Measuring BMI in an Aboriginal population survey: who are the non-responders?

Objective To describe the characteristics of South Australian Aboriginal respondents reporting unhealthy weight, as well as those not knowing their height or weight. Methods Trained Aboriginal interviewers undertook 399 face-to-face interviews with Aboriginal people 15 years and over from randomly selected dwellings, in metropolitan, rural and remote areas of South Australia (response rate: 57.7%). Questions were included to determine prevalence of unhealthy weight in this representative population. Results Self-reported prevalence of unhealthy weight was n= 79/106, (74.5% 95% CI 65.1-81.6), and these respondents were more likely to have diabetes, high blood pressure, or had lived in their residence for more than 6 months; and less likely to have asthma, or experience food insecurity, than those who were underweight or normal weight. Those who did not know their height and weight (n= 247/353, 70.1%, 95% CI 65.0–74.5), were more likely to be unemployed, undertake home duties, or be retired or unable to work; and less likely to live in rural or remote South Australia, be aged 45 years and over, or have a mental health condition that those who had answered the height and weight questions. Conclusions Unhealthy weight in the Aboriginal population exceeds general population levels. The main limitation to assessing accurate levels of unhealthy weight was that a large proportion of Aboriginal people in this study did not know their height and weight. Limited access to primary health care, the social undesirability of reporting increased weight, or the conflict of health and lifestyle priorities, may explain this. Implications Identification of the characteristics of this population are important; strategies may be defined to prevent non-response in similar surveys. These data are a powerful resource informing policy and future research involving the social determinants of Aboriginal health.Avery, JC, Taylor, AW, Dal Grande,

A survey of retirement intentions of Baby Boomers: an overview of health, social and economic determinants

Background: Governments have been implementing policies aimed at halting the trend towards early retirement for Baby Boomers. Public policies can have a strong effect on when a person retires and this analysis contributes to an improved understanding of retirement aspirations in regards to health, social, workplace and economic determinants. Methods: In October 2011 a telephone survey was undertaken with participants aged 50 to 65 years who were in paid employment and who had been in the workforce for the previous three years. Participants were obtained from two identical South Australian cohort studies - the North West Adelaide Health Study and the Florey Adelaide Male Ageing Study. The results of the telephone survey were linked to the original cohort data. Data were weighted by sex, age, postcode and probability of selection in the household. Work related questions included how much they thought about their retirement, current occupation, employment status, type of workplace and hours worked per week. Health related questions included current smoking status, physical activity, body mass index, self-reported health status and overall life satisfaction. Uni-variable and multi-variable analyses were undertaken to compare the different associations between people who were and were not intending to retire. Results: In total, 25.9% (n = 210) of people who were currently in paid employment indicated that they intend to retire completely from the workforce. The remainder indicated that they will continue to work (41.8% retire from full-time work but work part-time, 25.7% continue working part-time but reduce their current hours, and 6.7% never retire). The multi-variable results indicate that those with lower education, having a savings habit, and sales workers more likely to anticipate complete retirement. The self-employed, and those thinking only moderately about retirement, were more likely to extend their working life beyond age 65. Conclusion: An important finding of this study is the large number of Baby Boomers who indicated that they would be happy to work part-time or never retire. Policies and continued dialogue aimed at making the workplace a safe, flexible and welcoming environment to accommodate this wish, and to entice others to take up this option over complete withdrawal from the labour force, is required.Anne W Taylor, Rhiannon Pilkington, Helen Feist, Eleonora Dal Grande and Graeme Hug

Culturally appropriate methodology in obtaining a representative sample of South Australian Aboriginal adults for a cross-sectional population health study: challenges and resolutions

Background: The considerably lower average life expectancy of Aboriginal and Torres Strait Islander Australians, compared with non-Aboriginal and non-Torres Strait Islander Australians, has been widely reported. Prevalence data for chronic disease and health risk factors are needed to provide evidence based estimates for Australian Aboriginal and Torres Strait Islanders population health planning. Representative surveys for these populations are difficult due to complex methodology. The focus of this paper is to describe in detail the methodological challenges and resolutions of a representative South Australian Aboriginal population-based health survey. Methods: Using a stratified multi-stage sampling methodology based on the Australian Bureau of Statistics 2006 Census with culturally appropriate and epidemiological rigorous methods, 11,428 randomly selected dwellings were approached from a total of 209 census collection districts. All persons eligible for the survey identified as Aboriginal and/or Torres Strait Islander and were selected from dwellings identified as having one or more Aboriginal person(s) living there at the time of the survey. Results: Overall, the 399 interviews from an eligible sample of 691 SA Aboriginal adults yielded a response rate of 57.7%. These face-to-face interviews were conducted by ten interviewers retained from a total of 27 trained Aboriginal interviewers. Challenges were found in three main areas: identification and recruitment of participants; interviewer recruitment and retainment; and using appropriate engagement with communities. These challenges were resolved, or at least mainly overcome, by following local protocols with communities and their representatives, and reaching agreement on the process of research for Aboriginal people. Conclusions: Obtaining a representative sample of Aboriginal participants in a culturally appropriate way was methodologically challenging and required high levels of commitment and resources. Adhering to these principles has resulted in a rich and unique data set that provides an overview of the self-reported health status for Aboriginal people living in South Australia. This process provides some important principles to be followed when engaging with Aboriginal people and their communities for the purpose of health research.Tania Marin, Anne Winifred Taylor, Eleonora Dal Grande, Jodie Avery, Graeme Tucker, and Kim More

The north west Adelaide health study: detailed methods and baseline segmentation of a cohort for selected chronic diseases

The North West Adelaide Health Study is a population-based biomedical cohort study investigating the prevalence of a number of chronic conditions and health-related risk factors along a continuum. This methodology may assist with evidence-based decisions for health policy makers and planners, and inform health professionals who are involved in chronic disease prevention and management, by providing a better description of people at risk of developing or already diagnosed with selected chronic conditions for more accurate targeting groups for health gain and improved health outcomes. Longitudinal data will provide information on progression of chronic conditions and allow description of those who move forward and back along the continuum over time. Detailed methods are provided regarding the random recruitment and examination of a representative sample of participants (n = 4060), including the rationale for various processes and valuable lessons learnt. Self-reported and biomedical data were obtained on risk factors (smoking, alcohol consumption, physical activity, family history, body mass index, blood pressure, cholesterol) and chronic conditions (asthma, chronic obstructive pulmonary disease, diabetes) to classify participants according to their status along a continuum. Segmenting this population sample along a continuum showed that 71.5% had at least one risk factor for developing asthma, chronic obstructive pulmonary disease or diabetes. Almost one-fifth (18.8%) had been previously diagnosed with at least one of these chronic conditions, and an additional 3.9% had at least one of these conditions but had not been diagnosed. This paper provides a novel opportunity to examine how a cohort study was born. It presents detailed methodology behind the selection, recruitment and examination of a cohort and how participants with selected chronic conditions can be segmented along a continuum that may assist with health promotion and health services planning.Janet F Grant, Catherine R Chittleborough, Anne W Taylor, Eleonora Dal Grande, David H Wilson, Patrick J Phillips, Robert J Adams, Julianne Cheek, Kay Price, Tiffany Gill and Richard E Ruffi

South Australian Monitoring and Surveillance System (SAMSS): health risk factor and chronic disease report

Jodie Avery, Elenora Del Grand

Chronic disease and risk factor surveillance using the SA Monitoring and Surveillance System (SAMSS) - history, results and future challenges

Anne Taylor and Eleonora Dal Grand

The South Australian Health Omnibus Survey 15 years on: has public health benefited?

Anne Taylor, Eleonora Dal Grande, David Wilso

Are baby boomers booming too much? An epidemiological description of overweight and obese baby boomers

SummaryObjectiveTo provide a social, demographic, and health-related description of overweight and obese baby boomers (born between 1946 and 1964).MethodData were collected using a monthly chronic disease and risk factor surveillance system in which a representative random sample of South Australians are selected from the Electronic White Pages each month and interviewed using computer assisted telephone interviewing (CATI).ResultsIn 2006-2007, 65% of baby boomers in South Australia were overweight or obese, and 26% were obese. There were statistically significant increases in both categories between 2002 and 2007. In 2006-2007, the overweight or obese groups were significantly different on a wide range of social, demographic and health-related variables when compared to their non-overweight peers at the univariate level. In the multivariate analysis the obese group was more likely to have risk factors (high blood pressure, insufficient exercise) and chronic disease (diabetes, asthma, arthritis). They were also more likely to be in lower socio-economic areas, to be of Aboriginal or Torres Strait Islander origin and have lower levels of education.ConclusionsAddressing the high rates of overweight and obesity within the baby boomers generation should be a policy priority. As this generation moves towards old age the significant associations between body mass index and chronic disease and disability promise to increase demand upon an already pressurized health system.Graeme Hugo, Anne W. Taylor, Eleonora Dal Grand

Population-attributable risk of childhood sexual abuse for symptoms of depression and suicidal ideation in adulthood

Objective. The aim of the study was to assess the population-attributable risks (PAR) of childhood sexual abuse (CSA) for depressive symptoms and suicidal ideation in adulthood. Method. A total of 2501 adult participants were randomly recruited and interviewed using a computer-assisted telephone interviewing system. They responded to items designed to assess depressive symptoms (SF-12), suicidal ideation (GHQ-28), and other distressing events, including CSA, as part of a broader, mental health survey of the South Australian population. Results. Logistic regression analyses indicated that CSA was associated with both depressive symptoms and suicidal ideation. However, PAR estimates indicated that only 0.8% of depressive symptoms could be attributed to CSA. Similarly, only 2.2% of suicidal ideation in the population could be attributed to CSA. Conclusions. Notwithstanding the individual distress associated with CSA, a population perspective indicated that the impact of CSA in adulthood was not as great as one might interpret from media reports.Robert D. Goldney, Eleonora Dal Grande and Anne Taylo

Beware the pitfalls of ill-placed questions - revisiting questionnaire ordering

Anne W Taylor, Eleonora Dal Grande, Tiffany Gil