Solomon Islands NCD Risk Factors STEPS REPORT

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2 Solomo Islads NCD Risk Factors STEPS REPORT Prited i Suva, Fiji February, 2010

3 Ackowledgemets The Solomo Islads NCD Risk Factors STEPS REPORT (referred as the Report ) is a record of a combied effort of several orgaizatios ad idividuals. We would like to ackowledge each orgaizatio ad everyoe s cotributios, dedicatio ad determiatio i completig the survey ad fializig the Report. The Report is a collaborative effort betwee the Solomo Islads Miistry of Health ad Medical Services (MHMS), World Health Orgaizatio ad the Fiji School of Medicie (FSM). The Report was compiled by: Ms Nevaly Laesago (MHMS), Dr Graham Roberts (FSM), Dr Li Da (WHO, Suva), Dr Joh Paulse (MHMS), Ms Leae Riley (WHO, Geeva), Mr Makiva Tui (MHMS), Ms Josephie Watoto (MHMS), Mr Shalvidra Raj (WHO, Suva) ad Dr Ja Pryor (USA). Appreciatio is exteded to the Ho. Miister for Health ad Medical Services, Mr Clay Forau Soalaoi, the Permaet Secretary, Dr Lester Ross, ad Udersecretary for Health Care, Dr Carl Susuairara for their leadership ad support of the NCD STEPS work i Solomo Islads. A special thak is made to the STEPS field survey staff (see Appedix 3 of the Report). Grateful ackowledgemet is made to the World Health Orgaizatio ad its staff, to Dr Che Ke (WHO Represetative i the South Pacific, Suva) for his great support, to Dr Ha Tieru, Dr Lida Mila, Dr Cheria Varghese (WHO Office i Maila) for their support. Thaks are due to Dr Ja Pryor ad Ms Shakila Naidu (UNICEF) as research cosultats for this STEPS survey. We ackowledge the statistical support ad result geeratio provided by Ms Leae Riley, Ms Melaie Cowa ad Ms Regia Guthold (WHO Office i Geeva) ad Mr Shalvidra Raj who made substatial cotributio to the completio of data aalyses. Ms Taivua Bulamaibau (WHO Office i Suva), Ms Salome Ziku ad Ms Coria Teika (WHO Office i Hoiara) provided admiistrative support to the fializatio of the Report. The Solomo Islads STEPS survey ad the Report were fuded by the Australia Agecy for Iteratioal Developmet (AusAID), New Zealad Agecy for Iteratioal Developmet (NZAID) ad WHO. The Miistry of Health ad Medical Services, Solomo Islads provided i-kid cotributio. Dr Graham Roberts (FSM) drafted the first versio of the Report, workig closely with WHO Office i Suva. Ms Leae Riley, Dr Li Da, Mr Robert Hughes (Australia), Dr Cheria Varghese, Mr Shalvidra Raj ad Ms Melaie Cowa have coducted techical reviews for the Report. The coutry cosultatio held i Hoiara, Solomo Islads was atteded by Dr Carl Susuairara (MHMS), Dr Teeth Dalipada (MHMS), Ms Nevaly Laesago, Ms Yukako Toriyama (MHMS), Dr William Adu-Krow (WHO Office i Hoiara) ad Dr Li Da. Dr Li Da, Mr Robert Hughes ad Dr Graham Roberts are the fial techical ad editorial reviewers of the Report. WHO Office i Suva arraged the pritig, o behalf of the Solomo Islads Miistry of Health ad Medical Services. 2

4 CONTENTS FOREWORD 8 EXECUTIVE SUMMARY INTRODUCTION Backgroud ad Ratioale The Natioal Cotext Geography Populatio ad Livig Eviromet Govermet, Culture ad the Ecoomy Nocommuicable Disease Health Status ad Health Ifrastructure Developig WHO STEPS Survey i Solomo Islads OBJECTIVES METHODOLOGY Survey Structure Survey Samplig Methodology Natioal/Provicial Level Samplig Ward/village level samplig Household level samplig Sample Size Data Collectio Procedures Data Collectio Process Registratio of Participats Step 1 - Behavioural Risk Factors Iterviews Step 2 - Physical Measuremets Step 3 - Biochemical Measuremets Check-out Statio ad Cousellig Data Maagemet ad Aalyses Data Etry Data Weightig ad Aalysis RESULTS Characteristics of Survey Populatio Tobacco Use Betel Nut Use Alcohol Cosumptio Itake of Fruit ad Vegetables Physical Activity Questios Aalysis Levels of Physical Activity Overweight ad Obesity Height ad Weight Body Mass Idex Categories Waist Circumferece 46 3

5 4.8 Blood Pressure ad Hypertesio Fastig Blood Glucose ad Diabetes Total Cholesterol Combied Risk Factors DISCUSSION AND CONCLUSIONS RECOMMENDATIONS 54 APPENDICES 56 Appedix 1 Solomo Islads STEPS Survey Questioaire 57 Appedix 2 The Whole Data Book of the Solomo Islads STEPS Survey 66 Appedix 3 List ad Resposibilities of STEPS Survey Staff from Solomo Islads 115 Appedix 4 Refereces 117 KEY CONTACTS 4

6 LIST OF FIGURES Figure 1 The WHO STEPwise approach to surveillace of NCDs 18 Figure 2 Sequece of data collectio ad statios at the survey base 20 LIST OF TABLES Table A Solomo Islads NCD STEPS Survey: Provice Samples 19 Table B Total Households (HH) i Hoiara Provice ad sample selected 19 Table C Total Households (HH) i Wester Provice ad sample selected 20 Table D Total Households (HH) i Malaita Provice ad sample selected 20 Table 1 Age ad Geder of study populatio 25 Table 2 Mea umber of years of educatio by geder ad age group 26 Table 3 Percetage of curret smokers i the study populatio by geder ad age group 26 Table 4 Curret smokig status amog me i the study populatio by age group 27 Table 5 Curret smokig status amog wome i the study populatio by age group 27 Table 6 Curret smokig status amog both sexes i the study populatio by age group 28 Table 7 Mea age started smokig amog curret daily smokers 28 Table 8 Mea umber of years of smokig amog curret daily smokers 29 Table 9 Percetage of curret daily smokers who smoke maufactured cigarettes 29 Table 10 Percetage of curret betel ut chewers amog me durig the past 12 moths by age group 30 Table 11 Percetage of curret betel ut chewers amog wome durig the past 12 moths by age group 30 Table 12 Percetage of curret betel ut chewers amog both sexes durig the past 12 moths by age group 31 Table 13 Mea age started chewig betel ut amog curret daily chewers 31 Table 14 Mea umber of years of betel ut chewig amog curret daily chewers 31 Table 15 Curret chewig status amog me i the study populatio by age group 32 Table 16 Curret chewig status amog wome i the study populatio by age group 32 Table 17 Curret chewig status amog both sexes i the study populatio by age group 33 Table 18 Percetage of alcohol cosumptio amog me durig the past 12 moths by age group 33 Table 19 Percetage of alcohol cosumptio amog wome durig the past 12 moths by age group 34 Table 20 Percetage of alcohol cosumptio amog both sexes durig the past 12 moths by age group 34 Table 21 Frequecy ad quatity of driks cosumed by male curret drikers i the last 7 days 35 Table 22 Frequecy ad quatity of driks cosumed by female curret drikers i the last 7 days 35 Table 23 Number of driks per drikig day amog male curret drikers by age group 36 5

7 Table 24 Number of driks per drikig day amog female curret drikers by age group 36 Table 25 Number of driks per drikig day amog both geder of curret drikers by age group 36 Table 26 Mea umber of days i a week fruits cosumed by geder ad age group 37 Table 27 Mea umber of days i a week vegetables cosumed by geder ad age group 37 Table 28 Mea umber of servigs of fruits cosumed o a day whe fruits were eate 38 Table 29 Mea umber of servigs of vegetables cosumed o a day whe vegetables were eate 38 Table 30 Mea umber of combied servigs of fruit ad vegetables cosumed per average day 38 Table 31 Percetage who cosumed less tha five combied servigs of fruit ad vegetables per average day 39 Table 32 Categories of total physical activity amog me by age group 40 Table 33 Categories of total physical activity amog wome by age group 40 Table 34 Categories of total physical activity amog both sexes by age group 41 Table 35 Level of total physical activity (mea METmiutes per day) by geder ad age group 41 Table 36 Level of work-related physical activity (mea METmiutes per day) by geder ad age group 42 Table 37 Level of trasport-related physical activity (mea METmiutes per day) by geder ad age group 42 Table 38 Level of recreatio-related physical activity (mea METmiutes per day) by geder ad age group 42 Table 39 Mea height (cm) by geder ad age group 43 Table 40 Mea weight (kg) by geder ad age group 43 Table 41 Mea body mass idex (kg/m 2 ) by geder ad age group 44 Table 42 BMI classificatios amog me by age group 44 Table 43 BMI classificatios amog wome by age group 45 Table 44 BMI classificatios amog both geders by age group 45 Table 45 Percetage of obesity (BMI 30 kg/m 2 ) by geder ad age group 45 Table 46 Mea waist circumferece (cm) by geder ad age group 46 Table 47 Mea restig systolic blood pressure (mmhg) by geder ad age group 47 Table 48 Mea restig diastolic blood pressure (mmhg) by geder ad age group 47 Table 49 Percetage with hypertesio (SBP 140 ad/or DBP 90 or curretly o medicatio for raised blood pressure) 47 Table 50 Mea fastig blood glucose (mmol/l) by geder ad age group 48 Table 51 Prevalece of diabetes by geder ad age group 49 Table 52 Mea total blood cholesterol (mmol/l) by geder ad age group 49 Table 53 Percetage with raised total blood cholesterol ( 5.0 mmol/l or 190 mg/dl) 50 Table 54 Percetage of NCD risk categories amog me by age group 50 Table 55 Percetage of NCD risk categories amog wome by age group 51 Table 56 Percetage of NCD risk categories amog both geders by age group 51 6

8 LIST OF ABBREVIATIONS BMI BP CHD CI CVD DBP DM FBS HTN MET mg/dl mmhg mmol/l NCD PICs SBP WHO MHMS Body Mass Idex Blood Pressure Coroary Heart Disease Cofidece Iterval Cardiovascular Disease Diastolic Blood Pressure Diabetes Mellitus Fastig Blood Sugar Hypertesio Metabolic equivalet Milligrams per decilitre (uit of blood chemistry values) Millimetres of mercury (uit of blood pressure measuremet) Millimoles per litre (uit for blood chemistry values) Nocommuicable disease Pacific islad coutries ad areas Systolic Blood Pressure World Health Orgaizatio Miistry of Health ad Medical Services 7

9 FOREWORD Almost every coutry i the world has experieced a dramatic icrease i chroic or lifestyle diseases that lead to death attributable to chage i lifestyles ad the surroudig eviromet referred to may as ocommuicable diseases (NCDs). I order to address this growig problem effectively ad efficietly, we must have accurate iformatio regardig the risk factors that cotribute to the developmet of NCDs. A Risk factor refers to ay characteristic or exposure that icreases a perso s likelihood of developig a NCD. These risk factors iclude smokig, alcohol use, physical iactivity, obesity, high blood pressure, a raised level of blood glucose or cholesterol, ad a ubalaced diet. Each coutry eeds to establish its capacity i order to coduct populatio risk surveillace over time for coutries plaig of program activities ad services. We are pleased that the WHO has assisted the Solomo Islads to build our atioal capacity i populatio risk factors survey ad aalysis. The fidigs suggest actios for implemetatio of policy i NCD cotrol ad prevetio, supportive physical eviromet ad ifrastructure, ad improved health care services. The Solomo Islads NCD STEPS survey was specifically desiged to assess the prevalece of the commo NCDs ad risk factors i our populatio. The iformatio from this survey provides a importat platform for the developmet ad implemetatio of strategic plas ad programs to address the growig epidemic of NCDs i Solomo Islads. This report is the result of the STEPS survey carried out i Solomo Islads i It shows high prevalece of NCDs ad their risk factors amog our populatio ad suggests actios to: cotrol ad prevetio NCDs; provide a supportive physical eviromet ad ifrastructure, ad improved health service delivery. This is the first populatio-based survey o the prevalece of the NCD risk affectig our populatio. It represets a milestoe i our efforts to address the icreasig NCD epidemic affectig our people ad marks a icreased commitmet by the Miistry of Health ad Medical Services to tackle the NCD challege. The survey results ad recommedatios will eable us to develop more effective health policies ad programs i primary ad secodary NCD prevetio ad i moitorig ad evaluatig our ogoig efforts i NCD prevetio. 8

10 The WHO STEPS survey i Solomo Islads would ot have bee possible without the visio ad leadership of our predecessors. Their determiatio eabled this importat survey to be give priority i Solomo Islads. Their determiatio i esurig that Solomo Islads STEPS survey with WHO s support has bee realized. Last but certaily ot the least, we would like to thak all the staff of this Miistry of Health ad Medical Services, parters like the Fiji School of Medicie for completig the first ever NCD populatio survey i Solomo Islads, WHO for its strog techical support, ad AusAID for fiacial support. This report is dedicated to the hard work ad commitmet evideced from the iceptio to the completio of the NCD Risk Factors STEPS survey i Solomo Islads. We hope that the fidigs ad recommedatio i this report will guide our actios for improvig health for all. Mr Clay Forau Soalaoi Miister for Health ad Medical Services Solomo Islads Dr Lester Ross Permaet Secretary Miistry of Health ad Medical Services Solomo Islads 9

11 The WHO STEPwise Approach to Surveillace of Risk Factors for NCDs (STEPS) is the WHO recommeded surveillace tool for chroic disease risk factors ad chroic disease-specific morbidity ad mortality at atioal level. To date, 120 coutries ad areas throughout the world utilize WHO STEPS to coduct atioal surveys o risk factors of chroic disease ad morbidity of NCDs. The publicatio of the Solomo Islads NCD Risk Factors STEPS REPORT marks a milestoe as it provides the scietific, atioal, updated ad comparable data that will assist the govermet i addressig the escalatig issue of NCDs. The atioal STEPS Survey i Solomo Islads was coducted i Some of the key results of the survey ad the report iclude the followig: 30.6% of the populatio smoked tobacco daily. 62.6% of the total populatio (67.8% of me ad 57.3% of wome) chewed betel ut. 25.1% of me drak a average of 5 or more stadard driks of alcohol, 20.3% of wome drak a average of 4 or more stadard driks of alcohol per day i the past week. 93.6% of the populatio cosumed less tha five combied servigs of fruit ad vegetables per day. 41.9% of the populatio was with low level of physical activity. 67.4% of the populatio was overweight, 32.8% was obese. 13.5% of the populatio was diabetic. 10.7% of the populatio was hypertesive. WHO has developed the summary of combied risk factors, selectig five commo ad critical risk factors for NCDs: curret daily smokers, overweight (BMI 25kg/m²), raised blood pressure (SBP 140 ad/or DBP 90 mmhg or curretly o medicatio for raised blood pressure), less tha 5 servigs of fruit ad vegetables per day ad low level of physical activity (<600 METmiutes per week). Accordig to this comprehesive assessmet, oly 0.7% of the whole populatio i Solomo Islads was of low risk to NCDs, compared with 46.0% of the populatio at high risk. More attetio is required for those aged 45 to 64 years age group for both me (56.9%) ad wome (53.1%) classified at high risk for NCDs. 10

12 These results clearly documet that NCDs are a major problem i Solomo Islads. The atioal STEPS results ca be used for formulatig or updatig the atioal NCD strategy, evaluatig the impact of comprehesive NCD itervetio activities, moitorig atioal treds, etc. Future priorities eed to be give to both primary ad secodary prevetio activities to prevet ad cotrol key NCDs, icludig diabetes, cardiovascular diseases, cacer, ad their risk factors icludig smokig ad betel ut use, uhealthy diet, physical iactivity ad excessive cosumptio of alcohol. WHO is hooured to be a critical part of the collaborative efforts betwee the Solomo Islads Miistry of Health ad Medical Services, the Fiji School of Medicie, Australia Agecy for Iteratioal Develomet ad New Zealad Agecy for Iteratioal Developmet to complete the atioal STEPS survey ad report i Solomo Islads. WHO, through its offices i Hoiara, Suva, Maila ad Geeva is proud to collaborate with the Solomo Islads Miistry of Health ad Medical Services i publishig this first atioal NCD STEPS report i Solomo Islads ad will cotiue to work with health authorities, health workers ad the public to address the issues raised i this report. Dr Che Ke World Health Orgaizatio Represetative i the South Pacific Dr William Adu-Krow World Health Orgaizatio Coutry Liaiso Officer for Solomo Islads 11

13 Executive Summary The Solomo Islads NCD STEPS survey provides the baselie assessmet of the risk factors of ocommuicable diseases (NCDs) ad their associated risk factors amog Solomo Isladers. The data are based o three populatios withi the atio: i Hoiara the atioal capital i Guadalcaal Provice, Gizo i Wester Provice ad Auki i Malaita. The survey data were collected betwee December, 2005 ad November, The key objectives of the NCD STEPS survey were: To documet the prevalece ad magitude of key NCDs amog adults To documet the prevalece ad magitude of major modifiable risk factors for NCDs icludig tobacco use, betel ut use, alcohol cosumptio, dietary behaviours, physical iactivity, obesity, raised blood pressure, raised blood glucose ad cholesterol levels To compare NCDs ad their risk factors across differet age groups ad betwee me ad wome. A total of 2,833 idividuals aged participated i the survey. This report s mai tables preset data ad commetary o the sample aged years (=1925), followig the stadard age group reportig for WHO STEPS surveys. Additioal results for respodets aged years are described at the ed of each sectio of behavioural risk factors. Some risk factor behaviours (like tobacco ad alcohol cosumptio) were worse for this group tha for older adults. Step 1. Behavioural risk factors Overall, the prevalece of curret smokers amog those aged years was 39.8%. More tha half of me (54.1%) were curret smokers compared to 25% of wome. Amog curret smokers 30.6% smoked daily (smokig all types), with a geder differece of 43.9% of me ad 16.9% of wome. The mea age at which smokig started was reported to be 21 years, although people i the years age group reported startig at 16 years. Betel Nut chewig is widespread i the Solomo Islads ad was practiced by 62.6% of the total populatio (67.8% of me ad 57.3% of wome). Thirty percet (30%) of males ad females combied chewed betel o a daily basis. Importatly, rather tha beig o the decrease amog youg people betel was chewed by 77.5% of me ad 66.3% of wome i the years age group. The data also reveals a youger mea age of uptake i the yougest group, agai suggestive of a recet reductio i the age of uptake. Data o the duratio of betel chewig suggest that, oce started, it remais a lifetime habit, as those i the age group had a mea of 33 years duratio of betel cosumptio. Overall, 33.5% of the sample had cosumed alcohol i the past 12 moths ad were classified as curret drikers, highest i the yougest age groups of (45.3%) ad i age group (42%). A sigificat geder differece of 51.5% of me ad 14.9% of wome curret drikers was observed i age groups 25-64; higher still i the age group (63.8% of males ad 25.2% of females). Amog male curret drikers 25.1% reported drikig more tha 5 stadard driks o a drikig day ad 20.3% of wome reported drikig 4 or more, suggestive of bige drikig. The highest proportio of bige drikig amog me was i the years age group ad amog wome i the years age group (27.1% ad 23.8% respectively). The average cosumptio of fruit ad vegetables amog Solomo Islads falls well below the recommeded levels. The mea umber of days per week fruit ad vegetables were cosumed were 2.5 ad 4.7 days for me ad wome, respectively. Whe fruit ad vegetables were cosumed o those days, the mea umber of combied fruit ad vegetables servigs was 2.1 serves per average 12

14 day. The vast majority (93.6%) cosumed less tha 5 combied servigs of fruit ad vegetables per day. The survey foud that 41.9% of the sample reported a low level of total physical activity, that is, less tha 600 METmiutes per week (males 557 ad females 455 METmiutes per week respectively). 600 METmiutes per week are equivalet to 30 miutes of moderate-itesity physical activity for 5 days per week, or 20 miutes of vigorous activity for 3 days per week. A greater proportio of wome (47.4%) had low level of physical activity compared to me (36.5%). Coversely, a higher proportio of me reported a high level of total physical activity compared to wome (38.1% ad 26.9% respectively), largely due to work-related activities. Mai cotributio to physical activity i the Solomo Islads was from the work domai, followed by trasport ad recreatio-related activities. Step 2: Physical risk factors The overall prevalece of overweight (BMI 25kg/m 2 ) was 67.4%, ad of obesity (BMI 30kg/m 2 ) was 32.8%. Amog wome, 72.7% were overweight ad 40.4% of these were obese. Amog me, 62.5% were overweight ad 25.8% of these were obese. A estimated 32.0% of the sample had a ormal body mass idex (18.5 BMI 24.9): 26.5% of wome ad 37.0% of me. Mea waist circumferece was similar i both geders ad highest i males aged Wome i age groups had mea waist circumferece values exceedig 88 cm, a cut-off value for wome cosidered to icrease cardiovascular disease risks; while males were well below the 102cm where the risk of cardiovascular disease icreases. The survey foud a estimated 10.7% of the sample had raised blood pressure/was hypertesive (defied as havig SBP 140 mmhg ad/or DBP 90 mmhg or o medicatio for raised blood pressure). Hypertesio icreased with age i both geders, icreased sigificatly i the years age group ad was highest i wome i the years age group. Step 3. Biochemical risk factors Based o measures of fastig capillary whole blood, the overall prevalece of diabetes (fastig glucose level 6.1 mmol/l or o medicatio for raised blood glucose) i the sample aged years was 13.5%, with a slightly higher rate amog me (15.3%) tha wome (11.7%). Rates of diabetes icreased with age i both geders ad was highest amog males aged Overall, 24.6% of the sample was foud to have raised total blood cholesterol levels exceedig 5.0 mmol/l ( 190 mg/dl), higher i wome (28.5%) tha i me (19.6%) ad highest i wome i the years age group, where half of the sample had raised cholesterol. Combied risk factors As the umber of NCD risk factors for a idividual icreases, so does the risk of developig a NCD. For this report, the surveyed populatio was classified ito three NCD risk categories: High Risk (with 3-5 risk factors), Moderate Risk (with 1-2 risk factors) or Low Risk (with o risk factors). The combied NCD risk factors icluded i the computatio of NCD risk categories were curret daily smokers, overweight (BMI 25 kg/m 2 ), raised blood pressure (SBP 140 ad/or DBP 90 mmhg or curretly o medicatio), cosumig less tha five combied servigs of fruit ad vegetables per day, ad a low level of physical activity (<600 METmiutes per week). This survey foud that overall, less tha 1% of the sample was at Low Risk of NCDs, 53.3% at Moderate Risk ad 46.0% at High Risk. I age group years, 54.8% of me ad 59% of wome were already at Moderate risk of NCD, reportig 1-2 risk factors ad 44.2% of me ad 40.7% of wome were at High risk, reportig 3-5 risk factors. 13

15 Coclusio The Solomo Islads STEPS survey represets a sigificat step forward i gatherig atioal iformatio for iformig the atioal strategy for the prevetio, cotrol ad maagemet of NCDs. The survey has provided strog evidece that NCDs ad related modifiable risk factors are prevalet i the Solomo Islads. Oe outstadig feature of the fidigs is that the yougest group (15-24) appears to have adopted NCD risk lade behaviours at a earlier age tha the rest of the sample. This factor aloe suggests that curret prevetio programs are ot deterrig them from adoptig these behaviours ad that they are a clear target group for health educatio, health promotio ad health protectio iitiatives. The followig recommedatios are outlied as priority actios for the Solomo Islads: Addressig Iformatio eeds That the Miistry of Health ad Medical Services: Use the opportuity of the publicatio of this Solomo Islads NCD Risk Factors STEPS Report to orgaize atioal NCD risk factor reductio campaigs, focusig o adults, childre should be paid attetio too Compare the sub-samples (Hoiara with Gizo ad Auki) to determie whether differeces exist betwee them i the cosumptio of fruit ad vegetables, cigarettes, betel ut ad alcohol ad i other NCD risk behaviours Coduct additioal aalysis of the data cotaied herei to compare mea values ad idetify statistically sigificat associatios amog the variables Establish strog leadership ad secure political ad fiacial commitmet to maitai a systematic ad rigorous approach to STEPS data collectio supported by a workforce traied i implemetig the survey, i order to create a ogoig ad robust STEPS surveillace system i the Solomo Islads Repeat the NCD STEPS surveys periodically to determie the outcome of the NCD prevetio ad cotrol programmes/activities implemeted i the Solomo Islads Participate i the compariso of NCD STEPS fidigs across all PICs that have completed the NCD STEPS survey, i order to idetify the risk factors that are particular to ad most ameable to modificatio withi the Solomo Islads Addressig policy, orgaizatioal ad evirometal factors That govermet: Earmark fuds for ogoig NCD strategy implemetatio ad moitorig Implemet the WHO Framework Covetio o Tobacco Cotrol ad the Regioal Actio Pla for the Tobacco-Free Iitiative for the Wester Pacific Cosider the potetial for maufacturers ad importers of cigarettes ad alcohol to be taxed to the degree that they subsidize the health services provided to cosumers of their products Geerate resources for ogoig atioal health educatio programs aimed at atioal ad persoal productivity Cotiue to ba Betel ut from sale i urba markets Develop policies supportig importatio of healthy foods Ivestigate the potetial to improve the distributio, marketig ad availability of fruit ad vegetables Develop policies to establish physical activity-friedly eviromets, such as walkig tracks, urba parklads, sports facilities ad workplace fitess programs 14

16 Addressig NCD behavioural risk factors That govermet, Miistry of Health ad Medical Services ad NGO agecies create ad provide: Comprehesive ati-smokig campaigs to reduce smokig rates, particularly targetig teeagers ad the youger adult age groups to prevet smokig uptake, ad smokig cessatio programs to reduce smokig rates across all age groups Comprehesive health promotio campaigs to reduce alcohol cosumptio, particularly targeted at youg people ad bige drikig Comprehesive health promotio campaigs promotig the recommeded levels of fruit ad vegetable cosumptio ad icreasig public awareess of the adverse effects of excessive cosumptio of high-fat, high-salt, ad high-sugar foods Culturally-appropriate ad diverse programs to promote daily physical activity Public awareess campaigs o the importace of regular moitorig ad screeig of blood pressure, blood cholesterol ad blood sugar levels Public awareess programs targeted to icrease awareess of the multipliers of NCD risk associated with combiig the 5 major NCD risk factors (curret daily smokig, beig overweight, havig raised blood pressure, eatig less tha five combied servigs of fruit ad vegetables per day, ad havig a low level of physical activity) A system of commuity-based care ad maagemet of idividuals with diagosed NCDs 15

17 1. INTRODUCTION 1.1 Backgroud ad Ratioale I all coutries, o-commuicable diseases (NCDs) 1 are resposible for a high proportio of death ad disability. I developig coutries, the burde of disease caused by NCDs is icreasig rapidly ad there are sigificat social, ecoomic, ad health cosequeces for these coutries. NCDs caused a estimated 60% of deaths i the world ad 43% of the global burde of diseases i Based o curret treds, by the year 2020 these diseases are predicted to accout for 73% of deaths ad 60% of the disease burde 2. Most of these icreases will reflect the epidemiological trasitio i developig coutries; from commuicable to o commuicable diseases. Uless icreasig prevalece ca be reversed the disability ad depedecy that accompaies NCDs will preset a icreasig burde o health facilities ad o families. Despite such observatios that NCDs are a icreasig health burde to the coutry, to date there is o i-depth kowledge of the prevalece of the commo risk factors cotributig to NCDs i the Solomo Islads. Comprehesive policy has ot progressed sice the Miistry of Health ad Medical Services developed a Practical Guide to Maagemet of NCDs i Whilst the guide is helpful to cliical maagemet, there is a eed for a clearer uderstadig of the cultural ad behavioural factors that cotribute to NCDs i order to improve prevetio ad cotrol programs. This STEPS survey, beig the first i the Solomo Islads, provides a baselie for future STEPS surveys to assist i determiig the effectiveess, or otherwise, of prevetio ad cotrol measures. It also provides the basis for compariso with other coutries. I the immediate term, this STEPS report provides iformatio for atioal policy developmet, health educatio programs ad health protectio ad promotio iitiatives, as ultimately, the improvemets i diet ad physical activity ad the cotrol of risk lade cosumptios are vested with the atio, the commuity ad the idividual. 1.2 The Natioal Cotext Geography The Solomo Islads is a group of almost 1,000 islads lyig to the east of Papua New Guiea. Together they cover a lad mass of 28,400 square kilometres. The climate of the Solomo Islads is mostly tropical ad mosooal with little extremes i temperature ad a mea aual temperature of 27 C. The terrai is mostly rugged moutais with some low coral atolls Populatio ad Livig Eviromet I 2005 the populatio of the Solomo Islads was estimated at 538,032 people. The populatio profile was estimated as: 0-14 years: 41.9%, years: 54.9% ad 65 years ad over: 3.2%. Populatio growth was estimated as 2.68% per aum, highest i the Pacific regio ad sufficiet to double the populatio i 25 years. The birth rate was estimated at births/1,000 populatio ad the mortality rate at 3.98 deaths/1,000 populatio. The livig eviromet of Hoiara ad orther Guadalcaal reportedly differ from the o-ecoomically active provices, where the populatio survives o subsistece farmig ad have comparatively less access to health ad other services Govermet, Culture ad the Ecoomy The Solomo Islads achieved idepedece from The Uited Kigdom i The form of govermet is a parliametary democracy. The Solomo Islads has 10 admiistrative divisios, 9 of 16

18 which are provices; Cetral, Choiseul, Guadalcaal, Isabel, Makira-Ulawa, Malaita, Reel ad Belloa, Temotu, Wester ad 1 capital territory - Hoiara. The majority populatio is Melaesia (94.5%) ad miority groups iclude, Polyesia (3%), Microesia (1.2%), other (1.1%) ad uspecified (0.2%). There are approximately 64 idigeous laguages spoke i the Solomo Islads. Culturally, Solomo Isladers participate i Melaesia traditios, where acestral guides assist i maitaiig cultural values ad lad owership is cla based, leadig to moder day tesios as outer islad populatios move to Guadalcaal, where the capital is situated alog with much of the atio s ecoomic activity. The ecoomy is largely subsistece, ad people deped o agriculture, fishig, ad forestry for their livelihood (75% of the labour force). Its per capita GDP of US$600 raks Solomo Islads as a lesser developed atio Nocommuicable Disease, Health Status ad Health Ifrastructure Miistry of Health ad Medical Services Pla idetified its secod priority as reducig the health determiats or factors cotributig to poor health ad poverty. The prevetio ad cotrol of NCDs is cosistet with this priority. The Pla states that i sum, the populatio health status has ot bee severely affected despite the crisis but the health determiats ad risk factors to poor health ad poverty have bee observed to have deteriorated sigificatly i the past few years at a alarmig rate. The policy goals o morbidity ad mortality reductio icluded: To prevet or delay oset of the ocommuicable diseases, icludig reductio i occupatioal diseases, i order to maximize disability-free ad productive lives i older age. I 2005, cardiovascular diseases, eoplasms, malaria, respiratory diseases ad eoatal causes were major causes of mortality. Cardiovascular diseases (cerebrovascular accidet or CVA as the leadig causes) was the leadig cause of mortality. Although ifectious diseases are still major causes of morbidity ad mortality, there is some evidece that ocommuicable diseases like cacer (cervical ad breast cacers are reported to be the most commo, followed by lug cacer), diabetes mellitus, hypertesio, tobacco-related diseases ad metal illess are icreasig oticeably (WHO ). Adult mortality is high, with a average life expectacy of oly 60.6 years for males ad 61.6 years for females. Average life expectacy for both me ad wome is close to beig the lowest i the Pacific regio. The provisio of health services i Solomo Islads is a fuctio of the cetral Govermet i agreemets with implemetig agecies i the provice uder the Provicial Agreemet Act. It relies heavily o primary health care approaches ad commuity participatio. There are 157 public sector health facilities 116 of which are primary health care cetres, 29 are district level referral hospitals ad 12 are geeral hospitals, icludig the Natioal Referral Hospital i Hoiara. The reliace o primary health care approaches challeges the atio to provide adequate services for the prevetio ad maagemet of NCDs at the local level. 1.3 Developig WHO STEPS Survey i Solomo Islads No populatio-wide epidemiological data o NCD risk factors have bee collected i the Solomo Islads. Recogizig the gap i kowledge o the magitude of major NCDs ad their risk factors for plaig ad policy developmet, a umber of agecies came together to implemet the WHO STEPS survey i The survey was coducted by the Miistry of Health ad Medical Services, with techical support provided by the Fiji School of Medicie ad the World Health Orgaizatio. 17

19 2. OBJECTIVES The overall aim of the NCD STEPS risk factor survey is to ivestigate the prevalece of key NCDs ad their associated risk factors. The STEPS survey: Documets the prevalece ad magitude of key NCDs amog adults Documets the prevalece ad magitude of major modifiable risk factors for NCDs icludig smokig, alcohol cosumptio, poor eatig patters, physical iactivity, obesity, raised blood pressure, raised blood glucose ad cholesterol Compare NCDs ad their risk factors by age ad geder groups. 3. METHODOLOGY 3.1 Survey Structure The Solomo Islads STEPS survey followed a sequetial three-step process as follows (Figure 1): Step 1: A questioaire-based (iterview) survey o tobacco use, betel ut chewig, alcohol drikig, fruit ad vegetable cosumptio, physical activity, ad history of a NCD coditio. Step 2: Physiological measures of blood pressure, height, weight, ad waist circumferece. Step 3: Biochemical measures of fastig blood glucose ad total cholesterol. Similar to other STEPS surveys coducted i the Pacific regio, the Solomo Islad survey collected core iformatio across the three steps. STEPS stadardized survey methodology was followed. This approach esures that the Solomo Islads has available populatio-wide ad represetative data for betwee-coutry comparisos as well as withi-coutry comparisos. I future surveys, Solomo Islads could add more questios or measuremets to the core questios, depedig o local eeds. Step 3 Step 2 Biochemical measuremets Step 1 Physical measuremets Self report iformatio Optioal Expaded Miimum Figure 1. The WHO STEPwise approach to surveillace of NCDs 3.2 Survey Samplig Methodology Followig the WHO STEPS guidelies 3, the survey used a multi-stage cluster samplig method, usig Probability Proportioate to Size (PPS) methods i all 3-study provices. 18

20 3.2.1 Natioal/Provicial Level Samplig The total populatio of the Solomo Islads was divided ito 9 provices usig the Statistical boudaries ad classificatios from the year 2004 Cesus. From the 9 provices, 6 provices were excluded for logistical reasos, although this was cosidered ot to compromise represetativeess. The 3 remaiig provices i the samplig frame were Hoiara, Wester ad Malaita. Table A: Solomo Islads NCD STEPS Survey: Provice Samples POPULATION SIZE Age Age Age Age Age Total Age Total CODE PROVINCES Sub sample 1 Hoiara 13,236 15,468 8,837 4,948 2,451 44, Wester 15,539 12,195 8,602 4,978 2,943 44, Malaita 28,987 19,008 12,411 8,075 5,676 74, TOTAL 163,354 3, Ward/village level samplig The first-stage cluster samplig radomly selected 10 Wards i Hoiara (Table B), 2 villages i Gizo (Table C) ad 3 villages i Auki (Tables D) Household level samplig Secod-stage cluster samplig commeced i Hoiara with oe radomly selected household withi each of the 10 Wards. Recruitmet cotiued with participats from adjacet households util the target umber of people withi the age group of i each Ward was achieved. Table B: Total Households (HH) i Hoiara Provice ad sample selected Code Provice 1 Hoiara Wards Total # HH Sample # H 101 Ngossi 6, Mbumburu 2, Rove. Legakiki 2, Vavea 6, Mataiko 2, Kukum 1, Kola a 7, Vura 8, Paatia 9, Vuhokesa 1, Total 49,125 2,500 Two villages were selected i Gizo i the Wester Provice ad three were selected i Auki i Malaita Provice. People livig withi each defied area o the map/list were ivited to atted the survey at a cetral site. This arragemet was commuicated to the village leaders or Church pastors, ad a map or list was provided to them i advace. 19

21 Table C: Total Households (HH) i Wester Provice ad sample selected Wester: Village - Based POPULATION SIZE Code Provice 2 Gizo Total # HH Target # HH 213 Titiaa Village Rarumaa Total 1, Table D: Total Households (HH) i Malaita Provice ad sample selected Malaita: Village - Based POPULATION SIZE Code Provice 3 Auki Total # HH Target # HH 322 Lilisiaa Dala South Fiu Total 1, Sample Size A total target sample size of 3,000. Participats were selected from the age group years to udergo STEP 1 ad STEP 2. 2,833 participats took part i the survey. The fial sample comprised 1,925 people i the age group ad 908 people i the age group Oe third of the sample was radomly selected to participate i STEP Data Collectio Procedures Survey persoel obtaied iformed coset from survey participats ad gave fastig istructios to those radomly selected for STEP 3 (excludig the age group) ad made appoitmet times for those who coseted to participate i the survey. All study provices ad selected wards/villages followed the same procedure for selectig eligible participats. Figure 2: Sequece of data collectio ad statios at the survey base Registratio Statio If fastig If ot fastig Blood test Statio Refreshmet Statio Iterview Statio Height Measuremets Weight Measuremets Blood pressure Statio Hip/Waist Measuremets Check out & couselig 20

22 3.5 Data Collectio Process Registratio of Participats Idividual Household Summary Forms ad a Household Trackig Form were used to keep track of the umber of participats i each household ad the umber of total idividuals recruited. At the registratio statio, survey staff cofirmed iformed coset, participats date of birth, fastig status of the participat, ad explaied to participats all the steps ivolved i the survey. 21

23 3.5.2 Step 1 - Behavioural Risk Factors Iterviews All participats participated i a face-to-face iterview i which questios were asked o smokig, alcohol cosumptio, fruit ad vegetable cosumptio, physical activity ad history of chroic coditios ad medicatios. Participats were also asked about the umber of years of their formal educatio ad their mai work status Step 2 - Physical Measuremets Survey staff coducted the physical measuremets followig the recommeded STEPwise protocols. The OMRON M4 Digital Automatic Blood Pressure Moitor was used to measure restig blood pressure. Blood pressure was measured three times; the first readig followed by two more measuremets take with 2-3 miute itervals. The three readigs of the blood pressure were recorded, ad the average of the secod ad third readigs was used i the aalysis. Height ad weight were measured oce usig the Seca Leicester Height Measure to the earest whole cetimeter ad the Siltec PS500L to the earest 0.1 kg, respectively. Participats were measured without shoes ad wearig oly light clothig. Waist circumferece was measured oce usig the Figure Fider costat tesio tape ad recorded to the earest 0.1 cm. Waist circumferece of female pregat participats was ot measured. 22

24 3.5.4 Step 3 - Biochemical Measuremets The survey icluded assessmets of fastig blood glucose ad fastig total cholesterol. Participats fasted from the previous ight for 12 hours util the followig morig, whe their capillary blood samples were draw usig the method of figer prick. 23

25 3.5.5 Check-out Statio ad Cousellig After the STEPS 1, 2 & 3 were completed, participats received health advice ad couselig ad were provided with literature about smokig, alcohol drikig, obesity ad utritio, physical activity, hypertesio, diabetes, ad heart diseases. Participats who were idetified as beig at high risk of developig, or with, advaced chroic coditios were referred for a follow-up cliical examiatio. 3.6 Data Maagemet ad Aalyses Data Etry Fiished questioaires were checked radomly by staff to assess overall quality of data collectio ad completeess. Data etry was coducted by the survey staff at the Miistry of Health ad Medical Services office usig the EpiData software cofigured for double data etry fuctio Data Weightig ad Aalysis Post-stratificatio weights were calculated usig the 2005 populatio projectios based o Solomo Islads 2004 cesus of the populatio aged years. This weightig adjusted for certai age/sex stratum ad populatio structure beig either over-represeted or uder-represeted i the survey data. Weighted sample meas were computed for cotiuous variables. Frequecy distributios were calculated usig weighted frequecies for categorical variables. For both weighted frequecy estimates ad weighted meas, 95% cofidece itervals were reported by 10-year age groups ad geder. 24

26 With support from the WHO Office i Suva, WHO Office i Geeva performed fial data cleaig, data weightig, ad aalysis. Data aalyses were coducted usig the EpiIfo 2002 Versio The WHO Office i Suva compiled the Data Book. I this report, mai data tables preset fidigs for those aged years, followig the stadard age group reportig for WHO STEPS surveys. However, as data for the age group of years was also collected, additioal commetary is preseted at the ed of each sectio of behavioural risk factors. 4. RESULTS 4.1 Characteristics of Survey Populatio The study selected ad ivited 3,000 Solomo Isladers aged years to participate i the survey. A total of 2,833 idividuals participated (respose rate of 94.4%). Data for those aged years are reported here i the mai tables, followig the stadard age group reportig for WHO STEPS surveys. Table 1 presets the age ad geder distributio of the etire survey sample. Overall, more wome respodets i all age groups participated i the survey tha me: 56.9% ad 43.1%, respectively. Hereafter, percetages give i the text relate to the age groups 25-64, ad commetary o the age group is provided at the ed of each sectio. Of the sample age 25-64, 41.5% were wome aged Two thirds (67.7%) of the sample was aged below 45 years, ad oly 10.6% were i the years age group. Table 1 Age ad Geder of study populatio Age group ad geder of respodets Me Wome Both Sexes % % % Table 2 presets the mea years of educatio of the survey respodets. Me reported a greater mea years of educatio tha wome: 8.4 years ad 6.0 years respectively. I both geders, the yougest age group (25-34 years) reported the highest mea years of educatio 9.4 ad 7.1 years respectively, while the oldest age group (55-64) reported the shortest mea years of educatio collectively, although that of me was higher tha wome:6.6 ad 3.8 years respectively. 25

27 Table 2 Mea umber of years of educatio by geder ad age group Mea umber of years of educatio Me Wome Both Sexes Mea Mea Mea Those aged of both geders reported havig the logest duratio of educatio of ay age group i the sample (males 9.5 years ad females 8.5). 4.2 Tobacco Use Tobacco use was measured by askig participats if they curretly smoke tobacco products. Respodets were categorized ito the followig smokig status: Curret smokers those who had smoked ay tobacco product (such as cigarettes, cigars or rolled tobacco) i the past 12 moths. Daily smokers those who smoke ay tobacco product every day. No-daily smokers those curret smokers who do ot smoke o a daily basis. Table 3 shows that 39.8% of respodets were curret smokers. More tha half of me (54.1% ±6.9) were curret smokers, compared to a quarter of wome (25% ±4.5) respodets. This greater tha two-fold geder differece was observed i all age groups except i those aged years. The highest proportio of curret smokers amog both geders was i the years age group: 59.5% ±8.4 of me ad 27.9% ±5.2 of wome. Table 3 Percetage of curret smokers i the study populatio by geder ad age group Age Group Percetage of curret smokers Me Wome Both Sexes % % % Curret Curret Curret smoker smoker smoker ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±5.0 26

28 Table 4 shows that 45.9 % of male respodets were o-smokers. Of the balace (54%) who smoked, 43.9% ±5.7 smoked o a daily basis. Almost half (48.4% ±7.8) of youg me aged years were daily smokers. The proportio of daily smokers decreased thereafter to a low of 35% ±12.3 of daily smokers i the age group years, as did the proportio of o-daily smokers. Table 4 Curret smokig status amog me i the study populatio by age group Smokig status Me Curret smoker % Does % Nodaily % Daily ot smoke ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±6.9 Table 5 shows that 75% of the female respodets were o-smokers, 16.9% ±3.8.smoked o a daily basis. The proportios of daily smokers decreased with icreasig age, from 17.6% ±3.9 i the yougest age group (25-34 years) to 14.9% ±9.0 i the oldest age group (55-64 years), while the proportio of o-daily smokers icreased i age Table 5 Curret smokig status amog wome i the study populatio by age group Smokig status Wome Curret smoker % Does % Nodaily % Daily ot smoke ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±4.5 Table 6 presets the prevalece of daily smokers, o-daily smokers ad o-smokers for me ad wome combied. Overall, 30.6 % ±3.9 of survey respodets were daily smokers, 9.1% ±2.0 were o-daily smokers ad 60.2% ±5.0 were o-smokers. The highest proportio of daily smokers (33.1% ±5.2) was reported i the age group 25-34, although those i age group reported a similar rate (28.9% ±5.2). 27

29 Table 6 Curret smokig status amog both sexes i the study populatio by age group Smokig status Both Sexes Curret smoker % Does % Nodaily % Daily ot smoke ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±5.0 Table 7 shows that amog curret daily smokers, the mea age of startig smokig for me was 20.3 ±0.5 years ad for wome was 23.1 ±1.2 years. This geder differece i the reported mea age of smokig uptake occurs i all age groups. Across both geders, the yougest cohort of years reported startig smokig earlier tha the older cohorts. The highest mea age of startig smokig (27.4 ±3.2 years) was reported amog wome i age groups Table 7 Mea age started smokig amog curret daily smokers Mea age started smokig Age Me Wome Both Sexes Group Mea Mea Mea age age age ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.5 Table 8 shows that amog curret daily smokers overall, the mea umber of years of smokig was 16.6 (±1.1) years. Me reported smokig for a mea of 17.2 ±1.4 years ad wome for a mea of 15 ±1.8 years. Respodets i age group reported a mea duratio of smokig as 37.3 ±2 years for me ad 33 ±7.6 years for wome. 28

30 Table 8 Mea umber of years of smokig amog curret daily smokers Mea duratio of smokig Age Me Wome Both Sexes Group Mea Mea Mea duratio duratio duratio ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±1.1 Table 9 shows that maufactured cigarettes were the most commo cigarettes smoked by curret daily smokers: 60.6% ±9.2 of me ad 56.3% ±5.1 of wome. The smokig of maufactured cigarettes was highest i the yougest age groups of both geders ad the lowest amog the oldest age group 55-64, particularly i females at 30.8% ±23.8, although the cofidece iterval is widest i this age group. Table 9 Percetage of curret daily smokers who smoke maufactured cigarettes Age Group % Maufactured cigarette smoker Maufactured cigarette smokers amog daily smokers Me Wome Both Sexes % Maufactured cigarette smoker % Maufactured cigarette smoker ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±7.3 Amog those aged15-24 years, 59.5% ±5.6 of males were curret smokers compared to 28.1% ±5.4 of females.42.4% ±4.5 of males ad 12.3% ±3.9 of females reported smokig o a daily basis. Males reported havig started smokig at age 16.4 ±0.6 years ad havig smoked for a mea of 4.3 ±0.7 years. Wome reported startig at age 16.8 ±0.6 years ad havig smoked for a mea of 4.2 ±0.4 years. Notably, the age of smokig uptake i both geders of this age group was youger tha i other age groups. The majority (71.2% ±7.0) of the sample i age group smoked maufactured cigarettes, the largest proportio of all age groups. 29

31 4.3 Betel Nut Use Table 10 shows that 32.2% ±7.7 of the male respodets were abstaiers from chewig betel ut. 67.8% ±7.7 of me who chewed betel ut i the past 12 moths, the largest proportio (72.8% ± 9.3) was i the age group Rates of betel ut use remaied relatively stable thereafter but declied i age group Table 10 Percetage of curret betel ut chewers amog me durig the past 12 moths by age group Betel ut chewig status Me % Chewed i last 12 % Abstaier moths ± ± ± ± ± ± ± ± ± ±7.7 Table 11 shows that 42.7% ±8.9 of female respodets were abstaiers from chewig betel ut. 57.3% ±8.9 of wome chewed betel ut i the past 12 moths, the largest proportio (65.6% ±8.1) was i the age group Rates of betel ut use declied thereafter i age group 35-44, peaked agai i age group ad declied agai i age group Table 11 Percetage of curret betel ut chewers amog wome durig the past 12 moths by age group Betel ut chewig status Wome % Chewed i last 12 % Abstaier moths ± ± ± ± ± ± ± ± ± ±8.9 Table 12 shows that 37.4% ± 8.0 of all respodets were abstaiers from chewig betel ut. 62.6% ± 8.0 chewed betel ut i the past 12 moths, the largest proportio (69.2% ±7.9) was i the age group Rates of betel use remaied relatively costat i age groups ad ad declied i age group

32 Table 12 Percetage of curret betel ut chewers amog both sexes durig the past 12 moths by age group Betel ut chewig status Both Sexes % Chewed i last 12 % Abstaier moths ± ± ± ± ± ± ± ± ± ±8.0 Table 13 shows that amog curret daily betel chewers overall, the mea age of startig betel use was 20.8 (±0.7) years. Me reported a mea age of startig betel use at 20.4 ±1.1 years ad wome reported a mea age of 21.5 ±0.7 years. Wome i the two youger age groups ad reported startig at a older age tha me, while older wome reported startig at a youger age tha me. Table 13 Mea age started chewig betel ut amog curret daily chewers Mea age started chewig Age Me Wome Both Sexes Group Mea Mea Mea age age age ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.7 Table 14 reveals that amog curret daily betel chewers, the mea umber of years of use was 17.1 ±1.0 years. Me reported betel use for a mea of 17.5 ±1.3 years ad wome for a mea of 16.4 ±1.2 years, although respodets i age group reported a mea duratio of betel use as 32.5 ± 3.4 years for me ad 34.8 ± 5.5.years for wome. Table 14 Mea umber of years of betel ut chewig amog curret daily chewers Mea duratio of chewig Age Me Wome Both Sexes Group Mea Mea Mea duratio duratio duratio ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±1.0 31

33 Table 15 presets the curret prevalece of daily betel users, o-daily users ad o-users amog me. Overall, 35.8 % ±4.7 of male respodets were daily chewers, 32.0% ±5.0 were o-daily chewers ad 32.2% ±7.7 were o-betel users. The highest proportio of daily betel chewers (38.0% ±5.7) was reported i the age group Table 15 Curret chewig status amog me i the study populatio by age group Chewig status Me Curret chewer % Does % Nodaily % Daily ot chew ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±7.7 Table 16 presets the curret prevalece of daily betel users, o-daily users ad o-users amog wome. Overall, 24.0 % ± 6.4 of female respodets were daily chewers, 33.3% ± 4.3 were o-daily chewers ad 42.7 ± 8.9 were o-betel users. The highest proportio of daily betel chewers (27.0% ± 7.7) was reported i the age group Table 16 Curret chewig status amog wome i the study populatio by age group Chewig status Wome Curret chewer % Does % Nodaily % Daily ot chew ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±8.9 Table 17 presets the curret prevalece of daily betel users, o-daily users ad o-users amog both me ad wome combied. Overall, 30.0 % ± 5.1.of respodets were daily chewers, 32.6% ± 4.4 were o-daily chewers ad 37.4 ± 8.0 were o-betel users. The highest proportio of daily betel chewers (32.5% ± 5.3) was reported i the age group

34 Table 17 Curret chewig status amog both sexes i the study populatio by age group Chewig status Both Sexes Curret chewer % Does % Nodaily % Daily ot chew ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±8.0 Amog those aged15-24 years, 77.5% ±8.3 of me were curret betel ut chewers compared to 66.3% ±5.9 of wome. Both geders curret users reported commecig betel use at age15.2 ±0.7 years, youger tha all other age groups, ad havig used betel ut for a mea of 5.3 ±0.6 years. Betel was chewed daily by 34% ±8.9 of me ad 20.9% ±5.9 of wome. 4.4 Alcohol Cosumptio This sectio describes patters of alcohol cosumptio. To assess patters ad prevalece of alcohol cosumptio, respodets were asked if they ever cosumed alcohol, ad the frequecy ad quatity of alcohol cosumed. Those who had cosumed a alcoholic drik i the past 12 moths were classified as curret drikers. Tables summarise the prevalece of alcohol cosumptio durig the past 12 moths amog me, wome ad both geders respectively. There was a sigificat geder differece i cosumptio behaviour, with more tha half of males (51.5%± 3.6) (Table 18) ad less tha a seveth of females (14.9% ± 2.5) (Table 19) classified as curret drikers. Males exceeded females i all age groups of curret drikers, while the highest proportios of curret drikers i both geders combied was i the age group More tha a quarter (26.9% ±4.7) of males ad three quarters (74% ±4.3) of females reported beig a lifetime abstaier from alcohol. The highest proportio of curret drikers amog both geders was i the years age group (42% ± 3.6). Thereafter, the proportio of curret drikers decreased with icreasig age (Table 20). Table 18 Percetage of alcohol cosumptio amog me durig the past 12 moths by age group % Lifetime Abstaier Alcohol cosumptio status Me % Past 12 mos. abstaier % curret driker (drak i past 12 mos.) ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±3.6 33

35 Table 19 Percetage of alcohol cosumptio amog wome durig the past 12 moths by age group % Lifetime Abstaier Alcohol cosumptio status Wome % Past 12 mos. abstaier % curret driker (drak i past 12 mos.) ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±2.5 Table 20 Percetage of alcohol cosumptio amog both sexes durig the past 12 moths by age group % Lifetime Abstaier Alcohol cosumptio status Both Sexes % Past 12 mos. abstaier % curret driker (drak i past 12 mos.) ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±2.5 Table 21 ad 22 preset iformatio o curret drikers by the frequecy (umber of drikig days) of alcohol cosumptio, quatity of driks cosumed (umber of driks o ay drikig day) ad the proportio that drak more that 20 alcohol driks i the past 7 days. Table 21 shows that amog male curret drikers 25.1% ±5.2.cosumed 5 or more driks o ay drikig day ad 3.9% ± 2.6 drak 20 or more driks over the 7 day period. The highest proportios that drak 5 or more stadard driks o ay day were i the age group (27.1% ±10.6) ad the age group (25.7 ± 7.7). 34

36 Age Group years Table 21 Frequecy ad quatity of driks cosumed by male curret drikers i the last 7 days %Drak 4+ Days 95% CI Frequecy ad quatity of driks cosumed i the last 7 days % Drak <4 days 95% CI % 5+ Driks o ay day Me % <5 Driks o ay day % 20+ driks i 7 days 95% CI % <20 driks i 7 days ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±2.6 95% CI Table 22 shows that amog female curret drikers 20.3% ± 9.0 cosumed 4 or more driks o ay drikig day ad 3.9% drak 15 or more driks over the 7 day period. The highest proportios that drak 4 or more stadard driks o ay day was i the age group (23.8%± 21.7) ad those i the age group were the oly group to report drikig o more tha 4 days. Table 22 Frequecy ad quatity of driks cosumed by female curret drikers i the last 7 days Age Group %Drak 4+ Days Frequecy ad quatity of driks cosumed i the last 7 days Wome % 4+ % <4 % % Driks Driks % Drak 95% 95% 95% 95% o o driks CI <4 CI CI CI CI ay ay i 7 days day day days % <15 driks i 7 days ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±3.9 95% CI Tables 23 ad 24 preset iformatio o the umber of stadard driks cosumed per drikig day by curret drikers ad show that heavy drikig is more commo amog me tha wome across all age groups, with 79.5% ±4.1 of me cosumig more tha 6 stadard driks o a drikig day compared to 45.5% ±10.4 of wome. Table 23 shows that curret male drikers drik a average of 8.3 ± 0.3 stadard driks o a drikig day ad that the largest mea umber (8.6 ± 0.4) was cosumed by the age group 25-34, of whom 84.7% ±5.0 cosumed six or more stadard driks o a drikig day. 35

37 Age Group Table 23 Number of driks per drikig day amog male curret drikers by age group % 1 drik Number of stadard driks cosumed o a drikig day Me 95% % % % % % 6+ 95% CI driks CI driks CI driks CI Mea # of stadard driks ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.3 95% CI Table 24 shows that curret female drikers drik a average of 5.4 stadard driks o a drikig day ad that the largest mea umber (5.7) was cosumed by the age group 25-34, of whom almost a half (49.4 ± 9.9) cosumed six or more stadard driks o a drikig day. Table 24 Number of driks per drikig day amog female curret drikers by age group Age Group % 1 drik Number of stadard driks cosumed o a drikig day Wome 95% CI % 2-3 driks 95% CI % 4-5 driks 95% CI % 6+ driks 95% CI Mea # of stadard driks ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± % CI Table 25 shows that curret drikers of both geders drik a average of 7.6 ± 0.3 stadard driks o a drikig day ad that the largest mea umber (8.0 ± 0.4) was cosumed by the age group 25-34, of whom more tha three quarters (76.5 ± 4.1) cosumed six or more stadard driks o a drikig day. Table 25 Number of driks per drikig day amog both geders of curret drikers by age group Age Group % 1 drik Number of stadard driks cosumed o a drikig day Both Sexes 95% % % % % % 6+ 95% CI driks CI driks CI driks CI Mea # of stadard driks ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.3 95% CI 36

38 Amog those aged15-24 years, 63.8% ±4.2 of males were curret drikers compared to 25.2% ±4.7 of females. Oe quarter of male curret drikers (25.2% ±8.3) reported drikig 5+ stadard driks o ay day i the last 7 days compared to 10.9% ±8.9 of females who reported drikig 4+ stadard driks. However, 76.4% ±5.1 of youg males reported drikig 6 or more stadard driks o a drikig day compared to 47.5% ±8.9 of youg females. 4.5 Itake of Fruit ad Vegetables Respodets fruit ad vegetable itake was assessed by askig how may days they cosumed fruit ad vegetables i a typical week, ad how may servigs of each they cosumed o oe of those days. Table 26 shows that wome reported margially higher mea days of fruit cosumed i a typical week (2.7 ±0.3) tha me (2.4 ±0.3) overall ad across all age groups. Table 27 shows that wome reported margially higher mea days of vegetable cosumptio i a typical week (4.8 ±0.3) tha me (4.6 ±0.2) overall ad across all age groups. Table 26 Mea umber of days i a week fruits cosumed by geder ad age group Mea umber of days fruit cosumed i a typical week Me Wome Both Sexes Mea Mea Mea umber umber umber of days of days of days ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.3 Table 27 Mea umber of days i a week vegetables cosumed by geder ad age group Mea umber of days vegetables cosumed i a typical week Me Wome Both Sexes Mea Mea Mea umber umber umber of days of days of days ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.3 Tables 28 ad 29 show the reported cosumptio of servigs of fruit ad vegetables o the day whe these food items were eate, while Table 30 shows the reported average cosumptio of combied servigs of fruit ad vegetables per day. Table 28 shows that, overall, respodets reported a average of 0.8 ± 0.1 servigs of fruit relatively cosistetly across all age groups. Table 29 shows that overall, respodets reported a average of 1.4 ±0.1 servigs of vegetables relatively cosistetly across all age groups. 37

39 Table 28 Mea umber of servigs of fruits cosumed o a day whe fruits were eate Age Group Mea umber of servigs of fruit o average per day Me Wome Both Sexes Mea Mea Mea umber umber umber of of of servigs servigs servigs ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.1 Table 29 Mea umber of servigs of vegetables cosumed o a day whe vegetables were eate Age Group Mea umber of servigs of vegetables o average per day Me Wome Both Sexes Mea Mea Mea umber umber umber of of of servigs servigs servigs ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.1 Table 30 shows that overall; respodets reported a average of 2.1. ±0.2 combied servigs of fruit ad vegetables relatively cosistetly across all age groups, although males i age group reported cosumig the least (1.9 ± 0.2). Table 30 Mea umber of combied servigs of fruit ad vegetables cosumed per average day Age Group Mea umber of servigs of fruit ad vegetables o average per day Me Wome Both Sexes Mea Mea Mea umber umber umber of of of servigs servigs servigs ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.2 38

40 Table 31 shows that 93.6% ±2.3 of respodets of both geders cosumed less tha five combied servigs of fruit ad vegetables o a average day with o differece betwee me (93.3% ±3.1) ad wome (93.9% ± 1.8), although males i age group preseted the lowest proportio of those eatig less tha 5 combied servigs per average day. Table 31 Percetage who cosumed less tha five combied servigs of fruit ad vegetables per average day Age Group Less tha five servigs of fruit ad vegetables o average per day Me Wome Both Sexes % < 5 % < 5 % < 5 servigs servigs servigs per day per day per day ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±2.3 Those aged15-24 years reported cosumig fruit o 2.8 ± 0.3 days a week, vegetables o 4.6 ±0.3 days a week ad 2.2 ±0.3 combied servigs of fruit ad vegetables o a average per day. The majority (92.1% ±3.0) reported cosumig less tha 5 combied servigs of fruit ad vegetables o a average day. 4.6 Physical Activity Questios Respodets were asked how ofte (frequecy) ad how log (duratio) they egaged i three domais of physical activity i a typical week: work-related, trasport-related ad leisure-related. I the work ad leisure domais, respodets were asked how may days per week ad how may hours/miutes per day they participate i moderate ad vigorous itesity activities. I the trasport domai, respodets were asked how ofte ad how log they either walk ad/or cycle to ad from places Aalysis The three physical activity domais were first examied separately to determie the proportio of activity udertake i each domai as a compoet of total physical activity. For each domai, three levels of activity were recorded: low, moderate, ad high. I each domai, the total time participats spet i a activity per 5 day week was computed by multiplyig the umber of days by the duratio of the activity. To accout for the differet levels of eergy expediture required for the activities (i.e. low, moderate or high), the daily duratio of activity was coverted ito METmiutes per day. The term MET (metabolic equivalet) is used as a idicatio of the itesity of physical activity. A MET is the ratio of the associated metabolic rate for a specific activity divided by the restig metabolic rate. The eergy cost of sittig is equivalet to a restig metabolic rate of 1 MET. 39

41 I this report, the followig MET values were allocated to the three physical activity domais: Moderate physical activity (work ad leisure domai) High physical activity (work ad leisure domai) Travel related walkig/cyclig = 4.0 METS = 8.0 METS = 4.0 METS The followig levels of activity i terms of METmiutes were defied as: Low activity: Moderate activity: High activity: <600 METmiutes per week METmiutes per week >1500 METmiutes per week Levels of Physical Activity Table 32 shows that whe physical activity doe as part of work, trasport ad leisure time are combied 36.5% ±3.3 of me reported a low level of total physical activity. Moderate physical activity was reported by 25.4% ±2.8 of me ad a high level of physical was reported by 38.1% ±3.4. The proportios of low total physical activity icreased i age group 45-54, while the proportios reportig a moderate level of physical activity varied little. A high level of total physical activity decreased i the age group ad further decreased i age group Table 32 Categories of total physical activity amog me by age group Level of total physical activity Me % % Low % High Moderate ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±3.4 Table 33 shows that whe physical activity doe as part of work, trasport ad leisure time are combied 47.4% ±4.5 of wome reported a low level of total physical activity. Moderate physical activity was reported by 25.6% ±3.0 of wome ad a high level of physical was reported by 26.9% ±3.0. The proportios of low total physical activity icreased i age group 45-54, while the proportios reportig a moderate level of physical activity varied little. A high level of total physical activity decreased i the age group ad further decreased i age group Table 33 Categories of total physical activity amog wome by age group Level of total physical activity Wome % % Low % High Moderate ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±3.0 40

42 Table 34 shows that whe physical activity doe as part of work, trasport ad leisure time are combied 41.9% ±2.8 of both geders reported a low level of total physical activity. Moderate physical activity was reported by 25.5% ±1.8 ad a high level of physical was reported by 32.6% ±2.5. The proportios of low total physical activity icreased i age group 45-54, while the proportios reportig a moderate level of physical activity decreased i age group ad icreased i age group A high level of total physical activity decreased i the age group ad further decreased i age group Table 34 Categories of total physical activity amog both sexes by age group Level of total physical activity Both Sexes % % Low % High Moderate ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±2.5 Table 35 presets the mea miutes of total physical activity across all three domais i METmiutes per day by geder ad age. Overall, respodets reported a average of ±8.2 METmiutes per day spet i total physical activity. There was a sigificat geder differece with me egaged i physical activity for a mea of ±10.4 METmiutes per day, ad wome for a mea of 91.0 ± 9.1 METmiutes per day. Table 35 Level of total physical activity (mea METmiutes per day) by geder ad age group Mea METmiutes of total physical activity o average per day Age Me Wome Both Sexes Group Mea Mea Mea miutes miutes miutes ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±8.2 Tables preset results o mea METmiutes per day egaged i work-related, trasportrelated ad recreatio-related physical activity. Table 36 shows that work-related physical activities comprised 68.5 ±9.2 METmiutes/day for me ad 57.7 ±8.0 METmiutes/day for wome. Across age groups 25-35, ad me reported egagig i more METmiutes of work-related physical activity tha wome, although wome reported more METmiutes tha me i age group

43 Table 36 Level of work-related physical activity (mea METmiutes per day) by geder ad age group Mea miutes of work-related physical activity o average per day Age Me Wome Both Sexes Group Mea Mea Mea miutes miutes miutes ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±7.1 Table 37 shows that trasport-related physical activities comprised 29.0 ±2.0 METmiutes/day for me ad 21.5 ±2.0 METmiutes/day for wome. Across all age groups me reported egagig i more METmiutes/day of trasport related physical activity tha wome. Table 37 Level of trasport-related physical activity (mea METmiutes per day) by geder ad age group Mea miutes of trasport-related physical activity o average per day Age Me Wome Both Sexes Group Mea Mea Mea miutes miutes miutes ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±1.5 Table 38 shows that recreatio-related physical activities comprised 13.9 ± 2.1 METmiutes/day for me ad 11.8 ±2.5 METmiutes/day for wome. I age groups ad me reported egagig i more METmiutes/day of recreatio related physical activity tha wome, while i age groups ad wome reported egagig i more METmiutes/day of recreatio-related physical activity tha me. Table 38 Level of recreatio-related physical activity (mea MET miutes per day) by geder ad age group Mea miutes of recreatio-related physical activity o average per day Age Me Wome Both Sexes Group Mea Mea Mea miutes miutes miutes ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±1.6 42

44 Amog those aged15-24 years 43.2% ± 4.3 of both geders combied reported a low level of physical activity (38.3% ±5.0 for me ad 48.5% ±6.4 for wome). Youg me reported more mea METmiutes of total physical activity tha youg wome (86.1 ±11.7 METmiutes ad 67.1 ±6.7 respectively) largely due to more trasport-related ad recreatio-related activity. 4.7 Overweight ad Obesity Height ad Weight The height ad weight of each participat was measured followig the stadardized STEPS protocol. The body mass idex (BMI) of each participat was computed by dividig the weight (kilograms) by the square of the height (metres 2 ). BMI risk categories are defied as follows: Uderweight BMI < 18.5 Normal weight 18.5 BMI 24.9 Overweight BMI 25.0 Obese BMI 30.0 Tables 39 ad 40 show that me were sigificatly taller (166.4 cm ±0.7) ad heavier (75.3kg ±1.5) tha wome (155.7cm ±0.6 ad 70.4kg ±2.0). I both geders, youger people were margially taller tha older people. Amog me, weight peaked i the year group (79.2kg ±2.6) ad amog wome i the years age group (73kg ± 2.6). Table 39 Mea height (cm) by geder ad age group Mea height (cm) Me Wome Mea Mea ± ± ± ± ± ± ± ± ± ±0.6 Table 40 Mea weight (kg) by geder ad age group Mea weight (kg) Me Wome Mea Mea ± ± ± ± ± ± ± ± ± ±2.0 43

45 4.7.2 Body Mass Idex Categories Table 41 presets the mea BMI scores for both geders, idividually ad combied. The overall mea BMI was 28.1kg/m 2 ±0.5. Wome had a higher mea BMI (29kg/m 2 ±0.7) tha me (27.2 kg/m 2 ± 0.5) ad i all age groups. The mea BMI for me was highest i the age group, while for wome there was little variatio across age groups. Age Group Table 41 Mea body mass idex (kg/m 2 ) by geder ad age group Mea BMI (kg/m 2 ) Me Wome Both Sexes Mea Mea Mea ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.5 Tables 42, 43 ad 44 preset the proportio of the sample populatio i 3 BMI classificatios - uderweight, ormal ad overweight (icludes obese) for me, wome ad both geders combied. Table 42 shows that 62.5% ± 6.6 of me are classified as overweight, 37% ±6.4 as ormal ad 0.5% ± 0.6 as uderweight. Table 42 BMI classificatios amog me by age group BMI classificatios Me Age Group % Uderweight weight weight % Normal % Over- < ± ± ± ± ± ± ± ± ± ± ± ± ± ±6.6 Table 43 shows that 72.7% ±5.5 of wome are classified as overweight, 26.5 ±5.3 as ormal ad 0.8% ±0.7 as uderweight. 44

46 Table 43 BMI classificatios amog wome by age group BMI classificatios Wome Age Group % Uderweight weight weight % Normal % Over- < ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±5.5 Table 44 shows that the proportio of males ad females combied classified as beig overweight was 67.4% ±5.7, as ormal 32% ±5.6 ad 0.6% ±0.5 as uderweight. Table 44 BMI classificatios amog both geders by age group BMI classificatios Both Sexes Age Group % Uderweight weight weight % Normal % Over- < ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±5.7 Table 45 presets rates of obesity (BMI 30 kg/m 2 ) for both geders, idividually ad combied. The overall prevalece of obesity was 32.8% ±3.3. The obesity rate was sigificatly higher amog wome (40.4% ±5.8) tha amog me (25.8% ±2.6). The highest prevalece of obese wome (47.3% ±7.0) was i the age group, while for me it was i the age group. Table 45 Percetage of obesity (BMI 30 kg/m 2 ) by geder ad age group Age Me Wome Both Sexes Group % % % BMI 30 BMI 30 BMI ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±3.3 45

47 The mea height of those aged15-24 years was similar to the mea height of the other age groups, while mea weight was lower for both geders. Mea BMI for both geders were lower tha the sample meas of the other age groups Waist Circumferece Waist circumferece was assessed as a measure of cetral obesity, a measure of risk of cardiovascular diseases. Table 46 shows the mea waist circumferece for both me ad wome, that wome had a margially higher mea waist circumferece (89.6cm ±1.4) tha me (88.2cm ±1.2), that mea waist circumferece i me varied more tha i wome ad was highest i age group i both geders. Table 46 Mea waist circumferece (cm) by geder ad age group Waist circumferece (cm) Me Wome Mea Mea ± ± ± ± ± ± ± ± ± ± Blood Pressure ad Hypertesio As part of the Step 2 protocol, all survey participats had their blood pressure measured. Participats were also asked if they had had their blood pressure measured i the last 12 moths, withi the last 1-5 years or loger, whether they had ever bee told i the last 12 moths by a health worker that they had high blood pressure, ad if they were curretly receivig ay medical treatmet for high blood pressure. The STEPS protocol reports the presece of raised blood pressure to iclude people with: a mea systolic pressure of 140 mmhg, whether or ot they had previously bee told by a health worker that they had high blood pressure, OR a mea diastolic pressure of 90 mmhg, whether or ot they had previously bee told by a health worker that they had high blood pressure, OR ormal mea systolic ad diastolic pressures (i.e. ormotesive) AND who were curretly receivig ati-hypertesive medicatio, whether or ot they had previously bee told by a health worker that they had high blood pressure. Those participats who reported havig bee previously told by a health worker that they had high blood pressure, but who were ormotesive ad NOT o ati-hypertesive medicatio, were NOT icluded amog those cosidered to have hypertesio. 46

48 Table 47 presets mea restig systolic ad Table 28 mea restig diastolic blood pressures for both geders, idividually ad combied. Table 47 shows a higher mea systolic blood pressure i males tha i females (117.0 ±2.0 ad ±2.1 respectively), icreasig with age i both geders, particularly i females, where the meas i age groups ad exceeded those of males. Age Group Table 47 Mea restig systolic blood pressure (mmhg) by geder ad age group Mea systolic blood pressure (mmhg) Me Wome Both Sexes Mea Mea Mea ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±1.8 Table 48 shows a higher mea diastolic blood pressure i males tha i females (72.3 ±2.5 ad 71.0 ±2.1 respectively), icreasig with age i both geders util age where it decreased margially i males ad was relatively uchaged i females, both remaiig above the sample mea. Age Group Table 48 Mea restig diastolic blood pressure (mmhg) by geder ad age group Mea diastolic blood pressure (mmhg) Me Wome Both Sexes Mea Mea Mea ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±2.2 Table 49 presets the prevalece of hypertesio i the sample, cosistet with the above defiitio. Hypertesio was foud i 11% ±4.2 of me ad 10.5% ±2.5 of wome ad 10.7% ±2.6 overall. The prevalece of hypertesio icreased with icreasig age i both me ad wome. From the base of age group of 35-44, the male rate doubles (9.6% to 18.6%) ad the female rate more tha triples (6.1% to 21.6%) i age group 35-44; ad ultimately triples i males ad icreases six-fold i females i the age group Age Group Table 49 Percetage with hypertesio (SBP 140 ad/or DBP 90 or curretly o medicatio for raised blood pressure) SBP 140 ad/or DBP 90 mmhg or curretly o medicatio for raised blood pressure Me Wome Both Sexes % % % ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±2.6 47

49 4.9 Fastig Blood Glucose ad Diabetes Survey participats were asked if they had bee told by a health worker i the previous 12 moths that they had diabetes, withi 1-5 years or loger, ad whether they were curretly receivig medical treatmet for diabetes. To measure fastig blood sugar levels, capillary whole blood was draw usig the figer prick method. Estimates of diabetes prevalece were computed based o the capillary whole blood glucose test results ad by followig the WHO guidelies for defiig ad classifyig diabetes mellitus 4. fastig capillary whole blood value of glucose greater tha or equal to 6.1 mmol/l ( 110 mg/dl) whether or ot they had previously bee told by a health worker that they had diabetes, OR ormal capillary whole blood value of glucose less tha 6.1 mmol/l (<110 mg/dl) AND who were curretly receivig ati-diabetes medicatio prescribed by a health worker. Those participats who had bee advised by a health worker that they had diabetes but who had ormal fastig blood glucose, ad who were NOT o ati-diabetes medicatio or o a special diet prescribed by a health worker, were NOT icluded amog those cosidered as havig diabetes. Table 50 summarizes results o mea fastig blood glucose for both geders idividually ad combied. The overall mea fastig blood glucose was 5.4 mmol/l ±0.2. Me reported a margially higher mea fastig glucose level (5.5 mmol/l ±0.2) tha wome (5.4 mmo/l ±0.2), although this differece was ot statistically sigificat. For both me ad wome, mea fastig blood glucose levels icreased with icreasig age ad peaked i the oldest age group. Table 50 Mea fastig blood glucose (mmol/l) by geder ad age group Mea fastig blood glucose (mmol/l) Me Wome Both Sexes Mea Mea Mea ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.2 Table 51 shows the prevalece of diabetes for both geders idividually ad combied. The overall prevalece diabetes was 13.5% ±4.3. Diabetes prevalece was greater i me tha i wome (15.3% ± 5.1 ad 11.7% ±4.0 respectively). More tha oe third of the sample i the age group was diabetic (32.4 ±11.4). The oset of adult diabetes is evidet i the icrease i age group 24-35; thereafter both geder rates icrease with icreasig age, two ad half-fold by age

50 Age Group Table 51 Prevalece of diabetes by geder ad age group Raised blood glucose or curretly o medicatio for diabetes ** Me Wome Both Sexes % % % ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±4.3 ** capillary whole blood value: 6.1 mmol/l (110 mg/dl) 4.10 Total Cholesterol For elevated total blood cholesterol, a cut-off poit 5.0 mmol/l (or 190 mg/dl) was used to classify participats as beig i a high-risk group for coroary artery disease. Table 52 shows the mea total cholesterol level for both geders idividually ad combied. The overall mea was 4.6 mmol/l ±0.1 ad similar mea levels for me (4.5 mmol/l ±0.1) ad wome (4.7 mmol/l ±0.1) showed little variace across age groups, although were highest i both geders i the age group. Table 52 Mea total blood cholesterol (mmol/l) by geder ad age group Mea total cholesterol (mmol/l) Me Wome Both Sexes Mea Mea Mea ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.1 Table 53 shows the proportio of the sample with raised blood cholesterol for both geders idividually ad combied. Close to a quarter of the sample (24.6% ±5.3) had raised blood cholesterol, a greater proportio i wome tha i me (28.5% ±5.3. ad 19.6 ±6.1 respectively) ad particularly i age group where half (50% ±19.7) of wome ad a quarter of me (25% ±21.4) had raised blood cholesterol. 49

51 Age Group Table 53 Percetage with raised total blood cholesterol ( 5.0 mmol/l or 190 mg/dl) Total cholesterol 5.0 mmol/l or 190 mg/dl Me Wome Both Sexes % % % ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± Combied Risk Factors To summarize the fidigs for the five importat risk factors for NCDs, the followig factors were combied ad are preseted i Tables 54, 55, ad 56 i two age groups, ad curret daily smokers, overweight (BMI 25 kg/m 2 ), raised blood pressure (SBP 140 ad/or DBP 90 mmhg or curretly o medicatio), cosumed less tha five combied servigs of fruit ad vegetables per day, ad low level of activity (<600 METmiutes per week). These five risk factors were summed to idicate the overall risk for NCDs as follows: Low Risk: 0 of 5 risk factors Moderate Risk: 1 or 2 of 5 risk factors High Risk: 3 or more of 5 risk factors Table 54 shows that almost half of the male respodets (47.8% ±4.9) were classified as at High Risk ad more tha half (51.1% ±4.3) as at Moderate Risk. Table 55 shows wome at a margially lower risk tha me with 44.2% ±5.4 at High Risk ad 55.6% ±5.3 at Moderate Risk. I both geders (table 56) the highest level of risk was i the older age group, although 44.2% ±6.1 of youger me ad 40.7% ± 5.2 of youger wome were i the High Risk category. Overall, 46.0% ±4.8 of the Solomo Islads sample was at High Risk of NCDs. Table 54 Percetage of NCD risk categories amog me by age group Level of Risk Me % with 0 % with 1-2 % with 3-5 risk risk risk factors factors factors ± ± ± ± ± ± ± ± ±4.9 50

52 Table 55 Percetage of NCD risk categories amog wome by age group Raised Risk Wome % with 0 % with 1-2 % with 3-5 risk risk risk factors factors factors ± ± ± ± ± ± ± ± ±5.4 Table 56 Percetage of NCD risk categories amog both geders by age group Raised Risk Both Sexes % with 0 % with 1-2 % with 3-5 risk risk risk factors factors factors ± ± ± ± ± ± ± ± ±4.8 51

53 5. DISCUSSION AND CONCLUSIONS This sectio summarizes key fidigs from the STEPS survey ad presets a rage of recommedatios to cotrol NCDs i the Solomo Islads. Behavioural risk factors for NCDs are commo i the Solomo Islads ad preset a public health problem at all ages of adulthood, with almost half of the sample aged classified as at High Risk (with 3-5 cocurret risk factors) of developig a NCD. Solomo Islads wome face oly slightly less risk tha me. The highest level of combied risk factors is i the age group, although over 40% of me ad wome aged years were also i the High Risk category. More tha half of the sample was at Moderate Risk (with 1-2 cocurret risk factors). As the combiatio of risk factors icrease the risk of developig ad dyig from a NCD also icreases. Compared to the mea values calculated for the years group, a higher proportio of curret smokers, a youger age of smokig uptake, a higher proportio usig maufactured cigarettes, a youger age of betel ut uptake ad a higher rate of betel ut chewig, a higher proportio of curret alcohol drikers, a higher proportio of female curret drikers drikig 6 or more stadard driks o a drikig day, ad a higher proportio egaged i low levels of work-related physical activity i years group. These fidigs suggest peer group pressure, or the effects of marketig activities producig a recet reductio i the age of risk factor uptake, ad idicate the eed to target prevetio strategies to teeagers. Compared to the older age groups, greater proportios of the age group, smoked maufactured cigarettes. This behaviour raised the eed for health protectio legislatio. More tha a third of the sample populatio was classified as curret smokers: more tha half of me ad a quarter of wome surveyed, the majority of whom reported that they smoked o a daily basis. For most curret smokers, smokig uptake occurred durig the early 20s ad cotiued as a lifetime habit, with a reported duratio of 36 years amog the age group. Betel ut is widely used i the Solomo Islads, as idicated by the more tha three quarters ad of me ad oe third of wome i the sample reportig its use, ad of whom 25% cosume it o a daily basis. Chroic use of betel uts may icrease the risk of some cacers, ad immediate effects ca iclude worseig of asthma, high or low blood pressure, ad abormal heart rate. Betel ut use has bee show to have a harmful effect o the gums, it is closely related to the oral cacer. These facts have bee well observed i Melaesia commuities, so icreases the proportio of abstaiers (curretly almost oe quarter of me ad a third of wome) through health educatio campaigs. Cotiuig the ba o betel ut sale i urba markets to reduce the red stai from betel spittig is likely to cotribute to a reductio i betel ut use. Just over a half of me i the sample were curret alcohol drikers. The highest proportios of drikers i both geders were i the age group (although ot as high as i the years age group). That oe quarter of male curret drikers drak 5 or more driks ad oe fifth of females drak 4 or more driks o a drikig day is suggestive of bige drikig. Bige drikig leads to social disruptio, damage to the brai ad liver, risk of cacer of the mouth, throat or oesophagus, possible icreased risk of eurological disorders ad heart problems ad icreases the potetial for violece ad uprotected sex. The majority (93%) of the sample was ot cosumig the recommeded five combied servigs of fruit ad vegetables per day. The cosumptio level of fruit ad vegetables did ot differ much across geder ad age groups but did suggest that males of the age group were better fed tha the rest of the populatio. More tha a third of males ad almost a half of females aged reported Low levels of physical activity. As measured by METmiutes, males egaged i more physical activity tha females across 52

54 all age groups, but both geders scored Low levels of physical activity per 5 day week (males 557 ad females 455 METmiutes respectively), where Low Activity is defied as < 600. Surprisigly, youg people i the age group egaged i less METmiutes per week tha the years age group (385 ad 507 METmiutes respectively). Work related physical activity accouted for the majority of physical activity ad recreatio for the least amog both males ad females. The BMI for females exceeded that for males i all age groups. Overall, as classified by BMI, there was a sigificatly higher proportio of obese females tha males. The highest proportios of overweight ad obese females were i the year age group, while the highest proportios of overweight ad obese males were i the age group. This decade differece may be explaied by a combiatio of biological ad social roles, where females are still i the reproductive years ad males have decreased their level of physical activity ad icreased their waist circumferece. The mea waist circumferece for me ad wome were greatest i the age groups (94.7cm ad 92.1cm respectively), although oly wome were at a elevated risk of high blood pressure, high blood cholesterol, type-2 diabetes, heart disease ad stroke. (Me with a waist circumferece of more tha 102cm ad wome with a waist circumferece of more tha 88cm may have a higher disease risk tha people with smaller waist circumfereces). Although hypertesio was idetified i approximately 11% of the sample, the fidigs for those aged ad show a marked icrease from age ad are highest i females. Hece a substatial portio of the older populatio was hypertesive, ad had a elevated risk of developig cardiovascular disease or stroke. Similarly, the proportio of the sample with diabetes was approximately 14% overall but icreased i the groups ad Oe quarter of the surveyed populatio was foud to have elevated fastig blood cholesterol, distributed across all age groups, but over oe third i age group ad reachig 50% i older females. These behavioural, physiological ad biochemical measures idicate the substatial presece of NCDs ad NCD risk factors i the Solomo Islads, all of which icrease markedly i the older age groups. While the behavioural risk factor data were collected from self-reports ad, as such, the prevalece of some risk factors may be over-estimated or uder-estimated, the key stregth of the survey is its size ad its populatio-wide characteristics. A importat stregth of the survey is that key physiological ad biochemical idicators were measured usig objective ad cliical techiques by staff traied i the STEPS protocol. The Solomo Islads STEPS survey has cofirmed that NCDs pose a threat to public health ad logevity, ad a challege to atioal productivity. A atioal strategy is required to address crosssectoral cotributig factors, such as the availability of fruit ad vegetables for daily cosumptio, the licesig ad regulatio of products that impact adversely o health status, health educatio campaigs o the outcomes of risk lade behaviours, particularly amog youg people who may yet have the potetial to avoid NCDs by chagig their behaviours. Importatly, all of the risk factors metioed herei are modifiable. However, for such a strategy to be effective, the populatio has to be iformed the risks ad value the outcome of improved health. This chage will eed to be drive by iformatio, such as that provided i this STEPS report ad provided i a maer that is sesitive to the prevailig social, ecoomic ad cultural eviromets of Solomo Islads. 53

55 6. RECOMMENDATIONS Addressig Iformatio eeds That the Miistry of Health ad Medical Services: Use the opportuity of the publicatio of this Solomo Islads NCD Risk Factors STEPS Report to iitiate a atioal NCD risk factor reductio campaig Compare the sub-samples (Hoiara with Gizo ad Auki) to determie whether differeces exist i the cosumptio of fruit ad vegetables ad cosumables Coduct secodary aalysis of the data cotaied herei to compare mea values ad to determie statistical associatios amog the variables Establish strog leadership ad secure political ad fiacial commitmet to maitai a systematic ad rigorous approach to STEPS data collectio supported by a workforce traied i implemetig the survey, i order to create a ogoig ad robust STEPS surveillace system i the Solomo Islads Repeat the NCD STEPS surveys to determie the effectiveess, or otherwise, of NCD prevetio ad cotrol measures implemeted i the Solomo Islads Participate i the compariso of NCD STEPS fidigs across all PICT that have completed the NCD STEPS survey, i order to idetify the risk factors that are particular to ad most ameable to modificatio withi the Solomo Islads Ehace the dissemiatio of this atioal STEPS report through workshops/meetigs from atioal to provicial levels ad with differet stakeholders MHMS ad WHO eed to orgaize the stadardized traiig for atioal STEPS Surveys Esure sufficiet fiacial support for the 2 d -roud atioal STEPS survey Addressig policy, orgaizatioal ad evirometal factors That govermet: Earmark fuds for ogoig NCD prevetio ad cotrol activities Implemet the WHO Framework Covetio o Tobacco Cotrol ad the Regioal Actio Pla for the Tobacco-Free Iitiative for the Wester Pacific Cosider the potetial for maufacturers ad importers of cigarettes ad alcohol to be taxed to the degree that they subsidize the health services provided to cosumers of their products Geerate resources for ogoig atioal health educatio programs aimed at productivity Cotiue to ba Betel ut from sale i urba markets Develop policies supportig importatio of healthy foods. Ivestigate the potetial to improve the distributio, marketig ad availability of fruit ad vegetables Develop policies to establish physical activity-friedly eviromets, such as walkig tracks, urba parklads, sports facilities ad workplace fitess programs Itegrated approach for commuity ivolvemet, e.g., health village settig 54

56 Addressig NCD behavioural risk factors That govermet, Miistry of Health ad Medical Services ad NGO agecies create ad provide: Comprehesive ati-smokig campaigs to reduce smokig rates, particularly targetig teeagers ad the youger adult age groups to prevet smokig uptake, ad smokig cessatio programs to reduce smokig rates across all age groups Comprehesive health promotio campaigs to reduce alcohol cosumptio, particularly targeted at youg people ad bige drikig Comprehesive health promotio campaigs promotig the recommeded levels of fruit ad vegetable cosumptio ad icreasig public awareess of the adverse effects of excessive cosumptio of high-fat, high-salt, ad high-sugar foods Make fruit ad vegetables available ad affordable Culturally-appropriate ad diverse programs to promote daily physical activity Public awareess campaigs o the importace of regular moitorig ad screeig of blood pressure, blood cholesterol ad blood sugar levels Public awareess programs targeted to icrease awareess of the multipliers of NCD risk associated with combiig the 5 major NCD risk factors (curret daily smokig, beig overweight, havig raised blood pressure, eatig less tha five combied servigs of fruit ad vegetables per day, ad havig a low level of physical activity) A system of commuity-based care ad maagemet of idividuals with diagosed NCDs 55

57 APPENDICES 56

58 PART 2 - APPENDIX 1- SOL STEPS INSTRUMENT Respodet Idetificatio Number Appedix 1. Solomo Islads STEPS Survey Questioaire The WHO STEPwise approach to Surveillace of Nocommuicable Diseases (STEPS) Check if the followig are completed (to be checked by:) Yes No Sigature Fastig status (Registratio Statio) Step 1, 2 & 3 data collectio (Checkout Statio) First EpiData data etry (Data etry persoel) Secod EpiData data etry (Data etry persoel) Data etry irregularities (Data etry persoel) Idetificatio Iformatio: I 1 Provice code I 2 Provice Name: I 3 Village code: (SEE NOTE BELOW) I 4 Iterviewer code I 5 Date of completio of the questioaire Coset / /200 Day Moth Year Respodet ID Number - I 6 Coset has bee read out to respodet Yes 1 No 2 If NO, read coset I 7 Coset has bee obtaied (verbal or writte) Yes 1 No 2 If NO, END I 8 I 9 I 10 I 11 I 12 I 13 Iterview Laguage Time of iterview (24 hour clock) Family Name First Name Cotact phoe umber where possible Eglish 1 Pidgi Eglish 2 : Specify whose phoe Work 1 Home 2 Neighbour 3 Other (specify) 4 Note: Idetificatio iformatio I6 to I13 should be stored separately from the questioaire because it cotais cofidetial iformatio. Please ote: Village code is required as part of mai istrumet for data aalyses. Date of iterview is required to calculate age. 57

59 PART 2 - APPENDIX 1- SOL STEPS INSTRUMENT Respodet Idetificatio Number Step 1 Demographic Iformatio C1 Sex (Record Male / Female as observed ) C2 What is your date of birth? If Do t Kow, See Note* below ad Go to C3 Codig Colum Male 1 Female 2 Day Moth Year19 C3 How old are you? Years C4 What is your ethic backgroud? Melaesia Polyesia Microesia Chiese/Asia Others I total, how may years have you spet at school or C5 i full-time study (excludig pre-school)? Years C6 What is the highest level of educatio you No formal schoolig 1 have completed? Preclass 2 Primary school 3 Secodary/High school 4 Higher educatio/college 5 C7 C8 C9 C10 Which of the followig best describes your mai work status over the last 12 moths? [INSERT COUNTRY-SPECIFIC CATEGORIES] USE SHOWCARD How may people older tha 18 years, icludig yourself, live i your household? Takig the past year, ca you tell me what the average earigs of the household have bee? If you do t kow the amout, ca you give a estimate of the aual household icome if I read some optios to you? Is it [USE SHOWCARD & READ OPTIONS] [INSERT QUINTILE VALUES] other tha secodary school Uiversity 6 Post graduate degree 7 Govermet employee 1 No-govermet employee 2 Self-employed 3 No-paid 4 Studet 5 Homemaker 6 Retired 7 Uemployed (able to work) 8 Uemployed (uable to 9 work) Number of people OR per moth OR per year Per week Go to Next Sectio (S1a) if give estimated earigs Refused 8 Quitile (Q) 1 1 More tha Q 1, Q 2 2 More tha Q 2, Q 3 3 More tha Q 3, Q 4 4 More tha Q 4 5 Refused 8 If Refused Go to C10 Note*: 1) The Date of Birth (C2) or the age (C3) or both (C2 ad C3) have to be filled. If both C2 ad C3 ot available, the STOP. CODE DK FOR DON T KNOW or DON T REMEMBER. 58

60 PART 2 - APPENDIX 1- SOL STEPS INSTRUMENT Respodet Idetificatio Number Step 1 Behavioural Measures Tobacco Use (Sectio S) Now I am goig to ask you some questios about various health behaviours. This icludes thigs like smokig, drikig alcohol, eatig fruits ad vegetables ad physical activity. Let's start with smokig. Respose Codig Colum S 1a Do you curretly smoke ay tobacco products, Yes 1 such as cigarettes, cigars or pipes? No 2 S 1b If Yes, Yes 1 Do you curretly smoke tobacco products daily? No 2 S 2a How old were you whe you first started Age smokig daily? Do t remember D K S 2b Do you remember how log ago it was? I Years Years OR i Moths Moths OR i Weeks Weeks S 3 O average, how may of the followig do you smoke each day? Maufactured cigarettes (RECORD FOR EACH TYPE) Had-rolled cigarettes Pipes full of tobacco Cigars, cheroots, cigarillos Other (please specify): If No, go to N1a If No, go to N1a If Kow, go to S 3 Betel Nut Use (Sectio N) The ext questios ask about the use of betel ut. N 1a Do you curretly chew betel ut? N 1b N 2a N 2b N 3 If Yes, Do you curretly chew betel uts daily? How old were you whe you first started chewig betel uts daily? Do you remember how log ago it was? (CODE DK FOR DON T REMEMBER) Do you usually smoke while chewig betel ut? Yes 1 No 2 If No, go to A1a Yes 1 No 2 If No, go to A1a Age If Kow, go to Do t remember D K N3 I Years Years OR i Moths Moths OR i Weeks Weeks Yes No

61 PART 2 - APPENDIX 1- SOL STEPS INSTRUMENT Respodet Idetificatio Number Alcohol Cosumptio (Sectio A) The ext questios ask about the cosumptio of alcohol. A 1a Have you ever cosumed a drik that cotais alcohol such as beer, wie, spirit or fermeted cider? USE SHOWCARD or SHOW EXAMPLES A 1b Have you cosumed alcohol withi the past 12 moths? A 2 A 3 Have you ever tried or druk home brewed alcohol or kwaso i the past 12 moths? I the past 12 moths, how frequetly have you had at least oe drik? (READ RESPONSES) USE SHOWCARD Note: Code DK for Do t kow or Do t remember. Respose Yes No Yes No Yes No 5 or more days a week 1-4 days per week 1-3 days a moth Less tha oce a moth Codig Colum If No, Go to D1a If No, Go to D1a A 4 A 5 A 6 A 7 Whe you drik alcohol, o average, how may driks do you have durig oe day? Durig each of the past 7 days, how may stadard driks of ay alcoholic drik did you have each day? (RECORD FOR EACH DAY USE SHOWCARD) Durig the last 30 days, o how may days did you drik home brewed alcohol or kwaso? Do you usually smoke durig or after drikig alcohol? Number Do t kow D K Moday Tuesday Wedesday Thursday Friday Saturday Suday Number of days Yes No 1 2 Diet (Sectio D) The ext questios ask about the fruits ad vegetables that you usually eat. I have a utritio card here that shows you some examples of local fruits ad vegetables. Each picture represets the size of a servig. As you aswer these questios please thik of a typical week i the last year. D 1a D 1b D 2a D 2b I a typical week, o how may days do you eat fruit? USE SHOWCARD How may servigs of fruit do you eat o oe of those days? USE SHOWCARD I a typical week, o how may days do you eat vegetables? USE SHOWCARD How may servigs of vegetables do you eat o oe of those days? USE SHOWCARD Number of days Number of servigs Number of days Number of servigs If Zero days, go to D 2a If Zero days, go to Sectio P 60

62 PART 2 - APPENDIX 1- SOL STEPS INSTRUMENT Respodet Idetificatio Number D 3 D 4 D 5 What type of oil or fat is most ofte used for meal preparatio i your household? SELECT ONLY ONE Vegetable oil 1 Lard or suet 2 Butter or ghee 3 Margarie 4 Cocout oil Other 5 Noe i particular 6 Noe used 7 Do t kow 8 I a typical week, o how may days do you eat fresh fish? Number of days I a typical week, o how may days do you eat tied fish? Number of days Note: Code DK for Do t kow or Do t remember. Physical Activity (Sectio P) Next I am goig to ask you about the time you sped doig differet types of physical activity. Please aswer these questios eve if you do ot cosider yourself to be a active perso. Thik first about the time you sped doig work. Thik of work as the thigs that you have to do such as paid or upaid work, household chores, harvestig food, fishig or hutig for food, seekig employmet. [Isert other examples if eeded] Does your work ivolve mostly sittig or stadig, Yes 1 P 1 with walkig for o more tha 10 miutes at a time? No 2 P 2 Does your work ivolve vigorous activity, like [heavy Yes 1 liftig, diggig or costructio work] for at least 10 No 2 miutes at a time? INSERT EXAMPLES & USE SHOWCARD P 3a I a typical week, o how may days do you do Days a week vigorous activities as part of your work? P 3b O a typical day o which you do vigorous activity, I hours ad miutes how much time do you sped doig such work? hrs : mis OR i Miutes oly or miutes P 4 P 5a Does your work ivolve moderate-itesity activity, like brisk walkig [or carryig light loads] for at least 10 miutes at a time? INSERT EXAMPLES & USE SHOWCARD I a typical week, o how may days do you do moderate-itesity activities as part of your work? O a typical day o which you did moderate-itesity activities, how much time do you sped doig such work? Yes No Days a week 1 2 P 5b I hours ad miutes hrs : mis OR i Miutes oly or miutes How log is your typical work day? P 6 Number of hours hrs Other tha activities that you ve already metioed, I would like to ask you about the way you travel to ad from places. For example to work, for shoppig, to market, to church. [isert other examples if eeded] P 7 P 8a P 8b Do you walk or use a bicycle (pedal cycle) for at least 10 miutes cotiuously to get to ad from places? I a typical week, o how may days do you walk or bicycle for at least 10 miutes to get to ad from places? How much time would you sped walkig or bicyclig for travel o a typical day? Yes No Days a week I hours ad miutes OR i Miutes oly If Yes, go to P6 If No, go to P4 If No, go to P6 1 If No, go to P9 2 hrs : mis or miutes 61

63 PART 2 - APPENDIX 1- SOL STEPS INSTRUMENT Respodet Idetificatio Number The ext questios ask about activities you do i your leisure time. Thik about activities you do for recreatio, fitess or sports [isert relevat terms]. Do ot iclude the physical activities you do at work or for travel metioed already. P 9 Does your [recreatio, sport or leisure time] ivolve Yes 1 mostly sittig, recliig, or stadig, with o physical activity lastig more tha 10 miutes at a time? No 2 P 10 P 11a P 11b P 12 P 13a P 13b I your [leisure time], do you do ay vigorous activities like [ruig or streuous sports, weight liftig] for at least 10 miutes at a time? INSERT EXAMPLES & USE SHOWCARD If Yes, I a typical week, o how may days do you do vigorous activities as part of your [leisure time]? How much time do you sped doig this o a typical day? Note: Code DK for Do t kow or Do t remember. I your [leisure time], do you do ay moderateitesity activities like brisk walkig,[cyclig or swimmig] for at least 10 miutes at a time? INSERT EXAMPLES & USE SHOWCARD If Yes I a typical week, o how may days do you do moderate-itesity activities as part of [leisure time]? How much time do you sped doig this o a typical day? Yes No Days a week I hours ad miutes OR i Miutes oly Yes No Days a week 1 2 hrs : mis or miutes If Yes, go to P 14 If No, go to P If No, go to P 14 I hours ad miutes hrs : mis OR i Miutes oly or miutes The followig questio is about sittig or recliig. Thik back over the past 7 days, to time spet at work, at home, i [leisure], icludig time spet sittig at a desk, visitig frieds, readig, or watchig televisio, but do ot iclude time spet sleepig. Over the past 7 days, how much time did you sped I hours ad miutes P 14 sittig or recliig o a typical day? hrs : mis OR i Miutes oly or miutes History of High Blood Pressure V 1 H 1 H 2 H 3 How may times did you visit the doctor durig the last 12 moths? (Iclude hospitalisatio or visits to the outpatiet departmet/health cliics; do ot iclude visits to the detist). Whe was your blood pressure last measured by a health professioal? Durig the past 12 moths have you bee told by a doctor or other health worker that you have elevated blood pressure or hypertesio? Number of times Withi past 12 moths 1-5 years ago Not withi past 5 yrs Yes No Are you curretly receivig ay of the followig treatmets for high blood pressure prescribed by a doctor or other health worker? Yes 1 No 2 H 3a Drugs (medicatio) that you have take i the last 2 weeks H 3b Special prescribed diet Yes No H 3c Advice or treatmet to lose weight Yes No H 3d Advice or treatmet to stop smokig Yes No H 3e Advice to start or do more exercise Yes No If No, skip to Next Sectio 62

64 PART 2 - APPENDIX 1- SOL STEPS INSTRUMENT Respodet Idetificatio Number H 4 H 5 Durig the past 12 moths have you see a traditioal healer for elevated blood pressure or hypertesio Are you curretly takig ay herbal or traditioal remedy for your high blood pressure? Yes No Yes No History of Diabetes H 6 H 7 Whe was your blood sugar last measured by a health professioal Have you ever bee told by a doctor or other health worker that you have diabetes? Withi past 12 moths 1-5 years ago Not withi past 5 yrs H 8 H 8a Isuli Yes No H 8b Yes No Are you curretly receivig ay of the followig treatmets for diabetes prescribed by a doctor or other health worker? 1 2 Oral drug (medicatio that you have take i the last Yes 1 2 weeks No Durig the past 12 moths have you see a Yes 1 traditioal healer for diabetes? No 2 Are you curretly takig ay herbal or traditioal Yes 1 remedy for your diabetes? No 2 Note: Code DK for Do t kow or Do t remember H 8c Special prescribed diet Yes No H 8d Advice or treatmet to lose weight Yes No H 8e Advice or treatmet to stop smokig Yes No H 8f Advice to start or do more exercise Yes No H 9 H 10 If No, skip to Next Sectio Commets: Step 1 V 2 Are there ay irregularities or problems with the measuremets? (to be aswered by the Iterviewer) Yes No 1 2 If yes, please describe. 63

65 PART 2 - APPENDIX 1- SOL STEPS INSTRUMENT Respodet Idetificatio Number Step 2 Physical Measuremets Height ad weight M 1 M 2a & 2b M 3 M 4 Techicia ID Code Device IDs for height ad weight (2a) height Codig Colum (2b) weight. Height (i Cetimetres) Weight If too large for scale, code (i Kilograms). 1 2 M 5 (For wome) Are you pregat? Yes No If Yes, Skip Waist Waist ad Hip M 6 Techicia ID M 7 Device ID for waist M 8 Waist circumferece (i Cetimetres). M 9 Hip circumferece (i Cetimetres). Blood pressure M 10 M 11 Techicia ID Device ID for blood pressure M 12 Cuff size used Normal Large Maual Codig Colum M 13a Readig 1 Systolic BP Systolic mmhg M 13b Diastolic BP Diastolic mmhg M 14a Readig 2 Systolic BP Systolic mmhg M 14b Diastolic BP Diastolic mmhg M 15a Readig 3 Systolic BP Systolic mmhg M 15b Diastolic BP Diastolic mmhg 64

66 PART 2 - APPENDIX 1- SOL STEPS INSTRUMENT Respodet Idetificatio Number Step 3 Biochemical Measuremets Blood glucose B 1 B 2 B 3 B 4 B 5 Sice 10pm last ight, have you had aythig to eat or drik, other tha water? Techicia ID Code Device ID code Time of day blood specime take (24 hour clock) Blood glucose Yes No Low High Uable to assess Codig Colum hrs : mis mmol/l. Blood Lipids B 6 B 7 B 8 Techicia ID Code (cholesterol) Device ID code (cholesterol) Total cholesterol Low High Uable to assess mmol/l. B 9 Techicia ID Code (triglycerides) B 10 Device ID code (triglycerides) B 11 Triglycerides Haemoglobi B 12 Techicia ID Code B 13 Device ID Code B 14 Haemoglobi Low High Uable to assess Low 1 High 2 Uable to access mmol/l. g/l. If yes, please describe. Commets: Step 2 ad 3 (to be aswered by ay Step 2 or 3 techicia) V 3 Are there ay irregularities or problems with the Yes 1 measuremets? No 2 65

67 Appedix 2. The Whole Data Book of the Solomo Islads STEPS Survey WHO STEPS Chroic Disease Risk Factor Surveillace DATA BOOK FOR SOLOMON ISLANDS 66

68 Demographic Iformatio Results Age group by sex Descriptio: Summary iformatio by age group ad sex of the respodets. Istrumet questio: Sex What is your date of birth? Age group ad sex of respodets Me Wome Both Sexes % % % Ethicity Descriptio: Summary results for the ethicity of the respodets. Istrumet Questio: What is your [isert relevat ethic group/racial group/cultural subgroup/others] backgroud? Ethic group of respodets Both Sexes 1) Melaesia 2) Polyesia 3) Microesia 4) Chiese/Asia 5) Other

69 Educatio Descriptio: Mea umber of years of educatio amog respodets. Istrumet questio: I total, how may years have you spet at school or i full-time study (excludig pre-school)? Mea umber of years of educatio Me Wome Both Sexes Mea Mea Mea

70 Highest level of educatio Descriptio: Highest level of educatio achieved by the survey respodets. Istrumet questio: What is the highest level of educatio you have completed? Age Group % No formal schoolig Highest level of educatio Me % % % Primary Secodary Preclass school School % Higher educatio / college % Uiversity % Post graduate degree Age Group % No formal schoolig Highest level of educatio Wome % % % Primary Secodary Preclass school School % Higher educatio / college % Uiversity % Post graduate degree Age Group % No formal schoolig Highest level of educatio Both Sexes % % % Primary Secodary Preclass school School % Higher educatio / college % Uiversity % Post graduate degree

71 Employmet status Descriptio: Proportio of respodets i paid employmet ad those who are upaid. Upaid icludes persos who are o-paid, studets, homemakers, retired, ad uemployed. Istrumet questio: Which of the followig best describes your mai work status over the last 12 moths? Employmet status Me % % Nogovermet Govermet employee employee % Selfemployed % Upaid Employmet status Wome % % Nogovermet Govermet employee employee % Selfemployed % Upaid Employmet status Both Sexes % % Nogovermet Govermet employee employee % Selfemployed % Upaid

72 Upaid work ad uemployed Descriptio: Proportio of respodets i upaid work. Istrumet questio: Which of the followig best describes your mai work status over the last 12 moths? Age Group Upaid work ad uemployed Me Uemployed % Home- % Nopaid % Retired % Studet % Able to % Not able maker work to work Age Group Upaid work ad uemployed Wome Uemployed % Home- % Nopaid % Retired % Studet % Able to % Not able maker work to work Age Group Upaid work ad uemployed Both Sexes Uemployed % Home- % Nopaid % Retired % Studet % Able to % Not able maker work to work

73 Per capita aual icome Descriptio: Mea reported per capita aual icome of respodets i local currecy. Istrumet questio: How may people older tha 18 years, icludig yourself, live i your household? Takig the past year, ca you tell me what the average earig of the household has bee? Mea aual per capita icome Mea Estimated household earigs Descriptio: summary of participat household earigs by quitile. Istrumet questio: If you do't kow the amout, ca you give a estimate of the aual household icome if I read some optios to you? Estimated household earigs % Quitile 1: % Quitile 2: % Quitile 3: % Quitile 4: % Quitile 5: Uder $... $...-$... $...-$... $...-$... Over $

74 Tobacco Use Curret smokig Descriptio: Curret smokers amog all respodets. Istrumet questios: Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Percetage of curret smokers Me Wome Both Sexes % % % Curret Curret Curret smoker smoker smoker

75 Smokig Status Descriptio: Smokig status of all respodets. Istrumet questios: Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Do you curretly smoke tobacco products daily? Smokig status Me Curret smoker % Does % Nodaily % Daily ot smoke Smokig status Wome Curret smoker % Does % Nodaily % Daily ot smoke Smokig status Both Sexes Curret smoker % Does % Nodaily % Daily ot smoke

76 Frequecy of smokig Descriptio: Percetage of curret daily smokers amog smokers. Istrumet questio: Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Do you curretly smoke tobacco products daily? Curret daily smokers amog smokers Me Wome Both Sexes % Daily % Daily % Daily smokers smokers smokers Maufactured cigarette smokers Descriptio: Percetage of smokers who use maufactured cigarettes amog daily smokers. Istrumet questio: O average, how may of the followig do you smoke each day? Maufactured cigarette smokers amog daily smokers Me Wome Both Sexes % % % Maufactured Maufactured factured Mau- cigarette cigarette cigarette smoker smoker smoker

77 Amout of tobacco used amog smokers by type Descriptio: Mea amout of tobacco used by daily smokers per day, by type. Istrumet questio: O average, how may of the followig do you smoke each day? Age Group Mea # of maufacture d cig. Mea amout of tobacco used by daily smokers by type Me Mea Mea #of # of had pipes - of rolled tobac cig. co Mea # of other type of tobacc o Age Group Mea # of mau - factur ed cig. Mea amout of tobacco used by daily smokers by type Wome Mea #of hadrolled cig. Mea # of pipes of tobac co Mea # of other type of tobacc o Age Group Mea # of mau - factur ed cig. Mea amout of tobacco used by daily smokers by type Both Sexes Mea #of hadrolled cig. Mea # of pipes of tobac co Mea # of other type of tobacc o

78 Iitiatio of smokig Descriptio: Mea age of iitiatio ad mea duratio of smokig, i years, amog daily smokers (o total age group for mea duratio of smokig as age iflueces these values). Istrumet questios: How old were you whe you first started smokig daily? How log ago did you stop smokig daily? Mea age started smokig Me Wome Both Sexes Mea Mea Mea age age age started started started smokig smokig smokig Mea duratio of smokig Me Wome Both Sexes Mea Mea Mea yrs of yrs of yrs of smokig smokig smokig

79 Betel Nut Use Betel Nut Use Descriptio: Percetage of participats who chew betel ut. Betel Nut Use Me Curret User % Does ot use % Daily % Nodaily Betel Nut Use Wome Curret User % Does ot use % Daily % Nodaily Betel Nut Use Both Sexes Curret User % Does ot use % Daily % Nodaily

80 Iitiatio of Use Descriptio: Mea age of iitiatio amog curret betel ut chewers. Age of Iitiatio of Betel Nut Chewig Me Wome Both Sexes % % % Smokig while chewig Descriptio: Percetage of betel ut chewers who usually smoke while chewig. Usually Smoke while Chewig Betel Nut Me Wome Both Sexes % % %

81 Alcohol Cosumptio Alcohol cosumptio status Descriptio: Alcohol cosumptio status of all respodets. Istrumet questios: Have you ever cosumed alcohol? Have you cosumed alcohol (such as beer, wie, spirits, fermeted cider, or (add other local examples) withi the past 12 moths? Alcohol cosumptio status Me % Past 12 % curret % Lifetime mos. driker (drak i Abstaier abstaier past 12 mos.) Alcohol cosumptio status Wome % Past 12 % curret % Lifetime mos. driker (drak i Abstaier abstaier past 12 mos.) Alcohol cosumptio status Both Sexes % Past 12 % curret % Lifetime mos. driker (drak i Abstaier abstaier past 12 mos.)

82 Frequecy of alcohol cosumptio Descriptio: Frequecy of alcohol cosumptio i the last year amog those respodets who have drak i the last 12 moths. Istrumet questio: I the past 12 moths, how frequetly have you had at least oe drik? Age Group % less tha oce a moth Frequecy of alcohol cosumptio i the last 12 moths Me % 1-3 % 1-4 days per days per moth week % >=5 days per week Age Group % less tha oce a moth Frequecy of alcohol cosumptio i the last 12 moths Wome % 1-3 % 1-4 days per days per moth week % >=5 days per week Age Group % less tha oce a moth Frequecy of alcohol cosumptio i the last 12 moths Both Sexes % 1-3 % 1-4 days per days per moth week % >=5 days per week

83 Stadard driks per drikig day Descriptio: Number of stadard driks cosumed o a drikig day amog those respodets who have drak i the last 12 moths. Istrumet questio: Whe you drik alcohol, o average, how may driks do you have durig oe day? Age Group % 1 drik Number of stadard driks cosumed o a drikig day Me % 2-3 driks % 4-5 driks % 6+ driks Mea # of stadard driks Age Group % 1 drik Number of stadard driks cosumed o a drikig day Wome % 2-3 driks % 4-5 driks % 6+ driks Mea # of stadar d driks % CI Age Group % 1 drik Number of stadard driks cosumed o a drikig day Both Sexes % 2-3 driks % 4-5 driks % 6+ driks Mea # of stadar d driks

84 Heavy drikig Descriptio: Frequecy ad quatity of driks cosumed i the last 7 days by curret (last 30 days) driker, grouped ito three categories. Istrumet questio: Durig each of the past 7 days, how may stadard driks of ay alcoholic drik did you have each day? Frequecy ad quatity of driks cosumed i the last 7 days Me % Drak % 5+ % 20+ o 4+ driks o driks i 7 days ay day days Frequecy ad quatity of driks cosumed i the last 7 days Wome % Drak % 4+ % 15+ o 4+ driks o driks i 7 days ay day days Frequecy ad quatity of driks cosumed i the last 7 days Both Sexes % Drak o 4+ days

85 Hazardous ad harmful drikig Descriptio: Percetage of curret (last 30 days) driker egagig i hazardous ad harmful drikig i the last 7 days. Harmful drikig is defied as 60g of pure alcohol o average per day for me ad 40 g for wome. Hazardous drikig is defied as g of pure alcohol o average per day for me ad g for wome. A stadard drik cotais approximately 10g of pure alcohol. Istrumet questio: Durig each of the past 7 days, how may stadard driks of ay alcoholic drik did you have each day? Hazardous ad harmful drikig i the last 7 days Me % % harmful hazardous drikig drikig Hazardous ad harmful drikig i the last 7 days Wome % % harmful hazardous drikig drikig

86 Fruit ad Vegetable Cosumptio Mea umber of days of fruit ad vegetable cosumptio Descriptio: mea umber of days fruit ad vegetables cosumed. Istrumet questios: I a typical week, o how may days do you eat fruit? I a typical week, o how may days do you eat vegetables? Mea umber of days fruit cosumed i a typical week Me Wome Both Sexes Mea Mea Mea umber umber umber of days of days of days Mea umber of days vegetables cosumed i a typical week Me Wome Both Sexes Mea Mea Mea umber umber umber of days of days of days

87 Mea umber of servigs of fruit ad vegetable cosumptio Descriptio: mea umber of fruit, vegetable, ad combied fruit ad vegetable servigs o average per day. Istrumet questios: I a typical week, o how may days do you eat fruit? How may servigs of fruit do you eat o oe of those days? I a typical week, o how may days do you eat vegetables? How may servigs of vegetables do you eat o oe of those days? Mea umber of servigs of fruit o average per day Me Wome Both Sexes Mea Mea Mea umber umber umber of of of servigs servigs servigs Mea umber of servigs of vegetables o average per day Me Wome Both Sexes Mea Mea Mea umber umber umber of of of servigs servigs servigs Mea umber of servigs of fruit ad/or vegetables o average per day Me Wome Both Sexes Mea Mea Mea umber umber umber of of of servigs servigs servigs

88 Fruit ad vegetable cosumptio per day Descriptio: Frequecy of fruit ad/or vegetable cosumptio. Istrumet questios: I a typical week, o how may days do you eat fruit? How may servigs of fruit do you eat o oe of those days? I a typical week, o how may days do you eat vegetables? How may servigs of vegetables do you eat o oe of those days? Age Group % o fruit ad/or vegetables Number of servigs of fruit ad/or vegetables o average per day Me % 1-2 servigs % 3-4 servigs % 5 servigs Age Group % o fruit ad/or vegetables Number of servigs of fruit ad/or vegetables o average per day Wome % 1-2 servigs % 3-4 servigs % 5 servigs Age Group % o fruit ad/or vegetables Number of servigs of fruit ad/or vegetables o average per day Both Sexes % 1-2 servigs % 3-4 servigs % 5 servigs

89 Fruit ad vegetable cosumptio per day Descriptio: Percetage of those eatig less tha five servigs of fruit ad/or vegetables o average per day. Istrumet questios: I a typical week, o how may days do you eat fruit? How may servigs of fruit do you eat o oe of those days? I a typical week, o how may days do you eat vegetables? How may servigs of vegetables do you eat o oe of those days? Age Group Less tha five servigs of fruit ad/or vegetables o average per day Me Wome Both Sexes % < five % < five % < five servigs servigs servigs per day per day per day

90 Type of oil used most frequetly Descriptio: type of oil or fat most ofte used for meal preparatio i households (preseted oly for both sexes because results are for the household ot idividuals). Istrumet questio: What type of oil or fat is most ofte used for meal preparatio i your household? (households) % Vegetable oil Type of oil or fat most ofte used for meal preparatio i household % % % % 95% 95% Butt Cocout Noe Lard CI CI er Oil used % CI % Other Fish Cosumptio Descriptio: Mea o. of days per week tied or fresh fish cosumed. Fresh Fish Cosumptio Me Wome Both Sexes Mea Mea Mea o. of o. of o. of days days days Tied Fish Cosumptio Me Wome Both Sexes Mea Mea Mea o. of o. of o. of days days days

91 Physical Activity Itroductio Aalysis physical activity data ca be very complicated ad the result cofusig. The followig guidelies will help clarify the results of the physical activity data ad will also provide valuable iformatio o the classificatios. Make sure you use some of these guidelies whe you report physical activity data. MET values are applied to vigorous ad moderate itesity variables i the work, trasport ad recreatio domais. These have bee calculated usig a average of the typical types of activity udertake. Differet types of activities have bee grouped together ad give a MET value based o the itesity of the activity. Applyig MET values to types of activities allows us to calculate total physical activity. For more iformatio regardig MET values go the STEPS website at The calculatios below use multiple questios i the physical activity sectio. To simplify this a bit the questios have bee clustered ito four groups (as they appear i the Istrumet). I the Istrumet questios sectio of the table, oly the group label appears. The specific questios for each group are preseted below. Activity at work: Does your work ivolve vigorous-itesity activity that causes large icreases i breathig or heart rate like [examples] for at least 10 miutes cotiuously? I a typical week, o how may days do you do vigorous-itesity activities as part of your work? How much time do you sped doig vigorous-itesity activities at work o a typical day? Does your work ivolve moderate-itesity activity, that causes small icreases i breathig or heart rate such as brisk walkig for at least 10 miutes cotiuously? I a typical week, o how may days do you do moderate-itesity activities as part of your work? How much time do you sped doig moderate-itesity activities at work o a typical day? Travel to ad from places: Do you walk or use a bicycle for at least 10 miutes cotiuously to get to ad from places? I a typical week, o how may days do you walk or bicycle for at least 10 miutes cotiuously to get to ad from places? Cotiued o ext page 90

92 Physical Activity, Cotiued Itroductio (cot.) How much time do you sped walkig or bicyclig for travel o a typical day? Recreatioal activities: Do you do ay ivolve vigorous-itesity sports, fitess or recreatioal activities that cause large icreases i breathig or heart rate like [examples] for at least 10 miutes cotiuously? I a typical week, o how may days do you do vigorous-itesity sports, fitess or recreatioal activities? How much time do you sped doig vigorous-itesity sports, fitess or recreatioal activities o a typical day? Do you do ay ivolve moderate-itesity sports, fitess or recreatioal activities that cause large icreases i breathig or heart rate like [examples] for at least 10 miutes cotiuously? I a typical week, o how may days do you do moderate--itesity sports, fitess or recreatioal activities? How much time do you sped doig moderate--itesity sports, fitess or recreatioal activities o a typical day? Sedetary behaviour : How much time do you usually sped sittig or recliig o a typical day? 91

93 Levels of total physical activity Descriptio: Percetage of respodets classified ito three categories of total physical activity. Istrumet questios: activity at work travel to ad from places recreatioal activities Level of total physical activity Me % % Low % High Moderate Level of total physical activity Wome % % Low % High Moderate Level of total physical activity Both Sexes % % Low % High Moderate

94 Total physical activitymea Descriptio: Mea miutes of total physical activity o average per day. Istrumet questios activity at work travel to ad from places recreatioal activities Mea miutes of total physical activity o average per day Age Me Wome Both Sexes Group Mea Mea Mea miutes miutes miutes Total physical activitymedia Descriptio: Media miutes of total physical activity o average per day. Istrumet questios activity at work travel to ad from places recreatioal activities Age Group Media miutes Media miutes of total physical activity o average per day Me Wome Both Sexes Iter-quartile Iter-quartile Media Media rage (P25- rage (P25- miutes miutes P75) P75) Iter-quartile rage (P25- P75)

95 Domaispecific physical activitymea Descriptio: Mea miutes spet i work-, trasport- ad recreatio-related physical activity o average per day. Istrumet questios: activity at work travel to ad from places recreatioal activities Mea miutes of work-related physical activity o average per day Me Wome Both Sexes Mea Mea Mea miutes miutes miutes Mea miutes of trasport-related physical activity o average per day Me Wome Both Sexes Mea Mea Mea miutes miutes miutes Mea miutes of recreatio-related physical activity o average per day Me Wome Both Sexes Mea Mea Mea miutes miutes miutes

96 Domaispecific physical activity - media Descriptio: Media miutes spet o average per day i work-, trasport- ad recreatio-related physical activity. Istrumet questios: activity at work travel to ad from places recreatioal activities Media miutes of work-related physical activity o average per day Me Wome Both Sexes Iterquartile Media quartile Media quartile Iter- Iter- Media miutes rage (P25- miutes rage miutes rage (P25- P75) (P25-P75) P75) Media miutes of trasport-related physical activity o average per day Me Wome Both Sexes Iterquartile Media quartile Media quartile Iter- Iter- Media miutes rage miutes rage miutes rage (P25-P75) (P25-P75) (P25-P75) Media miutes of recreatio-related physical activity o average per day Me Wome Both Sexes Iterquartile Media quartile Media quartile Iter- Iter- Media miutes rage miutes rage miutes rage (P25-P75) (P25-P75) (P25-P75)

97 No physical activity by domai Descriptio: Percetage of respodets classified as doig o work-, trasport- or recreatioal-related physical activity. Istrumet questios: activity at work travel to ad from places recreatioal activities No work-related physical activity Me Wome Both Sexes % o % o % o activity activity activity at work at work at work No trasport-related physical activity Me Wome Both Sexes % o % o % o activity activity activity for for for trasport trasport trasport No recreatio-related physical activity Me Wome Both Sexes % o % o % o activity at activity at activity at recreatio recreatio recreatio

98 Compositio of total physical activity Descriptio: Percetage of work, trasport ad recreatioal activity cotributig to total activity. Istrumet questios: activity at work travel to ad from places recreatioal activities % Activity from work Compositio of total physical activity Me % Activity for trasport % Activity durig leisure time % Activity from work Compositio of total physical activity Wome % Activity for trasport % Activity durig leisure time % Activity from work Compositio of total physical activity Both Sexes % Activity for trasport % Activity durig leisure time

99 No vigorous physical activity Descriptio: Percetage of respodets ot egagig i vigorous physical activity. Istrumet questios: activity at work recreatioal activities No vigorous physical activity Me Wome Both Sexes % o % o % o vigorous vigorous vigorous activity activity activity

100 Sedetary Descriptio: Miutes spet i sedetary activities o a typical day. Istrumet questio: sedetary behaviour Miutes spet i sedetary activities o average per day Me Mea miutes Media miutes Iter-quartile rage (P25-P75) Miutes spet i sedetary activities o average per day Wome Mea miutes Media miutes Iter-quartile rage (P25-P75) Miutes spet i sedetary activities o average per day Both Sexes Mea miutes Media miutes Iter-quartile rage (P25-P75)

101 Blood Pressure ad Diabetes History Blood pressure diagosis ad treatmet Descriptio: Raised blood pressure diagosis ad treatmet results amog all respodets. Istrumet questios: Durig the past 12 moths have you bee told by a doctor or other health worker that you have elevated blood pressure or hypertesio? Are you curretly receivig ay of the followig treatmets/advice for high blood pressure prescribed by a doctor or other health worker? Drugs (medicatio) that you have take i the last 2 weeks? Raised blood pressure diagosed by doctor or health worker i last 12 moths Age Me Wome Both Sexes Group % % % diagosed diagosed diagosed Curretly takig blood pressure drugs prescribed by doctor or health worker Me Wome Both Sexes % takig % takig % takig meds meds meds

102 Blood pressure lifestyle advice Descriptio: Percetage of respodets who received lifestyle advice from a doctor or health worker to treat raised blood pressure. Istrumet questio: Are you curretly receivig ay of the followig treatmets/advice for high blood pressure prescribed by a doctor or other health worker? Advised by doctor or health worker to have special prescribed diet Me Wome Both Sexes % % % Advised by doctor or health worker to lose weight Me Wome Both Sexes % % % Advised by doctor or health worker to stop smokig Me Wome Both Sexes % % % Advised by doctor or health worker to start or do more exercise Me Wome Both Sexes % % %

103 Blood pressure advice by a traditioal healer Descriptio: Percetage of respodets who have sought advice or received treatmet from traditioal healers for raised blood pressure. Istrumet questios: Durig the past 12 moths have you see a traditioal healer for raised blood pressure? Are you curretly takig ay herbal or traditioal remedy for your high blood pressure? See a traditioal healer i the last 12 moths Me Wome Both Sexes % % % Curretly takig herbal or traditioal remedy for high blood pressure Me Wome Both Sexes % % %

104 Diabetes diagosis ad treatmet Descriptio: Diabetes diagosis ad treatmet results amog all respodets. Istrumet questios: Durig the past 12 moths, have you ever bee told by a doctor or other health worker that you have diabetes? Are you curretly takig ay of the followig treatmets/advice for diabetes prescribed by a doctor or other health worker? Diabetes diagosed by doctor or health worker i last 12 moths Age Me Wome Both Sexes Group % % % diagosed diagosed diagosed Curretly takig isuli prescribed for diabetes by doctor or health worker Me Wome Both Sexes % takig % takig % takig isuli isuli isuli Curretly takig oral drugs prescribed for diabetes by doctor or health worker Me Wome Both Sexes % takig % takig % takig meds meds meds

105 Diabetes lifestyle advice Descriptio: Percetage of respodets who received lifestyle advice from a doctor or health worker to diabetes. Istrumet questio: Are you curretly takig ay of the followig treatmets/advice for diabetes prescribed by a doctor or other health worker? Advised by doctor or health worker to have special prescribed diet Me Wome Both Sexes % % % Advised by doctor or health worker to lose weight Me Wome Both Sexes % % % Advised by doctor or health worker to stop smokig Me Wome Both Sexes % % % Advised doctor or health worker to start or do more exercise Me Wome Both Sexes % % %

106 Diabetes advice by traditioal healer Descriptio: Percetage of respodets who are have sought advice or treatmet from traditioal healers for diabetes. Istrumet questios: Durig the past 12 moths have you see a traditioal healer for diabetes? Are you curretly takig ay herbal or traditioal remedy for your diabetes? See a traditioal healer for diabetes i the last 12 moths Me Wome Both Sexes % % % Curretly takig herbal or traditioal treatmet for diabetes Me Wome Both Sexes % % %

107 Physical Measuremets Height, weight ad BMI Descriptio: Mea height, weight, ad body mass idex amog all respodet (excludig pregat wome for weight ad BMI). Istrumet questios: Height Weight Mea height (cm) Me Wome Mea Mea Mea weight (kg) Me Wome Mea Mea Mea BMI (kg/m 2 ) Me Wome Both Sexes Mea Mea Mea

108 BMI categories Descriptio: Percetage of respodets (excludig pregat wome) i each BMI category. Istrumet questios: Height Weight BMI classificatios Me Age Group % Uderweight weight weight Obese % Normal % Over- % < BMI classificatios Wome Age Group % Uderweight weight weight Obese % Normal % Over- % < BMI classificatios Both Sexes Age Group % Uderweight weight weight Obese % Normal % Over- % <

109 Waist circumferece Descriptio: Mea waist circumferece amog all respodets (excludig pregat wome). Istrumet questio: Waist circumferece measuremet Waist circumferece (cm) Me Wome Mea Mea Hip circumferece Descriptio: Mea hip circumferece amog all respodets (excludig pregat wome). Istrumet questio: Hip circumferece measuremet Hip circumferece (cm) Me Wome Mea Mea Waist / hip ratio Descriptio: Mea waist-to-hip ratio amog all respodets (excludig pregat wome). Istrumet questio: Waist ad hip circumferece measuremet Mea waist / hip ratio Me Wome Mea Mea

110 Blood pressure Descriptio: Mea blood pressure amog all respodets. Istrumet questio: Readig 1-3 systolic ad diastolic blood pressure Age Group Mea systolic blood pressure (mmhg) Me Wome Both Sexes Mea Mea Mea Mea diastolic blood pressure (mmhg) Me Wome Both Sexes Mea Mea Mea Raised blood pressure Descriptio: Percetage of respodets with raised blood pressure. Istrumet questio: Readig 1-3 systolic ad diastolic blood pressure SBP 140 ad/or DBP 90 mmhg Me Wome Both Sexes % % % SBP 160 ad/or DBP 100 mmhg Me Wome Both Sexes % % %

111 Biochemical Measuremets Mea fastig blood glucose Descriptio: mea fastig blood glucose results excludig those curretly o medicatio for diabetes (No-fastig recipiets excluded). Istrumet questios: Are you curretly receivig ay of the followig treatmets for diabetes prescribed by a doctor or other health worker? Isuli? Oral drugs (medicatio) that you have take i the last 2 weeks? Durig the last 12 hours have you had aythig to eat or drik, other tha water? Blood glucose measuremet Mea fastig blood glucose (mmol/l) Me Wome Both Sexes Mea Mea Mea Age Group Mea fastig blood glucose (mg/dl) Me Wome Both Sexes Mea Mea Mea

112 Raised blood glucose Descriptio: Categorizatio of respodets ito blood glucose level categories ad percetage curretly o medicatio for raised blood glucose (o-fastig recipiets excluded). Istrumet questios: Are you curretly receivig ay of the followig treatmets for diabetes prescribed by a doctor or other health worker? Isuli? Oral drugs (medicatio) that you have take i the last 2 weeks? Durig the last 12 hours have you had aythig to eat or drik, other tha water? Blood glucose measuremet Impaired Fastig Glycaemia* Me Wome Both Sexes % % % Raised blood glucose or curretly o medicatio for diabetes** Me Wome Both Sexes % % % Curretly o medicatio for diabetes Me Wome Both Sexes % % % * Impaired fastig glycaemia is defied as either plasma veous value: 6.1mmol/L (110mg/dl) ad <7.0mmol/L (126mg/dl) capillary whole blood value: 5.6mmol/L (100mg/dl) ad <6.1mmol/L (110mg/dl) ** Raised blood glucose is defied as either plasma veous value: 7.0 mmol/l (126 mg/dl) capillary whole blood value: 6.1 mmol/l (110 mg/dl) 111

113 Total cholesterol Descriptio: Mea total cholesterol amog all respodets ad percetage of respodets with raised total cholesterol. Istrumet questio: Total cholesterol measuremet Mea total cholesterol (mmol/l) Me Wome Both Sexes Mea Mea Mea Mea total cholesterol (mg/dl) Me Wome Both Sexes Mea Mea Mea Total cholesterol 5.0 mmol/l or 190 mg/dl Me Wome Both Sexes % % % Total cholesterol 6.2 mmol/l or 240 mg/dl Me Wome Both Sexes % % %

114 Fastig Triglycerides Descriptio: Mea fastig triglycerides amog all respodets ad percetage of respodets with raised fastig triglycerides. Istrumet questio: Triglyceride measuremet Triglycerides (mmol/l) Me Wome Both Sexes Mea Mea Mea Triglycerides (mg/dl) Me Wome Both Sexes Mea Mea Mea Percetage of those with Triglycerides 1.7 mmol/l or 150 mg/dl Me Wome Both Sexes % % % Percetage of those with Triglycerides 2.0 mmol/l or 180 mg/dl Me Wome Both Sexes % % %

115 Raised Risk Raised risk Descriptio: Percetage of respodets with 0, 1-2, or 3-5 of the followig risk factors: curret daily smoker less tha 5 servigs of fruits & vegetables per day low level of activity (<600 MET -miutes) overweight or obese (BMI 25 kg/m 2 ) raised BP (SBP 140 ad/or DBP 90 mmhg or curretly o medicatio for raised BP). Istrumet questios: combied from Step 1 ad Step 2 Raised Risk Me % with 0 % with 1-2 % with 3-5 risk risk risk factors factors factors Raised Risk Wome % with 0 % with 1-2 % with 3-5 risk risk risk factors factors factors Raised Risk Both Sexes % with 0 % with 1-2 % with 3-5 risk risk risk factors factors factors

116 Appedix 3. List ad Resposibilities of STEPS Survey Staff from Solomo Islads Team Members Makiva Tui Josephie Watoto Micha Malefoata Elwi Talomatakwe Harriet Salokei Adria Leamaa Clemet Iva Jeifer Aga Julie Au Margaret Kisita Rachael Sorumaa Albert Keioa Ao Tavalusu Japhet Hoimae Dalcie Darcy Julie Daefoi Code No Resposibility Iterviewer Statio 01 Team Leader / Quality check-up Yes Overall 06 Team Leader / Quality check-up Yes Overall 13 Multi-purpose (Blood testig) Yes Multi 17 Multi-purpose (Blood pressure) Yes Multi 08 Multi-purpose (Height/Weight) Yes Multi 07 Multi-purpose (Couselig) Yes Multi 33 Multi-purpose (Couselig) Yes Multi 16 Multi-purpose (Waist/Hip) Yes Multi 18 Registratio / Data Etry Yes Registratio 24 Registratio / Data Etry Yes Registratio 26 Blood testig Yes Blood testig 21 Blood testig Yes Blood testig 10 Blood testig Yes Blood testig 12 Blood testig Yes Blood testig 04 Blood pressure Yes Blood pressure 14 Blood pressure Yes Blood pressure 115

117 Elle Hoimae Silas Torihahia Nellie Hao Christia qotso Sarah Fekau Jack Hou Nevaly Laesago Dr. Joh Paulse Grace Bauro Rebecca Dorothy 15 Blood pressure Yes Blood pressure 09 Blood pressure Yes Blood pressure 05 Height/Weight Yes Height/Weight 27 Waist/Hip Yes Waist/Hip 19 Waist/Hip Yes Waist/Hip 22 Couselig (Registratio) Yes Checkout 02 Couselig (Registratio) Yes Checkout 03 Couselig (Registratio) No Checkout 11 Data Etry Yes Data Etry 28 Data Etry No Data Etry 29 Data Etry No Data Etry Simo palmer. 30 Multi-purpose Yes Multi. 116

118 Appedix 4. Refereces 1. Beaglehole R, Yach D. Globalisatio ad the prevetio ad cotrol of ocommuicable disease: the eglected chroic diseases of adults. Lacet 2003; 362: Dwyer T, Tieru H, Hyes K, Zhag C. Profile of Cardiovascular Diseases, Diabetes Mellitus ad Associated Risk Factors i the Wester Pacific Regio. World Health Orgaizatio, Philippies, World Health Orgaizatio. The WHO stepwise approach to surveillace of ocommuicable diseases (STEPS): Steps istrumet for NCD risk factors (core ad expaded versio 1.4). Available from: [Accessed 28 Jauary 2009]. 4. World Health Orgaizatio (1999b). Defiitio, Diagosis ad Classificatio of Diabetes Mellitus ad its Complicatios. Report of a WHO Cosultatio. Part 1: Diagosis ad Classificatio of Diabetes Mellitus. Departmet of Nocommuicable Disease Surveillace, Geeva, World Health Orgaizatio. WHO/NCD/NCS/

119 KEY CONTACTS Solomo Islads Miistry of Health ad Medical Services Cotact: Dr Lester Ross Permaet Secretary Miistry of Health ad Medical Services P. O. Box 349 Hoiara Solomo Islads Tel: (677) Fax: (677) WHO Cotact: Dr Li Da Medical Officer Nocommuicable Diseases WHO Office for the South Pacific Plaza Oe, Dowtow Boulevard P. O. Box 113 Suva Fiji Tel: (679) Fax: (679) Fiji School of Medicie Cotact: Dr Graham Roberts Director-Research Fiji School of Medicie Hoodless House i Brow Street Suva Fiji Tel: (679) ext g.roberts@fsm.ac.fj

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