Migrant Health Survey

Migrant Health Survey October 1996 February 1997 Conducted for The Migrant Health Service SA Health Commission Anne Taylor Eleonora Dal Grande Jacci Parsons Peter Kunst Yixia Zhang SERCIS Behavioural Epidemiology Unit Epidemiology Branch SAHC

National Library of Australia cataloguing-in-publication Migrant Health Survey October 1996 - February 1997. ISBN 0 7308 5643 7. 1. Public health - South Australia - Evaluation. 2. Medical care - South Australia - Evaluation. 3. Immigrants - Health and hygiene - South Australia - Evaluation. 4. Immigrants - Medical care - South Australia. 5. Immigrants - Services for - South Australia. 6. South Australian Health Commission. Migrant Health Service - Evaluation. I. Taylor, Anne, 1950-. II. South Australian Health Commission. Migrant Health Service. III. Social Environmental Risk Context Information System +. I. South Australian Health Commission. Behavioural Epidemiology Unit. 362.108099423 2

TABLE OF CONTENTS EXECUTIVE SUMMARY 7 1. BACKGROUND AND METHODOLOGY 11 1.1 BACKGROUND 12 1.2 SURVEY OBJECTIVES 13 1.3 SURVEY DESIGN 13 1.3.1 Sample Selection 13 1.3.2 Introductory letter 16 1.3.3 Questions 16 1.3.4 Pilot testing 17 1.4 DATA COLLECTION 17 1.4.1 CATI 18 1.4.2 Call backs 18 1.4.3 Validation 18 1.4.4 Response rate 19 1.4.4.1 Stage 1 19 1.4.4.2 Stage 2 20 1.4.4.3 Stage 3 22 1.4.5 Control group selection 23 1.5 DATA PROCESSING 23 1.5.1 Analysis 23 1.5.2 Weighting 24 1.6 DATA INTERPRETATION 24 1.6.1 Estimates 24 1.6.2 Unadjusted Estimates 24 1.6.3 Adjusted Country of Birth Estimate (Adjusted for age and sex) 24 1.6.4 Additional interpretation concerns 25 2. DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS 27 2.1 DEMOGRAPHIC CHARACTERISTICS OF PEOPLE BORN IN ALL NON-ENGLISH SPEAKING COUNTRIES COMBINED 28 2.2 DEMOGRAPHIC PROFILE OF RESPONDENTS BORN IN ITALY 40 2.3 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN GREECE 48 2.4 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN FORMER YUGOSLAVIA 56 2.5 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN GERMANY 66 2.6 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN THE NETHERLANDS 76 2.7 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN OTHER WESTERN/NORTHERN EUROPEAN COUNTRIE 84 2.8 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN POLAND 94 2.9 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN USSR AND BALTIC STATES 102 3

2.10 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN OTHER EASTERN EUROPEAN COUNTRIES 112 2.11 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN THE MIDDLE EAST 122 2.12 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN MALAYSIA 132 2.13 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN VIETNAM AND CAMBODIA 140 2.14 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN THE PHILIPPINES 148 2.15 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN INDIA, SRI LANKA OR BANGLADESH156 2.16 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN CHINA AND HONG KONG 164 2.17 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN OTHER COUNTRIES 172 3. HEALTH STATUS OF RESPONDENTS 183 3.1 OVERALL HEALTH STATUS 184 3.1.1 Fair or poor overall health status 186 3.1.2 Good, very good or excellent overall health status 188 3.2 DISEASE SPECIFIC 190 3.2.1 Diabetes 192 3.2.2 A hearing loss 194 3.2.3 Osteoporosis 196 3.2.4 Arthritis 198 3.2.5 Asthma 200 3.2.6 Heart attack / angina 202 3.2.7 Stroke 204 3.2.8 Cervical cancer 206 3.2.9 Breast cancer 208 3.2.10 Prostate cancer 210 3.3 GENERAL HEALTH QUESTIONNAIRE (GHQ) 212 3.3.1 Non-English speaking people with moderate to severe disturbance 213 3.3.2 Non-English speaking people with severe disturbance 215 3.4 SOCIAL INDICATIONS (SOCIAL HEALTH BATTERY) 217 3.4.1 Social (friends) 218 3.4.1.1 Number of neighbourhood acquaintances 218 3.4.1.2 Home visits by friends 221 3.4.1.3 Visits to homes of friends 224 3.4.2 Social (friends/relatives) 227 3.4.2.1 Number of close friends and relatives 227 3.4.2.2 Visits with friends and relatives 230 3.4.2.3 Telephone contacts 233 3.4.2.4 Letter writing to friends and relatives 236 3.4.3 Community 237 3.4.3.1 Attendance at religious services 237 3.4.3.2 Voluntary group membership 240 3.4.3.3 Activity in groups 243 3.4.4 Subjective 246 3.4.4.1 Getting along with others 246 4. HEALTH SERVICE USE IN THE PREVIOUS TWELVE MONTHS 250 4.1 USE OF GENERAL PRACTITIONERS 253 4

4.2 USE OF DENTISTS 255 4.3 USE OF OPTOMETRIST 257 4.4 USE OF CHEMIST FOR ADVICE 259 4.5 USE OF SPECIALIST DOCTORS (NOT IN A HOSPITAL) 261 4.6 USE OF PHYSIOTHERAPIST 263 4.7 USE OF HOSPITAL CLINIC 265 4.8 USE OF HOSPITAL AS AN INPATIENT 267 4.9 USE OF CHIROPRACTOR 269 4.10 USE OF HOSPITAL ACCIDENT AND EMERGENCY DEPARTMENT 271 4.11 USE OF DAY SURGERY 273 4.12 USE OF PODIATRIST 275 4.13 USE OF COMMUNITY HEALTH CENTRES 277 4.14 USE OF ALTERNATIVE THERAPIST 279 4.15 USE OF 24 HOUR CLINIC 281 4.16 USE OF AMBULANCE 283 4.17 USE OF ACUPUNCTURIST 285 4.18 USE OF HERBALIST 287 4.19 USE OF DISTRICT OR OTHER COMMUNITY NURSE 289 4.20 USE OF COMMUNITY MENTAL HEALTH SERVICES 291 4.21 USE OF RESPITE CARE 293 4.22 PEOPLE WHO DID NOT USE ANY HEALTH SERVICE 295 5. RISK FACTORS 298 5.1 ALCOHOL RISK 300 5.1.1 No Alcohol Risk Drinkers 301 5.1.2 Low Alcohol Risk 303 5.1.3 High Alcohol Risk 305 5.2 Exercise 307 5.2.1 Walking for Exercise 307 5.2.2 Moderate Exercise Levels 309 5.2.3 Vigorous Exercise Levels 311 5.2.4 No Exercise Undertaken 313 5.3 SMOKING STATUS 315 5.4 BODY MASS INDEX (BMI) 317 5.4.1 Overweight or Obese 318 5.4.2 Obese 320 5.5 MULTIPLE RISK FACTORS 322 5

5.6 INJURY 324 5.6.1 Injury in Previous Two Years 324 5.6.2 Most recent injury at work 326 5.6.3 Treatment sought for injury 328 5.6.4 Days lost from work, school or home duties as a result of most recent injury 330 5.6.5 Additional information about injuries 332 6. EXPERIENCES WITH THE AUSTRALIAN HEALTH SYSTEM 333 6.1 EXPERIENCES WITH AUSTRALIAN HEALTH SYSTEM 335 6.1.1 Very good or good experiences with the Australian health system 336 6.1.2 Reasons for good or very good experiences with the Australian health system 338 6.1.3 Poor or very poor experiences with the Australian health system 339 6.1.4 Reasons for poor or very poor experiences with the Australian health system 341 6.2 SERVICES USED AT THE MIGRANT HEALTH SERVICES 342 6.2.1 People who had never used the Migrant Health Services 343 6.2.2 People who did not know the Migrant Health Services existed 345 7. EXPERIENCES WITH SETTLING IN AUSTRALIA 348 7.1 Very good or good experiences with settling in Australia 351 7.2 Poor or very poor experiences with settling in Australia 353 7.3 Reasons for good or very good experiences with settling in Australia 355 7.4 Reasons for poor or very poor experiences with settling in Australia 356 APPENDIX 1: SERCIS STEERING COMMITTEE MEMBERS 359 APPENDIX 2: AREAS OF ADELAIDE COVERED BY EACH OF THE HEALTH SERVICES PLANNING AREA 361 APPENDIX 3: AREAS OF SOUTH AUSTRALIA COUNTRY REGIONS COVERED BY THE COUNTRY HEALTH SERVICES PLANNING AREA 365 APPENDIX 4: EASTERN HEALTH REGION OF ADELAIDE 369 APPENDIX 5: LETTER INTRODUCING THE SURVEY 371 APPENDIX 6: MIGRANT QUESTIONNAIRE 373 APPENDIX 7: INTRODUCTION TO THE QUESTIONNAIRE 385 6

EXECUTIVE SUMMARY

Executive summary This report is the result of a major community survey of people from non-english speaking (NES) countries who live in South Australia. The survey comprised a representative population sample of NES adults together with a comparison group of migrants from the United Kingdom and Ireland. The data contained in the report is a major Australian advance in our understanding of the health status, health service use, major health risk factors, experiences with Australian health services and experiences following settlement in Australia of people from NES countries. As such, the data will provide a rich source of information for the further development of policies and services to the diverse peoples who are a part of the Australian community. In analysing and reporting the data, the following summary observations were observed: Many demographic differences were observed between NES groups and these will have a direct effect on health status or health outcomes following illness, and the ability of people to benefit from health services and programs designed for the Australian community as a whole. Overall, NES people report poorer health status than migrants from the United Kingdom or Ireland. Overall, 22% of NES people indicated their health status was less than good with the highest percentages being found among people from Vietnam and Cambodia. The proportions of people reporting diabetes were similar for NES and United Kingdom/Irish migrants. Within the NES community, a significantly higher proportion of people from Poland reported having diabetes. A lower proportion of NES people reported a hearing problem compared with people from the United Kingdom or Ireland. The proportion of NES people reporting cervical cancer was lower than people from the United Kingdom or Ireland. In terms of their mental health, a higher proportion of people from NES countries report a moderate/severe disturbance as measured by the General Health Questionnaire. Within the NES community, the highest proportions were found among people from Poland and the Philippines. 8

Executive summary People from NES countries were significantly less likely to use the services of a chemist, hospital clinic, hospital emergency or community health centre. In comparisons between NES migrants and migrants from the United Kingdom or Ireland on four major risk factors, NES migrants were significantly less likely to consume alcohol at risk levels and to engage in exercise. NES migrants were significantly less likely than migrants from the United Kingdom or Ireland to have suffered a personal injury that was bad enough to interfere with daily activities. There were no significant differences in the occurrence of work related injuries between the migrant groups in the previous two years. Overall, 71% of NES migrants reported good or very good experiences with the Australian health system. They were, however, significantly less likely than people from the United Kingdom or Ireland to report good or very good experiences. Within the NES community, 24% of people did not know of the Migrant Health Services. These people were significantly more likely to come from Italy, Greece and Cyprus, India Sri Lanka or Bangladesh. The data collected in this health survey will allow the Migrant Health Services of the South Australian Health Commission to target migrant health issues and groups more effectively in the future. 9

Executive summary 10

1. BACKGROUND AND METHODOLOGY

Background and Methodology BACKGROUND AND METHODOLOGY 1.1 BACKGROUND SERCIS (Social, Environmental and Risk Context Information System) is a telephone monitoring system designed to provide high quality health data on large samples of the South Australian population. It is particularly applicable for surveys where planning information is required on health problems, use of health services and consumer perspectives. Some of the issues examined to date in SERCIS surveys include: reported information on health status including quality of life; health activities and behaviours; the context of health problems; use of health services; and, satisfaction with services. SERCIS is a flexible system and can be used not only in direct self-report surveys, but also in recruiting for postal or other surveys requiring more detailed or complex information than can be obtained in telephone surveys (such as clinical information). The advantage of obtaining large samples lies in the opportunity to describe health problems and compare the health status and activities of different groups of people, either crosssectionally or over time. Large samples are important for the planning and development of health services on specific issues and SERCIS provides the opportunity to obtain population data regarding these issues. This survey was conducted for The Migrant Health Service, a Division of the South Australian Health Commission, to obtain data that will contribute to health planning within the Service. The development of the questionnaire was done in conjunction with personnel from The Migrant Health Service and SERCIS staff. Some of the issues explored in this survey have been previously surveyed in other SERCIS surveys [1,2,3,4]. SERCIS is managed within the Behavioural Epidemiology Unit and overseen by a Steering Committee. This committee comprises health professionals with health planning, epidemiological and survey method experience. Members of this committee are listed in Appendix 1. 12

Background and Methodology 1.2 SURVEY OBJECTIVES The objectives of The Migrant Health Services survey were as follows: To survey people in South Australia, aged 18 years or older, who were born in countries where English is not the main language spoken, and to describe : health status; risk factors for ill-health; patterns of health service use; prevalence of particular diseases; and, experiences with the Australian health system. 1.3 SURVEY DESIGN 1.3.1 Sample Selection The sample selected for this survey was undertaken in three stages. Stage 1 In five SERCIS surveys undertaken in 1996, country of birth was asked of all respondents. Each respondent was also asked if they would be willing to be re-contacted by the South Australian Health Commission to answer further questions. Table 1.1 shows for each survey, the total number of people originally interviewed, the total number of people from non-english speaking countries (NES) and the proportion of respondents who indicated they were willing to be re-interviewed. 13

Background and Methodology Table 1.1: Previous SERCIS surveys n NES Country % NES Country Permission to be reinterviewed % reinterviewed Southern Adelaide 1523 126 8.3 121 96.0 Western Adelaide 1530 266 17.4 246 92.5 Northern Adelaide 1528 181 11.8 155 85.6 Country SA 3154 139 4.4 131 94.2 Whole of State 3014 296 9.8 279 94.3 Overall 10749 1008 9.4 932 92.5 A slightly different sampling methodology was used for each of the surveys listed in Table 1.1. For the surveys conducted in the south, west and north of Adelaide, the survey used a multistage sampling methodology. First, telephone numbers were selected from the electronic white pages (EWP) telephone listings of postcodes that comprised each of the Health Planning Areas. Telephone numbers that overlapped with Local Government Areas (LGAs) outside the region were not considered eligible for the survey and were rejected from the list. Telephone numbers were then randomly selected from this regional list. Appendix 2 shows the areas of Adelaide covered by each of the Health Services Planning Units; the population of the areas; and the relevant postcodes and LGAs. For the survey undertaken in Country SA, the seven country health regions formed the survey strata and telephone numbers were selected from each of the regional EWP listings. Regions with small populations were over sampled to provide adequate power in the analyses of data. Appendix 3 shows the areas covered by each of the country regions; the population of the regions; and the relevant postcodes and LGAs. Finally, in the survey undertaken in the whole of SA, all households in SA with a telephone connected were eligible for selection in the sample. Telephone numbers were randomly selected from the Adelaide and country regions EWP telephone listings. For all five surveys, the person who had their birthday last, and was 18 years or older, was selected for interview. Initially, only one interview was conducted per household. There was no replacement for non-contactable persons. Respondents were asked if they would 14

Background and Methodology be willing to be re-contacted by the SAHC at a later date, if the need arose. Overall 92.5% of respondents who were born in a NES country indicated their willingness. Each of the respondents in these five surveys who indicated they were born in NES countries and were willing to be re-interviewed were re-contacted. In addition, all other members of the household who were born in a NES country and aged 18 years of age or older were interviewed. Stage 2 The Eastern Health Region of Adelaide had not been surveyed in the previous 12 months using SERCIS methodology. To ensure the representative of the NES migrant survey, a sample of 2300 was drawn from in the Eastern suburbs of Adelaide. Sample methodology was the same as the other metropolitan surveys. Appendix 4 shows the areas of east Adelaide covered; the population of the area; and the relevant postcodes and LGAs. Initially, the person answering the telephone, if born in a NES country, was interviewed. In addition, other members of the household who were born in a NES country were interviewed. If household members were not born in a NES country interviews were not conducted. Stage 3 To increase the sample size, a joint state-wide survey incorporating The Migrant Health Service and the Disability Services Office of the SAHC was undertaken. Initially a sample of 18000 was selected. All households in SA with a telephone connected were eligible for selection in the sample. Telephone numbers were randomly selected from the Adelaide and country regions EWP telephone listings. Initially, the person answering the telephone, if born in a NES country, was asked the relevant NES questions. In addition, other members of the household who were born in a NES country were interviewed if aged 18 years or older. 15

Background and Methodology 1.3.2 Introductory letter A letter introducing the health survey was sent to the household of each selected telephone number (Appendix 5). This informed people of the purpose of the survey and indicated that they could expect to be contacted by telephone within the time frame of the survey. 73.3% of respondents reported receiving the letter. 1.3.3 Questions Where possible, questions previously included in other surveys were used. In the development of this survey, it was possible to include questions that had been used in the South Australian Health Omnibus Surveys [5], or in the previously conducted SERCIS surveys, and had, therefore, indicated their reliability. An interview time of 15 minutes per interview was considered suitable so as not to over burden respondents. The health issues covered in this survey are listed in Table 1.2. Table 1.2: Issues covered in survey Area covered Number of questions Overall health status 1 General Health Questionnaire (GHQ12) 12 Health services used 21 Social health battery 11 Risk factors alcohol consumption 2 BMI (Body Mass Index) 2 exercise levels 3 smoking 2 injury 6 Disease specific 10 Experience with Australian health services 4 Experience with settling in Australia 3 16

Background and Methodology In addition, 22 demographic questions were asked including mother s and father s country of birth, main (and second) language spoken at home, and current and previous (before migration) occupation. Respondents were also asked if they would be willing to be contacted at a later date to clarify any issues of importance (95.8% responded affirmatively). The full list of questions asked in this survey is contained in Appendix 6. 1.3.4 Pilot testing Before the conduct of the main survey, the questionnaire was pilot tested (n = 50). The original questionnaire was amended slightly on the basis of the information obtained. 1.4 DATA COLLECTION Data collection was undertaken by the contracted agency, Harrison Health Research, in September (Stage 1 and 2), and November 1996 to February 1997 (Stage 3). Pilot testing took place on Thursday 5 and Friday 6 September 1996. Stage 1 of the survey then commenced on Thursday 12 September. Stage 2 commenced on Wednesday 18 September. Stage 3 commenced on November 18 and concluded on Friday 7 February, 1997. Telephone calls were made between 10.00 am and 9.00 pm, seven days a week. Professional interviewers conducted the interviews and were supervised by Harrison Health Research and SERCIS personnel. Disposition codes were supplied to SERCIS staff daily, or as required, to ensure careful monitoring of survey activities. On contacting the household, the interviewer initially identified themselves and the purpose of the survey. The introductory procedure is included as Appendix 7. If required, appointments were made to conduct the interview in English, Italian, Greek, Vietnamese, Spanish, Polish, Chinese, Croatian, Hungarian, Cambodian, Bosnian, Serbian, Cantonese, Mandarin or Persian. Trained telephone interpreters were employed from The Interpreting and Translating Centre. These interviewers underwent training before commencement of the interviews. 17

Background and Methodology 1.4.1 CATI The CATI III (Computer Assisted Telephone Interview) system was used to conduct the interviews. This system allows immediate entry of data from the interviewer s questionnaire screen to the computer database. The main advantages of this system are the precise ordering and timing of call backs and correct sequencing of questions as specific answers are given. The CATI system enforces a range of checks on each response with most questions having a set of pre-determined response categories. In addition, CATI automatically rotates response categories, when required, to minimise bias. When openended responses were required, these were transcribed exactly by the interviewer. 1.4.2 Call backs At least five call-backs were made to the telephone number selected to interview household members. Different times of the day or evening were scheduled for each call-back. If a person could not be interviewed immediately they were re-scheduled for interview at a time suitable to them. Where a refusal was encountered, another interviewer generally (at the discretion of the supervisor) called later, in an endeavour to obtain the interview(s). Replacement interviews for persons who could not be contacted or interviewed were not permitted. 1.4.3 Validation 10% of each interviewer s work was selected at random for validation by the supervisor. In addition, Harrison Health Research is a member of Interviewer Quality Control Australia (IQCA), a national quality control assurance initiative of the Market Research Society of Australia. Accredited organisations must strictly adhere to rigorous quality assurance requirements and are subject to regular audits by IQCA auditors. 18

Background and Methodology 1.4.4 Response rate 1.4.4.1 Stage 1 The response rate for Stage 1 was 84.3%. From the 932 NES respondents recruited from previous SERCIS surveys, contact was established with 720 households. Sample loss of 78 occurred due to disconnected numbers (69) (respondents who had possibly moved since the original contact) and fax/modem connections (9). From the eligible sample of 854, the response rate was calculated as shown in Table 1.3. Table 1.3: Response Rate - Stage 1 n % Initial eligible sample 854 100.0 Refusals 45 5.3 Non-contact after 5 attempts 89 10.4 Households contacted 720 84.3 From the total number of households contacted (n = 720), 970 interviews were conducted. Table 1.4 shows the number of interviews conducted per household. Table 1.4: Number of interviews conducted within each household - Stage 1 Number of NES people in each household Interviews conducted % Single person NES household 493 50.8 Two person NES household 412 42.5 Three person NES household 57 5.9 Four person NES household 8 0.8 Total 970 100.0 19

Background and Methodology Overall, 9.5% of people required an interpreter. Table 1.5 shows the languages required. Table 1.5: Interviews undertaken by an interpreter - Stage 1 Language n % Italian 36 39.1 Greek 24 26.1 Vietnamese 15 16.3 Polish 6 6.5 Croatian 3 3.3 Cantonese 2 2.2 Serbian 2 2.2 Bosnian 1 1.1 Chinese 1 1.1 Mandarin 1 1.1 Spanish 1 1.1 Total 92 100.0 1.4.4.2 Stage 2 The sample response rate for the Eastern suburbs component was 73.9%. Initially a sample of 2300 was drawn. Sample loss of 430 occurred due to non-connected numbers (193), non-residential numbers (49), and fax/modem connections (31). From the eligible sample of 2035, the response rate was calculated as shown in Table 1.6. Table 1.6: Response Rate - Stage 2 n % Initial eligible sample 2035 100.0 Refusals 199 9.8 Non-contact after 5 attempts 281 13.8 Incapacitated and unable to be interviewed 44 2.2 Terminated interviews 8 0.4 Households contacted 1504 73.9 20

Background and Methodology From the total number of eastern suburbs households contacted (n = 1504), 249 (16.6%) contained people from a NES country and 335 interviews were conducted. Table 1.7 shows the number of NES interviews conducted per household. Table 1.7: Number of interviews conducted within each household - Stage 2 Number of NES people in each household Interviews conducted % Single person NES household 172 51.3 Two person NES household 142 42.4 Three person NES household 12 3.6 Four person NES household 4 1.2 Five person NES household 5 1.5 Total 335 100.0 Overall, 13.7% of people required an interpreter. Table 1.8 shows the languages required. Table 1.8: Interviews undertaken by an interpreter - Stage 2 Language n % Italian 30 65.2 Greek 12 26.1 Serbian 2 4.3 Vietnamese 1 2.2 Cantonese 1 2.2 Total 46 100.0 21

Background and Methodology 1.4.4.3 Stage 3 The sample response rate for Stage 3 was 76.0%. Initially a sample of 18000 was drawn. Sample loss of 2027 occurred due to non-connected numbers (1405), non-residential numbers (470), and fax/modem connections (152). From the eligible sample of 15973, the response rate was calculated as shown in Table 1.9. Table 1.9: Response Rate - Stage 3 n % Initial eligible sample 15973 100.0 Refusals 1400 8.8 Non-contact after 5 attempts 2066 12.9 Respondent unable to speak selected languages 145 0.9 Incapacitated and unable to be interviewed 177 1.1 Terminated interviews 53 0.3 Households contacted 12132 76.0 Of the total number of households contacted (n = 12132), 1555 (12.8%) contained people from a NES country and 2049 interviews were conducted. Table 1.10 shows the number of interviews conducted per household. Table 1.10: Number of interviews conducted within each household - Stage 3 Number of NES people in each household Interviews conducted % Single person NES household 1118 54.6 Two person NES household 788 38.5 Three person NES household 90 4.4 Four person NES household 48 2.3 Five person NES household 5 0.2 Total 2049 100.0 22

Background and Methodology Overall, 6.6% of people required an interpreter. Table 1.5 shows the languages required. Table 1.11: Interviews undertaken by an interpreter - Stage 3 Language n % Greek 35 25.7 Italian 34 25.0 Croatian 15 11.0 Vietnamese 15 11.0 Polish 9 6.6 Cantonese 6 4.4 Mandarin 5 3.7 Chinese 4 2.9 Spanish 4 2.9 Iranian 3 2.2 Serbian 3 2.2 Hungarian 2 1.5 Cambodian 1 0.7 Total 136 100.0 1.4.5 Control group selection For comparison purposes, 500 extra interviews were conducted with people born in the United Kingdom or Ireland. These people were selected in Stage 3 and were the first 500 people born in the United Kingdom or Ireland interviewed. 1.5 DATA PROCESSING 1.5.1 Analysis Raw data from the CATI system was imported into SPSS for Windows format. Data were then analysed using SPSS Version 7.5. To determine any statistically significant differences between specific countries (or areas) of birth and the NES people as a whole, logistic regression modelling was undertaken adjusting for age and sex. If the addition of country of birth to the model produced a statistically significant improvement, at least one of the countries was reported as being statistically significantly different from the NES average. Occasionally, the addition of a country of birth did not produce a statistically significant improvement to the model but an individual country 23

Background and Methodology did show a statistically significant difference from the NES average. In these cases the country of birth is reported but caution is expressed in the interpretation of the results. The conventional five per cent level of statistical significance was used to determine statistically significant differences. 1.5.2 Weighting The data were weighted by age and gender to the NES population for South Australia, as obtained from the Australian Bureau of Statistics Census Population for 1991 (ABS Matrix Software, Catalogue No 2714.0), so that the estimates provided would be representative of the South Australian NES migrant population. 1.6 DATA INTERPRETATION 1.6.1 Estimates In this report, two sets of figures have been produced: Country of birth estimates (Unadjusted) Adjusted country of birth estimates (Adjusted for age and sex) 1.6.2 Unadjusted Estimates The weighted data were used when estimates for each country of birth (unadjusted) are reported. Care should be exercised when comparisons are made between country of birth groups on the basis of the unadjusted estimate. 1.6.3 Adjusted Country of Birth Estimate (Adjusted for age and sex) Each country of birth may have different age and sex profiles, and, as many health issues can be determined by age, or are sex specific, these variables should be accounted for before comparisons are made. If, for example, immigrants from a particular country of birth have a high prevalence of diabetes, the unadjusted country of birth estimate will tell us this. If, however, we wish to compare this diabetes prevalence estimate with other NES countries, it is first necessary to adjust the estimate by age and sex, to account for the fact that any 24

Background and Methodology differences observed are not simply due to demographic differences (eg. a higher proportion of older people from one country of birth where the higher estimate is seen). If the prevalence of diabetes remains high after adjusting for age and sex, it suggests that the prevalence of diabetes is higher than expected and may require additional attention and intervention. Statistically significant differences are reported for this adjusted figure only. 1.6.4 Additional interpretation concerns The data were analysed by 15 major countries of birth. Although the term country of birth is used throughout this report, in many instances country of birth refers to area of birth. For example, people born in Sri Lanka and Bangladesh were included with people born in India. In this report each country of birth has been compared with the NES migrants as a whole. Some of the estimates in this report do appear higher or lower than the estimate for NES as a whole, but did not achieve statistical significance. They cannot therefore be regarded as different, but may require further attention in terms of monitoring the trend or more detailed surveys. It should also be pointed out that some differences in this report may be real but have not achieved statistical significance. This may be due to the fact that sample sizes for that issue were not large enough to detect a significant difference. In the charts and tables all statistically significant differences are clearly highlighted. Although significant differences were reported after adjustment for age and sex, other variables may also account for differences observed. In drawing conclusions from the data for planning purposes, it may be necessary to conduct multi-variate analyses to identify the best combination of variables that explain the health issue of interest. 25

Background and Methodology 26

2. DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS

Demographic characteristics 2.1 DEMOGRAPHIC CHARACTERISTICS OF PEOPLE BORN IN ALL NON-ENGLISH SPEAKING COUNTRIES COMBINED Table 2.1 and Chart 2.1 show the age and sex composition, household living arrangements, marital status and country of birth of people born in all non-english speaking countries combined. Table 2.1: Demographic profile of people born in all non-english speaking countries combined - gender, age, household size, number of bedrooms and marital status Variable Response Categories % of Respondents n = 3354 Gender Males 51.0 Females 49.0 Age groups (years) 18-24 yrs 8.0 25-34 yrs 12.6 35-44 yrs 23.1 45-54 yrs 19.1 55-64 yrs 17.8 65-74 yrs 14.3 75+ yrs 5.1 Household size 1 adult 12.6 (18 years and over) 2 adults 55.9 3 adults 17.4 4 adults or more 14.1 Number of Bedrooms One 1.9 Two 14.8 Three 51.8 Four or more 20.4 Unknown 11.1 Marital Status Single 14.9 Married or Defacto 73.3 Separated or Divorced 5.8 Widowed 6.0 Total 100.0 28

Demographic characteristics Chart 2.1: Demographic profile of people born in all non-english speaking countries - gender, age, household size, number of bedrooms and marital status GENDER Male Female AGE 18-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs 65-74 yrs 75+ yrs HOUSEHOLD SIZE 1 adult 2 adults 3 adults 4 adults or more NUMBER OF BEDROOMS One Two Three Four or more Not stated MARITAL STATUS Single Married or Defacto Separated or Divorced Widowed 0 10 20 30 40 50 60 70 80 Percentage 29

Demographic characteristics Table 2.2 and Chart 2.2 show the country of birth of people born in all non-english speaking countries combined. Table 2.2: Demographic profile of people born in all non-english speaking countries combined - country of birth Variable Response Categories % of Respondents n = 3354 Country of birth Italy 20.4 Greece 10.7 Former Yugoslavia 6.3 Germany 9.9 Netherlands 6.9 Other Western/Northern Europe 4.0 Poland 5.5 USSR & Baltic States 3.7 Other Eastern Europe 3.4 Middle East 1.9 Malaysia 2.6 Vietnam and Cambodia 6.8 Philippines 1.9 India 2.6 China and Hong Kong 2.8 Other Countries 10.6 Total 100.0 30

Demographic characteristics Chart 2.2: Demographic profile of people born in all non-english speaking countries - country of birth COUNTRY OF BIRTH Italy Greece, Cyprus Former Yugoslavia Germany Netherlands Other Western/Northern European Countries Poland Other Eastern European countries USSR & Baltic States Middle East India, Sri Lanka, Bangladesh Malaysia Vietnam, Cambodia Philippines China/Hong Kong Other Countries 0 5 10 15 20 25 Percentage 31

Demographic characteristics Table 2.3 and Chart 2.3 show the variables that describe area of residence, annual household income level, highest educational level obtained, work status and pension status for people born in all non-english speaking countries combined. The respondents whose work status was unemployed, home duties, retired, student or other were also asked if they receive a pension or benefit from the department of social security. The other category of work status generally relates to people on disability pensions, WorkCover, or sickness benefits. Table 2.3: Demographic profile of people born in all non-english speaking countries combined - area of residence, annual household income, highest educational level obtained, work status, and pension status Variable Response Categories % of Respondents n = 3354 Area Metropolitan 88.6 Country 11.4 Income Less than $12000 per annum 14.1 $12001-$20000 per annum 19.4 $20001-$30000 per annum 13.0 $30001-$40000 per annum 9.9 $40001-$50000 per annum 9.3 $50001-$60000 per annum 6.1 $60001-$80000 per annum 6.9 More than $80001 per annum 4.6 Don t know 16.5 Highest Education Still at school 0.6 Level Obtained Left school before aged 15 years 27.0 Left school after 15 years of age 21.8 Left school after age 15 but still studying 4.4 Trade/Apprenticeship 14.9 Certificate/Diploma of 1 year or less 4.9 Certificate/Diploma of more than 1 year 9.9 Degree or higher 16.5 Work Status Full time employed 33.5 Part time employed 14.5 Unemployed 11.4 Home Duties 9.3 Retired 22.0 Student 6.0 Other 3.4 % of NES who do not work full or part time n = 1946 Receive a Pension Yes 71.3 No 28.4 Don t know 0.3 Total 100.0 32

Demographic characteristics Chart 2.3: Demographic profile of people born in all non-english speaking countries - area of residence, annual household income, highest educational level obtained, work status and pension status AREA OF RESIDENCE Metropolitan Adelaide SA Country HOUSEHOLD INCOME Less than $12,000 $12,001 to $20,000 $20,001 to $30,000 $30,001 to $40,000 $40,001 to $50,000 $50,001 to $60,000 $60,001 to $80,000 $80,001 or more Don't know EDUCATIONAL LEVEL Still at school Left school < 15 yrs Left school 15> yrs Left school 15>, still studying Trade/Apprenticeship Certifte/Diploma < 1 yr Certifte/Diploma 1> yr Degree or higher WORK STATUS Full time employed Part time employed Unemployed Home Duties Retired Student Other RECEIVING PENSION Yes No Don't know 0 20 40 60 80 100 Percentage 33

Demographic characteristics Table 2.4 and Chart 2.4 show the usual occupation, previous occupation, Australian citizenship and permanent resident status of people born in all non-english speaking countries combined. Table 2.4: Demographic profile of people born in all non-english speaking countries combined - usual occupation, previous occupation, Australian citizenship and permanent residence status Variable Response Categories % of Respondents Usual Occupation Manager or Administrator 9.2 n = 1610 Professional 18.7 (full or part time workers Para-professional 7.1 only) Trades person 18.6 Clerk 9.2 Sales person 14.2 Plant or machine operator 5.9 Labourer or related worker 16.8 Other 0.5 Previous Occupation Manager or administrator 1.2 before migration to Professional 7.0 Australia Para-professional 3.4 n = 3354 Trades person 11.9 Clerk 3.9 Sales person 3.9 Plant or machine operator 2.3 Labourer or related worker 12.1 Other 0.4 Too young to work 31.3 Unemployed 0.9 Home Duties 6.1 Retired 0.2 Student 15.2 Australian Citizen Yes 83.6 n = 3354 No 16.4 Permanent Resident Yes 85.6 n = 549 No 13.8 (not an Australian Citizen) Don t know 0.7 Total 100.0 34

Demographic characteristics Chart 2.4: Demographic profile of people born in all non-english speaking countries - usual occupation, previous occupation, Australian citizenship and permanent resident status USUAL OCCUPATION Manager or Administrator Professional Para-professional Trades person Clerk Sales person Plant or machine operator Labourer or related worker Other PREVIOUS OCCUPATION Manager or administrator Professional Para-professional Trades person Clerk Sales Person Plant or machine operator Labourer Other Too young to work Unemployed Home Duties Retired Student AUSTRALIAN CITIZEN Yes No PERMANENT RESIDENT Yes No Don t know 0 10 20 30 40 50 60 70 80 90 Percentage 35

Demographic characteristics Table 2.5 and Chart 2.5 show how well English is spoken and the first language spoken at home, for people born in all non-english speaking countries combined. Table 2.5: Demographic profile of people born in all non-english speaking countries combined - how well English is spoken and first language spoken at home Variable Response Categories % of Respondents n = 3354 How well English is Very well 54.4 Spoken Well 29.3 Not well 15.3 Not at all 1.0 First language spoken English 55.5 at home Italian 9.5 Greek 6.7 Vietnamese 4.1 Polish 3.9 Chinese 3.1 Croatian 2.0 German 1.9 Cantonese 1.2 Serbian 1.1 Spanish 1.0 Other 10.1 Total 100.0 36

Demographic characteristics Chart 2.5 Demographic profile of people born in all non-english speaking countries - how well English is spoken and first language spoken at home HOW WELL ENGLISH IS SPOKEN Very well Well Not well Not at all FIRST LANGUAGE English Italian Greek Vietnamese Polish Chinese German Croatian Serbian Spanish Other 0 10 20 30 40 50 60 Percentage 37

Demographic characteristics Table 2.6 and Chart 2.6 show the second language spoken at home for people born in all non-english speaking countries combined. Table 2.6: Demographic profile of people born in all non-english speaking countries combined - second language spoken at home Variable Response Categories % of Respondents n = 3354 Second language None 32.0 spoken at home English 34.0 Italian 9.4 German 5.5 Greek 3.2 Dutch 2.2 Chinese 1.8 Polish 1.6 Croatian 1.0 Spanish 0.8 Hungarian 0.6 Tangalog 0.6 French 0.5 Vietnamese 0.5 Other 6.4 Total 100.0 38

Demographic characteristics Chart 2.6 Demographic profile of people born in all non-english speaking countries - second language spoken at home SECOND LANGUAGE None English Italian German Greek Dutch Chinese Polish Croatian Spanish Tagalog (Filipino) Hungarian Vietnamese French Other 0 5 10 15 20 25 30 35 40 Percentage 39

Demographic characteristics 2.2 DEMOGRAPHIC PROFILE OF RESPONDENTS BORN IN ITALY Table 2.7 and Chart 2.7 show the age and sex composition, household living arrangements, and marital status of people born in Italy Table 2.7: Demographic profile of people born in Italy - gender, age, household size, number of bedrooms and marital status Variable Response Categories % of Respondents n = 684 Gender Males 53.0 Females 47.0 Age groups (years) 18-24 yrs 2.5 25-34 yrs 4.3 35-44 yrs 20.6 45-54 yrs 24.6 55-64 yrs 25.8 65-74 yrs 17.9 75+ yrs 4.3 Household size 1 adult 9.2 (18 years and over) 2 adults 50.3 3 adults 21.9 4 adults or more 18.6 Number of Bedrooms One 0.6 Two 9.4 Three 56.8 Four or more 18.9 Unknown 14.3 Marital Status Single 6.0 Married or Defacto 83.7 Separated or Divorced 4.5 Widowed 5.7 Total 100.0 40

Demographic characteristics Chart 2.7: Demographic profile of people born in Italy - gender, age, household size, number of bedrooms and marital status GENDER Male Female AGE 18-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs 65-74 yrs 75+ yrs HOUSEHOLD SIZE 1 adult 2 adults 3 adults 4 adults or more NUMBER OF BEDROOMS One Two Three Four or more Not stated MARITAL STATUS Single Married or Defacto Separated or Divorced Widowed 0 10 20 30 40 50 60 70 80 90 Percentage 41

Demographic characteristics Table 2.8 and Chart 2.8 show the variables that describe area of residence, annual household income level, highest educational level obtained, work status and pension status for people born in Italy. The respondents whose work status was unemployed, home duties, retired, student or other were asked if they receive a pension or benefit from the department of social security. The other category of work status generally relates to people on disability pensions, WorkCover, or sickness benefits. Table 2.8: Demographic profile of people born in Italy - area of residence, annual household income, highest educational level obtained, work status, and pension status Variable Response Categories % of Respondents n = 684 Area Metropolitan 92.7 Country 7.3 Income Less than $12000 per annum 14.3 $12001-$20000 per annum 15.6 $20001-$30000 per annum 11.5 $30001-$40000 per annum 12.4 $40001-$50000 per annum 8.1 $50001-$60000 per annum 7.1 $60001-$80000 per annum 6.0 More than $80001 per annum 3.8 Don t know 21.3 Highest Education Still at school 0.2 Level Obtained Left school before aged 15 years 48.1 Left school after 15 years of age 19.3 Left school after age 15 but still studying 0.9 Trade/Apprenticeship 19.1 Certificate/Diploma of 1 year or less 4.4 Certificate/Diploma of more than 1 year 4.6 Degree or higher 3.5 Work Status Full time employed 37.5 Part time employed 13.9 Unemployed 13.9 Home Duties 6.3 Retired 23.7 Student 0.7 Other 4.1 % of people born in Italy who do not work full or part time n = 333 Receive a Pension Yes 78.1 No 21.9 Don t know - Total 100.0 42

Demographic characteristics Chart 2.8 Demographic profile of people born in Italy - area of residence, annual household income, highest education level obtained, work status and pension status AREA OF RESIDENCE Metropolitan Adelaide SA Country HOUSEHOLD INCOME Less than $12,000 $12,001 to $20,000 $20,001 to $30,000 $30,001 to $40,000 $40,001 to $50,000 $50,001 to $60,000 $60,001 to $80,000 $80,001 or more Don't know EDUCATIONAL LEVEL Still at school Left school < 15 yrs Left school 15> yrs Left school 15> yrs, still studying Trade/Apprenticeship Certifte/Diploma < 1 yr Certifte/Diploma 1> yr Degree or higher WORK STATUS Full time employed Part time employed Unemployed Home Duties Retired Student Other PENSION OR BENEFIT Yes No Don't know 0 10 20 30 40 50 60 70 80 90 100 Percentage 43

Demographic characteristics Table 2.9 and Chart 2.9 show the usual occupation, previous occupation, Australian citizenship and permanent resident status of people born in Italy. Table 2.9: Demographic profile of people born in Italy - usual occupation, previous occupation, Australian citizenship and permanent residence status Variable Response Categories % of Respondents Usual Occupation Manager or Administrator 11.6 (full or part time workers Professional 7.7 only) Para-professional 4.8 Trades person 26.7 Clerk 8.0 Sales person 17.5 Plant or machine operator 5.5 Labourer or related worker 17.7 Other 0.5 Previous Occupation Manager or administrator 0.8 before migration to Professional 0.4 Australia Para-professional 1.1 n = 684 Trades person 12.2 Clerk 0.4 Sales person 1.7 Plant or machine operator 2.5 Labourer or related worker 21.9 Other 0.3 Too young to work 36.0 Unemployed 1.6 Home Duties 8.6 Retired 0.1 Student 12.3 Australian Citizen Yes 77.3 n = 684 No 22.7 Permanent Resident Yes 97.4 n = 155 No 1.6 (not an Australian Citizen) Don t know 1.0 Total 100.0 44

Demographic characteristics Chart 2.9 Demographic profile of people born in Italy - usual occupation, previous occupation, Australian citizenship and permanent residence status USUAL OCCUPATION Manager or Administrator Professional Para-professional Trades person Clerk Sales person Plant or machine operator Labourer or related worker Other PREVIOUS OCCUPATION Manager or Administrator Professional Para-professional Trades person Clerk Sales person Plant or machine operator Labourer or related worker Other Too young to work Unemployed Home Duties Retired Student AUSTRALIAN CITIZEN Yes No PERMANENT RESIDENT Yes No Don t know 0 20 40 60 80 100 120 Percentage 45

Demographic characteristics Table 2.10 and Chart 2.10 show how well English is spoken, first language spoken at home, second language spoken at home, Mother s country of birth and Father s country of birth, for people born in Italy. Table 2.10: Demographic profile of people born in Italy - how well English is spoken, first language spoken at home, second language spoken at home, Mother s country of birth and Father s country of birth Variable Response Categories % of Respondents n = 684 How well English is Very well 46.6 Spoken Well 32.0 Not well 19.5 Not at all 1.9 First language spoken English 55.7 at home Italian 44.1 Yugoslavian 0.1 Slovenian 0.1 Second language None 17.8 spoken at home Italian 43.0 English 38.1 German 0.5 Croatian 0.4 Khmer (Cambodian) 0.1 Slovenian 0.1 Mother s country of Italy 97.1 birth Austria 1.3 Croatia 0.3 Australia 0.3 Brazil 0.3 United States 0.2 Slovenia 0.1 Switzerland 0.1 Argentina 0.1 Father s country of Italy 97.6 birth Austria 1.0 Croatia 0.4 Slovenia 0.3 UK/Ireland 0.3 Australia 0.1 Czech Republic 0.1 Macedonia 0.1 Former Yugoslavia 0.1 Total 100.0 46

Demographic characteristics Chart 2.10 Demographic profile of people born in Italy - how well English is spoken, first language spoken at home, second language spoken at home, Mother's country of birth, Father's country of birth HOW WELL ENGLISH IS SPOKEN Very well Well Not well Not at all FIRST LANGUAGE English Italian Slovenian Yugoslavian SECOND LANGUAGE Italian English None German Croatian Slovenian Khmer (Cambodian) MOTHER'S COB Italy Austria Brazil Australia Croatia United States Argentina Switzerland Slovenia FATHER'S COB Italy Austria Croatia UK/Ireland Slovenia Former Yugoslavia Macedonia Czech Republic Australia 0 20 40 60 80 100 120 Percentage 47

Demographic characteristics 2.3 DEMOGRAPHIC PROFILE OF PEOPLE BORN IN GREECE Table 2.11 and Chart 2.11 show the age and sex composition, household living arrangements, and marital status of people born in Greece. Table 2.11: Demographic profile of people born in Greece - gender, age, household size, number of bedrooms and marital status Variable Response Categories % of Respondents n = 359 Gender Males 51.6 Females 48.4 Age groups (years) 18-24 yrs 2.0 25-34 yrs 5.2 35-44 yrs 24.5 45-54 yrs 25.1 55-64 yrs 25.1 65-74 yrs 15.0 75+ yrs 3.3 Household size 1 adult 9.5 (18 years and over) 2 adults 50.5 3 adults 27.7 4 adults or more 12.3 Number of Bedrooms One 0.4 Two 12.6 Three 58.0 Four or more 14.3 Unknown 14.8 Marital Status Single 8.9 Married or Defacto 80.9 Separated or Divorced 5.4 Widowed 4.9 Total 100.0 48

Demographic characteristics Chart 2.11 Demographic profile of people born in Greece - gender, age, household size, number of bedrooms and marital status GENDER Male Female AGE 18-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs 65-74 yrs 75+ yrs HOUSEHOLD SIZE 1 adult 2 adults 3 adults 4 adults or more NUMBER OF BEDROOMS One Two Three Four or more Not stated MARITAL STATUS Single Married or Defacto Separated or Divorced Widowed 0 10 20 30 40 50 60 70 80 90 Percentage 49

Demographic characteristics Table 2.12 and Chart 2.12 show the variables that describe area of residence, annual household income level, highest educational level obtained, work status and pension status for people born in Greece. The respondents whose work status was unemployed, home duties, retired, student or other were also asked if they receive a pension or benefit from the department of social security. The other category of work status generally relates to people on disability pensions, WorkCover, or sickness benefits. Table 2.12: Demographic profile of people born in Greece - area of residence, annual household income, highest educational level obtained, work status, and pension status Variable Response Categories % of Respondents n = 359 Area Metropolitan 89.5 Country 10.5 Income Less than $12000 per annum 9.8 $12001-$20000 per annum 31.1 $20001-$30000 per annum 13.3 $30001-$40000 per annum 7.4 $40001-$50000 per annum 7.9 $50001-$60000 per annum 4.5 $60001-$80000 per annum 4.3 More than $80001 per annum 4.1 Don t know 14.5 Highest Education Still at school 0.2 Level Obtained Left school before aged 15 years 51.3 Left school after 15 years of age 21.1 Left school after age 15 but still studying 0.7 Trade/Apprenticeship 10.8 Certificate/Diploma of 1 year or less 3.9 Certificate/Diploma of more than 1 year 6.2 Degree or higher 5.9 Work Status Full time employed 28.4 Part time employed 14.7 Unemployed 14.6 Home Duties 10.6 Retired 25.0 Student 1.5 Other 5.2 % of people born in Greece who do not work full or part time n = 205 Receive a Pension Yes 77.1 No 22.4 Don t know 0.5 Total 100.0 50