Methodological Notes – Behaviour Module

Updated: March 2012

Concepts and Definitions

It is well established that some personal behaviours or lifestyles are associated with the development of certain diseases and health problems. Of particular importance are such behaviours as smoking, diet, alcohol and drug use, physical activity, sexual behaviour, and safety practices. The modification of such behaviours has become the core activity of health promotion programs.

Monitoring such behaviours usually require surveys based on interviews with respondents who are asked specific questions. Despite the existence of numerous health interview surveys in all the developed countries, international standardization is rare. Only one behaviour is included in CircHOB for the time being – smoking. Smoking is among the most important health determinants or risk factors, and it is basic information collected by most health surveys. Even so, there is considerable inconsistency in how smoking is measured and categorized. In the future, other behaviours with even less international standardization will be added to CircHOB.

On the basis of a set of questions, individuals can be categorized into never smokers, former smokers, and current smokers. Among the last group, it can be further divided into those who smoke daily and those only irregularly, or occasionally – the prevalence of daily smoking among adults. This information is one that is most comparable across countries and surveys, although there are still significant differences, which are highlighted in the following section, and thus caution is needed when interpreting the data.

In some countries (eg. USA and Finland) there is an additional requirement that a current smoker is someone who has smoked at least a certain amount (100 cigarettes or 100 times) in their lifetime and still smoking.

Although cigarettes are the most widely used vehicles in delivering tobacco, other forms such as pipes, cigars and smokeless tobacco are also used. Although it is not always explicitly stated in survey reports, it is cigarette smoking that is usually asked and recorded. Again, reading the fine print in the survey documentation will allow one to determine if “smoking” refers only to cigarette smoking or to any form of smoking.

In addition to frequency, estimates of the duration of use and the amount consumed per day can also be derived from surveys. Increasingly issues such as ages of initiation and cessation, attempt at quitting, attitudes towards smoking, knowledge of its health effects, and exposure to passive smoking at home and at work are also part of smoking surveys.

Data Sources and Limitations

CircHOB presents the proportion of daily smokers in the adult population. The lower limit of “adult” differs – 15, 16, 18, etc. Some surveys have no upper age limits, while other surveys are truncated at 75 or even 65. Smoking prevalence is decreasing in most populations, some more rapidly than others, a trend that may be evident from the 2000-04 and 2005-09 periods. In the case of annual surveys where all 5 years’ data are available, they are pooled (or averaged, depending on the type of data available). Where surveys are conducted less frequently, data from a year close to the midpoint of each period are presented. The upper age limit is set to be as close to 75 as possible, to achieve comparability of the “adult” rate.

United States

For the United States nationally, data are as reported by OECD Health Data 2011, based on annual results of the National Health Interview Survey (NHIS) for the 2000-09 period. Daily smokers are defined as current smokers who have smoked 100 cigarettes in their lifetime and still smoke everyday. The age range is 18 and above. The NHIS is a major national survey of a representative sample of the U.S. civilian, noninstitutionalized household population.

For Alaska, data originate from the Behavioral Risk Factor Surveillance System (BRFSS) Prevalence and Trends Data website. BRFSS is an annual telephone survey conducted by the CDC and state health departments.

Canada

Canadian national and territorial data are based on special analyses of the Canadian Community Health Survey (CCHS), conducted by Statistics Canada. Although the surveys covered ages 12 and above, only data from individuals aged 15 and above are presented. The daily smoking indicator was derived from the question “at the present time, do you smoke cigarettes daily, occasionally, or not at all?”. For the 2000-04 period, data are pooled from cycles 2000/01, 2003 and 2005. For the 2005-09 data are pooled from cycles 2007, 2008, and 2009.

Greenland

Greenland-wide surveys on smoking habits have not been conducted. For native Greenlanders, data from surveys conducted by the National Institute of Public Health during 1999-2002 in three towns and four villages in West Greenland, and the 2005-09 survey covering the whole of Greenland.

Faroe Islands

Data for Faroes Islands are available for all adults aged 15+, as reported by NOMESCO in the annual publication Health Statistics in Nordic Countries, Table 3.1. Data for 2003-09 are also available from the Nordic Statbank, Table Heal01.

Iceland

Data are as reported in OECD 2011 Health Data, based on surveys conducted for the Public Health Institute three times per year.

Denmark

The source is OECD 2011 Health Data, based on polling firm data conducted for Sundhedsstyrelsen.

Norway

Norwegian national and regional data can be accessed from the Norgeshelsa website, [ > Statistics > Determinants of Health > Smoking, adults, regional figures], which provides data from Statistics Norway’s Travel and Holiday Survey (Reise- og ferieundersøkelse), conducted quarterly among adults aged 16-74. These are summed annually and averaged over the 5 year periods.

Sweden

National and regional data are collected by Statistics Sweden, based on the annual Survey of Living Conditions (Undersökningarna av levnadsförhållanden, or ULF) conducted annually among adults aged 16-84. The data shown in CircHOB are by special request to Statistics Sweden for custom tabulation.

Finland

Data are from the published reports of the annual survey called Health Behaviour and Health among Finnish Adult Population (Suomalaisen aikuisväestön terveyskäyttäytyminen ja terveys, or AVTK), conducted by the National Institute of Health and Welfare. Data are not available for Oulu and Lappi regions individually, but combined as a northern region, based on the survey design and sampling strategy. Daily smokers are defined as individuals who have ever smoked at least 100 times [note: not 100 cigarettes], who have ever smoked daily, and who last smoked either today or yesterday. This survey only covers the age group 15-64. For the elderly aged 65-84, there is a separate survey. However, the two surveys cannot be combined to produce an “adult” population that is comparable to the other countries. Also, separate data for the North are not reported in the survey on the elderly.

Russian data are very sketchy, and only at the national level. For the 2000-04 period, data from WHO’s World Health Survey in 2003 are used (Table 4.1). Although representative of the country as a whole, no regional data were available. Note that the age groups used in the report are 18-29, 30-44, 45-59 and 60-69.

For the 2005-09 period, data from the Russia country report from the 2009 Global Adult Tobacco Survey (GATS) are used. Several northern regions were sampled: Arkangelsk Oblas, Komi Republic, Taymyr AO, and Evenkia AO but separate regional data were not reported.

Another source of smoking data is the National Assessment of Household Well-being and Involvement in Social Programs (Natsional’noye obsledovaniye blagnosostoyaniya domohozyuistv i uchastiya sotsial’nih programmah or NOBUS) as reported in Public Health in Russia 2005 (Table 11.5). The survey was conducted in 2003 as part of the World Bank assistance project to restructure the social security system. This survey was sufficiently large (45, 000 households) to generate regional estimates, although these were not available from published sources.