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National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste, 2014

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National survey for noncommunicable disease risk factors and injuries using approach in Timor-Leste – 2014

WHO STEPS

Authors: Dr João Soares Martins, MPH, PhD Dr Avelino Guterres Correia, MPH Norberto Belo, SKM, M.Kes Dr Herculano Seixas dos Santos Dr Maria do Ceu Sarmento Pina da Costa

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

WHO Library Cataloguing-in-publication data World Health Organization, Regional office for South-East Asia. National Survey for Non-Communicable Disease Risk Factors and Injuries: Using WHO STEPS approach in Timor-Leste – 2014. 1. Accidents, Traffic. 4. Risk Factors. I. Title ISBN 978-92-9022-495-2 2. Cardiovascular Diseases. 3. Food Habits. 5. South-East Asia. 6. Tobacco Use. (NLM classification: WT 500)

Contributors: Dr João Soares Martins, PhD, Dr Avelino Guterres Correia, MPH, Norberta Belo, SKM, M.Kes, Dr Herculano Seixas dos Santos, Dr Maria do Ceu Sarmento Pina da Costa, Dr Dhirendra N Sinha, Dr Lubna Bhatti, Ms Melanie Cowan, Dr Gampo Dorji, Dr Renu Garg and Mr Naveen Agrawal The publication may be obtained from: World Health Organization Regional Office for South-East Asia World Health House Indraprastha Estate Mahatma Gandhi Marg New Delhi, India Office of the WHO Representative to Timor-Leste United Nations House Caicoli Street Dili Timor-Leste

© World Health Organization 2015 All rights reserved. Requests for publications, or for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – can be obtained from SEARO Library, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India (fax: +91 11 23370197; e-mail: searolibrary@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. This publication does not necessarily represent the decisions or policies of the World Health Organization. Printed in India

Contents List of figures........................................................................................................................................... v List of tables..........................................................................................................................................viii Acronyms..............................................................................................................................................xiv Message................................................................................................................................................ xv Foreword ............................................................................................................................................. xvii Acknowledgement................................................................................................................................xix Executive summary................................................................................................................................xxi 1. Introduction......................................................................................................................................1 2. Methodology....................................................................................................................................3 3. Background characteristics..............................................................................................................11 4. Tobacco use....................................................................................................................................13 5. Alcohol consumption......................................................................................................................21 6. Dietary habits..................................................................................................................................29 7. Dietary salt......................................................................................................................................31 8. Physical inactivity............................................................................................................................35 9. Overweight and obesity..................................................................................................................39 10. History of blood pressure................................................................................................................41 11. Blood glucose.................................................................................................................................45 12. Abnormal lipids...............................................................................................................................47 13. Combined risk factors and cardiovascular disease risk prediction.....................................................49 14. Lifestyle advice by health-care provider...........................................................................................51 15. Violence and injury.........................................................................................................................53 16. Discussion.......................................................................................................................................57 17. Conclusion and recommendations..................................................................................................61 Bibliography..........................................................................................................................................63 Annexes 1. Data Tables.....................................................................................................................................65 2. Survey Instruments.......................................................................................................................113 3. Sampling methodology.................................................................................................................131 4. Fact Sheet.....................................................................................................................................135

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List of figures Figure 2.1: Figure 2.2: Figure 2.3: Figure 2.4: Figure 2.5: Figure 2.6: Figure 2.7: Figure 4.1: Figure 4.2: Figure 4.3: Figure 4.4: Figure 4.5: Figure 4.6: Figure 4.7: Figure 4.8: Figure 4.9: The signing of the Technical Agreement by the Minister for Health and the Rector of the Universidade Nacional Timor Lorosa’e.................................... 3 An enumerator conducting interview for STEP-1 accompanied by supervisors........... 5 Enumerators assembling height equipment to measure the height........................... 5 Measuring blood pressure using digital sphygmomanometer.................................... 6 Measuring fasting blood glucose and cholesterol..................................................... 6 Enumerators reading the map to identify the demarcation of EA............................. 7 Training of enumerators and supervisors.................................................................. 8 Current tobacco users by sex and type of tobacco.................................................. 13 Percentage of current tobacco smokers by sex and age.......................................... 14 Proportion of never smokers, former smokers, non-daily and daily smokers among respondents by sex............................................................... 14 Mean age of initiation and duration of smoking among current daily smokers by sex................................................................................... 15 Prevalence of current smokeless tobacco use, by sex and age................................ 15 Proportion of never users, former users, non-daily and daily users of smokeless tobacco products, by sex .................................................................. 16 Exposure to secondhand smoke among respondents by sex................................... 17 Current smokers who have tried to stop smoking................................................... 17 Percentage of respondents who noticed information during the past 30 days in the media about the dangers of smoking that encourages quitting ...... 18

Figure 4.10: Percentage of current smokers who noticed health warnings on cigarette packages and who noticed and thought of quitting ................................ 18 Figure 4.11: Percentage of respondents who noticed cigarette promotions during the past 30 days.......................................................................................... 19 Figure 5.1: Figure 5.2: Figure 5.3: Figure 5.4: Figure 5.5: Figure 5.6: Figure 5.7: Percentage of alcohol consumption status for man, women and both sexes ......... 21 Frequency of alcohol consumption in the past 12 months ..................................... 22 Frequency of alcohol consumption in the past seven days among current drinkers.......................................................................................... 22 Proportion of drinkers by amount and sex among current (past 30 days) drinkers .............................................................................. 23 Drinking level among all respondents on average per occasion............................... 23 Percentage of consumption of unrecorded alcohol................................................. 24 Mean number of standard drinks and standard drinks of unrecorded alcohol on average per day in the past seven days among current drinkers ........... 24

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 5.8: Figure 5.9:

Unrecorded alcohol consumption during the past seven days by type for both sexes ........................................................................................... 25 Mean maximum number of standard drinks consumed on one occasion in the past 30 days............................................................................ 25

Figure 5.10: Percentage of adults consuming six or more drinks on a single occasion at least once during the past 30 days, by sex and age groups ................. 26 Figure 5.11: Mean number of times with six or more drinks during a single occasion in the past 30 days among current drinkers............................................. 26 Figure 5.12: Percentage of former drinkers (those who did not drink during the past 12 months) who stopped drinking due to health reasons......................... 27 Figure 6.1: Figure 6.2: Figure 6.3: Figure 7.1: Figure 7.2: Figure 7.3: Figure 7.4: Figure 7.5: Figure 8.1: Figure 8.2: Figure 8.3: Figure 8.4: Figure 8.5: Figure 8.6: Figure 9.1: Figure 9.2: Mean numbers of fruit, vegetables and combined fruit and/or vegetable servings on average per day................................................................... 29 Number of servings of fruit and/or vegetables on average per day......................... 30 Percentage of respondents consuming less than five servings of fruit and/or vegetables on average per day............................................................ 30 Salt consumption habits......................................................................................... 31 Self-reported quantity of consumed salt ................................................................ 32 Percentage of respondents who agree with the importance of lowering salt in diet................................................................................................ 32 Percentages of respondents who take specific action on a regular basis to control salt intake....................................................................... 33 Type of oil or fat most often used for meal preparation in household..................... 33 Percentage not meeting WHO recommendations for physical activity for health..... 35 Percentage of respondents not doing any work-, transport-, or recreation-related physical activity........................................................................... 36 Contribution of work-, transport- and recreation-related physical activity to total activity............................................................................... 36 Percentage of respondents not engaging in vigorous physical activity.................... 37 Mean minutes spent on domain-specific physical activity on average per day......... 37 Mean and median minutes spent in sedentary activity on a typical day................... 38 Percentage of respondents (excluding pregnant women): body mass index (BMI) classifications among adults............................................... 39 Mean waist and hip circumference in centimeters by sex........................................ 40

Figure 10.1: Blood pressure measurement and diagnosis among adults..................................... 41 Figure 10.2: Percentage of previously diagnosed hypertensive respondents who have visited or received treatment from a traditional healer...................................................... 42 Figure 10.3: Mean systolic and diastolic blood pressure (mmHg)................................................ 42 Figure 10.4: Percentage of respondents with raised blood pressure by sex................................. 43

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 10.5: Percentage of respondents with treated and/or controlled raised blood pressure among adults....................................................................... 43 Figure 11.1: Blood sugar measurement and diagnosis ............................................................... 45 Figure 11.2: Percentage of respondents having impaired fasting glycaemia and raised blood glucose or were currently on medication for diabetes.................. 46 Figure 12.1: Total cholesterol measurement and diagnosis ........................................................ 47 Figure 12.2: Percentage of adults with raised total cholesterol or who currently on medication for raised cholesterol....................................................................... 48 Figure 13.1: Status of combined risk factors among respondents by sex.................................... 49 Figure 13.2: Percentage of respondents with a 10-year CVD risk ≥ 30% or with existing CVD................................................................................................... 50 Figure 14.1: Percentage of respondents who have been advised by doctor or health worker to change their life style.............................................................. 51 Figure 15.1: Percentage of persons not always using safety measures at driving in past 30 days among adults................................................................................. 53 Figure 15.2: Percentage of respondents who were involved in road traffic crashes and/or injured in non-road traffic related accidents in the past 12 months............. 54 Figure 15.3: Percentage of respondents who were seriously injured in non-road traffic accident..................................................................................... 54 Figure 15.4: Location of accidental serious injuries among respondents seriously injured .......... 55 Figure 15.5: Percentage of respondents who have driven after having two or more alcoholic drinks or rode motorized vehicle with drunken driver after having had 2 or more alcoholic drinks in the past 30 days ............................. 55 Figure 15.6: Percentage of respondents being frightened of other person, by each of the types of people they were afraid of................................................. 56

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List of tables Table 2.1: Table 3.1: Number of Enumeration Areas selected per district.................................................. 4 Characteristics of the study participants.................................................................. 11

Annex 1 Background characteristics Table 3.1: Table 3.2: Table 3.3: Table 3.4: Table 3.5: Table 3.6: Table 3.7: Tobacco use Table 4.1: Table 4.2: Table 4.3: Table 4.4: Table 4.5: Table 4.6: Table 4.7: Table 4.8: Table 4.9: Table 4.10: Table 4.11: Table 4.12: Table 4.13: Table 4.14: Table 4.15: Table 4.16: Table 4.17: Table 4.18: Table 4.19: Percentage of current tobacco smokers, by age and sex......................................... 68 Smoking Status of respondents by age and sex...................................................... 68 Current daily smokers among smokers................................................................... 68 Mean age started smoking among current daily smokers....................................... 69 Mean duration of smoking among current daily smokers....................................... 69 Manufactured cigarette smokers among daily smokers.......................................... 69 Manufactured cigarette smokers among current smokers...................................... 69 Mean amount of tobacco used by daily smokers by type........................................ 70 Mean amount of tobacco used by daily smokers by type........................................ 70 Percentage of daily smokers smoking given quantities of manufactured or hand–rolled cigarettes per day.................................................... 71 Former daily smokers among all respondents......................................................... 71 Former daily smokers among ever daily smokers.................................................... 71 Mean years since cessation..................................................................................... 72 Current smokers who have tried to stop smoking................................................... 72 Current smokers who have been advised by doctor to stop smoking...................... 72 Current users of smokeless tobacco........................................................................ 72 Smokeless tobacco use........................................................................................... 73 Former daily smokeless tobacco users among all respondents................................ 73 Former daily smokeless tobacco users among ever daily users................................ 73 Age group and sex of respondents......................................................................... 65 Mean number of years of education among all respondents.................................. 65 Highest level of education of respondents by age and sex ..................................... 65 Marital status of respondents by age and sex......................................................... 66 Employment status of respondents by age and sex................................................ 66 Unpaid work and unemployed of respondents by age and sex............................... 67 Per capita annual income........................................................................................ 67

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National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 4.20: Table 4.21: Table 4.22: Table 4.23: Table 4.24: Table 4.25: Table 4.26: Table 4.27: Table 4.28: Table 4.29: Table 4.30:

Mean times per day smokeless tobacco used by daily smokeless tobacco users by type............................................................................................. 74 Percentage of current users of smokeless tobacco using each of the following products............................................................................... 74 Current tobacco users............................................................................................ 75 Daily tobacco users................................................................................................. 75 Exposed to second–hand smoke in home and workplace during the past 30 days.......................................................................................... 75 Percentage of respondents noticed information in media about dangers of smoking or that encourages quitting during the past 30 days............... 75 Percentage of respondents noticed advertisements or signs promoting cigarettes in stores................................................................................ 76 Percentage of all respondents who noticed cigarette promotions during the past 30 days.......................................................................................... 76 Percentage of current smokers who noticed health warnings on cigarette packages during the past 30 days....................................................... 77 Percentage of current smokers who saw health warnings on cigarette packages that thought of quitting...................................................... 77 Mean average price paid for 20 manufactured cigarettes in USD........................... 77

Alcohol consumption Table 5.1: Table 5.2: Table 5.3: Table 5.4: Table 5.5: Table 5.6: Table 5.7: Table 5.8: Table 5.9: Table 5.10: Table 5.11: Table 5.12: Alcohol consumption status of respondents by age and sex................................... 78 Frequency of alcohol consumption in the past 12 months...................................... 78 Frequency of alcohol consumption in the past 7 days............................................. 79 Proportion of drinkers by amount and sex among current (past 30 days) drinkers............................................................................... 79 Drinking level of pure alcohol among all respondents on average per occasion...... 80 Percentage of consumption of unrecorded alcohol................................................. 80 Percentage of unrecorded alcohol from all alcohol consumed during past 7 days.................................................................................................. 80 Mean number of standard drinks and standard drinks of unrecorded alcohol on average per day in the past 7 days among current drinkers................... 81 Unrecorded alcohol consumption during the past 7 days by type: Both Sexes........ 81 Mean number of drinking occasions in the past 30 days among current (past 30 days) drinkers............................................................................... 81 Mean number of standard drinks per drinking occasion among current (past 30 days) drinkers............................................................................... 81 Mean maximum number of standard drinks consumed on one occasion in the past 30 days............................................................................ 82

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 5.13: Table 5.14: Table 5.15:

Six or more drinks on a single occasion at least once during the past 30 days among total population............................................................... 82 Mean number of times with six or more drinks during a single occasion in the past 30 days among current drinkers................................. 82 Percentage of former drinkers (those who did not drink during the past 12 months) who stopped drinking due to health reasons.............. 82

Dietary habits Table 6.1: Table 6.2: Table 6.3: Table 6.4: Dietary salt Table 7.1: Table 7.2: Table 7.3: Table 7.4: Table 7.5: Table 7.6: Table 7.7: Table 7.8: Salt consumption habits......................................................................................... 85 Percentage of people who think they consume far too much or too much salt....... 85 Self–reported quantity of salt consumed................................................................ 85 Percentage of respondents who agree with the importance of lowering salt in diet............................................................................................ 86 Percentage of respondents who think that consuming too much salt could cause serious health problems................................................ 86 Techniques used on a regular basis to reduce salt intake........................................ 87 Type of oil or fat most often used for meal preparation in household..................... 87 Mean number of meals eaten outside a home........................................................ 88 Mean number of days fruits and vegetables consumed in a typical week............... 83 Mean number of servings of fruit, vegetable and combined fruit and vegetable serving on average per day.............................................................. 83 Number of servings of fruit and/or vegetables on average per day......................... 84 Less than five servings of fruit and/or vegetables on average per day.................... 84

Physical activity Table 8.1: Table 8.2: Table 8.3: Table 8.4: Table 8.5: Table 8.6: Table 8.7: Table 8.8: Table 8.9: Table 8.10: Metabolic Equivalent (MET).................................................................................... 89 Not meeting WHO recommendations on physical activity for health....................... 89 Level of total physical activity according to former recommendations..................... 89 Minutes spent on total physical activity on average per day.................................... 90 Mean minutes of physical activity on average per day............................................ 90 Median minutes of physical activity on average per day.......................................... 91 Percentage of respondents not doing minimum recommended (at least 10 minutes) physical activity (work-, transport- and recreation-related)...... 91 Contribution of work-, transport- and recreation-related physical activity to total activity............................................................................... 92 Percentage of respondents not engaging in vigorous physical activity.................... 92 Minutes spent in sedentary activity on a typical day................................................ 92

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Overweight and obesity Table 9.1: Table 9.2: Table 9.3: Table 9.4: Table 9.5: Table 9.6: Table 9.7: Mean height (cm) among all respondents.............................................................. 93 Mean weight (kg) among all respondents.............................................................. 93 Mean BMI (kg/m2) among all respondents............................................................. 93 Percentage of respondents (excluding pregnant women) in each BMI category.............................................................................................. 93 Percentage of respondents (excluding pregnant women) classified as overweight (BMI>25)........................................................................... 94 Mean waist circumference (cm) and hip circumference (cm) among all respondents (excluding pregnant women)............................................. 94 Mean waist to hip ratio among all respondents (excluding pregnant women)........ 94

Blood pressure Table 10.1: Table 10.2: Table 10.3: Table 10.4: Table 10.5: Table 10.6:

Blood pressure measurement and diagnosis of hypertension................................. 95 Percentage of respondents currently taking blood pressure drugs prescribed by doctor or health worker, among those diagnosed............................. 95 Percentage of previously diagnosed hypertensive respondents who have visited or received treatment from a traditional healer............................ 96 Mean systolic and diastolic blood pressure (mmHg), including those currently on medication for raised blood pressure......................................... 96 Percentage of respondents with raised blood pressure........................................... 96 Percentage of respondents with treated controlled raised blood pressure, among those with raised blood pressure (SBP>140 and/or DBP>90 mmHg) or currently on medication for raised blood pressure..................................................97 Mean heart rate (beats per minute) among all respondents................................... 97

Table 10.7:

Blood glucose Table 11.1: Table 11.2: Table 11.3: Table 11.4: Table 11.5: Table 11.6: Table 11.7: Table 11.8: Blood glucose measurement and diagnosis of diabetes mellitus............................. 98 Percentage of respondents currently oral medication and insulin, among those previously diagnosed: Both sexes...................................................... 98 Percentage of respondents who have sought advise or treatment from a traditional healer for diabetes among those previously diagnosed: Both sexes..... 99 Mean fasting plasma glucose (mmol/L) among all respondents.............................. 99 Mean fasting plasma glucose (mg/dl) among all respondents, including those currently on medication for raised blood pressure.......................... 99 Impaired fasting glycaemia among all respondents (plasma Venous Value >110mg/dl and <126mg/dl)......................................................................... 99 Raised blood glucose (plasma Venous Value >126mg/dl) or currently on medication for diabetes.................................................................... 100 Percentage of respondents currently on medication for diabetes.......................... 100

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Abnormal lipids Table 12.1: Table 12.2: Total cholesterol measurement and diagnosis....................................................... 101 Percentage of respondents currently taking oral treatment (medication) prescribed for raised total cholesterol among those previously diagnosed: Both sexes............................................................................................................ 101 Percentage of respondents who have sought advise or treatment form a traditional healer for raised cholesterol among those previously diagnosed: Both sexes............................................................................................................ 101

Table 12.3:

Seen a traditional healer Table 12.4: Table 12.5: Table 12.6: Mean total cholesterol (mmol/L) among all respondents, including those currently on medication for raised cholesterol............................................. 102 Mean total cholesterol (mg/dl) among all respondents, including those currently on medication for raised cholesterol............................................. 102 Percentage of respondents with raised total cholesterol or on medication for raised cholesterol..................................................................... 102

Combined risk factors and cardiovascular disease risk prediction Table 13.1: Table 13.2: Table 13.3: Table 13.4: Table 13.5: Summary of Combined Risk Factors...................................................................... 103 Percentage of respondents having ever had a heart attack or chest pain from heart disease or a stroke............................................................. 103 Percentage of respondents currently taking aspirin/statins regularly to prevent or treat heart disease.......................................................................... 103 Percentage of respondents with a 10–year CVD risk >30% or with existing CVD................................................................................................. 104 Percentage of eligible persons (defined as aged 40-69 years with a 10-year cardiovascular disease (CVD) risk ≥30%, including those with existing CVD) receiving drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes.................................................................... 104

Lifestyle advice by health care provider Table 14.1: Table 14.2: Table 14.3: Advised by doctor or health worker to change life style among all respondents......................................................................................... 105 Cervical cancer screening...................................................................................... 106 Cervical cancer screening among women aged 30–49 years................................ 106

Violence and injury Table 15.1: Table 15.2: Percentage of drivers or passengers not always using a seat belt during the past 30 days........................................................................................ 107 Percentage of drivers or passengers of a motorcycle or motor-scooter not always using a helmet during the past 30 days........................ 107

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National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 15.3: Table 15.4: Table 15.5: Table 15.6: Table 15.7: Table 15.8: Table 15.9:

Percentage of cyclists who did not always wear a helmet among those riding a bike in the past 30 days...................................................... 107 Percentage of respondents who have been involved in a road traffic crash during the past 12 months.......................................................................... 107 Percentage of respondents seriously injured as a result of road traffic crash among those involved in a road traffic crash in the past 12 months............ 108 Percentage of respondents injured in a non-road traffic related accident that required medical attention in the past 12 months........................... 108 Percentage of respondents who were seriously injured other than road traffic crashes in the past 12 months.......................................... 109 Location of accidental serious injuries among respondents seriously injured in the past 12 months............................................................................... 110 Percentage of respondents who have driven a motorized vehicle after having had 2 or more alcoholic drinks in the past 30 days............................ 111

Table 15.10: Percentage of respondents who rode in a motorized vehicle where the driver has had 2 or more alcoholic drinks in the past 30 days.............. 111 Table 15.11: Percentage of respondents involved in a violent incident during the past 12 months resulting in an injury.............................................................. 111 Table 15.12: Percentage of respondents who reported being frightened for the safety of themselves or their families because of the anger or threats of another person................................................................ 111 Table 15.13: Percentage of respondents frightened by each of the following types of people in past 12 months: Both sexes..................................................... 112

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Acronyms BMI BP CI COPD CVD DBP body mass index blood pressure confidence interval chronic obstructive pulmonary disease cardiovascular disease diastolic blood pressure

dl decilitre EA HDL enumeration areas high density lipoproteins

Hg mercury HLM MET mmol/L NCD PDA PEN PHC PI PPS SBP UNTL WHO WHO FCTC high-level meeting metabolic equivalents of task millimoles per litre noncommunicable disease personal digital assistant WHO Package of Essential NCD primary health care principal investigator probability proportionate to size systolic blood pressure Universidade Nacional Timor Lorosa’e World Health Organization WHO Framework Convention on Tobacco Control

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National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Message Noncommunicable diseases are the most common cause of morbidity and mortality worldwide and in the South-East Asia Region also. Planning for control of noncommunicable diseases (NCDs) needs persuasive evidence generated through a strong monitoring system and through surveillance of NCD risk factors. Using the standard protocol of STEPs noncommunicable disease risk factors survey not only provides the proper opportunity for strengthening strategies to control NCDs, but also for international and national comparisons at different time intervals. To this end, WHO took the initiative to collect internationally comparable data on risk factors of chronic diseases to provide specific measures and interventions to reduce them. We are happy to note that the Ministry of Health Timor-Leste, has come up with this report of NCD risk factors 2014 which presents the key findings from the nationally representative survey conducted in Timor-Leste and delivers new insights into the health status of its population. It is also praiseworthy to note that the Ministry of Health is promoting collaboration and multisectoral approaches through integrated surveillance to address the major NCD risk factors. The WHO Regional Office for South-East Asia is committed to supporting and facilitating the STEPs survey and NCD-related surveillance activities in Member States. We hope that Timor-Leste will use the rich data presented in this document to strengthen and improve the NCD programme in the country for the wellbeing of its population.

Dr Poonam Khetrapal Singh Regional Director WHO South-East Asia Region

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Foreword The first national survey on risks factors of Non Communicable Diseases in Timor-Leste was conducted in 2014 with full financial support from government of Timor-Leste and technical support from the World Health Organization. The survey has been conducted in 11 countries in South East Asia Region including Timor-Leste using WHO STEPS approach. The government of Timor-Leste through the Ministry of Health commissioned this study to the Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e (UNTL). The survey aims to collect information on risks factors of noncommunicable diseases from population aged 18-69 years old both male and female focusing on tobacco use and alcohol consumptions, diet and physical activity, anthropometric measurement, examination of fasting blood glucose and total cholesterol. The findings of this study is expected to guide planning, implementation, monitoring and evaluation of NCD interventions in Timor-Leste as well as to compare progresses made in relation to NCD situations in Timor-Leste with our neighboring countries. On behalf of the Ministry of Health, I thank the government for making available financial resources to fund this survey, and also thank the World Health Organization for providing technical and material support, providing international experts to assist our national research team in this survey from proposal development, training of enumerators and supervisers, data analysis and report writing. My thanks goes to the National Statistics Directorate for allowing its database on 2010 population census and enumeration areas from which the sample frame were drawn in. I congratulate the Universidade Nacional Timor Lorosa'e particularly the Faculty of Medicine and Health Sciences, the researchers, supervisers and enumerators for hard working and dedication in completing this study timely. I thank the study participants for their valuable information. This study would not have been possible without their participations and collaborations. I also thank the municipal administrators, all13 directors of municipal health services and all chief of villages for their cooperation for allowing this study to take place. I welcome the report of the first NCD Risk Factors Survey 2014 and expect that all information contains in this survey to be useful and can be appropriately used, therefore,as the Minister for Health of the 6th Constitutional Government, I encourage all health managers and professionals, and other entities that work in health sector to properly use data from this survey as guidance and tools to improve the quality and the range of NCD services in Timor-Leste.

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Acknowledgement This is the first ever survey conducted in Timor-Leste, attempting to reveal the evidence on risk factors for NCD in the country. This survey is made possible through the support of the Ministry of Health and the WHO country, Regional Office and Headquarters. The Ministry of Health financed this survey and WHO provided support for training, procurement of equipment and survey materials and assignment of consultants/expert to assist Timorese researchers. Therefore, to each of them, we give our highest appreciation and gratitude. WHO also provided experts: Dr Rajesh Pandav, Dr Dhirendra N Sinha, Dr Lubna Bhatti, Ms Melanie Cowan, Dr Renu Madanlal Garg, Professor (Mr) Anand Krishnan, and Dr Gampo Dorji to support us in refining the methodology and assisting us in data analysis and writing up of the final report. We thank them for their intellectual inputs and generous contributions to this work. We also thank Mr Naveen Agarwal for his contribution in creating all the graphs in this report. We are grateful to the former Minister of Health, H.E. Dr Sergio Lobo, for approving this survey and thank the current Minister for Health, H.E. Dr Maria do Ceu Sarmento P. da Costa, for her continuous support and for being the first to initiate the proposal for this study. We thank Universidade Nacional Timor Lorosa’e for letting the researchers and lecturers of the FMCS take part in this research as supervisors. Our gratitude goes to the enumerators who have worked very hard, criss-crossing the country, climbing mountains and valleys in order to find the samples. We thank especially the female enumerators who were in their early trimester of pregnancy, but worked tirelessly to complete the survey. We feel it is important to also include their names in this report: Aida B dos Santos, Antonio S de Carvalho, Arifin A dos Santos, Aristides C Carvalho Avelina M. Soares, Feronimo FL Hornai, Flavio J Boavida, Guerina C Rosales, Heitor C Pereira, Hermenegildo Pereira, Hernanio J da Silva, Ivonia FC Belo, Joaquim J Vaz, Joaquim S Araujo, Jacinta Vaz, Jeronimo de Sousa, Julio M Goncalves, Marcelo M Mali, Norjelito Francisco, Neslon V Caldas and Pascoela V Martins. Our gratitude goes to the 12 supervisors who supervised data collection in fields throughout the territory. These supervisors are: M/s Acacio G Pereira, Antonio Bukiifai, Antonio Ximenes, Eduardo C Gaio, Joaquim Pinto, Joaquim G de Carvalho, Jose Dionisio Ximenes, Leonildo TT da Costa, and Manuel C Fernandes; and Ms Etelvina J Tilman, Meriana Barreto, and Natalia Pereira. We thank Mr Leoneto Pinto (WHO country office staff), Mr Francisco Soares (MoH NCD staff), Mr Joe R de Oliveira (Administrative and Finance Officer) for their support in helping us in the secretarial work. We are also thankful to the Ranemotor Company who facilitated transport during the surveys. We thank all authorities who facilitated this survey and informed and allowed their communities to take part in it. Finally, we thank all respondents who voluntarily gave their time and information; this report could not be produced without their participation.

Investigators: Dr João Soares Martins, PhD Dr Avelino Guterres Correia, MPH Norberta Belo, SKM, M.Kes Dr Herculano Seixas dos Santos Dr Maria do Ceu Sarmento Pina da Costa

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Executive summary Timor-Leste, as a newly independent country, is currently confronted with challenges of high prevalence and incidence of communicable diseases and neglected tropical diseases. However, noncommunicable diseases (NCD) such as cardiovascular diseases, hypertension, cholesterol, stroke, diabetes, chronic respiratory disease, cancer and kidney diseases etc. are also on the rise and becoming major health challenges for the Timorese national health system. This is the report of the first Timor-Leste NCD survey using WHO STEPS approach, jointly conducted by the Ministry of Health and Universidade Nacional Timor-Lorosae with technical support from the World Health Organization during July–December 2014. The purpose of this survey is to provide the baseline assessment of the key risk factors of NCD and among Timorese adults, to help develop a comprehensive national programme and set targets on NCD and injury prevention and control in Timor-Leste. A cross-sectional study survey was implemented using WHO STEPS methodology. The survey included males and females aged 18–69 years old, residing in Timor-Leste. Sample size calculation used an expected risk factor prevalence of 50%, absolute precision of 5%, alpha error of 5% and design effect of 1.5. A multistage complex sample design was used to produce representative data. Probability proportional to size sampling was used to select 150 enumeration areas (EA) from total 1827 EA in all 13 districts. Systematic random sampling was used to then select 18 households from each of the selected EA. From each selected household, one eligible individual was selected by KISH method. The data collection instruments consisted of three steps: Step one (interviews), Step two (physical measurements) and Step three (biochemical measurements). The survey team was composed of one principal investigator, supported by four co-investigators, 12 supervisors, 21 enumerators and one administrative officer. Data weighting and analysis was conducted in accordance with STEPs survey using Microsoft Excel, access and EpiInfo version 3.5.4 Software. In total, 320 items of questionnaire were analysed. The survey included 2609 adults [1083 (41.5%) males and 1526 (58.5%) females] and brought the overall response rate to 96.3%. Out of the sample population, 882 (34.4%) of the sample had no formal education or schooling and 2055(78.9%) currently married. The findings indicate that more than half (56%) of adults used some form of tobacco product, and tobacco use was much higher among men (70.6%) as compared to women (28.9%). Among respondents, 48.6% smoked and 19.8% used smokeless tobacco products. More men (69.5%) than women (9.6%) smoked tobacco; more women (26.8%) than men (16.1%) used smokeless tobacco products. Nearly nine in 10 adults were exposed to secondhand smoke in homes; more than half of adults (51%) were exposed to secondhand smoke in work places. Respondents started smoking very young, with mean age of starting smoking being 16.4 years. The prevalence of current alcohol consumption (drank in the past 30 days) was 17.4% (42.8% men and only 2% women). Among those who drank in the past 12 months, 40% were monthly drinkers, nearly 60% were weekly drinkers and less than 1% were daily drinkers. Among current drinkers 97.1% indulged in lower-end drinking. On average, current drinkers had taken at least

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

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one alcoholic drink on 15.1 occasions in the past 30 days and consumed 4.4 standard drinks on a single drinking occasion. More men (21.8%) engaged in heavy episodic drinking (six or more drinks on any occasion in the past 30 days) than females (1%). The surveyed population ate fruits on average on 2.3 days in a typical week. Average vegetable consumption was rela tively better than fruit consumption, with vegetables being eaten on 6.7 days in a typical week. The quantity of intake was measured by servings: one serving of fruit was defined as equal to a medium-sized banana or apple or equivalent and one serving of vegetables equal to one cup of green leafy vegetables or half a cup of cooked vegetables. The minimum requirement for an adult is five or more servings of fruit or vegetables a day. The overall daily per capita consumption in an aver age day of fruit was 0.9 servings; and of vegetables was five servings (5.4 servings of fruits and vegetables). Comparing this to the minimum recommended in take, 77.5% of respondents did not consume recommended amounts of fruit and vegetables on an average day. Physical activity related to work, transportation and recreational activities was assessed in terms of minutes that caused the respondent to feel breathless or experience increased heart rate. The WHO recommendations on physical activity for health are ≥150 minutes of moderateintensity physical activity per week, 75 minutes of vigorous physical activity per week, or an equivalent combination of the two. It was found that 16.7% (men 12.8%, women 23.3%) of all respondents did not meet the WHO recommendations. However, 73.3% of females and 39.9% of males were not engaging in vigorous physical activity. Among women aged 30–49, only 1.1% ever had a screening test for cervical cancer. The report also indicates that majority of drivers or passengers of motor vehicles, motorcycles or motor-scooters did not always use seat-belts or helmets. During the past 30 days, 97.5% didn’t use seat-belt in a motorized vehicle and 81.9% didn’t use a helmet when riding a cycle or a motorcycle. The survey found the mean body mass index (BMI) for overall population was 21.2 kg/m2. There was no difference mean of BMI between males (21.3 kg/m2) and females (21.0 kg/m2). The overall prevalence of overweight was 11.2%. The overweight rate was significantly higher among age group 45–69 (18.7%) than among age group 18–44 (8.8%). Females tended to be overweight than males. Raised blood pressure (defined as having SBP ≥140 mmHg and/or DBP ≥90 mmHg or currently on medication for raised blood pressure) was found 39.3% all adults (45.3% of men and 28% of women), 97.3% of those were currently not on medication for raised blood pressure (98.1% of men and 94.7% of women). The overall mean fasting blood glucose level (including those currently on medication for raised blood glucose) for both sexes was 4.3 mmol/L or 77.6 mg/dl, with very little difference between men and women and among the age groups. Overall prevalence of raised blood glucose (fasting glucose level ≥7.0 mmol/L or on medication for raised blood glucose) was 1.5 %.

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National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Prevalence of raised total cholesterol (defined as having total cholesterol ≥5.0 mmol/L or currently on medication for raised blood cholesterol) was 21% in both sexes, with more females having raised blood cholesterol than males (25.5%versus 18.5%). Among all respondents, only 7.8% had no common risk factors for NCDs; three fourths (72.8%) had 1-2 risk factors; and one in five respondents (19.4%) had 3-5 risk factors. Among respondents, 1.4% had a 10-year CVD risk ≥ 30% or with existing CVD. Less than 20% of respondents received life style advice by health-care provider. If combined, the risk factors (currently daily smokers, less than five servings of fruits and vegetables per day, insufficient physical activity, overweight (BMI ≥ 25 kg/m2) and raised BP (SBP≥140 nad/or DBP ≥ 90 mmgH or currently on medication for raised BP), it was found that overall for both sexes, only 7.8% of the population had none of the above risk factors and 19.4% had three or more of the above risk factors. Based on the findings of the first NCD risk factor survey in Timor-Leste, the following are the key recommendations: tt

The survey suggests a low NCD health-care coverage for NCD and existence of a high treatment gap. NCD screening services should be improved and integrated and strengthened at the primary health-care services. One model for consideration is introducing the WHO Package of Essential NCD (PEN) services in the primary health-care services to increase the coverage of NCD services. Given that most primary health-care facilities in Timor-Leste are staffed by competent health professionals (doctors, nurses and midwives), interventions on NCD could be integrated into a PHC package and family health programmes (Saúde na familia). The survey indicated that the key NCD risk factors are highly prevalent. Strategic health promotion for NCD should be stepped up to promote physical activity, encourage consumption of healthy diet including consumption of fruits and vegetables, and reduce intake of salt, alcohol and tobacco. The national recommendations for diet, and physical activity, if available, should be advocated through the media and developed further. Addressing tobacco, alcohol and processed food requires adequate legislation and enforcement systems. In particular, legislation and education discouraging smoking in home and work settings and public spaces, marketing and health warning labels of tobacco, alcohol, and processed foods should be well regulated and enforced. Nationwide campaign to encourage smokers to quit smoking and discourage youth and students from taking up smoking should start immediately. Road safety policies including control of drink-driving, use of seat-belt and helmet should be enforced as a public health measure. NCD prevention and control should also design gender-sensitive programmes to improve consumption of fruits and or vegetables among females and reduce female overweight and undernutrition.

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Pap smear screening programmes should be introduced as routine services in the healthcare settings. Diagnostics, treatment and control, including palliative care, should also receive appropriate attention. Increasing physical activity in the population will require appropriate structural planning and development and partnerships between various sectors including health, education, roads, planning, and transport to ensure creation of health-promoting environment such as pedestrian lanes, urban parks, and community walk trails. Adequacy of the current urban plans should be made sensitive enough to accommodate the “health-in-all-policies approach”. A multisectoral framework action for NCD prevention and control should be introduced to holistically address NCD prevention and control. Health education on NCD risk factors and promotion of healthy lifestyle should be advocated in communities by quitting smoking, reducing alcohol consumption, eating healthy foods, doing regular physical activity. Health workers and those who understand the value of healthy lifestyle should be encouraged to be role models for others. Training and upgrading the knowledge and awareness on NCD risk factors, and NCD with their consequences of health workers and the population should be initiated.

Surveillance system for NCD to monitor NCD trends and risk factors trends regularly should be reinforced. Health systems should be equipped with adequate infrastructure, human resource, diagnostic tools, drugs and equipment to address NCD problems in all level of health- care facilities.

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National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

1. Introduction Noncommunicable diseases (NCD) are a group of conditions that covers cardiovascular diseases, cancer, mental health problems, diabetes mellitus, and chronic respiratory disease. Preventable actions include common NCD modifiable risk factors such as tobacco use, unhealthy diet, lack of physical activity, and the harmful use of alcohol. Exposure to the NCD risk factors lead to four major metabolic diseases: overweight/obesity, high blood pressure, raised blood sugar and blood lipids which, in turn, are responsible for four groups of major NCD: (cardiovascular diseases, diabetes, chronic respiratory diseases and cancers. NCD are responsible for more than 36 million global deaths per year, of whom most die prematurely and contributes to a sizeable economic impact on households, industries and societies through losses in income, productivity and capital formation. The increasing burden of NCD is attributed to population ageing, rapid and unplanned urbanization, as well as international trade introducing processed foods and diets high in total energy, fats, salt, and sugar into the daily lives of people in developing countries. Aggressive marketing by tobacco and alcohol industries is also resulting in increased use of these products. Furthermore, injuries are emerging as the leading contributors to death, hospitalization and disability in South-East Asian countries. Unintentional injuries including transport accidents, falls, drowning, and burns constitute the major burden due to injuries, while intentional injuries (self-harm and assault) are also important in selected settings. WHO’s Global Strategy for the prevention and control of NCD rests on the three pillars of surveillance, primary prevention and strengthened health care. The United Nations General Assembly convened a High-Level Meeting (HLM) in New York in September 2011. As a follow-up to the Political Declaration of UN HLM, WHO developed a Global Action Plan (2013–2020) and a comprehensive monitoring framework with indicators and global voluntary targets through a consultative process. This meeting provided an opportunity for strengthening and shaping primary prevention in a most cost-effective way in tackling risk factors for NCD. While endorsing the Global Action Plan along with the list indicators and targets, the Sixty-sixth World Health Assembly in May 2013 also urged Member States to consider development of national plans of action for addressing NCD along with national monitoring framework with targets and indicators.

Brief snapshot of NCD situation in Timor-Leste prior to this survey Timor-Leste gained independence in May 2002. Situated in the eastern half of the island of Timor, which lies between Indonesia and Australia, the country occupies a land area of 14 874 km2 and a population of 1 066 409 in 2010 census. Thirty per cent of the population lives in the urban areas with two thirds living in the country’s capital Dili (NSD 2010). Administratively, Timor-Leste is divided into 13 districts, 65 sub-districts, 442 sucos and 2225 aldeias. The climate is tropical; hot, semi-arid; rainy and dry seasons. Timor-Leste is facing a double burden of disease. Communicable diseases such as TB, malaria and dengue continue to pose a public health challenge, while on the other hand, NCDs including cardiovascular and chronic obstructive pulmonary diseases have emerged among the top ten causes of mortality. Hospital data from 2012 indicate that about 22% of all deaths were due to

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

NCDs (cardiovascular diseases, stroke, diabetes, chronic respiratory disease and kidney diseases). Available information indicates that tobacco use and the use of firewood and kerosene for cooking are the major risk factors for NCD. In particular, tobacco use is highly prevalent among males. According to the Demographic Health Survey (2009), current tobacco use among males between ages 15–49 years is 69.5% while tobacco use among females was low (4.7%). Prevalence of overweight among women and diabetes are also emerging as possible public health problems. Overweight among females was 5.1%, and the urban females were 2.5 times more overweight than their rural counterparts (DHS 2009–2010). According to the blindness survey on population >40 years, the prevalence of raised blood sugar was 4.6%. No information is available on diet and physical activity and blood pressure from the Timorese population. Information on NCD and injury risk factors is essential to plan an evidence-based national strategy for their prevention and control. Timor-Leste is in the process of formulating its national strategy for NCD and injury prevention and control and fixing its own targets. Timor-Leste’s grand strategic development plan 2011–2030 envisions a healthier population as a result of comprehensive, high quality health services accessible to all Timorese people. To achieve a healthier population in the country, the role of prevention and control of NCD and injuries cannot be ignored; they play a central part in this.

Purpose of the STEPS Survey This is the first national survey in Timor-Leste to establish a baseline on NCDs and injury situations for understanding the magnitude of the NCDs and injuries ,with which NCDs trends can be tracked in future. The data from the study are also expected to help develop a comprehensive national programme and set targets on NCD and injury prevention and control in Timor-Leste. WHO provided full technical support for the survey including the training of the teams for data collection.

Study objectives (1) (2) (3) To assess the prevalence and establish a baseline of key NCD risk factors in the Timorese population using WHO STEPs approach; To assess the burden of injuries and identify key risk factors; and To utilize the data from the survey to develop evidence-based national strategy for NCD and injury prevention and control.

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

2. Methodology The NCD Risk Factor Survey was commossioned by the Ministry of Health to the Universidade Nacional Timor Lorosa’e (UNTL). The technical agreement for this survey was officially signed by the Minister for Health Dr Sergío Gama Lobo Sp.B and the Rector of the UNTL Prof Dr Aurélio Guterres on 8 July 2014 Figure 2.1: The signing of the Technical Agreement by the Minister for Health and the Rector of the Universidade Nacional Timor Lorosa’e

Study design This was a cross-sectional survey conducted using the WHO’s eSTEPS survey methodology to assess the prevalence of risk factors for NCD and injuries among the Timorese population.

Study population The target population of the study was all individuals (both male and females), aged 18–69 years old residing in Timor-Leste. The purpose was to generalize from the study sample to overall population of the country in order to make inferences about the situation of NCD and injuries.

Sample size Since there was no existing prevalence data on NCDs and injuries in Timor-Leste, assumption was made that the estimated prevalence of the risk factors within the target population was 50%. Using assumptions of absolute precision – 5%; alpha error of 5%; design effect of 1.5 for complex sampling strategy; and response rate of 85% provided a sample size of 576 or (384*1.5). The total sample size for the country is based on the age/sex subgroups for which the estimates were required. The sub-groups were 18–44 years and 45–69 years for each sex i.e. four subgroups only which gives the final sample size of 2304 or (576*4).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Sample size was based on the following assumptions: tt tt tt tt tt tt

Prevalence of risk factor – 50% (Maximizes sample size for a given precision) Absolute precision – 5% Alpha error of - 5% Design effect – 1.5 Strata = 4 (age groups 18–44, 45–69 for each sex) = 2304 With a correction for an anticipated 85% response rate, this came to 2710.

Sampling procedure: A multi-stage sampling procedure was adopted. All 13 districts were included in the sample. Although the National Parliament Act Parlamento nacional: LEI N.O 11/2009 de 7 de Outubro Divisão Administrativa do Território defines the administrative division of the territory of Timor-Leste in which “district” is replaced by “municipality” and the term “municipality” has been increasingly used in 2015, in this survey we continue to use “district”. The sample was drawn proportionally from enumeration areas (EA) in districts. Timor-Leste has a total 1827 EAs based on census 2010. At the first stage, a total of 150 EA were selected by probability proportional to size (PPS) sampling method. Number of EAs selected per district for this survey is presented in Table 1. At the second stage, 18 households were selected from each EA by systematic random sampling (2710/150). Thirdly, from each selected household; one individual was selected within the required age-group by KISH sampling. Table 2.1: Number of Enumeration Areas selected per district No 1 2 3 4 5 6 7 8 9 10 11 12 13 Districts Aileu Ainoro Baucau Bobonaro Covalima Dili Ermera Lautem Liquica Manatuto Manufahi Oecusse Viqueque Total Population 47 643 63 121 116 934 96 271 62 203 266 236 124 687 65 475 67 831 45 098 51 904 68 654 72 797 1 148 854 Percentage (%) 4.15 5.49 10.18 8.38 5.41 23.17 10.85 5.7 5.9 3.93 4.52 5.98 6.34 100 Total sucos 31 21 59 50 30 31 52 34 23 29 29 18 35 442 EA per district 80 99 204 210 111 297 206 127 109 78 87 121 96 1827 EA selected 6 8 16 15 9 29 16 9 8 6 6 11 11 150 Household 108 144 288 270 162 522 288 162 144 108 108 198 198 2700

Source: Directorate of the National Statistics, Ministry of Planning and Finance

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Study instruments The data collection instruments consisted of three steps and corresponding modules, based on WHO STEPS methodology and was translated into Tetum as follows: STEP 1 included demographic information and behavioural measurements such as assessments on tobacco use, alcohol consumption, diet including salt and physical activity (Figure 2.1). These questions were adapted for the national context and optional modules on violence and injury and tobacco policy were added. Figure 2.2: An enumerator conducting interview for STEP-1 accompanied by supervisors

STEP 2 included anthropometric measurements, which included height, weight and waist circumference. Height and weight were measured to calculate the body mass index (BMI). Height was measured by a portable height/length measuring scale to the nearest millimeter (Figure 2.3). Figure 2.3: Enumerators assembling height equipment to measure the height

Weight was measured by an electronic platform scale. Waist circumference was measured in a separate room or area screened off from other people, in order to maintain the privacy of

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

participants. This was measured by an elastic measuring tape directly on the skin at the end of a normal expiration, at the midpoint between the lower margin of the last palpable rib and the top of the hip bone with the arms relaxed at the sides. Waist circumference was measured to the nearest millimeter. Blood pressure was measured using digital sphygmomanometers on the left arm, while the participants were in sitting position with the hand resting on the armrest of the chair or some objects; after ensuring that they had rested for 10 minutes. A second and third reading was taken after two minutes’ resting interval (Figure 2.4) and the mean of the last two measurements of blood pressure used for analysis. Figure 2.4: Measuring blood pressure using digital sphygmomanometer

STEP 3 included biochemical measurements including fasting blood glucose and cholesterol were done by dry chemistry method using CardioChek devices (Figure 2.5). All the measurements were taken at the house of the participant. Figure 2.5: Measuring fasting blood glucose and cholesterol

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Fieldwork and data collection Study team: The study team was composed of one principal investigator (PI), and four coinvestigators. PI was fully responsible for the overall planning, implementation, supervision, data analysis and report-writing of the risk factors survey. The co-investigators contributed to the implementation of the study from proposal development, data collection, data analysis and writing up the report. The co-investigators also supervised data collection, ensuring that enumerators and district supervisors conducted the survey in a rigorous and scientifically sound manner. They also supported translation of questionnaires and report of the survey, and assisted in data analysis and report writing. Data Collection Team: The project recruited 21 enumerators from the newly graduated medical doctors and nurses to collect data in the field and 12 supervisors to supervise data collection. Thereafter, the enumerators were divided into seven teams of three enumerators each. Twelve supervisors were assigned to supervise data collection in districts. Data collection plan: Data was collected using HP iPAQs personal digital assistants (PDA) loaded with eSTEPs software. Data collection, commencing on 8 October 2014, was divided into two phases and was completed on 18 December 2014. The first phase started with eight districts (Aileu, Ainaro, Bobonaro, Covalima, Dili, Ermera, Liquiça and Oecussi). All seven groups of enumerators conducted data collection in Dili district. After completing data collection in Dili, six groups were assigned to collect data in 12 districts, supervised by 11 supervisors. The remaining group and one supervisor were sent to undertake data collection in the enclave district of Oecussi and in the island of Atauro (part of Dili District). After completion of these seven districts, the data collection team moved to phase two, with the remaining six districts (Baucau, Lautem, Manatuto, Manufati and Viqueque). Each EA was covered in three days, depending on the size of households and geographical and climatic conditions. In addition, enumerators were provided with the map of EA supplied by the National Statistics Directorate, Ministry of Finance, to assist in identifying geographic boundaries of the selected EA (Figure 2.6). Figure 2.6: Enumerators reading the map to identify the demarcation of EA

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Day 1 – Survey of the suco for verification of the number of households, calculation of sampling interval, approaching households, taking consent from the selected individuals, interviewing for the STEP 1 and STEP 2, informing the respondents to fast for next day. Day 2 and 3 – Morning fasting samples to be taken from the respondents (by trained enumerators only) whose interviews were completed the previous day. The remaining respondents were interviewed and asked to be fasting for the next day to collect blood samples. The data collection effectively took 45 days.

Training of interviewers The training of enumerators (21) and district supervisors was held in Dili on 23–27 June 2014 at the National Institute of Health, Ministry of Health. The training workshop was conducted with the technical support from the World Health Organization, Ministry of Health, and technical task force (Figure 2.7). The members of the task force committee assisted in the training of enumerators as facilitators. Training also included methods of interpersonal communication, obtaining informed consent and correct measuring methods of physical and biochemical measurement factors and learning electronic data collection using PDA. Figure 2.7: Training of enumerators and supervisors

Quality control One field coordinator was identified for each district. The team coordinator ensured completeness of data collection. The team coordinator also ensured high compliance rate in the sample and brought to notice any problem to the PI at the earliest so that action can be taken. The coordinator also visited one house among the houses visited by two field workers a day before and filled the details in a hard copy (including anthropometry), which was compared to the handheld entries at the end of the day. District supervisors supervised the data collection team twice a week to maintain rigorous data collection procedures and ensure the completeness of data collection, and help resolve any problem arising during data collection period. They liaised with the local authorities and community

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

leaders before commencement of the study in a district, information head of respective selected sucos where EA were drawn from before the commencement of the data collection and ensured that community and community leaders are informed about the study. This is important in order to maximize the participant of community and study sample in this study. Principal investigator and co-investigators supervised the data collection team once per week to maintain rigorous data collection procedures and ensured the completeness of data collection, and helped resolve any problem arising during data collection period which could not be handled by enumerators and supervisors in the field.

Data management and analysis Data management: The data from PDAs were transferred to the computer at the end of coverage of each EA. These were uploaded into one complete file. Data cleaning and data weighting was done in accordance with the WHO STEPS guidelines for analysis. Data analysis: Data analysis was conducted in accordance with STEPs survey. EpiInfo software was used to assist data analysis. Frequency tables were calculated for various variables. The team was supported by an experienced statistician provided by WHO, who worked with the research team to undertake statistical analysis of this survey.

Ethical considerations Ethical clearance was obtained from the Technical and Ethical Review Committee of the Cabinet of Ethics and Quality Control, Ministry of Health for ethical review. Written informed consent was obtained from the participants of the survey. Confidentiality was maintained in the process of collection, management and analysis of data. All those found to be having abnormal values for biomedical risk factors were referred to the nearest health facilities.

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

3. Background characteristics A total of 2609 respondents participated in the study with 1083 (41.5%) males and 1526 (58.5%) females (Table 1.3). By age group, 62.3% were in the 18–44 years age group and 37.7% were aged 45–69 years. According to the education level, 34.4% had no formal schooling, 17.3% had less than primary education, 22.1% had secondary school education, 2.9% had college/university and others either completed pre-secondary or secondary levels. Almost equal proportion of male and female respondents were currently married (80% of males and 78% of females). Slightly more females were widowed as compared to males (8% versus 3%). Overall, males were more employed than females. Among male respondents, 37.7% were self-employed, 32.7% unpaid, 16% government employees, and 14% were nongovernment employees. Nearly three fourth of females (72.5%) were unpaid workers, while only one third (32.7%) of males were unpaid workers. (Table 3.1) Table 3.1: Characteristics of the study participants Variables Age group (in years) (n=2609) 18–44 45–69 18–69 Education ( n=2562) No formal schooling Less than primary school Primary school completed Pre secondary school completed Secondary school completed College diploma completed College/university completed Post graduate degree Marital status Never married Currently married Separated Divorced Widowed Cohabiting n 602 481 1083 n=1069 326 213 92 104 233 45 48 8 n=1079 155 863 11 9 31 10 14.4 80.0 1.0 0.8 2.9 0.9 30.5 19.9 8.6 9.7 21.8 4.2 4.5 0.8 Males (%) 37.1 48.8 41.5 Females n 1022 504 1526 556 230 119 191 333 34 27 3 160 1192 19 17 116 19 (%) 62.9 51.2 58.5 37.2 15.4 8.0 12.8 22.3 2.3 1.8 0.2 10.5 78.3 1.2 1.1 7.6 1.2 Both sexes n 1624 985 2609 882 443 211 295 566 79 75 11 n=2602 315 2055 30 26 147 29 12.1 78.9 1.2 1.0 5.6 1.1 (%) 62.2 37.8 100.0 34.4 17.3 8.2 11.5 22.1 3.1 2.9 0.4

n=1493

n=2562

n=1523

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Variables Age group (in years) (n=2609) Employment status Government employee Non-government employee Self-employed Unpaid n

Males (%) n= 1033 165 141 389 338 16 13.6 37.7 32.7

Females n 68 58 277 1062 (%) n=1465 4.6 4.0 18.9 72.5

Both sexes n 233 199 666 1400 (%) n=2498 9.3 8.0 26.7 56.0

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

4. Tobacco use Tobacco use was measured by asking respondents separate sets of questions to gather information on smoke and smokeless tobacco use. Respondents were grouped into current smokers and non-smokers. Current smokers are respondents who smoked any tobacco products (e.g. cigarettes, cigars or hand-rolled tobacco) in the past 30 days. Current smokers are composed of daily smokers and non-daily smokers. Daily smokers are those who smoke tobacco products every day; and non-daily smokers those current smokers who smoke tobacco products not on a daily basis. Non-smokers consisted of those who never smoked and former smokers; never smoked refers to those who had never smoked tobacco products, whereas former smokers were those who had quit smoking.

Current tobacco users More than half of the respondents (56.1%) reported current use of any form of tobacco (smoked or smokeless tobacco) (Figure 4.1). Tobacco use was much higher among men (70.6%) as compared to women (28.9%). Nearly half (48.6%) of the respondents were current smokers with a much higher prevalence among males (69.5% males and 9.6% females). More women (26.8%) than men (16.1%) used smokeless tobacco products. Figure 4.1: Current tobacco users by sex and type of tobacco 100 90 80 70 Percentage 60 50 40 30 20 10 0 Tobacco users Tobacco smokers Overall Men Women Smokeless tobacco users 28.9 19.8 9.6 16.1 56.1 48.6 70.6 69.5

26.8

Older people smoked more than younger groups both among men and women (Figure 4.2).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 4.2: Percentage of current tobacco smokers by sex and age 100 90 80 70 Percentage 60 50 40 30 20 10 0 Total Men 18-44 years 45-69 years Women 9.0 12.5 43.0 63.1 65.6 77.1

Daily and non-daily smokers The proportion of current daily smokers was significantly higher among men (49.6%) as compared to women (7.8%). Ratios of non-daily and daily smoking among men was 1:2.5, while this proportion among women was 1:4 (Figure 4.3). A higher proportion of the older age group smoked daily as compared to the younger age group. (Annex 1, Table 4.2) Figure 4.3: Proportion of never smokers, former smokers, non-daily and daily smokers among respondents by sex 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men Never user 7.8 Women Former user Non-daily 49.6 1.0 1.8 35 3.6 19.8 89.4 26.9 48.7

2.7 13.5

Total Daily

Types of smoked tobacco products used Most of the the current smokers (94.8%) used manufactured cigarettes, which men smoked more than women (95.2% versus 89.3%) (Annex 1, Table 4.7).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Age of initiation and duration of smoking Figure 4.4 presents the mean age at which daily smokers started smoking. The survey found that the mean age of initiation of smoking was 16.3 years for men and 17.6 years for women. The age of starting smoking in men is similar between the younger and older age groups (16.2 and 16.4 years old respectively); however, women in the younger age group started smoking much earlier (16.4 years old) than those in the older age group (25 years) (Annex 1, Table 2.4). The mean duration of smoking was 27.2 years with prolonged exposures among males (28 years for males and 17.5 years for females) (Figure 4.4). Figure 4.4: Mean age of initiation and duration of smoking among current daily smokers by sex 50

40 Mean number 28.0 27.2 17.5

30 17.6

16.3

16.4

0 Mean age started smoking Men Women Mean duration of smoking Both sexes

Current smokeless tobacco users Overall, 19.8% of respondents used smokeless tobacco products such as snuff, chewing tobacco, betel etc. with much higher prevalence among women (26.8%) as compared to men (16.1%) (Figure 4.1). Older people among (45–69) both men and women used smokeless tobacco more than the younger age group (Figure 4.5). Figure 4.5: Prevalence of current smokeless tobacco use, by sex and age 100 90 80 70 60 50 40 30 20 10 0

Percentage

57.5 44.2 40.5 20.4 10.4 3.8 Men 18-44 years 45-69 years Women

Total

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

The ratio of non-daily and daily smokeless tobacco use among men was 1:7, while this proportion among women was 1:1 (Figure 4.6) Figure 4.6: Proportion of never users, former users, non-daily and daily users of smokeless tobacco products, by sex 100 90 80 70 Percentage

63.9 78.6

60 50 40 30 20 10 0

73.5

9.3 5.3 14 Men Never users 2.1 13.4 13.4 Women Former users Non-daily users 6.7 6.0 13.8 Total Daily users

Types of smokeless tobacco products used The most common smokeless tobacco product to be used was betel quid (59.3%) followed by chewing tobacco (13.2%). Use of betel quid among men is more than five times and in women nearly four times higher than chewing tobacco (Annex 1, Table 4.21).

Exposure to second-hand smoke About 92.1% of total respondents reported being exposed to second-hand smoke at home during the past 30 days. This proportion was slightly higher in men than women (94.6% versus 87.4%). The overall prevalence of exposure to second-hand smoke in work place was 51.0%. The percentage of women exposed to second-hand smoke at home (87.4%) was more than twice as compared to exposure at workplace (38.9%). It was also observed that exposure of men at workplace was much higher than women (74.4% versus 38.9%). (Figure 4.7)

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 4.7: Exposure to secondhand smoke among respondents by sex 100 90 80 70 Percentage 60 50 40 30 20 10 0 Total Men Women 51.0 38.9 74.4 92.1 94.6 87.4

Home

Workplace

Smoking cessation It is interesting to note that 23% of current smokers of both sexes have tried to stop smoking, with more women trying to quit smoking than men (75.2% women, 19.1% men) (Annex 1, Table 2.14). More people in the younger age group (18–44 years) wanted to quit than their older counterparts (45–69 years). (Figure 4.8) Among these current smokers, 22.5% reported that a doctor or other health worker had advised them to stop smoking in the past 12 months and the proportion between male and female were about the same (Annex 1, Table 4.15). Figure 4.8: Current smokers who have tried to stop smoking 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men Women 18-44 years 45-69 years Total 8.2 25.7 41.2 30.7 85.1

9.6

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Tobacco policy The survey also collected information on select tobacco policy measures, such as noticing information in the newspapers, and on television and radio, about the danger of smoking that encouraged quitting. In total, nearly a quarter (22.3%) noticed such information in newspapers, and nearly one thirds of them reported seeing this on television (32.4%) and on radio (32.9%) (Figure 4.9). Figure 4.9: Percentage of respondents who noticed information during the past 30 days in the media about the dangers of smoking that encourages quitting 50 45 40 35 Percentage

47.7 41.3 32.4 22.3 32.9 25.4 27.8 25.2 16.5

30 25 20 15 10 5 0 Total

Men Newspapers or magazines Television

Women Radio

Among current smokers, 35.7% of both genders noticed health warnings on cigarette packages, and nearly 18.6% saw and thought of quitting as a result of those warnings (Figure 4.10). Figure 4.10: Percentage of current smokers who noticed health warnings on cigarette packages and who noticed and thought of quitting 50 45 40 35 Percentage 30 25 20 15 10 5 0 Men Noticed health warning Total Noticed and thought of quiting 17.6 18.6 37.5 35.7

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

On the other hand, Table 4.8 shows more than a quarter respondents seeing advertisements in stores that promoted cigarettes, and interestingly nearly one third of respondents (29.0%) received free samples of cigarettes. People were also exposed to other forms of indirect tobacco advertisements (Figure 4.11). Figure 4.11: Percentage of respondents who noticed cigarette promotions during the past 30 days Free samples In stores Coupons for cigarettes Sale on cigarettes Cigarette brand logo on cloths Free gifts/discount Promotion via mail 0 1.1 0.7 5 10 15 20 25 Percentage 30 35 40 45 50 4.5 9.3 20.7 29.0 27.4

The mean average price paid for 20 manufactured cigarettes was US$ 4.7. Men spent on an average US$ 4.8, while women spent US$ 2.8 for manufactured cigarettes. The younger age group spent more than the older age groups in both sexes (Annex 1, Table 4.30).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

5. Alcohol consumption Respondents were asked whether they had ever consumed alcohol or not. If they had never consumed alcohol, they were classified as lifetime abstainer. If they had ever drunk alcohol, they were then asked about the frequency and the quantity of alcohol they consumed. Respondents who consumed alcohol in the past 30 days were classified as current drinkers.

Alcohol users Figure 5.1 shows the alcohol consumption status. Among the respondents, 28.6% were current drinkers (drank alcohol in the past 30 days). Current drinking was almost exclusively occurring among males (42.8% males and 2.0% females). Considering the drinking history, 8.2% who drank alcohol in the past 12 months were not current drinkers. Among respondents, 57.7% were lifetime abstainers and 5.5% abstained in the past 12 months. The majority of lifetime abstainers were females (92.1%). Figure 5.1: Percentage of alcohol consumption status for man, women and both sexes 100 90 80 70 Percentage 60 50 40 30 20 10 0 Total Lifetime abstainers Past 12 months abstainer Men Women Current drinkers Drank in past 12 months 28.6 2.8 3.1 2.0 5.5 8.2 42.8 57.7 6.9 10.9 39.4

92.1

Frequency of alcohol consumption Figure 5.2 shows the frequency of alcohol consumption in men and women in the past 12 months. Four out of five (83%) women consumed 1-3 drinks or less per month, the rest (17%) were weekly or daily drinkers, Among men, three out of five ( 62.6%) were weekly or daily drinkers and the rest (two out of five (37.4%)) drank 1-3 drinks or less per month.. Among men, the highest proportion was 26.1% for those who drank alcohol 3-4 days/week, followed by 21.4% who drank 5–6 days/per week, 19.3% drank less than once a month drank, and the lowest percentage were the daily consumers with 0.2%. Whereas for women, almost

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

half (50.6%) drank alcohol less than once a month, those having alcohol 1–3 days/month and 1–2 days/week were ranked second (32.4%) and third place (15.9%) respectively. (Figure 5.2) In both sexes, around a quarter (24.9%) respondents drank 3-4 days per week, those who drank alcohol less than one a month had a proportion of 20.8% and those drinking alcohol 5-6 days per week with 20.4%, the lowest being who drank alcohol daily (0.2%) (Figure 5.2). Figure 5.2: Frequency of alcohol consumption in the past 12 months 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men Once a month 1-3 days/month 21.4 0.2 Women 1-2 days/week 15.9 0.3 0.0 0.9 20.4 0.2 Total 5-6 days/week Daily 26.1 32.4 24.9 18.3 14.6 50.6 19.0 14.6 19.3 20.8

3-4 days/week

Drinking alcohol on 1-2 days in the past seven days reported 39.5% of current drinkers, followed by 5–6 days/week with 22.3% of the respondents. Nearly one out of five (20.1%) current drinkers reported that they consumed alcohol on daily basis (Figure 5.3). Daily drinking was common among men (20.4%). Most of the women either didn’t consume alcohol in the last seven days (11.0%) or had drinks 1–2 days in a week (67.6%) (Figure 5.3). Figure 5.3: Frequency of alcohol consumption in the past seven days among current drinkers 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men 0 days 1-2 days 20.4 13.8 5.6 Women 3-4 days 5-6 days 2.0 20.1 22.8 16.5 67.6 16.4 38.9 1.5 1.8 23.1

11.0

22.3

Total Daily

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Drinking pattern Figure 5.4 shows the percentage for high-end, intermediate and lower-end level drinking among current drinkers (drinking alcohol in the past 30 days) in males, females and both sexes (see definition in figure 5.4). As compared to women (1.2%), more men (25.1% ) drank at high-end. Nearly three fourth of men (72.8%) and most of the women (91.1%) drank at the lower-end. Figure 5.4: Proportion of drinkers by amount and sex among current (past 30 days) drinkers 100 90 80 70 Percentage 60 50 40 30 20 10 0 Overall Men Women 24.5 2.1 25.1 1.7 1.2 2.1 Men Women Lower-end <40g <20g Intermediate 40-59.9g 20-39.9g High-end >=60g >=40g 73.4 72.8 97.1

Drinking alcohol on high-end level is more common in men than in women as shown in figure 5.5. Figure 5.5: Drinking level among all respondents on average per occasion 35 30.5 30 25 Percentage 20.4 20 15 10.5 10 5 0 Men 0.9 1.7 0.0 0.0 Women 6.8 0.6 Total

Women Men High-end <20g <40g Intermediate 40-59.9g 20-39.9g Low-end >=40g >=60g

Consumption of unrecorded alcohol On an average 60.7% of adults reported that they had consumed unrecorded alcohol; for males it was two times higher (61.4%) than for females (33.5%). For both sexes, younger age group seemed to consume more unrecorded alcohol as opposed to older age group (Figure 5.6).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 5.6: Percentage of consumption of unrecorded alcohol 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men 18-44 years Women 45-69 years Total 18-69 years 38.8 38.3 24.0 33.5 38.5 61.4 79.8 78.6

60.7

The mean number of standard drinks on average per day in the past seven days among current drinkers was much higher in men (1.4 mean standard drinks) in comparison to women (0.4 mean standard drinks). The mean number of standard drinks of unrecorded alcohol consumption on average per day in the past seven days among current drinkers, was 0.5for both sexes. This was slightly higher in men than in women (Figure 5.7). Figure 5.7: Mean number of standard drinks and standard drinks of unrecorded alcohol on average per day in the past seven days among current drinkers 1.6 1.4 1.4 1.2 Mean number 1 0.8 0.6 0.4 0.2 0 Men Mean standard drinks consumed Women Overall Mean standard drinks unrecorded consumed 0.5 0.4 0.3 0.5 1.4

Among unrecorded alcohol consumption, mostly home-brewed spirits (78.0%) or homebrewed beer/wine (21.0%) is consumed (Figure 5.8).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 5.8: Unrecorded alcohol consumption during the past seven days by type for both sexes Brought over border 0.8% Surrogate alcohol 0.1% Home brewed beer/wine 21.0% Other 0.0%

Home brewed spirits 78.0%

Drinking occasions and drinks per occasion The mean number of drinking occasions in the past 30 days for men was almost two times higher (4.3) compared to women (2.2). Men in the older age group had a slightly higher mean number of drinking occasions than men in the the younger age group; however, in women, there is no difference in the mean number between the age groups. The mean number of drinking occasion in both sexes is 4.2, older age group had mean higher than in younger age group (Annex 1, Table 5.10). Overall, both genders had a mean number of 15.1 standard drinks per drinking occasion among current drinkers in the past 30 days . A separate analysis for both genders showed that men had a five time higher mean number of standard drinks per drinking occasion among current drinkers (15.4)than women (3.1). (Annex 1, Table 5.11). On an average current drinkers consumed 4.7 standard drinks (men 4.8, women 3.6) on a single occasion (Annex 1, Table 5.12). Higher age groups in all categories showed a little higher percentage than in younger age groups (Figure 5.9) Figure 5.9: Mean maximum number of standard drinks consumed on one occasion in the past 30 days 12 10 Mean number 8 6 4 2 0 Men Women 18-44 years 45-69 years Total 4.7 4.9 3.4 3.9 4.9

4.6

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Six or more drinks on a single occasion are predominantly a male phenomenon in all age groups and especially in older age groups. Among all respondents, 14.5% consumed six or more drinks on a single occasion during the past 30 days. One in five men (21.8%) took six or more drinks at single occasion while this was minimal for women (1.0%) (Figure 5.10). Figure 5.10: Percentage of adults consuming six or more drinks on a single occasion at least once during the past 30 days, by sex and age groups 50 45 40 35 Percentage 30 25 20 15 10 5 0 Men 18-44 years Women 45-69 years Total 18-69 years 0.8 2.1 1.0 14.5 10.1 6.4 21.8 35.6 44.9

High mean number of times with six or more drinks on a single occasion is predominantly a male phenomenon especially marked in older age groups (Figure 5.11) Figure 5.11: Mean number of times with six or more drinks during a single occasion in the past 30 days among current drinkers 14 12 10 Percentage 8 6 4 2 0 Men 18-44 years Women 45-69 years Total 18-69 years 1.1 1.3 5.0 2.7 1.8 4.9 9.4 9.3

1.1

Stopped alcohol due to health reasons The survey found that 20.7% of both genders stopped drinking alcohol due to health reasons women having a much higher percentage of drinking cessation due to health reasons (31.5%)

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

compared to men (18.3%). In men, predominantly the younger age group and among women, predominantly the older age group stopped drinking alcohol due to health reasons (Figure 5.12). Figure 5.12: Percentage of former drinkers (those who did not drink during the past 12 months) who stopped drinking due to health reasons 50 45 40 35 Percentage 30 25 20 15 10 5 0 Men 18-44 years Women 45-69 years Total 18-69 years 18.3 14.9 23.7 20.7 17.8 33.4 39.7 31.5

29.8

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

6. Dietary habits Fruits and vegetable consumption The fruit and vegetable consumption patterns of the study population were assessed by asking about the frequency and quantity of fruit and vegetables consumed. In a typical week, the study population ate fruits on 2.3 days per week (men on 2.2 days, women on 2.6 days). The findings show that fruit consumption is low among the study population. Vegetable consumption was a bit higher, with respon dents consuming vegetables on 6.7 days on average in a typical week, with the same average for men and women (Annex 1, Table 6.1). The average daily fruit intake was also low in both men (1.0 serving per day) and women (0.9 servings per day). The average daily vegetable intake was better than the fruit intake in both sexes, men had 6.3 servings per day and women 2.8 servings per day, with an overall average of 5 servings of vegetables per day for both sexes. When fruit and vegetable consumption was combined, the average consumption was 5.4 servings of fruit and/or vegetables on a typical day (Figure 6.1). Figure 6.1 Mean numbers of fruit, vegetables and combined fruit and/or vegetable servings on average per day 10 9 8 7 Mean number 6 5 4 3 2 1 0 Fruit Men Vegetable Women Total Fruit and vegetable 1.0 0.9 0.9 2.8 6.3 5.0 3.5 6.4 5.4

One fifth (22.5%) of the survey population consumed the recommended five or more servings of fruit and vegetables per day while one third of the study population (3 5%) consumed 3–4 servings. The majority of respondents consumed 1–2 servings of fruit and vegetables (39%); this proportion was slightly higher for men (40.1%) than for women (37%). (Figure 6.2)

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 6.2 Number of servings of fruit and/or vegetables on average per day 100 90 80 Percentage of servings 70 60 50 40 30 20 10 0 Men >5 servings 3-4 servings 2.9 Women 1-2 servings 4.5 Total no fruit and/or vegetables 3.5 40.1 37.0 39.0 27.7 29.3 9.6 22.5

48.9 35.0

The survey found that 77.5% did not consume the recommended daily amount of fruits and/ or vegetables (<five servings), this was higher among women (90.4%) than men (70.7%) (Figure 6.3). Adequate fruit and vegetable consumption reduces the risk of noncommunicable disease; however, the survey showed that most of the population consumed an inadequate quantity of fruit and vegetables (less than the recommended five servings a day, Figure 6.3). Figure 6.3 Percentage of respondents consuming less than five servings of fruit and/or vegetables on average per day 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men Women Total 70.7 90.4 77.5

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

7. Dietary salt The knowledge, attitudes and behaviour of the study population towards dietary salt were assessed using structured questions.

Salt intake Three fourth of respondents (overall 78.0%, men 74.7%, women 84.1%) always, or often, added salt to their food right before eating or while eating. Nearly seven out of ten respondents (68.6%) added salt either always, or often, during cooking or while preparing food at home. This proportion was almost equal in all age groups and for both sexes. Similarly, 12.9% of all respondents reported that they often or always consumed processed food containing high amounts of salt. This proportion was higher among men (15.8%) than women (7.3%) and highest among the younger age groups (18–44 years) (Figure 7.1). Figure 7.1: Salt consumption habits 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men Women Total Consume always or often processed food high in salt Add salt before or while eating Add salt always or often while cooking 15.8 7.3 12.9 74.7 67.6 84.1 78.0 70.5 68.6

When asked about their dietary salt consumption, 16.1% of both sexes reported that they thought they were consuming too much salt (19.3% men versus 10.4% women). Men in the younger age group thought that they consume too much salt compared to men in the older age group (25.8% versus 5.4%). On the other hand, more older women thought that they consume too much salt compared to women in the younger age group (18.7% versus 8.7%) (Annex 1, Table 7.2). The self-reported quantity of salt consumed in relative measures was also assessed. Nearly seven in one (69.1%) respondents thought that they were using just the right amount of salt. Almost 15% of respondents thought that they were using too much salt (16.1%) or too little salt (14.7%). Responses from men and women were a bit different, as shown in figure 7.2.

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 7.2: Self-reported quantity of consumed salt 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men Far too little Too Little 18.2 1.1 8.5 Women Just Right Too much 14.8 1.8 Total Far too much 1.3 65.5 75.9 69.1 14.9 0.3 13.2 0.6 14.3 0.4

Awareness on lowering salt intake Nearly half (48.1%)of the respondents (men 45.6%, women 52.5%) thought that lowering salt in their diet would be very important. About one fifth of the respondents (21.3%) thought it would be somewhat important. This proportion was higher among women (26.4%) than among men (18.3%). Around 30.6% (men 36.2%, women 21.2%) thought lowering salt intake would be not at all important. This proportion was highest among 18–44 year olds with 41.3% in total (men 53.7%, women 24.5%) (Figure 7.3 & Annex 1, Table 7.4). Figure 7.3: Percentage of respondents who agree with the importance of lowering salt in diet 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men Not important Women Somewhat important Total Very important 45.6 52.5 48.1 18.3 36.2 26.4 21.3 21.2 30.6

Nearly one-fourth of all respondents (23.7%) thought that consuming too much salt could cause serious health problems. This proportion was higher in women (32.8%) than in men (18.9%) (Annex 1, Table 7.5).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Actions to reduce salt intake The survey also assessed the various or actions which were used by respondents regularly to control their salt intake . Among all respondents, limiting processed food (18.9%), use of alternative spices (12.1%) and looking at the salt content of food items (10.8%) were the most prevalent actions taken to reduce their salt intake. (Figure 7.4). Figure 7.4: Percentages of respondents who take specific action on a regular basis to control salt intake 30 25 20 Percentage

24.8

Limit processed foods 18.9 Use spices other than salt Look at salt content on food labels Buy low salt alternatives 5.6 0.2 Total Avoid eating outside Other things to control salt

15.7 15 10 5 0 Men 9.5 8.7 5.1 4.4 0.1

17.1 14.7 12.1 10.8 7.9 7.2 5.9

0.4 Women

Type of oil used Oil or fat consumption was assessed by asking about the oil or fat most often used for meal preparation in the household. The study found that most (93.4%) of respondents most often used vegetable oil for meal preparation (Figure 7.5). Figure 7.5: Type of oil or fat most often used for meal preparation in household

Vegetable oil 94%

Other, 3% None in particular, 2% None used, 1% Lard, 0% Margarine, 0% Butter, 0%

Eating outside home Adults in Timor-Leste consume less than one meal per week which is not prepared at a home (men: 0.3 meals/week, women: 0.7 meals/week) (Annex 1, Table 7.8).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

8. Physical inactivity Physical activity of the survey population was assessed by assessing the intensity and duration of activities undertaken during work, travel and recreation.

Not meeting WHO recommendations of physical activity The WHO recommendations on physical activity for health are ≥150 minutes of moderate-intensity physical activity per week, 75 minutes of vigorous physical activity per week, or an equivalent combination of the two. It was found that 16.7% (men 12.8%, women 23.3%) of all respondents did not meet the WHO recommendations. In general, more adults in the younger age group did not meet the recommended physical activity level in comparison to the older age group (19.8% versus 9.7%); and more females did not achieve the recommended level of physical activity as compared to males (23.3% versus 12.8%) (Figure 8.1). Figure 8.1: Percentage not meeting WHO recommendations for physical activity for health 50 45 40 35 Percentage 30 25 20 15 10 5 0 Men 18–44 years Women 45–69 years 18–69 years Total 4.8 17.9 12.8 9.7 22.2 28.2 23.3 19.8 16.7

Physical activity by domain (work/household, transport, leisure time) Figure 8.2 shows that 11.5% of the population did NOT engage in any work-related physical activity, while 55.5% did not do any physical activity for transport, and 84.1% did not do any recreational physical activity. In particular among women, physical activity during leisure/recreation time was extremely rare with 95.0% not doing any of this type of physical activity.

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 8.2: Percentage of respondents not doing any work-, transport-, or recreation-related physical activity 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men No work-related physical activity No recreation-related physical activity Women Total No transport-related physical activity 8.4 16.7 11.5 60.7 46.8 77.7 95.0 84.1

55.5

Contribution of domain-specific physical activity to total physical activity When looking at the total physical activity of the entire population, the current data reveal that work-related activity has by far the largest contribution: The proportion of work-related to total activity was 83.1% (men 86.2%, women 77.7%), followed by 12.9% (men 9.2%, women 19.6%) for transport-related activity. Leisure time activity was very rare, and only contributed to the overall activity with 4.0% (men 4.7%, women 2.7 ) for recreational-related activity (Figure 8.3). Figure 8.3: Contribution of work-, transport- and recreation-related physical activity to total activity 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men At leisure time Women Transport-related Total Work-related 86.2 77.7 83.1 9.2 4.7 19.6 2.7 12.9 4.0

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Engagement in vigorous physical activity More than half (52.4%) of all the respondents did not engage in any vigorous physical activity; among women, it was twice as high (73.3%) as compared with men (39.9%). This proportion was higher among men in the older age groups compared to the younger group in the study population (Figure 8.4). Figure 8.4: Percentage of respondents not engaging in vigorous physical activity 100 90 80 70 60 50 40 30 20 10 0 Men 18–44 years Women 45–69 years 18–69 years Total 26.9 39.9 60.9 75.5 62.6 48.5 73.3 61.2 52.4

Time spent on physical activity by domain As shown in Figure 8.5, work-related physical activities were more common than other activities. The mean time spent on work-related physical activity was 114.5 minutes; among women, it was almost half than that of men (men 140.1 minutes, women 71.3 minutes). The mean time spent on transport-related activity was 11.3 minutes followed by recreation-related activities with 4.9 minutes. Figure 8.5: Mean minutes spent on domain-specific physical activity on average per day 160 140 120 Mean minutes 100 80 60 40 20 0 Men Work-related Women Transport-related Total Recreation-related 9.9 6.7 13.6 1.9 11.3 4.9 71.3 140.1 114.5

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Time spent sitting The median time spent in sedentary activities was found to be 62 minutes for all respondents, whereas it was double in men (120 minutes) than in women (60 minutes). However the mean minutes for all respondents (men, women or total) was around 100 minutes (Figure 8.6). Figure 8.6: Mean and median minutes spent in sedentary activity on a typical day 140 120 100 Mean/Median 80 60 40 20 0 Mean Men Women Total Median 60.0 62.0 101.0 99.5 100.5 120.0

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

9. Overweight and obesity Body mass index The mean height for men was 158.7 cm, generally men were taller than women (152.9 cm). Across both genders, younger age groups were generally taller than older age groups (Annex 1, Table 9.1). The mean weight for men and women were 53.7 kg and 49.1 kg respectively. In men, the older age group was slightly heavier than the younger age group, but for women, the younger age group was slightly heavier than the older age group (Annex 1, Table 9.2). The mean body mass index (BMI) for both sexes was 21.2 kg/m2. It was almost similar for men and women and across all age groups (Annex 1, Table 9.3). Around one-fifth of all respondents (18.5%) were found to be underweight (BMI <18.5). This proportion was higher in women (31.3%) compared to men (11.2%). Around two thirds (70.3%) of all respondents had BMI in the normal range (BMI 18.5-24.9). This proportion was lower in women (52%) than in men (80.6%). The prevalence of being overweight (BMI 25.0-29.9) among all respondents was 10.3% (men 7.5%, women 15.4%), while the prevalence of obesity (BMI ≥30.0) was 0.9% overall (men 0.7%, women 1.3%). (Figure 9.1) Figure 9.1: Percentage of respondents (excluding pregnant women): body mass index (BMI) classifications among adults 100 90 80 70 Percentage 60 50 40 30 20 10 0 11.2 Men Obese (≥30.0) Overweight (25.0–29.9) Women Normal weight (18.5–24.9) 31.3 18.5 Total Underweight (<18.5) 80.6 52.0 70.3 7.5 0.7 15.4 1.3 10.3 0.9

Waist–hip ratio Waist and hip circumference were also measured in the survey to determine truncal obesity. The mean waist circumference for men was 71.3 cm and for women 77.4 cm. In regard to hip circumference, women had a higher mean hip circumference than men (83.7 cm for women

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

versus 76.5 cm for men). Older age groups in both sexes generally had a higher hip circumference in comparison to the younger age groups of both sexes (Figure 9.2 & Annex 1, Table 9.6) Figure 9.2: Mean waist and hip circumference in centimeters by sex 100 90 Mean number in centimeters 80 70 60 50 40 30 20 10 0 Waist Men Women Hip 71.3 77.4 76.5 83.7

The mean waist to hip ratio was 0.9 for both sexes and across all age groups (Annex 1, Table 9.7).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

10. History of blood pressure The current health status and health-seeking behaviour of the study population related to high blood pressure were assessed by asking respondents about history of blood pressure and their treatment history In addition, blood pressure of the respondents (who consented) was also measured by trained health care workers.

History of raised blood pressure (hypertension) Most of the study population (87.3%) had never had their blood pressure measured by a doctor or any other health worker. This proportion was higher in men (91.5%) than in women (79.7%). The prevalence of self-reported hypertension in both sexes (diagnosed within the past 12 months) was 2.8%. (Figure 10.1) Figure 10.1: Blood pressure measurement and diagnosis among adults 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men Women Total 91.5 87.3 Diagnosed within past 12 months Diagnosed, not in past 12 months Measured, not diagnosed Never measured 2.1 5.9 0.5 4.2 14.8 1.4 2.8 9.0 0.8

79.7

Blood pressure treatment Among those with self-reported diagnosed hypertension, only 47.7% of both sexes (men 46.6%, women 48.7%) were currently taking medication for blood pressure as prescribed by a doctor or other health worker. This proportion was higher among the 45–69 year age group (total: 53.9%, men 47.8%, women 60.5%) than in the younger age group (Annex 1, Table 10.2).

Traditional healers and remedies Among the previously self-reported diagnosed hypertensive population, 16% had visited traditional healers. This proportion was a little higher in men (17.5%) than in women (14.6%). About 36.9% of all respondents were taking herbal or traditional remedies for hypertension; this proportion was higher among men (39%) than among women (35%) (Figure 10.2).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 10.2: Percentage of previously diagnosed hypertensive respondents who have visited or received treatment from a traditional healer 50 45 40 35 Percentage 30 25 20 15 10 5 0 Men Seen a traditional healer Women Total Taking herbal or traditional remedies 17.5 14.6 16.0 39.0 35.0 36.9

Blood pressure measurement The mean systolic blood pressure of the all adults was 129.0 mmHg (men 133.1 mmHg, women 121.4 mmHg). Mean diastolic blood pressure was 83.1 mmHg (men 83.5 mmHg, women 82.4 mmHg). (Figure 10.3) Figure 10.3: Mean systolic and diastolic blood pressure (mmHg) 140 120 Mean (mmHg) 100 80 60 40 20 0 Men Women Systolic BP Diastolic BP Total 83.5 82.4 83.1 133.1 121.4 129.0

The prevalence of raised blood pressure, using the criteria of SBP≥140 or DBP≥90 mmHg and excluding those on medication, was 38.6% (men 44.8%, women 26.9%). When those persons who were currently on medication were included, this prevalence rose to 39.3% (men 45.3%, women 28.0%). The proportion of men with raised blood pressure including those currently on medication for hypertension was highest (48.2%) among the 18–44 years age group, as compared with 45–69 years olds (39.7%). Among women it was the opposite: 26.7% of the younger age group had a raised blood pressure or were currently on medication and 34.4% of the 45-69 years old ones.(Figure 10.4 and Annex 1, Table 10.5)

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Using the criteria SBP ≥160 and/or ≥100 mmHg and excluding those on medication, 6% of the total respondents (men 7%, women 4.2%) were found to have raised blood pressure. This prevalence was a little higher (7%) when those currently on medication were included (men 7.8%, women 5.6%) (Figure 10.4). Figure 10.4: Percentage of respondents with raised blood pressure by sex 50 45 40 35 Percentage 30 25 20 15 10 5 0 SBP ≥140 and/or DBP ≥ 90 mmHg, no medication SBP ≥140 and/or DBP ≥ 90 mmHg or on medication SBP ≥160 and/or DBP ≥ 100 mmHg, no medication SBP ≥160 and/or DBP ≥ 100 mmHg or on medication

44.8 38.6

45.3 39.3

26.9

28.0

7.0

4.2

6.0

7.8

5.6

7.0

Men

Women

Both sexes

As shown in Figure 10.5, among those with raised blood pressure (characterized as SBP≥140 and/or DBP≥90 mmHg), almost all (97.3%) were not on medication. This proportion was 98.1% for men and 94.7% for women. Figure 10.5: Percentage of respondents with treated and/or controlled raised blood pressure among adults 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men 1.0 0.8 Women 3.3 2.0 Total 1.6 1.1 98.1 94.7 97.3 Not on medication and SBP>140 and/or DBP>90 On medication and SBP>140 and/or DBP>90 On medication and SBP<140 and DBP<90

Heart rate The mean heart rate of all respondents was 75.8 beats per minute, among male respondents it was 74.5 beats per minute, and among female respondents it was 78.3 beats per minute (Annex 1, Table 10.7). .

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

11. Blood glucose The current health status and health-seeking behaviour of the study population related to high blood glucose or Diabetes were assessed by asking respondents about history of blood glucose and their treatment history In addition, blood glucose of the respondents (who consented) was also measured by trained health care workers following the standard STEPS 3 protocol, using the validated equipment mentioned in the data collection section.

History of raised blood glucose (diabetes mellitus) The prevalence of raised blood glucose of the survey population was identified by asking the respondents about their history of Diabetes or measurement of high blood sugar. Only 0.2 % of all respondents have reported being diagnosed for diabetes by a doctor or a health worker in the past 12 months. Blood glucose had never been measured in 99.2% of the adults. This proportion was almost similar in both sexes (men 99.4%, women 98.8%). (Figure 11.1) Figure 11.1: Blood sugar measurement and diagnosis 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men Women Total 99.4 98.8 99.2 Diagnosed within past 12 months Diagnosed, but not in past 12

0.2 0.0 0.5

0.2 0.2 0.8

0.2 0.1 0.6

months Measured, not diagnosed Never measured

Blood glucose measurement The survey found that mean fasting blood glucose (mmol/L) for both genders was 4.3 mmol/L (equivalent to 77.6 mg/dl); men had a slightly higher mean blood glucose than women (4.4 mmol/L versus 4.1 mmol/L or 79.7 mg/dl versus 74.0 mg/dl). Generally older age groups of both men and women had higher mean fasting glucose than younger age groups (Annex 1, Table 11.4 & 11.5). Among all respondents, 4.1% had impaired fasting glycaemia [plasma venous value: ≥6.1mmol/L (110mg/dl) and <7.0mmol/L (126mg/dl)]. The prevalence was a little higher in men (5.7%) than in women (1.2%) (Annex 1, Table 11.6).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Overall 1.5% had raised blood sugar [(plasma venous value: ≥ 7.0 mmol/L (126 mg/dl)] or were currently on medication for diabetes. This prevalence was same for men (1.5%) and women (1.6%). (Figure 11.2) Figure 11.2: Percentage of respondents having impaired fasting glycaemia and raised blood glucose or were currently on medication for diabetes 10 9 8 7 Percentage 6 5 4 3 2 1 0 Men Women Impaired fasting glycaemia Total Raised blood glucose 1.5 1.2 1.6 1.5 5.7 4.1

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

12. Abnormal lipids An abnormal lipid profile is known to be a major risk factor for cardiovascular diseases. The current health status and health-seeking behaviour of the study population related to high blood cholesterol were assessed by asking respondents about history of blood cholesterol and their treatment history In addition, total cholesterol was also measured by trained health care workers following the standard STEPS 3 protocol, using the validated equipment mentioned in the data collection section.

History of raised total cholesterol Almost all respondents (99.3%) had never had measured their cholesterol. Only 0.2 % of the respondents mentioned that they were diagnosed with raised cholesterol in the last 12 months (Figure12.1). Figure 12.1: History of cholesterol measurements 0.1 0.0 0.3 0.4 0.2 0.8 0.2 0.1 0.4

100 90 80 70 Percentage 60 50 40 30 20 10 0 Men 99.6

98.6

99.3 Diagnosed within past 12 months Diagnosed, but not in past 12 months Measured, not diagnosed Never measured

Women

Total

Among previously diagnosed high cholesterol, 39.5% were taking oral medicines (Annex 1 Table 12.2), 19.6% were getting treatment from traditional healers and 15.7% were taking herbal medicines (Annex 1 Table 12.3).

Biochemical measurement The mean cholesterol level for both sexes (total) was 3.9 mmol/L (equivalent to 149.9 mg/dl) and was slightly higher for females (4.2 mmol/L equivalent to 160.7mg/dl) than for males (3.7 mmol/L) (Annex 1, Table 12.4 and 12.5). The proportion of respondents with raised total cholesterol (≥ 5.0 mmol/L or ≥ 190 mg/dl) or currently on medication for raised cholesterol was 21.0%. This proportion was higher for women (25.5%) than for men (18.5%). Overall, 5.3% of the respondents had raised total cholesterol ≥ 6.2 mmol/L or ≥ 240 mg/dl or were currently on medication for raised cholesterol. It was a little higher in men (5.5%) than in women (4.9%) (Figure 12.2).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 12.2: Percentage of adults with raised total cholesterol or who currently on medication for raised cholesterol 30 25.5 25 21.0 Percentage 20 15 10 5.5 5 0 Men 4.9 5.3 18.5

Women

Total

Cholesterol >190 mg/dl or who currently on medication for raised cholesterol

Cholesterol >240 mg/dl or who currently on medication for raised cholesterol

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

13. Combined risk factors and cardiovascular disease risk prediction Combined risk factors For the purpose of exploring combined risk factors, responses were grouped into three categories according to the presence of the five major risk factors based on principal component analysis. The first category was ‘no risk factors’; the second ‘one or two risk factors’, and the third ‘three to five risk factors’. The five major risk factors are: tt tt tt tt tt

current daily smokers less than five servings of fruit and vegetables per day low level of activity (<600 MET-minutes) overweight or obese (BMI ≥ 25 kg/m2) raised blood pressure (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg or currently on medication for raised blood pressure)

One in five respondents (19.4%) had three to five risk factors. This proportion was higher among men (21.1%) than women (16.6%) (Figure 13.1 and Annex 1, Table 13.1). Only 7.8% of adults had no risk factors. Three fourth (72.8%) of respondents were found to have 1-2 risk factors. This proportion was higher among women (79.1%) as compared to men (68.8%). This proportion was found to be higher among men (10.1%) compared to women (4.2%) (Figure 13.1). Figure 13.1: Status of combined risk factors among respondents by sex 100 90 80 70 Percentage 60 50 40 30 20 10 0 10.1 Men 4.2 Women 7.8 Total 68.8 79.1 72.8 3−5 risk factors 1−2 risk factors 0 risk factors 21.1 16.6 19.4

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Cardiovascular disease risk prediction A 10-year risk of having a cardiovascular (CVD) event of ≥30% is defined according to age, sex, blood pressure, smoking status (current smokers or those who quit smoking less than one year before the assessment), total cholesterol, and diabetes (previously diagnosed or a fasting plasma glucose concentration ≥126 mg/dl) status of the respondents. The proportion of respondents in the age group 40–69 years with a 10-year CVD risk of ≥30% was 1.4% for both sexes (men 0.9%, women 2.9%). Among women, this proportion was higher for the 55-69 years age group (5.2%) compared to the 40-54 years age group (1.7%). Among men, there was no difference in risk among younger or older population. (Figure 13.2) Figure 13.2: Percentage of respondents with a 10-year CVD risk ≥ 30% or with existing CVD 6 5.2 5 4 Percentage 3 2 1 0 Men 40–54 years Women 55–69 years 40–69 years Total 1.0 0.8 0.9 1.7 1.3 2.9

1.6

1.4

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

14. Lifestyle advice by health-care provider Less than 20% of respondents had been advised by their doctors or health workers to quit or not to start tobacco use (19.7%); to reduce salt in their diet (18.6%); to eat five servings of fruit/ vegetables each day (17.4%); to start or to do more physical activity (15%); to reduce fat in their diet (14.8%); to maintain a healthy body weight or to lose weight (11.3%). More women than men were advised to follow the above mentioned life style (Figure 14.1). Figure 14.1: Percentage of respondents who have been advised by doctor or health worker to change their life style 30 25 20 15 10 5 0 Quit or not to start tobacco Reduce salt in the diet Eat five servings of fruit/vegetables each day Start or do more physical activity Reduce fat in the diet Maintain a healthy body weight or to lose weight

24.5 22.5 18.2 19.7 15.4 18.6 14.0

23.6 19.3 17.4 15.0 12.6 12.4 9.0 19.1 14.8 15.6 11.3

Men

Women

Total

Cervical cancer screening Among all female respondents (18-69 years), 0.7% had ever had a screening test for cervical cancer while only 1.1% among women aged 30–49 years, ever had a screening test for cervical cancer (Annex 1, Table 14.2)

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

15. Violence and injury The survey assessed risk behaviors related to violence and injury.

Use of seatbelt or helmet while driving or being a passenger Almost all adults (97.5%), who were either drivers or passengers of a motor vehicle did not always use a seat belt in the past 30 days (Figure 15.1). Similar patterns were observed in both sexes. The percentage of drivers or passengers of a motorcycle/motor-scooter not always using a helmet in the past 30 days was also high (81.9%); it was slightly higher in men (83.0%) than in women (79.7%). The percentage of cyclists who did not always use helmets while riding among those riding a bike in the last 30 days was 95.1% and almost similar patterns were in both sexes (Total) (Annex 1, Table 15.1,15.2 and 15.3). Figure 15.1: Percentage of persons not always using safety measures at driving in past 30 days among adults 100 90 80 70 Percentage 60 50 40 30 20 10 0 Seat belt Helmet - motorized two-wheeler Men Women Total Helmet - cyclist 97.0 98.3 97.5 83.0 79.7 81.9 95.5 94.6 95.1

Road traffic crashes The prevalence of road traffic crashes among road users in the past 12 months (driver, passenger or pedestrian) was 3.0% and it was almost as twice as high in men (3.6%) compared to women (1.9%). The percentage of respondents injured in non-road traffic related accidents in the past 12 months was 2.5% and the percentage was almost the same in both sexes (Figure 15.2).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 15.2: Percentage of respondents who were involved in road traffic crashes and/or injured in non-road traffic related accidents in the past 12 months 5.0 4.0 Percentage 3.0 2.0 1.0 0.0 Men Road traffic crash Women Non-road traffic crash 3.6 2.8 2.4 1.9

Among those involved in road crashes in the past 12 months, 49.6% were seriously injured requiring medical attention. The percentage for women (59.0%) was higher than for men (46.9%) (Annex 1, Table 15.5).

Non-road Traffic Accidents Among all respondents who were seriously injured due to non- road traffic accidents in the past 12 months, top two causes were falls (62.5%) and cuts (21.0%). Fall was main cause in men (72.3%) as well as in women (47.1%). Most of these injuries were seen in the younger (18–44 years) age groups. (Figure 15.3, Annex 1, Table 15.7) Figure 15.3: Percentage of respondents who were seriously injured in non-road traffic accident 100 90 80 70 Percentage 60 50 40 30 20 10 0 Men Women Total 72.3 47.1 62.5 6.6 8.3 8.6 0.6 1.2 2.3 1.5 1.1 0.0 0.9 1.2 1.4

7.9 1.8 40.5

7.1 5.8 21.0

Burn Near drowning Poisoning Animal Bites Other Cut Fall

Among person reporting being seriously injured in the past 12 months, most accidents happened at home or on the road/street/highway(35 % each ), followed by School/Workplace with 22.4 (Figure 15.4).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Figure 15.4: Location of accidental serious injuries among respondents seriously injured 100 90 80 70 Percentage

9.6 19.4 21.9

0.0 0.8 26.8

0.0 2.1 1.2

6.2 22.4

0.0 1.3

60 50 40 30 20 10 0

Sports area 35.0 55.0 Farm Other School/workplace 35.0 14.9 Home On road Total

48.3

Men

Women

Driving under the influence of the alcohol Approximately, one tenth of all respondents (9.6%) had driven a motorized vehicle after having two or more alcoholic drinks in the past 30 days. The percentage was significantly higher in men (14.8%) than in women (2.5%). Overall 7.5% reported that they had taken a ride on a motorized vehicle where the driver had consumed two or more alcoholic drinks before driving. The prevalence in men was significantly higher (12.5%) than in women (0.5%). (Figure 15.5) Figure 15.5: Percentage of respondents who have driven after having two or more alcoholic drinks or rode motorized vehicle with drunken driver after having had 2 or more alcoholic drinks in the past 30 days 20

15 Percentage

14.8 12.5

9.6 7.5

5 2.5 0.5 0 Drunken driving Men Women Rode with drunken driver Total

Injuries due to violent events Overall 1.0% of all respondents reported being seriously injured from violent incidents in the past 12 months (men 1.1% and women 0.7%) (Annex 1, Table 15.11).

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

1.9% of all respondents were frightened for the safety of themselves or their families because of the anger or threats of another person (Annex 1, Table 15.12). Majority of respondents who reported being frightened, claimed that it was someone within the family (57.8%), followed by official or legal authority (20.0%), friend or acquaintance (9.2%) and stranger (8.5%). (Figure 15.6) Figure 15.6: Percentage of respondents being frightened of other person, by each of the types of people they were afraid of

Official or legal authority 20.0%

Someone within the family 57.8%

Friend or acquaintance 9.2%

Stranger 8.5%

Unrelated caregiver 4.5%

16. Discussion Similar to many developing countries, Timor-Leste is undergoing an epidemiological transition with an increasing burden of NCDs. Deaths due to ischaemic heart diseases and stroke rank third and fourth after tuberculosis and lower respiratory infection among the top causes of the mortality. This kind of NCD burden is likely to be even more problematic in the immediate future, considering the population’s high exposure to commonly known risk factors of NCDs such as tobacco use, excessive alcohol consumption, physical inactivity, unhealthy diet, and high salt consumption. Tobacco use (both smoked and smokeless) is highly prevalent in Timor-Leste and this is confirmed by this survey which found current tobacco use in nearly 60% of adults. Nearly half (48.6%) of the population are current smokers, mostly smoking manufactured cigarettes. A great majority of men use tobacco (70.6% men versus 28.9% women). Other household surveys such as Demographic Health Survey (15-49 years) and school based surveys such as Global Youth Tobacco Survey (13-15) done in the past show high prevalence of tobacco use in different age groups. In addition to the active use of tobacco by adults, second-hand smoke exposure both at homes and at work places is also alarmingly high. Exposure to second-hand smoke can affect adversely non-smokers, including children. High prevalence of second-hand smoke exposure indicates that in addition to low health literacy on the risks of tobacco use, the existing tobacco public health interventions are inadequate in protecting the non-users. Also the hazards of consumption of smokeless tobacco and betel quid are not fully considered. It appears that there is no widespread dissemination of information on the hazards of tobacco in the newspapers, radio and other common media of communication. Smoking and smokeless tobacco use cessation should be addressed through strategic public health campaigns. Low report of health warnings on cigarette packages by current smokers indicates that the package health warnings decree which came into force in 2006 and was recommended by the WHO Framework Convention on Tobacco Control (WHO FCTC) is not fully implemented or enforced. Without a robust tobacco prevention programme, tobacco-related mortality such as atherosclerosis, cardiovascular disease (CVD), lung cancer, and chronic obstructive pulmonary disease (COPD) are likely to rise in the country with the current rate of tobacco use. Timor-Leste has taken several steps in combating NCD risk factors control. Any level of alcohol consumption is harmful. However, hazardous drinking in excess of the recommended daily limit is damaging to health. Nearly 60% of the population in Timor-Leste are life-time alcohol abstainers. Current drinkers (28.6%) of whom the majority are males, drink regularly (most days in the week) and in harmful quantities (mean number of standard drinks is 15 per drinking occasion among men). Drinking, besides harming individual health, is also a cause of harm for non-drinkers. Other alcohol-related domestic and social violence were not fully explored in this survey; however, hazards of drink and drive are apparent in Timor-Leste. Almost 15% men reported having driven a motorized vehicle after consuming 2 or more alcoholic drinks. Intake of fruits and vegetables plays a protective role in the prevention of cancers, heart diseases and many other diseases. The World Health Organization (WHO) recommends a minimum of five daily servings of fruits and/or vegetables. The survey reveals a huge consumption gap

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

of fruits and/or vegetables in the population with more than three fourths not consuming the recommended number of five servings per day. Less consumption of fruits and or vegetables by females compared to males warrants a special programmatic response targeting the female population. Consumption of fruits and vegetables and dietary practices is not simply a health literacy issue, rather it is determined by underlying social and economic factors of prices and affordability. Current low consumption of fruits and vegetables should be regarded in the context of the existing level of access and affordability of commodities of fruits and vegetables. This should be changed through broad supportive public and economic policy reforms. In addition, public campaigns for general population and health education in schools should be launched to inform the population and schoolchildren about the importance of consuming fruit and vegetables in maintaining individual health. Nutritional problems in both spectrums of overweight and underweight are visible in the population. On the one hand the high prevalence of underweight (18.5%) indicates a cohort of population who experienced a prolonged conflict before the nation’s independence in 2002. On the other hand, the prevalence of overweight (10.3%) although still low compared to other neighbouring countries, is likely to rise with the political stability and economic progress. Nutritional programming needs to address the double threat of overweight and under-nutrition in the population. Because more females were underweight compared to males (31.3% versus 11.2%), gender-sensitive nutritional programming should be required to address the nutritional needs of the female population in particular. The benefits of physical activity include prevention of heart diseases and diabetes, reduction in obesity, blood pressure and cholesterol, and improvement in mental health conditions. However, only 16.7% of the population are not attaining the WHO recommended level of physical activity (≥150 minutes of moderate intensity physical activity per week, or equivalent). Recreation and transport-related physical activity contribute the least. Strategic national health promotion activities are required to address the current low level of physical activity. In particular, recreation and leisure time physical activity, and transport-related physical activity such as cycling should be promoted, while the current coincidental work-related physical activity should be maintained. The physical activity level was not analysed by urban–rural residents; it can be assumed that more urban settlers do not achieve the recommended level of physical activity. Generally, such disparities will require an urban health promotion, which includes improving built urban structures to make a conducive health-promoting environment. The metabolic risk factors for NCDs are raised blood pressure, obesity, raised cholesterol and blood sugar. They will lead to a growing burden of NCDs. Nearly two fifths of the population above 18 years have raised blood pressure, homogenous prevalent in all age groups, and 13.3% have impaired fasting glycaemia Those living with metabolic abnormalities or already suffering from NCDs do not receive the required treatment. Health-seeking behaviour for NCD management is low; the majority had (>99%) never had their blood pressure or blood cholesterol measured and 97.3% with raised blood pressure are not receiving treatment. Even among those diagnosed with hypertension or raised cholesterol, or diabetes, the majority did not receive treatment. Likewise, 99.3% of females between 18 and 69 have never been screened for cervical cancer. Health systems should be made more responsive to address treatment and health-seeking behaviour.

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Both private and public health systems should be involved in integrating NCD services to promote as well as managing NCD patients. Despite the existence of a traffic code in Timor-Leste since 2003, road safety practices such as use of seat belt and helmet are not very widespread just as drink driving; strategic communication, education and enforcement should be stepped up to improve the road safety practices. The prevalence of combined risk factors such as current daily smokers, less than five servings of fruits and vegetables per day, insufficient physical activity, overweight, raised blood pressure also need to take into account. The results of this survey revealed that the prevalence of three or more of the risk factors, mentioned above, for both sexes was higher among age group 45–69 years (28.2%) in comparison to age group 18–44 years (16.3%). Males had a higher prevalence (21.1%) of three or more risk factors than females (16.6%). These findings suggest that the prevalence of risk factors increases with age. Exposure to a single risk factor as well as combination of more risk factors can substantially increase the risk of developing multiple NCDs. One out of five individuals in Timor-Leste is already exposed to three or more NCD risk factors. NCDs will potentially emerge as a the biggest public health challenge in Timor-Leste due to the high prevalence of NCD risk factors, and the already existing gap between prevalence and treatment. However, if greater investments in NCD prevention and services are made through the right policies and public health measures, the imminent NCD epidemic could be controlled. Health systems should be made more responsible for treatment and health-seeking behaviour. Both private and public health systems should be involved in integrating NCD services to promote as well as managing NCD patients. The development of national strategy for prevention and control of noncommunicable diseases, injuries, disabilities and care of the elderly and NCD National Action Plan 2014–2018 is one way counteracting these NCD problems and burdens in Timor-Leste. This requires the involvement of all government institutions as well as private sector, civil society, faith-based organizations, academia and community to have a comprehensive and multi-sectoral approach for preventing and controlling NCDs in Timor-Leste.

Study limitations This is the first nationwide survey conducted specifically to identify risk factors for noncommunicable diseases in Timor-Leste. The strength of this study was the nationally-representative sample size with a high response rate of 96%.The equipment and materials used in this survey are reliable and valid. This survey used a cross-sectional design, it is weak to establish causal relationships but its strength is that it can be used to measure prevalence of any disease including NCDs at any point of time with a large sample size.

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

17. Conclusion and recommendations Conclusion This is the first ever adult nationwide survey to assess the risk factors for noncommunicable diseases in Timor-Leste using a cross-sectional study design. Population included both males and females aged between 18 and 69 years. The survey found high rates of tobacco and alcohol use, inadequate physical activity, unhealthy dietary behaviours, risky road safety behaviours, and low levels of health screening for major NCD risk factors.

Recommendations This is a nationally representative survey that provides rich information on the prevalence of key NCD risk factors in Timor-Leste. The findings of this survey will be very useful to inform policymakers, programmers and researchers for planning interventions in NCD control in the country. The following are relevant recommendations with regard to the findings of this survey: tt

The survey suggests low NCD health-care coverage and reveals the existence of a high gap in treatment. NCD screening services should be improved and integrated and strengthened at the primary health care services. One model should be the introduction of the WHO Package of Essential NCD (PEN) services in the primary health care services to increase the coverage of NCD services. Primary health-care (PHC) facilities in Timor-Leste have been equipped by competent health professionals (doctors, nurses and midwives), so that interventions on NCDs can be integrated in those PHC packages and family health programmes (Saúde na familia). The survey indicates that risk factors for NCDs are highly prevalent. Strategic health promotion for NCD should be stepped up to promote physical activity, healthy diet including consumption of fruits and vegetables and to reduce salt, alcohol and tobacco consumption. The national recommendations for diet, and physical activity, if available, should be developed further and be spread through media. Addressing the consumption of tobacco, alcohol and processed food: there has to be required adequate legislations and enforcement authorities. In particular, legislation and education should discourage smoking in home and work settings as well as in public spaces, Marketing and health warning labels of tobacco, alcohol, and processed foods should be well regulated and enforced. A nationwide campaign should start immediately to encourage smokers to quit smoking and discourage youth and students from taking up smoking. Road safety policies including control of drink-driving, use of seat belt and helmet should be enforced as public health measures in collaboration with other government sectors. NCD prevention and control should also design gender-sensitive programmes to improve the consumption of fruits and/or vegetables among females and to reduce female overweight and undernutrition.

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Cervical cancer screening programmes should be introduced as routine services in the health-care settings. Diagnostics, treatment and control including palliative care should also receive appropriate attention. Increasing physical activity in the population will require appropriate structural planning and development as well as partnerships between various sectors including health, education, roads, urban planning, and transport. This will ensure promoting a conductive health environment with pedestrian lanes, urban parks, community walk trails. Adequacy of the current urban plans should be made sensitive enough to accommodate the “healthin-all-policies approach”. A multisectoral framework for action should be introduced to holistically address NCD prevention and control. Health education should be provided on NCD risk factors and promotion of healthy lifestyle in communities by quitting smoking, reducing alcohol consumption, eating healthy foods, doing regular physical activity. Health workers and those who understand the value of healthy lifestyle should be encouraged to be models for others. Training and upgrading the knowledge and awareness of health workers and the population on NCD risk factors with their consequences should receive attention. A regular surveillance system for NCDs to routinely monitor NCD-trends and risk factor trends should be implemented. Health systems should be adequately equipped with adequate infrastructure, human resources, diagnostic tools, drugs and equipment to address NCD problems at all levels of health-care facilities.

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Bibliography Ministry of Health. Non-Communicable Diseases (NCD) Prevention and Control Strategy 2012-2016. In: PoPH DoN-CDC, editor. Dili: Ministry of Health; 2013. WHO. 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non-Communicable Disease. Geneva: The World Health Organization; 2018. WHO. From Burden to “best Buys”: Reducing the Economic Impact on Non-Communicable Diseases in Low- and Middle Income Countries. World Economic Forum. Geneva: The World Health Organization; 2011. WHO. Scaling up action against non-communicable disease: How much will it cost. Geneva: The World Health Organization; 2001. UN General Assembly. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases2011. WHO. Follow-up to the Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-communicable diseases - Sixty-sixth World Health Assembly: The World Health Organization; 2013. Beaglehole R, Bonita R, Horton R. Independent global accountability for NCDs. The Lancet. 2012;381. WHO. Implementation tools Package of Essential Noncommunicable (PEN) disease interventions for prmary health care in low-resource settings. Geneva: The World Health Organization; 2013. National Statistics Directorate and Measure DHS ICF Macro. Demographic Health Survey Timor-Leste 20092010. Dili: National Statistics Directorate, Ministry of Finance, Timor-Leste and Measure DHS, ICF Macro, Calverton, Maryland, USA, 2010. WHO. Timor-Leste: WHO Statistics Profile: The World Health Organization; 2012. Timor-Leste RDd. Timor-Leste Strategic Development Plan 2011-2030: Republica Democratica de TimorLetse; 2011. Ministério da Saúde. National Strategy for Prevention and Control of Noncommunicable Diseases (NCDs), Injuries, disabeilities and care of elderly & NCD National Action Plan 2014-2018. Dili, Timor-Leste: Ministério da Saúde, RDTL; 2014. Ministério da Saúde and WHO, Dili Declaration on Implementation of WHO Framework Convention on Tobacco Control (WHO FCTC). The 68th Session of Regional Committee Meeting; 2015; Dili, Timor-Leste: Ministério da Saúde and WHO. Ministério da Saúde. Global Youth Tobacco Survey (GYTS). Timor-Leste, 2013: The World Health Organization; 2015. República Democrática de Timor-Leste. Health Warning Labels and Tax Control of Manudactured Tobacco Products. Dili: República Democrática de Timor-Leste; 2006. República Democrática de Timor-Leste. Decree-Law No.6/2003 of 3 April; The Highway Code. Sect. PART XII Special security rules, section 75 and section 762003. Directorate of the National Statistics, Ministry of Planning and Finance. WHO eSTEPS – http://www.who.int/chp/steps/esteps/en/

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Annex 1: Data Tables Background characteristics Table 3.1*: Age group and sex of respondents Age Group (years) 18–44 45–69 18–69 Men n 602 481 1083 % 37.1 48.8 41.5 n 1022 504 1526 Women % 62.9 51.2 58.5 n 1624 985 2609 Both Sexes % 62.2 37.8 100

Table 3.2: Mean number of years of education among all respondents Age Group (years) 18–44 45–69 18–69 Men n 596 450 1046 Mean 8.7 3.3 6.4 n 999 454 1453 Women Mean 7.6 1.8 5.8 n 1595 904 2499 Both Sexes Mean 8.0 2.6 6.1

Table 3.3: Highest level of education of respondents by age and sex Age Group (years) n %Pre % % Post % No % Less than % Primary % High % College/ Secondary Secondary graduate formal primary school school University school school degree schooling school completed completed completed completed completed completed

Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 18–44 45–69 18–69 Both Sexes 1611 951 2562 18.7 61.0 34.4 14.8 21.6 17.3 10.6 4.2 8.2 15.5 4.7 11.5 31.4 6.3 22.1 3.9 1.7 3.1 4.3 0.5 2.9 0.7 0.0 0.4 1010 483 1493 20.6 72.0 37.2 15.4 15.3 15.4 10.4 2.9 8.0 16.9 4.1 12.8 30.6 5.0 22.3 3.3 0.2 2.3 2.5 0.4 1.8 0.3 0.0 0.2 601 468 1069 15.6 49.6 30.5 13.6 28.0 19.9 11.0 5.6 8.6 13.1 5.3 9.7 32.8 7.7 21.8 5.0 3.2 4.2 7.5 0.6 4.5 1.3 0.0 0.7

* Fist digit of table number are matching with chapter numbers for ease of understanding.

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 3.4: Marital status of respondents by age and sex Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 1619 983 2602 18.2 2.1 12.1 77.0 82.2 79.0 1.0 1.4 1.2 0.7 1.5 1.0 1.5 12.5 5.6 1.7 0.2 1.1 1020 503 1523 14.9 1.6 10.5 79.3 76.1 78.3 1.2 1.4 1.2 0.9 1.6 1.1 2.0 19.1 7.6 1.8 0.2 1.2 599 480 1079 23.7 2.7 14.4 73.1 88.5 80.0 0.7 1.5 1.0 0.3 1.5 0.8 0.7 5.6 2.9 1.5 0.2 0.9 n % Never married % Currently married % Separated % Divorced % Widowed % Cohabiting

Table 3.5: Employment status of respondents by age and sex Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 1561 937 2498 9.4 9.2 9.3 8.5 7.2 8.0 22.9 33.0 26.7 59.3 50.7 56.0 983 482 1465 4.9 4.1 4.6 4.2 3.5 4.0 16.8 23.2 18.9 74.2 69.1 72.5 578 455 1033 17.1 14.5 16.0 15.7 11.0 13.6 33.2 43.3 37.7 33.9 31.2 32.7 n % Government employee % Non– government employee % Self– employed % Unpaid

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 3.6: Unpaid work and unemployed of respondents by age and sex Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 925 475 1400 4.6 5.7 5.0 18.2 0.0 12.0 57.4 67.4 60.8 0.3 5.7 2.1 18.6 15.2 17.4 0.9 6.1 2.6 729 333 1062 3.7 4.5 4.0 13.0 0.0 8.9 67.6 76.3 70.3 0.4 6.0 2.2 14.7 7.8 12.5 0.5 5.4 2.1 196 142 338 8.2 8.5 8.3 37.2 0.0 21.6 19.4 46.5 30.8 0.0 4.9 2.1 33.2 32.4 32.8 2.0 7.7 4.4 n % Non– paid % Student % Home– maker Unemployed % Retired % Able to work % Not able to work

Table 3.7: Per capita annual income n 1927 Mean 715.38

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Tobacco use Table 4.1: Percentage of current tobacco smokers, by age and sex Age Group (years) 18–44 45–69 18–69 Men n 601 481 1082 % 65.6 77.1 69.5 95% CI 63.0–68.2 70.3–83.8 67.0–72.0 n 1019 504 1523 Women % Current smoker 9.0 12.5 9.6 95% CI 4.0–14.0 8.6–16.5 5.8–13.4 n 1620 985 2605 Both Sexes % Current smoker 43.0 63.1 48.6 95% CI 37.2–48.7 42.3–83.9 38.4–58.7

Table 4.2: Smoking Status of respondents by age and sex Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 1620 985 2605 28.3 52.5 35.0 26.7–29.9 35.3–69.8 29.8–40.3 14.7 10.6 13.5 9.0–20.4 7.0–14.2 8.5–18.6 2.3 3.8 2.7 0.0–4.8 0.0–8.2 0.0–5.7 54.8 33.1 48.7 51.2–58.3 16.5–49.6 41.4–56.0 1019 504 1523 7.8 7.9 7.8 1.8–13.7 4.9–10.9 2.8–12.8 1.2 4.6 1.8 0.1–2.3 2.3–6.9 0.4–3.2 0.4 3.8 1.0 0.0–0.9 1.3–6.2 0.1–1.9 90.6 83.7 89.4 86.0–95.3 79.3–88.1 86.2–92.6 601 481 1082 41.9 64.8 49.6 33.1–50.8 60.2–69.5 46.3–53.0 23.7 12.2 19.8 16.3–31.1 9.9–14.5 14.9–24.8 3.6 3.8 3.6 0.0–7.9 0.0–9.3 0.0–8.3 30.8 19.1 26.9 24.8–36.8 17.5–20.8 23.8–30.0 Current smoker n % Daily 95% CI % Non– daily 95% CI % Former smoker Non–smokers 95% CI % Never smoker 95% CI

Table 4.3: Current daily smokers among smokers Age Group (years) 18–44 45–69 18–69 Men n 406 311 717 % 63.9 84.1 71.4 95% CI 51.9–75.9 82.4–85.9 65.0–77.8 n 52 58 110 Women % 86.8 63.2 81.5 95% CI 67.5–100.0 49.2–77.1 60.5–100.0 n 458 369 827 Both Sexes % 65.8 83.2 72.1 95% CI 56.8–74.9 82.2–84.3 67.4–76.9

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 4.4: Mean age started smoking among current daily smokers Age Group (years) 18–44 45–69 18–69 Men n 299 234 533 Mean 16.2 16.4 16.3 95% CI 15.3–17.0 15.1–17.7 15.3–17.3 n 30 33 63 Women Mean 16.4 25.0 17.6 95% CI 14.0–18.8 20.7–29.3 13.8–21.5 n 329 267 596 Both Sexes Mean 16.2 16.6 16.4 95% CI 15.2–17.2 15.0–18.2 15.2–17.6

Table 4.5: Mean duration of smoking among current daily smokers Age Group (years) 18–44 45–69 18–69 Men n 299 234 533 Mean 16.8 42.4 28.0 95% CI 11.5–22.0 39.6–45.2 20.4–35.7 n 30 33 63 Women Mean 15.4 29.8 17.5 95% CI 14.2–16.5 24.6–35.0 15.1–19.8 n 329 267 596 Both Sexes Mean 16.6 42.1 27.2 95% CI 11.9–21.3 38.9–45.3 20.5–34.0

Table 4.6: Manufactured cigarette smokers among daily smokers Age Group (years) 18–44 45–69 18–69 Men n 315 260 575 % 95.4 93.6 94.6 95% CI 90.6–100.0 83.8–100.0 88.0–100.0 n 30 40 70 Women % 98.1 68.5 93.0 95% CI 94.3–100.0 48.4–88.6 82.5–100.0 n 345 300 645 Both Sexes % 95.7 92.8 94.5 95% CI 90.9–100.0 82.1–100.0 87.7–100.0

Table 4.7: Manufactured cigarette smokers among current smokers Age Group (years) 18–44 45–69 18–69 Men n 392 299 691 % 96.0 93.8 95.2 95% CI 91.1–100.0 84.3–100.0 88.9–100.0 n 50 57 107 Women % 95.4 68.4 89.3 95% CI 88.0–100.0 51.2–85.5 76.4–100.0 n 442 356 798 Both Sexes % 96.0 92.8 94.8 95% CI 91.0–100.0 82.1–100.0 88.0–100.0

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 4.8: Mean amount of tobacco used by daily smokers by type Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 18–44 45–69 18–69 30 39 69 344 298 642 2.7 3.9 2.9 13.2 10.6 12.1 1.5–3.9 28 2.4–5.4 38 1.6–4.2 66 8.5–18.0 335 8.0–13.2 294 8.6–15.7 629 1.8 3.3 2.0 0.9 6.4 3.2 1.4–2.2 28 1.7–4.8 35 1.7–2.4 63 0.2–1.6 339 4.9–7.9 285 2.4–4.1 624 0.0 0.1 0.0 0.0 0.1 0.0 0.0–0.0 0.0–0.2 0.0–0.0 0.0–0.0 0.0–0.2 0.0–0.1 29 37 66 336 288 624 0.6 1.6 0.8 1.0 3.9 2.2 0.0–1.9 0.0–3.2 0.0–2.1 0.0–2.2 2.5–5.2 1.9–2.6 314 259 573 14.6 10.8 12.9 8.3–20.9 307 8.5–13.2 256 8.9–17.0 563 0.8 6.5 3.3 0.0–1.7 311 5.1–7.9 250 2.4–4.3 561 0.0 0.1 0.0 0.0–0.1 0.0–0.2 0.0–0.1 307 251 558 1.1 4.0 2.3 0.0–2.3 2.7–5.2 1.9–2.8 Mean # of manu– 95% CI factured cig. Mean # of hand– 95% CI rolled cig. Mean # of 95% CI pipes of tobacco Mean # of cigars, 95% CI cheerots, cigarillos

Both Sexes

Table 4.9: Mean amount of tobacco used by daily smokers by type Age Group (years) Men 18–44 406 45–69 311 18–69 717 Women 18–44 45–69 52 58 94.2 67.3 88.1 95.0 92.0 93.9 85.2–100.0 50.3–84.3 74.2–100.0 89.0–100.0 80.2–100.0 86.1–100.0 76.0 49.2 70.0 14.6 86.9 40.8 41.4–100.0 31.7–66.6 36.3–100.0 8.6–20.5 67.9–100.0 32.5–49.1 0.7 2.8 1.1 1.0 2.0 1.4 0.0–2.3 0.0–6.9 0.0–3.0 0.0–2.4 0.0–5.0 0.0–3.2 8.3 22.8 11.6 9.0 34.6 18.3 0.0–21.2 9.0–36.7 0.0–25.3 0.0–20.0 26.7–42.5 15.2–21.4 95.1 93.1 94.3 89.2–100.0 82.5–100.0 87.0–100.0 9.0 88.6 38.6 0.0–19.6 71.3–100.0 31.7–45.6 1.1 2.0 1.4 0.0–2.5 0.0–5.1 0.0–3.3 9.1 35.1 18.8 0.0–20.0 27.7–42.5 16.1–21.5 n % Manuf. cigs. 95% CI % Hand– rolled cigs. 95% CI % Pipes of tobacco 95% CI % Cigars, cheroots, cigarillos 95% CI

18–69 110 Both Sexes 18–44 458 45–69 369 18–69 827

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 4.10: Percentage of daily smokers smoking given quantities of manufactured or hand–rolled cigarettes per day Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 310 272 582 20.5 5.8 14.3 15.6–25.4 0.0–14.7 6.7–21.8 12.4 8.4 10.7 0.0–26.5 0.0–21.0 0.0–24.4 9.5 29.8 18.1 0.0–20.2 25.2–34.4 15.3–20.9 38.8 18.7 30.2 20.5–57.1 17.1–20.3 21.3–39.2 18.9 37.2 26.7 9.0–28.7 21.1–53.4 12.5–40.9 27 37 64 91.3 27.4 80.8 75.7– 100.0 10.3–44.5 52.5– 100.0 5.2 48.2 12.3 0.0–14.9 28.4–68.0 0.0–30.6 1.4 17.2 4.0 0.0–4.3 2.1–32.2 0.0–10.4 2.1 4.7 2.5 0.0–6.5 0.0–10.1 0.0–7.0 0.0 2.6 0.4 0.0–0.0 0.0–7.3 0.0–1.5 283 235 518 11.5 5.2 8.7 0.0–23.9 0.0–13.3 0.0–19.8 13.3 7.2 10.6 0.0–27.6 0.0–18.3 0.0–24.1 10.5 30.2 19.3 0.0–21.7 26.1–34.3 16.8–21.8 43.4 19.1 32.6 19.4–67.5 17.7–20.6 22.2–42.9 21.2 38.3 28.9 8.7–33.8 23.3–53.3 13.1–44.6 n % <5 Cigs. 95% CI % 5–9 Cigs. 95% CI % 10–14 % 15–24 % 95% CI 95% CI 95% CI Cigs. Cigs. ≥ 25 Cigs.

Table 4.11: Former daily smokers among all respondents Age Group (years) 18–44 45–69 18–69 Men n 601 481 1082 % 4.0 4.1 4.1 95% CI 0.0–8.9 0.0–10.1 0.0–9.3 n 1019 504 1523 Women % 0.1 2.0 0.4 95% CI 0.0–0.2 0.8–3.2 0.0–0.8 n 1620 985 2605 Both Sexes % 2.5 3.7 2.8 95% CI 0.0–5.1 0.0–7.8 0.0–5.8

Table 4.12: Former daily smokers among ever daily smokers Age Group (years) 18–44 45–69 18–69 Men n 384 339 723 % 8.8 6.0 7.6 95% CI 0.6–17.0 0.0–14.5 0.0–16.1 n 31 52 83 Women % 1.2 19.8 5.0 95% CI 0.0–3.7 8.6–31.1 0.0–12.1 n 415 391 806 Both Sexes % 8.0 6.5 7.4 95% CI 0.0–16.0 0.0–15.4 0.0–15.8

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 4.13: Mean years since cessation Age Group (years) 18–44 45–69 18–69 Men n 55 60 115 Mean 7.5 23.6 13.0 95% CI 5.5–9.4 18.5–28.6 9.7–16.3 n 6 18 24 Women Mean 5.9 22.7 17.6 95% CI 2.9–9.0 12.0–33.4 9.0–26.1 n 61 78 139 Both Sexes Mean 7.4 23.4 13.5 95% CI 5.5–9.3 18.6–28.1 10.3–16.7

Table 4.14: Current smokers who have tried to stop smoking Age Group (years) 18–44 45–69 18–69 Men n 406 311 717 % 25.7 8.2 19.1 95% CI 16.2–35.1 0.0–20.6 7.3–31.0 n 52 58 110 Women % 85.1 41.2 75.2 95% CI 63.3–100.0 27.3–55.1 47.3–100.0 n 458 369 827 Both Sexes % 30.7 9.6 23.0 95% CI 24.6–36.7 0.0–23.5 13.1–33.0

Table 4.15: Current smokers who have been advised by doctor to stop smoking Age Group (years) 18–44 45–69 18–69 Men n 296 236 532 % 20.3 24.9 22.4 95% CI 1.4–39.3 15.6–34.1 8.7–36.1 n 40 49 89 Women % 12.0 65.0 23.3 95% CI 0.0–31.3 49.8–80.2 0.0–51.8 n 336 285 621 Both Sexes % 19.3 26.7 22.5 95% CI 0.0–38.6 15.2–38.2 7.6–37.4

Table 4.16: Current users of smokeless tobacco Age Group (years) 18–44 45–69 18–69 Men n 601 481 1082 % 3.8 40.5 16.1 95% CI 0.0–8.4 32.9–48.1 14.0–18.2 n 1020 504 1524 Women % 20.4 57.5 26.8 95% CI 15.1–25.7 51.7–63.4 17.9–35.6 n 1621 985 2606 Both Sexes % 10.4 44.2 19.8 95% CI 4.4–16.4 41.4–46.9 16.3–23.4

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 4.17: Smokeless tobacco use Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 1621 985 2606 5.8 34.5 13.8 4.4–7.2 21.9–47.1 10.4–17.2 4.6 9.7 6.0 0.0–9.5 0.0–20.6 0.0–12.5 8.7 1.5 6.7 2.1–15.3 0.0–3.3 2.5–10.8 80.9 54.3 73.5 79.2–82.6 52.2–56.4 71.6–75.3 1020 504 1524 11.1 24.2 13.4 7.7–14.6 19.2–29.3 11.4–15.4 9.2 33.3 13.4 1.2–17.2 28.5– 38.2 3.8–23.0 10.5 3.6 9.3 0.5–20.4 1.8–5.4 0.2–18.3 69.2 38.9 63.9 63.4–75.0 33.2–44.6 61.1–66.8 601 481 1082 2.2 37.3 14.0 0.0–4.9 25.4–49.3 9.6–18.4 1.6 3.2 2.1 0.0–3.6 0.0–7.8 0.0–4.8 7.5 1.0 5.3 2.7–12.2 0.0–2.4 3.0–7.6 88.7 58.6 78.6 87.2–90.3 52.3–64.8 74.4–82.8 Current user n % Daily 95% CI % Non– daily 95% CI % Past user Non user 95% CI % Never used 95% CI

Table 4.18: Former daily smokeless tobacco users among all respondents Age Group (years) 18–44 45–69 18–69 Men n 601 481 1082 % 1.1 2.3 1.5 95% CI 0.0–2.4 0.0–5.7 0.0–3.4 n 1020 503 1523 Women % 13.3 17.3 14.0 95% CI 5.7–20.9 13.3–21.3 8.1–19.8 n 1621 984 2605 Both Sexes % 5.9 5.5 5.8 95% CI 4.5–7.4 0.0–11.8 4.9–6.8

Table 4.19: Former daily smokeless tobacco users among ever daily users Age Group (years) 18–44 45–69 18–69 Men n 66 120 186 % 32.4 5.8 9.5 95% CI 18.8–46.0 0.0–15.6 0.0–23.3 n 186 221 407 Women % 54.4 41.6 51.0 95% CI 46.2–62.5 33.3–49.9 41.7–60.4 n 252 341 593 Both Sexes % 50.7 13.8 29.7 95% CI 39.8–61.6 0.0–31.6 21.8–37.6

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 4.20: Mean times per day smokeless tobacco used by daily smokeless tobacco users by type Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 140 215 355 0.9 0.4 0.6 0.0–2.1 0.0–1.0 0.0–1.3 144 214 358 2.0 1.7 1.8 0.2–3.9 0.0–3.4 0.0–3.6 100 131 231 0.2 1.9 0.8 0.0–0.6 1.4–2.4 0.1–1.4 103 130 233 1.9 5.7 3.1 0.0–4.1 4.8–6.6 0.6–5.6 40 84 124 3.1 0.2 0.5 0.0–6.7 0.0–0.4 0.0–1.3 41 84 125 2.5 1.0 1.2 1.5–3.4 0.2–1.8 0.2–2.1 n Chewing tobacco 95% CI n Betel, quid 95% CI

Table 4.21: Percentage of current users of smokeless tobacco using each of the following products Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 367 426 793 12.4 13.7 13.2 5.1–19.7 0.0–29.7 1.1–25.3 67.4 54.3 59.3 34.6–100.0 24.5–84.1 26.3–92.2 295 291 586 8.2 36.6 18.7 2.2–14.1 29.9–43.4 10.6–26.9 62.7 90.9 73.1 23.8–100.0 86.6–95.2 44.7–100.0 72 135 207 27.5 4.7 8.3 12.4–42.7 0.0–12.6 0.0–20.0 84.5 40.0 46.9 69.9–99.1 21.3–58.7 21.4–72.4 n % Chewing tobacco 95% CI % Betel, quid 95% CI

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 4.22: Current tobacco users Age Group (years) 18–44 45–69 18–69 Men n 601 481 1082 % 66.6 78.5 70.6 95% CI 63.2–70.1 73.8–83.2 68.9–72.4 n 1019 504 1523 Women % 21.9 62.9 28.9 95% CI 15.4–28.3 57.2–68.5 18.6–39.2 n 1620 985 2605 Both Sexes % 48.7 75.1 56.1 95% CI 46.6–50.8 67.6–82.7 53.3–58.8

Table 4.23: Daily tobacco users Age Group (years) 18–44 45–69 18–69 Men n 601 481 1082 % 42.3 65.6 50.1 95% CI 33.0–51.5 62.1–69.2 46.2–54.1 n 1019 504 1523 Women % 12.1 29.4 15.1 95% CI 9.3–14.8 24.2–34.7 13.3–16.9 n 1620 985 2605 Both Sexes % 30.2 57.8 37.9 95% CI 27.5–32.9 46.4–69.2 35.4–40.4

Table 4.24: Exposed to second–hand smoke in home and workplace during the past 30 days Age Group (years) Home 18–44 45–69 18–69 Workplace 18–44 45–69 18–69 450 353 803 32.7 48.6 38.9 0.0–69.6 38.0–59.2 13.9–63.9 779 368 1147 76.5 63.6 74.4 64.3–88.8 57.4–69.8 62.6–86.2 1229 721 1950 50.9 51.3 51.0 31.3–70.5 39.1–63.5 33.8–68.2 601 481 1082 94.1 95.7 94.6 87.1–100.0 89.4–100.0 87.8–100.0 1020 503 1523 88.9 80.3 87.4 79.1–98.6 75.9–84.6 78.3–96.5 1621 984 2605 92.0 92.3 92.1 83.6–100.0 83.7–100.0 83.6–100.0 Men n % 95% CI n Women % 95% CI n Both Sexes % 95% CI

Table 4.25: Percentage of respondents noticed information in media about dangers of smoking or that encourages quitting during the past 30 days Age Group (years) 18–44 45–69 18–69 Men n % 95% CI n Women % 95% CI n Both Sexes % 95% CI

Newspapers or magazines 531 403 934 22.9 30.2 25.4 8.8–37.0 26.4–34.0 17.6–33.1 925 412 1337 17.0 13.7 16.5 1.6–32.4 9.3–18.1 3.8–29.2 1456 815 2271 20.5 27.1 22.3 6.5–34.6 20.2–33.9 14.0–30.6

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Age Group (years) 18–44 45–69 18–69 18–44 45–69 18–69

Men n % 95% CI n

Women % 95% CI n

Both Sexes % 95% CI

On television 542 421 963 544 427 971 25.6 32.0 27.8 17.1 41.0 25.2 8.4–42.9 30.3–33.8 16.9–38.6 0.0–37.9 39.1–42.9 13.1–37.2 949 435 1384 955 432 1387 44.9 21.6 41.3 50.8 31.3 47.7 35.0–54.8 16.0–27.1 30.1–52.4 33.3–68.2 25.1–37.6 30.8–64.7 1491 856 2347 1499 859 2358 33.3 30.0 32.4 30.6 39.1 32.9 25.0–41.7 26.3–33.7 27.0–37.8 22.2–39.0 35.4–42.8 27.7–38.1

On the radio

Table 4.26: Percentage of respondents noticed advertisements or signs promoting cigarettes in stores Age Group (years) 18–44 45–69 18–69 Men n 532 416 948 % 31.3 29.1 30.6 95% CI 28.1–34.5 23.8–34.4 28.6–32.5 n 903 409 1312 Women % 22.7 12.7 21.1 95% CI 12.7–32.6 8.4–16.9 11.5–30.7 n 1435 825 2260 Both Sexes % 27.9 26.0 27.4 95% CI 24.0–31.8 17.9–34.0 22.5–32.2

Table 4.27: Percentage of all respondents who noticed cigarette promotions during the past 30 days Age Group (years) 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 Men n % 95% CI n Women % 95% CI n Both Sexes % 95% CI

Got free samples of cigarettes 525 406 931 525 406 931 522 404 926 518 395 913 47.3 4.0 32.7 5.4 3.0 4.6 22.9 26.9 24.3 1.3 0.5 1.1 32.0–62.6 0.0–10.0 27.0–38.5 0.0–12.1 0.0–7.6 0.0–10.7 14.4–31.5 18.2–35.5 15.5–33.0 0.0–3.1 0.0–1.5 0.0–2.5 898 414 1312 896 407 1303 897 408 1305 881 399 1280 23.8 10.0 21.7 20.5 8.6 18.6 15.4 5.5 13.9 1.3 1.0 1.2 14.9–32.8 6.2–13.7 12.5–30.9 8.5–32.4 5.1–12.1 7.1–30.2 5.6–25.2 2.8–8.2 4.4–23.3 0.0–2.8 0.0–1.9 0.0–2.5 1423 820 2243 1421 813 2234 1419 812 2231 1399 794 2193 38.0 5.1 29.0 11.3 4.1 9.3 20.0 22.8 20.7 1.3 0.6 1.1 23.5–52.5 0.0–11.5 20.8–37.1 10.0–12.6 0.0–9.1 7.2–11.4 10.4–29.5 10.9–34.7 10.5–31.0 0.0–2.9 0.0–1.5 0.0–2.5

Noticed sale prices on cigarettes

Noticed coupons for cigarettes

Noticed free gifts or special discount offers on other products when buying cigarettes

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Age Group (years) 18–44 45–69 18–69 18–44 45–69 18–69

Men n % 95% CI n

Women % 95% CI n

Both Sexes % 95% CI

Noticed clothing or other items with a cigarette brand name or logo 525 400 925 509 389 898 6.5 2.3 5.1 0.7 0.3 0.6 0.0–14.7 0.0–5.8 0.0–11.9 0.0–1.8 0.0–0.9 0.0–1.5 881 407 1288 863 403 1266 2.5 7.0 3.2 0.9 0.5 0.8 0.0–5.0 3.3–10.7 0.5–6.0 0.0–1.9 0.0–1.3 0.0–1.7 1406 807 2213 1372 792 2164 4.9 3.2 4.5 0.8 0.4 0.7 0.0–10.6 0.0–7.2 0.0–9.6 0.0–1.8 0.0–0.9 0.0–1.5

Noticed cigarette promotions in the mail

Table 4.28: Percentage of current smokers who noticed health warnings on cigarette packages during the past 30 days Age Group (years) 18–44 45–69 18–69 Men n 356 249 605 % 49.0 18.0 37.5 95% CI 42.5–55.6 14.5–21.6 35.1–39.9 n 46 49 95 Women % 6.2 27.7 10.4 95% CI 0.0–16.1 11.7–43.7 0.0–23.7 n 402 298 700 Both Sexes % 45.4 18.4 35.7 95% CI 40.7–50.1 14.4–22.4 33.2–38.2

Table 4.29: Percentage of current smokers who saw health warnings on cigarette packages that thought of quitting Age Group (years) 18–44 45–69 18–69 Men n 140 61 201 % 18.6 13.1 17.6 95% CI 0.0–44.4 0.0–32.4 0.0–42.1 n 11 11 22 Women % 70.6 62.4 66.3 95% CI 37.4–100.0 23.5–100.0 44.7–88.0 n 151 72 223 Both Sexes % 19.2 15.8 18.6 95% CI 0.0–45.5 0.0–37.6 0.0–43.8

Table 4.30: Mean average price paid for 20 manufactured cigarettes in USD Age Group (years) 18–44 45–69 18–69 Men n 307 213 520 Mean 5.9 2.8 4.8 95% CI 3.7–8.1 2.6–2.9 3.6–6.1 n 42 39 81 Women Mean 2.6 3.7 2.8 95% CI 1.5–3.8 1.6–5.8 1.6–4.0 n 349 252 601 Both Sexes Mean 5.6 2.8 4.7 95% CI 3.8–7.5 2.6–2.9 3.6–5.8

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Alcohol consumption Table 5.1: Alcohol consumption status of respondents by age and sex Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 1619 982 2601 22.0 45.8 28.6 19.9–24.0 21.1–70.6 20.3–36.9 6.3 13.1 8.2 0.0–12.9 11.9–14.3 3.6–12.7 1.8 14.9 5.5 0.0–3.9 10.8–18.9 4.8–6.1 69.9 26.2 57.7 62.6–77.3 0.0–55.6 53.7–61.8 1018 503 1521 1.6 3.9 2.0 0.1–3.1 2.1–5.8 0.5–3.6 2.2 7.5 3.1 0.2–4.3 4.6–10.3 0.7–5.5 1.7 8.0 2.8 0.1–3.4 4.6–11.5 0.6–5.1 94.5 80.6 92.1 89.6–99.4 75.8–85.4 86.3–97.9 601 479 1080 35.5 57.3 42.8 33.1–37.9 42.2–72.5 37.1–48.6 9.0 14.7 10.9 0.0–19.7 13.1–16.2 3.7–18.1 1.9 16.8 6.9 0.0–4.3 14.3–19.2 6.2–7.6 53.6 11.3 39.4 39.5–67.7 0.0–27.4 37.2–41.6

% Current drinker (past 30 days)

% Drank in past 12 95% CI months, not current

95% CI

% Past 12 months abstainer

95% CI

% Lifetime 95% CI abstainer

Table 5.2: Frequency of alcohol consumption in the past 12 months Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 71 57 128 1.4 0.0 0.9 0.0–4.2 – 0.0–2.6 0.0 0.0 0.0 – – – 0.5 0.0 0.3 0.0–1.4 – 0.0–0.9 18.4 11.8 15.9 4.4–32.3 1.1–22.3 6.4–25.3 30.7 4.4–32.3 49.0 35.9–62.0 36.3–69.9 38.9–62.1 332 223 555 0.1 0.2 0.2 0.0–0.4 0.0–0.5 0.0–0.4 0.8 46.7 21.4 0.0–1.8 30.2–63.2 6.3–36.6 46.7 0.9 26.1 0.0–95.6 0.0–2.6 8.1–44.2 12.8 16.8 14.6 0.6–24.9 15.1–18.6 7.9–21.2 17.1 1.0–33.3 22.4 1.3–43.5 8.4–22.7 3.4–35.3 n % Daily 95% CI % 5–6 days/ week 95% CI % 3–4 days/ week 95% CI % 1–2 days/ week 95% CI % 1–3 days/ month % < once 95% CI a month 95% CI

19.8 13.4–26.3 15.5 18.3 7.1–29.6 19.3

35.1 20.3–49.7 53.2 32.4 21.7–42.9 50.6

Both Sexes 18–44 45–69 18–69 403 280 683 0.2 0.2 0.2 0.0–0.6 0.0–0.5 0.0–0.5 0.8 44.8 20.4 0.0–1.6 26.0–63.6 4.8–36.0 44.2 0.9 24.9 0.0–92.5 0.0–2.40 6.2–43.5 13.1 16.6 14.6 0.0–92.5 15.1–18.1 8.2–21.1 17.9 1.9–33.7 23.9 2.7–45.0 7.8–26.3 3.9–37.7

20.5 13.2–27.6 17.1 19.0 7.5–30.5 20.8

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 5.3: Frequency of alcohol consumption in the past 7 days Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 184 122 306 1.1 42.3 20.1 0.0–2.7 32.1–52.4 10.8–29.3 41.2 0.1 22.3 9.8–72.6 0.0–0.5 10.8–33.8 28.2 2.5 16.4 21.4–35.1 0.0–7.0 13.9–18.9 27.0 54.2 39.5 0.0–60.4 50.1–58.3 23.1–55.9 2.5 0.9 1.8 0.0–5.9 0.0–2.6 0.0–4.5 21 16 37 8.7 0.0 5.6 0.0–20.7 – 0.0–13.5 3.1 0.0 2.0 0.0–9.4 – 0.0–6.1 19.2 3.8 13.8 0.0–43.6 0.0–11.7 0.0–30.7 55.1 90.4 67.6 31.5–78.6 76.4–100.0 49.5–85.8 13.9 5.8 11.0 0.0–28.8 0.0–17.5 0.6–21.5 163 106 269 0.9 43.0 20.4 0.0–2.3 34.0–52.0 11.4–29.3 42.2 0.1 22.8 11.3–73.2 0.0–0.5 11.7–33.9 28.5 2.5 16.5 21.7–35.2 0.0–7.0 13.9–19.0 26.2 53.5 38.9 0.0–59.6 50.4–56.7 23.1–54.6 2.2 0.8 1.5 0.0–5.3 0.0–2.4 0.0–4.0 n % Daily 95% CI % 5–6 days 95% CI % 3–4 days 95% CI % 1–2 days 95% CI %0 days 95% CI

Table 5.4: Proportion of drinkers by amount and sex among current (past 30 days) drinkers Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 210 150 360 0.5 53.1 24.5 0.0–1.3 38.7–67.5 11.6–37.5 2.9 1.1 2.1 0.0–7.3 0.0–3.2 0.0–5.4 96.6 45.8 73.4 91.7–100.0 33.3–58.3 63.2–83.5 24 18 42 186 132 318 n % high– end (>60g) 0.5 54.0 25.1 (>40g) 0.0 3.4 1.2 0.0–0.0 0.0–10.3 0.0–3.7 0.0–1.4 40.9–67.1 12.6–37.6 95% CI % intermediate (40–59.9g) 2.9 1.2 2.1 (20–39.9g) 2.6 0.0 1.7 0.0–7.9 – 0.0–5.1 0.0–7.4 0.0–3.3 0.0–5.5 95% CI % lower– end (<40g) 96.6 44.9 72.8 (<20g) 97.4 96.6 97.1 92.1–100.0 89.7–100.0 92.9–100.0 91.6–100.0 33.7–56.0 63.3–82.4 95% CI

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 5.5: Drinking level of pure alcohol among all respondents on average per occasion Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 1582 964 2546 0.1 24.1 6.8 0.0–0.3 4.1–44.1 0.9–12.7 0.6 0.5 0.6 0.0–1.5 0.0–1.2 0.0–1.3 20.2 20.8 20.4 16.7–23.7 14.6–26.9 16.2–24.5 1014 501 1515 568 463 1031 n % high– end (>60g) 0.2 30.7 10.5 (>40g) 0.0 0.1 0.0 0.0–0.0 0.0–0.4 0.0–0.1 0.0–0.5 14.7–46.7 3.5–17.5 95% CI % intermediate (40–59.9g) 1.0 0.7 0.9 (20–39.9g) 0.0 0.0 0.0 0.0–0.1 0.0–0.0 0.0–0.1 0.0–2.5 0.0–1.7 0.0–2.2 95% CI % lower– end (<40g) 33.0 25.5 30.5 (<20g) 1.4 3.5 1.7 0.0–2.7 1.8–5.2 0.4–3.1 30.3–35.6 24.0–27.0 28.7–32.2 95% CI

Table 5.6: Percentage of consumption of unrecorded alcohol Age Group (years) 18–44 45–69 18–69 Men n 218 143 361 % 79.8 38.8 61.4 95% CI 56.3–100.0 37.2–40.3 54.3–68.5 n 28 20 48 Women % 38.3 24.0 33.5 95% CI 17.3–59.2 0.3–47.7 16.7–50.2 n 246 163 409 Both Sexes % 78.6 38.5 60.7 95% CI 54.5–100.0 36.9–40.0 52.9–68.6

Table 5.7: Percentage of unrecorded alcohol from all alcohol consumed during past 7 days Age Group (years) 18–44 45–69 18–69 Men n 94 63 157 % 34.7 8.7 18.9 n 9 8 17 Women % 48.8 21.1 41.6 n 103 71 174 Both Sexes % 34.8 8.8 19.0

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 5.8: Mean number of standard drinks and standard drinks of unrecorded alcohol on average per day in the past 7 days among current drinkers Age Group (years) 18–44 45–69 18–69 Men n Mean 95% CI n Women Mean 95% CI n Both Sexes Mean 95% CI

Standard drinks 163 106 269 1.1 1.9 1.4 0.7–1.4 1.6–2.1 1.0–1.8 21 16 37 0.4 0.4 0.4 0.3–0.6 0.2–0.6 0.3–0.6 184 122 306 1.0 1.8 1.4 0.7–1.4 1.5–2.2 1.0–1.8

Standard drinks of unrecorded alcohol 18–44 45–69 18–69 83 42 125 0.5 0.4 0.5 0.5–0.5 0.4–0.5 0.4–0.5 7 4 11 0.4 0.2 0.3 0.2–0.5 0.1–0.3 0.2–0.4 90 46 136 0.5 0.4 0.5 0.4–0.5 0.4–0.5 0.4–0.5

Table 5.9: Unrecorded alcohol consumption during the past 7 days by type: Both Sexes Both Sexes Age Group (years) 18–44 45–69 18–69 n 52 23 75 % home– brewed spirits 76.4 82.3 78.0 % home– brewed beer/ wine 22.5 17.3 21.0 % brought over border 1.1 0.2 0.8 % surrogate alcohol 0.0 0.0 0.1 % other 0.0 0.0 0.0

Table 5.10: Mean number of drinking occasions in the past 30 days among current (past 30 days) drinkers Age Group (years) 18–44 45–69 18–69 Men n 189 137 326 Mean 3.9 4.7 4.3 95% CI 3.3–4.5 4.4–5.1 3.7–4.9 n 26 19 45 Women Mean 2.2 2.2 2.2 95% CI 1.6–2.8 0.9–3.4 1.6–2.8 n 215 156 371 Both Sexes Mean 3.8 4.7 4.2 95% CI 3.2–4.5 4.3–5.1 3.6–4.9

Table 5.11: Mean number of standard drinks per drinking occasion among current (past 30 days) drinkers Age Group (years) 18–44 45–69 18–69 Men n 192 134 326 Mean 4.5 28.2 15.4 95% CI 2.5–6.5 22.4–34.0 10.6–20.1 n 25 18 43 Women Mean 3.4 2.6 3.1 95% CI 1.3–5.4 0.6–4.6 1.6–4.6 n 217 152 369 Both Sexes Mean 4.5 27.7 15.1 95% CI 2.6–6.4 21.3–34.2 10.0–20.1

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 5.12: Mean maximum number of standard drinks consumed on one occasion in the past 30 days Age Group (years) 18–44 45–69 18–69 Men n 173 127 300 Mean 4.7 4.9 4.8 95% CI 3.9–5.4 4.7–5.1 4.4–5.2 n 23 17 40 Women Mean 3.4 3.9 3.6 95% CI 1.9–4.9 1.0–6.8 2.3–4.9 n 196 144 340 Both Sexes Mean 4.6 4.9 4.7 95% CI 3.9–5.3 4.7–5.1 4.4–5.1

Table 5.13: Six or more drinks on a single occasion at least once during the past 30 days among total population Age Group (years) 18–44 45–69 18–69 Men n 601 479 1080 % 10.1 44.9 21.8 95% CI 0.0–22.0 30.5–59.2 20.1–23.4 n 1018 503 1521 Women % 0.8 2.1 1.0 95% CI 0.0–1.7 0.8–3.5 0.1–1.9 n 1619 982 2601 Both Sexes % 6.4 35.6 14.5 95% CI 0.0–13.1 14.1–57.2 12.7–16.4

Table 5.14: Mean number of times with six or more drinks during a single occasion in the past 30 days among current drinkers Age Group (years) 18–44 45–69 18–69 Men n 169 122 291 Mean 1.1 9.4 5.0 95% CI 0.0–2.5 7.6–11.2 3.9–6.1 n 19 15 34 Women Mean 1.3 2.7 1.8 95% CI 0.6–2.0 0.3–5.0 0.8–2.7 n 188 137 325 Both Sexes Mean 1.1 9.3 4.9 95% CI 0.0–2.5 7.4–11.2 3.8–6.1

Table 5.15: Percentage of former drinkers (those who did not drink during the past 12 months) who stopped drinking due to health reasons Age Group (years) 18–44 45–69 18–69

Men n 28 56 84

Women 95% CI 12.9–53.9 0.0–39.2 0.0–42.9

Both Sexes 95% CI 9.7–37.6 19.7–59.7 17.9–45.2

% 33.4 14.9 18.3

n 29 37 66

% 23.7 39.7 31.5

n 57 93 150

% 29.8 17.8 20.7

95% CI 14.4–45.1 0.0–43.1 0.0–43.3

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Dietary habits Table 6.1: Mean number of days fruits and vegetables consumed in a typical week Age Group (years) Fruit 18–44 45–69 18–69 Vegetables 18–44 45–69 18–69 576 462 1038 6.6 6.8 6.7 6.3–7.0 6.5–7.1 6.3–7.1 985 488 1473 6.7 6.3 6.6 6.4–7.0 6.0–6.5 6.3–6.9 1561 950 2511 6.6 6.7 6.7 6.3–7.0 6.3–7.1 6.3–7.0 552 442 994 2.1 2.3 2.2 1.9–2.3 1.9–2.6 1.9–2.5 951 466 1417 2.8 1.7 2.6 1.7–3.9 1.5–1.9 1.5–3.7 1503 908 2411 2.4 2.2 2.3 1.8–2.9 1.7–2.6 1.8–2.8 Men n Mean 95% CI n Women Mean 95% CI n Both Sexes Mean 95% CI

Table 6.2: Mean number of servings of fruit, vegetable and combined fruit and vegetable serving on average per day Age Group (years) Fruit 18–44 45–69 18–69 Vegetable 18–44 45–69 18–69 18–44 45–69 18–69 530 425 955 556 443 999 7.3 4.8 6.3 6.9 5.5 6.4 3.3–11.2 3.9–5.7 3.8–8.9 4.2–9.6 4.4–6.6 4.4–8.5 911 456 1367 951 473 1424 2.8 2.8 2.8 3.5 3.1 3.5 2.5–3.1 2.4–3.1 2.5–3.0 3.3–3.7 2.8–3.5 3.3–3.7 1441 881 2322 1507 916 2423 5.3 4.4 5.0 5.6 5.0 5.4 3.0–7.6 3.2–5.6 3.1–7.0 3.7–7.5 3.6–6.4 3.7–7.2 529 422 951 1.1 0.7 1.0 0.8–1.5 0.6–0.8 0.7–1.2 914 443 1357 0.9 0.5 0.9 0.6–1.3 0.4–0.6 0.5–1.2 1443 865 2308 1.0 0.7 0.9 0.7–1.4 0.6–0.8 0.6–1.2 Men n Mean 95% CI n Women Mean 95% CI n Both Sexes Mean 95% CI

Combined fruit and vegetable

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 6.3: Number of servings of fruit and/or vegetables on average per day Age Group (years) Men 18–44 45–69 18–69 Females 18–44 45–69 18–69 18–44 45–69 18–69 951 473 1424 1507 916 2423 3.9 7.6 4.5 3.6 3.2 3.5 0.1–7.7 4.0–11.2 0.8–8.2 0.0–7.6 0.0–7.2 0.0–7.4 33.8 52.9 37.0 40.2 36.0 39.0 23.1–44.4 46.5–59.4 25.7–48.3 34.3–46.1 24.3–47.8 31.6–46.5 53.7 25.0 48.9 34.8 35.5 35.0 32.1–75.2 19.1–31.0 27.3–70.4 27.8–41.7 27.9–43.1 27.9–42.0 8.7 14.4 9.6 21.5 25.2 22.5 0.7–16.7 9.4–19.4 2.2–17.1 18.2–24.8 17.0–33.4 18.0–27.0 556 443 999 3.3 2.1 2.9 0.0–7.6 0.0–5.3 0.0–6.8 44.4 31.6 40.1 39.8–48.9 23.4–39.8 33.9–46.3 22.4 38.3 27.7 20.1–24.7 32.9–43.7 24.1–31.3 29.9 28.1 29.3 22.7–37.1 22.0–34.1 22.6–35.9 n % no fruit and/or vegetables 95% CI % 1–2 servings 95% CI % 3–4 servings 95% CI % >5 servings 95% CI

Both Sexes

Table 6.4: Less than five servings of fruit and/or vegetables on average per day Age Group (years) 18–44 45–69 18–69 Men n 556 443 999 % 70.1 71.9 70.7 95% CI 62.9–77.3 65.9–78.0 64.1–77.4 n 951 473 1424 Women % 91.3 85.6 90.4 95% CI 83.3–99.3 80.6–90.6 82.9–97.8 n 1507 916 2423 Both Sexes % 78.5 74.8 77.5 95% CI 75.2–81.8 66.6–83.0 73.0–82.0

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Dietary salt Table 7.1: Salt consumption habits Age Group (years) Men n 601 478 1079 601 479 1080 597 476 1073 % 74.2 75.7 74.7 67.0 68.7 67.6 22.4 2.8 15.8 95% CI 63.8–84.7 72.7–78.7 67.0–82.5 63.0–70.9 66.7–70.8 64.5–70.6 13.4–31.3 0.0–7.0 12.2–19.4 n 1017 501 1518 1017 501 1518 1011 496 1507 Women % 84.0 84.6 84.1 70.8 68.8 70.5 7.2 7.9 7.3 95% CI 78.4–89.6 79.7–89.6 79.2–89.0 66.3–75.4 62.4–75.2 66.5–74.5 0.7–13.8 5.0–10.9 1.8–12.9 n 1618 979 2597 1618 980 2598 1608 972 2580 Both Sexes % 78.1 77.7 78.0 68.5 68.8 68.6 16.3 3.9 12.9 95% CI 69.0–87.3 73.0–82.3 70.2–85.8 64.3–72.8 66.3–71.2 65.1–72.1 12.0–20.6 0.0–8.5 10.9–14.8

Add salt always or often before eating or when eating 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69

Add salt always or often when cooking or preparing food at home

Always or often consume processed food high in salt

Table 7.2: Percentage of people who think they consume far too much or too much salt Age Group (years) 18–44 45–69 18–69 Men n 564 448 1012 % 25.8 5.4 19.3 95% CI 20.4–31.1 0.0–13.2 17.4–21.1 n 973 480 1453 Women % 8.7 18.7 10.4 95% CI 0.7–16.6 13.1–24.2 2.4–18.3 n 1537 928 2465 Both Sexes % 19.0 8.3 16.1 95% CI 16.6–21.3 0.0–17.8 13.7–18.6

Table 7.3: Self–reported quantity of salt consumed Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 973 480 1453 1.8 1.9 1.8 0.0–4.0 0.5–3.2 0.1–3.6 6.8 16.8 8.5 0.5–13.1 11.3–22.3 1.9–15.1 79.2 59.2 75.9 60.8–97.7 52.1–66.4 58.0–93.7 11.7 20.6 13.2 1.2–22.3 15.5–25.7 3.3–23.1 0.4 1.5 0.6 0.0–0.8 0.1–2.9 0.0–1.2 564 448 1012 1.3 0.6 1.1 0.0–3.1 0.0–1.4 0.0–2.6 24.5 4.8 18.2 17.8–31.2 0.0–11.9 16.1–20.3 66.5 63.5 65.5 61.3–71.6 61.0–66.0 61.5–69.5 7.4 30.9 14.9 0.0–16.5 24.4–37.3 11.7–18.1 0.3 0.2 0.3 0.0–0.8 0.0–0.6 0.0–0.7 n % Far too much 95% CI % Too much 95% CI % Just the right amount 95% CI % Too little 95% CI % Far too little 95% CI

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Age Group (years) Both Sexes 18–44 45–69 18–69

% Far too much

95% CI

% Too much

95% CI

% Just the right amount

95% CI

% Too little

95% CI

% Far too little

95% CI

1537 928 2465

1.5 0.8 1.3

0.0–3.4 0.0–1.9 0.0–3.0

17.5 7.5 14.8

14.1–20.8 0.0–16.0 13.1–16.5

71.5 62.6 69.1

62.3–80.8 59.1–66.0 61.7–76.5

9.1 28.6 14.3

0.0–19.0 21.0–36.2 9.1–19.6

0.3 0.5 0.4

0.0–0.8 0.0–1.2 0.0–0.9

Table 7.4: Percentage of respondents who agree with the importance of lowering salt in diet Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 1163 659 1822 42.5 63.6 48.1 8.3–76.7 48.1–79.2 19.2–77.0 16.2 35.3 21.3 13.1–19.3 18.6–52.0 17.9–24.6 41.3 1.1 30.6 4.7–77.8 0.0–2.4 4.7–56.6 742 337 1079 48.1 76.2 52.5 14.2–82.1 70.1–82.3 20.5–84.4 27.4 21.0 26.4 17.8–36.9 15.0–26.9 17.5–35.3 24.5 2.9 21.2 0.0–49.1 0.7–5.0 0.0–44.4 421 322 743 38.4 60.2 45.6 4.9–71.9 45.3–75.1 19.5–71.6 8.0 39.3 18.3 0.0–17.3 23.6–54.9 16.1–20.4 53.7 0.6 36.2 11.3–96.1 0.0–1.5 11.2–61.1 n % Very important 95% CI % Somewhat important 95% CI % Not at all important 95% CI

Table 7.5: Percentage of respondents who think that consuming too much salt could cause serious health problems Age Group (years) 18–44 45–69 18–69 Men n 601 479 1080 % 21.1 14.5 18.9 95 % CI 0.0–46.1 0.0–35.3 0.0–42.8 n 1018 503 1521 Women % 30.4 44.0 32.8 95% CI 4.4–56.5 38.1–49.8 9.6–56.0 n 1619 982 2601 Both Sexes % 24.9 20.9 23.7 95% CI 0.0–50.9 0.0–44.3 0.0–49.1

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 7.6: Techniques used on a regular basis to reduce salt intake Age Group (years) Men n 601 479 1080 601 479 1080 601 479 1080 601 479 1080 601 479 1080 601 479 1080 % 18.7 9.9 15.7 10.0 6.2 8.7 5.8 3.8 5.1 11.0 6.5 9.5 4.9 3.4 4.4 0.2 0.0 0.1 95% CI 0.0–40.8 0.0–24.1 0.0–35.6 0.0–22.0 0.0–15.3 0.0–19.9 0.0–12.9 0.0–9.3 0.0–11.7 0.0–24.2 0.0–15.8 0.0–21.6 0.0–10.8 0.0–8.4 0.0–10.0 0.0–0.6 0.0–0.0 0.0–0.4 n 1018 503 1521 1018 503 1521 1018 503 1521 1018 503 1521 1018 503 1521 1018 503 1521 Women % 23.4 31.5 24.8 14.1 17.7 14.7 6.8 9.3 7.2 16.3 20.8 17.1 7.5 9.7 7.9 0.3 0.5 0.4 95% CI 3.3–43.6 25.7–37.2 7.1–42.5 1.8–26.4 12.7–22.6 4.0–25.4 0.7–12.9 5.5–13.1 1.8–12.7 2.1–30.4 15.9–25.7 4.7–29.4 0.7–14.2 5.7–13.7 1.9–13.8 0.0–0.8 0.0–1.3 0.0–0.8 n 1619 982 2601 1619 982 2601 1619 982 2601 1619 982 2601 1619 982 2601 1619 982 2601 Both Sexes % 20.6 14.5 18.9 11.6 8.7 10.8 6.2 5.0 5.9 13.1 9.6 12.1 5.9 4.8 5.6 0.3 0.1 0.2 95% CI 0.0–42.2 0.0–31.0 0.0–39.1 0.0–23.9 0.0–18.6 0.0–22.4 0.0–12.9 0.0–10.7 0.0–12.3 0.0–27.0 0.0–20.4 0.0–25.2 0.0–12.3 0.0–10.3 0.0–11.7 0.0–0.7 0.0–0.3 0.0–0.5

Limit consumption of processed foods 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69

Look at the salt or sodium content on food labels

Buy low salt/sodium alternatives

Use spices other than salt when cooking

Avoid eating foods prepared outside of a home

Do other things specifically to control your salt intake

Table 7.7: Type of oil or fat most often used for meal preparation in household % n Vege– (house– table holds) oil 723 95% CI % Lard 95% CI % % % none in % 95% Marg– 95% CI 95% CI None Butter CI particular arine used 0.0 – 0.3 0.0 – 0.9 2.3 0.0 – 4.6 0.5 95% CI 0.0 – 1.1 % Other 3.0 95% CI 0.9 – 5.1

93.4 90.0 – 96.7 0.4 0.0 – 0.9

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 7.8: Mean number of meals eaten outside a home Age Group (years) 18–44 45–69 18–69 Men n 494 399 893 Mean 0.5 0.1 0.3 95% CI 0.1–0.9 0.0–0.2 0.0–0.7 n 815 401 1216 Women Mean 0.8 0.2 0.7 95% CI 0.4–1.1 0.1–0.3 0.3–1.1 n 1309 800 2109 Both Sexes Mean 0.6 0.1 0.5 95% CI 0.5–0.7 0.0–0.3 0.4–0.6

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Physical activity Table 8.1: Metabolic Equivalent (MET) Domain Work Transport Recreation MET value • Moderate MET value = 4.0 • Vigorous MET value = 8.0 Cycling and walking MET value = 4.0 • Moderate MET value = 4.0 • Vigorous MET value = 8.0

Table 8.2: Not meeting WHO recommendations on physical activity for health Age Group (years) 18–44 45–69 18–69 Men n 526 419 945 % 17.9 4.8 12.8 95% CI 15.2–20.5 0.0–11.9 7.6–18.0 n 908 447 1355 Women % 22.2 28.9 23.3 95% CI 8.5–36.0 23.4–34.4 10.9–35.7 n 1434 866 2300 Both Sexes % 19.8 9.7 16.7 95% CI 12.5–27.1 0.0–21.2 7.8–25.6

Table 8.3: Level of total physical activity according to former recommendations Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 1434 866 2300 28.4 33.5 30.0 18.7–38.2 31.3–35.7 23.0–37.0 25.2 14.5 22.0 18.6–31.8 12.4–16.5 18.3–25.7 46.3 52.0 48.1 42.6–50.1 48.6–55.4 44.3–51.8 908 447 1355 35.4 41.0 36.3 23.1–47.8 34.9–47.1 25.2–47.5 47.8 18.3 42.9 20.5–75.0 14.2–22.3 16.5–69.3 16.8 40.7 20.8 1.4–32.3 34.4–47.1 4.9–36.7 526 419 945 22.8 31.6 26.2 15.7–29.9 29.4–33.8 23.0–29.3 7.2 13.5 9.6 0.0–15.1 12.2–14.7 5.1–14.1 70.0 54.9 64.2 55.5–84.5 53.0–56.8 57.0–71.4 n % Low 95% CI % Moderate 95% CI % High 95% CI

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 8.4: Minutes spent on total physical activity on average per day Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 1434 866 2300 134.9 121.1 130.7 121.7–148.1 102.7–139.5 124.0–137.4 98.6 71.1 85.7 32.1–200.0 34.3–183.4 34.3–199.3 908 447 1355 79.8 122.5 86.8 58.8–100.7 103.0–142.0 63.7–110.0 42.9 58.3 47.1 25.7–102.9 12.9–184.3 21.4–102.9 526 419 945 179.1 120.8 156.7 148.8–209.3 99.1–142.4 148.9–164.5 186.4 71.1 154.3 51.4–278.6 34.3–183.4 34.3–248.6 n Mean 95% CI Median Inter-quartile range (P25–P75)

Table 8.5: Mean minutes of physical activity on average per day Age Group (years) 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 Men n Mean 95% CI n Women Mean 95% CI n Both Sexes Mean 95% CI

Work-related 526 419 945 526 419 945 526 419 945 158.9 109.9 140.1 9.9 9.9 9.9 10.3 1.0 6.7 121.2–196.6 93.4–126.4 908 447 64.2 107.2 71.3 13.7 13.0 13.6 1.9 2.3 1.9 43.7–84.6 88.4–126.0 48.5–94.0 11.6–15.9 9.7–16.3 11.5–15.7 0.0–3.8 0.6–3.9 0.3–3.6 1434 866 2300 1434 866 2300 1434 866 2300 116.8 109.3 114.5 11.6 10.5 11.3 6.5 1.3 4.9 100.1–133.4 95.9–122.8 105.5–123.5 8.7–14.4 6.6–14.4 8.1–14.4 4.2–8.9 0.0–2.9 2.7–7.2

126.8–153.4 1355 4.1–15.7 6.0–13.7 4.9–14.9 6.8–13.7 0.0–2.7 3.3–10.1 908 447 1355 908 447 1355

Transport-related

Recreation-related

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 8.6: Median minutes of physical activity on average per day Men Age Group (years) n Median Interquartile range (P25–P75) 25.7–259.3 34.3– 183.4 34.3–214.3 0.0–12.9 0.0–17.1 0.0–12.9 0.0–19.3 0.0–0.0 0.0–0.0 n Women Median Interquartile range (P25–P75) 20.6–68.6 0.0–171.4 17.1–68.6 0.0–25.7 0.0–17.1 0.0–25.7 0.0–0.0 0.0–0.0 0.0–0.0 n Both Sexes Median Interquartile range (P25–P75) 20.6–188.6 34.3–183.4 25.7–188.6 0.0–17.1 0.0–17.1 0.0–17.1 0.0–0.0 0.0–0.0 0.0–0.0

Work-related 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 526 419 945 526 419 945 526 419 945 169.3 71.1 120.0 0.0 0.0 0.0 0.0 0.0 0.0 908 447 1355 908 447 1355 908 447 1355 34.3 38.6 34.3 6.4 0.0 5.7 0.0 0.0 0.0 1434 866 2300 1434 866 2300 1434 866 2300 68.6 71.1 68.6 0.0 0.0 0.0 0.0 0.0 0.0

Transport-related

Recreation-related

Table 8.7: Percentage of respondents not doing minimum recommended (at least 10 minutes) physical activity (work-, transport- and recreation-related) Age Group (years) 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 Men n % 95% CI n Women % 95% CI n Both Sexes % 95% CI

No work-related physical activity 526 419 945 526 419 945 526 419 945 10.3 5.4 8.4 60.2 61.5 60.7 65.2 97.8 77.7 0.0–21.5 0.0–13.6 0.0–18.8 52.1–68.2 56.4–66.6 53.8–67.6 56.6–73.7 94.4–100.0 75.6–79.8 908 447 1355 908 447 1355 908 447 1355 15.0 25.3 16.7 43.9 61.4 46.8 94.9 95.4 95.0 1.1–28.8 19.9–30.7 3.8–29.6 24.1–63.7 55.1–67.7 28.0–65.6 90.1–99.8 93.1–97.8 91.0–99.0 1434 866 2300 1434 866 2300 1434 866 2300 12.4 9.5 11.5 52.9 61.5 55.5 78.4 97.3 84.1 0.0–24.8 0.0–20.8 0.0–23.7 48.1–57.8 57.0–65.9 52.9–58.1 74.3–82.5 94.0–100.0 82.3–85.9

No transport-related physical activity

No recreation-related physical activity

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 8.8: Contribution of work-, transport- and recreation-related physical activity to total activity Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both sexes 18–44 45–69 18–69 1188 718 1906 81.0 88.0 83.1 73.4–88.7 81.3–94.6 75.5–90.7 13.8 10.7 12.9 9.8–17.9 5.7–15.8 8.5–17.3 5.2 1.3 4.0 1.3–9.0 0.0–3.1 0.6–7.3 733 356 1089 77.3 79.9 77.7 75.2–79.4 76.2–83.5 76.0–79.4 20.0 17.4 19.6 17.8–22.2 13.9–20.8 17.4–21.8 2.7 2.8 2.7 0.0–5.6 0.7–4.9 0.2–5.2 455 362 817 83.9 89.7 86.2 71.6–96.2 84.3–95.1 76.1–96.3 9.1 9.3 9.2 1.4–16.7 5.4–13.2 3.1–15.3 7.0 1.0 4.7 2.1–11.9 0.0–2.6 0.5–8.8 % Activity from work % Activity for transport % Activity during leisure time

95% CI

Table 8.9: Percentage of respondents not engaging in vigorous physical activity Age Group (years) 18–44 45–69 18–69 Men n 526 419 945 % 26.9 60.9 39.9 95% CI 15.6–38.2 50.4–71.4 38.0–41.9 n 908 447 1355 Women % 75.5 62.6 73.3 95% CI 66.4–84.6 56.2–69.0 64.0–82.6 n 1434 866 2300 Both Sexes % 48.5 61.2 52.4 95% CI 44.1–52.9 53.2–69.3 50.6–54.1

Table 8.10: Minutes spent in sedentary activity on a typical day Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both sexes 18–44 45–69 18–69 92

Mean

95% CI

Median

Interquartile range (P25–P75) 60.0–150.0 35.0–123.0 60.0–150.0 60.0–134.0 60.0–150.0 60.0–140.0 60.0–141.0 35.0–123.0 60.0–141.0

601 479 1080 1018 502 1520 1619 981 2600

107.7 87.8 101.0 96.6 113.5 99.5 103.2 93.4 100.5

94.2–121.1 78.2–97.5 95.8–106.2 86.5–106.6 102.3–124.7 88.9–110.0 97.4–109.1 79.4–107.4 97.6–103.3

120.0 60.0 120.0 60.0 90.0 60.0 120.0 60.0 62.0

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Overweight and obesity Height and weight measurement (Step 2) Table 9.1: Mean height (cm) among all respondents Age Group (years) 18–44 45–69 18–69 Men n 585 464 1049 Mean 159.4 156.8 158.7 95% CI 157.5–161.3 155.1–158.6 156.8–160.6 n 952 490 1442 Women Mean 153.4 150.5 152.9 95% CI 151.7–155.1 149.8–151.3 151.1–154.7

Table 9.2: Mean weight (kg) among all respondents Age Group (years) 18–44 45–69 18–69 Men n 584 464 1048 Mean 53.4 54.3 53.7 95% CI 52.5–54.2 53.2–55.5 53.2–54.1 n 950 490 1440 Women Mean 49.5 47.7 49.1 95% CI 48.9–50.0 46.3–49.1 48.5–49.8

Table 9.3: Mean BMI (kg/m2) among all respondents Age Group (years) 18–44 45–69 18–69 Men n 582 463 1045 Mean 21.0 22.2 21.3 95% CI 20.8–21.2 21.2–23.2 20.9–21.8 n 942 481 1423 Women Mean 21.0 21.0 21.0 95% CI 20.7–21.3 20.5–21.5 20.7–21.3 n 1524 944 2468 Both Sexes Mean 21.0 21.9 21.2 95% CI 20.9–21.1 20.9–22.9 21.0–21.5

Table 9.4: Percentage of respondents (excluding pregnant women) in each BMI category Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 942 481 1423 32.4 26.4 31.3 18.1–46.6 21.7–31.1 18.8–43.9 50.0 61.4 52.0 31.7–68.3 56.7–66.2 35.4–68.6 16.7 8.9 15.4 11.7–21.8 5.8–12.1 10.2–20.6 0.9 3.2 1.3 0.0–1.8 1.0–5.5 0.2–2.4 582 463 1045 12.3 8.4 11.2 4.3–20.3 0.0–19.2 2.4–20.0 84.5 70.6 80.6 72.8–96.3 67.2–74.0 71.7–89.6 2.4 20.5 7.5 0.0–5.5 12.0–29.1 6.4–8.6 0.7 0.5 0.7 0.0–1.7 0.0–1.2 0.0–1.5 % Under– weight <18.5 % Normal weight 18.5–24.9 % Overweight 25.0–29.9 % Obese >30.0

95% CI

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Age Group (years)

% Under– weight <18.5 20.2 13.1 18.5

95% CI

% Normal weight 18.5–24.9

95% CI

% Overweight 25.0–29.9

95% CI

% Obese >30.0

95% CI

Both Sexes 18–44 45–69 18–69 1524 944 2468 18.6–21.8 0.7–25.5 15.0–21.9 71.0 68.2 70.3 68.2–73.8 63.6–72.9 67.2–73.5 8.1 17.5 10.3 6.8–9.3 8.3–26.7 8.8–11.9 0.8 1.2 0.9 0.0–1.7 0.0–2.5 0.0–1.8

Table 9.5: Percentage of respondents (excluding pregnant women) classified as overweight (BMI>25) Age Group (years) 18–44 45–69 18–69 Men n 582 463 1045 % 3.2 21.0 8.2 95% CI 0.0–7.1 13.0–29.0 7.2–9.1 n 942 481 1423 % 17.6 12.1 16.7 Women 95% CI 13.3–22.0 8.6–15.7 12.4–21.0 n 1524 944 2468 Both Sexes % 8.8 18.7 11.2 95% CI 6.9–10.8 10.6–26.8 10.3–12.2

Table 9.6: Mean waist circumference (cm) and hip circumference (cm) among all respondents (excluding pregnant women) Age Group (years) Waist circumference 18–44 45–69 18–69 Hip circumference 18–44 45–69 18–69 578 463 1041 72.9 85.9 76.5 63.1–82.7 84.9–86.9 69.9–83.1 948 485 1433 83.4 85.4 83.7 81.3–85.5 84.0–86.8 81.7–85.7 578 463 1041 68.3 79.0 71.3 62.9–73.8 77.6–80.5 68.0–74.7 948 486 1434 77.5 76.5 77.4 75.7–79.3 75.1–77.8 75.7–79.0 Men n Mean 95% CI n Women Mean 95% CI

Table 9.7: Mean waist to hip ratio among all respondents (excluding pregnant women) Age Group (years) 18–44 45–69 18–69 Men n 578 463 1041 Mean 0.9 0.9 0.9 95% CI 0.9–1.0 0.9–0.9 0.9–1.0 n 948 485 1433 Women Mean 0.9 0.9 0.9 95% CI 0.9–1.0 0.9–0.9 0.9–1.0

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Blood pressure Table 10.1: Blood pressure measurement and diagnosis of hypertension Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 18–44 45–69 18–69 1017 502 1519 1618 981 2599 83.7 60.4 79.7 89.2 82.5 87.3 69.6–97.7 54.6–66.3 65.2–94.1 77.9–100.0 62.7–100.0 73.8–100.0 12.8 24.1 14.8 8.4 10.6 9.0 1.8–23.9 19.3–28.9 4.2–25.3 0.0–17.2 0.0–22.6 0.0–18.6 0.8 4.0 1.4 0.5 1.7 0.8 0.0–1.7 1.8–6.3 0.3–2.5 0.0–1.0 0.0–3.8 0.0–1.7 2.7 11.4 4.2 1.9 5.2 2.8 0.2–5.1 8.0– 14.8 1.1–7.2 0.0–4.0 0.0– 11.1 0.0–5.9 601 479 1080 92.9 88.5 91.5 84.6–100.0 72.0–100.0 80.7–100.0 5.4 6.9 5.9 0.0–11.8 0.0–16.9 0.0–13.4 0.2 1.1 0.5 0.0–0.5 0.0–2.8 0.0–1.2 1.4 3.5 2.1 0.0–3.3 0.0–8.6 0.0–4.9 % Measured, not diagnosed % Diagnosed, but not 95% CI within past 12 months % Diagnosed within past 12 months

% Never measured

95% CI

Both sexes

Table 10.2: Percentage of respondents currently taking blood pressure drugs prescribed by doctor or health worker, among those diagnosed Age Group (years) 18–44 45–69 18–69 Men n 29 73 102 % 45.0 47.8 46.6 95% CI 21.9–68.2 33.3–62.2 34.1–59.1 n 72 72 144 Women % 37.8 60.5 48.7 95% CI 24.7–50.9 46.7–74.4 38.3–59.1 n 101 145 246 Both Sexes % 40.8 53.9 47.7 95% CI 28.9–52.7 43.4–64.4 39.6–55.9

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 10.3: Percentage of previously diagnosed hypertensive respondents who have visited or received treatment from a traditional healer Age Group (years) Men n 29 73 102 29 73 102 % 17.6 17.4 17.5 46.0 34.0 39.0 95% CI 2.7–32.6 5.1–29.8 8.3–26.8 21.3–70.7 19.0–48.9 24.8–53.2 n 72 72 144 72 72 144 Women % 9.8 20.0 14.6 29.1 41.4 35.0 95% CI 2.5–17.0 9.9–30.0 7.5–21.8 18.7–39.5 30.0–52.7 26.5–43.5 n 101 145 246 101 145 246 Both Sexes % 13.0 18.6 16.0 36.1 37.5 36.9 95% CI 5.3–20.8 10.1–27.2 9.6–22.3 22.0–50.2 28.6–46.5 28.2–45.5

Seen a traditional healer 18–44 45–69 18–69 18–44 45–69 18–69

Currently taking herbal or traditional remedies for high blood pressure

Blood pressure measurement Table 10.4: Mean systolic and diastolic blood pressure (mmHg), including those currently on medication for raised blood pressure Age Group (years) 18–44 45–69 18–69 18–44 45–69 18–69 Men n Mean 95% CI n Women Mean 95% CI n Both Sexes Mean 95% CI

Mean systolic blood pressure (mmHg) 595 471 1066 595 471 1066 134.6 130.1 133.1 87.3 75.9 83.5 124.3–144.8 128.6–131.6 126.9–139.2 80.0–94.5 71.7–80.1 80.7–86.2 1011 495 1506 1011 495 1506 119.6 130.1 121.4 82.2 82.9 82.4 118.3–120.9 127.9–132.3 120.7–122.2 79.4–85.1 81.6–84.2 80.1–84.7 1606 966 2572 1606 966 2572 128.6 130.1 129.0 85.3 77.4 83.1 120.8–136.4 128.9–131.4 123.7–134.4 79.4–91.1 72.4–82.4 80.4–85.8

Mean diastolic blood pressure (mmHg)

Table 10.5: Percentage of respondents with raised blood pressure Age Group (years) Men n 588 449 1037 595 471 1066 % 47.9 38.7 44.8 48.2 39.7 45.3 95% CI 20.3–75.5 35.7–41.7 26.1–63.6 21.0–75.3 37.7–41.6 27.3–63.3 n 991 475 1466 1011 495 1506 Women % 26.0 31.5 26.9 26.7 34.4 28.0 95% CI 16.5–35.5 26.9–36.0 19.6–34.3 17.8–35.6 29.8–39.1 21.5–34.5 n 1579 924 2503 1606 966 2572 Both Sexes % 39.2 37.2 38.6 39.6 38.5 39.3 95% CI 17.2–61.2 33.0–41.3 21.7–55.6 18.1–61.0 35.8–41.3 23.2–55.4

SBP >140 and/or DBP > 90 mmHg, excluding those on medication for raised blood pressure 18–44 45–69 18–69 18–44 45–69 18–69

SBP >140 and/or DBP > 90 mmHg or currently on medication for raised blood pressure

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Age Group (years)

Men n 588 449 1037 595 471 1066 % 8.7 3.6 7.0 9.2 5.1 7.8 95% CI 5.4–12.1 0.0–8.8 6.4–7.6 6.3–12.1 0.0–12.4 6.7–8.9 n 991 475 1466 1011 495 1506

Women % 2.6 12.5 4.2 3.4 16.3 5.6 95% CI 0.2–4.9 9.1–15.8 1.1–7.3 0.4–6.5 12.6–20.0 1.5–9.7 n 1579 924 2503 1606 966 2572

Both Sexes % 6.3 5.4 6.0 6.9 7.5 7.0 95% CI 4.6–7.9 0.0–11.8 5.3–6.8 5.8–8.0 0.0–16.0 5.3–8.8

SBP >160 and/or DBP > 100 mmHg, excluding those on medication for raised blood pressure 18–44 45–69 18–69 18–44 45–69 18–69

SBP >160 and/or DBP > 100 mmHg or currently on medication for raised blood pressure

Table 10.6: Percentage of respondents with treated controlled raised blood pressure, among those with raised blood pressure (SBP>140 and/or DBP>90 mmHg) or currently on medication for raised blood pressure Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 18–44 45–69 18–69 226 178 404 342 352 694 1.2 4.7 2.0 0.7 2.2 1.1 0.0–3.0 0.4–9.1 0.0–4.1 0.0–1.9 0.0–5.1 0.0–2.8 2.1 7.9 3.3 0.9 3.4 1.6 0.0–5.0 3.4–12.4 0.0–6.7 0.0–2.6 0.0–7.7 0.0–4.1 96.6 87.4 94.7 98.4 94.4 97.3 92.4–100.0 80.8–93.9 89.4–100.0 95.7–100.0 87.4–100.0 93.2–100.0 116 174 290 0.5 1.6 0.8 0.0–1.5 0.0–4.2 0.0–2.3 0.5 2.3 1.0 0.0–1.6 0.0–6.0 0.0–2.9 99.0 96.1 98.1 97.1–100.0 90.0–100.0 95.0–100.0 % On medication and SBP<140 and DBP<90 % On medication and SBP>140 and/ or DBP>90 % Not on medication and SBP>140 and/or DBP>90

95% CI

Both Sexes

Table 10.7: Mean heart rate (beats per minute) among all respondents Age Group (years) 18–44 45–69 18–69 Men n 595 471 1066 Mean 72.9 77.6 74.5 95% CI 72.5–73.4 75.3–79.9 73.4–75.6 n 1011 495 1506 Women Mean 78.4 77.5 78.3 95% CI 76.5–80.3 76.3–78.6 76.8–79.7 n 1606 966 2572 Both Sexes Mean 75.1 77.6 75.8 95% CI 73.9–76.3 75.7–79.4 75.4–76.2

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Blood glucose Table 11.1: Blood glucose measurement and diagnosis of diabetes mellitus Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 18–44 45–69 18–69 1018 501 1519 1619 980 2599 99.2 96.5 98.8 99.4 98.4 99.2 98.5–100.0 94.5–98.5 97.8–99.8 98.8–100.0 96.5–100.0 98.2–100.0 0.4 2.6 0.8 0.4 1.1 0.6 0.0–0.9 0.9–4.4 0.1–1.5 0.0–0.8 0.0–2.5 0.0–1.3 0.2 0.2 0.2 0.1 0.1 0.1 0.0–0.4 0.0–0.7 0.0–0.4 0.0–0.2 0.0–0.3 0.0–0.2 0.2 0.6 0.2 0.1 0.4 0.2 0.0–0.4 0.0–1.3 0.0–0.5 0.0–0.3 0.0–0.9 0.0–0.4 601 479 1080 99.6 98.9 99.4 99.0–100.0 97.3–100.0 98.5–100.0 0.4 0.7 0.5 0.0–0.9 0.0–1.8 0.0–1.1 0.0 0.1 0.0 0.0–0.0 0.0–0.2 0.0–0.1 0.1 0.3 0.2 0.0–0.2 0.0–0.9 0.0–0.4 % % % Diagnosed, Measured, Diagnosed 95% CI but not 95% CI 95% CI not within past within past diagnosed 12 months 12 months

% Never measured

95% CI

Both sexes

Table 11.2: Percentage of respondents currently oral medication and insulin, among those previously diagnosed: Both sexes Age Group (years) Taking oral drugs 18–44 45–69 18–69 Taking insulin 18–44 45–69 18–69 6 9 15 0.0 17.2 8.3 0.0–0.0 0.0–45.4 0.0–22.3 6 10 16 37.6 50.2 44.2 0.0–83.9 15.6–84.8 15.4–73.0 n % 95% CI

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 11.3: Percentage of respondents who have sought advise or treatment from a traditional healer for diabetes among those previously diagnosed: Both sexes Age Group (years) Seen a traditional healer 18–44 45–69 18–69 18–44 45–69 18–69 6 9 15 6 9 15 26.1 0.0 13.5 22.7 6.8 15.0 0.0–63.9 – 0.0–33.9 0.0–65.9 0.0–22.1 0.0–39.9 n % 95% CI

Currently taking herbal or traditional treatment

Biochemical measurements Table 11.4: Mean fasting plasma glucose (mmol/L) among all respondents Age Group (years) 18–44 45–69 18–69 Men n 550 444 994 Mean 4.2 4.9 4.4 95% CI 4.1–4.3 4.5–5.3 4.3–4.6 n 961 469 1430 Women Mean 4.0 4.4 4.1 95% CI 3.9–4.2 4.2–4.7 4.0–4.3 n 1511 913 2424 Both Sexes Mean 4.2 4.8 4.3 95% CI 4.1–4.2 4.4–5.2 4.2–4.4

Table 11.5: Mean fasting plasma glucose (mg/dl) among all respondents, including those currently on medication for raised blood pressure Age Group (years) 18–44 45–69 18–69 Men n 550 444 994 Mean 76.1 88.8 79.7 95% CI 74.7–77.4 81.8–95.8 76.7–82.6 n 961 469 1430 Women Mean 72.8 79.9 74.0 95% CI 70.8–74.8 76.0–83.8 71.4–76.6 n 1511 913 2424 Both Sexes Mean 74.8 86.6 77.6 95% CI 74.1–75.5 79.1–94.0 75.8–79.4

Table 11.6: Impaired fasting glycaemia among all respondents (plasma Venous Value >110mg/dl and <126mg/dl) Age Group (years) 18–44 45–69 18–69 Men n 550 444 994 % 19.1 1.1 5.7 95% CI 5.5–32.8 0.0–2.6 3.0-8.5 n 961 469 1430 Women % 14.2 1.4 1.2 95% CI 0.8–27.6 0.3–2.5 0.2-2.2 n 1511 913 2424 Both Sexes % 17.2 1.1 4.1 95% CI 3.3–31.1 0.0–2.4 2.2-6.1

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

Table 11.7: Raised blood glucose (plasma Venous Value >126mg/dl) or currently on medication for diabetes Age Group (years) 18–44 45–69 18–69 Men n 550 444 994 % 2.1 20.5 1.5 95% CI 0.0–4.8 11.8–29.2 0.0-3.5 n 961 469 1430 Women % 2.1 6.3 1.6 95% CI 0.1–4.0 3.9–8.7 0.3-2.9 n 1511 913 2424 Both Sexes % 2.1 16.9 1.5 95% CI 0.0–4.4 7.0–26.9 0.0-3.2

Table 11.8: Percentage of respondents currently on medication for diabetes Age Group (years) 18–44 45–69 18–69 Men n 602 481 1083 % 0.8 0.3 0.6 95% CI 0.0–2.1 0.0–0.7 0.0–1.6 n 1022 504 1526 Women % 0.2 0.8 0.3 95% CI 0.0–0.5 0.0–1.7 0.0–0.6 n 1624 985 2609 Both Sexes % 0.6 0.4 0.5 95% CI 0.0–1.4 0.0–0.9 0.0–1.2

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Abnormal lipids Table 12.1: Total cholesterol measurement and diagnosis Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 18–44 45–69 18–69 1018 501 1519 1619 979 2598 99.1 96.1 98.6 99.4 98.8 99.3 98.2–100.0 93.8–98.4 97.4–99.8 98.8–100.0 97.3–100.0 98.4–100.0 0.5 2.4 0.8 0.3 0.7 0.4 0.0–1.0 0.7–4.0 0.1–1.5 0.0–0.7 0.0–1.7 0.0–1.0 0.1 0.4 0.2 0.1 0.2 0.1 0.0–0.3 0.0–1.1 0.0–0.4 0.0–0.1 0.0–0.4 0.0–0.2 0.3 1.1 0.4 0.2 0.3 0.2 0.0–0.6 0.0–2.5 0.0–0.9 0.0–0.4 0.0–0.8 0.0–0.5 601 478 1079 99.7 99.5 99.6 99.2–100.0 98.7–100.0 99.1–100.0 0.2 0.3 0.3 0.0–0.6 0.0–0.8 0.0–0.6 0.0 0.1 0.0 0.0–0.0 0.0–0.3 0.0–0.1 0.1 0.1 0.1 0.0–0.2 0.0–0.3 0.0–0.2 % % % Diagnosed, Measured, Diagnosed 95% CI but not 95% CI 95% CI not within past within past diagnosed 12 months 12 months

% Never measured

95% CI

Both sexes

Table 12.2: Percentage of respondents currently taking oral treatment (medication) prescribed for raised total cholesterol among those previously diagnosed: Both sexes Age Group (years) 18–44 45–69 18–69 n 11 8 19 % 38.4 40.7 39.5 95% CI 16.6–60.2 7.3–74.2 18.3–60.7

Table 12.3: Percentage of respondents who have sought advise or treatment form a traditional healer for raised cholesterol among those previously diagnosed: Both sexes Age Group (years) n % 95% CI

Seen a traditional healer 18–44 45–69 18–69 11 8 19 12.6 28.2 19.6 0.0–34.2 0.0–64.0 0.0–39.2

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Age Group (years) Taking herbal or traditional treatment 18–44 45–69 18–69

95% CI

11 8 19

5.5 28.2 15.7

0.0–18.0 0.0–64.0 0.0–34.1

Biochemical measurement Table 12.4: Mean total cholesterol (mmol/L) among all respondents, including those currently on medication for raised cholesterol Age Group (years) 18–44 45–69 18–69 Men n 569 449 1018 Mean 3.6 4.0 3.7 95% CI 3.5–3.6 3.8–4.3 3.6–3.8 n 982 483 1465 Women Mean 4.2 4.1 4.2 95% CI 3.8–4.6 4.0–4.2 3.8–4.5 n 1551 932 2483 Both Sexes Mean 3.8 4.1 3.9 95% CI 3.7–4.0 3.9–4.2 3.7–4.0

Table 12.5: Mean total cholesterol (mg/dl) among all respondents, including those currently on medication for raised cholesterol Age Group (years) 18–44 45–69 18–69 Men n 569 449 1018 Mean 138.7 156.6 143.7 95% CI 136.7–140.8 147.5–165.6 139.7–147.8 n 982 483 1465 Women Mean 161.2 158.3 160.7 95% CI 146.0–176.3 153.4–163.3 147.7–173.7 n 1551 932 2483 Both Sexes Mean 147.6 157.0 149.9 95% CI 142.5–152.8 150.5–163.5 144.7–155.1

Table 12.6: Percentage of respondents with raised total cholesterol or on medication for raised cholesterol Age Group (years) 18–44 45–69 18–69 18–44 45–69 18–69 Men n % 95% CI n Women % 95% CI n Both Sexes % 95% CI

Total cholesterol > 5.0 mmol/L or > 190 mg/dl or currently on medication for raised cholesterol 569 449 1018 569 449 1018 16.0 24.9 18.5 7.3 0.8 5.5 8.1–23.9 14.5–35.4 9.8–27.2 2.5–12.1 0.0–1.9 2.4–8.5 982 483 1465 982 483 1465 26.6 20.0 25.5 4.9 4.9 4.9 11.4–41.8 15.4–24.7 12.0–39.0 2.7–7.1 2.6–7.2 3.0–6.8 1551 932 2483 1551 932 2483 20.2 23.7 21.0 6.3 1.8 5.3 10.3–30.1 14.6–32.7 11.4–30.6 2.4–10.3 0.0–3.7 2.6–7.9

Total cholesterol > 6.2 mmol/L or > 240 mg/dl or currently on medication for raised cholesterol

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Combined risk factors and cardiovascular disease risk prediction Table 13.1: Summary of Combined Risk Factors Age Group (years) Men 18–44 45–69 18–69 Women 18–44 45–69 18–69 Both Sexes 18–44 45–69 18–69 1284 788 2072 6.1 12.8 7.8 4.4–7.8 5.0–20.7 6.4–9.3 77.6 59.0 72.8 75.6–79.6 46.0–72.0 68.3–77.2 16.3 28.2 19.4 13.5–19.1 22.8–33.5 16.1–22.7 795 408 1203 4.0 5.5 4.2 0.0–8.1 3.1–7.9 0.6–7.9 79.3 78.4 79.1 77.1–81.5 74.1–82.8 77.1–81.1 16.7 16.1 16.6 11.3–22.1 12.1–20.1 12.0–21.3 489 380 869 7.7 15.2 10.1 5.8–9.5 8.0–22.3 6.7–13.4 76.3 52.9 68.8 73.7–78.9 44.1–61.6 63.7–73.9 16.0 32.0 21.1 14.2–17.8 29.6–34.3 19.0–23.3 n % with 0 risk factors 95% CI % with 1–2 risk factors 95% CI % with 3–5 risk factors 95% CI

Table 13.2: Percentage of respondents having ever had a heart attack or chest pain from heart disease or a stroke Age Group (years) 18–44 45–69 18–69 Men n 601 478 1079 % 0.2 0.7 0.4 95% CI 0.0–0.5 0.0–1.8 0.0–0.9 n 1018 501 1519 Women % 0.6 2.4 0.9 95% CI 0.0–1.3 0.9–3.9 0.1–1.7 n 1619 979 2598 Both Sexes % 0.3 1.0 0.5 95% CI 0.0–0.8 0.0–2.3 0.0–1.2

Table 13.3: Percentage of respondents currently taking aspirin/statins regularly to prevent or treat heart disease Age Group (years) Men n % 95% CI n Women % 95% CI n Both Sexes % 95% CI

Taking aspirin 18–44 45–69 18–69 601 478 1079 0.1 0.1 0.1 0.0–0.3 0.0–0.4 0.0–0.3 1018 501 1519 0.1 0.4 0.2 0.0–0.4 0.0–0.9 0.0–0.4 1619 979 2598 0.1 0.2 0.1 0.0–0.3 0.0–0.5 0.0–0.3

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Age Group (years)

Men n % 95% CI n

Women % 95% CI n

Both Sexes % 95% CI

Taking statins 18–44 45–69 18–69 601 478 1079 0.1 0.1 0.1 0.0–0.2 0.0–0.3 0.0–0.2 1018 501 1519 0.3 0.2 0.3 0.0–0.6 0.0–0.5 0.0–0.6 1619 979 2598 0.2 0.1 0.2 0.0–0.4 0.0–0.3 0.0–0.3

Table 13.4: Percentage of respondents with a 10–year CVD risk >30% or with existing CVD Age Group (years) 40–54 55–69 40–69 Men n 337 243 580 % 1.0 0.8 0.9 95% CI 0.0–2.5 0.0–2.0 0.0–2.2 n 416 241 657 Women % 1.7 5.2 2.9 95% CI 0.4–3.1 2.2-8.2 1.5-4.1 n 753 484 1237 Both Sexes % 1.3 1.6 1.4 95% CI 0.1–2.4 0.0–3.6 0.0–2.9

Table 13.5: Percentage of eligible persons (defined as aged 40-69 years with a 10-year cardiovascular disease (CVD) risk ≥30%, including those with existing CVD) receiving drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes. Age Group (years) 40–54 55–69 40–69 Men n 7 7 14 % 24.7 38.1 30.3 95% CI 0.0–62.2 0.0–85.8 0.1–60.6 n 7 12 19 Women % 38.8 57.1 49.6 95% CI 0.0–79.3 24.7-89.5 22.2-77.1 n 14 19 33 Both Sexes % 30.8 49.6 40.3 95% CI 4.7–56.9 22.4-76.7 19.9-60.7

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Lifestyle advice by health care provider Table 14.1: Advised by doctor or health worker to change life style among all respondents Age Group (years) Men n % advised 19.7 15.3 18.2 16.8 12.7 15.4 15.6 10.9 14.0 13.7 9.9 12.4 14.6 8.7 12.6 10.3 6.5 9.0 95% CI n Women % advised 19.7 36.2 22.5 21.4 39.2 24.5 21.6 33.3 23.6 17.1 28.6 19.1 18.0 25.6 19.3 14.7 19.7 15.6 95% CI n Both Sexes % advised 19.7 19.8 19.7 18.7 18.4 18.6 18.0 15.7 17.4 15.1 13.9 14.8 16.0 12.4 15.0 12.1 9.3 11.3 95% CI

Quit using tobacco or don’t start 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 18–44 45–69 18–69 601 478 1079 601 478 1079 601 478 1079 601 478 1079 601 478 1079 601 478 1079 0.0–43.0 0.0–37.2 0.0–41.3 0.0–36.8 0.0–30.9 0.0–35.0 0.0–34.1 0.0–26.6 0.0–31.8 0.0–30.0 0.0–24.1 0.0–28.2 0.0–32.0 0.0–21.3 0.0–28.7 0.0–22.6 0.0–15.9 0.0–20.6 1018 501 1519 1018 501 1519 1018 501 1519 1018 501 1519 1018 501 1519 1018 501 1519 2.7–36.7 30.9–41.5 6.4–38.6 3.0–39.8 33.5–44.9 7.0–41.9 2.9–40.3 27.7–38.9 6.7–40.6 2.2–32.0 23.1–34.0 5.3–32.9 2.4–33.6 19.9–31.3 5.4–33.3 1.8–27.6 14.5–24.8 4.1–27.0 1619 979 2598 1619 979 2598 1619 979 2598 1619 979 2598 1619 979 2598 1619 979 2598 0.0–40.4 0.0–42.1 0.0–40.8 0.0–38.3 0.0–39.1 0.0–38.5 0.0–37.0 0.0–33.5 0.0–36.0 0.0–31.0 0.0–29.6 0.0–30.6 0.0–32.8 0.0–26.3 0.0–31.0 0.0–24.9 0.0–20.0 0.0–23.5

Reduce salt in the diet

Eat at least five servings of fruit and/or vegetables each day

Reduce fat in the diet

Start or do more physical activity

Maintain a healthy body weight or to lose weight

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Table 14.2: Cervical cancer screening Age Group (years) 18–44 45–69 18–69 Women n 958 449 1407 % ever tested 0.7 0.4 0.7 95% CI 0.0–1.5 0.0–1.0 0.0–1.3

Table 14.3: Cervical cancer screening among women aged 30–49 years Age Group (years) 30–49 Women n 668 % ever tested 1.1 95% CI 0.0–2.3

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Violence and injury Table 15.1: Percentage of drivers or passengers not always using a seat belt during the past 30 days Age Group (years) 18–44 45–69 18–69 Men n 518 380 898 % 96.1 98.8 97.0 95% CI 91.1–100.0 97.0–100.0 92.9–100.0 n 853 395 1248 Women % 98.4 98.1 98.3 95% CI 96.7–100.0 96.5–99.7 96.8–99.9 n 1371 775 2146 Both Sexes % 97.0 98.7 97.5 95% CI 93.5–100.0 97.0–100.0 94.4–100.0

Table 15.2: Percentage of drivers or passengers of a motorcycle or motor-scooter not always using a helmet during the past 30 days Age Group (years) 18–44 45–69 18–69 Men n 513 352 865 % 79.0 92.0 83.0 95% CI 53.1–100.0 80.1–100.0 60.7–100.0 n 779 330 1109 Women % 79.1 83.2 79.7 95% CI 58.6–99.6 77.6–88.8 62.4–96.9 n 1292 682 1974 Both Sexes % 79.1 90.4 81.9 95% CI 55.3–100.0 78.6–100.0 61.0–100.0

Table 15.3: Percentage of cyclists who did not always wear a helmet among those riding a bike in the past 30 days Age Group (years) 18–44 45–69 18–69 Men n 415 310 725 % 94.4 97.6 95.5 95% CI 89.1–99.6 94.0–100.0 90.7–100.0 n 713 329 1042 Women % 94.0 97.4 94.6 95% CI 88.6–99.4 94.2–100.0 90.3–98.9 n 1128 639 1767 Both Sexes % 94.2 97.5 95.1 95% CI 89.0–99.3 94.7–100.0 90.6–99.7

Table 15.4: Percentage of respondents who have been involved in a road traffic crash during the past 12 months Age Group (years) 18–44 45–69 18–69 Men n 586 468 1054 % 4.5 1.9 3.6 95% CI 0.0–10.0 0.0–4.8 0.0–8.3 n 1007 496 1503 Women % 1.7 2.6 1.9 95% CI 0.1–3.3 0.7–4.6 0.4–3.4 n 1593 964 2557 Both Sexes % 3.4 2.1 3.0 95% CI 0.0–7.1 0.0–4.5 0.0–6.3

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Table 15.5: Percentage of respondents seriously injured as a result of road traffic crash among those involved in a road traffic crash in the past 12 months Age Group (years) 18–44 45–69 18–69 Men n 53 30 83 % 44.7 57.3 46.9 95% CI 25.3–64.1 39.8–74.9 31.0–62.8 n 28 11 39 Women % 59.8 56.7 59.0 95% CI 38.0–81.5 29.8–83.7 40.6–77.5 n 81 41 122 Both Sexes % 47.8 57.2 49.6 95% CI 31.7–63.9 41.4–73.0 36.2–62.9

Table 15.6: Percentage of respondents injured in a non-road traffic related accident that required medical attention in the past 12 months Age Group (years) 18–44 45–69 18–69 Men n 592 472 1064 % 2.6 1.9 2.4 95% CI 0.0–5.8 0.0–4.7 0.0–5.4 n 1007 494 1501 Women % 2.1 6.3 2.8 95% CI 0.1–4.1 3.4–9.2 0.6–5.1 n 1599 966 2565 Both Sexes % 2.4 3.0 2.5 95% CI 0.0–5.0 0.0–6.3 0.0–5.3

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Table 15.7: Percentage of respondents who were seriously injured other than road traffic crashes in the past 12 months % Burn 95% CI % Poisoning 95% CI % Cut 95% CI 95% CI 95% CI % Other 3.1 0.0 2.3 0.0 0.0 0.0 2.1 0.0 1.4 0.0–3.6 21.0 11.8–30.2 0.0–0.0 33.1 17.6–48.6 0.0–5.1 15.6 4.7–26.4 1.7 0.0 1.2 0.0–0.0 40.5 25.4–55.7 1.1 0.0–0.0 44.6 25.5–63.7 0.0 0.0–0.0 0.0–3.5 0.0–4.4 0.0–0.0 0.0–3.0 0.0–0.0 37.8 14.7–60.9 1.9 0.0–5.9 8.8 6.6 7.9 3.9 14.4 7.1 0.0–5.9 8.6 2.0–15.1 1.2 0.0–3.8 6.6 0.0–0.0 21.5 3.1–39.8 0.0 0.0–0.0 22.4 0.0–7.8 4.3 0.0–10.8 1.7 0.0–5.1 1.4 0.0–4.4 0.4–44.4 0.2–13.1 0.0–20.4 0.0–16.5 0.0–16.2 0.0–8.2 1.7–27.1 2.1–12.2 11.1 0.0 8.3 0.0 4.5 1.8 7.4 2.3 5.8 % Near drowning % Animal Bites 95% CI

Age Group (years) 0.8 0.0 0.6 2.6 0.0 1.5 1.4 0.0 0.9 0.0–2.4 0.0–0.0 0.0–3.4 0.0–4.8 0.0–0.0 0.0–7.9 0.0–1.7 0.0–0.0 0.0–2.3

% Fall

95% CI

Men 0.0–31.9 0.0–0.0 0.0–24.3 0.0–0.0 0.0–13.7 0.0–5.5 0.0–21.5 0.0–6.9 0.0–15.8

18–44

77.7

56.2–99.1

45–69

56.1

31.6–80.7

18–69

72.3

55.8–88.8

Women

18–44

48.9

26.1–71.7

45–69

44.3

24.7–64.0

18–69

47.1

32.9–61.2

Both Sexes

18–44

68.0

51.8–84.2

45–69

50.2

32.9–67.5

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18–69

117

62.5

50.9–74.2

109

110

Table 15.8: Location of accidental serious injuries among respondents seriously injured in the past 12 months

Age Group (years) 95% CI 95% CI 95% CI % Farm 95% CI 95% CI % other

% Home

% School/ workplace % Sports– Athletic area 95% CI 15.1 32.4 19.4 35.2 13.4 26.8 22.2 22.8 22.4 13.5–31.2 35.0 20.5–49.6 1.3 8.7–36.9 11.2 2.9–19.5 1.7 10.3–34.0 45.4 27.4–63.4 1.2 0.0–3.5 0.0–5.0 0.0–3.2 14.5–39.1 14.9 4.9–24.9 2.1 0.0–6.1 0.0–28.8 4.7 0.0–11.4 0.0 0.0–0.0 0.0 0.0 0.0 0.0 0.0 17.4–53.0 21.3 6.5–36.1 3.3 0.0–9.9 0.0 7.8–31.1 48.3 27.7–69.0 0.8 0.0–2.5 0.0 0.0–0.0 0.0–0.0 0.0–0.0 0.0–0.0 0.0–0.0 0.0–0.0 0.0–0.0 11.9–53.0 17.8 2.5–33.1 3.4 0.0–10.3 0.0 0.0–0.0 2.1–28.1 58.4 34.3–82.5 0.0 0.0–0.0 0.0 0.0–0.0 12.8 0.0 9.6 0.0 3.1 1.2 8.3 1.6 6.2

% Road– Street– Highway

Men 0.6–26.8 22.7–70.1 8.7–35.0 20.5–59.9 62.2–95.6 41.8–68.2 10.2–35.8 46.9–78.6 23.7–46.4 0.0–33.7 0.0–0.0 0.0–25.7 0.0–0.0 0.0–9.4 0.0–3.6 0.0–22.1 0.0–4.7 0.0–16.1

18–44

13.7

45–69

46.4

18–69

21.9

Women

18–44

40.2

45–69

78.9

18–69

55.0

Both Sexes

18–44

23.0

45–69

62.7

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

18–69

120

35.0

Table 15.9: Percentage of respondents who have driven a motorized vehicle after having had 2 or more alcoholic drinks in the past 30 days Age Group (years) 18–44 45–69 18–69 Men n 408 327 735 % 23.8 1.8 14.8 95% CI 15.2–32.3 0.0–4.6 12.6–16.9 n 677 328 1005 Women % 2.6 2.0 2.5 95% CI 0.0–5.7 0.5–3.5 0.0–5.1 n 1085 655 1740 Both Sexes % 13.0 1.9 9.6 95% CI 10.7–15.3 0.0–4.1 8.2–11.0

Table 15.10: Percentage of respondents who rode in a motorized vehicle where the driver has had 2 or more alcoholic drinks in the past 30 days Age Group (years) 18–44 45–69 18–69 Men n 392 323 715 % 20.8 0.9 12.5 95% CI 9.9–31.7 0.0–2.4 9.4–15.7 n 661 326 987 Women % 0.5 0.8 0.5 95% CI 0.0–1.2 0.0–2.0 0.0–1.2 n 1053 649 1702 Both Sexes % 10.3 0.9 7.5 95% CI 6.2–14.4 0.0–2.1 5.2–9.7

Table 15.11: Percentage of respondents involved in a violent incident during the past 12 months resulting in an injury Age Group (years) 18–44 45–69 18–69 Men n 595 473 1068 % 1.5 0.3 1.1 95% CI 0.0–3.6 0.0–0.8 0.0–2.7 n 1011 499 1510 Women % 0.8 0.2 0.7 95% CI 0.0–1.8 0.0–0.6 0.0–1.5 n 1606 972 2578 Both Sexes % 1.2 0.3 1.0 95% CI 0.0–2.7 0.0–0.7 0.0–2.1

Table 15.12: Percentage of respondents who reported being frightened for the safety of themselves or their families because of the anger or threats of another person Age Group (years) 18–44 45–69 18–69 Men n 589 470 1059 % 2.8 0.5 2.0 95% CI 0.0–6.5 0.0–1.3 0.0–4.8 n 997 490 1487 Women % 1.3 2.6 1.6 95% CI 0.0–2.7 0.8–4.5 0.2–2.9 n 1586 960 2546 Both Sexes % 2.2 0.9 1.9 95% CI 0.0–4.8 0.0–2.1 0.0–4.0

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112

Table 15.13: Percentage of respondents frightened by each of the following types of people in past 12 months: Both sexes % Friend or acquaintance 95% CI 0.2–19.4 0.0–15.7 0.7–17.7 4.5 0.0–11.9 8.5 0.0–24.8 20.0 0.0 0.0–0.0 0.0 0.0–0.0 0.0 5.2 0.0–13.7 9.7 0.0–28.4 22.9 95% CI % Stranger 95% CI 95% CI 0.0–46.5 0.0–0.0 0.0–41.0 9.8 5.3 9.2 % Unrelated caregiver % Official or legal authority

Age Group (years)

% Someone within the family

95% CI

18–44

52.4

30.1–74.6

45–69

94.7

84.3–100.0

National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste – 2014

18–69

57.8

37.3–78.4

Annex 2: Survey Instruments Survey Information Location and Date Cluster/Centre/Village ID Cluster/Centre/Village name Interviewer ID Date of completion of the instrument Consent, Interview Language and Name Consent has been read and obtained ☐☐☐☐ Response └─┴─┴─┴─┴─┴─┘ Code I1 I2 I3 I4 Code 1 2 1 2 3 4 I6 If NO, END I5

dd / Response Yes No English

/ year

Interview Language

Tetun Portugese [Others]

Time of interview (24 hour clock) Family Surname First Name Additional Information that may be helpful Contact phone number where possible Step 1 Demographic Information CORE: Demographic Information Question Sex (Record Male / Female as observed) What is your date of birth?

└─┴─┘: └─┴─┘ hrsmins

I8 I9 I10

Response Male Female 1 2

Code C1

/ Don't Know 77 77 7777 How old are you? In total, how many years have you spent at school and in full-time study (excluding pre-school)? dd Years Years mm

/ year

If known, Go to C4

└─┴─┘ └─┴─┘

C3 C4

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No formal schooling Less than primary school (grade 6 not completed) Primary school completed (grade 6 completed) What is the highest level of education you have completed? Pre Secondary school completed (grade 9 completed) Secondary school completed (grade 12 completed) College Diploma completed (1-3 years)

2 3 4 5 6 C5

College/University Completed 7 (4-6 years) Post graduate degree 8 Refused Never married Currently married Separated What is your marital status? Divorced Widowed Cohabitating Refused Government employee Which of the following best describes your mainwork status over the past 12 months? Non-government employee Self-employed Non-paid Student Homemaker Retired Unemployed (able to work) Unemployed (unable to work) Refused How many people older than 18 years, including yourself, live in your household? Taking the past year, can you tell me what the average earnings of the household have been in US$? (RECORD ONLY ONE, NOT ALL 3) Number of people Per week OR per month OR per year Refused 88 1 2 3 4 5 6 88 1 2 3 4 5 6 7 8 9 88 └─┴─┘ └─┴─┴─┴─┴─┴─┴─┘ Go to T1 └─┴─┴─┴─┴─┴─┴─┘ Go to T1 └─┴─┴─┴─┴─┴─┴─┘ Go to T1 88 C9 C10a C10b C10c C10d C8 C7

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Step 1

Behavioural Measurements

CORE: Tobacco Use Now I am going to ask you some questions about tobacco use. Question Do you currently smoke any tobacco products, such as cigarettes, kreteks, tobacco lulun, cigars or pipes? (USE SHOWCARD) Do you currently smoke tobacco products daily? How old were you when you first started smoking? Do you remember how long ago it was? Response Yes No Yes No Age (years) Don’t know 77 In Years OR OR Don’t know 77 On average, how many of the following products do you smoke each day/week? Manufactured cigarettes Hand-rolled cigarette (IF LESS THAN DAILY, RECORD WEEKLY) (tobacco lulun) Pipes full of tobacco Kretek (RECORD FOR EACH TYPE, USE SHOWCARD) Other Other (please specify): Yes No Yes During any visit to a doctor or other health worker in the past 12 months, were you advised to quit smoking tobacco? No No visit during the past 12 months In the past, did you eversmoke any tobacco products? (USE SHOWCARD) Yes No Yes In the past, did you ever smoke daily? No in Months in Weeks └─┴─┘ DAILY↓ WEEKLY↓ T5a/T5aw T5b/T5bw T5c/T5cw T5d/T5dw T5f/T5fw T5other/ └─┴─┴─┴─┴─┴─┘ 1 2 1 If T2=Yes, go to T12; if T2=No, goto T9 2 If T2=Yes, go to T12; if T2=No, go to T9 3 If T2=Yes, go to T12; if T2=No, go to T9 1 2 If No, go to T12 1 If T1=Yes, go to T12, else go to T10 2 If T1=Yes, go to T12, else go to T10 T8 T7 T5otherw T6 └─┴─┴─┴─┘└─┴─┴─┴─┘ └─┴─┴─┴─┘└─┴─┴─┴─┘ └─┴─┴─┴─┘└─┴─┴─┴─┘ └─┴─┴─┴─┘└─┴─┴─┴─┘ └─┴─┘ If Known, go to T5a/T5aw └─┴─┘ If Known, go to T5a/T5aw └─┴─┘ If Known, go to T5a/T5aw 1 2 1 2 If No, go to T8 Code T1

T2 T3 T4a T4b

(RECORD ONLY 1, NOT ALL 3)

T4c

└─┴─┴─┴─┘└─┴─┴─┴─┘ If Other, go to T5other, else go to T6

Don’t Know 7777 During the past 12 months, have you tried to stop smoking?

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How old were you when you stopped smoking? How long ago did you stop smoking?

Age (years) Don’t Know 77 Years ago OR Months ago └─┴─┘ If Known, go to T12 └─┴─┘ If Known, go to T12 └─┴─┘ If Known, go to T12 └─┴─┘

T10 T11a T11b

(RECORD ONLY 1, NOT ALL 3) OR Don’t Know 77 Do you currently use any smokeless tobacco products such as [songe/chewing tobacco, mama malus/betel with songe/chewing tobacco]?(USE SHOWCARD) Do you currently usesmokeless tobacco products daily? Yes No Yes No DAILY↓ On average, how many times a day/week do you use …. Chewing tobacco/ Songe Weeks ago

T11c

1 2 1 2 If No, go to T14aw WEEKLY↓ └─┴─┴─┴─┘└─┴─┴─┴─┘ T14c/ T14cw T14d/ T14dw T14e/ T14ew T14other/ T14otherw T15 If No, go to T15 T12 T13

(IF LESS THAN DAILY, RECORD WEEKLY)

Mama Malus/Betel with └─┴─┴─┴─┘└─┴─┴─┴─┘ Songe/chewing tobacco

(RECORD FOR EACH TYPE, USE SHOWCARD)

Other

└─┴─┴─┴─┘└─┴─┴─┴─┘ If Other, go to T14other, if T13=No, go to T16, else go to T17 └─┴─┴─┴─┴─┴─┘ If T13=No, go to T16, else go to T17

Don’t Know 7777 In the past, did you ever use smokeless tobacco products such as [songe/chewing tobacco, mama malus/ betel with songe/chewing tobacco]? In the past, did you ever use smokeless tobacco products such as [[songe/chewing tobacco, mama malus/ betel with songe/chewing tobacco]?daily? During the past 30 days, did someone smoke in your home? During the past 30 days, did someone smoke in closed areas in your workplace (in the building, in a work area or a specific office)?

Other (please specify): Yes No Yes No Yes No Yes No Don't work in a closed area

1 2 1 2 1 2 1 2 3 If No, go to T17

T16

T17

T18

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The next questions ask about tobacco control policies. They include questions on your exposure to the media and advertisement, on cigarette promotions, health warnings and cigarette purchase. During the past 30 days, have you noticed information about the dangers of smoking cigarettes or that encourages quitting through the following media? (RECORD FOR EACH) Yes Newspapers or magazines No Don't know Yes Television No Don't know Yes Radio No Don't know Yes During the past 30 days, have you noticed any advertisements or signs promoting cigarettes in stores where cigarettes are sold? No Don't know 1 2 77 1 2 77 1 2 77 1 2 77 TP2 TP1c TP1b TP1a

During the past 30 days, have you noticed any of the following types of cigarette promotions? (RECORD FOR EACH) Yes Free samples of cigarettes No Don't know Yes Cigarettes at sale prices No Don't know Yes Coupons for cigarettes No Don't know Yes Free gifts or special discount offers on other products when No buying cigarettes Don't know 1 2 77 1 2 77 1 2 77 1 2 77 TP3d TP3c TP3b TP3a

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Yes Clothing or other items with a cigarettebrand name or logo No Don't know Yes Cigarette promotions in the mail No Don't know Yes During the past 30 days, did you notice any health warnings on cigarette packages? No Did not see any cigarette packages Don't know The next questions TP5 - TP8 are administered to current smokers only. Yes During the past 30 days, have warning labels on cigarette packages led you to think about quitting? No Don't know Number of cigarettes The last time you bought manufactured cigarettes for yourself, how many cigarettes did you buy in total? Don't know or Don't smoke or purchase manuf. cigarettes 7777 Amount Don't know Refused CORE: Alcohol Consumption The next questions ask about the consumption of alcohol. Have you ever consumed any alcohol such as beer, wine, spirits orTuaSabu or TuaMutin? (USE SHOWCARD OR SHOW EXAMPLES) Have you consumed any alcohol within the past 12 months? Have you stopped drinking due to health reasons, such as a negative impact on your health or on the advice of your doctor or other health worker? During the past 12 months, how frequently have you had at least one standard alcoholic drink? Yes No Yes No Yes No Daily 5-6 days per week 3-4 days per week 1-2 days per week (READ RESPONSES, USE SHOWCARD) 1-3 days per month

1 2 77 1 2 77 1 2 If no, go to TP7 3 If "did not see any cigarette packages", go to TP7 77 If Don't know, go to TP7 1 2 77 └─┴─┴─┴─┘ If "Don't know or don't smoke or purchase manuf. cig.", end section └─┴─┴─┴─┘ 7777 8888 TP7 TP6 TP5 TP4 TP3f TP3e

In total, how much money did you pay for this purchase? In US$

1 2 If No, go to A16 1 If Yes, go to A4 2 1 If Yes, go to A16 2 If No, go to A16 1 2 3 4 5 6 A4 A1

Less than once a month

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Have you consumed any alcohol within the past 30 days? During the past 30 days, on how many occasions did you have at least one standard alcoholic drink? During the past 30 days, when you drank alcohol, how many standarddrinks on average did you have during one drinking occasion? During the past 30 days, what was the largest number of standard drinks you had on a single occasion, counting all types of alcoholic drinks together? During the past 30 days, how many times did you have six or more standard drinks in a single drinking occasion? During each of the past 7 days, how many standard drinks did you have each day?

Yes No Number Don't know 77 Number Don't know 77 Largest number Don't Know 77 Number of times Don't Know 77 Monday Tuesday Wednesday

1 2 If No, go to A13

└─┴─┘

A7 └─┴─┘ A8 └─┴─┘ A9 └─┴─┘ └─┴─┘ └─┴─┘ └─┴─┘ └─┴─┘ └─┴─┘ └─┴─┘ └─┴─┘ A10a A10b A10c A10d A10e A10f A10g

(USE SHOWCARD)

Thursday Friday Saturday

Don't Know 77

Sunday

I have just asked you about your consumption of alcohol during the past 7 days. The questions were about alcohol in general, while the next questions refer to your consumption of homebrewed alcohol, alcohol brought over the border/from another country, any alcohol not intended for drinking or other untaxed alcohol. Please only think about these types of alcohol when answering the next questions. During the past 7 days, did you consume any homebrewed alcohol (TuaSabu,TuaMutin), any alcohol brought over the border/from another country, any alcohol not intended for drinking or other untaxed alcohol? (USE SHOWCARD) On average, how many standard drinks of the following did you consume during the past 7 days? Homebrewed spirits, e.g. moonshine, TuaSabu Homebrewed beer or wine, e.g. beer, palm or fruit wine, TuaMutin Alcohol brought over the border/from another country Alcohol not intended for drinking, e.g. alcohol-based medicines, perfumes, after shaves Other untaxed alcohol in the country └─┴─┘ └─┴─┘ └─┴─┘ A12a A12b A12c A12d └─┴─┘ └─┴─┘ A12e Yes 1 A11 No 2 If No, go to A13

[TuaMutin – Standard Drink = 120 ml TuaSabu – Standard Drink = 30 ml] (USE SHOWCARD)

Don't Know 77

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119

CORE: Diet The next questions ask about the fruits and vegetables that you usually eat. I have a nutrition card here that shows you some examples of local fruits and vegetables. Each picture represents the size of a serving. As you answer these questions please think of a typical week in the last year. Question In a typical week, on how many days do you eat fruit? (USE SHOWCARD) How many servings of fruit do you eat on one of those days? (USE SHOWCARD) In a typical week, on how many days do youeat vegetables? (USE SHOWCARD) How many servings of vegetables do you eat on one of those days? (USE SHOWCARD) What type of oil or fat is most often used for meal preparation in your household? (SELECT ONLY ONE) Response Number of days Don't Know 77 Number of servings Don't Know 77 Number of days Don't Know 77 Number of servings Don’t know 77 Vegetable oil Lard or suet Butter or ghee Margarine Other None in particular (USE SHOWCARD) None used Don’t know Other On average, how many meals per week do you eat that were not prepared at a home? By meal, I mean breakfast, lunch and dinner. Number Don’t know 77 └─┴─┘ 1 2 3 4 5 6 7 77 └─┴─┴─┴─┴─┴─┴─┘ D5other If Other, go to D5 other D5 └─┴─┘ └─┴─┘ └─┴─┘ If Zero days, go to D5 └─┴─┘ If Zero days, go to D3 Code D1

With the next questions, we would like to learn more about salt in your diet. Dietary salt includes ordinary table salt, unrefined salt such as sea salt, iodized salt, salty stock cubes and powders, and salty sauces such as soya sauce or fish sauce. How often do you add salt or a salty sauce such as soya sauce to your food right before you eat it or as you are eating it? (SELECT ONLY ONE) (USE SHOWCARD) Always Often Sometimes Rarely Never Don't know Always Often How often is salt, salty seasoning or a salty sauce added in Sometimes cooking or preparing foods in your household? Rarely Never Don't know 1 2 3 4 5 77 1 2 3 4 5 77 DS2 DS1

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How often do you eat processed food high in salt? By processed food high in salt, I mean foods that have been altered from their natural state, such as packaged salty snacks, canned salty food, salty foods prepared in quickservice, [KripikSalgadu, AimanasBudu, Balesaun, IkanMaran, NaanMaran, ModoMasin, Churiso] (USE SHOWCARD)

Always Often Sometimes Rarely Never Don't know Far too much Too much

1 2 3 4 5 77 1 2 3 4 5 77 1 2 3 77 1 2 77 No Don't know 2 1 2 1 2 1 2 1 2 1 If Yes, go to S7other 2 2 77 DS7b DS7c DS7d DS7e DS7f DS7other 1 DS5 DS3

How much salt or salty sauce do you think you consume?

Just the right amount Too little Far too little Don't know Very important

How important to you is lowering the salt in your diet?

Somewhat important Not at all important Don't know Yes

Do you think that too much salt or salty sauce in your diet could cause a health problem?

No Don't know

Do you do anything of the following on a regular basis to control your salt intake? (RECORD FOR EACH) Limit consumption of processed foods Look at the salt or sodium content on food labels Buy low salt/sodium alternatives Use spices other than salt when cooking Avoid eating foods prepared outside of a home Do other things specifically to control your salt intake Other (please specify) Yes No Yes No Yes No Yes No Yes No Yes No └─┴─┴─┴─┴─┴─┴─┘

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CORE: Physical Activity Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. Please answer these questions even if you do not consider yourself to be a physically active person. Think first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, study/ training, household chores, harvesting food/crops, fishing or hunting for food, seeking employment. [Insert other examples if needed]. In answering the following questions 'vigorous-intensity activities' are activities that require hard physical effort and cause large increases in breathing or heart rate, 'moderate-intensity activities' are activities that require moderate physical effort and cause small increases in breathing or heart rate. Work Does your work involve vigorous-intensity activity that causes large increases in breathing or heart rate like [carrying or liftingheavy loads, digging, ploughing field, cycle rickshaw driving or construction work] for at least 10 minutes continuously? (USE SHOWCARD) Yes No 1 2 If No, go to P 4 P2 P3 (a-b) P1

In a typical week, on how many days do you do vigorous-intensity Number of days activities as part of your work? How much time do you spend doing vigorous-intensity activities at work on a typical day? Does your work involve moderate-intensity activity, that causes small increases in breathing or heart rate such as brisk walking, housework, gardening, weaving (tais) , carrying water and carrying firewodd[or carrying light loads] for at least 10 minutes continuously? (USE SHOWCARD) In a typical week, on how many days do you do moderateintensity activities as part of your work? How much time do you spend doing moderate-intensity activities at work on a typical day? Travel to and from places Hours : minutes

└─┘ └─┴─┘: └─┴─┘ hrsmins

Yes No Number of days

1 2 If No, go to P 7

└─┘ └─┴─┘: └─┴─┘ hrsmins

P5 P6 (a-b)

Hours : minutes

The next questions exclude the physical activities at work that you have already mentioned. Now I would like to ask you about the usual way you travel to and from places. For example to work, for shopping, to market, to place of worship. [Insert other examples if needed] Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places? In a typical week, on how many days do you walk or bicycle for at least 10 minutes continuously to get to and from places? How much time do you spend walking or bicycling for travel on a typical day? Recreational activities The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness and recreational activities (leisure), [Insert relevant terms]. Do you do any vigorous-intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate like [running or active games like football, judo, karate] for at least 10 minutes continuously? (USE SHOWCARD) Yes No 1 P10 2 If No, go to P 13 Yes No Number of days 1 2 If No, go to P 10 P7

└─┘ └─┴─┘: └─┴─┘ hrsmins

P8 P9 (a-b)

Hours : minutes

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In a typical week, on how many days do you do vigorous-intensity Number of days sports, fitness or recreational (leisure) activities? How much time do you spend doing vigorous-intensity sports, fitness or recreational activities on a typical day? Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that cause a small increase in breathing or heart rate such as brisk walking, [cycling, swimming, dancing (pochopocho and jumba), volleyball] for at least 10 minutes continuously? [INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do moderateintensity sports, fitness or recreational (leisure) activities? Number of days

P11 └─┘ └─┴─┘: └─┴─┘ hrsmins P12 (a-b)

Hours : minutes

Yes

1 P13

If No, go to P16

P14 └─┘

How much time do you spend doing moderate-intensity sports, fitness or recreational (leisure) activities on a typical day?

Hours : minutes

└─┴─┘: └─┴─┘ hrsmins

P15 (a-b)

The following question is about sitting or reclining at work, at home, getting to and from places, or with friends including time spent sitting at a desk, sitting with friends, traveling in bus, reading, playing cards or watching television, but do not include time spent sleeping. (USE SHOWCARD) How much time do you usually spend sitting or reclining on a typical day? History of Raised Blood Pressure Have you ever had your blood pressure measured by a doctor or other health worker? Have you ever been told by a doctor or other health worker that you have raised blood pressure or hypertension? Have you been told in the past 12 months? In the past two weeks, have you taken any drugs (medication) for raised blood pressure prescribed by a doctor or other health worker? Have you ever seen a traditional healer (matandok) for raised blood pressure or hypertension? Are you currently taking any herbal or traditional remedy for your raised blood pressure? History of Diabetes Have you ever had your blood sugar measured by a doctor or other health worker? Yes No 1 2 If No, go to H12 H6 Yes No Yes No Yes No Yes No Yes No Yes No 1 2 1 2 1 2 1 2 1 2 1 2 If No, go to H6 If No, go to H6 H1 Hours : minutes └─┴─┘: └─┴─┘ hrsmins P16 (a-b)

H2a

H2b

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Have you ever been told by a doctor or other health worker that you have raised blood sugar or diabetes? Have you been told in the past 12 months? In the past two weeks, have you taken any drugs (medication) for diabetes prescribed by a doctor or other health worker? Are you currently taking insulin for diabetes prescribed by a doctor or other health worker? Have you ever seen a traditional healer(matandok) for diabetes or raised blood sugar? Are you currently taking any herbal or traditional remedy for your diabetes? History of Raised Cholesterol Have you ever had your cholesterol (fat levels in your blood) measured by a doctor or other health worker? Have you ever been told by a doctor or other health worker that you have raised cholesterol? Have you been told in the past 12 months? In the past two weeks, have you taken any oral treatment (medication) for raised total cholesterol prescribed by a doctor or other health worker? Have you ever seen a traditional healer (matandok) for raised cholesterol? Are you currently taking any herbal or traditional remedy for your raised cholesterol? History of Cardiovascular Diseases Have you ever had a heart attack or chest pain from heart disease (angina) or a stroke (cerebrovascular accident or incident)? Are you currently taking aspirin regularly to prevent or treat heart disease?

Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No

1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 If No, go to H17 1 2 1 2 1 2 1 2 1 2 1 2 1 2 H19 H18 H17 H16 H15 H14 H13b If No, go to H17 H13a H12 H11 H10 H9 H7b H8 If No, go to H12 H7a

Are you currently taking statins (Lovostatin/Simvastatin/ Yes Atorvastatin or an`y other statin) regularly to prevent or treat heart No disease? Lifestyle Advice During the past three years, has a doctor or other health worker advised you to do any of the following? (RECORD FOR EACH) Quit using tobacco or don’t start Yes No 1 2

H20a

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Reduce salt in your diet Eat at least five servings of fruit and/or vegetables each day

Yes No Yes No Yes No Yes No Yes No

1 2 1 2 1 2 1 2 1 2 If C1=1 go to M1 If C1=1 go to M1

H20b H20c

Reduce fat in your diet

H20d

Start or do more physical activity

H20e

Maintain a healthy body weight or lose weight For women only: Cervical Cancer Screening

H20f

The next question asks about cervical cancer prevention. Screening tests for cervical cancer prevention can be done in different ways, including Visual Inspection with Acetic Acid/vinegar (VIA), pap smear and Human Papillomavirus (HPV) test. VIA is an inspection of the surface of the uterine cervix after acetic acid (or vinegar) has been applied to it. For both pap smear and HPV test, a doctor or nurse uses a swab to wipe from inside your vagina, take a sample and send it to a laboratory. It is even possible that you were given the swab yourself and asked to swab the inside of your vagina. The laboratory checks for abnormal cell changes if a pap smear is done, and for the HP virus if an HPV test is done. Yes Have you ever had a screening test for cervical cancer, using any of these methods described above? No Don’t know 1 2 77 CX1

Violence and Injury The next questions ask about different experiences and behaviours that are related to road traffic injuries. Question Response All of the time Sometimes In the past 30 days, how often did you use a seat belt when you were the driver or passenger of a motor vehicle? Never Have not been in a vehicle in past 30 days No seat belt in the car I usually am in Don't Know Refused All of the time Sometimes In the past 30 days, how often did you wear a helmet when you drove or rode as a passenger on a motorcycle or motorscooter? Never Have not been on a motorcycle or motor-scooter in past 30 days Do not have a helmet Don't Know Refused 5 77 88 1 2 3 4 5 77 88 1 2 3 4 V2 V1 Code

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Yes (as driver) Yes (as passenger) In the past 12 months, have you been involved in a road traffic crash as a driver, passenger, pedestrian, or cyclist? Yes (as pedestrian) Yes (as a cyclist) No Don’t know Refused Yes Did you have any injuries in this road traffic crash which required medical attention? No Don't know Refused

1 2 3 4 5 If No, go to V5 77 If don't know, go to V5 88 If Refused, go to V5 1 2 77 88 V4 V3

The next questions ask about the most serious accidental injury you have had in the past 12 months. Yes In the past 12 months, were you injured accidentally, other than the road traffic crashes which required medical attention? No Don't know Refused Fall Burn Poisoning Cut Please indicate which of the following was the cause of this injury. Near-drowning Animal bite Other (specify) Don't know Refused Other (please specify) Home School Workplace Road/Street/Highway Where were you when you had this injury? Farm Sports/athletic area Other (specify) Don’t know Refused Other (please specify) 1 2 3 4 5 6 7 77 88 └─┴─┴─┴─┴─┴─┴─┘ V7other V7 1 2 If No, go to V8 V5 77 If don't know, go to V8 88 If Refused, go to V8 1 2 3 4 5 6 7 77 88 └─┴─┴─┴─┴─┴─┴─┘ V6other V6

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The next questions ask about behaviours related to your safety and whether or not you drink alcohol while driving or being a passenger. Always Sometimes In the past 30 days, how often did you wear a helmet when you rode a bicycle or pedal cycle? Never Did not ride in the past 30 days Don't Know Refused In the past 30 days, how many times have you driven a motorized vehicle when you have had 2 or more alcoholic drinks? (USE SHOWCARD) In the past 30 days, how many times have you ridden in a motorized vehicle where the driver has had 2 or more alcoholic drinks? (USE SHOWCARD) Number of times Don't Know Refused Number of times Don't Know Refused 1 2 3 4 77 88 └─┴─┘ 77 88 └─┴─┘ 77 88 V10 V8

The following questions are about different experiences and behaviours that are related to violence. Never In the past 12 months, how many times were you in a violent incident in which you were injured and required medical attention? Rarely (1- 2 times) Sometimes (3 – 5 times) Often (6 or more times) Don’t know Refused Being shot with a firearm Please indicate which of the following caused your most serious injury in the last 12 months. (USE SHOWCARDS) A weapon (other than a firearm knife/arrow) used by the person who injured me Being injured without any weapon (slapped, pushed…) Don’t know Refused Intimate partner Parent Child, sibling, or other relative Friend or acquaintance Please indicate the relationship between yourself and the person(s) who caused your injury. Unrelated caregiver Stranger Official or legal authorities Other (specify) Refused 1 2 3 4 77 If don't know, go to V14 88 If Refused, go to V14 1 2 3 77 88 1 2 3 4 5 6 7 8 88 V13 V12 V11 If never, go to V14

The next questions ask about the most serious violent incidence you have had in the past 12 months.

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The next questions ask about behaviours related to your safety. In the past 12 months, have you been frightened for the safety of yourself or your family because of the anger or threats of another person(s)? Yes No Refused Intimate partner Parent Child, sibling, or other relative Friend or acquaintance Please specify of whom you were most often frightened. Unrelated caregiver Stranger Official or legal authority Other (specify) Refused Other (please specify) Step 2 Physical Measurements 1 2 1 2 3 4 5 6 7 8 88 └─┴─┴─┴─┴─┴─┴─┘ V18other V18 If no, go to V19 V17 88 If refused, go to V19

CORE: Blood Pressure and Heart Rate Interviewer ID Device ID for blood pressure Reading 1 Systolic ( mmHg) Diastolic (mmHg) Beats per minute Systolic ( mmHg) Diastolic (mmHg) Beats per minute Systolic ( mmHg) Diastolic (mmHg) Beats per minute └─┴─┴─┘ └─┴─┘ └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ 1 2 M1 M2 M4a M4b M16a M5a M5b M16b M6a M6b M16c M7

Blood Pressure Heart rate Reading 2

Blood Pressure Heart rate Reading 3

Blood pressure Heart rate

During the past two weeks, have you been treated for Yes raised blood pressure with drugs (medication) prescribed No by a doctor or other health worker? CORE: Height and Weight Question For women: Are you pregnant? Interviewer ID Response Yes No

Code 1 If Yes, go to M 16 2 └─┴─┴─┘ M8 M9

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Device IDs for height and weight Height Weight If too large for scale 666.6 CORE: Waist Device ID for waist Waist circumference Step 3 Question Biochemical Measurements

Height Weight in Centimetres (cm) in Kilograms (kg)

└─┴─┘ └─┴─┘ └─┴─┴─┘. └─┘

M10a M10b M11 M12

└─┴─┴─┘.└─┘

└─┴─┘ in Centimetres (cm) └─┴─┴─┘.└─┘

M13 M14

CORE: Blood Glucose Response 1 2 └─┴─┴─┘ └─┴─┘ Hours : minutes └─┴─┘: └─┴─┘ hrsmins └─┴─┘. └─┴─┘ 1 2 └─┴─┘ mmol/l Yes No └─┴─┘. └─┴─┘ 1 2 Code B1 B2 B3 B4 During the past 12 hours have you had anything to eat or Yes drink, other than water? No Technician ID Device ID Time of day blood specimen taken (24 hour clock) Fasting blood glucose [CHOOSE ACCORDINGLY: MMOL/L OR MG/DL]

mmol/l

Today, have you taken insulin or other drugs (medication) Yes that have been prescribed by a doctor or other health No worker for raised blood glucose? CORE: Blood Lipids Device ID Total cholesterol [CHOOSE ACCORDINGLY: MMOL/L OR MG/DL] During the past two weeks, have you been treated for raised cholesterol with drugs (medication) prescribed by a doctor or other health worker?

B7 B8

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Annex 3: Sampling methodology List of districts, sub-districts and susos in Timor-Leste with their populations and household numbers District 1. Dili Sub-district Vera Cruz Nain Feto Metinaro Atauro Dom Aleixo Cristo Rei 2. Ermera Railaco Ermera Letefoho Atsabe Hatolia 3. Baucau Baucau Laga Quelicai Baguia Vemase Venilale 4. Bobonaro Maliana Cailaco Balibo Atabae Lolotoe Bobonaro 5. Viqueque Uatucarbau Ossu Watulari Viqueque Lacluta 6. Oecussi PanteMacasar Nitibe  Oesilo Passabe Population 34 015 28 592 4727 8602 105 154 54 936 10 384 33 530 20 887 17 264 34 999 46 500 14 432 16 747 9465 9008 15 542 25 234 9957 1485 11 024 7129 23 854 7212 15 612 16 912 24 387 5853 35 226 11 366 9861 7572 Household 5318 4015 872 1618 15 896 7505 1632 5232 3754 3056 5656 7438 2868 4028 2109 1674 3138 4320 2015 2784 1826 1434 4504 1499 3134 3465 4616 1093 7290 2609 2224 1767 64 025 13 890 70 036 13 807 92 049 16 883 111 694 21 255 117 064 19 280 230 426 35 224 Cumulative population Cumulative household

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District 7. Liquiça

Sub-district Liquica Maubara Bazartete

Population 20 938 18 570 23 955 29 236 14 147 7201 5367 3836 1894 3332 4092 6291 25 164 7043 11 639 15 558 11 950 22 022 9695 27 554 7179 6902 6993 12 555 3089 7618 3030 4678 11 682 20 830 6267 10 055 7173

Household 3351 3299 3701 547 2932 1429 1108 731 422 615 873 1474 4359 1355 2307 2292 2058 3604 1710 4548 1179 1110 1019 1823 752 1273 444 843 1790 3274 1104 1497 1090

Cumulative population 63 403

Cumulative household 10 352

8. Lautem

Lospalos Lautem Iliomar Luro Tutuala

59 787

11 447

9. Covalima

Fatululic Fatumean Fohorem Maukatar Suai Tilomar Zumalai

59 455

11 015

10. Ainaro

Ainaro Hatu-Builico Hatu-Udo Maubisse

59 175

9664

11. Manufahi

Same Alas Fatuberliu Turiscai

48 628

7856

12. Manatuto

Manatuto  Laleia  Laclo Soibada Barique/ Natarbora Laclubar

42 742

6925

13. Aileu

Aileu Vila Liquidoe Remexio Laulara

44 325

6965

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Detailed Sampling Methodology Multistage stratified cluster sampling method was used. All districts were included in the sample. The Enumeration Areas (EAs) were selected by PPS from all 13 districts.

Table 1: Choice of Sampling Unit for the NCDRF Survey Sampling Unit First Stage (Primary) Second Stage (Secondary) Third Stage (Tertiary) Description Enumeration Area Household Individual Proposed Numbers 150 18 1

Sampling Procedure Note: Data from Census 2010 were used for all sampling considerations. Even though planning and mapping for 2015 Census is ongoing, data from the Census will only be available after July 2015.

STEP 1: Selection of Enumeration Area (1) List of EA with number of HH by district for Census 2010 was obtained from the Directorate of Statistics. There are 1826 EAs in Timor-Leste. Out of these, 150 EAs were selected. The number of EAs to be selected from each district was based on their proportion in the country’s population as per Census 2010 (See Table 2 below). The numbers of Households (HH) per EAs varied from 0 to more than 300. Therefore, probability proportion to size (PPS) was used. For each district, the EAs were arranged in ascending order of HH size. Sampling interval was obtained by dividing the total number of HH in the district by the number of EA to be selected from that district. A random number was generated between one and the sampling interval for that district, using tools available at random.org. The EA where that random number fell was the first EA to be selected. Subsequently, the sampling interval was added to the random number and the EA where this new number fell was selected. For the next number, the sampling interval was added to the number and so on, till the population of HH was exhausted or target number of EA achieved. This was done separately for each district.

(2) (3) (4) (5) (6) (7) (8)

(9)

(10) The final list was compiled and had 150 EAs. This list is shown in Annex 2. These are spread over about 125 sucos.

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STEP 2. Selection of Households in an Enumeration Area Listing the house numbers to be visited (1) (2) (3) (4) It was decided to use the 2010 HH size of each EA. Based on past experience, it was expected that the increase would be on an average about 4–5%. The list of households to be selected by enumerators was decided centrally. Sampling interval was calculated by dividing the total number of households in the EA by 18. The first HH number was selected randomly by reading the last two digits of a currency note. If the number represented by the two digits was more than 18, the last digit was taken into consideration. For each EA, a different currency note was used. This could also be done it by using the tool at random.org. or by draw of lots. The subsequent HH are identified by adding the sampling interval as was done for selection of EA. A worked out example is shown below. Worked out Example (i) Let us assume that an enumeration area has a listed population of 312 HHs. (ii) First the sampling interval is calculated = 312/18 = 17.33. It is always rounded off to lower integer. So, the sampling interval is 17. (iii) A number between 1 and 17 is randomly selected. Let it be 9. This means that the first house is the ninth house in the enumeration area. (iv) The next house will be 9+ 17 = 26 or 26th House. (v) Subsequent 16 houses can be obtained by continuing to add 17 to it i.e. 43,60,77,94,111,128, 145,162,179,196,213,230,247,264,281,298.

(5)

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Annex 4: Fact Sheet The STEPS survey of noncommunicable disease (NCD) risk factors in Timor-Leste was carried out from October to December 2014. Timor-Leste carried out Step 1, Step 2 and Step3. Socio demographic and behavioural information was collected in Step 1. Physical measurements such as height, weight and blood pressure were collected in Step 2. Biochemical measurements were collected to assess blood glucose and cholesterol levels in Step 3. The survey was a population-based survey of adults aged 18-69. A multistage complex sample design was used to produce representative data for that age range in Timor-Leste. A total of 2609 adults participated in the survey. The overall response rate was (96%). A repeat survey is planned for 2019 if funds permit. Results for adults aged 18-69 years (incl. 95% CI) Step 1: Tobacco Use Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily For those who smoke tobacco daily Average age started smoking (years) Percentage of daily smokers smoking manufactured cigarettes Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) Step 1: Alcohol Consumption Percentage who are lifetime abstainers Percentage who are past 12 month abstainers Percentage who currently drink (drank alcohol in the past 30 days) Percentage who engage in heavy episodic drinking (6 or more drinks on any occasion in the past 30 days) Step 1: Diet Mean number of days fruit consumed in a typical week Mean number of servings of fruit consumed on average per day Mean number of days vegetables consumed in a typical week Mean number of servings of vegetables consumed on average per day Percentage who ate less than 5 servings of fruit and/or vegetables on average per day Percentage who always or often add salt or salty sauce to their food before eating or as they are eating Percentage who always or often eat processed foods high in salt Step 1: Physical Activity Percentage with insufficient physical activity (defined as < 150 minutes of moderate-intensity activity per week, or equivalent)* Median time spent in physical activity on average per day (minutes) (presented with inter-quartile range) Percentage not engaging in vigorous activity 16.7% (7.8 – 25.6) 85.7 (34.3-199.3) 52.4% (50.6 – 54.1) 12.8% (7.6 – 18.0) 154.3 (34.3 – 248.6) 39.9% (38.0 – 41.9) 23.3% (10.9 – 35.7) 47.1 (21.4 – 102.9) 73.3% (64.0 – 82.6) 2.3 (1.8 – 2.8) 0.9 (0.6 – 1.2) 6.7 (6.3 – 7.0) 5.0 (3.1 – 7.0) 77.5% (73.0 – 82.0) 78.0 (70.2 – 85.8) 12.9 (10.9 – 14.8) 2.2 (1.9 – 2.5) 1.0 (0.7 – 1.2) 6.7 (6.3 – 7.1) 6.3 (3.8 – 8.9) 70.7% (64.1 – 77.3) 74.7 (67.0 – 82.5) 15.8 (12.2 – 19.4) 2.6 (1.5 – 3.7) 0.9 (0.5 – 1.2) 6.6 (6.3 – 6.9) 2.8 (2.5 – 3.0) 90.4% (82.9 – 97.8) 84.1 (79.2 – 89.0) 7.3 (1.8 – 12.9) 57.7% (53.7 –61.8) 5.5% (4.8 – 6.1) 28.6% (20.3 – 36.9) 14.5% (12.7 – 16.4) 39.4% (37.2 – 41.6) 6.9% (6.2 – 7.6) 42.8% (37.1 – 48.6) 21.8% (20.1 – 23.4) 92.1% (86.3 – 97.9) 2.8% (0.6 – 5.1) 2.0% (0.5 – 3.6) 1.0% (0.1 – 1.9) 16.4 (15.2 – 17.6) 94.5% (87.7 – 100.0) 12.1 (8.6 – 15.7) 16.3 (15.3 – 17.3) 94.6% (88.0 – 100.0) 12.9 (8.9 – 17.0) 17.6 (13.8 – 21.5) 93.0% (82.5 – 100.0) 2.9 (1.6 – 4.2) 48.6% (38.4 – 58.7) 35.0% (29.8 – 40.3) 69.5% (67.0 – 72.0) 49.6% (46.3 – 53.0) 9.6% (5.8 – 13.4) 7.8% (2.8 – 12.8) Both Sexes Males Females

* For complete definitions of insufficient physical activity, refer to the GPAQ Analysis Guide (http://www.who.int/chp/steps/GPAQ/en/index.html) or to the WHO Global recommendations on physical activity for health (http://www. who.int/dietphysicalactivity/factsheet_recommendations/en/index.html)

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Results for adults aged 18-69 years (incl. 95% CI) Step 1: Cervical Cancer Screening Percentage of women aged 30-49 years who have ever had a screening test for cervical cancer Step 2: Physical Measurements Mean body mass index - BMI (kg/m2) Percentage who are overweight (BMI > 25 kg/m2) Percentage who are obese (BMI > 30 kg/m2) Average waist circumference (cm) Mean systolic blood pressure – SBP (mmHg), including those currently on medication for raised BP Mean diastolic blood pressure – DBP (mmHg), including those currently on medication for raised BP Percentage with raised BP (SBP > 140 and/or DBP > 90 mmHg or currently on medication for raised BP) Percentage with raised BP (SBP > 140 and/or DBP > 90 mmHg) who are not currently on medication for raised BP Step 3: Biochemical Measurement Mean fasting blood glucose, including those currently on medication for raised blood glucose (mmol/L) Percentage with impaired fasting glycaemia as defined below • capillary whole blood value >5.6 mmol/Land <6.1 mmol/L Percentage with raised fasting blood glucose as defined below or currently on medication for raised blood glucose • capillary whole blood value > 6.1 mmol/L Mean total blood cholesterol, including those currently on medication for raised (mmol/L) Percentage with raised total cholesterol (> 5.0 mmol/L or currently on medication for raised cholesterol) Cardiovascular disease (CVD) risk Percentage aged 40-69 years with a 10-year CVD risk > 30%, or with existing CVD** Summary of combined risk factors •• •• •• current daily smokers less than 5 servings of fruits & vegetables per day insufficient physical activity •• ••

Both Sexes

Males

Females

1.1% (0.0 – 2.3)

21.2 (21.0 – 21.5) 11.2% (10.3 – 12.2) 0.9% (0.0 – 1.8)

21.3 (20.9 – 21.8) 8.2% (7.2 – 9.1) 0.7% (0.0 – 1.5) 71.3 (68.0 – 74.7)

21.0 (20.7 – 21.3) 16.7% (12.4 – 21.0) 1.3% (0.2 – 2.4) 77.4 (75.7 – 79.0) 121.4 (120.7 -122.2) 82.4 (80.1 – 84.7) 28.0% (21.5 – 34.5) 94.7% (89.4 – 100.0) 4.1 (4.0 – 4.3) 1.2% (0.2 – 2.2) 1.6% (0.3 – 2.9) 4.2 (3.8 – 4.5) 25.5% (12.0 – 39.0) 2.9% (1.5 – 4.1)

129.0 (123.7 – 134.4) 83.1 (80.4 – 85.8) 39.3% (23.2 – 55.4) 97.3% (93.2 – 100.0) 4.3 (4.2 – 4.4) 4.1% (2.2 – 6.1) 1.5% (0.0 – 3.2) 3.9 (3.7 – 4.0) 21.0% (11.4 – 30.6) 1.4% (0.0 – 2.9)

133.1 (126.9 – 139.2) 83.5 (80.7 – 86.2) 45.3% (27.3 – 63.3) 98.1% (95.0 – 100.0) 4.4 (4.3 – 4.6) 5.7% (3.0 – 8.5) 1.5% (0.0 – 3.5) 3.7 (3.6 – 3.8) 18.5% (9.8 – 27.2) 0.9% (0.0 – 2.2)

overweight (BMI > 25 kg/m2) raised BP (SBP > 140 and/or DBP > 90 mmHg or currently on medication for raised BP) 7.8% (6.4 – 9.3) 16.3% (13.5-19.1) 28.2% (22.8-33.5) 19.4% (16.1-22.7) 10.1% (6.7 – 13.4) 16.0% (14.2-17.8) 32.0% (29.6 – 34.3) 21.1% (19.0 – 23.3) 4.2% (0.6 – 7.9) 16.7 % (11.3 – 22.1) 16.1% (12.1 – 20.1) 16.6% (12.0 – 21.3)

Percentage with none of the above risk factors Percentage with three or more of the above risk factors, aged 18 to 44 years Percentage with three or more of the above risk factors, aged 45 to 69 years Percentage with three or more of the above risk factors, aged 18 to 69 years

** A 10-year CVD risk of >30% is defined according to age, sex, blood pressure, smoking status (current smokers OR those who quit smoking less than 1 year before the assessment), total cholesterol, and diabetes (previously diagnosed OR a fasting plasma glucose concentration >7.0 mmol/l).

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The findings from the Timor-Leste STEPs Noncommunicable Disease Risk Factor Survey 2014 provide information on important indicators such as tobacco use, alcohol consumption, dietary habits, physical inactivity, salt intake history, history of exposure to screening for cancer cervix, body mass index (BMI) measurement, blood pressure measurement, biochemical measurement of blood glucose and cholesterol in a national representative sample age group of 1869 years in Timor-Leste for the first time. This survey provides Timor-Leste an opportunity to know baseline information on NCD risk factors as well as an opportunity to compare with other countries. In addition, findings will help to better understand the effect of interventions and formulate strategies for improved tobacco control intervention among youth. The rich data contained in this document will be useful to programme managers, researchers, NCD control advocates and any other relevant stakeholders. The data will generate credible evidence to promote NCD control and to formulate strategies for strengthening NCD control in the country.

ISBN 978 92 9022 495 2

World Health House Indraprastha Estate, Mahatma Gandhi Marg, New Delhi-110002, India www.searo.who.int

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