Transcript Lifestyle data and surveys - Public health observatory

Lifestyle data and surveys
Irina Holland
[email protected]
Aims of session
• Consider why we need lifestyle data and how
we can find it
• Find out about the main national surveys
• Overview of the use of national data to create
local models
• Hear about an example of a local lifestyle
survey
• Understand the pros and cons of different
types of survey
Introduction
• Lifestyle is one of the wider
determinants of health
• Recent National Policies –
E.g. Choosing Health and
Healthy Weight, Healthy Lives
• Factors include physical activity, smoking,
alcohol and drug use, as well as attitudes
towards behaviour
Health and wellbeing
• Also look at wider
determinants which may
affect health and wellbeing
e.g. levels of education,
employment, housing,
access to services, family and friends, etc.
Why do we need to know?
• Monitor health of population
• Likely future health needs (incidence and
prevalence of disease or determinants)
• Plan and commission services relevant to our
local population
– Joint Strategic Needs Assessments (JSNA)
– Local Area Agreements (LAA)
• Monitor performance of services/programmes
• Reduce Health Inequalities
Sources of lifestyle data
• Commercial sector / market research
organisations
• Primary Care (e.g. QOF)
• National Surveys
• Synthetic estimates from national surveys
• Local surveys
Commercial organisations –
Pros and cons
E.g. Experian (MOSIAC), Dr Foster
• Positives
– Large volume of household survey and consumer
data
• Negatives
– Modelled to provide for all areas
– Detailed methods often not available
What is a survey?
• A survey is a way of gathering information from a
sample population of interest
• They are a planned method of data collection
• Data is collected in the same way from everyone
• The sample should represent the population of
interest
• Surveys can be one-off, repeated in the same
population, or repeated in a different population
Why are surveys useful?
• Can measure populations that don’t come into
contact with services
• Can measure issues that are not routinely
recorded, e.g. healthy eating, physical activity
levels
• Can help us to understand the link between
disease and determinant, e.g. income and
mental health
What surveys have you heard of?
Have you used the data from any
of these?
Main national surveys relevant to
Public Health
• Census*
• Health Survey for England (being replaced by
the Health and Social Care Survey in 2010)
• General LiFestyle Survey (GLF), formerly
known as the General Household Survey
(GHS)
• ONS Omnibus Survey
*The Census is unique in that it measures ALL population, not just a sample
Other national surveys
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Psychiatric Morbidity Survey
Adult Dental Health
Infant Feeding Survey
Living Costs and Food Survey
Active People Survey
National Diet & Nutrition Survey
National Survey of Sexual Attitudes & Lifestyles (NATSAL)
Smoking, Drinking and Drug use among Young People in
England
• Taking Part Survey
• Citizenship Survey
The Census in England and Wales
• A census is a count of all people and
households in the country. It provides
population statistics from a national to
neighbourhood level for government, local
authorities, business and communities.
• The last census for England and Wales was on
29 April 2001. The next will take place on 27
March 2011 and will involve around 25 million
households.
Census – Pros and cons
• Positives
– Biggest cross-sectional survey in England
– Best checked Census ever
• Negatives
– Old!
– Under-estimation of households and people
• Can you think who might be missed?
– Data suppressed if small numbers
General LiFestyle Survey (GLF)
• Formerly known as the General Household
Survey (GHS)
• Run since 1971
• The GLF is a module of the Integrated
Household Survey (IHS), run by ONS
• Adults 16+
• 13,000 involved annually
• Regular lifestyle topics
• Extensive socio-economic data
GHS/GLF – Pros and cons
• Positive
– General patterns of living
– Trends 30 years data
– Much data analysed by socio-economic status
– Easily accessible data
• Negative
– Little regional breakdown
– Time lag
Health Survey for England
• Part of an overall programme of surveys commissioned by DH
and designed to provide regular information on various
aspects of the nation's health
• Annual since 1991, Adults aged 16+ living in private
households, about 16,000 interviewed annually
• Children included since 1995
• Core topics include: general health, smoking, drinking and
fruit and vegetable consumption, height, weight, blood
pressure measurements and blood and saliva samples.
• Each year focuses on a different demographic group and looks
at such health indicators as cardio-vascular disease, physical
activity, eating habits, oral health, accidents, and asthma.
• Will be replaced with the Health and Social Care Survey
HSE – Pros and cons
• Positive
– Contains useful data on many risk factors for
major conditions, e.g. CHD, diabetes, cancer
– Not just self reported
– Trend data
– Regional breakdown
– Special reports from yearly topics well-researched
• Negative
– Not much on underlying determinants
ONS Omnibus Survey
• Since 1990
• Carried out by the Office for National Statistics
• Multi-purpose survey based on interviews with a sample of
about 1,800 adults per survey month, with one adult
selected from each household.
• The ONS Omnibus is used for a number of purposes, for
example:
– to provide quick answers to questions of immediate
interest
– to provide information on topics that do not require a
full survey
– to develop and pilot questions for other surveys
Information Centre Health Surveys
Programme Network
• Informs users of current programme of health
surveys
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HSE (HSCS)
Adult Dental Health Survey
Carers Survey
Smoking, Drinking and Drug use in young people
Omnibus
Infant Feeding Survey
Elements of the GLF and Integrated Household Survey
(IHS) delivered by ONS
National surveys delivered locally
National method but carried out locally
• Place Survey
• NHS Patient Surveys
• National Child Measurement Programme
(NCMP)
• TellUs
Place Survey
• The National Indicator Set launched by the
government in April 2008 contains 25
indicators which are informed by citizens'
views and perspectives.
• In order to minimise the number of surveys
that local authorities need to undertake, 18 of
these indicators are collected through a single
Place Survey administered by, or on behalf of,
each local authority.
• The Survey takes place every two years.
NHS Patient Surveys
• Gathers feedback from patients about care
they have recently received
• All services / settings included
National Childhood Measurement
Programme (NCMP)
• Since 2005
• Weighs and measures children in Reception
(age 5-6) and Year 6 (age 10-11)
• Population surveillance
• Data shared with parents to engage them
about the importance of healthy weight
TellUs
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Survey of children and young people
Linked to five Every Child Matters outcomes
Some lifestyle data, smoking, drink/drugs
Sample of schools selected in each Local
Authority
• TellUs1 started 2006
• TellUs3 available now, TellUs4 due March 2010
Model based estimates
(synthetic estimates)
• Demand for information at a range of
geographical levels, not always collected
locally
• National surveys designed to provide reliable
estimates at national or sometimes regional
levels
• Sample size usually too small to provide direct
estimates for smaller areas, e.g. Local
Authority
• Therefore need another technique . . .
Example of use – Health Profiles (1)
http://www.apho.org.uk/default.
aspx?QN=P_HEALTH_PROFIL
ES
Example of use – Health Profiles (2)
• Model-based estimates using Health
Survey for England data 2003-2005 for:
–Adults who smoke
–Binge drinking adults
–Healthy eating adults
–Obese adults
How does it work (briefly!)
• There is a relationship between national
survey estimate and another sources of
information related to behaviour, e.g.
demographic information
• Census data often used for this
• Logistic regression technique used
• Identifies characteristics most strongly related
to the behaviour
• Adjust for each area based on these
characteristics to develop local estimates
• Full technical description available from
http://www.dh.gov.uk/en/Publicationsandstat
istics/Statistics/StatisticalWorkAreas/Statistica
lworkareaneighbourhood/DH_4116713
Limitations of modelled estimates
• NOT an estimate of actual prevalence – this
measures expected prevalence
• Cannot be used to monitor performance
• Cannot usually compare between two sets of
model-based estimates in two different time
periods
• Does not reflect local initiatives
Local lifestyle Survey (1)
• Why . . . .
– Prioritise local services
– Evaluate local initiatives
– Compares smaller geographies, e.g. wards (if
sample size large enough)
– Informs targets and plans, e.g. Local Area
Agreements (LAAs) and Joint Strategic Needs
Assessments (JSNAs)
Local Lifestyle Survey (2)
• Real local data
• Flexibility and control over:
– Population to be surveyed (area, age, sex, etc)
– Sample size (statistical power vs cost)
– Design (cross-sectional/longitudinal,
census/sample)
– Method (phone, internet, face to face, postal)
– Subject matter – anything you like!
Local Lifestyle Survey (3)
Difficulties
• May not be able to compare with other areas
• May be difficult to get permission, e.g. names
and addresses
• Takes a lot of time
• Can be expensive
• Is it really representative . . . ?
Example of a bespoke local
Lifestyle Survey
(Somerset Lifestyle Survey 2009)
• Survey previously done in 1987, 1992, 1998,
2002
• 7,500 sample, registered adults 16-74
• 11-page postal questionnaire
• In house
• Produced using package called Formic
What was difficult
• Public! (Translations, complaints)
– Dedicated phone line with answerphone
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Volume of paper involved (33 boxes A4)
Logistics of franking 7,500 envelopes
And posting them!
Storage
Cleaning data
What survey method to use?
Method
Postal
Face-to-face
Telephone
Web
Pros
Cons
Some criteria for assessing and
comparing different sources
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Validity
Reliability
Bias
Timeliness
Cost