEEKLY^ BY SEX AND AGE, TASMANIA 2016....22

TABLE 28: ALCOHOL CONSUMPTION CAUSING RISK OF LIFE TIME HARM AT LEAST WEEKLY^ BY AGE AND REGION, TASMANIA 2016....................................................................................................................................................................23

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TABLE 29: ALCOHOL CONSUMPTION CAUSING RISK OF LIFE TIME HARM AT LEAST WEEKLY^ BY SEIFA QUINTILES, 18 YEARS AND OVER, TASMANIA 2016....................................................................................................................................23

TABLE 30: ALCOHOL CONSUMPTION CAUSING RISK OF LIFETIME HARM^, ADULTS WITH DEPENDENT CHILDREN, TASMANIA 2016.24

TABLE 31: SELF-REPORTED BMI, AGE STANDARDISED, 18 YEARS AND OVER, TASMANIA 2009 TO 2016................................25

TABLE 32: SELF-REPORTED BMI BY SEX, AGE STANDARDISED, 18 YEARS AND OVER, TASMANIA 2009 TO 2016........................26

TABLE 33: SELF-REPORTED BMI BY REGION, AGE-STANDARDISED, 18 YEARS AND OVER, TASMANIA 2016...............................27

TABLE 34: SELF-REPORTED OVERWEIGHT BMI BY AGE, TASMANIA, 2009 TO 2016.............................................................27

TABLE 35: SELF-REPORTED OBESE BMI BY AGE, TASMANIA, 2009 TO 2016.....................................................................28

TABLE 36: OBESE BMI BY SEIFA QUINTILES, AGE-STANDARDISED, 18 YEARS AND OVER, TASMANIA 2009 TO 2016.................29

TABLE 37: MET NHMRC GUIDELINES FOR FRUIT AND VEGETABLES, 18 YEARS AND OVER, TASMANIA 2009 TO 2016...............31

TABLE 38: MET NHMRC GUIDELINES FOR FRUIT AND VEGETABLES BY SEX, 18 YEARS AND OVER, TASMANIA 2009 TO 2016......31

TABLE 39: MET NHMRC GUIDELINES FOR FRUIT AND VEGETABLES BY REGION, 18 YEARS AND OVER, TASMANIA 2016.............32

TABLE 40: MET NHMRC GUIDELINES FOR FRUIT CONSUMPTION BY AGE, TASMANIA 2009 TO 2016....................................32

TABLE 41: MET NHMRC GUIDELINES FOR VEGETABLES BY AGE, TASMANIA 2009 TO 2016................................................33

TABLE 42: MET NHMRC GUIDELINES FOR FRUIT AND VEGETABLES, ADULTS WITH DEPENDENT CHILDREN, TASMANIA 2016........33

TABLE 43: MET NHMRC GUIDELINES FOR FRUIT AND VEGETABLES BY SEIFA QUINTILES, 18 YEARS AND OVER, TASMANIA 201634

TABLE 44: BREAD CONSUMPTION, 18 YEARS AND OVER BY SEX, TASMANIA 2016..............................................................35

TABLE 45: FREQUENCY OF FOLIC ACID SUPPLEMENTATION BY FEMALES AGED 18-50 YEARS, TASMANIA 2014.........................35

TABLE 46: FOLIC ACID SUPPLEMENTATION, FEMALES AGED 18-50 YEARS WHO DID NOT EAT ANY BREAD..................................36

TABLE 47: KNOWLEDGE OF REASONS FOR ADVICE TO TAKE FOLIC ACID, TASMANIA 2016....................................................36A

TABLE 48: TYPES OF DRINKS CONSUMED WHEN THIRSTY, 18 YEARS AND OVER, TASMANIA 2009 TO 2016..............................37

TABLE 49: TYPE AND FREQUENCY OF SWEETENED DRINK CONSUMPTION, 18 YEARS AND OVER, TASMANIA 2016.....................37

TABLE 50: NUMBER OF CUPS OF SWEETENED DRINKS USUALLY CONSUMED WEEKLY BY TYPE OF DRINK, TASMANIA 2016...........38

TABLE 51: CONSUMPTION OF SUGAR SWEETENED DRINKS BY BMI STATUS.........................................................................38

TABLE 52: TYPE OF MILK CONSUMED, 18 YEARS AND OVER, TASMANIA 2009 TO 2016.......................................................39

TABLE 53: TYPE OF CURRENT DIET/USUAL FOOD CONSUMED^ BY SEX, 18 YEARS AND OVER, TASMANIA 2016..........................40

TABLE 54: REASON FOR CURRENT TYPE OF DIET/USUAL FOOD, 18 YEARS AND OVER, TASMANIA 2016...................................40

TABLE 55: REASONS FOR DISSATISFACTION WITH AVAILABLE FOOD, 18 YEARS AND OVER, TASMANIA 2009 TO 2016................41

TABLE 56: LEVEL OF PHYSICAL ACTIVITY USING THE 1999 GUIDELINES, 18 YEARS AND OVER TASMANIA 2009 TO 2016............42

TABLE 57: LEVEL OF PHYSICAL ACTIVITY, 18-64 YEARS, TASMANIA 2016..........................................................................43

TABLE 58: LEVEL OF PHYSICAL ACTIVITY BY REGION, 18-64 YEARS, TASMANIA 2016............................................................43

TABLE 59: INSUFFICIENT PHYSICAL ACTIVITY (MVPA) BY SEX AND AGE, 2014 GUIDELINES, TASMANIA 2016...........................44

TABLE 60: PHYSICAL ACTIVITY LEVELS BY SEIFA QUINTILES, 18-64 YEARS, TASMANIA 2016....................................................44

TABLE 61: HOURS PER DAY SPEND SITTING^ ON WEEKDAYS AND WEEKENDS, 18 YEARS AND OVER, TASMANIA 2016.................45

TABLE 62: EIGHT HOURS OR MORE OF SITTING ON WEEKDAYS AND WEEKENDS BY REGION, TASMANIA 2016............................45

TABLE 63: EIGHT HOURS OR MORE OF SITTING ON WEEKDAYS AND WEEKENDS BY AGE, TASMANIA 2016.................................46

TABLE 64: EIGHT HOURS OR MORE OF SITTING ON WEEKDAYS AND WEEKENDS BY SEIFA QUINTILES, TASMANIA 2016...............46

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TABLE 65: ACTIVITY LEVELS AT WORK^, 18 YEARS AND OVER, TASMANIA 2016..................................................................46

TABLE 66: FREQUENCY OF USING ACTIVE TRANSPORT DURING LAST SEVEN DAYS^, 18 YEARS AND OVER, TASMANIA 2016..........47

TABLE 67: DID NOT USE ACTIVE TRANSPORT^ BY AGE, TASMANIA 2016............................................................................47

TABLE 68: DID NOT USE ACTIVE TRANSPORT^ BY SEIFA QUINTILE, TASMANIA 2016............................................................48

TABLE 69: UNDERSTANDING HEALTH INFORMATION, 18 YEARS AND OVER, TASMANIA 2016................................................49

TABLE 70: UNDERSTANDING HEALTH INFORMATION BY REGION, TASMANIA 2016...............................................................50

TABLE 71: UNDERSTANDING HEALTH INFORMATION BY SEX AND AGE, TASMANIA 2016........................................................50

TABLE 72: UNDERSTANDING HEALTH INFORMATION BY SEIFA QUINTILES, TASMANIA 2016..................................................51

TABLE 73: ABILITY TO DISCUSS HEALTH CARE CONCERNS WITH SERVICE PROVIDERS, 18 YEARS AND OVER, TASMANIA 2016........52

TABLE 74: ABILITY TO DISCUSS HEALTH CARE CONCERNS WITH SERVICE PROVIDERS BY REGION, TASMANIA 2016......................52

TABLE 75: USUALLY EASY/ALWAYS EASY TO DISCUSS HEALTH CARE CONCERNS WITH HEALTH CARE PROVIDERS BY AGE AND SEX, TASMANIA 2016.............................................................................................................................................53

TABLE 76: USUALLY EASY/ALWAYS EASY TO DISCUSS HEALTH CARE CONCERNS WITH HEALTH CARE PROVIDER BY SEIFA QUINTILES, TASMANIA 2016.............................................................................................................................................53

TABLE 77: SELF-REPORTED EVER DIAGNOSED CHRONIC CONDITIONS, AGE STANDARDISED, 18 YEARS AND OVER, TASMANIA 2009 TO 2016............................................................................................................................................................54

TABLE 78: SELF-REPORTED EVER DIAGNOSED CHRONIC CONDITIONS BY REGION, AGE STANDARDISED, TASMANIA 2009 TO 2016. 55

TABLE 79: SOUGHT PROFESSIONAL HELP FOR A MENTAL HEALTH RELATED PROBLEM^ BY SEX, 18 YEARS AND OVER, TASMANIA 2009 TO 2016..............................................................................................................................................56

TABLE 80: ACTIONS TAKEN TO MANAGE CURRENT HYPERTENSION^, 18 YEARS AND OVER, TASMANIA 2009 TO 2016...............57

TABLE 81: ACTIONS TAKEN TO MAANAGE CURRENT DIABETES TYPE 1 AND TYPE 2^, 18 YEARS AND OVER, TASMANIA 2016........57

TABLE 82: PROVIDED WITH AN ASTHMA ACTION PLAN BY REGION, 18 YEARS AND OVER, TASMANIA 2009 TO 2016................58

TABLE 83: PARTICIPATION IN PREVENTIVE HEALTH SCREENING^, 18 YEARS AND OVER, TASMANIA 2009 TO 2016....................59

TABLE 84: PARTICIPATION IN PREVENTIVE HEALTH SCREENING^ BY GENDER, TASMANIA 2016..............................................59

TABLE 85: PARTICIPATION IN PREVENTIVE HEALTH SCREENING^ BY REGION, TASMANIA 2009 TO 2016..................................60

TABLE 86: PARTICIPATION IN PREVENTIVE HEALTH SCREENING^ BY TYPE AND AGE, TASMANIA 2016......................................61

TABLE 87: SELF-ASSESSED ORAL HEALTH BY SEX, 18 YEARS AND OVER, TASMANIA 2016......................................................62

TABLE 88: SELF-ASSESSED ORAL HEALTH BY REGION, 18 YEARS AND OVER, TASMANIA 2016.................................................62

TABLE 89: SELF-ASSESSED ORAL HEALTH BY AGE, TASMANIA 2016...................................................................................63

TABLE 90: SELF-ASSESSED ORAL HEALTH BY SEIFA QUINTILES, 18 YEARS AND OVER, TASMANIA 2016......................................63

TABLE 91: FREQUENCY OF TOOTHACHES DURING LAST 12 MONTHS BY SEX, 18 YEARS AND OVER, TASMANIA 2016...................64

TABLE 92: FREQUENCY OF TOOTHACHES DURING LAST 12 MONTHS BY REGION, 18 YEARS AND OVER, TASMANIA 2016.............64

TABLE 93: FREQUENCY OF TOOTHACHES DURING LAST 12 MONTHS BY SEIFA QUINTILES, TASMANIA 2016.............................64

TABLE 94: USUAL FREQUENCY OF BRUSHING TEETH BY SEX, 18 YEARS AND OVER, TASMANIA 2016.......................................65

TABLE 95: USUAL FREQUENCY OF BRUSHING TEETH BY REGION, 18 YEARS AND OVER, TASMANIA 2016.................................65

TABLE 96: USUAL FREQUENCY OF BRUSHING TEETH BY AGE, TASMANIA 2016....................................................................66

TABLE 97: USUAL FREQUENCY OF BRUSHING TEETH BY SEIFA QUINTILES, TASMANIA 2016...................................................66

TABLE 98: FREQUENCY OF ADULTS BRUSHING TEETH OF CHILDREN AGED 5 YEARS AND UNDER, TASMANIA 2016......................67

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TABLE 99: FREQUENCY OF ADULTS BRUSHING TEETH OF CHILDREN AGE 5 YEARS AND UNDER BY REGION, TASMANIA 2016........67

TABLE 100: ADULTS ALWAYS BRUSHING TEETH OF CHILDREN AGE 5 YEARS AND UNDER BY SEIFA, TASMANIA 2016...................67

TABLE 101: BRUSHING TEETH TWICE A DAY OR MORE OFTEN BY ADULTS WITH CHILDREN IN HOUSEHOLD, TASMANIA 2016........68

TABLE 102: TIME SINCE LAST DENTAL VISIT BY SEX, 18 YEARS AND OVER, TASMANIA 2016...................................................68

TABLE 103: TIME SINCE LAST DENTAL VISIT BY REGION, 18 YEARS AND OVER, TASMANIA 2016.............................................69

TABLE 104: TIME SINCE LAST DENTAL VISIT BY AGE, TASMANIA 2016...............................................................................69

TABLE 105: TIME SINCE LAST DENTAL VISIT BY SEIFA QUINTILES, TASMANIA 2016..............................................................70

TABLE 106: WHETHER AVOIDED OR DELAYED A DENTAL VISIT DURING THE LAST 12 MONTHS BECAUSE OF COST, 18 YEARS AND OVER, TASMANIA 2016....................................................................................................................................71

TABLE 107: WHETHER AVOIDED OR DELAYED A DENTAL VISIT DURING THE LAST 12 MONTHS BECAUSE OF COST BY REGION, 18 YEARS AND OVER, TASMANIA 2016....................................................................................................................71

TABLE 108: AVOIDED OR DELAYED A DENTAL VISIT DURING THE LAST 12 MONTHS DUE TO COST BY AGE, TASMANIA 2016........71

TABLE 109: AVOIDED OR DELAYED A DENTAL VISIT DURING THE LAST 12 MONTHS BY FAMILY STATUS, TASMANIA 2016............72

TABLE 110: AVOIDED OR DELAYED A DENTAL VISIT DURING THE LAST 12 MONTHS BECAUSE OF COSTS BY SEIFA, TASMANIA 201672

TABLE 111: MAIN SOURCE OF ENERGY USED TO HEAT HOME, 18 YEARS AND OVER, TASMANIA 2016....................................73

TABLE 112: MAIN SOURCE OF ENERGY USED TO HEAT HOME BY REGION, TASMANIA 2016..................................................74

TABLE 113: WOOD USED AS THE MAIN SOURCE OF ENERGY TO HEAT HOME BY AGE, TASMANIA 2016...................................74

TABLE 114: WOOD USED AS THE MAIN SOURCE OF ENERGY TO HEAT HOME BY SEIFA QUINTILES^, 18 YEARS AND OVER, TASMANIA 2016.............................................................................................................................................75

TABLE 115: MAIN METHOD OF COOLING HOME, 18 YEARS AND OVER, TASMANIA 2016.....................................................76

TABLE 116: MAIN METHOD OF COOLING HOME BY REGION, TASMANIA 2016...................................................................76

TABLE 117: WITHOUT ANY AIR COOLING APPLIANCES BY AGE, TASMANIA 2016.................................................................77

TABLE 118: WITHOUT ANY AIR COOLING APPLIANCES BY SEIFA QUINTILES, TASMANIA 2016...............................................77

TABLE 119: HOME IS LOCATED IN AN AREA AT RISK FROM BUSHFIRE, TASMANIA 2016........................................................78

TABLE 120: HOME IS LOCATED IN AN AREA AT RISK FROM BUSHFIRE BY REGION, TASMANIA 2016.........................................78

TABLE 121: REASON FOR LEAVING HOME DURING A NEARBY BUSHFIRE, 18 YEARS AND OVER, TASMANIA 2016........................79

TABLE 122: REASON FOR DECISION ‘NOT TO LEAVE’ DURING A BUSHFIRE, TASMANIA 2016...................................................79

TABLE 123: ‘WOULD NOT LEAVE’ BY AGE, TASMANIA 2016............................................................................................80

TABLE 124: USED A TASMANIAN PUBLIC HOSPITAL^ DURING PRECEDING 12 MONTHS BY REGION, TASMANIA 2009-2016........81

TABLE 125: LEVEL OF SATISFACTION WITH TASMANIAN PUBLIC HOSPITAL SERVICES^, TASMANIA 2009-2016........................81

TABLE 126: LEVEL OF SATISFACTION WITH TASMANIAN PUBLIC HOSPITAL SERVICES^ BY REGION TASMANIA 2016...................82

TABLE 127: USED A COMMUNITY HEALTH CENTRE DURING PRECEDING 12 MONTHS BY REGION, TASMANIA 2009-2016.........83

TABLE 128: LEVEL OF SATISFACTION WITH COMMUNITY HEALTH CENTRE SERVICES, TASMANIA 2009-2016............................83

TABLE 129: LEVEL OF SATISFACTION WITH COMMUNITY HEALTH CENTRE SERVICE BY REGION, TASMANIA 2016.......................84

TABLE 130: USED A CHAPS DURING PRECEDING 12 MONTHS BY REGION, TASMANIA 2009-2016........................................85

TABLE 131: LEVEL OF SERVICE SATISFACTION WITH SERVICES PROVIDED BY CHAPS, TASMANIA 2009-2016............................85

TABLE 132: LEVEL OF SERVICE SATISFACTION WITH SERVICES PROVIDED BY CHAPS BY REGION TASMANIA 2016.......................86

TABLE 133: DAILY AND CURRENT SMOKERS BY LGA, 2016............................................................................................89

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TABLE 134: ALCOHOL CONSUMPTION CAUSING OCCASIONAL AND LIFETIME HARM BY LGA, 2016.........................................90

TABLE 135: DID NOT MEET GUIDELINES FOR FRUIT AND VEGETABLE CONSUMPTION BY LGA, 2016........................................91

TABLE 136: DID NOT MEET PHYSICAL ACTIVITY GUIDELINES FOR ADULTS 18-64 YEARS BY LGA, 2016.....................................92

TABLE 137: OVERWEIGHT AND OBESE BMI, AGE STANDARDISED BY LGA, 2016.................................................................93

TABLE 138: PROFILE OF RESPONDENTS IN THE TASMANIAN POPULATION HEALTH SURVEY 2016...........................................98

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Figures

FIGURE 1: FAIR/POOR SELF-ASSESSED HEALTH BY SEIFA QUINTILES, TASMANIA 2016............................................................8

FIGURE 2: ALCOHOL CONSUMPTION CAUSING HARM ON SINGLE OCCASIONS^ BY SEX AND AGE, TASMANIA...............................19

FIGURE 3: ALCOHOL CONSUMPTION CAUSING RISK OF HARM ON A SINGLE OCCASION^, ADULTS WITH DEPENDENT CHILDREN, TASMANIA 2016.............................................................................................................................................21

FIGURE 4: SELF-REPORTED OBESE BMI BY AGE, TASMANIA 2009 TO 2016.......................................................................28

FIGURE 5: OBESE BMI BY SEIFA QUINTILES, AGE-STANDARDISED, 18 YEARS AND OVER, TASMANIA 2009-2016.....................29

FIGURE 6: MET NHMRC GUIDELINES FOR FRUIT AND VEGETABLE CONSUMPTION BY SEIFA QUINTILES, TASMANIA 2016..........34

FIGURE 7: CONSUMPTION OF SUGAR SWEETENED DRINKS BY BMI STATUS, 18 YEARS AND OVER, TASMANIA 2016...................39

FIGURE 8: TYPE OF MILK CONSUMED, 18 YEARS AND OVER, TASMANIA 2009 - 2016..........................................................40

FIGURE 9: DID NOT USE ACTIVE TRANSPORT^ BY AGE, TASMANIA 2016.............................................................................47

FIGURE 10: DID NOT USE ACTIVE TRANSPORT BY SEIFA QUINTILES, TASMANIA 2016..........................................................48

FIGURE 11: UNDERSTANDING HEALTH INFORMATION BY SEIFA QUINTILES, TASMANIA 2016................................................51

FIGURE 12: SOUGHT PROFESSIONAL HELP FOR A MENTAL HEALTH PROBLEM BY SEX, TASMANIA 2009 TO 2016.......................56

FIGURE 13: PROVIDED WITH AN ASTHMA ACTION PLAN BY REGION, TASMANIA 2009 TO 2016............................................58

FIGURE 14: PARTICIPATION IN PREVENTIVE HEALTH SCREENING BY AGE, TASMANIA 2016....................................................61

FIGURE 15: USUAL FREQUENCY OF BRUSHING TEETH BY SEX, TASMANIA 2016...................................................................65

FIGURE 16: TIME SINCE LAST DENTAL VISIT BY SEIFA QUINTILES, TASMANIA 2016.............................................................70

FIGURE 17: MAIN SOURCE OF ENERGY USED TO HEAT HOME, TASMANIA 2016...................................................................73

FIGURE 18: WOOD USED AS THE MAIN SOURCE OF ENERGY TO HEAT HOME BY SEIFA QUINTILES, TASMANIA 2016..................75

FIGURE 19: LOCATED IN AN AREA AT RISK OF BUSHFIRES BY REGION, TASMANIA 2016.........................................................78

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Introduction

The Tasmanian Population Health Survey 2016 is the third population health survey, and follows on from surveys conducted in 2009 and 2013. A total of 6 300 Tasmanians aged 18 years and over participated in this survey during October and November 2016. The Tasmanian Population Health Survey is a component of population health surveillance undertaken by the Department of Health and Human Services. Information provided by the survey is used to improve the health status of Tasmanians and will assist in the implementation of the Healthy Tasmania Strategic Plan 2016. Specifically, the survey aims to:

provide base-line data for the Healthy Tasmania Strategy

track changes in key lifestyle risk factor indicators monitor the prevalence of chronic conditions and preventive screening identify emerging health issues provide data to local governments and NGOs to better target health

system improvements

This report is a comprehensive presentation of findings, including trends since 2009, and is presented state-wide and by region, with key lifestyle risk factor indicator data for Local Government Areas included as an appendix.The data presented in this report cover a range of key indicators of importance to population health in Tasmania. These include tobacco smoking, overweight and obesity, inadequate fruit and vegetable consumption, intake of sugar sweetened drinks, insufficient physical activity and sedentariness, and alcohol consumption at harmful levels, as well as low levels of health literacy. These are modifiable lifestyle risk factors, which are known to contribute to the development of chronic diseases.Key health outcomes data in this report cover self-reported health, psychological distress, oral health and chronic conditions. Also included are participation rates in preventive screening for chronic diseases and actions taken to manage chronic conditions. For the first time, this report also presents data on home heating and cooling issues, as well as bush fire preparedness. These items were included to gain more knowledge about issues affecting air quality - such as household wood heating, as well as improving assessment of the ability of the Tasmanian population to cope with potential heat waves and increased bushfire risk due to climate change.Trends in the use of selected public health services, and satisfaction ratings, are included to assess changes in service provision and delivery at both the state and regional level, and also how Tasmanians rate their experience with those services over time.

1


Interpretation

The Tasmanian Population Health Survey (TPHS) uses Computer Assisted Telephone Interviewing (CATI), with the target population defined as all non-institutionalised Tasmanian residents aged 18 years and over. The 2016 sample included 6300 Tasmanian adults, stratified into sub-samples of 2100 for each of the three regions, large enough for reliable regional estimates and key indicator estimates for most local government areas. Interviewing was conducted from October to November 2016. As seasonality may impact on self-reported physical and mental health1, the months selected for interviewing in 2016 matched the time-frame used in previous surveys. As sole mobile phone use is increasing, currently estimated at 33 per cent of the Tasmanian population2, and has been found in the past to be more common amongst younger persons, the survey employed a dual frame approach by including a mobile phone sample (~30 per cent) in order to reduce the potential bias found in landline only sample frames. (Refer to Appendix A)Overall, the key demographic characteristics of the survey participants are similar to those in 2013 with the main exception of greater male participation. There was no change in the proportion of participants under the age of 35 years compared with 2013.The response rate in 2016 varied by sample type, with 70 per cent and 62.4 per cent for mobile and landline phones respectively. The overall response rate was 64.4 per cent.To make the survey results representative of the Tasmanian population, and address imbalances in age and gender when compared to the Tasmanian Estimated Resident Population June 2015, a tailored weighting methodology was used. Refer to Appendix A for details.As chronic diseases, and to a lesser extent high body mass index (BMI) and poor self-assessed health, are more common with older age, estimates for these items have been age-standardised, making it possible to assess changes between estimates independent of population ageing.All estimates are presented with confidence intervals (95%CI) to allow for statistical significance testing. Confidence intervals reflect the size of the sample, with large intervals reflecting small numbers, which is an indication of the uncertainty present in each category. Confidence intervals give a simple means of assessing differences between categories. When the confidence intervals of two estimates do not overlap, the estimates are statistically significantly different. When the confidence intervals of the estimates do overlap, the estimates are deemed to not be significantly different. However, this should be considered a guide only and a formal test would be required to arrive at a statistically credible conclusion.

1 Haomiao J and Lubetkin E.I., Time Trends and Seasonal Patterns of Health-related Quality of Life Among U.S. Adults, Public Health Reports. 124 (5), 20092 Australian Bureau of Statistics, National Health Survey 2014/15 Table Builder

2


The Index of Relative Socio-economic Disadvantage (IRSD) is part of the suite of indexes in the Socio-Economic Indexes for Areas (SEIFA) developed by the ABS, and is used extensively in this report. The IRSD summarises a range of information about the economic and social conditions of individuals and households within a geographic area (e.g. income, education, qualifications) and provides a broad measure of disadvantage.

3


Key Findings

Overall, Tasmanians felt more stressed and less healthy in 2016 compared to previous years, with significantly more Tasmanians reporting financial hardship and food insecurity. Socio-economic disadvantage significantly contributed to poor self-assessed health, poor dental health, and low health literacy. The proportion of adults with fair or poor health continued to increase, and there were more Tasmanians reporting high levels of psychological distress in 2016 than in 2009, particularly among Aboriginal and Torres Strait Islanders and young people.Most modifiable lifestyle risk factors remained similar to 2013 levels, with fruit consumption being the sole indicator with a statistically significant change. Only smoking and low fruit consumption were associated with socio-economic disadvantage, with obese BMI no longer linked to socio-economic disadvantage in 2016.Whilst there were substantive increases in some chronic conditions, particularly diabetes, eye diseases and depression/anxiety, preventive chronic disease screening rates and chronic disease management recorded a small, but significant, improvement.

There has been limited progress towards healthier lifestyles measured against indicators of key risk factors, including the metabolic risk factor of obesity.

Smoking has declined significantly since 2009, with no further improvements noted since 2013. Among young males and females age 18-24 years, smoking has been substantially reduced since 2009, particularly among males.

There have been marked improvements in reducing passive smoking since 2009, with more smoke-free households.

Physical activity has been maintained at similar levels since 2009, with two-thirds of Tasmanians gaining a health benefit from their activity.

4


2009 2013 2016

90.8%

94.6%95.1%

Never smoke inside

2009 2013 2016 2009 2013 2016

22.9% 23.0%

18.9%20.6%

17.1%19.6%

Males Females

Smokers 18-24 years

18-24 25-34 35-44 45-54 55-64 65+

10.2%

13.0%

15.7% 15.3%

18.4%

25.0%

Insufficient physical activity

Age has remained an important driver of insufficient physical activity, with older Tasmanians being more physically inactive than younger Tasmanians.

5


Prolonged sitting has harmful effects on health, and may affect over a third of Tasmanians reporting to be mostly sedentary at work in 2016.

Alcohol consumption at levels risking harm from injuries, with more than 4 standard drinks on a single occasion, was significantly more likely among males than females. Nearly six in ten males drank alcohol at potentially harmful levels compared to one in three females. Similarly, males were significantly more likely than females to consume alcohol at levels risking lifetime harm, meaning more than two standard drinks daily.

Healthy eating has declined further, with greater proportions of Tasmanians not meeting national nutrition guidelines for vegetable and fruit consumption.

Fruit consumption in particular recorded a significant decrease from previous years.Water is increasingly becoming the drink of choice, with over three quarters of all Tasmanians choosing water over alternative drinks in 2016.Folic acid supplementation is declining. In addition, two out of five females age

18 to 50 years fail to benefit from folic acid fortification of bread by not eating any bread.While most Tasmanians do not drink sugar sweetened beverages, the greatest proportion of those who do consume these drinks are Tasmanians with an obese BMI.

Obesity, a metabolic risk factor, has increased significantly compared to 2009 but not compared to 2013. The most substantial increases in obesity rates since 2009 have been among females and Tasmanians aged 65 years and over.

6


2009 2013 2016

49.8%

44.2%39.3%

10.9%8.5% 7.5%

Met fruit guidelines

Met vegetable guidelines

Single occasion Lifetime

57.0%

28.5%33.2%

13.3%

Males MalesFemale Female

Alcohol causing risk of harm

Mostly sitting Mostly standing Mostly walking Mostly heavy labour

39.0%

22.3%20.2%

14.5%

Activity levels at work

Improvements were noted in chronic disease screening rates and in actions taken to manage chronic conditions, although more Tasmanians were diagnosed with a chronic condition and more likely to have visited a public hospital in 2016 than in previous years.

Chronic conditions including depression/anxiety, eye diseases and diabetes have significantly increased compared to 2013 and 2009, with the largest increase noted for depression/anxiety.Potentially linked to the growth in depression/anxiety was a substantial rise in the proportion of Tasmanians seeking professional help for a mental health problem in 2016.Chronic disease prevention through health screening saw a significant increase in bowel cancer screening in 2016. This is likely to have been strongly influenced by more Tasmanians eligible to participate in the National Bowel Cancer Screening Program.Chronic disease management took a big step forward for Tasmanians with asthma, with a substantial rise in the provision of asthma plans in 2016. Tasmanians with diabetes or hypertension engaged in a range of actions to manage their condition, with medication, exercise, weight loss and diet modifications being the most commonly reported actions taken.The use of public hospitals has increased significantly in 2016 compared with 2013 and 2009, and satisfaction with services provided by Tasmanian public health services remains high.

Socio-economic disadvantage has increased and continues to drive smoking and low fruit consumption, as well as poor self-assessed health and oral health status.

Tasmanians reported more financial hardship in 2016 than in previous years, with more Tasmanians reporting difficulties with raising $2 000 in an emergency and food insecurity.

Younger Tasmanians aged 18 to 24 years made up a substantial proportion of those reporting food insecurity or perceiving some foods as too expensive. Socio-economic disadvantage is associated with poor self-assessed health, poor oral health and smoking, as well as low health literacy and inadequate fruit consumption.

7


Unable to raise $2,000 in an emergency

Ran out of food and unable to buy more

Some foods too expensive

17.9%

7.3%

26.8%2009 2013 2016

2009 2013 2016

5.5% 6.2%8.1%

21.4%

25.5%

30.0%

9.2% 10.1%11.7%

Depression/anxiety

Eye diseases

Diabetes

For the first time, socio-economic disadvantage was not related to obesity in 2016.

8


most disadvantaged least disadvantaged

27.2%

15.8%

29.8%

20.2%24.5%

9.8%Fair/poor self-assessed health

Fair/poor dental health

Smoking

Chapter 1: Physical and mental health

The key physical and mental health and wellbeing indicators include self-assessed health and psychological distress.

Self-assessed health

Self-reported health status (see Glossary) is a reliable predictor of disease and health service use, and is usually included in national and state surveys as a key indicator of general health status.Survey participants summarise their perceptions about their health by assessing their health as excellent, very good, good, fair or poor. Estimates have been age standardised to remove the impact of different age distributions for populations being compared (see Glossary).A statistically significant change was observed with fair/poor health, which increased from 19 per cent in 2013 to 23.7 per cent in 2016.

Table 1: Self-assessed health, age standardised, 18 years and over, Tasmania 2009 to 2016


2009%

200995% CI

2013%

201395% C

2016%

201695% CI

Excellent/Very Good

42.6% [41.0%,44.2%]

40.9% [39.0%,42.7%]

37.1%# [34.6%,39.7%]

Good 37.3% [35.7%,38.8%]

39.8% [37.9%,41.6%]

38.9% [36.4%,41.6%]

Fair/Poor 19.9% [18.7%,21.2%]

19.0% [17.8%,20.4%]

23.7%*#

[21.6%,25.9%]

Tasmanian Population Health Surveys 2009, 2013, 2016; *statistically significant increase compared with 2013, #statistically significant increase compared with 2009

Tasmanian Aboriginal and Torres Strait Islanders reported more fair and poor health (29.5 per cent) and less excellent or very good health (28.9 per cent) in 2016 compared to previous years, but these differences were not statistically significant. There were no statistically significant differences between the self-assessed health status of Aboriginal and Torres Strait Islanders and Tasmania’s total population.Table 2: Self-assessed health, age standardised, Aboriginal and Torres Strait Islanders, 18 years and over, Tasmania 2009-2016


2009%

200995% CI

2013%

201395% C

2016%

201695% CI

Excellent/Very Good

37.8% [30.3%,45.9%]

37.1% [30.0%,44.9%]

28.9% [21.7%,37.3%]

Good 36.2% [28.4%,44.8%]

39.9% [32.6%,47.6%]

41.6% [34.1%,49.5%]

9



2009%

200995% CI

2013%

201395% C

2016%

201695% CI

Fair/Poor 21.2% [15.5%,28.3%]

23.0% [17.5%,29.6%]

29.5% [23.1%,36.9%]

Tasmanian Population Health Surveys 2009, 2013, 2016

10


Across regions, statistically significant changes were observed in the North, with an increase in fair/poor health from 20.1 per cent in 2013 to 25.2 per cent in 2016. Excellent/very good health in the North fell from 40.9 per cent in 2013 and to 33.3 per cent in 2016. The Southern region had a statistically significant increase in fair/poor health in 2016 at 22.2 per cent, up from 15.8 per cent in 2013.

Table 3: Self-assessed health status by region, age standardised, 18 years and over, Tasmania 2016


North%

North95% CI

North-West

%

North-West95% CI

South%

South95% CI

Excellent/Very Good

33.3%*#

[29.6%,37.2%]

34.9% [30.6%,39.4%]

39.9% [36.0%,43.9%]

Good 41.3% [37.2%,45.6%]

39.2% [34.6%,44.0%]

37.8% [33.9%,41.9%]

Fair/Poor 25.2%* [21.8%,29.0%]

25.3% [21.3%,29.6%]

22.2%*

[19.1%,25.6%]

Tasmanian Population Health Surveys 2016; *statistically significant different compared to 2013; #statistically significant different compared with 2009

Although health is affected by ageing, with chronic conditions and hospitalisations becoming more common, almost two fifths of Tasmanians aged 65 years and over (38.1 per cent) reported excellent or very good health. Comparing self-assessed health by age, Tasmanians aged 45-54 and 55-64 years reported more poor/fair health and less excellent/very good health than Tasmanians aged 65 years and over, but this was not significant.

Table 4: Self-assessed health by age, Tasmania 2016

AgeExcellent/Very Good

%

Excellent/Very Good

95% CI

Good%

Good95% CI

Fair/Poor

%

Fair/Poor95% CI

18-24 39.3% [30.7%,48.5%]

45.5% [36.3%,54.9%]

14.5% [9.2%,22.3%]

25-34 39.9% [33.3%,46.8%]

39.1% [32.7%,45.8%]

21.1% [15.9%,27.3%]

35-44 37.0% [31.6%,42.9%]

38.6% [33.2%,44.2%]

23.9% [19.5%,28.9%]

45-54 36.0% [31.6%,40.5%]

34.6% [30.5%,38.9%]

29.4% [25.6%,33.6%]

55-64 35.9% [32.2%,39.8%]

36.0% [32.5%,39.8%]

28.0% [24.6%,31.7%]

65+ 38.1% [34.9%,41.4%]

36.4% [33.3%,39.7%]

24.9% [22.1%,27.9%]

Total 37.5% [35.5%,39.7%]

37.8% [35.7%,39.9%]

24.4% [22.7%,26.2%]

Tasmanian Population Health Survey 2016

11


Self-assessed health status is strongly linked to the Index of Relative Socio-economic Disadvantage (IRSD), which is the most commonly used index of all the Socio-economic Indexes for Areas (SEIFA). (see Glossary)Tasmanians in the most disadvantaged first quintile reported significantly worse health status than Tasmanians in the least disadvantaged fifth quintile.The Table and Figure below show that of all Tasmanians in the most disadvantaged quintile, 27.2 per cent rated their health as fair or poor compared to only 15.8 per cent of Tasmanians in the least disadvantaged fifth quintile. Excellent or very good health was reported by only 26.8 per cent of Tasmanians in the most disadvantaged quintile compared to 48.1 per cent in the least disadvantaged quintile.

Table 5: Self-assessed health by SEIFA quintiles, age standardised, 18 years and over, Tasmania 2016

SEIFA IRSD^ 2011Excellent/Very

Good%

Excellent/Very Good

95% CI

Fair/Poor

%

Fair/Poor95% CI

1st (most disadvantaged)

26.8%* [22.3%,31.8%] 27.2%* [22.9%,31.9%]

2nd 33.5% [29.3%,38%] 28.6% [24.5%,33.2%]

3rd 33.4% [28.7%,38.4%] 24.0% [20.0%,28.5%]

4th 42.4% [36.5%,48.5%] 23.9% [19%,29.7%]

5th (least disadvantaged)

48.1% [42.1%,54.1%] 15.8% [11.8%,20.8%]

Tasmanian Population Health Survey 2016, ^SEIFA 2011 – Index of Relative Socio-economic Disadvantage; *statistically significantly different compared with quintile five

Figure 1: Fair/poor self-assessed health by SEIFA quintiles, Tasmania 2016

1st (most disadvantaged) 2nd 3rd 4th 5th (least disadvantaged)

27.2%*28.6%

24.0% 23.9%

15.8%

Tasmanian Population Health Survey 2016, *statistically signficant ly different compared to quintile five

12


Psychological distress

Psychological distress was assessed with the Kessler 10 Psychological Distress Scale (K10). The K10 has been validated as a diagnostic screening tool for the presence of anxiety and depression (see Glossary). Based on aggregated response scores, psychological distress is grouped into low, moderate, high, and very high psychological distress.More Tasmanians reported high/very high levels of psychological distress in 2016 at 13.7 per cent than in previous years, with a significant increase compared to 2009.High levels of psychological distress are more common for females than males, with an increase from 12.4 per cent in 2013 to 16.0 per cent in 2016, but this was not statistically significant.

Table 6: High/very high level of psychological distress by sex, 18 years and over, Tasmania 2009 to 2016

Gender2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

Males 8.7% [7.4%,10.2%]

10.3% [8.5%,12.5%]

11.4% [9.4%,13.7%]

Females 13.0% [11.7%,14.4%]

12.4% [10.8%,14.1%]

16.0% [13.9%,18.4%]

Persons 10.9% [9.9%,11.9%]

11.4% [10.1%,12.7%]

13.7%#

[12.3%,15.4%]

Tasmanian Population Health Surveys 2009, 2013, 2016; #statistically significantly different compared to 2009

High/very high levels of psychological distress have increased in two regions since 2013, from 10.9 per cent in the North and 11.3 per cent in the South to 13.5 per cent and 14.7 per cent respectively, but these differences were not significant. High levels of psychological distress were similar across the regions in 2016, with the lowest levels in the North West region.

Table 7: Level of psychological distress by region, 18 years and over, Tasmania 2016

Psychological distress

North%

North95% CI

North-West

%

North-West

95% CI

South%

South 95% CI

High/very high 13.5% [11.2%,16.2%]

11.7% [9.6%,14.1%]

14.7% [12.3%,17.5%]


13


Over the period 2009 to 2016, the prevalence of high/very high psychological distress has been consistently higher for Aboriginal and Torres Strait Islanders compared to the total population. In 2016, over one-fifth of Aboriginal and Torres Strait Islanders (22.8 per cent) reported high/very high levels of psychological distress, compared to 13.7 per cent of the general population, a difference which is statistically significant.

Table 8: High/very high levels of psychological distress, Aboriginal and Torres Strait Islanders, 18 years and over, Tasmania 2009 to 2016

High/very high psychological distress

2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

Aboriginal and Torres Strait Islanders

23.1%*

[16.3%,31.7%]

18.0%

[10.5%,29.0%]

22.8%*

[15.5%,32.2%]

Total persons 10.9% [9.9%,11.9%]

11.4%

[10.1%,12.7%]

13.7% [12.3%,15.4%]

Tasmanian Population Health Surveys 2009, 2013, 2016; *statistically significantly higher than total persons

There were no statistically significant changes since 2009 in high levels of psychological distress for any age group. Tasmanians aged 18-24 years and 25-34 years reported more psychological distress in 2016 than in 2013, but this was not statistically significant.High levels of psychological distress decline with older age, with the lowest proportions recorded by Tasmanians aged 65 years and over.Compared to the total population, significantly more psychological distress was reported by young people aged 18 to 24 years and significantly less psychological distress was reported by Tasmanians aged 65 years and over.

Table 9: High/very high level of psychological distress by age, Tasmania 2009 to 2016

Age2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

18-24 11.3% [7.8%,15.9%]

16.6% [11.4%,23.7%]

22.4%* [15.8%,30.9%]

25-34 11.6% [8.9%,15.0%]

10.8% [6.5%,17.2%]

15.4% [11.0%,21.0%]

35-44 12.1% [10.0%,14.6%]

12.4% [10.0%,15.1%]

13.7% [10.2%,18.2%]

45-54 11.0% [9.2%,13.2%]

12.9% [10.7%,15.5%]

15.4% [12.3%,19.2%]

55-64 10.6% [8.8%,12.8%]

10.9% [9.2%,12.8%]

12.1% [9.9%,14.7%]

65+ 8.8% [7.4%,10.6%]

7.2%* [6.1%,8.4%] 8.4%* [6.6%,10.7%]

Total 10.9% [9.9%,11.9%]

11.4% [10.1%,12.7%]

13.7% [12.3%,15.4%]

Tasmanian Population Health Survey 2009, 2013, 2016; *statistically significantly different from the total population

14


There were no significant changes of high/very high levels of psychological distress by socio-economic quintiles noted since 2009. The distribution of high/very high levels of psychological distress across the five quintiles is similar to previous years, except for a significant difference between the most disadvantaged and least disadvantaged quintile in 2013, which was not repeated in 2016.An increase was noted in distress levels of the least disadvantaged fifth quintile, from 7.7 per cent in 2013 to 14.5 per cent in 2016, but this was not statistically significant on the basis of overlapping confidence intervals.

Table 10: High/very high levels of psychological distress by SEIFA quintiles^, 18 years and over, Tasmania 2009 to 2016

High/very psychological distress

SEIFA IRSD^ 2011

2009%

200995% CI

2013%

201395% CI

2016%

201695% CI


11.8% [9.7%,14.4%]

16.0%* [12.5%,20.2%]

15.8% [12.2%,20.1%]

2nd 12.3% [10.4%,14.4%]

11.3% [9.1%,13.9%]

15.1% [12.2%,18.5%]

3rd 11.5% [9.6%,13.7%]

11.7% [9.4%,14.5%]

11.2% [8.8%,14.1%]

4th 9.8% [7.9%,12.2%]

10.2% [7.8%,13.2%]

12.2% [9.3%,16.0%]


9.0% [6.9%,11.7%]

7.7% [5.4%,10.9%]

14.5% [10.7%,19.3%]

Tasmanian Population Health Survey 2016 , ^SEIFA 2011 – Index of Relative Socio-economic Disadvantage; *statistically significantly higher than quintile five

15


Financial stress and food insecurity

Financial stress and/or food insecurity have a negative impact on health and wellbeing.Indicators of financial stress provide insight into the economic well-being of Tasmanians. The ability to raise $2000 in an emergency within a couple of days is a national indicator of financial hardship. Food insecurity includes inadequate access or supply of food or inappropriate food. Lack of money, lack of transport, or a lack of knowledge can result in food insecurity.There were statistically significant increases for both indicators in 2016. Financial insecurity has increased significantly in all regions compared with 2013 and 2009, and food insecurity has increased statewide and in the Southern region when compared with 2009 data.State-wide, most of those Tasmanians who ran out of food reported to do so less than once a month (52.4 per cent).

Table 11: Financial stress and food insecurity, 18 years and over, Tasmania 2009 to 2016

Region Year Unable to raise $2,000

in an emergency

within 2 days

%

Unable to raise $2,000

in an emergency

within 2 days95% CI

Ran out of food and could not

afford to buy any more within last 12 months

%

Ran out of food and could not afford to buy

any more within last 12

months95% CI

North 2009 11.6% [10.0%,13.3%] 6.3% [5.0%,7.8%]

North-West 2009 11.7% [10.2%,13.4%] 4.7% [3.8%,5.9%]

South 2009 10.6% [9.1%,12.4%] 4.3% [3.3%,5.6%]

Tasmania 2009 11.1% [10.2%,12.2%] 5.0% [4.3%,5.7%]

North 2013 10.8% [9.1%,12.9%] 5.7% [4.3%,7.3%]

North-West 2013 13.9% [11.7%,16.4%] 4.8% [3.6%,6.4%]

South 2013 12.1% [10.1%,14.4%] 4.7% [3.4%,6.3%]

Tasmania 2013 12.2% [10.9%,13.5%] 5.0% [4.2%,5.9%]

North 2016 18.9%*# [16.2%,21.9%] 7.4% [5.7%,9.6%]

North-West 2016 17.6%# [15.0%,20.6%] 6.4% [4.7%,8.8%]

South 2016 17.6%*# [14.9%,20.6%] 7.7%# [5.8%,10.2%]

Tasmania 2016 17.9%*# [16.2%,19.8%] 7.3%*# [6.1%,8.8%]

Tasmanian Population Health Survey 2009, 2013, 2016; *statistically significantly different compared to 2013; #statistically significantly different compared to 2009

16


Running out of food and not being able to buy more has increased across all socio-economic quintiles, with the greatest, but not significant, increase occurring in the third and fourth quintiles compared to 2013. The increase in the least disadvantaged quintile, from 0.6 per cent in 2009 to 5 per cent in 2016 is statistically significant, but the 2016 proportion has high relative errors and must be used with caution.Table 12: Ran out of food and could not afford to buy any more within last 12 months, Tasmania 2009 to 2016

SEIFA IRSD^^ 2011

2009%

200995% CI

2013%

201395% CI

2016%

201695% CI


10.0% [8.3%,12.1%]

12.0% [9.4%,15.1%]

12.3% [8.7%,17.2%]

2nd 6.2% [4.7%,8.1%]

6.7% [4.9%,9.2%] 6.8% [4.8%,9.4%]

3rd 5.0% [3.5%,7.1%]

3.0% [1.8%,5.1%] 6.5% [4.6%,9.1%]

4th 2.6% [1.5%,4.5%]

2.0% [0.9%,4.6%] 6.2% [4.0%,9.4%]


0.6% [0.2%,1.9%]

5.0% [4.1%,6.0%] 5.0%^#

[2.8%,8.7%]

Tasmanian Population Health Survey 2009, 2013, 2016; ^^SEIFA 2011 – Index of Relative Socio-economic Disadvantage; *statistically significantly higher than 2009; ^RSE >25% -<50%- use with caution

17


Chapter 2: Lifestyle risk factors

Many chronic diseases are associated with modifiable lifestyle risk factors, such as tobacco smoking, a high body mass index, insufficient physical activity, an unhealthy diet, or risky alcohol consumption.

Smoking

Tobacco smoking is a major risk factor for coronary heart disease, stroke, peripheral vascular disease, respiratory illnesses, and some types of cancers.Current smokers include Tasmanians who smoke daily or occasionally. Ex-smokers are those who smoked at least 100 cigarettes in their life time and currently do not smoke.The prevalence of smoking has signficantly declined since 2009. Since 2013, the proportion of Tasmanian smokers at 15.7 per cent (63 247 persons) has remained stable, as have the proportions of ex-smokers and never smokers.

Table 13: Smoking status, 18 years and over, Tasmania 2009 to 2016

Smoking Status2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

Current smoker^ 19.8% [18.5%,21.1%]

15.0% [13.6%,16.5%]

15.7%# [14.2%,17.4%]

Daily smoker 16.1% [15.0%,17.4%]

11.9% [10.7%,13.2%]

12.1%# [10.7%,13.6%]

Ex-smoker 27.6% [26.1%,29.0%]

27.5% [26.3%,28.9%]

28.0% [26.2%,29.8%]

Never-smoked 52.2% [50.6%,53.7%]

56.9% [55.1%,58.7%]

56.2%# [54.1%,58.3%]

Tasmanian Population Health Surveys 2009, 2013, 2016; ^daily and occasional combined; #statistically significantly different compared with 2009

There were no statistically significant differences in smoking status across regions.

Table 14: Smoking status by region, 18 years and over, Tasmania 2016

Smoking StatusNorth2009

%

North2009

95% CI

North-West2013

%

North-West2013

95% CI

South2016

%

South2016

95% CI

Current smoker^ 16.3% [13.9%,19.1%]

16.9% [14.3%,19.8%]

14.9% [12.4%,17.7%]

Daily smoker 13.3% [11.1%,15.9%]

13.4% [11.1%,16.1%]

10.8% [8.7%,13.3%]

Ex-smoker 25.2% [22.5%,28.0%]

28.6% [25.8%,31.5%]

29.2% [26.4%,32.3%]

Never-smoked 58.5% [55.2%,61.7%]

54.0% [50.5%,57.5%]

55.9% [52.4%,59.3%]

Tasmanian Population Health Survey 2016; ^daily and occasional combined

18


19


The downward trend in smoking since 2009 is most evident among Tasmanians aged 18-44 years, but this is not statistically significant.

Table 15: Current smokers by age, Tasmania 2009 to 2016

Age2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

18-24 23.0% [18.1%,28.8%]

19.7% [13.6%,27.8%]

18.3% [11.8%,27.3%]

25-34 27.1% [22.6%,32.0%]

22.5% [17.0%,29.0%]

20.8% [15.8%,26.9%]

35-44 25.7% [22.8%,28.9%]

16.9% [14.2%,20.1%]

20.4% [16.2%,25.4%]

45-54 22.9% [20.2%,25.8%]

16.2% [13.8%,18.9%]

20.0% [16.8%,23.7%]

55-64 13.6% [11.6%,15.9%]

12.2% [10.4%,14.2%]

12.1% [9.9%,14.6%]

65+ 8.8% [7.4%,10.4%]

7.0% [6.0%,8.2%] 7.8% [6.0%,10.0%]

Total 19.8% [18.5%,21.1%]

15.0% [13.6%,16.5%]

15.7% [14.2%,17.4%]

Tasmanian Population Health Survey 2009, 2013, 2016

Apart from the youngest and oldest age groups, males were slightly more likely to be current smokers (16.5 per cent) than females (15.0 per cent). There were no statistically significant differences between male and female smoking rates in 2016 for any age group compared with 2013.The proportion of male and females smokers aged 18 to 24 years has experienced a statistically significant decline compared with 2009, but not 2013.

Table 16: Current smokers by sex and age, Tasmania 2013 and 2016Current smokersAge

Males2013

%

Males 2013

95% CI

Males 2016

%

Males2016

95% CI

Females

2013%

Females2013

95% CI

Females

2016%

Females2016

95% CI

18-24 18.9% [10.7%,31.2%]

17.1%^

[8.8%,30.7%]

20.6% [12.5%,32.2%]

19.6%^

[10.9%,32.8%]

25-34 24.8% [16.3%,35.7%]

21.4% [14.1%,31.1%]

20.2% [14.0%,28.1%]

20.3% [14.1%,28.3%]

35-44 19.0% [14.6%,24.4%]

22.2% [15.8%,30.3%]

14.9% [11.8%,18.7%]

18.7% [13.6%,25.1%]

45-54 15.8% [12.1%,20.2%]

22.7% [17.9%,28.3%]

16.6% [13.7%,20.0%]

17.5% [13.3%,22.6%]

55-64 11.5% [8.9%,14.6%]

13.1% [9.7%,17.5%]

12.9% [10.7%,15.6%]

11.0% [8.6%,14.0%]

65+ 7.1% [5.6%,9.0%]

7.1% [5.0%,10.0%]

6.9% [5.7%,8.5%]

8.4% [5.8%,12.0%]

Total 15.5% [13.3%,17.9%]

16.5% [14.2%,19.1%]

14.5% [12.8%,16.4%]

15.0% [12.9%,17.2%]

Tasmanian Population Health Survey 2013 and 2016; ^RSE >25% -<50%- use with caution

20


There were no statistically significant differences in smoking prevalence across age groups and regions.Table 17: Current smokers by age and region, Tasmania 2016

AgeNorth

%North95% CI

North West

%

North West95% CI

South%

South 95% CI

18-24 n/a n/a 20.6%^ [9.7%,38.8%]

22.7% [12.3%,38.1%]

25-34 24.9% [16.2%,36.2%] 21.0% [13.0%,32.2%]

18.8% [11.8%,28.5%]

35-44 23.8% [16.2%,33.5%] 24.2% [17.0%,33.2%]

17.0% [11.2%,25.0%]

45-54 21.4% [16.2%,27.6%] 22.9% [17.9%,28.9%]

18.0% [13.0%,24.4%]

55-64 15.2% [11.4%,20.1%] 11.7% [8.6%,15.7%]

10.4% [7.3%,14.8%]

65+ 7.7% [5.4%,11.0%] 8.1% [5.1%,12.7%]

7.6% [4.9%,11.7%]

Total 16.3% [13.9%,19.1%] 16.9% [14.3%,19.8%]

14.9% [12.4%,17.7%]

Tasmanian Population Health Survey2016; ^RSE >25% -<50%- use with caution; n/a = estimates are too unreliable to be published (RSE>50%)

The proportion of Tasmanian Aboriginal and Torres Strait Islanders who smoked in 2016 (26.3 per cent) continued to be statistically significantly higher than the total proportion of smokers in Tasmania (15.7 per cent). Although smoking among Aboriginal and Torres Strait Islanders has declined from 32.9 per cent in 2009 to 26.3 per cent in 2016, this difference is not statistically significant.

Table 18: Current smokers among Aboriginal and Torres Strait Islanders, 18 years and over, Tasmania 2009 to 2016

Current smoker 2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

Aboriginal and Torres Strait Islanders

32.9% [25.1%,41.9%]

30.0% [19.9%,42.6%]

26.3%* [18.5%,35.9%]

Total population 19.8% [18.5%,21.1%]

15.0% [13.6%,16.5%]

15.7% [14.2%,17.4%]

Tasmanian Population Health Survey 2009, 2013, 2016; *statistically significantly higher compared with the total population

21


Smoking continues to be significantly more prevalent in lower socio-economic areas. Of all Tasmanians in the socio-economically most disadvantaged quintile, 24.5 per cent were current smokers in 2016, compared to 9.8 per cent of Tasmanians in the least disadvantaged quintile. The gap between the lowest and highest quintiles has grown from 8.3 per cent in 2009 to 14.7 per cent in 2016.

Table 19: Current smokers by SEIFA quintiles, 18 years and over, Tasmania 2009 to 2016

SEIFA IRSD^ 2011

2009%

2009 95% CI

2013%

201395% CI

2016%

201695% CI


24.0% [20.8%,27.4%]

18.7% [15.4%,22.6%]

24.5%* [20.0%,29.6%]

2nd 21.8% [19.4%,24.5%]

17.5% [14.8%,20.5%]

15.3%# [12.5%,18.5%]

3rd 20.3% [17.8%,23.1%]

16.9% [13.7%,20.5%]

15.1% [12.4%,18.3%]

4th 17.4% [14.7%,20.4%]

12.7% [10.0%,16.1%]

13.9% [10.8%,17.6%]


15.7% [12.6%,19.4%]

9.1% [6.4%,12.8%]

9.8% [6.8%,13.9%]

Tasmanian Population Health Survey 2009, 2013, 2016; ^SEIFA 2011 – Index of Relative Socio-economic Disadvantage; *statistically significantly higher than all other quintiles in 2016; #statistically significantly lower compared with 2009

The proportion of Tasmanians who live in households where residents never smoke inside has increased from 90.8 per cent in 2009 to 95.1 per cent in 2016. The increase since 2009 is statistically significant, as is the decline in the proportion of Tasmanians who live in households were residents smoke inside occasionally.

Table 20: Frequency of smoking inside a home, 18 years and over, Tasmania 2009 to 2016

Smoking inside 2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

Never 90.8% [89.7%, 91.7%]

94.6% [93.8%, 95.4%]

95.1%# [94.0%,96.0%]

Occasionally 5.0% [4.4%, 5.8%]

2.9% [2.4%, 3.6%] 2.0%# [1.5%,2.6%]

Frequently 4.2% [3.5%, 5.0%]

2.4% [1.9%, 2.9%) 2.8% [2.1%,3.8%]

Tasmanian Population Health Survey 2009, 2013, 2016; #statistically significantly different compared to 2009

22


Alcohol consumption

Harmful levels of alcohol consumption are associated with a variety of adverse health consequences. Road injuries, suicide, and violence are linked to excessive consumption on single occasions, while liver cirrhosis, pancreatitis and some types of cancers are examples of potential lifetime harm.For the purpose of determining the risk of alcohol-related harm, the 2009 guidelines categorise risk into lifetime risk of harm and single occasion risk of harm (short-term harm).According to the guidelines, adults are at a reduced risk of lifetime harm by consuming no more than two standard drinks on any day, and no more than four standard drinks on any single occasion.

NHMRC Alcohol Guidelines, 2009NHMRC, Australian guidelines to reduce health risks from drinking alcohol, 2009

Males FemalesReduced lifetime risk of harm <2 standard

drinks<2 standard drinks

Reduced single occasion risk of harm

<4 standard drinks

<4 standard drinks

Single occasion harmA total of 45 per cent of all Tasmanians aged 18 years and over in 2016 exceeded the Guidelines by consuming more than four standard drinks on a single occasion either on a daily basis, weekly, monthly or yearly.More than one in two Tasmanian males (57 per cent) were at risk of harm by consuming more than four standard drinks at least yearly, compared to one in three females (33.2 per cent). The difference between males and females is statistically significant.

Table 21: Alcohol consumption causing single occasion risk of harm^ by frequency and sex, Tasmania 2016

Level of Risk Males%

Males95% CI

Females%

Females95% CI

Persons%

Persons95% CI

Abstain/No longer

drink alcohol11.5% [9.7%,13.5%

]20.4% [18.4%,22.5

%]16.0% [14.6%,17.4

%]Reduced risk (never

more than 4)29.8% [27.1%,32.8%] 44.4% [41.7%,47.2%] 37.2% [35.2%,39.2%]

Increased risk - at

least yearly but less

than monthly

24.8% [21.9%,28.0%] 19.5% [17.2%,22.1%] 22.2% [20.3%,24.2%]

Increased risk - at

least monthly^^32.1% [29.1%,35.3%] 13.7% [11.6%,16.0%] 22.8% [21.0%,24.8%]

Total at risk 57.0%* [53.8%,60.1%]

33.2% [30.5%,36.0%]

45.0% [42.9%,47.1%]

Tasmanian Population Health Survey 2016; ^> 4 standard drinks on a single occasion; ^^includes weekly and daily; *statistically significantly higher compared to females and total persons

23


The proportion of Tasmanian Aboriginal and Torres Strait Islanders at risk of harm from alcohol consumption on a single occasion (53.1 per cent) was not statistically significantly different from the total population at risk of harm on a single occasion (45 per cent).Alcohol consumption causing risk of harm on a single occasion is associated with age, with statistically significantly higher proportions of younger Tasmanians at risk of harm.The Table and Figure below show males at significantly higher risk of harm than females for most age groups.

Table 22: Alcohol consumption causing risk of harm on a single occasion ^ by sex and age, Tasmania 2016

Age Males%

Males95% CI

Females%

Females95% CI

Persons%

Persons95% CI

18-24 73.6% [59.4%,84.2%]

63.5% [51.3%,74.2%]

68.9%# [59.7%,76.7%]

25-34 72.0%* [61.9%,80.3%]

50.2% [41.2%,59.2%]

61.0%# [54.3%,67.4%]

35-44 60.3% [51.2%,68.7%]

47.8% [40.5%,55.1%]

54.0%# [48.2%,59.6%]

45-54 65.2%* [58.8%,71.1%]

31.3% [25.7%,37.6%]

48.2% [43.8%,52.7%]

55-64 47.0%* [41.3%,52.8%]

21.2% [17.0%,26.0%]

34.1% [30.4%,37.9%]

65+ 37.1%* [32.2%,42.3%]

10.2% [7.9%,13.2%]

23.0% [20.2%,26.1%]

Total 57.0%* [53.8%,60.1%]

33.2% [30.5%,36.0%]

45.0% [42.9%,47.1%]

Tasmanian Population Health Survey 2016; ^> 4 standard drinks on a single occasion, either daily, weekly, monthly or yearly; *statistically significantly different compared to females; #statistically significantly higher than total persons

Figure 2: Alcohol consumption causing harm on single occasions^ by sex and age, Tasmania

18-24 25-34 35-44 45-54 55-64 65+

73.6% 72.0%*

60.3%65.2%*

47.0%*

37.1%*

63.5%

50.2% 47.8%

31.3%

21.2%

10.2%

MalesFemales

Tasmanian Population Health Survey 2016 ^>4 drinks either daily, weekly, monthly, yearly; *stat-istically signficantly different compared with females

24


25


The Southern region reported the highest alcohol consumption at harmful levels, followed by the Northern region with 44.3 per cent, and the North West region with 39.7 per cent. The North West region reported the lowest consumption of all regions.Table 23: Alcohol consumption causing risk of harm on a single occasion^ by age and region, Tasmania 2016

AgeNorth

%North95% CI

North West

%

North West

95% CI

South%

South95% CI

18-24 65.3% [50.1%,77.9%] 59.3% [40.7%,75.6%]

74.9% [60.2%,85.4%]

25-34 62.3% [51.4%,72.1%] 56.6% [44.5%,67.9%]

62.1% [51.5%,71.6%]

35-44 55.3% [45.6%,64.6%] 47.9% [38.5%,57.4%]

55.8% [46.6%,64.6%]

45-54 48.1% [41.4%,54.9%] 44.0% [37.8%,50.4%]

50.3% [42.8%,57.8%]

55-64 36.6% [31.0%,42.6%] 31.3% [26.3%,36.9%]

33.8% [27.9%,40.4%]

65+ 19.4% [15.4%,24.2%] 20.0% [16.1%,24.5%]

26.7% [21.9%,32.1%]

Total 44.3% [41.0%,47.7%] 39.7% [36.3%,43.3%]

47.7%* [44.3%,51.1%]

Tasmanian Population Health Survey2016; ^>4 standard drinks on a single occasion, either daily, weekly, monthly or yearly; *statistically significantly higher compared to the North West region

Alcohol consumption at levels that cause a risk of harm on a single occasion was not associated with socio-economic disadvantage. The proportions of Tasmanians at risk of harm were similar between the lowest (49.9 per cent) and highest (50.1 per cent) quintiles.

Table 24: Alcohol consumption causing risk of harm on a single occasion^ by SEIFA quintiles, 18 years and over, Tasmania 2016

Tasmanian Population Health Survey 2016; ^> 4 standard drinks on a single occasion, either daily, weekly, monthly or yearly; ^^SEIFA 2011 – Index of Relative Socio-economic Disadvantage

26


Alcohol harmSEIFA IRSD 2011^^

Single occasion risk of harm

%

Single occasion risk of harm

95% CI


49.9% [44.8%,55.0%]

2nd 43.2% [39.2%,47.4%]

3rd 39.7% [35.7%,43.9%]

4th 42.1% [37.3%,47.0%]


50.1% [44.4%,55.8%]

Parents have an important function as role models in shaping their children’s attitude to alcohol and drinking behaviour. (https://drinkwise.org.au/parents/is-your-drinking-influencing-your-kids/#)The table and figure below show the proportion of Tasmanian parents consuming more than four standard drinks on a single occasion. Of all adults with children less than 10 years of age, one in two adults had consumed more than four alcoholic drinks on a single occasion during the previous year, reflecting the greater prevalence of harmful alcohol consumption on single occasions among younger people.

Table 25: Alcohol consumption causing risk of harm on a single occasion^, adults with dependent children, Tasmania 2016

Tasmanian Population Health Survey 2016; ^> 4 standard drinks on a single occasion, either daily, weekly, monthly or yearly;

Figure 3: Alcohol consumption causing risk of harm on a single occasion^, adults with dependent children, Tasmania 2016

0-5 years 6-9 years 10-15 years

54.7% 55.6%52.1%

Tasmanian Population Health Survey 2016 ^>4 drinks either daily, weekly, monthly, yearly

27


Age of ChildrenSingle occasion risk of harm^

%

Single occasion risk of harm^

95% CI

0-5 years 54.7% [48.1%,61.2%]

6-9 years 55.6% [48.8%,62.1%]

10-15 years 52.1% [46.1%,58.0%]

https://drinkwise.org.au/parents/is-your-drinking-influencing-your-kids/


Lifetime harmAdults are at a reduced risk of lifetime harm by consuming no more than two standard drinks on any day. A total of 38.5 per cent of Tasmanians adults were at risk of lifetime harm by exceeding two standard alcoholic drinks either at least monthly or weekly.The proportions of males consuming more than two standard alcoholic drinks at least monthly (21 per cent) or weekly (28.5 per cent) were statistically significantly higher compared to females.

Table 26: Alcohol consumption causing risk of life-time harm^ by sex, Tasmania 2016

Level of RiskMales

%Males95% CI

Females%

Females95% CI

Persons%

Persons95% CI

Abstain/No longer drink

alcohol11.5% [9.7%,13.5%

]20.4% [18.4%,22.

5%]16.0% [14.6%,17.

4%]Reduced risk 12.1% [10.4%,14.1

%]23.7% [21.6%,26.

0%]18.0% [16.6%,19.

5%]Increased risk at least

yearly but not monthly 24.6%[21.8%,27.6

%] 24.8%[22.4%,27.

4%] 24.7%[22.8%,26.


monthly but not weekly 21.0%*[18.3%,24.0

%] 14.5%[12.5%,16.

8%] 17.7%[16.0%,19.


weekly 28.5%*[25.7%,31.4

%] 13.3%[11.4%,15.

5%] 20.8%[19.1%,22.

6%]Tasmanian Population Health Survey2016; ^>2 standard drinks for males/females on any day; *statistically significantly higher compared to females

Males were more at risk of lifetime harm than females across all age groups. Middle aged males were most at risk of harm, with 33.8 per cent and 37.1 per cent of males aged 35-44 and 45-54 years respectively having more than two standard drinks at least weekly. Table 27: Alcohol consumption causing risk of life-time harm at least weekly^ by sex and age, Tasmania 2016

AgeMales

%Males95% CI

Females%

Females95% CI

Persons%

Persons95% CI

18-24 19.4%^^ [10.6%,32.8%]

9.8%^^ [4.0%,22.0%]

14.8% [9.1%,23.3%]

25-34 26.6% [18.5%,36.6%]

19.7% [13.2%,28.3%]

23.1% [17.7%,29.5%]

35-44 33.8%* [25.9%,42.8%]

16.0% [11.1%,22.7%]

24.7% [20.0%,30.2%]

45-54 37.1%* [31.1%,43.5%]

12.3% [8.8%,17.0%]

24.5% [21.0%,28.4%]

55-64 27.0% [22.5%,32.1%]

18.0% [14.0%,23.0%]

22.5% [19.4%,25.9%]

65+ 25.3%* [21.0%,30.1%]

6.5% [4.6%,9.2%] 15.5% [13.1%,18.2%]

Total 28.5%* [25.7%,31.4%]

13.3% [11.4%,15.5%]

20.8% [19.1%,22.6%]

Tasmanian Population Health Survey2016; ^>2 standard drinks for males/females on any day; ^^ RSE >25% -<50%- use with caution; *statistically significantly higher compared to females

28


Of all Aboriginal and Torres Strait Islanders, 20.5 per cent were at risk of lifetime harm compared with 20.8 per cent of all Tasmanians. The proportion of Tasmanians at risk of lifetime harm was similar across the regions, with the Southern region recording a slightly higher proportion of 21.7 per cent. There were differences across regions by age groups, but these were not statistically significant.

Table 28: Alcohol consumption causing risk of life time harm at least weekly^ by age and region, Tasmania 2016

AgeNorth

%North95% CI

North West%

North West95% CI

South%

South95% CI

18-24 7.9% [3.1%,18.7%] 15.3% [5.4%,36.2%]

18.5% [9.5%,33.0%]

25-34 27.3% [18.2%,38.8%] 10.0% [5.1%,18.9%]

25.9% [17.7%,36.3%]

35-44 27.6% [19.9%,37.0%] 20.8% [14.2%,29.4%]

24.8% [17.5%,33.9%]

45-54 26.9% [21.2%,33.4%] 26.4% [21.1%,32.5%]

22.4% [16.9%,29.0%]

55-64 23.4% [18.6%,29.1%] 22.4% [17.9%,27.6%]

22.0% [17.0%,27.9%]

65+ 13.3% [10.0%,17.5%] 14.1% [10.1%,19.2%]

17.4% [13.5%,22.2%]

Total 21.0% [18.4%,23.8%] 18.4% [15.8%,21.3%]

21.7% [18.9%,24.8%]

Tasmanian Population Health Survey2016; ^> 2 standard drinks for males/females on any day

Alcohol consumption at a level that causes a risk of lifetime harm is not associated with socio-economic disadvantage, with similar proportions in the first (21.3 per cent) and fifth quintile (23.8 per cent).

Table 29: Alcohol consumption causing risk of life time harm at least weekly^ by SEIFA quintiles, 18 years and over, Tasmania 2016

Tasmanian Population Health Survey 2016; ^>2 standard drinks for males/females on any day^^SEIFA 2011 – Index of Socio-economic Relative Disadvantage

29


AlcoholSEIFA IRSD 2011^^

Life time harm

%

Life time harm95% CI


21.3% [17.1%,26.1%]

2nd 18.8% [15.8%,22.1%]

3rd 19.9% [16.9%,23.3%]

4th 20.1% [16.6%,24.2%]


23.8% [19.3%,29.0%]

Parents have an important function as role models in shaping their children’s attitude to alcohol and drinking behaviour. (https://drinkwise.org.au/parents/is-your-drinking-influencing-your-kids/#)The proportion of Tasmanians drinking more than two standards alcoholic drinks at least weekly ranged from 18.8 per cent for households with children aged 0-5 years to 23.6 per cent for households with 10 to 15 year old dependent children. Table 30: Alcohol consumption causing risk of lifetime harm^, adults with dependent children, Tasmania 2016

Tasmanian Population Health Survey 2016; ^> 2 standard drinks at least weekly

30


Age of ChildrenLifetime risk of

harm^%

Lifetime risk of harm^95% CI

0-5 years 18.8% [13.8%,24.9%]

6-9 years 19.7% [14.8%,25.7%]

10-15 years 23.6% [18.6%,29.4%]



Body Mass Index

A high Body Mass Index (BMI) increases the risk of a wide range of health problems, including cardiovascular disease, type 2 diabetes, some cancers, and other chronic conditions. The BMI analysis in this report is based on self-reported height and weight, which provides lower estimates for overweight/obese BMI than measured height and weight. The National Health Survey 2007/8 found that self-reported BMI under-estimates overweight and obese BMI by >5 per cent.

BMI estimates have been age standardised to remove the impact of population ageing across the three surveys (see Glossary). Proportions of obese and overweight/obese BMI combined have remained relatively stable since 2013, but were significantly higher than in 2009. The proportion of Tasmanians with an underweight BMI has significantly declined since 2009.

Table 31: Self-reported BMI, age standardised, 18 years and over, Tasmania 2009 to 2016

BMI category2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

Underweight 2.3 [1.7,3.1] 2.0 [1.3, 3.0] 1.1%# [0.8%,1.6%]

Normal weight 43.4 [41.4,45.4] 39.1 [36.7,41.5] 38.9% [36.3%,41.6%]

Overweight 35.3 [33.4,37.2] 36.9 [34.5,39.3] 35.6% [33.2%,38.2%]

Obese 19.0 [17.7,20.4] 22.0 [20.3,23.9] 24.3%# [22.2%,26.6%]

Overweight/Obese 54.3 [52.4,56.3] 58.9 [56.5,61.3] 60.0%# [57.3%,62.6%]

Tasmanian Population Health Survey 2009, 2013, 2016; estimates are age-standardised; #statistically significantly different compared to 2009

31


BMI score Weight category

<18.5 Underweight

18.5-24.9 Normal

25.0-29.9 Overweight

>30.0 Obese

A significant increase since 2009 in obese BMI was noted for females, from 18.4 per cent to 25.9 per cent in 2016, with a similar increase noted for combined overweight/obese BMI for females. For females, normal BMI has significantly declined, from 47.7 per cent in 2009 to 40.7 per cent in 2016.For males, the prevalence of overweight and combined overweight/obese fell slightly and obese BMI recorded a small increase. Differences in BMI distributions of Tasmanian males were not statistically significant when compared with previous years, but an overweight BMI was significantly more common for males (39.8 per cent) than females (31.4 per cent) in 2016. It should be noted, however, that BMI does not differentiate between muscle and body fat, and an overweight BMI may reflect significant muscle mass in some cases.

Table 32: Self-reported BMI by sex, age standardised, 18 years and over, Tasmania 2009 to 2016

BMI categorySex 2009

%2009

95% CI201

3%

201395% CI

2016%

201695% CI

Underweight M 1.0%^

[0.6%,1.8%] 2.0%^

[0.9%,4.1%] 0.2%^ [0.1%,0.5%]

Normal weight M 39.1% [36.3%,41.9%]

32.3%

[28.8%,36.0%]

36.9% [33.4%,40.5%]

Overweight M 40.4% [37.6%,43.2%]

43.9%

[40.3%,47.6%]

39.8% [36.5%,43.2%]

Obese M 19.5% [17.5%,21.7%]

21.8%

[19.2%,24.7%]

23.0% [20.1%,26.3%]

Overweight/Obese

M 59.9% [57.1%,62.6%]

65.8%

[62.1%,69.2%]

62.8% [59.2%,66.3%]

Underweight F 3.6% [2.5%,5.2%] 2.0% [1.4%,3.0%] 2.0% [1.3%,3.0%]

Normal weight F 47.7% [44.9%,50.4%]

46.1%

[42.9%,49.3%]

40.7%#

[37.0%,44.5%]

Overweight F 30.3% [27.9%,32.9%]

29.5%

[26.7%,32.5%]

31.4% [28.0%,35.0%]

Obese F 18.4% [16.9%,20.0%]

22.4%

[20.2%,24.7%]

25.9%#

[22.9%,29.1%]

Overweight/Obese

F 48.7% [46%,51.4%]

51.9%

[48.7%,55%] 57.2%#

[53.5%,61.0%]

Tasmanian Population Health Survey 2009, 2013, 2016; estimates are age-standardised; ^RSE >25% -<50%- use with caution #statistically significantly different compared to 2009

32


There were no significant differences between the regions in the distribution of overweight and obesity in 2016, with obese and overweight/obese BMI slightly less prevalent in the South.

Table 33: Self-reported BMI by region, age-standardised, 18 years and over, Tasmania 2016

BMI CategoryNorth

%North95% CI

North West

%

North West95% CI

South%

South 95% CI

Underweight 1.1%^ [0.6%,2%] 1.6%^ [0.8%,3.3%] 0.9%^ [0.6%,1.6%]

Normal weight 36.9% [33%,40.9%] 36.2% [31.4%,41.4%] 40.6% [36.6%,44.8%]

Overweight 34.2% [30.3%,38.3%]

36.8% [31.9%,41.9%] 36.2% [32.4%,40.1%]

Obese 27.8% [24.4%,31.6%]

25.4% [21.8%,29.4%] 22.2% [19.1%,25.8%]

Overweight/Obese

62.0% [58%,65.9%] 62.1% [57%,67%] 58.5% [54.3%,62.5%]

Tasmanian Population Health Survey 2016; estimates are age-standardised; ^RSE >25% -<50%- use with caution

Proportions of overweight BMI were relatively evenly distributed across age groups, with the exception of a significantly lower proportion of overweight Tasmanians aged 18-24 years in both 2009 and 2016. The proportions of Tasmanians with an overweight BMI have remained relatively unchanged across age groups since 2009.Table 34: Self-reported overweight BMI by age, Tasmania, 2009 to 2016

Age2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

18-24 22.4%* [16.8%,29.1%]

32.5% [24.6%,41.5%]

20.3%* [13.1%,30.0%]

25-34 36.7% [31.9%,41.9%]

35.2% [28.3%,42.9%]

41.3% [34.4%,48.5%]

35-44 38.4% [34.9%,42.0%]

38.4% [34.3%,42.7%]

38.4% [32.7%,44.5%]

45-54 36.6% [33.4%,40.0%]

38.6% [34.9%,42.3%]

35.1% [30.9%,39.7%]

55-64 39.8% [36.6%,43.2%]

38.4% [35.4%,41.5%]

40.9% [36.9%,44.9%]

65+ 38.7% [36.1%,41.5%]

40.2% [37.9%,42.5%]

40.9% [37.5%,44.4%]

Tasmanian Population Health Survey 2009, 2013, 2016; *statistically significantly lower compared to all other age groups

33


The prevalence of obese BMI for most age groups in 2016 was higher than in 2013, except for age 25-34 years. Obese BMI increased significantly for Tasmanians aged 65 years and over compared to 2009.

Table 35: Self-reported obese BMI by age, Tasmania, 2009 to 2016

Age 2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

18-24 10.4% [7.0%,15.3%] 9.7%^ [5.6%,16.3%

] 17.2%[11.1%,25.6

%]

25-34 18.8% [15.1%,23.1%] 24.1% [18.2%,31.1

%] 21.5%[16.3%,27.8

%]

35-44 21.1% [18.2%,24.3%] 24.2% [20.8%,27.9

%] 26.5%[21.7%,31.9

%]

45-54 25.7% [22.8%,28.8%] 30.1% [26.7%,33.8

%] 31.5%[27.3%,36.1

%]

55-64 26.0% [23.2%,29.1%] 28.8% [26.0%,31.7

%] 29.3%[25.7%,33.2

%]

65+ 16.7% [14.7%,18.8%] 20.4% [18.6%,22.2

%]24.5%

#[21.5%,27.7

%]

Tasmanian Population Health Survey 2009, 2013, 2016; ^RSE >25% -<50%- use with caution; #statistically significantly higher compared to 2009

Figure 4: Self-reported obese BMI by age, Tasmania 2009 to 2016

18-24 25-34 35-44 45-54 55-64 65+

17.2%

21.5%

26.5%

31.5%29.3%

24.5%*2009 2013 2016

Tasmanian Population Health Survey 2016; *statistically signficantly higher than 2009

34


Obese BMI continued to be more common in the most disadvantaged quintile (25 per cent) and less common in the least disadvantaged quintile (18 per cent). This difference used to be statistically significant in 2009 and 2013, but not in 2016, indicating a closing gap in obese BMI between the most and least disadvantaged socio-economic areas.

Table 36: Obese BMI by SEIFA quintiles, age-standardised, 18 years and over, Tasmania 2009 to 2016

SEIFA IRSD 2011^

2009%

200995% CI

2013%

201395% CI

2016%

201695% CI


24.5%* [21.3%,28.0%]

29.7%* [25.5%,34.3%]

25.0% [20.5%,30.2%]

2nd 19.7%* [17.2%,22.3%]

22.4% [18.8%,26.4%]

28.4% [24.5%,32.7%]

3rd 20.3%* [17.8%,23.1%]

21.4% [18.0%,25.3%]

25.1% [20.7%,30%]

4th 18.8%* [15.8%,22.2%]

18.5% [15.3%,22.1%]

27.1% [21.6%,33.4%]


12.1% [9.9%,14.8%]

17.0% [13.8%,20.7%]

18.0% [13.9%,23.1%]

Tasmanian Population Health Survey 2009, 2013, 2016; age-standardised estimates, ^SEIFA 2011 Index of Relative Socio-economic Disadvantage; *statistically significant difference compared with the least disadvantaged quintile

Figure 5: Obese BMI by SEIFA quintiles, age-standardised, 18 years and over, Tasmania 2009-2016


24.5%

19.7% 20.3% 18.8%

12.1%

25.0%

28.4%25.1%

27.1%

18.0%

2009 2013 2016

35


Fruit and vegetable consumption

Eating the recommended serves of fruit and vegetables offers protection from some cancers, diabetes, heart disease, as well as strokes.In 2013, the National Health and Medical Research Council (NHMRC) updated the dietary guidelines for fruit and vegetable consumption by increasing the recommended number of serves of vegetables for males aged 18 to 70, and for females aged 18 years. The tables below includes both guidelines and shows the differences in the number of serves of vegetables and fruit recommended in the 2009 and 2013 guidelines.

2013 Australian Dietary Guidelines

Recommended number of serves of vegetables and fruit per day, 2013

Age Vegetable serves^ per dayMales

Vegetable serves^ per dayFemales

Fruit serves^ per day

Males

Fruit serves^ per

dayFemales14-18 5.5 5 2 2

19-50 6 5 2 2

51-70 5.5 5 2 2

71+ 5 5 2 2

2003 Australian Dietary Guidelines

Recommended number of serves of vegetables and fruit per day, 2003

Age Vegetable serves per dayMales

Vegetable serves per dayFemales

Fruit serves per day

Males

Fruit serves per dayFemales

12-18 4 4 3 319-60 5 5 2 2

60+ 5 5 2 2

^vegetables = 75g/serve; fruit = 150g/serve

The 2013 dietary guidelines were retrospectively applied to the 2013 survey data for comparability with the 2016 data. The 2003 guidelines continue to apply to 2009 data. As the new Guidelines include an increase in the number of serves of vegetables for males, the 2013 and 2016 results for vegetables are not comparable with the 2009 data.The change in the 2013 Guidelines regarding fruit consumption applies to 18 year olds only.

36


A statistically significant decline in fruit consumption can be observed between 2013 and 2016, with the proportion of Tasmanians reporting adequate fruit consumption (i.e. 2 serves daily) decreasing from 44.2 per cent to 39.3 per cent in 2016. Vegetable consumption has also shown a decline, but this was not statistically significant between 2013 and 2016. Less than one in ten (7.5 per cent) of Tasmanians met the recommended five to six serves of vegetables daily in 2016.

Table 37: Met NHMRC guidelines for fruit and vegetables, 18 years and over, Tasmania 2009 to 2016

2013 Guidelines 2009^%

2009^95% CI

2013%

201395% CI

2016%

201695% CI

Met fruit consumption guidelines

49.8% [48.2%,51.4%]

44.2% [42.4%,46.1%]

39.3%*#

[37.3%,41.4%]

Mean serves of fruit daily

1.70 [1.66,1.74] 1.59 [1.55,1.64] 1.46*# [1.41,1.50]

Met vegetable consumption guidelines

10.9%^ [10.1%,11.9%]

8.5% [7.6%, 9.4%]

7.5% [6.5%,8.6%]

Mean serves of vegetables daily

2.54 [2.49,2.59] 2.51 [2.46,2.56] 2.34* [2.27,2.40]

Tasmanian Population Health Survey 2009, 2013, 2016; ^2003 guidelines; *statistically significantly different compared with 2013; #statistically significantly different compared to 2009

The decline in fruit and vegetable consumption occurred in both males and females. As in previous years, more females than males met the fruit and vegetable guidelines in 2016.

Table 38: Met NHMRC guidelines for fruit and vegetables by sex, 18 years and over, Tasmania 2009 to 2016

Sex Year


%


95% CI


%


95%CI

Males 2009^ 7.0% [5.9%,8.2%] 42.9% [40.4%,45.3%]

Males 2013 3.3% [2.5%,4.2%] 36.8% [33.9%,39.7%]

Males 2016 3.1% [2.1%,4.5%] 35.0%# [32.0%,38.2%]

Females 2009^ 14.7% [13.4%,16.1%] 56.4% [54.4%,58.4%]

Females 2013 13.5% [12.1%,15.1%] 51.5% [49.2%,53.8%]

Females 2016 11.7% [10.1%,13.6%] 43.5%*# [40.8%,46.4%]

Persons 2009^ 10.9% [10.1%,11.9%] 49.8% [48.2%,51.4%]

Persons 2013 8.5% [7.6%, 9.4%] 44.2% [42.4%,46.1%]

Persons 2016 7.5% [6.5%,8.6%] 39.3%*# [37.3%,41.4%]

37


Tasmanian Population Health Survey 2009, 2013, 2016; ^2003 guidelines; *statistically significantly different compared with 2013; #statistically significantly different compared with 2009

38


The South reported the highest fruit consumption, and the North had the highest proportion of persons meeting the national vegetable guidelines, but neither comparison was statistically significant.Table 39: Met NHMRC guidelines for fruit and vegetables by region, 18 years and over, Tasmania 2016

2013 GuidelinesNorth

%North95% CI

North-West

%

North-West

95% CI

South%

South95% CI

Met fruit guidelines 36.6% [33.4%,39.9%]

37.1% [33.7%,40.7%]

41.8% [38.4%,45.3%]

Mean number of serves of fruit daily 1.41 [1.34,1.48] 1.40 [1.32,1.47] 1.51 [1.44,1.59]

Met vegetable guidelines 8.5% [6.9%,10.4

%] 7.2% [5.7%,8.9%] 7.0% [5.4%,9.0%

]

Mean number of serves of vegetables daily

2.35 [2.25,2.45] 2.35 [2.25,2.44] 2.33 [2.22,2.43]


Fruit consumption has declined across most age groups in 2016 compared with the 2013 and 2009 survey. This was statistically significant for Tasmanians aged 35 years and over when compared to 2009 but not compared to 2013. Table 40: Met NHMRC guidelines for fruit consumption by age, Tasmania 2009 to 2016

Age2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

18-24 46.0% [39.4%,52.8%]

47.0% [38.6%,55.6%]

38.8% [30.1%,48.2%]

25-34 45.3% [40.6%,50.2%]

40.4% [33.5%,47.8%]

41.1% [34.5%,48.0%]

35-44 49.3% [45.9%,52.8%]

42.9% [39.0%,46.9%]

35.8%# [30.5%,41.5%]

45-54 47.3% [44.0%,50.6%]

42.8% [39.3%,46.3%]

36.3%# [32.0%,40.7%]

55-64 53.9% [50.7%,57.1%]

44.2% [41.3%,47.2%]

38.2%# [34.5%,42.1%]

65+ 55.1% [52.4%,57.7%]

47.7% [45.6%,49.9%]

43.9%# [40.7%,47.2%]

Total 49.8% [48.2%,51.4%]

44.2% [42.4%,46.1%]

39.3%*#

[37.3%,41.4%]

Tasmanian Population Health Survey 2009, 2013, 2016; *statistically significantly different compared with 2013; #statistically significantly different compared with 2009

39


Vegetable consumption has declined for most age groups in 2016 compared with 2013 and 2009. Significant changes were noted for Tasmanians aged 55 years and over compared to 2009, but these may be due to the increase in the number of serves from the 2003 to 2013 Guidelines.Table 41: Met NHMRC guidelines for vegetables by age, Tasmania 2009 to 2016

Age2009^^

%2009^^95%CI

2013%

201395%CI

2016%

201695%CI

18-24 6.5% [4.0%,10.4%]

6.5%* [3.3%,12.4%]

4.9%^ [2.2%,10.7%]

25-34 8.2% [6.0%,11.0%]

5.0%* [2.9%,8.6%] 6.2%^ [3.7%,10.3%]

35-44 9.4% [7.7%,11.6%]

6.7% [5.1%,8.8%] 8.0% [5.5%,11.7%]

45-54 10.4% [8.6%,12.5%]

8.9% [7.1%,11.0%]

7.7% [5.8%,10.3%]

55-64 15.3% [13.2%,17.6%]

10.8% [9.3%,12.6%]

7.4% [5.6%,9.8%]

65+ 14.2% [12.4%,16.2%]

11.1% [9.8%,12.4%]

8.9% [7.1%,11.2%]

Total 10.9% [10.1%,11.9%]

8.5% [7.6%,9.4%] 7.5% [6.5%,8.6%]

Tasmanian Population Health Survey 2009, 2013, 2016; ^^2003 guidelines; ^RSE >25% -<50%- use with caution

Healthy eating starts with parental role modelling. https://healthy-kids.com.au/parents/developing-positive-eating-behaviours/Fruit and vegetable consumption was slightly higher for Tasmanians with dependent children under the age of five years than for Tasmanians with older children, but this was not statistically significant.

Table 42: Met NHMRC guidelines for fruit and vegetables, adults with dependent children, Tasmania 2016

2013 Guidelines0-5

years%

0-5 years95% CI

6-9 years

%

6-9 years95% CI

10-15 years

%

10-15 years

95% CI

Adults met fruit guidelines 43.1%

[36.7%,49.7%] 38.8%

[32.4%,45.5%] 37.5%

[31.9%,43.5%]

Mean number of serves of fruit daily 1.47 [1.34,1.60] 1.40 [1.29,1.51] 1.41 [1.30,1.53]

Adults met vegetable guidelines 7.0%

[4.5%,10.7%] 6.9%

[4.3%,10.9%] 5.9%

[4.0%,8.6%]

Mean number of serves of vegetables daily 2.44 [2.25,2.62] 2.34 [2.17,2.52] 2.30 [2.15,2.45]



https://healthy-kids.com.au/parents/developing-positive-eating-behaviours/

41


Although Tasmanians in the most disadvantaged quintile were less likely to eat sufficient vegetables (5.3 per cent) than Tasmanians in the least disadvantaged quintile (8.8 per cent), this was not statistically significant. Tasmanians in the least disadvantaged quintile were significantly more likely (49.7 per cent) to meet the national guidelines for fruit consumption, as shown in the Table and Figure below.Table 43: Met NHMRC guidelines for fruit and vegetables by SEIFA quintiles, 18 years and over, Tasmania 2016

SEIFA IRSD^ 2011

Fruit%

Fruit95% CI

Vegetables%

Vegetables95% CI


34.1% [29.5%,38.9%] 5.3% [3.5%,7.8%]

2nd 35.6% [31.9%,39.6%] 7.6% [5.9%,9.7%]

3rd 38.6% [34.8%,42.6%] 7.7% [6.0%,9.9%]

4th 38.6% [34.1%,43.3%] 7.9% [5.7%,10.7%]


49.7%* [44.0%,55.3%] 8.8% [5.9%,12.8%]

Tasmanian Population Health Survey 2016; ^SEIFA 2011 Index of Relative Socio-economic Disadvantage; *statistically significantly higher compared with all other quintiles

Figure 6: Met NHMRC guidelines for fruit and vegetable consumption by SEIFA quintiles, Tasmania 2016


34.1% 35.6%38.6% 38.6%

49.7%*

5.3% 7.6% 7.7% 7.9% 8.8%

Fruit Vegetables

Tasmanian Population Health Survey 2016; *statistically signficant higher compared to other quintiles

42


Folate/folic acid

Folate is a B group vitamin needed for healthy growth and development. It is found naturally in food such as green leafy vegetables and as folic acid when added to foods such as bread, breakfast cereals or as a supplement. In September 2009 it became mandatory that all wheat flour for bread-making (except organic) contains folic acid. This means that 100 grams of bread, which is around two to three slices, will provide 120 mcg of folic acid. This was implemented to increase the intake of dietary folic acid among women of child bearing age and thereby reduce the incidence of neural tube defects. A folic acid supplement is also recommended for planning a pregnancy and the early stages (first 3 months). Recommended daily folate requirements for people aged 18 years and over are 400 micrograms (mcg) for males and females, increasing to 600 mcg during pregnancy.Significantly more females (40.2 per cent) than males (28.7 per cent) fail to benefit from folate by not eating any bread. Given bread is also used as the vehicle for mandatory iodine fortification via the use of iodised salt by bakers, this is also relevant for the health of Tasmanians, in particular women of child bearing age and pregnant.Table 44: Bread consumption, 18 years and over by sex, Tasmania 2016

Slices per day^

Males%

Males95% CI

Females%

Females95% CI

Persons%

Persons95% CI

None 28.7% [25.9%,31.6%] 40.2%*

[37.5%,42.9%] 34.5% [32.5%,36.5

%]

Less than 2 slices 12.0% [10.0%,14.3

%] 15.6% [13.7%,17.8%] 13.8% [12.4%,15.4

%]

2-4 slices 52.5% [49.3%,55.8%] 42.9% [40.1%,45.7

%] 47.6% [45.5%,49.8%]

>4 slices 6.8% [5.3%,8.8%] 1.3% [0.8%,2.1%] 4.0% [3.2%,5.1%]

Tasmanian Population Health Survey 2016; ^a bread roll counts as two slices; *statistically significantly higher compared to males

Folic acid supplementation rates have fallen significantly since 2009. The data show an increase in females not using folic acid supplementation, and a decrease in the daily use of folic acid since 2009.

Table 45: Frequency of folic acid supplementation by females aged 18 -50 years, Tasmania 2016

Folic acid intake^^

2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

Don’t take folic 69.8% [66.9%,72.5 72.9% [69.2%,76.2 76.8%# [72.7%,80.5%]

43


Folic acid intake^^

2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

acid %] %]

Daily 22.5%[20.2%,24.9

%]19.7%

[16.8%,23.0%]

15.8%# [12.6%,19.5%]

4-6 times per week 2.1% [1.5%,3.0%] 1.8%^ [1.0%,3.2%] n/a n/a

1-3 times per week 1.3%^ [0.7%,2.6%] 1.1%^ [0.5%,2.5%] 2.6%^ [1.5%,4.2%]

Less often 0.5%^ [0.2%,1.0%] 0.7%^ [0.3%,1.8%] 1.4%^ [0.7%,2.9%]

Tasmanian Population Health Survey 2009, 2011, 2016; ^^folic acid supplement or multivitamin containing folic acid; RSE >25% -<50%,- use with caution; #statistically significantly different compared with 2009; n/a = estimates are too unreliable to be published (RSE>50%)

44


Of all females age 18 to 50 years who did not eat any bread in 2016 (42.8 per cent), over three quarters (76.7 per cent) did not use folic acid supplementation.Table 46: Folic acid supplementation, females aged 18-50 years who did not eat bread, Tasmania 2016

Folic acid supplementationFrequency

No bread consumption

%

No bread consumption

95% CIDon't take folic acid

76.7% [70.0%,82.2%]

Daily 16.6% [11.8%,23.0%]

4-6 times per week 2.1%^ [0.9%,5.2%]

1-3 times per week n/a

Less often 2.3%^ [0.9%,5.5%]

Tasmanian Population Health Survey 2016 ^RSE >25% -<50%- use with caution

Less than half of all Tasmanian females aged 18 to 50 years knew the reason for folic acid supplementation by citing pregnancies (32.3 per cent) and preventing birth defects (7.7 per cent) as reasons for folic acid supplementation. A large proportion of females did not know of any reason for the need to supplement with folic acid (42.1 per cent).Table 47: Knowledge of reasons for advice to take folic acid, Tasmania 2016

ReasonsFolic acid

supplementation%

Folic acidSupplementati

on95% CIDo not know reason 42.1% [37.7%,46.6%]

Pregnancy related issue 32.3% [28.2%,36.7%]

To prevent birth defects 7.7% [5.5%,10.6%]

To improve general health 3.7% [2.4%,5.6%]

To balance the diet 0.9% [0.5%,1.8%]


45


Type of drinks consumed

There has been a statistically significant increase in the choice of water when thirsty since 2009, from 69.8 per cent to 73.0 per cent in 2013 and 77.4 per cent in 2016. Soft drinks and fruit/vegetable juice consumption experienced a significant decline as a drink of choice for thirst since 2009, falling to 5.1 per cent and 1.5 per cent respectively in 2016.

Table 48: Type of drinks consumed when thirsty, 18 years and over, Tasmania 2009 to 2016

Type of drink2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

Water 69.8% [68.4%,71.3%]

73.0% [71.4%,74.6%]

77.4%*#

[75.6%,79.1%]

Soft drinks 10.5% [9.5%,11.6%]

7.4% [6.4%,8.6%]

5.1%*# [4.2%,6.2%]

Tea/coffee 13.5% [12.5%,14.4%]

13.9% [12.9%,14.9%]

12.5% [11.3%,13.9%]

Fruit/vegetable juice

3.4% [2.8%,4.0%]

2.0% [1.5%,2.6%]

1.5%# [1.1%,2.1%]

Milk 0.9% [0.7%,1.3%]

1.9% [1.4%,2.6%]

1.4% [0.9%,2.1%]

Alcohol 1.4% [1.1%,1.8%]

1.1% [0.8%,1.5%]

0.9% [0.6%,1.3%]

Sports/energy drink n/a n/a n/a n/a n/a n/a

Other 0.1% [0.0%,0.2%]

0.1% [0.0%,0.2%]

n/a n/a

Tasmanian Population Health Survey 2009, 2011, 2016; *statistically significantly different compared with 2013; #statistically significantly different compared with 2009; n/a = estimates are too unreliable to be published (RSE>50%)

A high intake of sugar sweetened beverages is associated with weight gain as well as dental caries and type 2 diabetes. Sweetened drinks are available as sugar sweetened or diet drinks containing intense sweeteners. Sweetened drinks include soft drinks, cordial, sports drinks and caffeinated drinks but do not include fruit juice or flavoured milksOverall, most Tasmanians did not drink sugar sweetened drinks (64.1 per cent) or diet drinks (81.2 per cent), but sugar sweetened drinks were significantly more popular than diet drinks.

Table 49: Type and frequency of sweetened drink consumption, 18 years and over, Tasmania 2016

Frequency

Sugar sweetened drinks^

%

Sugar sweetened

drinks^95% CI

Diet drinks^

%

Diet drinks^95% CI

Daily 12.2% [10.8%,13.8%] 7.6% [6.4%,8.9%]

46


Frequency


%

Sugar sweetened

drinks^95% CI

Diet drinks^

%

Diet drinks^95% CI

Weekly 23.2% [21.4%,25.2%] 10.9% [9.5%,12.4%]

Don’t drink sweetened drinks

64.1% [62.0%,66.1%] 81.2% [79.4%,83.0%]

Tasmanian Population Health Survey 2016 ^includes cordials, sports and caffeinated drinks – 1 cup = 250ml

47


Tasmanians drank a significantly higher quantity of sugar sweetened drinks than diet drinks in 2016. One in four Tasmanians drank up to 1.5 litres of sugar sweetened drinks weekly, and almost one in eight drank 1.5 litres or more of these drinks per week.

Table 50: Number of cups of sweetened drinks usually consumed weekly by type of drink, Tasmania 2016

Number of cups^


%

Sugar sweetened

drinks^95% CI

Diet drinks^

%

Diet drinks^95% CI

<2 weekly 9.9% [8.6%,11.3%] 4.9% [4.0%,6.0%]

2 to <4 weekly 10.4% [9.0%,12.0%] 4.4% [3.5%,5.4%]

4 to <6 weekly 2.0% [1.4%,2.9%] 1.1% [0.7%,1.7%]

6 or more weekly 13.1% [11.6%,14.7%] 8.1% [6.9%,9.5%]

Don’t drink soft drinks 64.1% [62.0%,66.1

%] 81.2% [79.4%,83.0%]

Tasmanian Population Health Survey 2016 ^includes cordials, sports and caffeinated drinks – 1 cup = 250ml

Tasmanians with an obese BMI were the most likely to consume sugar sweetened drinks (41.1 per cent).

Table 51: Consumption of sugar sweetened drinks by BMI status, 18 years and over, Tasmania 2016

BMI status Sugar sweeten

ed drinks^

^

Sugar sweetened drinks^^95% CI

Diet drinks^^

%

Diet drinks^^95% CI

Underweight 19.7%^ [10.9%,32.8%] 5.3%^ [2.0%,13.1%]

Normal weight 33.6% [29.9%,37.5%] 12.2% [9.7%,15.1%]

Overweight 32.1% [28.7%,35.8%] 22.0% [18.9%,25.4%]

Obese 41.1%* [36.9%,45.4%] 23.5% [20.1%,27.2%]

Tasmanian Population Health Survey 2016 ^^sugar sweetened and includes cordials, sports and caffeinated drinks – 1 cup = 250ml; ^RSE >25% -<50%- use with caution; *statistically significant compared with overweight BMI

48


Figure 7: Consumption of sugar sweetened and diet drinks by BMI status, 18 years and over, Tasmania 2016

Underweight Normal weight Overweight Obese

19.7%

33.6% 32.1%

41.1%*

5.3%

12.2%

22.0% 23.5%

sugar sweetened drinks diet drinks

Tasmanian Population Health Survey 2016; *statistically signficantly higher than overweight BMI

The type of milk being consumed by Tasmanians has significantly changed in 2016 compared with previous years. Significantly more Tasmanians chose whole milk (full fat) in 2016 (55.9 per cent) compared with 2013 (42.6 per cent), with corresponding significant decreases in low/reduced fat and skim milk.The use of alternative types of milk, such as almond, rice or oat milk has tripled since 2009, from 1.6 per cent in 2009 to 4.7 per cent in 2016.

Table 52: Type of milk consumed, 18 years and over, Tasmania 2009 to 2016

Type of milk 2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

Whole milk 42.3%[40.8%,43.9

%] 42.6%[40.8%,44.4

%]55.9%*

#[53.9%,58.0

%]

Low/reduced fat 36.9%[35.4%,38.4

%] 35.8%[34.1%,37.5

%]23.4%*

#[21.7%,25.2

%]

Skim milk 11.0%[10.1%,12.0

%] 10.7% [9.6%,11.9%] 7.5%*# [6.6%,8.6%]

Soy milk 3.3% [2.7%,3.9%] 3.3% [2.7%,4.0%] 3.4% [2.7%,4.3%]

Other types of milk 1.6% [1.2%,2.1%] 2.8% [2.2%,3.5%] 4.7%*# [3.9%,5.8%]

Don’t drink milk 4.4% [3.8%,5.1%] 4.4% [3.8%,5.2%] 4.6% [3.9%,5.5%]


49


Figure 8: Type of milk consumed, 18 years and over, Tasmania 2009 - 2016

Whole milk Low/reduced fat Skim milk Other types of milk

42.3%36.9%

11.0%

1.6%

55.9%*

23.4%*

7.5%*4.7%*

2009 2013 2016

Tasmanian Population Health Survey 2016, *statistically signficantly different compared to 2009 and 2013

Type of diet and food satisfaction

The majority of Tasmanians (63.4 per cent) followed no specific type of diet. The top five diets/usual food reported were a sugar free/low sugar diet (17.5 per cent), a high protein diet (10.6 per cent), a low fat diet (9.5 per cent) and a low carbohydrate/high fat diet (6.9 per cent). Females were significantly more likely than males to report a sugar free/low sugar (19.6 per cent) and gluten free diet (6.3 per cent). Males were more likely to report a high protein (12.3 per cent) or low carb/high fat (7.3 per cent) diet than females, but this was not statistically significant.Table 53: Type of current diet/usual food consumed^ by sex, 18 years and over, Tasmania 2016

Current diet/usual food

Males%

Males95% CI

Females%

Females95% CI

Persons%

Persons95% CI

No specific diet 66.3% [63.2%,69.3%]

60.6% [57.8%,63.3%]

63.4% [61.3%,65.4%]

Sugar free/low sugar 15.3% [13.4%,17.4%]

19.6%* [17.5%,21.9%]

17.5% [16.0%,19.0%]

High protein 12.3% [10.2%,14.8%]

8.9% [7.3%,10.7%]

10.6% [9.2%,12.1%]

Low fat 8.1% [6.7%,9.9%]

10.9% [9.4%,12.6%]

9.5% [8.5%,10.7%]

Low carb and high fat 7.3% [5.9%,9.1%]

6.5% [5.3%,7.9%] 6.9% [5.9%,8.0%]

Vegetarian/vegan 3.1% [2.2%,4.4%]

4.9% [3.7%,6.4%] 4.0% [3.2%,4.9%]

Gluten free 2.8% [1.8%,4.1%]

6.3%* [5.0%,7.8%] 4.5% [3.7%,5.5%]

Other type of diet^^ 2.6% [1.9%,3.6%]

4.5% [3.6%,5.7%] 3.6% [3.0%,4.3%]

Tasmanian Population Health Survey 2016; ^multi-response question focused on type of food usually consumed or a new diet recently commenced; ^^’other diets’ included fasting diet, low salt diet, no red meat, dairy free and others; *statistically significantly different compared with males

50


Health reasons were by far the most common reasons cited for being on a particular type of diet.

Table 54: Reason for current type of diet/usual food, 18 years and over, Tasmania 2016


In 2016, 39.7 per cent of Tasmanians expressed dissatisfaction with food available to them for one or more reasons compared with 37.7 per cent in 2013.Dissatisfaction with the cost of food was significantly higher in 2016 (26.8 per cent) than in 2013, but not as high as in 2009. The proportion of Tasmanians dissatisfied with a lack of culturally appropriate food or food of adequate quality was similar to the 2013 results, but significantly lower than in 2009.Lack of quality (22.2 per cent) and variety (11.0 per cent), and the high costs of some foods, in particular fruit and vegetables (26.8 per cent) were the main dissatisfactions expressed by Tasmanians in 2016. These were the same main reasons cited in 2009 and 2013.

Table 55: Reasons for dissatisfaction with available food, 18 years and over, Tasmania 2009 to 2016

Food dissatisfaction

Reasons

2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

Some foods too expensive 28.9% [27.5%,30.4

%] 22.4% [20.8%,24.0%] 26.8%*

[24.9%,28.7%]

Lack of quality 29.2% [27.8%,30.6%] 22.0% [20.5%,23.

5%] 22.2%#[20.4%,24.0

%]

Lack of variety 12.2% [11.2%,13.3%] 9.3% [8.3%,10.4

%] 11.0% [9.7%,12.5%]

Lack of culturally appropriate foods 7.9% [7.0%,8.8%] 3.7% [3.1%,4.3%

] 3.7%# [3.0%,4.6%]

Inadequate/unreliable public transport

7.8% [6.9%,8.7%] 5.6% [4.8%,6.6%] 5.9% [4.9%,7.1%]


51


Reason Reason for diet%

Reason for diet95% CI

Health reasons 47.6% [44.3%,51.0%]

No specific reason 17.8% [15.3%,20.7%]

Health reasons and to lose weight

11.0% [9.1%,13.1%]

To lose weight 10.9% [8.8%,13.3%]

Other 11.5% [9.3%,14.3%]

52


Physical activity levels

Physical activity is a major modifiable risk factor for a range of chronic conditions including cardiovascular disease, type 2 diabetes, mental health disorders, and some cancers, and insufficient physical activity contributes to the Australian burden of disease.The health benefits of physical activity are determined by the frequency, duration, and intensity of the activity. The updated 2014 Guidelines introduced a range of minutes per week in the duration of moderate/vigorous physical activity and twice weekly muscle strengthening activity. Moderate intensity activities are those that take some effort, but you are still able to talk while doing them. Vigorous intensity activities refer to those activities that require more effort and make you breather harder and faster.

Physical Activity Guidelines, 1999 and 2014

Recommendations National Physical Activity Guidelines 1999^

Physical Activity and Sedentary Behaviour Guidelines 2014^^

Moderate intensity activity

30min/day (5 days) or 150 min/week 150-300 min/week

ORVigorous intensity activity

Not quantified 75-150 min/week

OR equivalent combination of both

Muscle strengthening activity

n/a Twice weekly

^includes everyone from age 18 years ^^ applies to people aged 18-64 years

The types of physical activity included in meeting the 2014 guidelines comprise walking (at least 10 minutes at a time), vigorous household chores and vigorous gardening activities, moderate and vigorous physical activity (sport/exercise) and muscle strengthening activities.Physical activity is reported as sufficient or insufficient in meeting the guidelines for moderate to vigorous physical activity (MVPA). Insufficient physical activity includes the absence of activity as well as activity levels which fall below the 2014 recommendations.The 1999 guidelines have been applied to the 2016 estimates below for trend analysis.The proportion of Tasmanians with sufficient levels of physical activity has slightly increased since 2013, from 63.9 per cent to 66 per cent, but this was not statistically significant.Table 56: Level of physical activity using the 1999 Guidelines, 18 years and over Tasmania 2009 to 2016

Activity levels (MVPA)

2009

%

2009

95% CI

2013

%

2013

95% CI

2016

%

2016

95% CI

Insufficient 27.5%

[26.1%,28.9%]

31.0% [29.3%,32.7%]

27.9% [26.1%,29.7%]

53


Activity levels (MVPA)

2009

%

2009

95% CI

2013

%

2013

95% CI

2016

%

2016

95% CI

Sufficient 68.2%

[66.7%,69.6%]

63.9% [62.1%,65.6%]

66.0% [64.1%,67.9%]


54


With the application of the 2014 Guidelines, sufficient moderate and vigorous physical activity was reported by 81.2 per cent of Tasmanians between 18 and 64 years of age, and a further 29.2 per cent of Tasmanians in this age group reported sufficient muscle strengthening activity.The combination of sufficient moderate and vigorous physical activity and sufficient muscle strengthening activity, as recommended by the 2014 Guidelines, was achieved by 29 per cent of Tasmanians aged 18-64 years.Table 57: Level of physical activity, 18-64 years, Tasmania 2016

2014 GuidelinesActivity levels (MVPA)^

18-64 years

%

18-64 years

95% CI

Insufficient 14.9% [13.2%,16.8%]

Sufficient 81.2% [79.2%,83.1%]

Muscle strengthening activity

- -

Insufficient 70.2% [67.7%,72.5%]

Sufficient 29.2% [26.8%,31.7%]

Combined measure - -

Insufficient 67.1% [64.6%,69.5%]

Sufficient 29.0% [26.6%,31.5%]

Tasmanian Population Health Survey 2016; ^MVPA refers to moderate and vigorous physical activity

Tasmanians in the Southern region recorded the highest proportions of sufficient physical activity and muscle strengthening activity, but this was not statistically significant.Table 58: Level of physical activity by region, 18-64 years, Tasmania 2016

Activity levels (MVPA)^

North%

North95% CI

North-West

%

North-West

95% CI

South%

South 95% CI

Insufficient 15.3% [12.6%,18.5%]

16.2% [13.6%,19.2%]

14.2% [11.6%,17.2%]

Sufficient 79.8% [76.2%,83.0%]

78.3% [74.9%,81.4%]

83.2% [80.0%,86.0%]

Muscle strengthening

- - - - - -

Insufficient 72.2% [68.2%,75.9%]

70.7% [66.6%,74.5%]

68.8% [64.7%,72.6%]

Sufficient 27.5% [23.9%,31.5%]

27.7% [23.8%,31.9%]

30.8% [26.9%,34.9%]

Combined measure - - - - - -

Insufficient 68.0% [63.9%,71.9%]

67.1% [63.0%,71.0%]

66.6% [62.4%,70.5%]

Sufficient 27.1% [23.4%,31.0%]

27.4% [23.6%,31.6%]

30.8% [26.9%,34.9%]

Tasmanian Population Health Survey 2016; ^MVPA refers to moderate and vigorous physical activity

55


The proportions of males and females reporting insufficient levels of moderate and vigorous physical activity in 2016 were similar across the age groups. Proportions of insufficient activity slightly increased with older age groups, but this was not statistically significant.Table 59: Insufficient physical activity (MVPA) by sex and age, 2014 Guidelines, Tasmania 2016

Insufficient physical activity*

Males%

Males95% CI

Females%

Females95% CI

18-24 9.1%^ [3.5%,21.8%] 11.3%^ [5.7%,21.3%]

25-34 12.1%^ [7.0%,20.2%] 13.9% [8.9%,21.2%]

35-44 15.6% [10.4%,22.7%] 15.9% [11.3%,21.8%]

45-54 14.0% [10.4%,18.7%] 16.5% [12.4%,21.6%]

55-64 19.5% [15.4%,24.4%] 17.3% [13.4%,22.0%]

Total 14.5% [12.1%,17.2%] 15.3% [13.1%,17.9%]

Tasmanian Population Health Survey 2016; * MVPA only, excludes muscle strengthening activity; ^RSE >25% -<50%- use with caution

A slightly higher proportion of Tasmanians in the most disadvantaged quintile were insufficiently active (17.7 per cent) when compared with the least disadvantaged quintile (12.1 per cent), but this was not statistically significant.Table 60: Physical activity levels by SEIFA quintiles, 18-64 years, Tasmania 2016

SEIFA IRSD 2011^Insufficient activity

%

Insufficient activity95% CI

Sufficient activity

%

Sufficient activity95% CI


17.7% [13.6%,22.8%] 78.4% [73.1%,82.9%]

2nd 15.8% [12.9%,19.3%] 79.4% [75.5%,82.8%]

3rd 15.6% [12.5%,19.3%] 78.4% [74.1%,82.1%]

4th 13.1% [9.8%,17.3%] 83.5% [78.9%,87.2%]


12.1% [8.4%,17.2%] 86.5% [81.3%,90.4%]

Tasmanian Population Health Survey 2016; ^Index of Relative Socio-economic Disadvantage; *MVPA only, excludes muscle strengthening activity

56


Sedentary behaviour (sitting)

Sedentary behaviour refers to sitting time, such as time spent sitting at work, on transport, or while reading or watching television.Research has suggested that prolonged sitting has harmful effects on health, and that sitting times should be minimised or interspersed with activity. Australia’s Physical Activity and Sedentary Behaviour Guidelines 2014 recommend that adults minimise the amount of time spent in prolonged sitting and break up long periods of sitting as often as possibleAlthough there are no official guidelines quantifying how much sitting time is harmful, there is some agreement on using eight hours or more of daily sitting time as a proxy indicator of a high level of sedentariness. http://www.ncbi.nlm.nih.gov/pubmed/26809451A significantly higher proportion of Tasmanians are sedentary for eight hour or more on weekdays (17.4%) than on weekends (9.9%).Table 61: Hours per day spent sitting^ on weekdays and weekends, 18 years and over, Tasmania 2016

SittingHours per day^

Weekdays%

Weekdays95% CI

Weekends%

Weekends95% CI

<2 hours 6.9% [5.8%,8.1%] 8.9% [7.7%,10.3%]

2-<4 hours 29.5%* [27.6%,31.5%] 34.9% [33.0%,37.0%]

4-<6 hours 28.3% [26.5%,30.3%] 29.9% [27.9%,31.9%]

6-<8 hours 13.5%* [12.0%,15.1%] 10.5% [9.2%,11.9%]

>8 hours 17.4%* [15.8%,19.2%] 9.9% [8.6%,11.3%]

Tasmanian Population Health Survey 2016; ^during the last 7 days; *statistically significantly different compared with weekends

The proportions of Tasmanians reporting sedentariness for eight hours or more on weekends and weekdays were almost identical across regions.Table 62: Eight hours or more of sitting^ on weekdays and weekends by region, Tasmania 2016

>8 Hours per day^

North%

North95% CI

North-West

%

North-West

95% CI

South%

South 95% CI

Weekdays 17.1% [14.6%,19.9%]

17.9% [15.3%,20.8%]

17.5% [14.9%,20.4%]

Weekends 9.3% [7.4%,11.7%]

9.8% [7.9%,12.2%]

10.2% [8.1%,12.6%]

Tasmanian Population Health Survey 2016; ^during the last 7 days

57


http://www.ncbi.nlm.nih.gov/pubmed/26809451

Tasmanians aged 25 to 44 years reported the most sedentariness for weekdays, while Tasmanians 65 years of age and older reported the least sedentariness on weekdays with 7.8 per cent.Table 63: Eight hours or more of sitting^ on weekdays and weekends by age, Tasmania 2016

>8 hours per day^

Weekdays%

Weekdays95% CI

Weekends%

Weekends95% CI

18-24 18.2% [11.8%,27.0%] 17.1%[11.2%,25.2

%]

25-3425.2%# [19.8%,31.5%] 12.3%

[8.4%,17.8%]

35-4424.0%# [19.4%,29.3%] 8.4%

[5.7%,12.2%]

45-54 19.8% [16.5%,23.7%] 8.8%[6.6%,11.6%

]

55-64 15.3% [12.7%,18.3%] 7.5% [5.7%,9.8%]

65+7.8%* [6.3%,9.7%] 8.4%

[6.7%,10.6%]

Total 17.4% [15.8%,19.2%] 9.9%[8.6%,11.3%

]

Tasmanian Population Health Survey2016; ^during the last 7 days; *statistically significantly lower than all other age groups and total; #statistically significantly higher compared with the total

There were no significant differences in sedentariness across the socio-economic quintiles.Table 64: Eight hours or more of sitting^ on weekdays and weekends by SEIFA quintiles, Tasmania 2016

>8 hours^SEIFA IRSD 2011^^

Weekdays%

Weekdays95% CI

Weekends%

Weekends95% CI

1st (most disadvantaged) 19.5% [15.4%,24.2%] 12.3% [9.0%,16.7%]

2nd 17.8% [14.9%,21.2%] 10.9% [8.6%,13.7%]

3rd 15.6% [12.9%,18.9%] 7.7% [5.8%,10.1%]

4th 14.5% [11.3%,18.4%] 8.4% [6.0%,11.6%]

5th (least disadvantaged) 19.8% [15.6%,24.9%] 10.1% [7.0%,14.2%]

Tasmanian Population Health Survey 2016; ^during the last 7 days; ^^Index of Relative Socio-economic Disadvantage

58


Two in five Tasmanians (39.0%) were mostly sitting at work in 2016.Table 65: Activity levels at work^, 18 years and over, Tasmania 2016

Mostly sitting%

Mostly sitting95% CI

Mostly standin

g%

Mostly standing95% CI

Mostly walkin

g%

Mostly walking95% CI

Mostly

heavy labou

r%

Mostly heavy labour95% CI

39.0%[36.2%,41.

8%] 22.3%[19.8%,25.

0%] 20.2%[17.9%,22.

7%] 14.5%[12.6%,16.6

%]

Tasmanian Population Health Survey 2016; ^employed or self-employed

59


Active transport

Active transport is about travelling to and from work, shopping or public transport by walking, running or cycling for at least 10 minutes continuously. Active transport provides benefits by increasing daily physical activity levels and by reducing greenhouse gas emissions. More than half of all Tasmanians (56.9 per cent) had not used active transport in the preceding week, and a quarter of Tasmanians (24.5 per cent) had used active transport on four or more days.Table 66: Frequency of using active transport during last seven days^, 18 years and over, Tasmania 2016

Frequency Males%

Males 95% CI

Females%

Females95% CI

Persons%

Persons 95% CI

None 55.8%[52.6%,59.

0%] 57.8%[55.1%,60.

6%] 56.9%[54.7%,58.

9%]

1-3 days 16.3%[14.0%,18.

9%] 18.4%[16.4%,20.

6%] 17.4%[15.8%,19.

0%]

4 or more days 26.7%[23.8%,29.

8%] 22.3%[19.9%,24.

8%] 24.5%[22.6%,26.

4%]

Tasmanian Population Health Survey 2016; ^cycling, walking or running for at least 10 minutes continuously during the last 7 days

The use of active transport is associated with age, with younger people significantly less likely not to use active transport.Table 67: Did not use active transport^ by age, Tasmania 2016

Age Active transport not used

%

Active transport not used95% CI

18-24 33.3%* [25.1%,42.7%]

25-34 54.2% [47.3%,60.9%]

35-44 57.4% [51.6%,62.9%]

45-54 59.1% [54.6%,63.5%]

55-64 61.9% [58.1%,65.5%]

65+ 63.9% [60.7%,67.1%]Tasmanian Population Health Survey 2016; ^cycling, walking or running for at least 10 minutes continuously during the last 7 days; *statistically significantly lower compared with all other age groups

Figure 9: Did not use active transport^ by age, Tasmania 2016

60


18-24 25-34 35-44 45-54 55-64 65+

33.3%*

54.2% 57.4% 59.1% 61.9% 63.9%

Tasmanian Population Health Survey 2016, ^preceding 7 days; *statistically significantly lower than all other age groups

61


The use of active transport shows an inverse relationship with socio-economic status, with a significantly higher proportion of Tasmanians in the most disadvantaged areas not using active transport (62.5 per cent) compared with the least disadvantaged Tasmanians (44.7 per cent).

Table 68: Did not use active transport^ by SEIFA quintile, Tasmania 2016

SEIFA IRSD 2011^^Active

transport not used

%

Active transport not used95% CI


62.5% [57.4%,67.4%]

2nd 58.2% [54.1%,62.2%]

3rd 60.1% [56.1%,64.0%]

4th 58.7% [53.8%,63.4%]


44.7%* [39.2%,50.4%]

Tasmanian Population Health Survey 2016; ^^Index of Relative Disadvantage^cycling, walking or running for at least 10 minutes continuously during the last 7 days*statistically significantly lower than all other quintiles

Figure 10: Did not use active transport by SEIFA quintiles, Tasmania 2016


62.5%58.2% 60.1% 58.7%

44.7%*

Tasmanian Population Health Survey 2016; *statistically signficantly lower than all other quintiles

62


Chapter 3: Indicators of health literacy

Low health literacy affects the capacity to make decisions and to manage health and health care, and has been associated with increased hospitalisation, lower use of preventive health services and poorer knowledge about chronic diseases and self-management skills.Understanding information well enough to know what to do is one component of health literacy and has been assessed with questions taken from the Health Literacy Questionnaire (Deakin University). Health literacy includes additional factors, which have not been included here.In addition to questions that inform Understanding health information well enough to know what to do, one question relating to Ability to Actively Engage with Health Care Providers was included for some information concerning interactions with health care providers.

Understanding health information

Over 80 per cent of Tasmanians assessed their ability to understand written information well enough to know what to do. Only a small proportion of Tasmanians perceived these tasks as difficult or very difficult, with an average of 10 per cent reporting occasional problems.The tasks rated as the most difficult were ‘confidently fill medical forms in the correct way’ and ‘read and understand all the information on medication labels’.

Table 69: Understanding health information, 18 years and over, Tasmania 2016

Domain indicators Cannot do/always difficult

%

Usually difficult

%

Sometimes

difficult%

Usually easy

%

Always easy%

Confidently fill medical forms in the correct way 1.6% 2.0% 12.0% 42.1% 39.2%

Accurately follow instructions from healthcare providers

0.6% 1.3% 8.8% 45.0% 43.2%

Read and understand written health information 1.1% 1.7% 10.1% 40.6% 45.6%

Read and understand all the information on medication labels

1.3% 1.6% 10.6% 38.0% 47.8%

Understand what health care providers are asking you to do

0.5% 1.0% 9.1% 44.7% 43.3%


63


A score was calculated for the domain of Understanding Health Information to allow for comparisons. This score is the average scale response over each of the five indicators comprising this domain.Whilst there were no statistically significant differences in the average regional scores compared to Tasmania overall, the Southern region had a statistically significantly higher average score compared to the North West region.

Table 70:.Understanding health information by region, Tasmania 2016Region Score 95% CI

North 4.26 [4.22,4.31]

North-West 4.24 [4.20,4.28]

South 4.33 [4.29,4.37]

Tasmania 4.29 [4.27,4.32]


With a domain score of 4.38, females had statistically significantly better health literacy than males (4.20). The higher score for females applied to most age groups, from age 35 years through to 65 years and over.

Table 71: Understanding health information by sex and age, Tasmania 2016Age Males

ScoreMales95% CI

FemalesScore

Females95% CI

Persons%

Persons95% CI

18-24 4.29 [4.14,4.44] 4.38 [4.27,4.50]

4.33 [4.24,4.43]

25-34 4.33 [4.22,4.44] 4.42 [4.31,4.53]

4.37 [4.29,4.45]

35-44 4.18 [4.05,4.30] 4.44* [4.36,4.51]

4.31 [4.24,4.39]

45-54 4.13 [4.02,4.23] 4.39* [4.32,4.47]

4.26 [4.20,4.33]

55-64 4.17 [4.10,4.24] 4.32* [4.26,4.37]

4.25 [4.20,4.29]

65+ 4.18 [4.11,4.25] 4.35* [4.30,4.39]

4.27 [4.23,4.31]

Total 4.20 [4.16,4.24] 4.38* [4.35,4.41]

4.29 [4.27,4.32]

Tasmanian Population Health Survey 2016; *statistically significantly higher compared with males

64


There is a clear socio-economic gradient of understanding health information, with the least disadvantaged quintile showing the highest score of 4.42, which is significantly higher than the scores of all other quintiles.Table 72: Understanding health information by SEIFA quintiles, Tasmania 2016

Tasmanian Population Health Survey 2016; ^SEIFA 2011 – Index of Relative Socio-economic Disadvantage*statistically significantly higher than all other quintiles

Figure 11: Understanding health information by SEIFA quintiles, Tasmania 2016


4.24 4.244.27

4.29

4.42*

Tasmanian Population Health Survey 2016; *statistically significantly higher than all other quintiles

65


SEIFA IRSD^ 2011 Understanding Health

Information Domain Score

Understanding Health Information

95% CI


4.24 [4.17,4.30]

2nd 4.24 [4.19,4.29]

3rd 4.27 [4.22,4.31]

4th 4.29 [4.24,4.35]


4.42* [4.36,4.49]

Engaging with health care providers

Only one question out of five was selected from the sixth domain of the Health Literacy Questionnaire ‘Ability to actively engage with health care providers’. The question selected was ability to discuss health care concerns with a health care provider.Difficulties with discussing health issues with health care providers affected 2.3 per cent of Tasmanians, with a further 11 per cent perceiving difficulties at times. The remaining Tasmanians (85.8 per cent) found it easy to discuss health issues with their health care providers.Table 73: Ability to discuss health care concerns with service providers, 18 years and over, Tasmania 2016

Cannot do/always difficult

Usually difficult

Sometimes difficult

Usually easy

Always easy

0.8% 1.5% 11.0% 38.1% 47.7%


Although Tasmanians in the Northern region had the highest proportion of people who thought it to be usually or always easy (87.9 per cent) to raise health issues with health care providers, regional differences were not statistically significant.Table 74: Ability to discuss health care concerns with service providers by region, Tasmania 2016

Level of abilityNorth

%North95% CI

North-West

%

North-West

95% CI

South%

South95% CI

Cannot do/always difficult

0.6% [0.3%,1.1%]

1.0% [0.6%,1.9%]

0.9% [0.4%,1.9%]

Usually difficult 1.1% [0.6%,2.0%]

1.7% [1.0%,3.0%]

1.7% [0.9%,3.0%]

Sometimes difficult 9.7% [7.8%,12.0%]

13.2% [10.8%,15.9%]

10.8% [8.7%,13.4%]

Usually easy 38.6% [35.3%,42.1%]

40.2% [36.8%,43.8%]

37.0% [33.7%,40.4%]

Always easy 49.3% [45.9%,52.7%]

42.8% [39.3%,46.3%]

48.9% [45.4%,52.4%]


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More females (87.7 per cent) than males (83.9 per cent) found it easy to actively engage with health care providers. Among males, older males found discussions with health care providers easier than younger males. However, neither of these comparisons was statistically significant. For both males and females, Tasmanians aged 65 years and over found it easier to discuss health care issues than younger Tasmanians, but this was not statistically significant.Table 75: Usually easy/always easy to discuss health care concerns with health care providers by age and sex, Tasmania 2016

AgeMales

%Males 95% CI

Females%

Females95% CI

Persons%

Persons95% CI

18-24 80.8% [67.5%,89.5%] 85.8% [73.7%,92.8%]

83.2% [74.6%,89.2%]

25-34 76.5% [66.5%,84.3%] 86.0% [78.5%,91.2%]

81.3% [75.2%,86.2%]

35-44 82.5% [73.8%,88.8%] 87.6% [82.3%,91.5%]

85.1% [80.2%,89.0%]

45-54 81.0% [74.7%,86.0%] 85.8% [81.4%,89.4%]

83.4% [79.7%,86.6%]

55-64 86.3% [82.4%,89.5%] 87.0% [83.4%,89.9%]

86.7% [84.1%,88.9%]

65+ 91.4% [88.4%,93.6%] 91.5% [88.7%,93.6%]

91.4% [89.5%,93.0%]

Total 83.9% [81.1%,86.3%] 87.7% [85.7%,89.5%]

85.8% [84.2%,87.3%]


Socio-economic differences did not affect the ability of Tasmanians to discuss health issues with their health care providers.Table 76: Usually easy/always easy to discuss health care concerns with health care provider by SEIFA quintiles, Tasmania 2016

SEIFA IRSD^ 2011Usually

easy/always easy%

Usually easy/always easy95% CI

1st (most disadvantaged) 82.2% [77.7%,86.0%]

2nd 84.0% [80.6%,86.8%]

3rd 88.5% [85.8%,90.8%]

4th 87.0% [83.1%,90.1%]

5th (least disadvantaged) 87.3% [82.6%,90.8%]

Tasmanian Population Health Survey 2016; ^SEIFA 2011 – Index of Relative Socio-economic Disadvantage

67


Chapter 4: Chronic Diseases

The chronic conditions data included here cover asthma, hypertension, diabetes, hyperglycaemia (high blood sugar), heart disease, stroke, cancer, depression/anxiety, osteoporosis, arthritis, and eye diseases. Estimates have been age-standardised to remove differences that occur over time as a consequence of population ageing.

Note that conditions are self-reported in response to the question ‘have you ever been told by a doctor that you have… (condition)?’ This means that chronic conditions reported may or may not be currently experienced. The proportions of chronic conditions in the tables below are therefore to be regarded as lifetime prevalence rather than current prevalence data.

Chronic disease lifetime prevalence

Most chronic conditions have increased in prevalence since 2013, with depression/anxiety, diabetes, and eye diseases showing statistically significant increases compared with 2009 as well as 2013 data.Table 77: Self-reported ever diagnosed chronic conditions, age standardised, 18 years and over, Tasmania 2009 to 2016

Chronic conditions (ever diagnosed)^

2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

Asthma 21.7% [20.1%,23.4%]

24.3% [22.2%,26.5%]

25.4% [23.2%,27.9%]

Hypertension^ 25.8% [24.6%,27.0%]

24.9% [23.5%,26.3%]

23.9% [22.4%,25.4%]

Diabetes 5.5% [5.0%,6.1%] 6.2% [5.5%,6.9%] 8.1%*# [7.1%,9.2%]

High blood sugar 3.8% [3.1%,4.5%] 3.5% [2.9%,4.3%] 4.9% [4.0%,6.0%]

Cancer 6.5% [5.9%,7.1%] 7.6% [6.8%,8.5%] 8.5%# [7.5%,9.6%]

Arthritis 21.0% [20.1%,22.0%]

22.5% [21.3%,23.6%]

23.3% [21.9%,24.6%]

Osteoporosis 5.2% [4.7%,5.7%] 5.2% [4.8%,5.7%] 6.1% [5.5%,6.8%]

Heart disease^ 5.6% [5.1%,6.1%] 6.8% [6.0%,7.7%] 7.0%# [6.2%,7.9%]

Stroke^ 2.8% [2.4%,3.3%] 2.3% [2.0%,2.7%] 2.8% [2.3%,3.4%]

Depression/Anxiety 21.4% [20.0%,22.8%]

25.5% [23.5%,27.7%]

30.0%*#

[27.7%,32.4%]

Eye diseases^ 9.2% [8.6%,9.7%] 10.1% [9.5%,10.6%]

11.7%*#

[10.9%,12.5%]

Tasmanian Population Health Survey 2009, 2013, 2016; *statistically significantly higher compared with 2013; #statistically significantly higher compared with 2009^hypertension includes gestational hypertension; heart disease includes coronary heart disease, cardiomyopathy, ischaemic heart disease, heart failure, hypertensive heart disease, inflammatory heart disease, disease affecting heart valves, heart murmur, having pacemaker; stroke includes mini strokes,

68


aneurisms and trans-ischaemic attacks; eye diseases includes cataracts, glaucoma, diabetic eye disease/retinopathy, macular degeneration.

69


All regions experienced an increase in some chronic conditions since 2009. The lifetime prevalence of eye diseases in the South increased significantly compared with 2009 and 2013.Table 78: Self-reported ever diagnosed chronic conditions by region, age standardised, Tasmania 2009 to 2016

Chronic conditions (ever diagnosed)

2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

North - - - - - -Asthma 23.1% [20.5%,25.9 26.7% [23.2%,30.4 26.3% [22.7%,30.1Hypertension 26.5% [24.6%,28.5 25.2% [23.0%,27.6 25.1% [22.5%,27.8Diabetes 5.8% [4.9%,6.7%] 7.0% [5.9%,8.3%] 9.9%# [8.0%,12.2High blood sugar 3.9% [3.0%,5.1%] 3.8% [2.7%,5.2%] 4.1% [3.0%,5.6%]Cancer 5.1% [4.4%,6.0%] 6.9% [5.6%,8.3%] 8.0%# [6.6%,9.6%]Arthritis 21.0% [19.5%,22.6 23.5% [21.7%,25.3 23.6% [21.5%,25.8Osteoporosis 4.8% [4.1%,5.6%] 5.0% [4.2%,5.8%] 5.5% [4.7%,6.4%]Heart disease 5.5% [4.7%,6.3%] 6.3% [5.5%,7.4%] 7.7%# [6.3%,9.3%]Stroke^ 2.8% [2.2%,3.4%] 2.6% [2.1%,3.3%] 3.2% [2.4%,4.2%]Depression/Anxiety 20.1% [17.9%,22.3 24.6% [21.5%,27.9 27.1%# [23.7%,30.8Eye diseases 8.3% [7.5%,9.1%] 9.8% [8.8%,10.8% 9.8% [8.7%,10.9

North West - - - - - -Asthma 20.5% [18.1%,23.3 22.6% [19.3%,26.4 23.6% [19.8%,27.9Hypertension^ 26.2% [24.3%,28.0 25.6% [23.2%,28.1 23.5% [21.3%,25.8Diabetes 6.7% [5.6%,7.9%] 7.2% [5.8%,8.8%] 8.5% [6.7%,10.8High blood sugar 3.9% [3.0%,5.2%] 2.7% [2.0%,3.5%] 4.3% [3.1%,5.8%]Cancer 7.2% [6.2%,8.2%] 7.4% [6.5%,8.5%] 7.3% [6.2%,8.6%]Arthritis 20.6% [19.1%,22.2 22.3% [20.6%,24.2 24.3% [21.9%,26.9Osteoporosis 4.6% [4.0%.5.4%] 5.1% [4.5%,5.9%] 6.4% [5.3%,7.7%]Heart disease 5.9% [5.1%,6.8%] 6.5% [5.7%,7.4%] 6.6% [5.3%,8.2%]Stroke^ 3.3% [2.7%,4.1%] 2.9% [2.2%,3.8%] 2.6% [1.9%,3.5%]Depression/Anxiety 20.0% [17.9%,22.3 22.7% [20.0%,25.6 29.4%# [24.8%,34.5Eye diseases 8.7% [7.8%,9.8%] 10.4% [9.4%,11.5% 10.0% [9.0%,11.1

South - - - - - -Asthma 21.4% [19.0%,24.1 23.6% [20.3%,27.2 25.8% [22.3%,29.7Hypertension 25.1% [23.2%,27.1 24.3% [22.2%,26.5 23.4% [21.1%,25.9Diabetes 4.8% [4.0%,5.7%] 5.1% [4.3%,6.1%] 7.1%# [5.7%,8.8%]High blood sugar 3.7% [2.7%,5.0%] 3.8% [2.8%,5.2%] 5.6% [4.1%,7.7%]Cancer 7.0% [6.0%,8.1%] 8.2% [6.9%,9.7%] 9.3% [7.7%,11.3Arthritis 21.2% [19.7%,22.7 21.9% [20.1%,23.9 22.7% [20.6%,24.9Osteoporosis 5.7% [4.9%,6.5%] 5.4% [4.8%,6.2%] 6.4% [5.3%,7.7%]Heart disease 5.5% [4.7%,6.4%] 7.1% [5.7%,8.8%] 6.8% [5.5%,8.3%]Stroke^ 2.6% [2.0%,3.5%] 1.9% [1.5%,2.5%] 2.7% [2.0%,3.8%]Depression/Anxiety 22.7% [20.6%,25.0 26.9% [23.6%,30.4 32.0%# [28.5%,35.8Eye diseases 9.9% [9.0%,10.9% 10.1% [9.3%,10.9% 13.5%* [12.1%,14.9

Tasmanian Population Health Survey 2009, 2013, 2016 *statistically significantly higher compared with 2013; #statistically significantly higher compared with 2009

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Chronic disease management

Chronic disease management refers to actions taken by individuals with chronic conditions to help them manage their condition. The chronic conditions included are currently experienced.

Mental HealthSignificantly more Tasmanians sought professional help for mental health related problems in 2016 (17.6 per cent) than in 2013 (11.6 per cent) and 2009 (10.3 per cent). There was a statistically significant increase in the proportion of females seeking professional help for a mental health related issue (21.9%) when compared with 2013 (13.5%) and 2009 (12.0%). The proportion of males seeking help in 2016 (13.1%) was significantly higher than in 2009 (8.5%), but not compared to 2013.

Table 79: Sought professional help for a mental health related problem^ by sex, 18 years and over, Tasmania 2009 to 2016

Gender2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

Males 8.5% [7.2%,10.0%] 9.7% [8.0%,11.8%

] 13.1%#[11.0%,15.6%

]

Females 12.0% [10.8%,13.4%] 13.5% [11.9%,15.3

%]21.9%*

#[19.5%,24.5%

]

Persons 10.3% [9.4%,11.3%] 11.6% [10.4%,13.0

%]17.6%*

#[15.9%,19.3%

]

Tasmanian Population Health Survey 2016; ^during the previous 12 months; *statistically significant increase compared with 2013; # statistically significant increase compared with 2009

Figure 12: Sought professional help for a mental health problem by sex, Tasmania 2009 to 2016

2009 2013 2016

8.5% 9.7%

13.1%12.0%13.5%

21.9%*

10.3%11.6%

17.6%*

Males Females Persons

Tasmanian Population Health Survey 2016; *statistically signficant increase since 2013

71


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Hypertension

There has been a significant decline in the proportion of Tasmanians with current hypertension who took no action to manage their hypertension from 5.8 per cent in 2009 to 2.7 per cent in 2016, but significantly fewer Tasmanians used stress management to control hypertension in 2016 (49.2 per cent) compared to 2013 (59.2 per cent).

Table 80: Actions taken to manage current hypertension^, 18 years and over, Tasmania 2009 to 2016

Actions2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

Modify diet (eg salt)

43.1% [40.5%,45.8%]

45.5% [42.8%,48.2%]

46.2% [42.7%,49.8%]

Weight loss 42.0% [39.4%,44.7%]

46.8% [44.2%,49.4%]

43.2% [39.7%,46.7%]

Exercise 60.4% [57.7%,63.0%]

62.5% [59.9%,65.0%]

57.8% [54.2%,61.2%]

Medications 75.5% [73.2%,77.7%]

77.0% [74.7%,79.1%]

78.4% [75.2%,81.3%]

Stress management

52.8% [50.1%,55.5%]

59.2% [56.6%,61.8%]

49.2%* [45.7%,52.7%]

Other action 1.4% [0.8%,2.2%]

2.0% [1.4%,2.8%] 2.0%^^ [1.2%,3.2%]

No action taken 5.8% [4.6%,7.3%]

4.0% [2.9%,5.4%] 2.7%# [1.8%,4.1%]

Tasmanian Population Health Survey 2009, 2013, 2016; ^excludes gestational hypertension; ^^RSE >25% -<50%- use with caution; *statistically significant increase compared with 2013; #statistically significant increase compared with 2009

Diabetes

Most Tasmanians with type 1 or type 2 diabetes, excluding gestational diabetes, engaged in actions to manage their disease, with the most common actions taken being diet modifications (81.5 per cent), medications (80.4 per cent), exercise (57.8 per cent), and weight loss (50.6 per cent).

Table 81: Actions taken to manage current diabetes type 1 and type 2^, 18 years and over, Tasmania 2016

Actions Diabetes (type 1 and 2)%

Diabetes (type 1 and 2)

95% CI

Modify diet 81.5% [77.0%,85.3%]

Medications 80.4% [74.6%,85.1%]

Exercise 57.8% [51.8%,63.6%]

Weight loss 50.6% [44.6%,56.6%]

Other action 2.2%^^ [1.0%,5.1%]

No action n/a n/a

73


Tasmanian Population Health Survey 2016; ^excludes gestational diabetes; ^^RSE >25% -<50%- use with caution; n/a = estimates are too unreliable to be published (RSE>50%)

74


Asthma

Of all Tasmanians aged 18 years and over who experienced asthma symptoms during the preceding 12 months, 71.9 per cent had received an asthma action plan on how to manage their symptoms, a significant increase from 57.6 per cent in 2013.All regions reported an increase in the provision of asthma action plans. The North West region had the highest proportion (81.4 per cent) of asthma action plans in 2016, representing a statistically significant increase compared with both 2013 and 2009.

Table 82: Provided with an asthma action plan by region, 18 years and over, Tasmania 2009 to 2016

Region2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

North 65.1% [57.5%,72.1%]

58.4% [49.0%,67.2%]

69.5% [60.0%,77.6%]

North West 64.7% [55.9%,72.7%]

61.2% [52.4%,69.3%]

81.4%*# [74.6%,86.7%]

South 59.3% [51.6%,66.6%]

55.6% [46.3%,64.5%]

69.1% [59.7%,77.1%]

Tasmania 62.2% [57.4%,66.7%]

57.6% [52.0%,63.1%]

71.9%* [66.4%,76.8%]

Tasmanian Population Health Survey 2009, 2013, 2016; *statistically significant increase compared with 2013; # statistically significant increase compared with 2009

Figure 13: Provided with an asthma action plan by region, Tasmania 2009 to 2016

North North West South Tasmania

65.1% 64.7%59.3% 62.2%

69.5%

81.4%

69.1% 71.9%200920132016

Tasmanian Population Health Survey 2009, 2013, 2016; statistically significantly higher than in 2013 and/or 2009

75


Preventive chronic disease screening

The aim of preventive screening is to reduce the burden of chronic diseases, such as cardiovascular diseases, diabetes, and bowel cancer with an early diagnosis and treatment.Screening rates for blood pressure, cholesterol and diabetes have remained relatively stable since 2009, but bowel cancer screening has increased significantly compared to both 2009 and 2013, possibly as a result of more Tasmanians being eligible to participate in the National Bowel Cancer Screening Program.

Table 83: Participation in preventive health screening^, 18 years and over, Tasmania 2009 to 2016

Screening type2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

Blood pressure 81.5% [80.2%,82.8%]

83.3% [81.6%,84.9%]

82.4% [80.5%,84.1%]

Cholesterol 53.2% [51.8%,54.6%]

57.2% [55.6%,58.8%]

54.9% [53.0%,56.9%]

Diabetes/hyperglycaemia

50.7% [49.3%,52.2%]

52.7% [51.0%,54.3%]

50.3% [48.3%,52.2%]

Bowel cancer 20.7% [19.7%,21.8%]

25.4% [24.3%,26.6%]

32.1%*#

[30.5%,33.8%]

Tasmanian Population Health Survey 2009, 2013, 2016; ^during the previous 2 years; *statistically significant compared with 2013; #statistically significant compared with 2009

Screening rates are similar for males and females, except for blood pressure screening. Males reported significantly less blood pressure checking (79.6 per cent) than females (85.1 per cent).Table 84: Participation in preventive health screening^ by gender, Tasmania 2016

Screening type Males%

Males95% CI

Females%

Females95% CI

Blood pressure 79.6%* [76.6%,82.3%]

85.1% [82.8%,87.1%]

Cholesterol 55.5% [52.5%,58.4%]

54.4% [51.8%,56.9%]

Diabetes/high blood sugar

49.2% [46.4%,52.0%]

51.3% [48.6%,54.0%]

Bowel cancer 32.4% [30.1%,34.8%]

31.9% [29.7%,34.1%]

Tasmanian Population Health Survey2016; ^during the previous 2 years; *statistically significantly lower than female rate

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Residents in the North West region were more likely to screen for cholesterol, and screening rates for diabetes were lower in the South than in other regions, but these differences were not statistically significant.Significant differences emerged with bowel cancer screening, which exceeded screening rates of previous years for all regions.Table 85: Participation in preventive health screening^ by region, Tasmania 2009 to 2016

Screening by Region2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

Blood pressure - - - - - -

North 80.8% [78.7%,82.8%]

83.5% [80.8%,85.9%]

84.4% [81.5%,86.8%]

North West 82.5% [80.3%,84.6%]

83.8% [81.0%,86.4%]

83.9% [80.7%,86.7%]

South 81.5% [79.2%,83.6%]

83.0% [80.1%,85.6%]

80.6% [77.5%,83.4%]

Cholesterol - - - - - -

North 52.6% [50.4%,54.8%]

57.9% [55.2%,60.6%]

53.4% [50.3%,56.5%]

North West 56.5% [54.2%,58.8%]

59.8% [57.2%,62.3%]

59.5% [56.1%,62.8%]

South 52.0% [49.7%,54.3%]

55.7% [53.1%,58.2%]

53.8% [50.6%,56.9%]

Diabetes/hyperglycaemia

- - - - - -

North 51.8% [49.4%,54.1%]

54.8% [52.0%,57.6%]

52.3% [49.1%,55.5%]

North West 51.4% [49.0%,53.7%]

55.6% [52.8%,58.3%]

53.4% [50.1%,56.8%]

South 49.8% [47.5%,52.2%]

50.2% [47.6%,52.8%]

47.7% [44.6%,50.9%]

Bowel cancer - - - - - -

North 21.0% [19.2%,22.9%]

27.0% [25.0%,29.1%]

31.8%*#

[29.3%,34.4%]

North West 25.4% [23.6%,27.2%]

27.5% [25.4%,29.6%]

34.0%*#

[31.3%,36.8%]

South 18.4% [16.9%,20.1%]

23.6% [21.9%,25.4%]

31.5%*#

[28.9%,34.2%]

Tasmanian Population Health Survey 2009, 2013, 2016; ^during the previous 2 years; *statistically significant compared with 2013; #statistically significant compared with 2009

77


Screening participation increases with age for all types of preventive health screening, with higher proportions of Tasmanians aged 45 years and over participating in all types of preventive health screening compared to younger age groups.Table 86: Participation in preventive health screening^ by type and age, Tasmania 2016

Age Blood

pressur

e

Blood

pressure

95% CI

Choles-

terol

%

Cholesterol

95% CI

Diabetes/

hyperglycae

mia

Diabetes/

hyperglycae

mia

Bowel

cancer

%

Bowel

cancer

95% CI

18-24 63.4% [53.8%,72.0%]

19.8% [13.2%,28.5%]

17.0% [11.1%,25.1%]

n/a n/a

25-34 65.5% [58.7%,71.7%]

19.7% [15.0%,25.5%]

29.6% [24.2%,35.7%]

5.5%* [3.0%,9.9%]

35-44 76.3% [71.1%,80.9%]

39.5% [34.0%,45.3%]

35.6% [30.4%,41.2%]

10.0% [7.1%,13.9%]

45-54 84.9% [81.4%,87.9%]

59.8% [55.3%,64.2%]

55.0% [50.5%,59.4%]

30.6% [26.6%,35.0%]

55-64 92.8% [90.7%,94.5%]

75.7% [72.2%,78.8%]

66.0% [62.3%,69.6%]

57.6% [53.7%,61.4%]

65+ 96.2% [95.0%,97.1%]

84.4% [81.9%,86.5%]

73.1% [70.0%,76.0%]

59.2% [55.9%,62.4%]

Total 82.4% [80.5%,84.1%]

54.9% [53.0%,56.9%]

50.3% [48.3%,52.2%]

32.1% [30.5%,33.8%]

Tasmanian Population Health Survey 2016; ^during the previous 2 years; *RSE >25% -<50%- use with caution; n/a = estimate is too unreliable to be published (RSE>50%)

Figure 14: Participation in preventive health screening by age, Tasmania 2016

18-24 25-34 35-44 45-54 55-64 65+0%

20%

40%

60%

80%

100%

120%

Blood pressureDiabetesCholesterolBowel cancer


78


Chapter 5: Oral Health

Oral health refers to the health of teeth and gums. Tooth decay and gum disease can lead to tooth loss, and poor dental health is linked to several chronic conditions. Regular dental visits are important to maintain oral health and prevent painful dental and gum conditions from developing. http://www.dhhs.tas.gov.au/oralhealth

Self-assessed oral health status

A quarter of all Tasmanians aged 18 years and over assessed their oral health as fair or poor. Males reported statistically significantly poorer oral health (29.0 per cent) than females (21.9 per cent), but significantly more females than males reported complete tooth loss.Table 8788: Self-assessed oral health by sex, 18 years and over, Tasmania 2016

Dental health status

Males%

Males95% CI

Females%

Females95% CI

Persons%

Persons95% CI

Excellent/Very Good33.9%*

[30.8%,37.2%] 43.8% [40.8%,46.

8%] 38.8% [36.6%,41.0%]

Good 37.0% [33.8%,40.4%] 34.0% [31.2%,36.

9%] 35.5% [33.4%,37.7%]

Fair/Poor29.0%*

[26.1%,32.0%] 21.9% [19.6%,24.

4%] 25.5% [23.6%,27.4%]

Complete tooth loss4.4%*

[3.6%,5.4%] 8.4% [7.3%,9.6%

] 6.4% [5.7%,7.2%]

Tasmanian Population Health Surveys 2016; *statistically significantly different compared with females

Tasmanians in the North West region had the highest proportion of fair or poor oral health, and a significantly higher prevalence of complete tooth loss compared with other regions and state-wide.Table 89: Self-assessed oral health by region, 18 years and over, Tasmania 2016

Oral health status

North%

North95% CI

North-West

%

North-West

95% CI

South%

South95% CI

Excellent/Very Good

37.1% [33.7%,40.6%]

39.5% [35.8%,43.4%]

39.5% [36.0%,43.1%]

Good 37.3% [33.9%,40.8%]

31.8% [28.4%,35.4%]

36.1% [32.7%,39.7%]

Fair/Poor 25.5% [22.6%,28.6%]

28.3% [25.1%,31.8%]

24.3% [21.4%,27.5%]

Complete tooth loss

5.9% [4.9%,7.1%] 10.2%* [8.8%,11.7%]

5.1% [4.1%,6.4%]

79


http://www.dhhs.tas.gov.au/oralhealth

Tasmanian Population Health Survey 2016; *statistically significantly different compared with other regions and state-wide

80


Younger people aged 18 to 24 years reported significantly more excellent/very good oral health (53.7 per cent) and less fair/poor health (14.4 per cent) compared with older age groups and the total population. Table 9091: Self-assessed oral health by age, Tasmania 2016

Age excellent/very good

%

excellent/very good

95% CI

good%

good95% CI

fair/poor

%

fair/poor95% CI

18-24 53.7%*[44.3%,62.9

%] 31.9% [23.8%,41.3%] 14.4%^ [8.5%,23.2%

]

25-34 40.5% [34.0%,47.4%] 37.4% [31.0%,44.3

%] 22.1% [17.0%,28.2%]

35-44 42.7% [37.1%,48.4%] 33.4% [28.2%,39.0

%] 23.8% [19.2%,29.0%]

45-54 35.3% [31.2%,39.8%] 33.5% [29.3%,37.9

%] 31.2% [27.2%,35.5%]

55-64 33.6% [30.0%,37.5%] 35.4% [31.6%,39.4

%] 30.7% [27.1%,34.6%]

65+ 33.3% [29.8%,37.0%] 40.0% [36.2%,43.9

%] 26.3% [23.1%,29.7%]

Total 38.8% [36.6%,41.0%] 35.5% [33.4%,37.7

%] 25.5% [23.6%,27.4%]

Tasmanian Population Health Survey 2016; ^RSE >25% -<50%- use with caution; *statistically significantly higher than total population

Significantly more fair and poor oral health was reported by Tasmanians in the most disadvantaged socio-economic quintile (29.8 per cent) compared with Tasmanians in the least disadvantaged quintile (20.2 per cent). Table 92: Self-assessed oral health by SEIFA quintiles, 18 years and over, Tasmania 2016

SEIFA IRSD^ 2011

excellent/

very good

excellent/very good

95% CI

good%

good95% CI

fair/poor

%

fair/poor95% CI


33.6% [28.6%,38.9%]

36.5% [31.3%,42.1%]

29.8%* [25.3%,34.9%]

2nd 40.6% [36.3%,44.9%]

34.9% [30.9%,39.1%]

24.3% [20.9%,28.0%]

3rd 36.0% [32.0%,40.3%]

35.4% [31.4%,39.6%]

28.4% [24.8%,32.3%]

4th 39.5% [34.7%,44.6%]

35.3% [30.7%,40.2%]

25.1% [21.1%,29.5%]


44.1% [38.4%,49.9%]

35.6% [30.3%,41.3%]

20.2% [15.9%,25.3%]

81


Tasmanian Population Health Survey 2016; ^SEIFA 2011 – Index of Relative Socio-economic Disadvantage; *statistically significantly higher than the fifth quintile

82


Oral health problems

In 2016, 11.4 per cent of dentate Tasmanians aged 18 years and over reported that they had experienced toothaches either often or sometimes during the previous 12 months.Table 93: Frequency of toothaches during last 12 months by sex, 18 years and over, Tasmania 2016

Toothache frequency

Males%

Males95% CI

Females%

Females95% CI

Persons%

Persons95% CI

Very often/often 3.6% [2.5%,5.0%]

4.5% [3.2%,6.2%] 4.0% [3.2%,5.1%]

Sometimes 7.4% [5.8%,9.5%]

7.4% [6.0%,9.1%] 7.4% [6.3%,8.7%]

Hardly ever/never 88.5% [86.1%,90.5%]

88.0% [85.8%,89.9%]

88.2% [86.7%,89.7%]

Tasmanian Population Health Surveys 2016

There were no significant differences across regions regarding the frequency of toothaches.Table 94: Frequency of toothaches during last 12 months by region, 18 years and over, Tasmania 2016

Toothache frequency

North%

North95% CI

North-West

%

North-West

95% CI

South%

South95% CI

Very often/often 3.7% [2.5%,5.4%] 3.5% [2.2%,5.4%] 4.4% [3.1%,6.3%]

Sometimes 8.2% [6.2%,10.8%] 7.3% [5.8%,9.2%] 7.0% [5.4%,9.2%]

Hardly ever/never 87.8%

[84.9%,90.2%] 89.1% [86.7%,91.2

%] 88.1% [85.5%,90.3%]


There were no significant differences in toothache frequency across the socio-economic quintiles.Table 95: Frequency of toothaches during last 12 months by SEIFA quintiles, Tasmania 2016

SEIFA IRSD^ 2011

very often/o

ften%

very often/oft

en95% CI

some-times

%

sometimes

95% CI

hardly ever/never

%

hardly ever/never

95% CI

1st (most disadvantaged) 5.1%^^

[3.0%,8.6%] 7.9%

[5.4%,11.3%] 86.9%

[82.6%,90.2%]

2nd 4.0%[2.5%,6.1

%] 8.0%[5.9%,10.7

%] 88.0%[84.8%,90.6

%]

83


SEIFA IRSD^ 2011

very often/o

ften%

very often/oft

en95% CI

some-times

%

sometimes

95% CI

hardly ever/never

%

hardly ever/never

95% CI

3rd 3.4%^^[2.0%,5.5

%] 5.7%[4.0%,8.1%

] 90.6%[87.6%,92.9

%]

4th 3.7%^^[2.1%,6.5

%] 8.4%[5.9%,11.8

%] 87.7%[83.8%,90.8

%]

5th (least disadvantaged) 3.9%^^

[2.1%,7.2%] 7.3%

[4.7%,10.9%] 88.0%

[83.6%,91.4%]

Tasmanian Population Health Survey 2016; ^SEIFA 2011 – Index of Relative Socio-economic Disadvantage; ^^RSE >25% - <50%, use with caution

84


Oral hygiene - adults

There is a statistically significant gender difference in oral hygiene. Only 64.1 per cent of Tasmanian males brushed their teeth twice daily or more often compared to 80 per cent of females.

Table 96: Usual frequency of brushing teeth by sex, 18 years and over, Tasmania 2016

FrequencyMales

%Males95% CI

Females%

Females95% CI

Persons%

Persons95% CI

>twice/twice a day 64.1%* [60.9%,67.3%]

80.0% [77.3%,82.4%]

72.0% [69.9%,74.0%]

Once a day 30.0%* [27.1%,33.1%]

19.0% [16.7%,21.6%]

24.6% [22.7%,26.6%]

< once a day/never 5.3%* [3.9%,7.2%]

1.0%^ [0.4%,2.2%] 3.1% [2.3%,4.2%]

Tasmanian Population Health Surveys 2016; ^RSE >25% - <50%, use with caution; *statistically significantly different compared with females

Figure 15: Usual frequency of brushing teeth by sex, Tasmania 2016

>twice/twice a day once a day < once a day/never

64.1%

30.0%

5.3%

80.0%

19.0%

1.0%

males females

Tasmanian Population Health Survey 2016; statistically significantly different from females

Compared to the other regions, more Tasmanians in the Southern region reported that they brushed their teeth at least twice daily (73.9 per cent). However, differences between the regions were not statistically significant.Table 97: Usual frequency of brushing teeth by region, 18 years and over, Tasmania 2016

FrequencyNorth

%North95% CI

North-West

%

North-West

95% CI

South%

South95% CI

>twice/twice a day

70.8% [67.5%,74.0%]

68.9% [65.2%,72.4%]

73.9% [70.5%,77.0%]

once a day 26.1% [23.0%,29.4%]

25.4% [22.3%,28.8%]

23.4% [20.4%,26.7%]

< once a day/never

3.1% [2.0%,4.7%]

5.0% [3.3%,7.6%]

2.4%^ [1.3%,4.3%]

Tasmanian Population Health Survey 2016; ^RSE >25% - <50%, use with caution

85


The frequency of brushing teeth was generally similar across age groups, with younger age groups under 35 years of age slightly less likely to brush their teeth at least twice daily.Table 98: Usual frequency of brushing teeth by age, Tasmania 2016

Age>twice/twice a

day

>twice/twice a day

95% CI

once a day%

once a day95% CI

< once a day/nev

er

< once a day/never

95% CI18-24 68.2% [58.6%,76.5%] 24.7% [17.2%,34.0

%]6.4%^ [2.6%,14.6

%]25-34 66.0% [59.4%,72.1%] 31.3% [25.4%,37.8

%]2.7%^ [1.3%,5.5%]

35-44 71.4% [66.1%,76.1%] 24.2% [19.8%,29.3%]

4.4%^ [2.5%,7.8%]

45-54 72.7% [68.5%,76.4%] 24.1% [20.5%,28.1%]

3.1% [1.9%,4.8%]

55-64 75.2% [71.6%,78.5%] 21.7% [18.5%,25.2%]

2.6% [1.7%,3.9%]

65+ 75.9% [72.6%,79.0%] 22.6% [19.6%,25.9%]

1.1% [0.7%,1.8%]

Total 72.0% [69.9%,74.0%] 24.6% [22.7%,26.6%]

3.1% [2.3%,4.2%]

Tasmanian Population Health Survey 2016; ^RSE >25% -<50%- use with caution

Oral hygiene behaviour shows an inverse linear relationship with socio-economic status. Brushing only once a day was twice as prevalent in the most disadvantaged quintile (32.9 per cent) compared to the least disadvantaged quintile (17.1 per cent), and brushing twice a day or more often is significantly less common in the most disadvantaged quintile (60.5 per cent) compared with the least disadvantaged quintile (82 per cent).Table 99: Usual frequency of brushing teeth by SEIFA quintiles, Tasmania 2016

SEIFA IRSD^ 2011

>twice/twice a

day%

>twice/twice a day

95% CI

once a day%

once a day95% CI


60.5%* [54.9%,65.9%] 32.9%* [27.7%,38.5%]

2nd 69.7%* [65.5%,73.6%] 25.5%* [22.0%,29.4%]

3rd 69.9%* [65.8%,73.8%] 26.8%* [23.1%,30.9%]

4th 76.8% [72.4%,80.7%] 21.1% [17.4%,25.4%]


82.0% [77.1%,86.1%] 17.1% [13.2%,22.0%]

Tasmanian Population Health Survey 2016; ^SEIFA 2011 – Index of Relative Socio-economic Disadvantage *statistically significantly different compared with the least disadvantaged quintile 5

86


Oral hygiene - children

Young children lack the dexterity to brush their teeth effectively on their own. Of all households with children up to five years of age, 77.9 per cent of adults always brush their children’s teeth.Table 100: Frequency of adults brushing teeth of children aged 5 years and under, Tasmania 2016


Compared to the North and North West, adults in the Southern region were more likely to always brush their young children’s teeth (82.8 per cent), but this was not statistically significant.Table 101: Frequency of adults brushing teeth of children age 5 years and under by region, Tasmania 2016

Brushing frequency

North%

North95% CI

North-West%

North-West95% CI

South%

South95% CI

% 95% CI % 95% CI % 95% CI

Always 72.5% [60.6%,81.9%]

71.2% [57.9%,81.7%]

82.8% [74.1%,89.0%]

Sometimes 13.4%^ [7.5%,23.0%]

15.0%^ [8.5%,25.3%]

4.9%^ [2.0%,11.7%]

Never 10.9%^ [5.1%,22.0%]

13.2%^ [6.1%,26.3%]

10.5%^

[6.1%,17.5%]


Helping young children brush their teeth is not associated with socio-economic status.Table 102: Adults always brushing teeth of children age 5 years and under by SEIFA, Tasmania 2016

87


FrequencyChildren <5

%Children <5

95% CI

Always 77.9% [71.9%,82.9%]

Sometimes 9.0% [6.1%,13.2%]

Never 11.1% [7.6%,16.0%]


88


SEIFA IRSD^ 2011

Always brushing teeth of child <5

years%

Always brushing teeth of child <5

years95% CI1st (most

disadvantaged)77.8% [64.1%,87.3%]

2nd 66.3% [50.7%,79.0%]

3rd 78.0% [64.6%,87.3%]

4th 85.1% [73.7%,92.1%]


79.3% [61.5%,90.1%]

Parents have a key role in helping their children to develop an oral hygiene routine. As role models, parents need to set a daily routine for brushing teeth and show the importance of oral hygiene.Most adults with children in the household brushed their teeth at least twice a day, with no significant differences compared to all Tasmanian adults.Table 103: Brushing teeth twice a day or more often by adults with children in household, Tasmania 2016

Children’s age>twice/twice a

day%

>twice/twice a day

95% CI0-5 years 68.3% [61.8%,74.2%]

6-9 years 71.1% [65.0%,76.6%]

10-15 years 69.5% [63.6%,74.9%]

All adults 72.0% [69.9%,74.0%]


Use of dental services and barriers

Most Tasmanians (52.5 per cent) saw a dentist less than 12 months ago, with males using dental services significantly less frequently than females. Table 104: Time since last dental visit by sex, 18 years and over, Tasmania 2016

Last dental visit

Males%

Males95% CI

Females%

Females95% CI

Persons%

Persons95% CI

Less than 12 months

48.0%* [44.9%,51.2%]

56.9% [54.1%,59.7%]

52.5% [50.4%,54.7%]

1 to less than 2 years

18.1% [15.6%,20.8%]

20.2% [17.9%,22.6%]

19.1% [17.5%,20.9%]


16.9%* [14.5%,19.6%]

11.7% [10.1%,13.5%]

14.2% [12.8%,15.8%]


9.1%* [7.3%,11.3%]

5.4% [4.2%,7.0%]

7.2% [6.1%,8.5%]

10 years or more 7.3%* [6.1%,9.0%] 4.9% [3.9%,6.1%]

6.1% [5.2%,7.1%]

Tasmanian Population Health Surveys 2016; *statistically significantly different compared to females

89


There were no significant differences across regions with regard to the time that had elapsed since the last dental visit. Table 105: Time since last dental visit by region, 18 years and over, Tasmania 2016

Last dental visitNorth

%North95% CI

North-West

%

North-West

95% CI

South%

South95% CI

Less than 12 months

51.5% [48.1%,54.9%]

49.0% [45.5%,52.6%]

54.6% [51.2%,58.1%]


17.6% [15.2%,20.3%]

17.6% [15.2%,20.4%]

20.6% [17.8%,23.8%]


14.6% [12.3%,17.3%]

17.3% [14.6%,20.4%]

12.7% [10.5%,15.3%]


8.1% [6.3%,10.4%]

7.3% [5.7%,9.5%]

6.7% [5.0%,8.9%]

10 years or more 7.4% [6.0%,9.2%]

7.6% [6.2%,9.3%]

4.7% [3.5%,6.4%]


Age differences in the frequency of dental visits were minimal across most age groups. More Tasmanians age 55 to 64 years of age reported more recent dental visits than all other age groups.Table 106: Time since last dental visit by age, Tasmania 2016

Age<12

months%

<12 months95% CI

1-<2 years

%

1-<2 years95% CI

2+ years

%

2+ years95% CI

18-24 50.6% [41.4%,59.8%]

22.4% [15.3%,31.6%]

25.2% [17.6%,34.6%]

25-34 43.7% [37.2%,50.5%]

22.7% [17.5%,29.0%]

33.3% [27.2%,40.0%]

35-44 51.1% [45.4%,56.8%]

22.2% [17.8%,27.3%]

26.4% [21.6%,31.9%]

45-54 52.3% [47.8%,56.8%]

20.1% [16.7%,24.1%]

27.2% [23.4%,31.3%]

55-64 60.1%* [56.3%,63.7%]

16.2% [13.7%,19.0%]

23.5% [20.4%,26.9%]

65+ 54.4% [51.1%,57.6%]

14.8% [12.6%,17.3%]

29.7% [27.0%,32.7%]

Total 52.5% [50.4%,54.7%]

19.1% [17.5%,20.9%]

27.7% [25.8%,29.6%]

Tasmanian Population Health Survey 2016; *statistically significantly higher compared with total population

90


There is a significant relationship between the frequency of dental visits and socio-economic status.

Tasmanians in the most disadvantaged quintile are significantly more likely to defer dental visits for two or more years (32.4 per cent) than Tasmanians in the least disadvantaged quintile (20.1 per cent). They are also less likely to schedule dental visits every 12 months or less (46.7 per cent) compared with Tasmanians in the least disadvantaged quintile (61.9 per cent)Table 107: Time since last dental visit by SEIFA quintiles, Tasmania 2016

SEIFA IRSD^ 2011

<12 months

%

<12 months95% CI

2+ years or never

%

2+ years or never95% CI


46.7%* [41.7%,51.8%] 32.4%* [27.6%,37.5%]

2nd 52.0%* [47.9%,56.1%] 30.7%* [26.9%,34.6%]

3rd 48.2%* [44.2%,52.2%] 30.8%* [27.2%,34.6%]

4th 53.8% [49.0%,58.6%] 24.5% [20.7%,28.7%]


61.9% [56.2%,67.3%] 20.1% [15.7%,25.3%]

Tasmanian Population Health Survey 2016; ^SEIFA 2011 – Index of Relative Socio-economic Disadvantage *statistically significantly different from the fifth quintile

Figure 16: Time since last dental visit by SEIFA quintiles, Tasmania 2016


46.7%*52.0%*

48.2%*53.8%

61.9%

32.4%* 30.7%* 30.8%*24.5%

20.1%<12 months 2+ years

Tasmanian Population Health Survey 2016; *statistically signficantly different from quintile 5

91


The cost of dental care was confirmed as a reason for delaying a visit to the dentist by more than a quarter of all Tasmanian adults (27.6 per cent) in 2016.Table 108: Whether avoided or delayed a dental visit during the last 12 months because of cost, 18 years and over, Tasmania 2016

Avoided/delayed visit

Females%

Females95% CI

Males%

Males95% CI

Persons%

Persons95% CI

Yes25.3%

[22.6%,28.3%] 29.9%

[27.4%,32.5%] 27.6%

[25.8%,29.6%]

No74.3%

[71.3%,77.0%] 69.8%

[67.2%,72.3%] 72.0%

[70.1%,73.9%]

Tasmanian Population Health Surveys 2016

There were no significant differences across the regions in the proportions of people delaying dental care because of the cost of dental services.Table 109: Whether avoided or delayed a dental visit during the last 12 months because of cost by region, 18 years and over, Tasmania 2016

Avoided/delayed visit

North%

North95% CI

North-West

%

North-West95% CI

South%

South

95% CI

Yes 27.5% [24.5%,30.7%] 28.7% [25.7%,32.0

%] 27.3% [24.2%,30.5%]

No 72.3% [69.1%,75.3%] 71.2% [67.9%,74.2

%] 72.2% [69.0%,75.3%]


Significantly more Tasmanians aged between 25 and 54 years of age avoided or delayed a dental visit because of costs than any other age group. Costs were much less of an issue for Tasmanians age 65 years and over (16 per cent).Table 110: Avoided or delayed a dental visit during the last 12 months due to cost by age, Tasmania 2016

92


Tasmanian Population Health Survey 2016; *statistically significantly higher than all other age groups and total

93


Age Yes%

Yes95% CI

18-24 21.1% [14.5%,29.6%]

25-34 37.4%* [31.0%,44.3%]

35-44 39.7%* [34.2%,45.4%]

45-54 34.0%* [29.9%,38.3%]

55-64 22.5% [19.4%,25.8%]

65+ 16.0% [13.7%,18.6%]

Total 27.6% [25.8%,29.6%]

Tasmanians with children aged 15 years and under were significantly more likely to defer a dental visit because of costs (34.8 per cent) compared with Tasmanians who do not have children in this age group at home (24.9 per cent).

Table 111: Avoided or delayed a dental visit during the last 12 months because of costs by family status, Tasmania 2016

Avoided/delayed dental visit

No children

aged <15 in

household%

No children

aged <15 in

household

95% CI

Children aged

<15 in househol

d%

Children aged <15

in househol

d95% CI

Total%

Total95% CI

Yes 24.9% [22.8%,27.1%] 34.8%* [30.9%,39.

1%] 27.6% [25.8%,29.6%]

Tasmanian Population Health Survey 2016; *statistically significantly higher compared to households without children <15 and Total

Deferring a dental visit because of costs is not affected by socio-economic disadvantage.

Table 112: Avoided or delayed a dental visit during the last 12 months because of costs by SEIFA, 18 years and over, Tasmania 2016

SEIFA IRSD^ 2011Yes%

Yes95% CI

1st (most disadvantaged) 28.9% [24.4%,33.9%]

2nd 26.1% [22.7%,29.7%]

3rd 28.7% [25.1%,32.5%]

4th 27.8% [23.7%,32.3%]

5th (least disadvantaged) 26.8% [22.0%,32.2%]


94


Chapter 6: Environmental health and wellbeing

Wood heating

The air quality inside and outside of our homes is important to our health and wellbeing. Outside of our homes, wood smoke is a major source of air pollution during winter. Wood smoke particles are associated with aggravating a number of conditions, such as asthma, chronic lung disease, heart problems, premature births and deaths. Some of the toxic chemicals in wood smoke are also known to cause cancer. https://www.environment.gov.au/resource/woodheaters-and-woodsmokeElectricity and wood were the two main sources of energy used to heat Tasmanian homes in 2016, with electric heating being twice as common as wood heating. Gas, pellets, which are derived from plantation timber waste, and ‘other sources’ are used by less than 10 per cent of Tasmanians.

Table 113: Main source of energy used to heat home, 18 years and over, Tasmania 2016


Figure 17: Main source of energy used to heat home, Tasmania 2016

Electricity61.7%

Gas 5.1%

Wood30.2%

Pellets0.5%

Other 2.1%


95


Source of energyEnergy used to

heat home%

Energy used to heat home

95% CI

Electricity 61.7% [59.7%,63.7%]

Wood 30.2% [28.3%,32.1%]

Gas 5.1% [4.2%,6.1%]

Pellets 0.5% [0.2%,0.9%]

Other source 2.1% [1.6%,2.8%]

https://www.environment.gov.au/resource/woodheaters-and-woodsmoke

https://www.environment.gov.au/resource/woodheaters-and-woodsmoke

96


Across Tasmanian regions, electricity was the most likely source for home heating in the Southern region (65.2 per cent) and wood was the least likely source (25.6 per cent) compared to other regions. Tasmanians in the Northern region relied significantly more on wood as their main source of heating (35.3 per cent) compared to the Southern region and state-wide (30.2 per cent). The North-West region also had a significantly higher proportion of wood-heated homes (34.2 per cent) than the Southern region.

Table 114: Main source of energy used to heat home by region, Tasmania 2016

Source of energy

North%

North95% CI

North-West

%

North-West

95% CI

South%

South95% CI

Electricity 58.1% [54.8%,61.3%]

58.4% [54.9%,61.9%]

65.2%* [61.9%,68.3%]

Gas 3.6% [2.6%,5.0%] 4.4% [3.4%,5.7%]

6.1% [4.7%,8.0%]

Wood 35.3% [32.2%,38.5%]

34.2% [30.9%,37.7%]

25.6%# [22.8%,28.6%]

Pellets 0.3%^ [0.1%,0.8%] n/a n/a 0.7%^ [0.3%,1.5%]

Other source 2.0% [1.3%,3.0%] 2.0%^ [1.2%,3.4%]

2.2% [1.5%,3.3%]

Tasmanian Population Health Survey 2016; ^RSE >25% -<50%- use with caution; n/a = estimates are too unreliable to be published (RSE>50%); #statistically significantly lower than other regions; * statistically significantly higher than other regions

Wood is more commonly used as the main source of heating by Tasmanians aged 35 to 44 years, with less use of firewood noted among younger age groups, and Tasmanians aged 65 years and over.Table 115: Wood used as the main source of energy to heat home by age, Tasmania 2016

Tasmanian Population Health Survey 2016; *statistically significantly higher than some other age groups and total

97


Age Wood heating%

Wood heating95% CI

18-24 20.8% [14.5%,29.0%]

25-34 26.2% [20.9%,32.2%]

35-44 39.0%* [33.5%,44.7%]

45-54 34.0% [30.0%,38.3%]

55-64 31.1% [27.8%,34.6%]

65+ 27.8% [24.9%,30.9%]

Total 30.2% [28.3%,32.1%]

The use of wood as the main source of home heating cuts across socio-economic quintiles and is not associated with socio-economic disadvantage. The greatest proportions of Tasmanians using wood as their main source of heating are located in the middle of the socio-economic quintiles. The least disadvantaged quintile shows a significantly lower proportion of firewood users compared with the preceding three quintiles, but not compared with the most disadvantaged quintile.Table 116: Wood used as the main source of energy to heat home by SEIFA quintiles^, 18 years and over, Tasmania 2016

Tasmanian Population Health Survey 2016; ^SEIFA 2011 – Index of Relative Socio-economic Disadvantage; *statistically significantly lower than quintiles two to four

Figure 18: Wood used as the main source of energy to heat home by SEIFA quintiles, Tasmania 2016


27.9%30.7%

38.3%

31.8%

22.2%*

Tasmanian Population Health Survey 2016; *statistically significantly lower than preceding three quintiles

98


SEIFA IRSD^ 2011 Wood heating%

Wood heating95% CI


27.9% [23.6%,32.6%]

2nd 30.7% [27.2%,34.4%]

3rd 38.3% [34.5%,42.3%]

4th 31.8% [27.7%,36.2%]


22.2%* [18.0%,27.1%]

Home cooling

Extreme heat and heatwaves pose a serious risk to health. Those at higher risk include older people, babies and young children, pregnant women and those with a serious chronic health condition. Without access to a cool environment, these people are highly vulnerable to heat induced illness. Climate change projections show an increase in the frequency and intensity of heatwaves in Tasmania in the future. http://www.environment.gov.au/climate-change/climate-science/impacts/tasNearly half of all Tasmanians use air conditioning to cool their home (46.7 per cent), with a further 14.5 per cent using fans. More than one-third of Tasmanians (37.6 per cent) do not use air conditioning or fans during hot conditions.

Table 117: Main method of cooling home, 18 years and over, Tasmania 2016


Residents in the North West region were significantly less likely to use air conditioning (36.5 per cent), and also were significantly more likely not to use any cooling method compared with other regions and Tasmania.

Table 118: Main method of cooling home by region, Tasmania 2016

TypeNorth

%North95% CI

North-West

%

North-West

95% CI

South%

South95% CI

Air conditioner 47.6% [44.2%,51.0%] 36.5%*

[33.1%,40.1%] 50.8% [47.3%,54.2

%]

Portable air conditioner/air cooler

0.7%^ [0.4%,1.3%] 0.9%^ [0.5%,1.6%] 0.7%^ [0.3%,1.8%]

Fans 17.6% [15.1%,20.3%] 14.6% [12.5%,17.0

%] 12.8% [10.7%,15.2%]

None of the above 33.7% [30.6%,37.0%] 47.7%*

[44.2%,51.3%] 35.4% [32.1%,38.8

%]

Tasmanian Population Health Survey 2016; ^RSE >25% -<50%- use with caution; *significantly different from other regions and Tasmania

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Type Cooling method

%

Cooling method95% CI

Air conditioner 46.7% [44.6%,48.9%]

Portable air conditioner/air cooler

0.8%^ [0.5%,1.2%]

Fans 14.5% [13.1%,16.0%]

None of the above 37.6% [35.6%,39.7%]

http://www.environment.gov.au/climate-change/climate-science/impacts/tas

http://www.environment.gov.au/climate-change/climate-science/impacts/tas

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Tasmanians aged 25 to 34 years made up the smallest proportion (28.5 per cent) of residents without any appliances to cool their home.Over a third of older Tasmanians 55 years of age and over did not have air conditioning or fans in 2016. As Tasmania’s population ages, the number of Tasmanians at risk from heatwaves will increase.

Table 119: Without any air cooling appliances by age, Tasmania 2016

Age No cooling appliances

%

No cooling appliances95% CI

18-24 43.5% [34.6%,52.8%]

25-34 28.5%* [22.9%,34.9%]

35-44 42.6% [36.9%,48.5%]

45-54 41.0% [36.7%,45.4%]

55-64 36.3% [32.6%,40.1%]

65+ 35.7% [32.6%,38.9%]

Total 37.6% [35.6%,39.7%]

Tasmanian Population Health Survey 2016; *statistically significantly lower than the total and ages 35 to 54 years

There is no evidence of a relationship between socio-economic status and being without air cooling appliances.

Table 120: Without any air cooling appliances by SEIFA quintiles, Tasmania 2016


101


SEIFA IRSD^ 2011

No cooling appliances

%

No cooling appliances

95% CI1st (most disadvantaged)

33.6% [28.9%,38.7%]

2nd 41.6% [37.6%,45.7%]

3rd 38.3% [34.4%,42.3%]

4th 33.8% [29.5%,38.5%]


40.8% [35.3%,46.5%]

Bushfire risk and evacuation triggers

As our climate changes, the number of severe and extreme fire danger rated days across Tasmania is expected to increase. For those living in areas at risk from bushfires, bushfire preparedness is increasingly important.To be at risk from a bushfire is defined as ‘living within 100 meters of bushland larger than one hectare, which is roughly the size of a football field’.

Close to one third of Tasmanians are located in an area at risk of bushfires (30.5 per cent).

Table 121: Home is located in an area at risk from bushfire, Tasmania 2016

Home located in an at risk area

Bushfire risk%

Bushfire risk95% CI

Yes 30.5% [28.6%,32.5%]

No 68.9% [66.9%,70.9%]


More than a third of all Tasmanians living in the Southern region were at risk of bushfires (36 per cent), compared to only 20.8 per cent of North West residents.

Table 122: Home is located in an area at risk from bushfire by region, Tasmania 2016

Home located in an at risk area

North%

North95% CI

North-West

%

North-West95% CI

South%

South95% CI

% 95% CI % 95% CI % 95% CI

Yes 28.1% [25.1%,31.3%]

20.8%* [18.3%,23.7%] 36.0%* [32.8%,39.4%]

No 71.8% [68.7%,74.8%]

78.6% [75.8%,81.2%] 63.1% [59.7%,66.4%]

Tasmanian Population Health Survey 2016; *statistically significantly different from the Northern region and Tasmania

Figure 19: Located in an area at risk of bushfires by region, Tasmania 2016

North North West South

28.1%

20.8%*

36.0%*

Tasmanian Population Health Survey 2016, *statistically signficantly different from the North and Tasmania

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Tasmanians who live in an area at risk from bushfires were asked what it takes to decide to leave if a bushfire is burning near their home: “During a bushfire, people may decide to leave their property at different points in time. If a bushfire was burning near your home, which of the following would best describe your decision to leave?”

Of those Tasmanians at risk from bushfires, the largest proportion would leave after official warnings were issued (33.2 per cent), followed by those who would leave only if faced with an immediate threat to their life or safety (24.6 per cent).

Table 123: Reason for leaving home during a nearby bushfire, 18 years and over, Tasmania 2016

Reason for leaving Reason for leaving

%

Reason for leaving95% CI

I would wait and leave after official warnings were issued

33.2% [29.5%,37.1%]

I would stay as long as I could and only leave if I believed there was an immediate threat to my life or safety

24.6% [21.4%,28.2%]

I would leave immediately if I thought the fire danger was too high

15.8% [13.1%,18.9%]

I would leave immediately without any further prompting

15.0% [12.5%,18.0%]

I would wait and leave after others confirmed there was a threat or I saw cars leaving the area

4.7% [3.2%,6.9%]

I would not leave 5.1% [3.7%,7.1%]

Other n/a n/a

Don’t know 0.9%^ [0.4%,2.0%]

Tasmanian Population Health Survey 2016; ^RSE >25% -<50%- use with caution; n/a = estimates are too unreliable to be published (RSE>50%)

Of those Tasmanians who would not leave their home during a bushfire (5.1 per cent), the majority (79 per cent) think that they are able to protect themselves and their home. Other reasons for not leaving were the availability of bushfire shelters and a refusal to leave their home.

Table 124: Reason for decision ‘not to leave’ during a bushfire, Tasmania 2016

Reason for staying % 95% CI

I think I can protect my home/myself 79.0% [61.5%,89.9%]

Other reasons 17.9%^ [8.5%,34.1%]

Tasmanian Population Health Survey 2016; “Other reasons” include “I have a bushfire shelter built on the property”, “This is my home” and “Other”; ^RSE >25% -<50%- use with caution

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Most Tasmanians who would not leave their home in the event of a nearby bushfire were aged 35 years and over. This may reflect the distribution of home ownership, with more Tasmanians aged under 35 years renting and therefore less likely to remain on the premises during a bushfire.

Table 125: ‘Would not leave’ during a bushfire by age, Tasmania 2016

Age Would not leave

%

Would not leave

95% CI

18-34 n/a n/a

35-54 6.7%^ [4.1%,11.0%]

55+ 5.8% [3.7%,9.2%]

Total 5.1% [3.7%,7.1%]

Tasmanian Population Health Survey2016; ^RSE >25% -<50%- use with caution; n/a = estimates are too unreliable to be published (RSE>50%)

Tasmania Fire Service recommends that…..“…you should not plan to defend your home when the Fire Danger Rating exceeds 50 (severe) in your area unless you have created a defendable space and ember-proofed your home.”“…unless your home has a defendable space and has been designed and built specifically to withstand a bushfire, you should not plan to defend it if the Fire Danger Rating exceeds 75 (extreme).”“…you should not plan to defend any home when the Fire Danger Rating exceeds 100 (catastrophic) in your area, regardless of any preparations you have made. If a fire starts on these days, you should leave for a safe place well before the fire threatens your home.”

http://www.fire.tas.gov.au/Show?pageId=colStay

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http://www.fire.tas.gov.au/Show?pageId=colStay

Chapter 7: Public Health Service Use and Satisfaction

The survey asked respondents whether they or a member of their close family had used a Tasmanian Public Hospital, Community Health Centre or a Child Health Centre/Parenting Centre during the last 12 months, and how satisfied they were with the services provided.

Public Hospitals

The use of public hospitals has increased from 49.7 per cent in 2013 to 55.2 per cent in 2016. This increase has occurred in all regions, with the Southern region recording the most significant increase since 2013.Table 126: Used a Tasmanian Public Hospital^ during preceding 12 months by region, Tasmania 2009-2016

Region 2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

North 50.1% [47.6%,52.6%]

54.6% [51.7%,57.5%]

56.5% [53.2%,59.9%]

North West 57.1% [54.5%,59.6%]

55.9% [52.9%,58.9%]

59.7% [56.3%,63.1%]

South 45.8% [43.2%,48.4%]

44.1% [41.0%,47.2%]

52.4%*#

[49.0%,55.8%]

Tasmania 49.5% [47.9%,51.1%]

49.7% [47.8%,51.5%]

55.2%*#

[53.1%,57.2%]

Tasmanian Population Health Survey 2009, 2013, 2016; ^outpatient or inpatient, used by self or close family member; *statistically significantly different compared with 2013; #statistically significantly different compared with 2009

There were no significant differences in the level of satisfaction with public hospital services compared with 2013. The majority of Tasmanians are satisfied (80.5 per cent), with a small increase in neither satisfied nor dissatisfied in 2016 (9 per cent) since 2013 and a significant increase compared with 2009.Table 127: Level of satisfaction with Tasmanian Public Hospital services^, Tasmania 2009-2016

Public hospitals 2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

Very satisfied/satisfied 82.4% [80.5%,84.1%]

84.7% [82.6%,86.6%]

80.5% [78.0%,82.9%]

Neither satisfied nor dissatisfied 5.5% [4.5%,6.6%

] 7.1% [5.7%,8.8%]

9.0%#

[7.3%,11.0%]

Very dissatisfied/dissatisfied 10.5% [9.2%,12.0

%] 7.7% [6.4%,9.1%] 8.5%

[7.0%,10.3%]

Tasmanian Population Health Survey 2009, 2013, 2016; ^outpatient or inpatient, used by self or close family member; #statistically significantly different compared with 2009

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Satisfaction levels with public hospital services were the highest in the Southern region, but regional differences were not statistically significant.Table 128: Level of satisfaction with Tasmanian Public Hospital services^ by region Tasmania 2016

Satisfaction with service

North%

North95% CI

North West

%

North-West

95% CI

South%

South95% CI


77.0% [72.1%,81.3%]

82.5% [78.2%,86.0%]

Neither satisfied nor dissatisfied 9.4% [6.7%,12.9

%] 11.5% [8.1%,15.9%] 7.6% [5.2%,10.9%

]

Very dissatisfied/dissatisfie

8.9% [6.6%,12.0%]

10.5% [7.5%,14.5%]

7.3% [5.2%,10.1%]

Tasmanian Population Health Survey 2016; ^outpatient or inpatient, used by self or close family member

106


Community Health Centres

There have been small increases in the use of Tasmanian Community Health Centres in all regions since 2009 and 2013, with the highest attendance noted for the North-West region.Table 129: Used a Community Health Centre during preceding 12 months by region, Tasmania 2009-2016

Region2009

%2009

95% CI2013

%2013

95% CI2016

%2016

95% CI

North 20.0% [18.0%,22.2%]

17.7% [15.6%,20.0%]

20.4% [17.7%,23.3%]

North West 20.4% [18.4%,22.4%]

21.5% [19.2%,24.0%]

22.8% [19.9%,26.0%]

South 20.8% [18.9%,22.9%]

21.1% [18.6%,23.7%]

21.9% [19.1%,24.9%]

Tasmania 20.5% [19.3%,21.8%]

20.2% [18.7%,21.8%]

21.7% [19.9%,23.5%]


The level of satisfaction with services provided by Tasmanian Community Health Centres has not changed significantly since 2009, with about 90 per cent of Tasmanians reporting to be satisfied. Dissatisfaction has declined over the preceding years, from 4.2 per cent in 2009 to 2.9 per cent in 2016.Table 130: Level of satisfaction with Community Health Centre services, Tasmania 2009-2016


2009%

200995% CI

2013%

201395% CI

2016%

201695% CI


92.3% [90.0%,94.1%]

89.4% [85.7%,92.2%]

Neither satisfied nor dissatisfied

3.7% [2.4%,5.5%]

2.9%* [1.7%,4.9%]*

6.3% [4.0%,9.8%]

Very dissatisfied/dissatisfied

4.2% [3.1%,5.7%]

3.2% [2.1%,4.8%]

2.9% [1.8%,4.5%]


107


The level of satisfaction with services provided by Tasmanian Community Health Centres in 2016 is similar across regions. Services in the Northern region had the highest satisfaction level, but this was not statistically significant.Table 131: Level of satisfaction with Community Health Centre service by region, Tasmania 2016


North%

North95% CI

North West

%

North-West95% CI

South%

South95% CI

Very satisfied/satisfied 93.0% [88.3%,95.9%] 87.9% [80.1%,92.9

%] 88.2% [81.8%,92.5%]

Neither satisfied nor dissatisfied 4.2%^ [2.0%,8.5%

] 7.6%^ [3.5%,15.7%] 6.9%^ [3.5%,13.2%

]


n/a n/a 3.6%^ [1.6%,7.7%] 3.3%^ [1.7%,6.3%]


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Child Health and Parenting Services (CHaPS)

The use of Child Health and Parenting Services in 2016 has declined state-wide and in the Northern region compared with 2009. This decline was statistically significant compared to 2009 but not compared to 2013.Table 132: Used a CHaPS during preceding 12 months by region, Tasmania 2009-2016

Region 2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

North 15.7% [14.0%,17.5%]

14.4% [12.5%,16.4%]

11.0%# [9.1%,13.3%]

North West 14.8% [13.1%,16.6%]

14.7% [12.7%,17.0%]

13.0% [10.9%,15.5%]

South 16.3% [14.5%,18.3%]

14.7% [12.7%,17.0%]

13.5% [11.2%,16.2%]

Tasmania 15.8% [14.7%,17.0%]

14.6% [13.4%,16.0%]

12.7%# [11.3%,14.2%]

Tasmanian Population Health Survey 2009, 2013, 2016; #statistically significantly lower than in 2009

Most Tasmanians continued to be satisfied (86.7 per cent) with services provided by Child Health and Parenting Services in 2016.Table 133: Level of service satisfaction with services provided by CHaPS, Tasmania 2009-2016


2009%

200995% CI

2013%

201395% CI

2016%

201695% CI

Very satisfied/satisfied

90.7% [88.1%,92.7%]

88.7% [85.0%,91.7%]

86.7% [81.7%,90.5%]

Neither satisfied nor dissatisfied

2.8% [1.8%,4.3%]

4.8%* [2.9%,7.8%] 3.9%^ [1.9%,8.1%]


2.7%* [1.7%,4.4%]

3.0%* [1.6%,5.7%] 4.1%^ [2.2%,7.4%]

Tasmanian Population Health Survey 2009, 2013, 2016; ^RSE >25% -<50%- use with caution

109


Across all regions, most Tasmanians expressed satisfaction with services provided by Child Health and Parenting Services, with satisfaction ratings ranging from 85.1 per cent through to 91.6 per cent. There were no significant differences across regions.Table 134: Level of service satisfaction with services provided by CHaPS by region Tasmania 2016


North%

North95% CI

North West

%

North-West95% CI

South%

South95% CI

Very satisfied/satisfied 91.6% [85.6%,95.

3%] 85.1% [77.3%,90.5%] 85.1% [76.1%,91.1

%]

Neither satisfied nor dissatisfied n/a n/a 3.8%^ [1.5%,9.5%] 5.4%^ [2.0%,13.5%

]


n/a n/a 3.7%^ [1.7%,7.8%] 5.4%^ [2.3%,11.9%]


110


Chapter 8: Risk factor prevalence in Local Government Areas

The tables below include estimates for the most common lifestyle risk factors. Estimates are not available for local government areas (LGAs) with very small populations, as the reliability of the estimates may be too low to be usable. In these cases, it has been indicated with n/a. Useable estimates with higher unreliability are annotated as ‘RSE >25% -<50% - use with caution’.

SmokingIn the Southern region, the Brighton LGA had the highest daily and current smoking rates at 26.7 per cent and 32.5 per cent respectively, significantly higher than for both the Southern region and Tasmania. Conversely, the daily smoking rate in the Hobart LGA was significantly lower than for Tasmania at only 5.1 per cent. For the North West region, the West Coast LGA had the highest current smoking rate at 37.5 per cent, significantly higher than for both the North West region and Tasmania. Circular Head LGA residents also had high rates and were significantly more likely to be current smokers (29.3%) compared to Tasmania.There were no LGAs in the Northern region which stood out as having smoking rates significantly different to either the Northern region or Tasmania.

AlcoholThe Kentish LGA had a significantly lower proportion of persons who were at single occasion risk (24.6 per cent) than Tasmania, but not when compared to the North West region.For both the Southern and Northern regions there were no LGAs that stood out as having lifetime or single occasion alcohol risk levels significantly different to their respective region or Tasmania.

NutritionA significantly higher proportion of residents of Break O’Day had inadequate vegetable consumption (97.8 per cent) compared to both the Northern region and Tasmania. Conversely, Dorset residents were significantly less likely to have inadequate vegetable consumption (77 per cent) than for either the Northern region or Tasmania. Residents of both Glamorgan/Spring Bay and the Huon Valley were significantly more likely to have inadequate vegetable consumption than either the Southern region or Tasmania, with proportions of 98.9 per cent and 96.7 per cent, respectively, not consuming adequate serves of vegetables daily. There were no LGAs in the Northern region which stood out as having inadequate vegetable consumption proportions significantly different to either the Northern region or Tasmania. Glenorchy LGA residents were significantly more likely to have inadequate fruit consumption (70.3 per cent) compared to the Southern region, whilst residents

111


of the Hobart LGA were significantly less likely to have inadequate fruit consumption (48.8 per cent) compared to Tasmania. For the North and the North West, there were no LGAs which stood out as being significantly different in fruit consumption compared to the respective region or Tasmania.

112


Physical ActivityIn the Southern region, residents of the Hobart LGA were significantly less likely to have insufficient physical activity levels (6.4 per cent) or undertake insufficient muscle strengthening (57.9 per cent) compared to Tasmania as a whole. In the North West, residents of Circular Head were significantly more likely to undertake insufficient muscle strengthening activity (84.6 per cent) compared to Tasmania. The Northern region did not display any significant LGA variations with regard to insufficient physical activity or muscle strengthening.

BMIThere were a number of significant LGA variations in the prevalence of overweight or obesity within regions. For the Northern region, Flinders residents were significantly less likely to be overweight or obese (30 per cent) compared to either the Northern region or Tasmania. Meander Valley residents were more likely to be obese (36.1 per cent) compared to the Northern region, and significantly more likely to be obese when compared to Tasmania. Conversely, residents of the George Town LGA were significantly less likely to be obese (16.2 per cent) compared to the Northern region.In the Southern region, Brighton stood out as having the highest rate of overweight/obese (74.5 per cent), but this was not statistically significant compared to either the Southern region or Tasmania. Conversely, four other LGAs had significantly lower rates of overweight/obese compared to either the Southern region or Tasmania – specifically Southern Midlands (47.3 per cent), Hobart (45.3 per cent), Tasman (44.4 per cent) and Glamorgan /Spring Bay (33.2 per cent). Looking just at obesity, three LGAs had a significantly lower rate than both the Southern region and Tasmania – specifically Glamorgan/Spring Bay (13.4 per cent), Hobart (13.3 per cent) and the Derwent Valley (12.1 per cent). Conversely, residents of Kingborough were significantly more likely to be obese (33.9 per cent) compared to both the Southern region and Tasmania.In the North West region, King Island stood out as having a significantly lower proportion of residents who were overweight/obese (28.2 per cent) compared to both the North West region and Tasmania. Looking specifically at obesity, a significantly higher proportion of West Coast residents (35.7 per cent) were obese compared to the North West region or Tasmania, whilst Burnie residents were significantly more likely to be obese (37.5 per cent) when compared to Tasmania. Conversely, King Island residents were significantly less likely to be obese (7.6 per cent) compared to either the Northern region or Tasmania.

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Table 135: Daily and current smokers by LGA, 2016

LGADaily

smokers%

Daily smokers95% CI

Current smokers^^

%

Current smokers^^

95% CI

North - - - -Break O'Day 25.1%^ [12.7%,43.7%] 29.7%^ [16.1%,48.2%]Dorset 12.7%^ [5.0%,28.8%] 13.1%^ [5.2%,28.9%]Flinders n/a n/a n/a n/aGeorge Town 21.7%^ [11.8%,36.7%] 23.5%^ [13.1%,38.4%]Launceston 11.1% [8.6%,14.2%] 14.4% [11.5%,18.0%]Meander Valley 17.5%^ [10.2%,28.5%] 18.6% [11.1%,29.4%]Northern Midlands 12.3%^ [6.3%,22.7%] 18%^ [10.6%,29.0%]West Tamar 16%^ [9.3%,26.0%] 18.4% [11.4%,28.4%]

South - - - -Brighton 26.7%*# [16.7%,39.7%] 32.5%*# [21.7%,45.7%]Central Highlands n/a n/a n/a n/aClarence 9.6% [5.9%,15.2%] 10.8% [6.9%,16.4%]Derwent Valley 24.3%^ [10.9%,45.6%] 27.4%^ [13.4%,48.0%]Glamorgan/Spring Bay n/a n/a 24.3%^ [8.4%,53.0%]Glenorchy 15.8% [9.6%,24.8%] 23.1% [15.5%,32.9%]Hobart 5.1%^* [2.5%,10.3%] 9.9%^ [6.0%,15.9%]Huon Valley 5.8%^ [3.1%,10.8%] 9%^ [4.9%,15.8%]Kingborough 5.4%^ [2.6%,10.9%] 9.4%^ [5.3%,16.2%]Sorell 13.7%^ [5.9%,28.7%] 14.3%^ [6.3%,29.1%]Southern Midlands n/a n/a 15.2%^ [5.7%,34.9%]Tasman n/a n/a n/a n/a

North West - - - -Burnie 11.5% [7.2%,17.7%] 15.1% [9.9%,22.3%]Central Coast 11.5%^ [6.9%,18.5%] 13.1% [8.2%,20.2%]Circular Head 24.2%^ [13.4%,39.7%] 29.3%* [17.6%,44.7%]Devonport 16.4% [11.5%,22.8%] 20.9% [15.3%,27.8%]Kentish 11.7%^ [5.5%,23.1%] 16.9%^ [9.1%,29.3%]King Island n/a n/a n/a n/aLatrobe 10.8%^ [6.6%,17.3%] 13.2% [8.4%,20.2%]Waratah/Wynyard 8.1%^ [4.4%,14.2%] 9.0%^ [5.1%,15.4%]West Coast 24.2%^ [10.9%,45.5%] 37.5%^*# [20.5%,58.3%]

Tasmanian Population Health Survey 2016; ^^ daily and occasional smoking combined; ^RSE >25% -<50%- use with caution; n/a estimate unable to be published to very high data unreliability (RSE>50%); #statistically significantly different compared within respective region; *statistically significantly different compared to Tasmania

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Table 136: Alcohol consumption causing occasional and lifetime harm by LGA, 2016

LGA Alcohol consumption

causing single

occasion harm (>4 drinks)

%

Alcohol consumption

causing single occasion harm

(>4 drinks)95% CI

Alcohol consumption causing lifetime

harm (>2 drinks)

%

Alcohol consumption

causing lifetime harm (>2 drinks)95% CI

North - - - -Break O'Day 39.5% [24.6%,56.6%] 27.5%^ [15.1%,44.8%]Dorset 39.9% [27.1%,54.3%] 24.9%^ [14.2%,40.0%]Flinders 46.5%^ [18.1%,77.4%] 45.7%^ [17.8%,76.5%]George Town 48.7% [34.1%,63.6%] 29.4%^ [17.2%,45.6%]Launceston 45.6% [40.9%,50.5%] 20.3% [16.8%,24.3%]Meander Valley 37.4% [27.5%,48.5%] 18.0% [11.0%,28.0%]Northern Midlands 40.7% [30.0%,52.4%] 13.2%^ [7.7%,21.7%]West Tamar 48.0% [38.1%,58.1%] 24.1% [16.7%,33.4%]

South - - - -Brighton 46.6% [34.8%,58.8%] 18.2%^ [10.5%,29.5%]Central Highlands n/a n/aClarence 42.4% [35.0%,50.0%] 19.6% [14.6%,25.8%]Derwent Valley 56.2% [38.3%,72.6%] 37.1%^ [20.3%,57.7%]Glamorgan/Spring Bay

29%^ [13.1%,52.6%] 22.3%^ [9.3%,44.5%]Glenorchy 54.1% [45.0%,63.0%] 19.6% [12.8%,28.7%]Hobart 53.4% [45.4%,61.3%] 27.1% [20.6%,34.7%]Huon Valley 41.5% [29.5%,54.6%] 18.6%^ [11.0%,29.6%]Kingborough 45.8% [37.5%,54.3%] 20.1% [14.1%,27.7%]Sorell 41.0% [27.5%,56.1%] 20.8%^ [11.0%,35.8%]Southern Midlands 38.5%^ [15.5%,68.1%] n/a n/a

Tasman 38.8%^ [16.3%,67.3%] n/a n/aNorth West - - - -

Burnie 40.6% [32.2%,49.6%] 16.4% [11.4%,23.0%]Central Coast 32.0% [25.1%,39.8%] 20.8% [15.1%,27.9%]Circular Head 48.7% [35.0%,62.6%] 29.2% [18.5%,42.8%]Devonport 47.7% [40.9%,54.6%] 18.0% [13.4%,23.8%]Kentish 24.6%^* [14.2%,39.2%] n/a n/aKing Island 22.6%^ [8.1%,49.1%] n/a n/aLatrobe 38.7% [28.7%,49.7%] 18.9%^ [11.2%,30.0%]Waratah/Wynyard 33.3% [23.0%,45.6%] 18.2%^ [9.9%,30.9%]West Coast 38.3%^ [19.7%,61.1%] 10.5%^ [4.3%,23.4%]

Tasmanian Population Health Survey 2016; ^RSE >25% -<50%- use with caution; n/a = estimates are too unreliable to be published (RSE>50%); *statistically significantly different compared to Tasmania

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Table 137: Did not meet guidelines for fruit and vegetable consumption by LGA, 2016

LGA Did not meet guidelines for

fruit consumption^^

%

Did not meet guidelines for

fruit consumption^^

95% CI


vegetable consumption^

^%


vegetable consumption^^

95% CI

North - - - -Break O'Day 57.8% [41.0%,73.0%] 97.8%*# [94.5%,99.2%]Dorset 50.7% [37.5%,63.8%] 77.0%*# [63.5%,86.5%]Flinders 61.0%^ [28.3%,86.1%] n/a n/aGeorge Town 68.0% [53.3%,79.9%] 85.5% [72.4%,93.0%]Launceston 62.8% [58.1%,67.3%] 92.4% [89.6%,94.4%]Meander Valley 66.5% [56.9%,74.9%] 94.8% [90.4%,97.2%]Northern Midlands 65.8% [55.2%,75.0%] 90.8% [83.8%,94.9%]West Tamar 67.0% [57.4%,75.3%] 91.1% [84.8%,94.9%]

South - - - -Brighton 66.1% [54.4%,76.2%] 94.8% [87.2%,98.0%]Central Highlands n/a n/aClarence 58.7% [51.3%,65.8%] 91.6% [86.7%,94.8%]Derwent Valley 70.0% [53.3%,82.6%] 91.0% [76.2%,97.0%]Glamorgan/Spring Bay

65.8% [41.9%,83.7%] 98.9%* [92.2%,99.8%]Glenorchy 70.3%# [61.6%,77.8%] 96.4% [91.0%,98.6%]Hobart 48.8%* [40.8%,56.8%] 88.6% [82.1%,93.0%]Huon Valley 57.4% [44.5%,69.3%] 96.7%* [93.3%,98.4%]Kingborough 50.7% [42.4%,58.9%] 95.0% [90.3%,97.5%]Sorell 59.3% [44.8%,72.3%] 93.2% [79.1%,98.1%]Southern Midlands 78.4% [54.6%,91.6%] 91.0% [62.1%,98.4%]Tasman 51.4%^ [24.5%,77.5%] n/a n/a

North West - - - -Burnie 63.7% [54.7%,71.8%] 95.2% [91.9%,97.2%]Central Coast 62.6% [55.1%,69.5%] 91.9% [87.4%,94.9%]Circular Head 71.2% [56.6%,82.5%] 93.9% [87.4%,97.2%]Devonport 59.3% [52.0%,66.3%] 92.6% [88.4%,95.3%]Kentish 56.6% [42.8%,69.6%] 90.5% [79.3%,96.0%]King Island 67.8% [44.5%,84.7%] n/a n/aLatrobe 60.6% [50.1%,70.2%] 91.6% [85.4%,95.3%]Waratah/Wynyard 67.2% [57.0%,75.9%] 90.6% [81.6%,95.5%]West Coast 71.1% [50.5%,85.6%] 97.1% [90.7%,99.2%]

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Tasmanian Population Health Survey 2016; ^^see recommendations for age/gender; ^RSE >25% -<50%- use with caution; n/a = estimates are too unreliable to be published (RSE>50%)%); #statistically significantly different compared within respective region; *statistically significantly different compared to Tasmania

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Table 138: Did not meet physical activity guidelines for adults 18-64 years by LGA, 2016

LGA Insufficient moderate/vigorous

activity^^%

Insufficient moderate/vigorous

activity^^95% CI

Insufficient muscle

strengthening activity^^

%

Insufficient muscle

strengthening activity^^

95% CI

North - - - -Break O'Day n/a - 83.5% [64.2%,93.5%]Dorset 19.3%^ [9.7%,34.7%] 79.0% [62.4%,89.5%]Flinders n/a - n/a -George Town 22.1%^ [10.0%,41.9%] 83.7% [66.8%,92.9%]Launceston 14.9% [11.3%,19.4%] 68.1% [62.4%,73.3%]Meander Valley 13.1%^ [6.2%,25.5%] 80.7% [70.9%,87.8%]Northern Midlands 16.6%^ [9.3%,27.7%] 76.7% [63.6%,86.1%]West Tamar 14.9%^ [8.3%,25.2%] 71.9% [59.0%,82.0%]

South - - - -Brighton 21.9%^ [12.9%,34.6%] 77.0% [63.3%,86.6%]Central Highlands n/a - n/a -Clarence 12.8% [8.3%,19.3%] 73.6% [64.6%,80.9%]Derwent Valley 12.2%^ [4.7%,28.4%] 76.7% [57.7%,88.8%]Glamorgan/Spring Bay n/a - 66.5%^ [30.5%,90.0%]Glenorchy 17%^ [10.1%,27.2%] 66.8% [55.2%,76.6%]Hobart 6.4%^* [3.3%,12.2%] 57.9%* [48.5%,66.7%]Huon Valley 12.7%^ [6.2%,24.2%] 77.9% [60.9%,88.8%]Kingborough 21.1% [13.5%,31.3%] 70.3% [60.4%,78.6%]Sorell 12.5%^ [4.7%,29.4%] 76.4% [59.4%,87.7%]Southern Midlands n/a - 81.9% [50.1%,95.3%]Tasman n/a - 56.3%^ [21.1%,86.1%]

North West - - - -Burnie 15.1% [10.1%,22.0%] 72.2% [62.1%,80.5%]Central Coast 14.9% [10.1%,21.6%] 72.1% [60.7%,81.2%]Circular Head 19.3%^ [11.1%,31.6%] 84.6%* [72.9%,91.9%]Devonport 16.6% [11.6%,23.3%] 63.8% [54.6%,72.1%]Kentish 9.8%^ [4.7%,19.2%] 57.4% [39.1%,73.9%]King Island n/a 79.5% [43.4%,95.2%]Latrobe 11.8%^ [6.6%,20.0%] 74.8% [61.1%,85.0%]Waratah/Wynyard 20.6%^ [11.9%,33.1%] 74.0% [57.0%,86.0%]West Coast 23.9%^ [10.4%,45.9%] 66.0% [40.0%,84.9%]

Tasmanian Population Health Survey 2016; ^^less than 150 min moderate/75min vigorous/week or combination, less than twice weekly muscle strengthening activity; ^RSE >25% -<50%- use with caution; n/a = estimates are too unreliable to be published (RSE>50%)%)%); *statistically significantly different compared to Tasmania

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Table 139: Overweight and obese BMI, age standardised by LGA, 2016

LGA Overweight/obese

%

Overweight/obese95% CI

Obese%

Obese95% CI

North - - - -Break O'Day 60.1% [54.5%,65.4%] 31.0% [25.6%,36.9%]Dorset 64.1% [54.2%,72.9%] 30.4% [21.1%,41.7%]Flinders 30.0%*# [28.6%,31.5%] n/a n/aGeorge Town 58.6% [51.5%,65.4%] 16.2%# [10.8%,23.8%]Launceston 58.8% [53.6%,63.9%] 24.7% [20.6%,29.4%]Meander Valley 64.4% [55.6%,72.3%] 36.1%* [28%,45.1%]Northern Midlands 67.6% [58.9%,75.3%] 25.7% [18.1%,35.1%]West Tamar 63.4% [52.1%,73.4%] 33.6% [25%,43.3%]

South - - - -Brighton 74.5% [61.9%,84%] 31.1% [21.6%,42.5%]Central Highlands n/a n/a n/a n/aClarence 58.5% [49.4%,67%] 26.5% [18.9%,35.9%]Derwent Valley 54.8% [45.4%,63.9%] 12.1%*# [8.3%,17.3%]Glamorgan/Spring Bay 33.2%*# [28.7%,38%] 13.4%*# [10.5%,17%]Glenorchy 64.1% [52.8%,74.1%] 24.0% [18.2%,30.9%]Hobart 45.3%*# [38.3%,52.5%] 13.3%*# [9.2%,18.8%]Huon Valley 63.6% [56.2%,70.4%] 28.2% [19.1%,39.4%]Kingborough 66.7% [57.6%,74.8%] 33.9%*# [26.6%,42.2%]Sorell 64.7% [55.8%,72.6%] 20.4% [13.8%,29.1%]Southern Midlands 47.3%*# [43.6%,51.1%] 22.0% [18.9%,25.4%]Tasman 44.4%*# [40.6%,48.3%] 26.6% [24.1%,29.2%]

North West - - - -Burnie 68.4% [58.8%,76.6%] 37.5%* [28.2%,47.8%]Central Coast 66.6% [60.2%,72.4%] 21.7% [15.4%,29.7%]Circular Head 54.2% [46.7%,61.4%] 20.2% [15%,26.5%]Devonport 54.9% [48.2%,61.4%] 21.9% [17.4%,27.2%]Kentish 63.7% [56.5%,70.3%] 27.2% [19.5%,36.6%]King Island 28.2%*# [23.6%,33.3%] 7.6%^#* [4.3%,13.1%]Latrobe 61.5% [54.4%,68.3%] 19.3% [13.2%,27.4%]Waratah/Wynyard 59.9% [51.1%,68.1%] 18.4% [12.1%,27%]West Coast 56.2% [49.1%,63.2%] 35.7%*# [29.4%,42.7%]

Tasmanian Population Health Survey 2016; #statistically significantly different compared within respective region; *statistically significantly different compared to Tasmania

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Appendix A: Survey methodology

The 2016 Tasmanian Population Health Survey (TPHS) was undertaken using Computer Assisted Telephone Interviewing (CATI). CATIs are frequently used in population health surveys because they offer the advantages of timely and cost-effective collection of data. All responses were self-reported and stored directly in the CATI system.As with the two previous Tasmanian Population Health Surveys, the target population was defined as all non-institutionalised Tasmanian residents aged 18 years and over. The Human Research Ethics Committee (Tasmania) approved the survey methodology and questionnaire content in May 2016 (Ethics Reference H0015759).The fieldwork data collection, dataset collation and population weighting, as well as the production of the technical report were undertaken by the Social Research Centre Pty Ltd in Melbourne.A total of 6 300 TPHS interviews (4 500 via landline and 1 800 via mobile phone) were completed, including 322 converted refusals. Interviewing was conducted between early October and late November 2016, with an average interview length of 21.2 minutes.The overall response rate for the 2016 TPHS was 64.4 per cent.

Survey design and sampling

Stratification

The survey sample of 6 300 was stratified by region, age and gender, with 2 100 allocated to each of the three regions: North, North West and South. This sample allocation allowed for an oversampling of the North West region to ensure sufficient accuracy of data estimates produced for this region. Whilst the target regional totals were treated as a quota, the focus was on completing the call cycle for all sample records initiated. However, the achieved regional response sample numbers were identical to the target sample of 2 100 per region.Dual frame methodology

The survey used a dual frame methodology, which combines a landline and mobile phone sampling frame, with the respondent selection being dependent on the type of sampling frame used. Because 33 per cent of the Tasmanian population are mobile phone users only (Australian Bureau of Statistics, National Health Survey 2014/15 Table Builder), including Tasmanian sole mobile phone users results in a more representative sample of the Tasmanian population.

1 Landline samplingThe survey used the ‘list assisted’ form of Random Digit Dialling (RDD) as the sample frame for the landline sample component. The sample frame was

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supplied by SamplePages, an external vendor. All residential households with land-line telephone connections were considered in-scope for the survey. The sample generation process involved:

The use of the “Register of Numbers” published and regularly updated by the Australian Communications and Media Authority as the initial basis for seed number (prefix) generation.

The generation of ten random telephone numbers per landline prefix number range on an ‘as required’ basis. The resultant ten-digit numbers were tested via a SS7 signal link (sometimes referred to as “pinging”) to assign a ‘working’ or ‘disconnected’ status to each number and thereby generate a geographically targeted sample frame.

All selected telephone numbers were allocated to the three Tasmanian regions using a “postcode of best fit” based on the Exchange Service Area (ESA) to which the number belongs. The initial approximate allocation was updated post-interview on the basis of locality information provided by the respondent, and then mapped to the appropriate DHHS health region.

The randomly generated numbers resulting from the above process were then “washed” against the Australia on Disc (AoD) 2015 listings to source a name and address, where available. The numbers were then matched to the Electronic White Pages (updated daily) to identify those name-address-telephone number combinations which remain current. Selected landline numbers where the surname and address matched those identified through Australia on Disc were included in the sample for primary approach letter mailing, as were those where the surname and the phone number remained the same, but the address had changed.

2 Mobile phone samplingRandom digit dialing (RDD) is a time consuming and expensive process, particularly for small jurisdictions, as thousands of unscreened phone numbers have to be dialled to find local residents. For Tasmania’s small population, it is estimated that only about one in fifty (2.3%) of all numbers dialled would be in scope. In recognition of this, the mobile phone sample component comprised pre-screened RDD mobile numbers as well as a supplementary top-up of list-based mobile numbers.Pre-screened RDD mobile numbers refers to random selection of mobile numbers that have previously been screened as a Tasmanian number as part of dual-frame CATI surveys run by the Social Research Centre which targeted locations other than Tasmania. This technique gives the mobile sample randomised characteristics, while reducing the need to call thousands of numbers.The list-based mobile sample was randomly selected from a commercially available list compiled by SamplePages. Unlike the RDD mobile sample, the list-based mobile numbers had a last known postcode which enabled apriori assignment to a DHHS region.

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Data collection

Pre interviewing contact (DHHS pre-approach letters and SMS invitations)

The Department mailed a letter of invitation to all households where the randomly selected telephone number matched a listing in an electronic directory of Tasmanian household telephone numbers. A total of 8 682 letters were mailed out this way.Mobile phone users were invited to participate via an SMS message sent prior to the first interview, as well as follow-up SMS messages in response to non-contact.

Survey hotline

The Department operated a survey Hotline 1800 number to address non-appointment related queries and concerns regarding the survey, including requests from Tasmanians who had received a primary approach letter to be excluded from the survey. The Social Research Centre also operated a survey Hotline 1800 number during the data collection period for the purposes of managing interview appointments.

Interviewing procedures

The Social Research Centre conducted the survey. After contacting a household via a landline, an interviewer would select for interview the adult resident with the most recent birthday. For mobiles, the phone answerer was treated as the target respondent for screening, other than in circumstances when it was clear that a child had answered. The call regimes differed between the landline and mobile samples.For the landline sample, a previously established call regime was used to make contact with households. This regime spread call attempts over different times of day and days of the week, with up to six calls to establish contact with the household and a further nine calls to achieve an interview with the selected person in the household (fifteen calls in total).For the mobile sample, a standard dual-frame call algorithm was applied. As with the landline sample, calls were made across various times of the day and week, but with a maximum of one call per day. Up to four calls were made to establish contact, with a further two calls to complete an interview where a qualifying respondent had been identified (six calls in total).Interviewing across all three DHHS regions was progressed equitably over the entire fieldwork period, with a view to spreading any bias resulting from seasonal or environmental factors. All interviewing was undertaken using English only.

Survey sample weighting

As the survey combined both dual frame probability samples (RDD landline and RDD mobile) with a list-based mobile sample, it was necessary to develop a tailored weighting methodology. This methodology was developed to adjust for

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unequal probabilities of selection for the RDD components, the non-random nature and unknown probabilities of selection of the listed mobile sample, as well as non-response bias.The first stage was to calculate the design weights which adjust for the different probabilities of each respondent being a participant in the survey. There were two approaches to this, one for the RDD landline and mobile sample components, and the other for the non-random list-based mobile sample.For the RDD sample components, the design weights were calculated to reflect whether or not the household had a landline and/or mobile, the number of adult household residents, the number of landline/mobile telephones within the region, and the number of respondents per region contacted by landline or mobile. Some of this information was known prior to the survey, whilst the rest was obtained during the survey interviews.Each respondent’s weight is the inverse of their probability (chance) of selection. For the RDD sample components, the chance of a respondent being selected to participate in the survey is calculated via the following formula:P = (SLL*LL)/(ULL*ADLL) + (SMP*MP/UMP) where SLL and SMP are the numbers of survey respondents per region contacted by a landline or mobile, respectively, ULL and UMP are the estimated number of landline and mobile numbers per region, respectively, ADLL is the number of adults within the household who could potentially participate in the survey, whilst LL and MP are dichotomous indicators as to the presence or otherwise of a landline or mobile phone, respectively, in the household (0 for no, 1 for yes).For the list-based mobile sample component (non-probability sample), which has unknown biases and probabilities of selections, three weighting methods were investigated. The chosen method resulted in estimates that were the closest to benchmark estimates from the 2014/15 National Health Survey, using four summary metrics which measured bias and weighting efficiency. This weighting method generated conditional probabilities, also known as propensity scores, of each respondent being in the non-probability part of the sample (rather than in the RDD part of the mobile sample) using a propensity-score statistical model which takes into account a number of associated respondent characteristics, such as sex and age. The inverse of these probabilities were used as pseudo-random design weights for the non-probability sample.The design weights were then “trimmed” to reduce the effect of extreme weights on survey estimates prior to post-stratification.The final step was to adjust for non-response bias (or error) to create a final weight (often called a post-stratification weight). The procedure employed was iterative proportional fitting, sometimes termed rim weighting or raking. This is an iterative procedure which allows the weighted sample to align with the distributions of several categorical variables at once, not just age, sex and region, but also, in this instance, telephone status (landline only, mobile only, landline & mobile). At the conclusion of this process, the weights were then scaled to the total population.

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Profile of survey respondents

The age and gender profile of survey respondents was compared with that of the Tasmanian population3 to provide an indication of how representative the survey participants were of the target population. Some key findings were: Whilst the inclusion of a mobile phone sample has improved male

participation compared to previous Tasmanian Population Health Surveys which were landline only, the achieved sample still under-represents males. This is mostly attributable to the landline component, which selects respondents using ‘most recent birthday’ selection, where some self-selection takes place by the phone answerer, based on their interest in the subject matter, which for females tends to be higher for health surveys generally.

The achieved sample under-represents younger people aged 18 to 44 years. This is consistent with projects that do not have a strategy, such as disproportionate chance of selection, for specifically targeting younger persons. However, the inclusion of mobile phone numbers in the sampling frame has boosted the achieved sample of 18 to 34 year olds compared to the landline-only 2013 Tasmanian Population Health Survey.

The age-gender distribution is relatively well-balanced across the regions, with the exception of persons aged 18 to 24 years in the North West.

The weighting strategy for the TPHS was designed to address these imbalances in age and gender.The table below shows the age and gender distributions of the survey respondents within each region, as well as the respective Tasmanian population distributions4.

Table 140: Profile of respondents in the Tasmanian Population Health Survey 2016

Sex/AgeNorth West

Population

North WestSampl

e

NorthPopulati

on%

NorthSampl

e%

SouthPopulati

on%

SouthSampl

e%

Tasmania

Population

Tasmania

Sample%

Male 49.2 42 49.3 42.1 49.4 41 49.3 41.7Female 50.8 58 50.7 57.9 50.6 59 50.7 58.318-24 years 11.4 1.6 11.4 2.5 10.5 2.7 11.2 2.325-34 years

13.9 4.9 15.5 4.6 13.3 5.3 14.6 4.935-44 years 15 8.8 15.8 8.8 15 8.6 15.4 8.745-54 years

17.5 17.2 17.5 15.7 18.1 14.7 17.6 15.955-64 years 17.8 23 17.5 23.4 18 24.2 17.7 23.665+ years

24.5 44.4 22.3 44.9 25 44.5 23.5 44.6

3 Population by Age and Sex, Regions of Australia, Australian Bureau of Statistics, cat. no. 3235.0, Table 6: Estimated Resident Population by Age, Tasmania, Persons – 30 June 2015. Released at 11.30am (Canberra time) 18 August 2016. The 18-24 year age-group population was estimated from the 15-19 and 20-24 year age-group information (40% of 15-19 population plus 20-24 population).

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Statistical analysis and interpretation of results

Statistical softwareThe survey data were analysed using the Stata statistical software package (Version 13, StatCorp LP, College Station Texas).

Weighting

The survey data have been weighted to the Tasmanian population, based on the stratified sampling design of the survey. Each respondent represents multiple persons based on their age, sex geographical area of residence and mode of selection (landline sample, RDD mobile sample, non-probability mobile sample). Consequently, data item estimates (mostly percentages) provided in the report refer to the Tasmanian population rather than just the selected respondents.

Statistical significance

Trends and patterns in the data that are discussed are not necessarily statistically significant, unless specifically indicated. Confidence intervals are provided to assist the reader in interpreting statistically significant results. As per the usual convention, 95 per cent confidence intervals (95%CI) are used. Significant differences between data item estimates exist where confidence intervals do not overlap. When the confidence intervals of the estimates do overlap, the estimates are deemed not to be significantly different. However, this should be considered a guide only and a formal test of statistical significance would be required to arrive at a statistically credible conclusion.

Crude ratesExcept where specifically noted, all population data item estimates provided in the report are crude rates. That is, adjustments for associated factors, such as age, have not been carried out. Crude rates, expressed as percentages, are calculated by dividing the estimated number of persons in the population of interest with a certain characteristic (e.g. current smoker) by the number of total persons in the respective population (e.g. males aged 18-24 years).

Age-standardisation

In making comparisons over time for data items which are strongly age-dependent, crude rates can sometimes be difficult to interpret because of changes to the population age distribution over time. Consequently, if changes to the population age distribution are not taken into account, any observed changes may be at least partially attributable to a change in the age distribution. This is particularly relevant for data items which increase in prevalence with increasing age, such as chronic diseases and obesity. In light of Tasmania’s ageing population, the population data item estimates provided in this report relating to chronic diseases, obesity and self-assessed health status have been adjusted for age using the 2001 Australian standard population, which is the standard population recommended by both the Australian Bureau of Statistics (ABS) and the Australian Institute of Health and Welfare (AIHW). This process is

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termed age-standardisation, and the resulting estimates are termed age-adjusted, or age-standardised, rates.

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Imputation

Explicit missing data imputation has not been undertaken for any data items. However, for variables which have been derived from component data items, such as BMI (based on self-reported height and weight) and the Kessler 10 (a composite score based on 10 separate data items), data estimates have been based solely on non-missing data values. Consequently, for the remaining data items in the survey, summation of percentages over the categories of a variable (such as self-assessed health) will not necessarily add up to 100 per cent due to a proportion of missing values (typically coded as don’t know/refused).

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Appendix B – Glossary

Age Standardisation This is a statistical method to account for differences in age composition when comparing data estimates for different populations. The aim of age standardisation is to identify whether the compared estimates are statistically significantly different after adjusting for age differences. The resultant rates are termed age-standardised rates or age-adjusted rates.

The most common method, and the one used in this report, is direct standardisation, which produces an aggregated weighted sum of age-specific (5 year age groups) rates applied to a standard population.

As per Australian Bureau of Statistics and Australian Institute of Health and Welfare recommendations, the standard population used in this report is the 2001 Australian resident population.

Confidence Interval The confidence interval is the range within which the “true” population value is likely to lie. The most common interval, and the one used in this report, is termed the 95 per cent confidence interval (95%CI).

The usual way to interpret this is that if we were to draw several random samples of the same size from the same population, on average 19 out of 20 such confidence intervals would contain the true population estimate, and one out of every 20 (5 per cent) would not.

The width of the confidence interval indicates the precision of the estimate. Wider confidence intervals imply less precision. The formula is: 95%CI= estimate +/- (1.96*SE), where SE refers to the standard error of the estimate.

Kessler 10 Kessler 10 Psychological Distress Scale (K10). The K10 has been validated as a diagnostic screening tool for the presence of anxiety and depression.

The K10 consists of ten questions that explore the level of psychological distress over the preceding four week

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period, covering feelings and experiences such as nervousness, hopelessness, restlessness, sadness and worthlessness.

Prevalence A measure of the level of the disease or characteristic in a population at a specific point in time. (AIHW, 2012)

Relative Standard Error (RSE)

This is a measure of the reliability of the data item estimate, and is defined as the ratio of the estimate’s standard error to the estimate, expressed as a percentage.

The convention employed by the Australian Bureau of Statistics, and the one used in this report, is to regard estimates with an RSE lower than 25 per cent as reliable, whilst those with RSEs above 25 per cent but lower than 50 per cent to be used with caution. Estimates with RSEs of 50 per cent or higher are deemed too unreliable to be published, and are cited in this report as n/a.

Self-Assessed Health Status

Refers to a respondent’s perception of his or her general health status as either excellent, very good, good, fair or poor.

SEIFA - IRSD The socio-economic status measure used in this report is one of the suite of Socio Economic Indexes for Areas (SEIFA) developed by the ABS. The specific index used in the report is the Index of Relative Socio-Economic Disadvantage. This index represents a single measure of socio-economic status derived from Census data, and includes variables such as education, income, occupation and housing in calculating the index score which applies to geographic areas. Areas with a low index score have high proportions of low income families, high unemployment and low educational qualifications, while the least disadvantaged areas have high proportions of high income earners and high index scores. This means areas with a low index score are more disadvantaged than areas with a high index score.

Standard Error (SE) The standard error is a measure of the variation in the data item estimate as a result of sampling a population. The standard error can be used to produce confidence intervals and relative standard errors, the first providing an indication of the likely range within

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which the “true” value lies, whilst the second provides an indication of the reliability of the estimate.

Statistical Significance

In this report, 95 per cent confidence intervals (95%CI) have been used to determine if a statistically significant difference exists between compared values. A statistically significant difference exists where the confidence intervals do not overlap and the difference between the estimates being compared is greater than that which could be explained by chance. Overlapping confidence intervals do not imply that the difference between two values is definitely merely due to chance, but rather that no statistically significant difference was found. Judgment should always be exercised in deciding whether or not the difference is of practical or clinical value

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Appendix C – TPHS 2016 questionnaire data items

Demographics Age Sex Household/family status Ages of children in householdNumber of people >18 in household Number of people <18 in household Indigenous status Country of birth

Socio-Economics Highest level of educationEmployment statusType of work activityHousehold income

Health Screening Blood pressure screening Cholesterol screening Diabetes/high blood sugar screeningBowel cancer screening and type of test

Health Service UseUse of and satisfaction with: - public hospital - child health/parent service- community health centre/multipurpose centre

Health Literacy Ability to understand health information and engage with health care provider

Health Risk Factors Number of serves vegetablesNumber of serves of fruit Type of milk consumed Type of drink consumed when thirsty Reasons for inadequate nutritionFolate consumption* Folate awareness Reason for taking folate Reason for not taking Source of folate information*females aged 18-50 only Bread/rolls amount Usual type of diet Reason for diet typeSoft drinksDiet soft drinks

BMISelf-reported height/weight

AlcoholWhether had alcohol during past 12 monthsFrequency of consumptionQuantity consumedFrequency of high risk consumption

SmokingCurrent smoking status Ex-smokers- smoked >100Smoke free home

Physical Activity

Frequency and time spent on walkingFrequency and time spent on vigorous household activityFrequency and time spent on vigorous gardeningFrequency and time spent on vigorous activities (sport/exercise)Frequency and time spent on moderate activities (sport/exercise)Frequency and time spent on muscle strengtheningSitting time Active transport

Chronic Conditions AsthmaAsthma diagnosisAsthma symptoms Asthma action plans provided HypertensionHypertension diagnosisActions to manage hypertensionDiabetesDiabetes diagnosisHigh sugar level diagnosisType of diabetesActions to manage

Physical and Mental Health Status Self-reported health Kessler 10 (psychological distress) Dental HealthDental health status Dental health problems - missing teeth, toothache Dental hygiene Dentist cost barrier Child brush assistance

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Chronic Diseases Ever diagnosed withHeart diseaseStrokeCancerOsteoporosisDepression/anxietyArthritisArthritis typeHas professional help been sought, and from whom, for mental health problemHad eye problems - cataracts, glaucoma, diabetic retinopathy, macular degeneration

Financial Security and Threats to HealthRaise $2000 if neededFood securityMain source of heatingMain source of coolingBushfire riskBushfire evacuation triggersReasons for staying on

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Appendix D – Tasmania’s regional structure

South North North-WestBrighton Break O’Day BurnieCentral Highlands Dorset Central CoastClarence Flinders Circular HeadDerwent Valley George Town DevonportGlamorgan/Spring Bay Launceston KentishGlenorchy Meander Valley King IslandHobart Northern Midlands LatrobeHuon Valley West Tamar Waratah/WynyardKingborough West CoastSorellSouthern MidlandTasman

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*I

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Report on the Tasmanian Population Health Survey 2016 ... Web viewThese are modifiable lifestyle...

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