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Lifestyle Data
Agenda
• The need for lifestyle data/current drivers– LDPs– LPSAs/LAAs
• Potential sources of lifestyle data
• Relevant current APHO projects– Review of sources– Child Obesity measurement– Community Profiles– Lifestyle Survey Toolkit
Lifestyle risk factors
• Smoking• Lack of physical activity• Unhealthy diet• Obesity• Excessive alcohol consumption/binge drinking• Drugs• Risky sexual behaviour• Not breastfeeding
Why do we need lifestyle data?
Needs Assessment• To identify adverse trends/future problems and/or ...• Compare local areas/pop. sub-groups in order to ...• Help PCTs/partners establish priorities and plan action
Awareness raising/campaigning• To generate a local profile in order to ...• Lobby for resources• Help to communicate important public health messages and
empower local people to take informed choices/action
Measuring progress/performance• Outcome measures for services• Progress re LPSA/LAA targets and LDPs
PCTs’ LDP reporting requirements• current:
– Smoking status amongst the population aged 15 to 75 years• Number of people aged 15 to 75 years on a GP register, recorded as
being a smoker in the last 15 months.• Number of people aged 15 to 75 years on a GP register, with a
smoking status recorded in the last 15 months.
– Obesity Status amongst the GP registered population aged 15 to 75 years
• Number of people aged 15 to 75 years on GP register, recorded as having a BMI of 30 or greater in the last 15 months
• Number of people aged 15 to 75 years on GP register, with a BMI recorded in the last 15 months.
• future:– child obesity prevalence– ?further alignment with Choosing Health
LPSA/LAA reporting requirements
• LAA roll out• new LAA guidance• current examples
– Nottingham
– Derby
• outcomes framework• reward element• the role of GOEM and EMPHO
Sources of Lifestyle Data
What’s the best source of local information on ....
Possiblesource
National Surveys(local boosts of)
National Surveys (estimates based on)
Regional or local surveys
Primary Care/other NHS Data
Commercial datasets
smoking
physical activity
diet
obesity
alcohol
Main National Surveys
National surveys with health-related lifestyle content include:
– Health Survey for England– General Household Survey– Psychiatric Morbidity Survey (drugs, alcohol)– ONS Omnibus Survey
Main National Surveys (cont.)
• Infant feeding survey• Food & expenditure survey• National diet & nutrition survey• National survey of sexual attitudes & lifestyles
(NATSAL)• Drug use, smoking and drinking among young people
in England in 2001
Where to find national surveysONS• http://www.statistics.gov.uk/• http://www.statistics.gov.uk/lib2001/index.html
Department of Health• http://www.dh.gov.uk/PublicationsAndStatistics/
PublishedSurvey/fs/en • http://www.dh.gov.uk/PublicationsAndStatistics/
PublishedSurvey/HealthSurveyForEngland/fs/en
UK Data Archive• http://www.data-archive.ac.uk/
What’s the best source of local information on ....
Possiblesource
National Surveys(local boosts of)
National Surveys (estimates based on)
Regional or local surveys
Primary Care/other NHS Data
Commercial datasets
smoking
physical activity
diet
obesity
alcohol
Buying local “boosts” of national surveys
• Some PCTs (Merseyside, Camden, Islington) have bought local boosts of the HSfE
• At around £100 per person this can be very expensive to get a useful level of precision in prevalence estimates
• Cost savings possible with cut-down interview and measurement schedules
Generating local estimates based on national surveys
• A quick way of providing a profile of the population when there is no “real” local data
• Appropriate when local demography is similar to national demography
Erewash PCT: Estimated smoking prevalence by age (Men)
Age group Male
Est.Smoking Prevalence %
Estimated No.
Adults 16+ Smokers
16 - 24 5364 36% 1931
25 - 34 7450 38% 2831
35 - 44 8550 34% 2907
45 - 54 7252 30% 2176
55 - 64 6600 24% 1584
65 - 74 4384 18% 789
75+ 3047 10% 305
Erewash PCT: Estimated smoking prevalence by age (Women)
Age group Female
Est.Smoking Prevalence %
Estimated No.
Adults 16+ Smokers
16 - 24 5257 36% 1893
25 - 34 7896 35% 2764
35 - 44 8634 30% 2590
45 - 54 7222 28% 2022
55 - 64 6403 23% 1473
65 - 74 4864 18% 876
75+ 5317 10% 532
Erewash PCT: Estimated smoking prevalence by in Electoral Wards
CAS Ward Name Population Estimated Smoking Estimated
Prevalence % No. Smokers
Little Eaton and Breadsall 2954 15.7 464
Sandiacre North 3493 25.7 898
Ockbrook And Borrowash 5888 17.8 1048
Old Park 3218 35.7 1147
Draycott 3165 21.5 680
Ilkeston Central 3550 35.4 1257
Sandiacre South 3532 17.3 612
Sawley 5368 25.2 1353
Nottingham Road 5030 28.0 1407
Derby Road East 3777 29.8 1124
Long Eaton Central 4825 25.0 1204
Kirk Hallam 5057 29.0 1468
West Hallam and Dale Abbey 4121 14.2 587
Cotmanhay 3494 35.4 1236
Stanley 1728 20.0 346
Breaston 3713 14.9 554
Ilkeston North 3095 36.1 1117
Little Hallam 3309 17.6 584
DH/NatCen ward-level “synthetic estimates”
• Dept of Health project
• Using data from the Health Survey for England
• Multivariate modelling to identify social and demographic predictors of smoking
• Ward-level estimates based on known social and demographic characteristics of ward populations
• Validated against local surveys in London and N.W. England
• Publication date – July 29th 2005– adult smoking– adult binge drinking– adult obesity– adult fruit and veg consumption– child fruit and veg consumption
West Midlands Regional Lifestyle Survey 2005
West Midlands Public Health Observatory
West Midlands Regional Survey 2005
• Coordinated by WMPHO. Delivered by BMG.
• 56 funding partners including PCTs, LAs, GO, LSCs, Police
• Sampling frame = Public Access Electoral Register
• Self-completion questionnaire sent to 174,000 adults aged 18 and over
• Overall response rate = 33.1%
• The survey “ has fostered partnership working”
A local health survey:
1999 and 2002 Erewash Health Surveys
Erewash Health Survey: Design
• two age groups (25-34 & 65-74)
• two samples compared:– a random sample of all residents– a random sample of residents of the most deprived
areas (Sawley, Cotmanhay and Kirk Hallam )
• postal questionnaire
Erewash Health Survey 1999: Response• People aged 25-34
– men representative 38%
– women representative 59%
– men deprived areas 33%
– women deprived areas 50%
• People aged 65-74– men representative 82%
– women representative 81%
– men deprived areas 83%
– women deprived areas 76%
Lifestyle data from general practice
• potential source for data on smoking and obesity ... but not (yet) other aspects of lifestyle
• LDP reporting obligations - current focus is still data quality
• QOF provides some financial incentives for improved data collection but scheme is essentially voluntary
• unregistered and non-attenders (incl some vulnerable groups) not represented
• QPID will provide summaries of prevalence at practice level but not (yet) for geographically defined populations
• the source of the future??
Lifestyle data from commercial market research organisations
• e.g. CACI, Claritas, Experian, Acxiom
• incl. smoking, expenditure on food and drink, obesity
• large volumes of household survey and consumer data modelled to provide estimates for all areas of the country
• methodologies obscure
• expensive
General Issues for Data Collection Systems• Validity: does the system measure what it aims to measure?• Reliability:
– do questions produce reproducible answers?– inter-observer differences– recall of past events
• Comparability ... e.g. vs neighbouring areas• Timeliness• Accuracy of data capture/data entry• Cost
Particular Issues for “Censuses”• Completeness
Particular Issues for Sample Surveys• Bias – is the sample representative of the target population?• Precision - is the sample size adequate?
Horses for courses:different systems suit different purposes
• Compare between localities
• Track progress on LPSA/LAA targets and Local Delivery Plans (LDPs).
• Outcome measures for services
Relevant current APHO projects
1. Review of sources of lifestyle data
2. Child Obesity measurement (Task Force project)
3. Community Profiles (Task Force project)
4. Lifestyle Survey Toolkit