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