Chapter 6 Health Behaviours

Key statistics at a glance

Nutrition

  • In 2007–2008, the majority of 2–15 year olds had the recommended amount of fruit and dairy, however less than half had the recommended amount of vegetables.[1]
    • 2–8 year olds were more likely than 9–15 year olds to have the recommended amount of fruit, dairy and vegetables.
    • Males were more likely than females to have the recommended amount of dairy, but not fruit or vegetables.
    • Children in rural areas were more likely than those in urban areas to have consumed the recommended amount of vegetables.
    • Children in the most disadvantaged areas were less likely than the population of 2–15 year olds in NSW to have consumed the recommended amount of vegetables.
  • Over the eight year period to 2008, the proportion of 2–15 year olds who had the recommended amount of vegetables and dairy increased significantly.
    • Fruit consumption decreased among 9–15 year olds and increased significantly among 2–8 year olds.

Healthy weight

  • In 2007–2008, almost two-thirds of 2–15 year olds had a healthy weight.[2]
    • 2–8 year olds were more likely than 9–15 year olds, males were more likely than females, and children in the most socioeconomically disadvantaged areas were more likely than the population of 2–15 year olds in NSW to be overweight or obese.

Perceptions of weight

  • In 2008, 71.2 per cent of 12–17 year old students thought they were about the right weight, 20.6 per cent thought they were too fat, and 8.2 per cent thought they were too thin.
    • Students aged 12–15 years were less likely than students aged 16–17 years to think they were too fat, and males were less likely than females to think they were too fat.
  • Over the seven year period to 2008 there was no significant change in the proportion of 12–17 year old students who thought they were too fat.

Physical activity

  • In 2009, approximately two-thirds of 5–14 year olds participated in at least one organised sport or physical activity outside of school hours.
  • In 2007–2008, one-quarter of 5–15 year olds met the recommended level of physical activity[3] outside of school hours.
    • A greater proportion of 5–8 year olds than 9–15 year olds met the recommended level of physical activity outside of school hours, and a greater proportion of children living in rural areas than those in urban areas met the recommended level.
  • In 2008, 13.3 per cent of 12–17 year old students met the recommended level of physical activity.
    • A greater proportion of males than females met the recommended level of activity.
  • Over the four year period to 2008 there was no significant change in the proportion of students aged 12–17 years who met the minimum recommended level of physical activity each day.

Sleeping patterns

  • In 2008, less than half of children aged 4–5 years and 8–9 years had a regular sleeping pattern.
    • Sleeping patterns were slightly less problematic for parents of 8–9 year olds than parents of 4–5 year olds.

Sexual and reproductive health

  • In 2008, 31.5 per cent of Year 10 students had had sex.
  • In 2008, there were 904 births to 15–17 year olds, or 0.7 births per 1,000 females in this age group.
    • Aboriginal females had nine times the birth rate of non-Aboriginal females in this age group.
  • Over the 15 year period to 2006, the birth rate among females aged 19 years and younger decreased substantially.

Alcohol use

  • In 2008, 56.1 per cent of 12–17 year old students drank alcohol in the last 12 months.
    • 12–15 year olds were less likely than 16–17 year olds, male students were just as likely as female students, and students living in rural areas were more likely than those living in urban areas to have drunk alcohol in the last 12 months.
  • The main source of alcohol for students aged 12–17 years who had drunk alcohol in the last seven days was parents, closely followed by ‘getting someone to buy it’ and friends.
    • Over the 24 year period to 2008 the proportion of 12–17 year old students who consumed alcohol in the previous 12 months decreased significantly.

Risky drinking

  • In 2008, 8.9 per cent of 12–17 year old students drank at risky levels.[4]
    • 8.0 per cent of students who were injured in the last six months had consumed alcohol in the six hours before they were injured.
    • A higher proportion of 16–17 year old students than 12–15 year old students drank at risky levels.
    • A smaller proportion of students in the former Greater Western Area Health Service[5] and students living in the most socioeconomically disadvantaged areas[6] drank at risky levels than the 12–17 year old student population in NSW.
  • Over the 24 year period to 2008, the proportion of students aged 12–17 years who consumed four or more drinks in one day during the last seven days ranged from 11.5 per cent in 1996 to 8.9 per cent in 2008.

Tobacco use

  • In 2008, 8.6 per cent of 12–17 year old students considered themselves a ‘current smoker’.
    • 12–15 year old students were less likely than 16–17 year old students, and males were just as likely as females, to consider themselves to be current smokers.
  • Over the 24 year period to 2009, the proportion of 12–17 year old students who had smoked tobacco decreased significantly.

Wanting to quit smoking

  • In 2008, 36.4 per cent of 12–17 year old students who were current smokers wanted to quit.
    • 12–15 year old students were less likely to want to quit than 16–17 year olds.

Smoking dependence

  • In 2008, 3.9 per cent of 12–17 year old students had patterns of smoking that indicated smoking dependence.[7]
    • 12–15 year old students were less likely than 16–17 year old students to have dependence-producing patterns.
    • Students in the former Greater Western and Hunter and New England Area Health Services were less likely than the 12–17 year old student population in NSW, to have dependence-producing patterns.
  • Over the nine year period to 2008, the proportion 12–17 year old students with established dependence-producing patterns of smoking decreased steadily.

Illicit drug use

  • In 2008, 14.6 per cent of 12–17 year old students had used an illicit drug sometime in their life.
    • The most common illicit drugs used were inhalants; sleeping tablets, sedatives or tranquillisers other than for medical reasons; and marijuana or cannabis.
    • With the exception of inhalants, 12–15 year old students were less likely than 16–17 year students to have used illicit drugs.
    • Male students were just as likely as female students to have used most illicit drugs, with the exception of using steroids and cocaine where male students were more likely users than female students. Female students were more likely to have used painkillers or analgesics than male students.
    • 5.5 per cent of 12–17 year old students who were injured in the last six months had consumed a drug in the six hours before they were injured.
  • Over the 13 year period to 2009, 160 children aged 12–17 years died in circumstances where an illicit drug was present.
  • Over the 13 year period to 2009, there was no illicit substance where usage increased among students aged 12–17 years.
    • There was a significant decrease in the use of painkillers or analgesics; inhalants; marijuana or cannabis; sleeping tablets, sedatives or tranquillisers other than for medical reasons; amphetamines; hallucinogens; cocaine; and heroin or opiates.
    • There was no change in the use of ecstasy, or steroids without a doctor’s prescription.

Introduction

It is important for children to develop healthy behaviours, as the patterns that develop in childhood often continue into adulthood (Dimitrakaki & Tountas, 2006; WHO, 2004) and can have a substantial influence on health outcomes. In 2003, tobacco smoking, physical inactivity, alcohol consumption, use of illicit drugs, lack of fruit and vegetables and unsafe sex were behaviours that accounted for the greatest burden of disease and injury in Australia (Begg S. et al, 2007).

There are many influences on children’s behaviour including their own biology, family, friends and other significant people, the media, micro and macro cultural norms, social and economic circumstances and the environment.

This chapter examines the extent to which NSW children adopt healthy behaviours. It examines nutrition and weight, physical exercise including participation in sport or physical activity, sleeping patterns in young children, sexual health and teenage pregnancy, alcohol use and risky drinking, illicit drug use and tobacco use.

The data presented is drawn from existing collections and established state, national or international measures are reported. Some additional information is presented to fill data gaps identified through the work of the NSW Commission for Children and Young People.

The information is provided as a resource for policy and research professionals working in both government and non-government settings who may or may not have detailed knowledge about the health behaviours of children. Since the purpose of reporting on this data is to help inform the development of policy and service delivery responses, a deficit approach is taken in preference to a strengths-based one. While deficit measures miss the positive aspects of children’s lives, such reporting is intended to assist policy makers to target their efforts at addressing both equity and efficiency concerns.

Nutrition

The National Health and Medical Research Council (NHMRC) has established minimum guidelines for the recommended intake of fruit, vegetables and dairy products. The minimum recommended daily consumption of fruit is one serve for 4–11 year olds and three serves for 12–18 year olds. The minimum recommended daily consumption of vegetables is two serves for 4–7 year olds and three serves for children aged eight years and over. The minimum recommended daily consumption of dairy products, including milk, yoghurt and cheese, is two serves for 4–11 year olds and three serves for 12–18 year olds. Good nutrition supports the growth and development that occurs in childhood, as well as contributing to physical and mental health (AIHW, 2009).

The NSW Population Health Survey (PHS) and the ABS National Health Survey (NHS) are the most reliable sources of information on the nutrition of children in NSW. The PHS provides parent-reported information on children aged 2–15 years and the NHS provides parent-reported information (or self-reported information where parental consent was given) on children aged 15–17 years and the demographic characteristics of these children. The two collections are used because together they provide greater coverage of the population of interest: children 0–17 years. The surveys adopt different methodologies and the reader should not compare the results reported in one survey with the other. More information on this can be found in the description of each collection in Appendix 1: Key survey sources and data reports.

Demographic characteristics of ongoing interest include Aboriginal children and children with a disability. While the PHS collects information on Aboriginal children, the small sample size limits regular reporting of Aboriginal children separately to non-Aboriginal children.

The PHS and the NHS, as with any survey, are subject to error. The limitations of these surveys include non-sampling and sampling errors, reporting by parents and not the child concerned (although the NHS may have personally interviewed children aged 15–17 years with parental consent), and the difficulties some respondents had in estimating the quantities consumed. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

Results from the NSW Population Health Survey (PHS)

The PHS asks parents of children in the 2–15 years age group the following questions: ‘How many serves of fruit does your child usually eat each day?’, ‘How many serves of vegetables does your child usually eat each day?’, ‘How many cups of milk does your child drink per day?’, ‘How many serves of custard does your child have per day?’, ‘How many serves of yoghurt does your child have per day?’ and ‘How many serves of cheese does your child have per day?’

In 2007–2008, 71.3 per cent of children aged 2–15 years[8] consumed the recommended daily intake of fruit, and 68.1 per cent the recommended intake of dairy. However, only 41.8 per cent consumed the recommended intake of vegetables (Figure 6.1) (Table A6.1 (XLSX 343.8KB), Table A6.3 (XLSX 343.8KB) and Table A6.5 (XLSX 343.8KB)).

Figure 6.1: Children aged 2–15 years consuming the minimum recommended daily intake of fruit, vegetables and dairy by age, NSW, 2007–2008

Source: NSW Population Health Survey 2007–2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.1 (XLSX 343.8KB), Table A6.3 (XLSX 343.8KB) and Table A6.5 (XLSX 343.8KB)).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location are considered:

  • A higher proportion of 2–8 year olds had the recommended amount of fruit, vegetables and dairy compared with 9–15 year olds.
    • For fruit, over 90 per cent of 2–8 year olds had the recommended intake compared with 50.5 per cent of 9–15 year olds (Table A6.1 (XLSX 343.8KB)).
    • For dairy, 82.8 per cent of 2–8 year olds had the recommended quantity compared with just over half of all 9–15 year olds (Table A6.3 (XLSX 343.8KB)).
    • For vegetables, half of 2–8 year olds had the recommended quantity compared with one-third of 9–15 year olds (49.5% compared with 35.1%) (Table A6.5 (XLSX 343.8KB)).

These results suggest that good eating habits during adolescence, which are particularly important during this period of rapid growth in both weight and height, are only evident in half of the 9–15 year old group.

  • There were no differences between males and females for fruit and vegetable consumption, but a higher proportion of males consumed the recommended daily dairy intake compared with females (70.6% and 65.4%) (Centre for Epidemiology and Research, 2010: 68).
  • There was no difference between children living in urban and rural areas for fruit or dairy consumption. However a greater proportion of children in rural health areas consumed the recommended daily vegetable intake compared with children in urban health areas (46.3% and 39.6%).
  • No difference was found among areas of socioeconomic disadvantage[9] for the consumption of fruit or dairy. However, a smaller proportion of children living in the most disadvantaged areas had consumed the recommended daily vegetable intake compared with the overall child population (34.5% and 41.8%) (Table A6.1 (XLSX 343.8KB), Table A6.3 (XLSX 343.8KB) and Table A6.5 (XLSX 343.8KB)).

Between 2001 and 2007–2008 there has been a significant increase in the proportion of children aged 2–15 years who consumed the recommended daily intake of vegetables and dairy. In the same period there has been no change in the proportion of children aged 2–15 years consuming the recommended daily fruit intake. However, there has been an increase in fruit consumption among children in the 2–8 years age group and a decrease among 9–15 year olds (Figure 6.2) (Table A6.2 (XLSX 343.8KB), Table A6.4 (XLSX 343.8KB) and Table A6.6 (XLSX 343.8KB)) (Centre for Epidemiology and Research, 2010: 66-69).

Figure 6.2: Children aged 2–15 years consuming the minimum recommended daily intake of fruit, vegetables and dairy, NSW, 2001 to 2007–2008

Source: NSW Population Health Survey 2007–2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.2 (XLSX 343.8KB), Table A6.4 (XLSX 343.8KB) and Table A6.6 (XLSX 343.8KB)).

Results for the ABS National Health Survey (NHS)

The 2007–2008 ABS National Health Survey extends the information available on age beyond 15 years. The Survey shows a similar decrease in nutrition as children get older with 18.0 per cent of children aged 16–17 years having an adequate intake of fruit, and 16.0 per cent an adequate intake of vegetables (ABS, 2009).

The National Partnership Agreement on Preventive Health seeks to address the rising prevalence of lifestyle-related chronic diseases with a specific outcome of increasing the proportion of children and adults at healthy body weight by 3 percentage points within ten years (COAG, 2008).

The NSW Government Plan for Preventing Overweight and Obesity in Children, Young People and their Families 2009–2011 presents a portfolio of initiatives to be implemented by the NSW Government to stop the growth in childhood obesity. The Plan promotes healthy food and physical activity choices and seeks to encourage behaviour change at both an individual and community level by addressing the five key priority areas: community information; healthy food; active lifestyles; sport and recreation infrastructure; and prevention and early intervention services (www.health.nsw.gov.au/pubs/2009/obesity_action_plan.html)

Healthy weight

Healthy weight and obesity are measured according to the Body Mass Index (BMI).[10] Children’s weight and BMI generally correlate with their nutritional intake, eating habits and levels of physical activity or inactivity.

The BMI categorises people into one of four groups: underweight, healthy weight, overweight, and obese.

Children who are underweight, overweight or obese are more likely to experience a range of intermediate and longer term health problems, such as increased risk of cardiovascular conditions, asthma and Type 2 Diabetes (AIHW, 2008). Australian research has found that being overweight and obese in childhood increases the risk of being overweight in adulthood (Magarey, Daniels, & Boulton, 2001), and that the onset of binge eating and overeating occurs in a significant number of 8–13 year olds (Allen, Byrne, La Puma, McLean, & Davis, 2008). Eating disorders such as binge eating, anorexia and bulimia are also recognised as mental health concerns that often occur alongside other mental health issues such as depression (RANZCP, 2005).

Reducing the prevalence of overweight and obese children is a key national and state priority area. It is also a key national and international indicator for reporting on the health of children (AIHW, 2010).

Body weight

The NSW Population Health Survey (PHS) and the NSW SchoolStudents Health Behaviours Survey (SSHBS) provide information on the Body Mass Index (BMI) of children calculated from parent-reported or self-reported height and weight and the demographic characteristics of these children. Characteristics of ongoing interest include Aboriginal children and children with a disability. While the PHS and SSHBS collect information on Aboriginal children, the small sample size limits regular reporting of Aboriginal children separately to non-Aboriginal children.The PHS provides parent-reported information on children aged 2–15 years and the SSHBS provides self-reported information for students aged 12–17 years. The two collections are used because together they provide greater coverage of the population of interest: children 0–17 years. The surveys adopt different methodologies and the reader should not compare the results reported in one survey with the other. More information on this can be found in the description of each collection in Appendix 1: Key survey sources and data reports.

The PHS and the SSHBS, as with any survey, are subject to error. The limitations of these surveys include non-sampling and sampling errors, difficulties some respondents had in estimating weight and height, and the BMI reported was calculated using either parent or self-reported height and weight measurements. While caution should be exercised when interpreting the BMI it remains a useful tool for ongoing surveillance of population health (Centre for Epidemiology and Research, 2010). The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

Results from the NSW Population Health Survey (PHS)

The PHS asked parents of children in the 2–15 years age group the following questions: ‘How tall is your child without shoes?’ and ‘How much does your child weigh without clothes or shoes?’

In 2007–2008, almost two-thirds (61.3%) of children aged 2–15 years in NSW had a BMI that placed them in the healthy weight range. The remainder were outside the healthy weight range: one in 10 children were underweight[11], one in five were overweight, and one in 12 were obese (Table A6.7 (XLSX 343.8KB)). A greater proportion of children aged 9–15 years had a healthy weight (65.7%), followed by 5–8 year olds (57.5%), and 2–4 year olds (52.6%).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location are considered:

  • A higher proportion of 2–8 year olds were overweight or obese compared with 9–15 year olds (31.3% and 27.2%) (Figure 6.3) (Table A6.7 (XLSX 343.8KB)).
  • A higher proportion of males were overweight or obese compared with females (31.3% and 26.5%) (Table A6.7 (XLSX 343.8KB)).

Figure 6.3: Weight status of children aged 2–15 years by sex and age group, NSW, 2007–2008

Note: Figures may not add up due to rounding.

Source: NSW Population Health Survey 2007–2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.7 (XLSX 343.8KB)).

  • A higher proportion of children living in areas in the most socioeconomically disadvantaged[12] group were overweight or obese compared with all children in NSW aged 2–15 years (33.7% and 28.9%). A lower proportion of children living in areas in the least disadvantaged group were overweight or obese compared with the overall NSW population of children aged 2–15 years (22.7% and 28.9%) (Table A6.8 (XLSX 343.8KB)) (Centre for Epidemiology and Research, 2010:177). This finding is supported by national research (Boese & Scutella, 2006).

Research in the US has also found that children in single-parent and step-parent (or no parent) families were at increased risk of unhealthy eating habits (i.e. skipping meals, fewer vegetables, and consuming more fast food) and had less parental monitoring of meals (Stewart & Menning, 2009).

Results from the NSW School Students Health Behaviours Survey (SSHBS)

The SSHBS asked students aged 12–17 years: ‘How tall are you without shoes?’, ‘How much do you weigh without clothes or shoes?’ and ‘Do you think of yourself as being too thin, about the right weight, or too fat?’

In 2008, among students aged 12–17 years, 21.4 per cent were overweight or obese (Table A6.9 (XLSX 343.8KB)).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location are considered:

  • No difference was found between age groups or students living in urban and rural health areas (Table A6.10 (XLSX 343.8KB)).
  • Male students were more likely than female students to be overweight or obese (26.2% and 15.3%).
  • Students living in areas in the most socioeconomically disadvantaged[13] group were more likely to be overweight or obese compared with all children in NSW aged 12–17 years (24.9% and 21.4%). Students living in areas in the least disadvantaged group were less likely to be overweight or obese compared with all children in NSW in this age group (15.8% and 21.4%) (Centre for Epidemiology and Research, 2009:27).

There has been no significant change in the proportion of 12–17 year old students who were overweight or obese between 2005 and 2008 (Table A6.11 (XLSX 343.8KB)).

Perceptions of body weight

In 2008, 8.2 per cent of students aged 12–17 years perceived themselves to be too thin, 71.2 per cent perceived themselves to be about the right weight, and 20.6 per cent perceived themselves to be too fat (Table A6.12 (XLSX 343.8KB)).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location were considered:

  • No difference was found between urban and rural health areas or among areas of socioeconomic disadvantage.[14]
  • Students aged 12–15 years were less likely to perceive themselves as too fat compared with students aged 16–17 years (19.9% and 22.6%).
  • Male students were less likely to perceive themselves as too fat compared with female students (15.0% and 26.4%).

Between 2002 and 2008 there has been no significant change in the proportion of 12–17 year old students who perceived themselves as too fat (Table A6.13 (XLSX 343.8KB)).

When students perceived body weight and calculated body mass were compared:

  • Of the 12–17 year old students who were underweight or had a healthy weight, 69.3 per cent perceived themselves as being too thin or about the right weight, and 9.3 per cent perceived themselves as being too fat.
  • Of the 12–17 year old students who were overweight or obese, 10.8 per cent perceived themselves as too thin or about the right weight, and 10.5 per cent perceived themselves as being too fat (Table A6.14 (XLSX 343.8KB)).

Physical activity

The National Physical Activity Guidelines for Australians outline the minimum levels of physical activity required to gain a health benefit. The Guidelines recommend that children aged 5–18 years accumulate at least 60 minutes of moderate to vigorous physical activity every day to keep healthy (DoHA, 2004a, 2004b).

Children’s physical activity is a critical health concern. In particular, children who are physically active have more favourable psychological health, showing lower levels of depression and anxiety (Booth et al., 2006). There is also increased risk of mortality and morbidity from a range of diseases and conditions when people undertake lower than recommended levels of physical activity (DoHA, 2004b).

Physical activity is also an important social activity, and has a positive impact on children’s ability to interact with peers and develop skills such as cooperation, self-discipline, sportsmanship, leadership and self-confidence (Booth, et al., 2006; Slater & Tiggemann, 2010).

Two areas of physical activity are reported here: participation in sport or physical activity, and activity level. Activity level is a key national indicator of physical health (AIHW, 2010). Participation in sport or physical activity is also reported to meet the needs of policy and service delivery professionals.

Participation in sport or physical activity

The ABS Children’s Participation in Cultural and Leisure Activities Survey (CPCLAS) and the Longitudinal Study of Australian Children (LSAC) provide information on the participation of children in sport or other physical activity. The collections currently provide the best source of data in this area. The CPCLAS provides adult-reported information about the participation of their children aged 5–14 years in sport or other physical activity undertaken outside of school hours. The LSAC provides similar information from parent reports about their children aged 4–5 years and 8–9 years. The two collections are used because together they provide greater coverage of the population of interest: children 0–17 years. The surveys adopt different methodologies and the reader should not compare the results reported in one survey with the other. More information on this can be found in the description of each collection in Appendix 1: Key survey sources and data reports.

The CPCLAS and the LSAC, as with any survey, are subject to error. The limitations of these surveys include non-sampling and sampling errors, reporting by parents or any other responsible adult in the household and not the child concerned and recall for self-reporting by children. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

Results for the ABS Children’s Participation in Cultural and Leisure Activities Survey (CPCLAS)

In 2009, ABS collected information from a sample of children aged between 5 and 14 years about their participation in sport or physical activity outside of school hours in the 12 months prior to interview. The data showed that 67.6 per cent of the children in NSW participated in sport or physical activity outside of school hours in the previous 12 months: 60.3 per cent participated in at least one organised sport or activity[15] and just over seven per cent were involved in dancing[16] (Table A6.15 (XLSX 343.8KB)).

While on average 45.8 per cent participated in an organised sport once a week or more (Table A6.16 (XLSX 343.8KB)), the majority of NSW children (56.5%) participated in organised sport for four hours or less over a two week period prior to the interview (Table A6.17 (XLSX 343.8KB)).

Results from the Longitudinal Study of Australian Children (LSAC)

In 2008, parents of LSAC children aged 4–5 and 8–9 years were asked: ‘In the past week, on how many days have you or an adult in your family played a game outdoors or exercised like walking, swimming or cycling with the child?’

Parents reported that 15.7 per cent of 4–5 year olds and 11.3 per cent of 8–9 year olds were involved in family activities such as outdoor games, walking, swimming or cycling nearly every day. Among 4–5 year olds, a greater proportion of males participated in these activities than females, although no gender differences were apparent between 8–9 year olds (Table A6.18 (XLSX 343.8KB)).

Other research has found that children from culturally and linguistically diverse backgrounds, and particularly girls, are under-represented in sport and recreation activities (Booth et al., 2006; CMYI, 2005). However, there are no data available on this for children living in NSW.

Potential reasons for lower participation rates among certain groups include neighbourhood and safety concerns felt by parents (Timperio, Crawford, Telford, & Salmon, 2004), especially for young children and adolescent females (Carver, Timperio, Hesketh, & Crawford, 2010). Parental and peer involvement and participation in sport and physical exercise are also likely to impact on children’s participation (Duncan, & Stryker, 2005; Loprinzi & Trost, 2010). Lower participation rates among girls in particular have been attributed to perceptions that it is neither ‘cool’ nor feminine to play sport, embarrassment at being watched, and teasing from peers, particularly by boys (Slater & Tiggemann, 2010).

Other barriers may include time, financial costs and the variety of activities available (Alston & Kent, 2009; Hardy, Kelly, Chapman, King, & Farrell, 2010; Hardy et al., 2010) suggest it is important for initiatives to promote organised sport by reducing costs and increasing variety, especially for families with lower incomes and those living in rural and regional areas.

In February 2011 the Commonwealth and State and Territory Ministers for Sport and Recreation endorsed the first National Sport and Active Recreation Policy Framework (the Framework).

The Framework gives governments the basis for clear alignment of Australia’s national sport and active recreation system. It will guide the future development of policies, strategies, and programs to deliver benefits to all Australians through sport – from grassroots participation through to national and international success

Reference: http://www.regional.gov.au/sport/resources/reports/nsarpf.aspx

Levels of physical activity

The NSW School Students Health Behaviours Survey (SSHBS) and the NSW Population Health Survey (PHS) provide information on activity levels for children and the demographic characteristics of the children. Characteristics of ongoing interest include Aboriginal children and children with a disability. While the PHS and SSHBS collect information on Aboriginal children, the small sample size limits regular reporting of Aboriginal children separately to non-Aboriginal children.

The SSHBS provides self-reported information from students aged 12–17 years. The PHS provides parent-reported information about the general levels of activity outside of school hours for their children aged 5–15 years. The two collections are used because together they provide greater coverage of the population of interest: children 0–17 years. The surveys adopt different methodologies and the reader should not compare the results reported in one survey with the other. More information on this can be found in the description of each collection in Appendix 1: Key survey sources and data reports.

The SSHBS and the PHS, as with all surveys, are subject to error. The limitations of these surveys include non-sampling and sampling errors and for the PHS, reporting by parents and not the child concerned. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

Results from the NSW Population Health Survey (PHS)

The PHS asked parents of 5–15 years olds: ‘On about how many days during the school week does your child usually do physical activity outside of school hours?’, ‘On those days, about how many hours does your child usually do physical activity?’, ‘On about how many weekend days does your child usually do physical activity?’, ‘On a typical weekend day, about how many hours does your child usually do physical activity?’

In 2007–2008 one-quarter of children aged 5–15 years usually undertook one or more hours of physical activity every day outside of school hours (Table A6.19 (XLSX 343.8KB)).

When the statistical significance of age, sex, socioeconomic disadvantage, geographic location were considered:

  • A greater proportion of 5–8 year olds than 9–15 year olds undertook one or more hours of physical activity every day outside of school hours (34.3% and 20.2%).
  • A greater proportion of male children, across all age groups, undertook one or more hours of physical activity every day outside of school hours (29.5% and 20.3%) (Figure 6.4) (Table A6.19 (XLSX 343.8KB)).

 

Figure 6.4: Children aged 5–15 years doing adequate physical activity outside of school hours every day by age and sex, NSW, 2007–2008

Note: Figures may not add up due to rounding.

Source: NSW Population Health Survey 2007–2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.19 (XLSX 343.8KB)).

  • A greater proportion of children living in rural areas undertook one or more hours of physical activity every day outside of school hours than children living in urban areas (30.8% and 22.1%) (Figure 6.5) (Table A6.19 (XLSX 343.8KB)).

Figure 6.5: Children aged 5–15 years doing adequate physical activity outside of school hours every day by age and location, NSW, 2007–2008

Note: Figures may not add up due to rounding.

Source: NSW Population Health Survey 2007–2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.19 (XLSX 343.8KB)).

  • A greater proportion of children living in areas in the fourth quintile of socioeconomic disadvantage[17] undertook one or more hours of physical activity every day outside of school hours than all children in NSW (29.8% and 25.0%) (Table A6.19 (XLSX 343.8KB)) (Centre for Epidemiology and Research, 2010).

Between 2005–2006 and 2007–2008 there had been no significant change in the proportion of children aged 5–15 years who met the criteria for adequate physical activity outside of school hours each day (Table A6.20 (XLSX 343.8KB)).

Results from the NSW School Students Health Behaviours Survey (SSHBS)

The SSHBS asked students aged 12–17 years: ‘How many days in the past week have you done any vigorous or moderate physical activity for a total of at least 60 minutes? (This could be made up of different activities during the day like cycling or walking to and from school, playing sport at lunchtime or after school, doing an exercise class, doing housework etc.)’

In 2008, 13.3 per cent of 12–17 year old students were involved in a minimum of 60 minutes of moderate to vigorous physical activity each day in the week before the survey, meeting the minimum recommended level of physical activity (Table A6.21 (XLSX 343.8KB)).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location were considered:

  • No significant difference was found between students living in rural health and urban health areas.
  • 12–15 year old students were more likely to meet the minimum standards compared with 16–17 year old students (14.6% and 10.2%).
  • Male students were more likely to meet the minimum standards compared with female students (16.2% and 10.5%).
    • When sex and age are compared, a smaller proportion of older teenagers and females on average undertook adequate exercise (Figure 6.6) (Table A6.21 (XLSX 343.8KB)). This is consistent with previous research (Slater & Tiggemann, 2010).

Figure 6.6: Students aged 12–17 years who do adequate physical activity by age and sex, NSW, 2008

Note: Figures may not add up due to rounding.

Source: NSW School Students Health Behaviours Survey 2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.21 (XLSX 343.8KB)).

  • Students living in the least socioeconomically disadvantaged group[18] were significantly less likely to meet the minimum recommended level of physical activity each day compared with all students aged 12–17 years (10.9% and 13.3%) (Table A6.21 (XLSX 343.8KB)) (Centre for Epidemiology and Research, 2009).

Between 2005 and 2008 there was no significant change in the proportion of 12–17 year old students who met the minimum recommended level of physical activity each day (Table A6.23 (XLSX 343.8KB)).

Sleeping patterns

The Australian Institute of Health and Welfare (AIHW, 2010:1) estimates that adolescents need approximately nine hours of sleep per night (Carskadon, 1999).

Sleep is critically important to a child’s development, behaviour and well-being (Galland & Mitchell, 2010; Hiscock, Canterford, Ukoumunne, & Wake, 2007; Raising Children Network, 2010). Sleep disorders and sleep deprivation can have an impact on the health and well-being of young people by reducing their capacity to undertake normal everyday activities. Thinking, emotional balance and behaviour are all affected by chronic sleep deprivation (Carpenter 2001), with demonstrated outcomes such as poorer school grades (Curcio et al. 2006; Wolfson & Carskadon 2003), and a higher rate of traffic accidents (Lucidi et al. 2006). Epidemiological studies have demonstrated that earlier bedtimes may protect against adolescent depression and suicidal ideation by increasing the period of time adolescents sleep (Gangwisch et al. 2010).

The Longitudinal Study of Australia’s Children (LSAC) currently provides the best source of data on the sleep of children.

The LSAC, as with any survey, is subject to error. The limitations of this survey include non-sampling and sampling errors, reporting by parents and not the child concerned and recall for self-reporting by children. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

In 2008, parents of LSAC children aged 4–5 years and parents of LSAC children aged 8–9 years were asked: ‘How much is your child’s sleeping patterns or habits a problem for you?’ and ‘Does your child go to bed at regular times? Regular means at the same time each night, not whether it’s early or late.’

Less than half of the parents with children aged 4–5 years and children aged 8–9 years reported that their child ‘always has a regular sleeping pattern’ (46.0% and 43.4%). There were few differences on the basis of sex and age (Table A6.24 (XLSX 343.8KB)).

For most parents, their child’s sleeping patterns were not a problem for the parent (Figure 7) (Table A6.25). However, sleeping patterns are slightly less problematic for parents of 8–9 year olds than parents of 4–5 year olds (79.0% and 72.1%) (Table A6.25 (XLSX 343.8KB)).

Figure 6.7: Children aged 4–9 years by sleeping pattern and age, NSW, 2008

Note: Figures may not add up due to rounding.

Source: Social Policy Research Centre (SPRC) calculations based LSAC 2008, Wave 3 data (Table A6.25 (XLSX 343.8KB)).

Sexual and reproductive health

Sexual development is a normal part of adolescence and sexual and reproductive behaviour during this time can have far-reaching consequences in later life (AIHW, 2010).

Three areas of sexual and reproductive health are reported here[19]: sexual intercourse, use of contraception, and births to young mothers. These areas are the subject of national and international reporting (AIHW, 2010).

The Secondary Students and Sexual Health Survey (SS&SHS) provides the best source of data on the sexual health of secondary school students in Years 10 and 12 and the demographic characteristics of the children. The NSW Midwives Data Collection (MDC) is the best source of information on births to young mothers in NSW public and private hospitals, and at home.

The SS&SHS and the MDC, as with any collection, are subject to error. The limitations of the 2008 SS&SHS include a smaller than average response rate and over-representation of Year 10 students in the sample. Limitations of the MDC include item non-response, transcription errors, coding errors, clerical and editing errors, and data conversion errors. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

Sexual intercourse

The timing of first sexual intercourse and the context in which it occurs have important implications for health (DEECD, 2007).

In 2008 the SS&SHS asked students in Year 10: ‘Have you ever had sex?’, ‘Over the last year with how many people have you had intercourse?’ and ‘The last time you had sex which, if any, forms of contraception did you or the person you had sex with use? The pill, IUD, diaphragm, the morning after pill, withdrawal rhythm method, condom, none, other – please specify, I’ve never had sex’.

Based on these responses, in 2008 31.5 per cent of students in Year 10 reported ever having sexual intercourse. A greater proportion of male Year 10 students had sexual intercourse compared with female students (35.1% and 29.5%) (Table A6.26 (XLSX 343.8KB)).

The majority of sexually active students (96.2%) reported having experienced sexual intercourse with at least one person in the year prior to being surveyed (Table A6.27 (XLSX 343.8KB)).

Consistent with international trends, in the age of onset of first sexual activity in Australia has fallen (DEECD, 2007 and Russel et al., 2003), and due to this young people may be at higher risk of unplanned pregnancy and sexually transmitted infections.

NSW sexual health services do not routinely work with children. In circumstances where children under 14 present for sexual health services, services are required to work with a Department of Family and Community Services case manager whose role is to coordinate the development of a protection plan, using the interagency approach, as per the ‘NSW Interagency Guidelines for Child Protection Interventions 2000’ and ‘NSW Interagency Guidelines for Child Protection Interventions 2006’. Young people’s sexual health needs are considered in the development of the NSW Youth Health Policy: Healthy bodies, healthy minds, vibrant futures 2010–2015. (NSW Government Response to the Parliamentary Inquiry into Children and Young People aged 9–14 years).

Reference: http://www.caah.chw.edu.au/policy/policy.htm

Within NSW Department of Health, a NSW STI Programs Unit was established in 2007 to assist coordination and, where appropriate, to implement state-wide aspects of the NSW Sexually Transmissible Infections Strategy 2006–2010, which has been evaluated with the view to revise the document in 2011. Young people are identified as a priority group within the Strategy.

There are three active campaigns in NSW created out of the Strategy. These include a HIV/AIDS, STI and Hepatitis C campaign

Reference: http://www.health.nsw.gov.au/policies/pd/2006/pdf/PD2006_071.pdf

Contraception

Reducing unwanted pregnancies and the prevalence of STIs among young people relies heavily on the use of effective contraception (AIHW, 2010).

In 2008, the SS&SHS reported sexually active students most commonly used a condom (63.3%) and/or the contraceptive pill (35.2%) the last time they had sex. Approximately one in 10 sexually active students (12.2%) reported using the withdrawal method at the last sexual encounter (Table A6.28 (XLSX 343.8KB)).

Births to teenage mothers

The number of teenage pregnancies reflects sexual health behaviour and maternal and perinatal outcomes. While births to young mothers do not always result in negative outcomes, teenage pregnancy can place young mothers at risk of poor health and the baby at a greater risk of perinatal death (AIHW, 2009; Laws & Sullivan, 2009). Teenage parenthood also leads to increased risk of interrupted education and employment for parents, lone parenthood, dependence on government assistance and poverty (AIHW, 2009).

In 2008, the Midwives Data Collection (MDC) recorded 904 births to 15–17 year olds (Table A6.29 (XLSX 343.8KB)). This represents a birth rate of 0.7 per 1,000 females 15–17 years. Just over 60 per cent (61.3%) of the 904 births were to 17 year olds.

The birth rate among Aboriginal females was nine times the rate for non-Aboriginal females (4.5 births per 1,000 compared with 0.5 births).

The birth rate among females aged 19 years or younger has, on the whole, decreased substantially over the period 1992–2006 (21.8 to 15.4 per 1,000 births) (Figure 6.8) (Table A6.30 (XLSX 343.8KB)).

Figure 6.8: Births per 1,000 live births for females aged 19 years and under, NSW, 1992–2006

Note: Births to NSW residents only were included.

Source: NSW Midwives Data Collection and ABS population estimates (HOIST) (Table A6.30 (XLSX 343.8KB)).

Alcohol use and risky drinking

The National Health and Medical Research Council (NHMRC) recommends, for healthy men and women, drinking no more than four standard drinks[20] on a single occasion to reduce the risk of alcohol-related injury arising from that occasion.

The NHMRC (2009) recommends that the onset of drinking alcohol be delayed as long as possible. Guideline 3 of the Australian Alcohol Guidelines states:

For children and young people under 18 years of age, not drinking alcohol is the safest option.

A. Parents and carers should be advised that children under 15 years of age are at the greatest risk of harm from drinking and that for this age group, not drinking alcohol is especially important.

B. For young people aged 15–17 years, the safest option is to delay the initiation of drinking for as long as possible.

The NHMRC base Guideline 3 on an assessment of the potential harms of alcohol for children under 18 years and research indicating that alcohol may ‘adversely affect brain development and be linked to alcohol related problems later in life. However, this evidence is not conclusive enough to allow definitive statements to be made about the risks of drinking for young people.’ (NHMRC, 2009: 57). As a result no ‘safe’ or ‘no-risk’ drinking level is set.

Alcohol consumption can place children and young people at greater risk of negative social and health outcomes (NHMRC, 2009). While alcohol use is not problematic for most teenagers, risky or chronic alcohol use can have serious long-term consequences (DEECD, 2009). These consequences may include unsafe behaviour as a result of impaired decision-making, including injury and self-harm, impaired brain development, risk of alcohol dependence in later life, and poor physical and mental health (AIHW, 2009).

Demographic factors have been found to be associated with young people’s alcohol consumption, including age, sex, Aboriginality and other cultural backgrounds, recreational spending money, life stage, life situation, family conflict, and age at first drink (Livingston, Laslett, & Dietze, 2008; Mission Australia, 2008). The likelihood of risky drinking behaviours has also been found to be higher among young people living in rural and remote areas, from dysfunctional families, and of Aboriginal background (Loxley, Toumbourou, & Stockwell, 2004).

Two areas of alcohol use are reported here: alcohol consumption and risky drinking. Risky drinking is a national indicator of young people’s health and well-being (AIHW, 2010).

Two collections are used to report on alcohol use: the NSW School Students Health Behaviours Survey (SSHBS) and the NSW Child Death Review Team (CDRT) collection. The SSHBS provides the best source of data about NSW students’ behaviours and attitudes to alcohol use and the characteristics of the children, and the CDRT collection holds the best source of information on deaths of children that occur where alcohol is present.

Demographic characteristics of ongoing interest include Aboriginal children and children with a disability. While the SSHBS collects information on Aboriginal children, the small sample size limits regular reporting of Aboriginal children separately to non-Aboriginal children. The CDRT collection supports regular reporting of Aboriginal children separately to non-Aboriginal children.

The SSHBS and the CDRT, as with any collection, are subject to error. The limitations of the SSHBS include non-sampling and sampling errors. The CDRT collection is subject to item non-response, transcription errors, coding errors, clerical and editing errors, and data conversion errors. In addition, the presence of alcohol is based on toxicology undertaken to inform autopsy; it is possible that alcohol may be present for reasons other than the child’s behaviour. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

Alcohol use

The SSHBS asked students aged 12–17 years a range of questions about their alcohol use including: ‘Have you had an alcoholic drink in the last twelve months?’, ‘During the last seven days, including yesterday, write the number of alcoholic drinks you had each day of the week’, ‘How many alcoholic drinks have you had each day in the last seven days?’, ‘Where, or from whom, did you get your last alcoholic drink?’ and ‘Had you consumed alcohol in the six hours before you were hurt or injured?’

Consumption in the last seven days

In 2008, the SSHBS reported 20.4 per cent of students aged 12–17 years had consumed alcohol in the last seven days (Table A6.31 (XLSX 343.8KB)).

The most reported source of the last alcoholic drink for 12–15 year olds who drank in the last seven days was parents (32.8%), while the most reported source for 16–17 year olds was ‘getting someone to buy it’ (28.5%), followed by parents (24.7%) and friends (24.3%). Other sources included siblings, taking alcohol from home without permission, and buying it themselves. While there is some difference in proportions, the common providers of alcohol were the same for male and female students (Table A6.32 (XLSX 343.8KB)).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location were considered:

  • No difference was found between male and female students or students living in rural and urban health areas.
  • 12–15 year old students were less likely to have consumed alcohol in the last seven days compared with students aged 16–17 years (14.2% and 36.2%) (Figure 6.9) (Table A6.31 (XLSX 343.8KB)).

Figure 6.9: Students aged 12–17 years consuming alcohol in last seven days by age and sex, NSW, 2008

Note: Figures may not add up due to rounding.

Source: NSW School Students Health Behaviours Survey 2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.31 (XLSX 343.8KB)).

  • Students living in areas in the most socioeconomically disadvantaged[21] group were less likely to have consumed alcohol in the last seven days compared with the overall student population aged 12–17 years (17.1% and 20.4%) (Table A6.31).
  • Students in the former Greater Southern Area Health Service[22] were more likely to have consumed alcohol in the last seven days compared with the overall student population aged 12–17 years (30.5% and 20.4%).Table A6.31 (XLSX 343.8KB)
  • Students in the former Greater Western Area Health Service were less likely to have consumed alcohol in the last seven days compared with the overall student population aged 12–17 years (11.9% and 20.4%) (Table A6.33 (XLSX 343.8KB)) (Centre for Epidemiology and Research, 2009:97).

The proportion of 12–17 year old students who had consumed alcohol in the last seven days decreased significantly between 1984 and 2008 (32.5% to 20.4%). This decrease is significant for both 12–15 year old students (28.4% to 14.2%) and 16–17 year old students (49.8% to 36.2%) (Centre for Epidemiology and Research, 2009:175) (Figure 6.10) (Table A6.34 (XLSX 343.8KB)).

Figure 6.10: Students aged 12–17 years consuming alcohol in the last seven days by age, NSW, 1984–2008

Source: NSW School Students Health Behaviours Survey 2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.34 (XLSX 343.8KB)).

Consumption in the last 12 months

In 2008, the SSHBS reported 56.1 per cent of 12–17 year old students said that they had consumed alcohol in the last 12 months, a greater proportion than had consumed alcohol in the last seven days[23] (Table A6.35 (XLSX 343.8KB)).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location were considered:

  • No difference was found between male and female students.
  • 12–15 year old students were less likely to have consumed alcohol in the last 12 months than those aged 16–17 years (47.1% and 79.2%).
  • Students living in areas in the third most socioeconomically disadvantaged[24] group were more likely (61.1%), and students in the fifth or most socioeconomically disadvantaged group (49.9%) were less likely, to have consumed alcohol in the last 12 months compared with the overall student population aged 12–17 years (56.1%).
  • Students living in rural health areas were more likely to have consumed alcohol in the last 12 months compared with students living in urban health areas (62.3% and 53.2%) (Table A6.35 (XLSX 343.8KB)).
  • Students in the Greater Southern (71.2%) and North Coast (69.3%) former Area Health Services[25] were more likely to have consumed alcohol in the last 12 months compared with the overall student population aged 12–17 years (56.1%).
  • Students in the former Sydney South West Area Health Service were less likely to have consumed alcohol in the last 12 months compared with the overall student population aged 12–17 years (48.5% and 56.1%) (Table A6.36 (XLSX 343.8KB)).

There was a significant decrease between 1984 and 2008 in the proportion of students aged 12–17 years who reported consuming alcohol in the last 12 months (72.4% to 56.1%). The decrease has been significant for both 12–15 year old students (68.1% to 47.1%) and 16–17 year old students (90.5% to 79.2%) (Centre for Epidemiology and Research, 2009:96) (Table A6.37 (XLSX 343.8KB)).

Risky drinking

As noted above just over 20 per cent of 12–17 years had consumed alcohol in the seven days before the 2008 SSHBS. The majority of students aged 12–17 (60.9%) who consumed alcohol in the previous week reported drinking 1–5 standard alcoholic drinks, a further 18.6 per cent reported drinking 6–10 drinks. The remainder reported drinking 11 or more drinks, while 7.8 per cent reported consuming over 21 drinks (Table A6.38 (XLSX 343.8KB)).

There was no significant difference between age groups, or between male and female students. A greater proportion of male students drank a larger number of standard drinks than female students (24.1% of male students and 16.5% of female students consumed 11 or more drinks) (Table A6.38 (XLSX 343.8KB)).

The number of alcoholic drinks consumed increased with age; 14.0 per cent of 12–15 year olds reported consuming 11 or more drinks in the previous week, compared with 27.1 per cent of 16–17 year olds (Table A6.39 (XLSX 343.8KB)).

Consumed four or more drinks in one day

In 2008, 8.9 per cent of students aged 12–17 years consumed four or more drinks on any one day during the last seven days. The NHMRC recommends four standard drinks for healthy men and women over the legal drinking age in Australia (18 years) (Table A6.40 (XLSX 343.8KB)).

While the statistical significance of age, sex, socioeconomic disadvantage and geographic location has not been determined, when proportions are considered:

  • No difference was found between male and female students.
  • 12–15 year old students were less likely to have consumed four or more drinks on any one day compared with students aged 16–17 years (4.3% and 20.7%).
  • Students living in areas in the most socioeconomically disadvantaged[26]group were significantly less likely (7.1%) to have consumed four or more drinks on any one day compared with the overall student population aged 12–17 years (8.9%).
  • Students in the former Greater Western (3.7%) Area Health Service[27] were less likely to have consumed four or more drinks on any one day compared with the overall student population aged 12–17 years (8.9%) (Table A6.40 (XLSX 343.8KB)).

Between 1984 and 2008, the proportion of students aged 12–17 years who consumed four or more drinks on any one day during the last seven days ranged from 8.9 per cent in 2008 to 11.5 per cent in 1996 (Figure 6.11) (Table A6.41 (XLSX 343.8KB)).

Figure 6.11: Students aged 12–17 years consuming four or more drinks on any one day during the last seven days, NSW, 1984–2008

Source: NSW School Students Health Behaviours Survey 2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.41 (XLSX 343.8KB)).

In March 2008, the then Prime Minister announced a National Binge Drinking Strategy to address binge drinking among young people. The strategy comprised:

- community level initiatives to confront the culture of binge drinking, particularly in sporting organisations;

- early interventions to assist young people and ensure that they assume personal responsibility for their binge drinking; and

- advertising that confronts young people with the costs and consequences of binge drinking

Reference: http://www.health.gov.au/internet/alcohol/publishing.nsf/Content/cli

In 2008, the then NSW Minister for Health launched a teenage binge drinking campaign including an interactive website and booklets to raise awareness among young people and their parents about the risks of binge drinking. The campaign forms part of an overall strategy to promote responsible drinking and reduce the growing number of young people abusing alcohol.

The website – www.whatareyoudoingtoyourself.com – expands on the key messages of the booklets as well as offering an interactive educational environment with a quiz and contact details for further information. The resources were developed in consultation with NSW Police, National Drug and Alcohol Research Council and City of Sydney Council

Reference: http://www.whatareyoudoingtoyourself.com

Injury and death

Alcohol consumption can be associated with physical injury and death, not only for those consuming alcohol, but also for those around them.

In 2008, the SSHBS reported that 38.8 per cent of students aged 12–17 years reported being injured in the last six months where they had to see a doctor or physiotherapist or health professional. Of these, 8.0 per cent had consumed alcohol in the six hours before they were injured. Students aged 12–15 years were significantly less likely than 16–17 year olds to have reported consuming alcohol in the six hours before they were injured (6.4% and 12.6%) (Table A6.42 (XLSX 343.8KB)).

Drinking contributes to the leading causes of death among young people – unintentional injuries and suicide (NHMRC, 2009:58).

In 2009, the CDRT reported nine children aged 12–17 years died an alcohol-related death[28], six of these children died in transport fatalities, either as pedestrians, drivers or passengers and three died by suicide. For all but one child, records indicated that alcohol had been consumed by the child in the period immediately prior to their death. The other child had a blood alcohol level of 0.102g/100mL with no information in case records on the child’s behaviour immediately prior to death (CDRT, 2010).

From 1996 to 2009, 179 children aged 12–17 years died in circumstances where alcohol was present (Table A6.43 (XLSX 343.8KB)):

  • Male children were 3 times more likely to die where alcohol was present compared with female children.
  • Aboriginal children were 2.8 times more likely to die where alcohol was present compared with non-Aboriginal children.
  • Children aged 16–17 years were 48.6 times more likely to die where alcohol was present compared with children aged 12–13 years, and children aged 14–15 years were 10.3 times more likely compared with the younger group.
  • Children living in outer and remote areas were 3.3 times more likely to die an alcohol-related death, and those living in inner regional areas were 1.7 times more likely, compared with those living in major cities (Table A6.43 (XLSX 343.8KB)).

Tobacco and other illicit drug use       

Illicit drugs are illegal drugs such as amphetamines, cannabis, and heroin; drugs and volatile substances used illegally such as petrol; pharmaceutical drugs taken for non-medical reasons such as pain killers; and tobacco products, as it is illegal for children under 18 years to purchase or use these products.

The use of illicit drugs is associated with psychological and other health problems. Use can lead to a range of medical conditions and behavioural problems, and has been linked to criminal behaviour (AIHW, 2010: 64). The World Health Organization (2010) has identified tobacco as the second major cause of death and the fourth most common risk factor for disease worldwide. Most people who become long-term smokers start smoking in their teenage years, and early uptake is associated with heavier smoking and greater difficulty in quitting (Centre for Epidemiology and Research, 2008).

Two areas of illicit drug use are reported here: use of illicit substances excluding tobacco use, and tobacco use. Both are national indicators of young people’s health and well-being (AIHW, 2010).

Two data collections are used to report on the illicit drug use of children: the NSW School Students Health Behaviours Survey (SSHBS) and the NSW Child Death Review Team (CDRT) collection.

The SSHBS provides self-reported information from students aged 12–17 years about their behaviours and attitudes to illicit drug use, including tobacco use, and the demographic characteristic of the children. It is the best source of data in NSW. The CDRT collection holds the best source of information on the deaths of children that occurred where illicit drugs were present.

Demographic characteristics of ongoing interest include Aboriginal children and children with a disability. While the SSHBS collects information on Aboriginal children, the small sample size limits regular reporting of Aboriginal children separately to non-Aboriginal children. The CDRT collection supports regular reporting of Aboriginal children separately to non-Aboriginal children.

The SSHBS and CDRT, as with any collection, are subject to error. Limitations of the SSHBS include non-sampling and sampling errors. The CDRT collection is subject to item non-response, transcription errors, coding errors, clerical and editing errors, and data conversion errors. In addition, it is possible that illicit drugs may be present for reasons other than the child’s behaviour, since the presence of illicit drugs is based on toxicology undertaken to inform autopsy. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

The aim of the National Drug Strategy 2010–2015 is to build safe and healthy communities by minimising alcohol, tobacco and other drug-related health, social and economic harms among individuals, families and communities.

The overarching approach of harm minimisation, which has guided the National Drug Strategy since its inception in 1985, will continue through 2010–2015.

The Strategy acknowledges closer integration with child and family services is needed to more effectively recognise and manage the impacts of drug use on families and children.

Reference: http://www.nationaldrugstrategy.gov.au

Tobacco use

Current smokers

The SSHBS defines ‘current smokers’ as students who considered themselves to be heavy, light, or occasional smokers. In 2008, 8.6 per cent of students aged 12–17 years considered themselves current smokers (Table A6.44 (XLSX 343.8KB)). NSW Department of Health report that 1.7 per cent considered themselves to be a heavy smoker, 2.4 per cent a light smoker, 4.5 per cent an occasional smoker, 2.2 per cent an ex-smoker, and 89.2 per cent a non-smoker (Centre for Epidemiology and Research, 2009:117).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location were considered:

  • No difference was found between male and female students, among different socioeconomically disadvantaged[29] areas, or between urban and rural health areas.
  • 12–15 year old students were less likely to be current smokers compared with students aged 16–17 years (5.5% and 16.6%) (Table A6.44 (XLSX 343.8KB)).
  • Students in the former Hunter and New England (4.4%) and Greater Western (3.9%) Area Health Services[30] were less likely to be current smokers compared with the overall student population aged 12–17 years (8.6%) (Table A6.45 (XLSX 343.8KB)).

Between 1984 and 2008, there was a significant decrease in the proportion of students aged 12–17 years who were current smokers (27.3% to 8.6%).

More recently, between 2005 and 2008 there was a significant decrease in current smokers for 12–15 year old students (7.3% to 5.5%) but no significant change for the 16–17 year age group (Table A6.46 (XLSX 343.8KB)) (Centre for Epidemiology and Research, 2009:117).

Smoking in the last seven days

In 2008, 7.3 per cent of students had smoked tobacco in the last seven days (Table A6.47 (XLSX 343.8KB)). Of these students, over half (53.2%) reported smoking 1–10 cigarettes, 13.2 per cent smoked 11–20 cigarettes, 9.7 per cent smoked 21–30 cigarettes, 6.2 per cent smoked 31–40 cigarettes, 3.2 per cent smoked 41–50 cigarettes, and 14.6 per cent smoked 51 or more cigarettes (Table A6.48 (XLSX 343.8KB)).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location were considered:

  • There was no significant difference between male and female students, among different socioeconomically disadvantaged[31] areas, or between urban and rural health areas.
  • Students aged 12–15 years were less likely to have smoked tobacco in the last seven days compared with students aged 16–17 years (4.7% and 14.0%) (Table A6.47 (XLSX 343.8KB)).
  • Students in the former Hunter and New England (4.0%) and Greater Western (3.9%) Area Health Services[32] were less likely to be current smokers, compared with the overall student population aged 12–17 years (7.3%) (Table A6.49 (XLSX 343.8KB)).

Among students aged 12–17 years who smoked in the last seven days, the source of their last cigarette included: friends (44.7%), bought by self (23.0%), ‘got someone to buy it’ (14.1%), parents (5.9%), brother or sister (5.0%), and taken from home without parental permission (3.9%) (Table A6.50 (XLSX 343.8KB)).

The proportion of students who had smoked tobacco in the last seven days decreased significantly between 1984 and 2008 (22.4% to 7.3%). The decrease was significant for students aged 12–15 years (20.5% to 4.7%) and students aged 16–17 years (30.1% to 14.0%).

There has been no significant change in the proportion of students aged 12–17 years who had smoked tobacco in the last seven days between 2005 and 2008 (Centre for Epidemiology and Research, 2009:116) (Figure 6.12) (Table A6.51 (XLSX 343.8KB)).

Figure 6.12: Students aged 1217 years smoking tobacco in last seven days by age, NSW, 1984–2008

Source: NSW School Students Health Behaviours Survey 2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.51 (XLSX 343.8KB)).

Tobacco dependence

Dependence-producing patterns of smoking for 12–17 year olds is defined by the National Tobacco Strategy 2004–2009[33] as having ever smoked at least 100 cigarettes (AIHW, 2011).

In 2008, 3.9 per cent of 12–17 year olds had smoked at least 100 cigarettes in their lives.

While the statistical significance of age, sex, socioeconomic disadvantage and geographic location has not been determined, when proportions are considered:

  • No difference was found between male and female students or among different socioeconomically disadvantaged[34] areas.
  • A lower proportion of 12–15 year old students had smoked at least 100 cigarettes in their lives compared with 16–17 year old students (1.8% and 9.3%).
  • A lower proportion of students from the former Greater Western (1.1%) and Hunter and New England (1.8%) Area Health Services[35] had smoked at least 100 cigarettes in their lives compared with the overall student population aged 12–17 years (3.9%) (Table A6.52 (XLSX 343.8KB)).

Between 1999 and 2008 there was a significant decrease in the proportion of students who had smoked at least 100 cigarettes in their lives (10.8% to 3.9%) (Figure 6.13) (Table A6.53 (XLSX 343.8KB)).

Figure 6.13: Students aged 12–17 years with established dependence-producing patterns of smoking, NSW, 1999–2008

Source: NSW School Students Health Behaviours Survey 2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A6.53 (XLSX 343.8KB)).

Wanting to quit smoking

In 2008, 36.4 per cent of the current smokers wanted to quit smoking. Students in the 12–15 years age group were significantly less likely to want to quit smoking than students aged 16–17 years (30.6% and 41.0%) (Table A6.54 (XLSX 343.8KB)).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location were considered:

  • No difference was found between male and female students, among different socioeconomically disadvantaged[36]areas, or between urban and rural health areas.
  • Students aged 12–15 years were less likely to want to quit smoking compared with students aged 16–17 years (30.6% and 41.0%) (Table A6.54 (XLSX 343.8KB)).
  • Students in the former Sydney West Area Health Service[37] were more likely to want to quit smoking, compared with the overall student population aged 12–17 years who currently smoke (46.8% and 30.6%) (Table A6.55 (XLSX 343.8KB)).

Between 2002 and 2008 the proportion of current smokers who want to quit decreased significantly (45.5% to 36.4%). This decrease was significant for students aged 12–15 years (45.4% to 30.6%) (Table A6.56 (XLSX 343.8KB)) (Centre for Epidemiology and Research, 2009:117).

Influences by Quit advertisements

In 2008, 37.4 per cent of current smokers aged 12–17 years had been encouraged to quit smoking by Quit advertisements.

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location were considered:

  • No significant difference was found between male and female students and between urban and rural health areas (Table A6.57 (XLSX 343.8KB)).
  • Students in the former Sydney West Area Health Service[38] (49.1%) were more likely to have been encouraged to quit smoking by Quit advertisements, compared with the overall student population aged 12–17 years (37.4%) (Table A6.58 (XLSX 343.8KB)).
  • Students living in areas in the third socioeconomically disadvantaged[39] group (29.8%) were less likely to have been encouraged to quit smoking by Quit advertisements, compared with the overall student population aged 12–17 years (37.4%) (Table A6.57 (XLSX 343.8KB)).

Other illicit drugs

The SSHBS asks 12–17 year old students a range of questions about illicit drug use including: ‘How many times, if ever, have you used or taken painkillers or analgesics such as Disprin, Panadol or Aspro, for any reason, in your lifetime?’, ‘…have you deliberately sniffed (inhaled) from spray cans or sniffed things like glue, paint, petrol or thinners in order to get high, or for the way it makes you feel, in your lifetime?’, ‘…have you smoked or used marijuana or cannabis in your lifetime?’, ‘…have you used or taken sleeping tablets, tranquillisers or sedatives, such as Valium, Serepax or Rohypnol, other than for medical reasons, in your lifetime?’, ‘…have you used or taken amphetamines in your lifetime?’, ‘…have you used or taken ecstasy in your lifetime?’, ‘…have you used or taken hallucinogens in your lifetime?’, ‘…have you used or taken cocaine in your lifetime?’, ‘…have you used or taken steroids without doctor’s prescription in an attempt to make you better at sport, to increase muscle size, or to improve your general appearance, in your lifetime?’, ‘…have you used or taken heroin in your lifetime?’, ‘In the last six months have you hurt yourself or had an injury which required medical attention from a doctor, physiotherapist or another health professional?’ and ‘Had you taken any drugs other than alcohol in the six hours before you were hurt or injured?’

Illicit drug usage

In 2008 the SSHBS reported that 14.6 per cent of students aged 12–17 years, had used an illicit substance sometime in their life, 8.8 had used one illicit substance, 2.2 per cent had used two, and 3.6 per cent had used three or more (Table A6.59 (XLSX 343.8KB)).

  • 94.9 per cent had used painkillers (94.2% of 12–15 year olds and 96.6% of 16–17 year olds).
  • 19.9 per cent had used inhalants (21.6% of 12–15 year olds and 15.6% of 16–17 year olds).
  • 16.1 per cent had used sleeping tablets, tranquillisers or sedatives, other than for medical reasons (15.3% of 12–15 year olds and 18.0% of 16–17 year olds).
  • 12.9 per cent had used marijuana or cannabis (8.1% of 12–15 year olds and 25.0% of 16–17 year olds).
  • 4.4 per cent had used ecstasy (2.4% of 12–15 year olds and 9.3% of 16–17 year olds).
  • 3.7 per cent had used amphetamines (2.6% of 12–15 year olds and 6.5% of 16–17 year olds).
  • 2.8 per cent had used hallucinogens (2.0% of 12–15 year olds and 4.9% of 16–17 year olds).
  • 2.8 per cent had used cocaine (1.9% of 12–15 year olds and 5.3% of 16–17 year olds).
  • 2.1 per cent had used heroin or opiates.
  • 2.0 per cent had used steroids without a doctor’s prescription (Table A6.60 (XLSX 343.8KB)).

Students aged 12–15 years were significantly less likely than 16–17 year olds to have used most illicit substances, with the exception of inhalants. Students aged 12–15 years were statistically more likely to have used inhalants than 16–17 year old students. There were no significant differences between the age groups for use of steroids, or heroin or opiates (Table A6.60 (XLSX 343.8KB)).

No significant difference was found between male and female use of most substances including inhalants; ecstasy; sleeping tablets; tranquillisers or sedatives, other than for medical reasons; marijuana or cannabis; amphetamines; hallucinogens; or heroin or opiates (Table A6.61 (XLSX 343.8KB)). However males were significantly more likely than females to have ever used steroids without a doctor’s prescription (2.6% and 1.4%) and to have ever used cocaine (3.4% and 2.3%). Females were significantly more likely than males to have ever used painkillers or analgesics (97.0% compared with 92.8%) (Table A6.61 (XLSX 343.8KB)).

Between 1996 and 2008 among students aged 12–17 years there was no illicit substance where usage increased significantly. There was a significant decrease in the use of painkillers or analgesics; inhalants; marijuana or cannabis; sleeping tablets, tranquillisers or sedatives, other than for medical reasons; amphetamines; hallucinogens; cocaine; and heroin or opiates. There was no change in the use of ecstasy, or steroids without a doctor’s prescription (Table A6.62 (XLSX 343.8KB)) (Centre for Epidemiology and Research, 2009;143).

Injury and death

Like alcohol consumption, illicit drug use is associated with physical injury and death. Of the 38.8 per cent of children aged 12–17 years who reported an injury in the six months leading up to the 2008 SSHBS, 5.5 per cent had consumed a drug other than alcohol in the six hours before they were injured. A smaller proportion of 12–15 year olds than 16–17 year olds reported consuming a drug other than alcohol before they were injured (4.6% and 8.0%) (Table A6.63 (XLSX 343.8KB)).

Like alcohol use, drug use contributes to the leading causes of death among young people: unintentional injuries and suicide (NHMRC, 209:58).

In 2009, the CDRT reported seven children aged 12–17 years had died where an illicit drug[40] was present; six of these children died in transport fatalities, either as pedestrians, drivers or passengers, and one died by suicide. The most common illicit drug present was cannabis – alcohol was also present for four of these children (CDRT, 2010).

From 1996 to 2009, 160 children aged 12–17 years died in circumstances where an illicit drug was present.

  • Male children were 2.5 times more likely to die where an illicit drug was present compared with female children.
  • Aboriginal children were 2.8 times more likely to die where an illicit drug was present compared with non-Aboriginal children.
  • Children aged 16–17 years were 59.8 times more likely to die where an illicit drug was present compared with children aged 12–13 years, and children aged 14–15 years were 19.5 times more likely compared with 12–13 year olds.
  • Children living in inner regional areas were 1.6 times more likely to die where an illicit drug was present compared with those living in major cities (Table A6.64 (XLSX 343.8KB)).

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[1]The minimum recommended daily consumption of fruit is one serve for 4–11 year olds and three serves for 12–18 year olds. The minimum recommended daily consumption of vegetables is two serves for 4–7 year olds and three serves for children aged eight years and over. The minimum recommended daily consumption of dairy products, including milk, yoghurt and cheese, is two serves for 4–11 year olds and three serves for 12–18 year olds.
[2]Healthy weight is determined by the Body Mass Index (BMI). The BMI is the ratio of weight in kilograms to the square of the height in meters.
[3]The minimum recommended level of physical activity is one hour of moderate to vigorous physical activity each day.
[4]The National Health and Medical Research Council (NHMRC) recommends that children under the age of 18 years not drink alcohol. This recommendation acknowledges that the consumption of any alcohol is risky for children. To provide information on children whose drinking patterns may result in alcohol-related injury, the NHMRC recommendation for healthy adult men and women is used. It recommends drinking no more than four standard drinks on a single occasion to reduce the risk of alcohol-related injury arising from that occasion.
[5]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas. See Appendix Maps of NSW geographical areas used in reporting.
[6]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[7]A dependence-producing pattern is defined as having smoked at least 100 cigarettes in their lives.
[8]As the NHMRC guidelines do not provide minimum recommendations for 2–3 year olds, the NSW Population Health Survey applies the minimum recommendations for 4–7 year olds.
[9]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[10]Healthy weight is determined by the Body Mass Index (BMI). The BMI is the ratio of weight in kilograms to the square of the height in meters.
[11] In 2007–2008, a greater proportion of females in the 2–4 years and 9–15 years age groups were underweight than males (17.1% and 15.6%; 8.4% and 5.9%). This pattern changed for the 5–8 years age group where just over twelve per cent (12.4%) of males were underweight compared with nearly ten per cent (9.8%) of females.
[12]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[13]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[14]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[15]This excludes dancing and refers to sports which are played or trained for outside of school hours and are organised by a school, club or association. Any organised or structured training or practice sessions are included as long as they have been set by an instructor or coach. Whether the child participated in an organised sport was left to the judgment of the respondent. Training is defined as undertaking a structured training activity or practice session which has been set by an instructor or coach.
[16]The interpretation of the term ‘dancing’ was left to the respondent. If the respondent queried the definition they were advised it included formal dancing lessons (e.g. ballet, callisthenics), musicals and eisteddfods where the child’s predominant activity was dancing. The dancing must have occurred outside of school hours and may have included lessons, practising and performances.
[17]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[18]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[19]For information on sexually transmitted infections see Chapter 9: Physical Health.
[20]A standard drink contains 10g of alcohol. This is equal to one glass of full strength beer (285ml), two glasses of light beer (2 x 285ml), one small glass of wine (100ml), one measure of spirits (30ml) or one glass of fortified wine such as sherry or port (60ml).
[21]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[22]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas. See Appendix Maps of NSW geographical areas used in reporting.
[23]This period is consistent with the National Drug Strategy Household Survey which defines recent use as ‘use in the previous 12 months’.
[24]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[25]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas. See Appendix Maps of NSW geographical areas used in reporting.
[26]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[27]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas. See Appendix Maps of NSW geographical areas used in reporting.
[28]A child was determined to have alcohol present where the International Classification of Disease, Australian Modification (ICD-10-AM) associated cause of death was toxic effect of alcohol (T51), mental and behavioural disorders due to use of alcohol (F10), evidence of alcohol involvement determined by blood alcohol level (Y90), or the toxicology report indicated alcohol in the blood where it was not otherwise coded.
[29]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[30]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas. See Appendix Maps of NSW geographical areas used in reporting.
[31] Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[32]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas. See Appendix Maps of NSW geographical areas used in reporting.
[33] The National Tobacco Strategy 2004–2009 was evaluated and a new strategy will be developed based on the findings.
[34]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[35]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas. See Appendix Maps of NSW geographical areas used in reporting.
[36]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[37]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas. See Appendix Maps of NSW geographical areas used in reporting.
[38]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas. See Appendix Maps of NSW geographical areas used in reporting.
[39]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles): the least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[40] A child was determined to have an illicit drug present where the International Classification of Disease, Australian Modification (ICD-10-AM) underlying or associated cause of death was mental and behavioural disorders due to use of opioids (F11); mental and behavioural disorders due to use of cannabinoids (F12); mental and behavioural disorders due to use of cocaine (F14); mental and behavioural disorders due to use of other stimulants, including caffeine (F15); mental and behavioural disorders due to use of hallucinogens (F16); poisoning by narcotics and psychodysleptics [hallucinogens] (T40); poisoning by psychotropic drugs, not elsewhere classified (T43); or accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified (X42).