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EHIS wave 2: Variables, questions and guidelines

EHIS wave 2: Variables, questions and guidelines. European Health Determinant Module Jakub Hrkal, Eurostat. Overview. Weight and height (BM). Instrument: respondent’s weight and height (no change) Guidelines (minor points):

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EHIS wave 2: Variables, questions and guidelines

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  1. EHIS wave 2: Variables, questions and guidelines European Health Determinant Module Jakub Hrkal, Eurostat TG HIS, 23-24 January 2012

  2. Overview TG HIS, 23-24 January 2012

  3. Weight and height (BM) • Instrument: respondent’s weight and height (no change) • Guidelines (minor points): • Length measured without wearing shoes and weigh without clothes and shoes • Women aged 50 or younger -> checked whether pregnant -> weight before pregnancy • Ask for an estimate: only when respondent indicates that she/he doesn’t know the exact answer • Other measurement units allowed -> for data delivery conversion into kg/cm • Self-completion: allowed • Derogations: no (other measurement units are allowed for data collection) TG HIS, 23-24 January 2012

  4. Physical activity / exercise (PE) • New instrument developed for EHIS wave 2 • covers 3 relevant public health domains: • work-related physical activity • “going from … to …” physical activity • leisure-time physical activity. • based on: • the framework of GPAQ • using a modified version of the current question from BRFSS to assess work-related physical activity, • the current NHIS-PAQ question to assess muscle-strengthening physical activity, • modified versions of GPAQ questions to assess transportation physical activity and leisure-time physical activity. • designed to measure compliance with the new WHO physical activity recommendations for the adult population aged 18-64. TG HIS, 23-24 January 2012

  5. Physical activity / exercise (PE) • Structure of the instrument: • work-related physical activity • transportation (commuting) physical activity (frequency and duration): • cycling • walking • leisure-time physical activities (frequency and duration): • doing sports, fitness or recreational activities • (of which) muscle-strengthening exercises • Important terms: • typical week (in given season), • at least 10 minutes continuously, • typical day (= average) TG HIS, 23-24 January 2012

  6. PE - Work-related physical activity • Answered by anyone performing any working tasks, not only employed! • Important terms explained: • ‘Working’ • mostly sitting or standing • mostly walking or tasks of moderate physical effort • mostly heavy labour or physically demanding work • not accomplishing any working tasks (= not applicable) TG HIS, 23-24 January 2012

  7. PE - Getting to and from places • Changes: • ‘I never do such physical activities’ category introduced • ‘for travel’ replaced by ‘bicycling in order to get to and from places’ • Includes all types of getting to and from places and performed for at least 10 minutes continuously: • work • school • shopping or market • Excludes all the work-related activities and travelling for long journeys • Other important terms: bicycling (including other non motor-driven means of active transportation) TG HIS, 23-24 January 2012

  8. PE – Leisure-time physical activities • 1. Doing sports, fitness or recreational activities: • Includes leisure-time physical activities which: • cause at least a small increase in breathing or heart rate and • are performed for at least 10 minutes continuously (aerobe/endurance activities) • Excludes: • all the work-related activities and • transportation (travel) activities • Other important terms: causing AT LEAST a small increase in breathing or heart rate • 2. Muscle-strengthening exercises: • may overlap with the previous question but should be asked to all respondents • Changes: • ‘I never do such physical activities’ category introduced • The filter for the muscle-strengthening exercises dropped (asked to all respondents) TG HIS, 23-24 January 2012

  9. PE - Problems and requests for derogations • Problems • NEW: not broadly tested yet, not fully validated • adaptations needed for different modes of data collection • Work-related PA: quantification not possible • Getting to and from places: seasonal/weekdays effect, answer categories not good, bicycling (not relevant everywhere) • Leisure-time PA: concept not clear/question confusing (recreational vs aerobic), answer categories not good • Derogations • NL: national instrument used • DK: not suitable in a self-administered questionnaire, still too difficult • ES: only if stable and adaptable • ES, FR: drop bicycling (not relevant) • FI: drop leisure-time PA • NO(?), CH(?): not tested/used yet • UK, SE, FI, FR: adaptation needed (mode of data collection) TG HIS, 23-24 January 2012

  10. Consumption of fruits and vegetables (FV) • Frequency and daily quantity consumption of fruits and vegetables • Changes: • response categories (1. Once or more a day / 2. 4 to 6 times a week / 3. 1 to 3 times a week / 4. Less then once a week / 5. Never) • Included: • fresh salads, • legume and • vegetable dishes (including soup) • Excluded: • juices, • potatoes and similar starchy foods, • not fresh FV (dried and canned) TG HIS, 23-24 January 2012

  11. FV - Guidelines • Reference to a typical week in given season • Important terms: a portion (with country specific examples) • Further discussion: • According to British Diet. Assoc. ‘frozen, canned, juiced or dried’ fruits and vegetables are included. Do we want to have them in? TG HIS, 23-24 January 2012

  12. FV - Problems and requests for derogations • Problems • Nutrition not given enough space • Definition and understanding of a portion problematic • Derogations • FI: inclusion ‘berries’ in frequency question on fruits, change of wording of the question on number of portions, different question on quantity of vegetables (400 g) • LT, HU, LV : adaptation of the wording (examples of one portion explicitly given) TG HIS, 23-24 January 2012

  13. Smoking (SK) • Smoking habits: • current smoking (former smoking missing!) • NEW: types of tobacco products consumed (Cigars, Pipe tobacco, Other) • amount of cigarettes (manufactured or hand-rolled cigarettes) smoked per day (in regular smokers only) • Frequency of exposure to indoor smoke: • Indoors: refers to inside the house where the person lives (at home), at work, at restaurants etc. (NEW: all indoor premises!) • Guidelines: self-completion allowed TG HIS, 23-24 January 2012

  14. SK - Problems and requests for derogations • Problems • The choice of mode of data collection has to be allowed • Former smoking not observed • Amount of other tobacco products consumed not observed • Frequency of exposure to indoor smoke – should refer to tobacco smoke from other people only? • Derogations • DE, NL: adaptation according to survey mode • FI, EE: adaptation but EHIS variable available (amount of other tobacco products consumed included) TG HIS, 23-24 January 2012

  15. Alcohol consumption (AL) • New instrument for EHIS wave 2 • EHIS wave 2 proposal: • Wide range of dimensions of drinking behaviour covered (drinking status, drinking pattern, volume of pure alcohol consumed) • based on the quantity/frequency method (or retrospective summary measures) • broken down into two specific periods of week (working days and weekend days) in order to capture part of the assumed variability in drinking behaviour between these two time periods • an opening generic frequency question is included to determine drinking status and frequency • a question on risky single-occasion drinking (RSOD) closes the questionnaire. TG HIS, 23-24 January 2012

  16. Alcohol consumption (AL) • I. Drinking status (including former drinking): • Explicitly mention ‘home-made alcohol’ • II. Volume of intake (only in weekly drinkers): • Observing: separately for week days and weekend days, not alcohol-specific • Important terms: • number of days ‘usually drinking’, • ‘average number of drinks’ on such a day, • a drink (glass/unit) • III. Pattern of alcohol consumption (binge drinking) • Important terms: • ‘6 or more drinks’ (country-specific number of drinks should be defined to fulfil the 60g of pure ethanol cut-off) • ‘One occasion’ • Use of: • Country-specific alcohol beverages • Country-specific ‘standard drink’ TG HIS, 23-24 January 2012

  17. AL - Problems and requests for derogations • Problems • The choice of mode of data collection has to be allowed • Not beverage-specific • Use of ‘standard drink’ problematic (incl. use of WHO correction factor) • Derogations • FR, SE: own instrument • ES: only if stable in EHIS + some questions not acceptable (lack of equivalence between standard drinks) • CH(?): not tested/used yet • LU, LT: different wording for ‘number of drinks’ questions • AT: use of specific beverage for ‘number of drinks’ questions • DK: drop/change questions on number of drinks • NL: different wording but EHIS variables available • SI(?): SMART wording of same questions • PT(?): more discussion needed • MT(?): slightly changed wording (premix inexistent) TG HIS, 23-24 January 2012

  18. Social support (SS) Oslo Social Support Scale (OSS-3) instrument: • Number of persons to count on if in serious trouble • Perceived positive interest and concern from other people: • Changes: simplification of response categories to avoid repetition • ‘People’ cover both family and non-family members (friends, colleagues, social and religious groups, etc…) • The concept of 'positive interest' should be taken into account when translating the question • The category 'uncertain' should represent a middle category in the sense of "neither little nor much concern“ • Available help from neighbours if necessary: • "Practical help" is a help with ordinary affairs like personal support, advice, money. TG HIS, 23-24 January 2012

  19. SS - Problems and requests for derogations • Problems (mostly for ‘Perceived positive interest and concern from other people’ question) • Concept not clear • Translation problematic • Culturally insensitive • Derogations • GR: drop q2 and q3 • EN, MT, RS: drop q2 • NL(?): drop (included in a special survey on social cohesion) • CH(?): not tested/used yet • CZ(?): change of middle response category in q2 TG HIS, 23-24 January 2012

  20. Provision of informal care or assistance (IC) Policy need: • Provide data on possible lack in LTC care and on barriers for people in exercising their "normal" job • Assessment of amount of long-term care (LTC) activities provided by non-professional carers I. Care/assistance provided by the respondent to people suffering from long-term health problems: • "Care or assistance" = help to other person with personal care or activities of household care • Only care related to long-term health state, disability or old age should be included • Provision of help "at least once a week" (cases of irregular or occasional help should be excluded) • Any care provided as part of the respondent's profession should be excluded. TG HIS, 23-24 January 2012

  21. Provision of informal care or assistance (IC) II. Relationship with the people to whom the respondent provide care/assistance: • Change of response categories: ‘Member(s) of respondent’s family’ = relatives living either in or outside the household versus ‘Others’ (focus on distinction between family versus others) • Only one answer allowed: in case multiple persons are involved, selection of one whom the respondent provides the most care. III. Total time during one week dedicated to take care of or provide assistance to other people: • Simpler recall period: sum the time spent during one week (an estimate if needed) • Simpler response categories: 0-9 hours per week / 10-19 hours / 20 hours or more TG HIS, 23-24 January 2012

  22. IC - Problems and requests for derogations • Problems • Not necessary in EHIS • Not all (less frequent) informal care covered • Not tested and validated • Derogations • PL, GR: drop • DK: not suitable in self-administered questionnaire • ES, FR(?): drop (not discussed/purpose not clear) • NL(?): drop (included in a special survey on social cohesion) • UK, FI: drop the question on amount of IC activities • CZ(?), NO(?): broader coverage of informal care • IT(?): the receiver perspective would be more useful TG HIS, 23-24 January 2012

  23. Physical activity / exercise (PE) – EHIS wave 1 • EHIS wave 1 instrument: adapted version of IPAQ-SF instrument. • Problems encountered: • the questions too difficult to understand and to reply and also vague (distinguish between moderate and vigorous activities) • the validity and reliability of the instrument questioned and related instability of the estimators as well • some relevant dimensions omitted (distinction between work and leisure-time activities). • Considered alternatives: • IPAQ-SF: • similar problems to those already reported by the MSs • the problems persist when using the original version of the IPAQ • US NHIS Adult Core: • respondents had difficulties with the underlying concept of the questions on ‘moderate’ and ‘vigorous’ activities; • focus only on the domain of leisure-time physical activity perceived as being insufficient TG HIS, 23-24 January 2012

  24. PE – Pros/Cons of EHIS wave 2 • Advantages: • Measuring compliance with the new WHO physical activity recommendations for Europe • Focus on ‘health-enhancing PA’ instead of ‘total PA’ • Less confusion to respondents (for example no distinction between vigorous and moderate activities compared to EHIS Wave 1) • Tested in different countries and cultural settings using different modes of data collection (PAPI, CATI). • Relatively short (despite covering and distinguishing between three relevant public health domains) • Various public health relevant and easy to understand outcome indicators can be calculated • Enables to monitor European health promotion strategies on the promotion of bicycling for transportation • Disadvantages: • The reliability and construct validity of the instrument has not been examined • Some terms not easily understandable and need interviewer's explanation (for example 'typical week') TG HIS, 23-24 January 2012

  25. Alcohol consumption (AL) – EHIS wave 1 • EHIS wave 1 instrument: based on AUDIT-C and PSNW approaches. • Problems encountered: • not all important data covered (former drinkers, alcohol dependence) and using the filters some information is missing (that is the consumption of infrequent users). • the instrument is too long. • the question on 'number of specific beverages consumed each day of a typical week' ambiguous and too difficult to answer. • observing the 'standard drinks' not appropriate (national measures should be used instead). • the order of response categories (from less amount/frequent to more should be reversed). • Considered alternatives: • AUDIT-C: • does not capture variability of drinking, • can't identify former drinkers • SMART: • longer than the proposed instrument, • not tested in the self-administered mode, • does not resolve the problem of variability in drinking pattern over time TG HIS, 23-24 January 2012

  26. AL – Pros/Cons of EHIS wave 2 instrument • Advantages: • Shorter and simpler • makes possible to distinguish between current drinkers, former drinkers and lifetime abstainers • Weekday/weekend period distinction -> more accurate data on the respondents drinking behaviour + a good compromise between 'detailed recalls' and a 'typical day' approaches. • Wide range of indicators can be computed (drinking status, drinking pattern, volume of pure alcohol consumed). • appropriate for self-administered form and face-to-face interview; can easily be adapted for other modes. • tested in different countries and cultural settings and is satisfactory for a majority of respondents. • Disadvantages: • Long reference period (12 months) for observing the general drinking pattern; but shorter reference period may also bias the results. • Total annual volume can't be calculated precisely as the quantity questions are asked only weekly drinkers; but it does not have big impact on total volume. • Relies on 'standard drinks' - it is very difficult to get precise data (converting their consumption into 'units' of alcohol) and they tend to consider that "drink is a drink". • The observed consumption of alcohol is not beverage-specific and not day-specific (the instrument would be too long). • The reliability and construct validity of the instrument has not been examined. TG HIS, 23-24 January 2012

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