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1 Introduction 1.1 The Health Survey for England The Health Survey for England comprises a series of annual surveys, of which the 1999 survey is the ninth. All nine surveys have covered the adult population aged 16 and over living in private households in England. Since 1995, the surveys have also covered children aged 2 to 15 living in households selected for the survey. The 1999 survey was the first to increase the representation of minority ethnic adults and children from Black Caribbean, Indian, Pakistani, Bangladeshi, Chinese and Irish communities. This report provides results for the minority ethnic groups, compared with data from the general population. Reference tables of findings relating to adults and children from the general population in 1999 may be found on the Department of Health's website. The Health Survey series is part of an overall programme of surveys commissioned by the Department of Health and designed to provide regular information on various aspects of the nation's health which cannot be obtained from other sources. The Health Survey series was designed to achieve the following aims: 1. To provide annual data for nationally representative samples
to monitor trends in the 2. To estimate the proportion of people in England who have specified health conditions. 3. To estimate the prevalence of certain risk factors associated with these conditions. 4. To examine differences between subgroups of the population
(including regional 5. To assess the frequency with which particular combinations
of risk factors are found, 6. To monitor progress towards selected health targets. 7. (From 1995) to measure the height of children at different
ages, replacing the National Each survey in the series consists of core questions and measurements (for example, anthropometric and blood pressure measurements and analysis of blood and saliva samples), plus modules of questions on specific issues that change periodically. Since 1994, the Health Survey for England has been carried out by the Joint Health Surveys Unit of the National Centre for Social Research (formerly Social and Community Planning Research) and the Department of Epidemiology and Public Health, UCL. 1.2 The 1999 Health Survey for England Previous research has shown significant differences in health between minority ethnic groups. The 1999 Health Survey was designed to augment existing research on the health of minority ethnic groups by interviewing a large-scale representative sample of minority ethnic adults and children throughout the country, and by covering an extensive range of health issues in an interview associated with objective physical measurements and the taking of a blood sample. All years of the Health Survey have sampled the general population, including minority ethnic groups, but this approach does not give sufficient numbers of people in these groups to examine their health in detail. In order to increase the number of informants from minority ethnic groups for analysis, the sample design of the 1999 survey was modified. Part of the sample was a general population sample that followed the same pattern as in previous years. This sample provided essential context against which to set the minority ethnic group results. The other part consisted of a 'boost' sample, designed solely to yield additional interviews with members of the most populous six minority ethnic groups: Black Caribbean, Indian, Pakistani, Bangladeshi, Chinese and Irish. Development work for a possible future health survey among Black Africans living in England is being carried out in 2000-2001. The general population sample was about half the size of previous years, and involved selecting about 6,500 addresses in 312 postal sectors that were issued over a 12 month period. All adults in the selected households were surveyed, as were all children if there were no more than two in the household. If there were more than two children, two were randomly selected for inclusion. In addition, a boost sample of over 64,000 addresses was selected from another 340 postal sectors, which were issued over a 10 month period (January to October 1999). At these addresses, only informants from the specified minority ethnic groups were eligible for inclusion in the survey. Among eligible informants at an address, a maximum of four adults and three children were selected for interview, so that a random selection procedure was used at addresses which contained more than this number of adults and/or children. (This methodology was not used for boosting the number of Chinese informants, who were followed up from an earlier survey which had looked at the health of the Chinese in England: see Section 1.5.4 below.) For informants from the specified minority ethnic groups (whether in the general population or the ethnic boost sample), the coverage of the 1999 survey was similar to that for 1998. The special topics included cardiovascular disease (CVD) for adults and asthma for children. Other topics covered included physical activity, eating habits, psychosocial health, social support, religion and cultural identity, as well as the 'core' topics which are repeated every year: smoking, alcohol consumption, general health, prescribed medication and use of services. For the first time in the Health Survey, informants aged 35 and over had an electrocardiographic measurement (ECG) and (among a sub-sample) a fasting blood sample was taken which was analysed for tricglycerides, LDL-cholesterol and glucose. For each child aged 4-15, parents were asked to complete the Strengths and Difficulties Questionnaire (SDQ), which was first used in the 1997 survey. Informants in the general population sample, unless they were members of the specified minority ethnic groups, were given a short version of the questionnaire covering only the core topics. Also, they did not have the follow-up nurse visit, except for a small sub-sample selected to provide comparisons with minority ethnic groups in respect of measurements not previously employed on the Health Survey, for which therefore earlier reports could not provide comparative data (see 'The nurse visit' in Section 1.5.6). A brief outline of survey methodology is given in Section 1.5. Further details will be found in Chapter 14: Survey Methodology in Volume 2 of this report. Ethical approval for the 1999 survey was obtained from the North Thames Multi-centre Research Ethics Committee (MREC) and from all Local Research Ethics Committees (LRECs) in England. The 1999 report is concerned primarily with findings for minority ethnic groups. Comparisons are made between groups as well as with results from the general population. It should be noted that the 'general population' is not intended to represent the remainder of the population (that is, all who are not members of these groups), but refers to the entire population of England, and therefore includes minority ethnic groups. Whenever possible, results for the adult general population are taken from the 1999 survey itself. However, because the general population sample was given only a short version of the questionnaire, some of the general population data required for comparisons are available only for earlier years of the Health Survey, the most recent year being used for comparison. Examples include cardiovascular disease, which was last asked about in 1998. Results for children aged 2-15 (presented in Chapter 13) have in most cases been compared with results from the 1997 Health Survey, which had a particularly large sample of children. Where the 1997 data are not exactly comparable (for example, owing to changes in question wording), results for children in the 1999 or 1998 general population sample have been used instead. Tables showing trends among the general population aged 16 and over since 1994, and in children since 1995, can be found on the Department of Health website (www.doh.gov.uk/public/summary.htm). The present report provides a full description of methods of sampling and data collection among the general population as well as among minority ethnic groups.1.5.1 The population sampled The survey was designed to provide a representative sample of the population of England aged two and over living in private households, with a boost sample for the most populous minority ethnic groups in the country: Black Caribbean, Indian, Pakistani, Bangladeshi, Chinese and Irish. Those living in institutions were outside the scope of the survey. This should be borne in mind when considering survey findings; the institutionalised population is likely to be older and, on average, less healthy than those living in private households. As some minority ethnic groups tend to have younger age profiles than the general population, the exclusion of institutions will have less effect on the results for these groups. The 1999 survey included three independently designed samples, which are briefly described below. A full account of the sample design is given in Section 14.2 of Chapter 14: Survey Methodology, in Volume 2 of this report. 1.5.2 The general population sample A random sample of 6,552 addresses was selected from the Postcode Address File (PAF), using a multi-stage sample design with appropriate stratification. 312 postcode sectors were selected and 21 addresses were selected within each sector.2 At each household contacted, all persons aged two and over were eligible for inclusion in the survey. Where there were more than two children aged 2-15, only two (selected randomly) were interviewed, in order to avoid an excessive burden on individual households.3 All adults aged 16 and over were interviewed. 1.5.3 The 'boost' sample of minority ethnic groups The boost sample aimed to increase the number of survey informants from five minority ethnic groups: Black Caribbean, Indian, Pakistani, Bangladeshi and Irish. (The sample of the sixth group, the Chinese community, was obtained in a different way: see Section 1.5.4.) Sampled addresses were visited to establish whether there were any residents from minority ethnic groups. In the two strata with the lowest density of minority ethnic residents, the technique of 'focused enumeration' was used in order to screen a larger number of addresses cost-effectively. (A full description of the screening procedures is provided in Chapter 14 in Volume 2 of this report.) In the minority ethnic boost sample, 26,528 addresses were randomly selected from PAF, within 340 postcode sectors. The number of addresses selected within each sector varied by stratum, from 64 to 140 addresses. All the sampled addresses were fully screened, and a further 37,632 adjacent addresses were covered by focused enumeration. At households which contained residents from the target minority ethnic groups, the age criteria for eligibility were the same as for the general population (that is, all persons aged two and over). Because minority ethnic groups tend, on average, to live in larger households than the general population, a maximum of four adults and three children were interviewed in a household. Where there were more than four adults, four were randomly selected for interview, and similarly with children. 1.5.4 The boost sample of Chinese informants The boost sample of Chinese informants was obtained by following up addresses found to contain Chinese households in a 1998 study on the health of the Chinese.4 In all, 569 addresses with Chinese residents (as established in the 1998 study) were issued to interviewers. Each of these addresses was visited to determine if it still contained any Chinese residents. At each address which did, the procedure used for the minority ethnic boost sample was followed, so that a maximum of four adults and three children were randomly selected for interview in the Health Survey. 1.5.5 Interviewing children Children aged 13-15 were interviewed in person, with the permission of a parent or guardian. Where the child was aged 2-12, one of the child's parents or guardians answered the questions on the child's behalf, with the child present during the interview. Because of children's need for privacy in respect of some of their responses, self-completion questionnaires were provided to children aged 8-15 for topics such as drinking and smoking. (This was also the case for young adults aged 16 and 17.) 1.5.6 Overall fieldwork design The interviewer visit Each sampled address was sent a letter in advance of an interviewer visit. The letter stated the purpose of the survey and, if it was an address in the minority ethnic boost sample, explained that as the survey was focusing on the health of people of different ethnic and cultural origins the interviewer would check whether any members of the household were eligible to participate. The interviewer sought the agreement of each adult in the household to an interview (or of the selected adults if part of the boost sample), and sought parents' and children's permissions to interview (selected) children. Interviews with minority ethnic informants were longer than those for the general population, averaging about 65 minutes and 45 minutes respectively. For all minority ethnic informants aged 2 and over, the interview covered: general health, longstanding illness and acute sickness; use of health services; accidents; physical activity; ethnic origin, religion and cultural identity. For adults only (aged 16 and over), there were additional question modules on CVD conditions, social support, HRT, contraception, education and occupation. Children aged 2-15 were asked a module of questions on respiratory disease. There were questions on smoking and drinking behaviour for informants aged 8 and over. The content of the interview is detailed in Chapter 14, while the questions asked are given in Appendix A. Interviews with adults in the general population did not include the questions on CVD conditions, and children in the general population were not asked the questions on accidents and respiratory disease. At the end of the interview, the interviewer measured the informant's height and weight and then (for minority ethnic group informants and the general population sub-sample - see 'The nurse visit' below) sought agreement for a visit by a nurse. At all stages of the survey, informants were given the opportunity to opt out. Computer-assisted interviewing methods were used, as in all surveys in the series since 1995. The nurse visit All informants in minority ethnic groups, whether in the boost sample or within the general population sample, were eligible for a nurse visit. Also visited by the nurse were a sub-sample5 of the general population aged 35 and over. The nurse visit for this sub-sample was designed to provide general population data for measurements that were new in the 1999 survey (ECG, and analytes from a fasting blood sample) with which minority ethnic group data could be compared. For other measurements made by the nurse, comparative general population data was taken from the preceding (1998) survey (or 1997 in the case of children). Using computer-assisted interviewing methods (introduced into the Health Survey for the nurse visit in 1998), the nurse obtained information on current medication. Nurses also asked parents of children aged 4-15 to complete the Strengths and Difficulties Questionnaire for each child, while all informants aged 16 and over were given a booklet of questions on their eating habits. Nurses then took a range of measurements, depending on the informant's age, which included blood pressure, lung function, waist, hip, mid-upper arm circumference, demi-span and electrocardiogram. A saliva sample for cotinine assay was obtained from those aged 4 and over. Informants aged 11 and over were asked to provide a small sample of blood by venepuncture. Those aged 35 and over were also asked to provide a fasting blood sample. Written consent was obtained prior to taking a sample. Informants aged 11-17 were offered the option of an anaesthetic cream prior to venepuncture. Blood samples were analysed for the following:
Non-English speaking informants All survey materials were translated into seven languages: Hindi, Gujarati, Punjabi, Urdu, Bengali, Mandarin and Cantonese. Informants who could not carry out an interview in English were provided with an interviewer who could speak the appropriate language. 1.5.7 Survey response Interviews were obtained with 7,798 adults (aged 16 or over) from the general population, which includes 695 from minority ethnic groups. In the minority ethnic boost sample, there were a further 5,487 adult interviews, with another 662 from the Chinese boost. Among minority ethnic informants 4,725 saw a nurse, and a blood sample was obtained from 3,653. 1,842 interviews were obtained with children aged 2-15 in the general population (of whom 294 were from minority ethnic groups), 2,857 in the boost sample, and 264 in the Chinese sample. Among minority ethnic children, 2,387 had a nurse visit, and blood samples were taken from 406 aged 11-15. Response to the survey can be calculated in two ways: at a household level and at an individual level. A summary of responses obtained to each component of the survey is given below for the general population as well as for each minority ethnic group. Interviews were carried out at 76% of the general population households, at 71% of known eligible boost sample households (67% of estimated eligible households) and at 81% of known Chinese sample households (76% of estimated eligible households). Within the general population sample, interviews were obtained with 92% of adults and 97% of (sampled) children in interviewed households. The equivalent figures for the total minority ethnic sample were 88% of adults and 95% of children. Assuming that households where the number of adults and children was not known contained, on average, the same number as in households where it was known, the estimated individual response rate for the general population was 70% for adults and 74% for (sampled) children. For the total minority ethnic sample, the equivalent percentages are estimated as 60% for adults and 65% for children. Not all those interviewed agreed to all other stages of the survey. The tables below give further details separately for adults and children. The first row gives the proportion of adults and children in estimated eligible households responding to the interview. The following rows show the estimated proportion of adults and children who responded to each stage of the survey for the general population and for each minority ethnic group. Where a stage is age-specific, the base for the percentage is the estimated number of adults or children in the eligible age group.
na not applicable.
na not applicable. 1.6.1 Introduction The Health Survey is a cross-sectional survey of the population. It examines associations between health states, personal characteristics and behaviour, but such associations do not necessarily imply causality. In particular, associations between current health states and current behaviour need careful interpretation, as current health may reflect past, rather than present, behaviour. Although the survey includes questions about past behaviour, these are necessarily subject to memory and other forms of error. 1.6.2 Weighting the sample The general population sample None of the surveys in the series have involved weighting the adult general population sample, as the achieved samples have been judged to reflect the shape of the population sufficiently closely to make this unnecessary. The general population adult sample in the 1999 survey remains unweighted. The general population sample of children has been weighted in all surveys since children were first included (in 1995) in order to compensate for the random selection of two children when there were more than two in a household. For similar reasons, the general population sample of children in the 1999 survey required weighting. The minority ethnic group boost samples Weighting was required for the minority ethnic group boost samples because of the different selection probabilities employed in the selection of PSUs in different strata and in the selection of addresses within them. The child weight used in the general population sample also had to be applied (though modified because the maximum number interviewed per household was three instead of two). Since a maximum of four adults was also imposed, an analogous weight had to be applied to deal with this. It should be noted that the minority ethnic group samples analysed in the report included not only those in the boost samples but those found within the general population sample. The latter group were included both within the general population sample and within the minority ethnic group samples, appropriate weights being applied to equalise selection probabilities. For a full account of the weighting procedures for adults and children, see Section 14.8 in Chapter 14: Survey Methodology in Volume 2 of this report. 1.6.3 Weighted and unweighted data and bases in the report tables All data in the tables in Chapters 1-13 of the report are weighted, except for a few tables dealing with response rates (for example, the proportion for whom height and weight were measured). Both unweighted and weighted bases are shown on all tables. The unweighted bases show the number of cases involved. The weighted bases show the relative sizes of the various sample elements after weighting. Scaling factors have been applied in order that the weighted size of each sample group should reflect its population size. Thus the weighted base for the general population sample is very large relative to the minority ethnic group samples. The weighted sample sizes have no absolute significance, and should be interpreted solely as indicating relative sizes (which is useful if, for example, it is desired to combine data from different columns in their correct proportions). One particular feature should be noted. General population data were not available in the 1999 survey itself for some variables, and have been imported from previous surveys. The imported adult data from 1998 did not involve weighting of any kind. The general population child data imported from the 1997 and 1998 surveys retained the weighting employed in those surveys, but the weighted bases are not shown because this imported data was not within the 1999 weighting scheme. 1.6.4 Age standardisation and risk ratios Except for the Irish, all the minority ethnic groups had a considerably
younger age profile than the general population, as the table below
shows.
Because of these differences in age distribution, differnces between minority ethnic groups and the general population in their health status or risk factors may be partly due to their age differences. Age standardisation is used to remove the age element of the difference when comparing groups. It should be noted that all analyses in the report are presented separately for men and women. All age standardisation has been undertaken separately within each sex, expressing male data to the overall male population and female data to the overall female population. When comparing data for the two sexes, it should be remembered that no age standardisation has been introduced to remove the effects of the sexes' different age distributions. In Health Survey reports since 1994, the direct standardisation method has been used. This is also used in the 1999 report, but instead of showing the age-standardised figures themselves, the 1999 report presents them only in the form of relative risks that compare each sub-group to the overall general population figure (this overall figure being sex-specific, that is, the calculation is done separately for men and women, as noted above). In the case of a prevalence, the age-standardised 'risk ratio' is shown. If prevalence in sub-group h is ph and that in the general population is pg, then the risk ratio is ph/pg. Both elements are age-standardised before the ratio is computed, so that the ratio itself is age-standardised. (The age distribution to which all sub-populations are standardised is an artificial distribution which was designed to minimise the percentage increase in standard errors that the standardised weights introduce. While the same age distribution is used for men and women, as noted above the ratios are computed on a sex specific basis.) The same procedure was adopted for means, but the resulting ratios are referred to as 'ratios of means' not as risk ratios. Given that the general population is taken as the base value of 1, a group with a risk ratio of, say, 1.5 is half again as likely (after allowing for age differences) to have that condition as the population in general. Similarly, a risk ratio of 0.7 means that, after allowing for age differences, the prevalence of the condition is 30% lower in that group than in the population as a whole. The standard errors of the risk ratios (or ratios of means) are shown on the tables. The tables in the report fall into four principal groups. The initial table in any section provides an analysis of the variable by minority ethnic group, with the general population being shown for comparison. On such tables, the observed values are shown in full, and then key values are selected for risk ratios, or ratios of means, to be shown in the lower part of the table. The second type of table, an age break within minority ethnic group, does not require age standardisation. Risk ratios are not shown. The third type of table, by social class of head of household, does require standardisation because different social class groups (manual and non-manual) have somewhat different age distributions. A risk ratio (for example) for Indian men in manual households is the ratio of the age-adjusted prevalence of that condition in Indian men in manual households to the age-adjusted prevalence in all men (in all social classes) in the general population (not to all men in manual households in the general population). On each table analysing a given prevalence estimate by men's social class (or income), risk ratios for both minority ethnic groups and the general population are shown for each social class. As noted above, the base for the risk ratios they show is always the age-adjusted prevalence for all men in the general population (all social classes combined). Risk ratios for the general population in a particular social class, like those for a minority ethnic group in a particular social class, may thus differ from 1. Prevalences for men can thus be compared across minority ethnic groups (and the general population) within social class, or across social classes within minority ethnic group, since the base for their ratios is the same in each case - all men in the general population. The same applies to women. The fourth type of table, by equivalised household income tertile, is exactly analogous to the social class table. (The derivation of equivalised household income, and of the tertiles based on it, is given in Appendix D: Glossary in Volume 2 of this report.) 1.6.5 Age as an analysis variable Age is a continuous variable. The presentation of tabular data involves classifying the sample into year bands. This can be done in two ways, age at last birthday and 'rounded age', that is, rounded to the nearest integer. In the present report, age always refers to age at last birthday. 1.6.6 Availability of published data As is the case of previous surveys, a copy of the 1999 Health Survey data will be deposited at The Data Archive at the University of Essex. Copies of anonymised data files can be made available for specific research projects through the Archive (telephone 01206 872001). In addition, data is available on the Department of Health's website at www.doh.gov.uk/public/summary.htm 1.7 The content of this report This report is in two volumes. Volume 1 presents the survey findings in Chapters 2 to 13. All chapters, except for the last deal exclusively with adults, while Chapter 13 presents results for children. Tables are presented at the end of each chapter. These tables are not all necessarily referred to in the commentary, but those not referred to have been retained for reference. Methodological issues are covered in Volume 2 (Chapter 14 and Appendices). Notes on the conventions adopted for tables will be found at the front of Volume I. Volume 1 Chapter 2: Self-reported health and psycho social well-being The first part of this chapter examines self-report of general health, longstanding illness and acute sickness. The second part looks at two measures of psycho social well-being (the GHQ12 and a social support scale). Chapter 3: CVD prevalence and association with risk factors The first part of this chapter examines self-report for a number of cardiovascular disease (CVD) conditions: angina, heart attack, stroke, heart murmur, abnormal heart rhythm, 'other heart trouble', diabetes and high blood pressure. For angina and heart attack, prevalence according to the Rose Angina Questionnaire is also presented, and electrocardiograph results are shown. The chapter also examines these conditions by socio-economic characteristics, and looks at the association between CVD and a variety of risk factors. Chapter 4: Cigarette smoking The first part of this chapter looks at the prevalence and amount of cigarette smoking and (for South Asian groups) chewing tobacco. The proportion using any form of tobacco is estimated. The self-reported use of tobacco products is compared with saliva cotinine levels. Chapter 5: Alcohol consumption Self-reports of alcohol consumption are examined, including estimates of usual weekly consumption levels, usual frequency of drinking, and drinking in the past week (including estimates of consumption on the heaviest drinking day). Chapter 6: Anthropometry Height, weight, body mass index (BMI, including the prevalence of overweight and obesity) and waist-hip ratio (WHR) are reported. The chapter also examines the relationship of BMI and WHR to socio-economic characteristics. Chapter 7: Blood pressure Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and pulse pressure are reported for each minority ethnic group. Prevalence of high blood pressure is also reported. The relationship of blood pressure with several socio-economic variables is also described. Chapter 8: Physical activity The chapter reports the proportion undertaking various types of physical activity in the past four weeks (housework, gardening and DIY, walking, sports and exercise and activity in job), and the number of days on which they were undertaken. Summary measures show the maximum intensity level achieved, and the extent to which informants' activities meet current guidelines. Chapter 9: Eating habits A comparison of the eating habits of the minority ethnic groups is presented from findings based on the Dietary Instrument for Nutrition Education (DINE) questionnaire. Results on fat and fibre intake are shown, along with consumption of salt and other selected foods. Chapter 10: Blood analytes For each minority ethnic group, distributions are shown for total and HDL-cholesterol, C-reactive protein, fibrinogen, ferritin, glycated haemoglobin, and from a fasting sample LDL-cholesterol, triglycerides and glucose. Chapter 11: Use of health services and prescribed medicine The first part of this chapter reports on levels of use of various health services (GP consultations, outpatient, day patient and inpatient visits, dental visits). The second part of the chapter describes informants' reports of any prescribed medicines they take, and women's use of contraceptive pills (16-54 only) and hormone replacement therapy (HRT). Chapter 12: Non-fatal accidents Accidents are classified as major (where professional help or advice was obtained) or minor (without professional help or advice, but where pain or discomfort was experienced for at least 24 hours). Accident rates are examined for each minority ethnic group. Chapter 13: Children This chapter presents results for minority ethnic children (aged 2-15) across the range of topics included in the survey for this age group. There are also sections on self-reported health, psycho social health, accidents, asthma and lung function, anthropometry and blood pressure. Health-related behaviour - including smoking, alcohol consumption and physical activity - and use of health services are also covered. Volume 2 Chapter 14: Survey methodology and response A full account of the survey design is provided, with an analysis of response to the various stages of the survey for the general population and minority ethnic boost samples. Sampling errors associated with many of the estimates shown in this report are presented. There is also an analysis of non-response and a description of the weighting procedures. Information about the laboratory technique and quality control of blood analytes and salivary cotinine is also included. Provides a list of the questions included in the computer assisted interviews (interviewers and nurses) and copies of other key fieldwork documents. Protocols used for making measurements of height, weight, demi-span, mid-upper arm circumference, blood pressure and electrocardiogram, and for taking blood and saliva samples. Summarises the system used to classify prescribed medicines. Is a glossary which contains descriptions and definitions of analysis
techniques and terms used frequently in the report. References and notes 1 The National Study of Health and Growth was set up in 1972 to monitor the growth of primary school children. For example, see Chinn S, Price CE, Rona RJ. The need for new reference curves for height. Archives of Disease in Childhood 1989; 64:1545-1553. 2 After selection, each postcode sector was divided in two equal parts and one of the two was randomly selected for allocation to interviewers. 3 For similar reasons, a maximum of ten adult interviews was imposed, but there was no case where this applied. 4 Sproston K, Pitson L, Whitfield G, Walker E. Health and lifestyles of the Chinese population in England. Health Education Authority, London, 1999. This 1998 survey looked at the health and lifestyles of Chinese residents aged 16-74 in England. It was carried out by the National Centre for Social Research on behalf of the Health Education Authority (now the Health Development Agency). 5 This sub-sample comprised all persons aged 35 and over in the general population sample in two randomly selected sampling points each month.
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