Grampian Adult Lifestyle Survey 2002
Contents Page
1. Introduction3
1.1 Aims and Objectives of the Survey
1.2 Survey Methods
1.3 Response Rate
1.4 Analysis
2. General Health and Primary Care5
2.1 General Health
2.2 Weight
2.3 Health Services - Opticians
2.4 Health Services - Dental Health
2.5 Health Professionals
2.6 Health Changes
2.7 Exposure to the Sun
2.8 Women’s Health
3. Food9
3.1 Healthy Eating Score
3.2 Healthy Eating Score by Sex
3.3 Healthy Eating Score by Age Group
3.4Healthy Diet
3.5Consumption of Fruit and Vegetables
3.6 Milk Consumption
3.7 Type of Spread
3.8 Making Changes
3.9 Support and Advice to Improve Eating Habits
4. Tobacco Smoking 15
4.1 Passive Smoking
4.2 Smoking Status
4.3 Age Group
4.4 Quantity of Cigarettes Smoked
4.5 Reasons for Smoking
4.6 Support to Stop Smoking
5. Alcohol 18
5.1 Frequency of Alcohol Consumption
5.2 Alcohol Consumption in the Last Seven Days
5.3 Alcohol Consumption Levels by Gender
5.4 Factors that Would Help Reduce Alcohol Intake
6. Work/Sport/Leisure23 6.1 Daily Activity
6.2 Regular Physical Activity
6.3 Reasons Given for Wishing to be More Active
7. Drugs25 7.1 Information
7.2 Drug Misuse
7.3 Types of Drugs Taken
7.4 Reasons for Taking Drugs
8. Sexual Health28 8.1 Lifestyle Changes
8.2 Sexually Transmitted Infection
9. Well-being30 9.1 Dealing with Problems
9.2 Issues which cause Problems
Conclusion32
References32
Appendix 33
1. Introduction
The 2002 Adult Lifestyle Survey was carried out by NHS Grampian to update the health and lifestyle information obtained from previous Grampian lifestyle surveys. Direct comparisons with the results of previous surveys will enable lifestyle changes to be monitored and will influence the development of policies and services to promote and improve health and to tackle health inequalities. In addition, these surveys provide the opportunity to collect new types of information relevant to health issues and developments within specific areas of Grampian. This report summarises the key findings from the 2002 survey.
1.1 Aims and Objectives of the Survey
•To measure the health-related behaviour, knowledge and attitudes of people in Grampian.
•To compare these results with the results of previous surveys.
•To monitor progress and/or establish baselines in relation to the national targets outlined in White Paper on Health, Towards a Healthier Scotland.1
•To provide information to inform the planning, monitoring and evaluation of health activities in Grampian.
•To identify areas where further research is needed.
1.2 Survey Methods
The fourth Grampian Adult Lifestyle Survey was carried out between November and December 2002. The Community Health Index (CHI) was used to obtain a sample of adults, aged 16 to 74 years, living in Grampian at the time of the survey. A 2% stratified random sample was selected, giving 8116 individuals who were each sent a questionnaire. The sample was stratified by age group, sex and postcode sector in order to ensure that the sample mirrored the underlying distribution of the Grampian population.
The self-completion postal questionnaire contained 65 questions on a range of topics including general health, food, tobacco, wellbeing, alcohol, drugs, physical activity, and sexual health. The Scottish Needs Assessment Programme (SNAP)2 core questions, which is a list of recommended questions to be used by health boards for comparison purposes, were included in the questionnaire. The questionnaires were sent out in November 2002 with one reminder letter sent approximately three weeks later.
In order to boost the response rate it was decided to re-send the questionnaire to those who had not responded, this was done in early January resulting in a better response rate.
1.3 Response Rate
Of the total number of questionnaires sent (8116), 225 were returned due to the intended recipient being unable to complete them. The total number of questionnaires returned was 4048, giving a response rate of 52.6%. The response rate was 5% better than in 1998 and justified the extra cost of re-sending the questionnaires, although still a little disappointing when compared to previous surveys. The size of the sample achieved, and the fact that bias was reduced by weighting the data, makes the survey a powerful and accurate statistical measure of people’s knowledge, behaviour and attitudes.
Other health boards conducting similar lifestyle studies have reported a fall in response rates in recent years.
There are several possible explanations for this lower level of response, the questionnaire has been modified since earlier studies in Grampian to include additional questions now used by all health boards in Scotland, the inclusion of drug misuse and more probing sexual health questions, and the increasing evidence of survey fatique among both public and professions. Many people returned blank questionnaires for this reason. Unfortunately there is no feasible alternative to surveys of this scale.
The percentage of responses from men and women were 51.7% compared to 47.7% respectively, different from 1998 survey when it was greater for women, 53%, compared to 38% for men. There was little difference in the response rate with age with 49.9% for those aged 16-24 to 47.7% for those over 55 years. The percentage of responses from the three local areas were varied, Aberdeenshire, the greatest, with 47% , 39% for Aberdeen City with Moray having just a 14% response rate.
1.4 Analysis
Responses have been weighted by sex and age group to ensure that these groups are correctly represented in the sample. Similar weighting criteria were also applied to the previous survey data to facilitate comparisons. All the figures reported in the following tables are based on weighted data.
This report highlights the key findings. In addition the ongoing ability to access and
re-analyse the raw data in-depth provides enormous opportunities to inform the work of NHS Grampian and partner organisations.
2. General Health and Primary Care
2.1 General Health
28% of respondents felt that they were in very good health and a further 46% described their health as good. As would be expected, older people were more likely to express their health as average or poor when compared to younger age groups. Responses were similar for both males and females.
2.2 Weight
Body mass index (BMI) is used as an indicator of obesity and is calculated by relating weight to height (BMI = weight in kg/ height in metres2). The following table indicates the BMI ranges associated with each category.
BMIUnderweight / <20.0
Acceptable weight / 20.1-25.0
Overweight / 25.1-29.9
Obese / >29.9
7.8% of respondents (9.7% of females and 6.0% of males) were of low BMI, 41% of acceptable BMI, 37% overweight and 15% obese. Being overweight or obese was more common in men than women. There were, however, 1.3% more women in the obese category and this was also more common in older age-groups for both sexes. It should be noted that height and weight were self reported.
The percentage of Grrespondents who were overweight has increased progressively since 1994, from 45% to 58% in males and from 37% to 45% in females. This is in line with national trends.
50.3% of men and 68.5% of women had tried to lose weight in the previous 12 months compared to 40% of men and 61% of women in the 1998 survey.
2.3 Health Services - Opticians
Percent of those who had been to an optician:
Aberdeen City% / Aberdeenshire % / Moray
% / Grampian
%
Within last 12 months / 32.3 / 30.8 / 28.0 / 30.9
1-5 years ago / 54.6 / 56.7 / 60.0 / 56.2
> 5 years ago / 13.0 / 12.6 / 12.1 / 12.9
2.4 Health Services - Dental Health
80% of respondents said that they are registered with a dentist, of those 70% were NHS and 24% were private.
Last visit to dentist / Aberdeen City% / Aberdeenshire
% / Moray
% / Grampian
%
In last 12 months / 67.4 / 71.5 / 71.3 / 69.8
1-5 years ago / 19.9 / 16.6 / 14.9 / 17.6
More than 5 years ago / 10.9 / 10.8 / 12.7 / 11.1
Never / 1.8 / 1.1 / 1.1 / 1.4
The recommended frequency for dental check-ups is a minimum of every 12 months, regardless of the number of natural teeth remaining - 69.8% of respondents met this target. Respondents from Aberdeen City were least likely to meet this target (67.4%).
2.5 Health Professionals
Respondents were asked if they had had contact with any of the following health professionals in the last 12 months. Responses were as follows:
Contact with health professional / Grampian 2002% / Grampian 1998
% / Grampian 1994
%
GP / 74.9 / 74.6 / 61.8
Nurse (GP Practice) / 39.5 / 39.3 / 18.6
Hospital/Clinic Staff / 35.3 / 36.9 / 24.2
Pharmacist / 35.7 / 32.0 / -
Health Visitor / 5.1 / 8.7 / 4.7
Health Promotion Staff / 4.8 / 6.6 / 2.3
Midwife / 3.8 / 6.2 / 3.1
District Nurse / 4.3 / 4.2 / 2.3
Results suggest that since 1994 there has been an increase in the percentage of respondents who have had contact with all listed health professionals. Since 1998 there appears to be less contact with the health visitor and health promotion staff but more contact with their pharmacist. Contact with their GP and hospital/clinic based staff has remained similar since 1998 when there was a noticeable increase in contact with these professionals since 1994.
In general, contact with health professionals was greater for older respondents. Those under 35 years of age had more contact with health visitors and midwives.
Contact with health professionals was similar for each of the three Grampian areas with the noticeable exception that respondents from Aberdeen City were more likely to have had contact with their pharmacist 39.3%. This compared to 32.6% of respondents from Moray and 33.8% of those from Aberdeenshire. Aberdeen City were also more likely to be in contact with hospital/clinic based staff than the other two areas.
Females were more likely than males to have contact with each type of health professional. Results are shown below:
Contact with health professional / Males% / Females
%
GP / 68.9 / 81.1
Hospital/clinic staff / 30.9 / 40.1
Pharmacist / 30.2 / 41.7
Nurse (GP Practice) / 29.4 / 50.2
Health promotion staff / 4.9 / 4.7
Health visitor / 1.7 / 8.8
District nurse / 3.7 / 4.9
Midwife / 0.1 / 8.0
2.6 Health Changes
When asked what lifestyle changes respondents had made during the last 12 months responses were as follows:
Lifestyle changes / Grampian2002 % / Grampian
1998 % / Grampian
1994 %
Male / Female / Total / Total / Total
Drink less alcohol / 35.4 / 31.2 / 33.4 / 33.4 / 18.9
Changed to a healthier diet / 57.7 / 73.8 / 65.5 / 66.1 / 45.9
Take more exercise / 62.3 / 75.4 / 68.7 / 69.4 / 62.5
Lose weight / 50.3 / 68.5 / 59.3 / 59.8 / 44.8
Relax more often / 55.9 / 64.4 / 60.0 / 60.8 / 56.3
Results suggest that there has been little change since 1998 when there was an increase in the percentage of people making lifestyle changes.
Females were more likely than males to have made lifestyle changes in the last year, although more males than females (35% and 31% respectively) said they had tried to cut down their alcohol intake.
Lifestyle Changes / Aberdeen City% / Aberdeenshire
% / Moray
% / Grampian
%
Drink less alcohol / 36.0 / 30.0 / 37.6 / 33.4
Changed to a healthier diet / 66.1 / 64.5 / 69.6 / 65.5
Take more exercise / 69.1 / 67.6 / 71.2 / 68.7
Lose weight / 69.4 / 58.8 / 62.9 / 59.3
Relax more often / 60.6 / 58.5 / 62.5 / 60.3
Respondents from Aberdeenshire were least likely to have made lifestyle changes in the year prior to the survey while those from Moray were the most likely.
2.7 Exposure to the Sun
Respondents were asked to supply information on various aspects of sunbathing; 2.3% of respondents said that during the last 12 months they had been badly sunburned with redness or soreness of the skin which lasted for at least one or two days. A further 21% said that they had experienced mild sunburn compared with 15% in 1998.
The percentage of respondents who had suffered from sunburn was highest among the
younger age ranges and lowest for those aged 65-74 years.
Age Range / % who had been badly or mildly sunburned in the last 12 months16-24 / 34.8
25-34 / 28.2
35-44 / 25.7
45-54 / 24.1
55-64 / 11.9
65-74 / 8.0
All ages / 23.4
9.5% of respondents always use a sun block of factor 15 or more in the UK and a further 41.7% said that they sometimes do. However, when abroad, 51% always use a sunscreen of at least factor 15 and 26% sometimes do. These figures are similar to those in the 1998 survey.
2.8 Women’s Health
3.7% (143) of repondents had had a baby in the year prior to the survey. Of these women 65.4% (i.e. 92 women) had breastfed their babies. Of the 92, 45.9% did so for at least 6 weeks. Dietary targets for Scotland for the year 2005 suggest that the proportion of women breast feeding their babies for the first 6 weeks of life should be more than 50%. Results show that Grampian still has a little way to go to meet this target.
3. Food
In Scotland there are two main problems related to eating habits: over-eating and not eating a balanced diet. Diet is implicated in many health problems such as coronary heart disease, cerebrovascular disease (stroke), non-insulin dependent diabetes, cancers, hypertension and dental caries. Therefore, a healthy diet will help people to avoid illness and stay in good health. The Scottish Diet Action Plan3 suggests that we should reduce consumption of saturated and animal fats, salt and sugar and increase consumption of fruit, vegetables and dietary fibre.
3.1 Healthy Eating Score
The questionnaire collected information on the frequency of consumption of a variety of foods from each of the different food groups. In order to interpret the information obtained, a healthy eating score was calculated. This score had been developed previously by Lanarkshire Health Board and has been widely used.
Ten foods were chosen: five healthy (fruit, vegetables, potatoes, rice/pasta and wholemeal bread) and five less healthy (chips, other fried food, crisps, cakes/scones/sweets/pastries and meat-filled pies, sausage rolls etc.). The scoring method was applied as follows:
Food / Score0 / 1 / 2 / 3
Per day
Fruit / < 1 piece / 1 piece / 2 pieces / 3 or more pieces
Vegetables / < 1 piece / 1 piece / 2 pieces / 3 or more pieces
Per week
Potatoes / < 1 day / 1-2 days / 3-5 days / 6-7 days
Rice/Pasta/other grains / < 1 day / 1-2 days / 3-5 days / 6-7 days
Wholemeal bread / < 1 day / 1-2 days / 3-5 days / 6-7 days
Chips / 6-7 days / 3-5 days / 1-2 days / < 1 day
Other fried foods / 6-7 days / 3-5 days / 1-2 days / < 1 day
Cakes/scones/sweet pastries / 6-7 days / 3-5 days / 1-2 days / < 1 day
Meat filled pies/ sausage rolls etc / 6-7 days / 3-5 days / 1-2 days / < 1 day
Crisps/other savoury snacks / 6-7 days / 3-5 days / 1-2 days / < 1 day
Where the respondent had failed to indicate a response, they were allocated the median value for that food. This resulted in a score between 0 and 30, where a score of 30 represented the healthiest diet. Respondents were classified into three categories according to their score. Category 1 represents the least healthy diet and 3 the healthiest diet.
Score / Category0-16 / 1= Least Healthy
17-20 / 2=Intermediate
21-30 / 3=Most Healthy
3.2 Healthy Eating Scores by Sex
Males% / Females
% / All respondents
%
Least Healthy / 38.5 / 22.5 / 30.5
Intermediate / 35.2 / 33.7 / 34.5
Most Healthy / 26.3 / 43.8 / 35.0
Results indicate a significant difference between sexes, with men tending to eat less healthily than women. Since 1998, the percentages eating the most healthy diet have declined in both men (from 29.3% to 26.3%) and women (from 50.7% to 43.8%).
3.3Healthy Eating Scores by Age Group
Results indicate progressive changes over the age groups. Increasing percentages eat the most healthy diet up to age group 55-64 (42.9%), but there is a decline by 65-74 (32.7%).
Single adults (i.e. those never married) (43%) and divorced people (36%) appear to have the worst diet – the highest ‘least healthy‘ diet scores. Respondents who were married (40%), cohabiiting (34%) or widowed (33%) had the healthiest diets.
There was a clear link between level of education and the type of diet consumed. Respondents who had a university or college degree or some other professional qualification had the healthiest diet.
University/college% / Other professional/technical qualification
% / Highers
% / Secondary school – other qualifications
% / No qualifications
% / Total
%
Least Healthy / 16.3 / 25.6 / 32.2 / 39.4 / 46.3 / 30.4
Intermediate / 34.2 / 36.0 / 31.8 / 36.4 / 31.7 / 34.5
Most Healthy / 49.5 / 38.4 / 36.1 / 24.2 / 22.0 / 35.1
3.4 Healthy Diet
The percentage of respondents who thought they had a healthy diet was tabulated against the diet category based on the healthy eating score.
Do you feel you have a healthy diet?
Yes% / No
% / Not sure
% / Total
%
Least Healthy / 17.1 / 54.5 / 44.0 / 30.2
Intermediate / 35.0 / 32.3 / 35.4 / 34.6
Most Healthy / 47.9 / 13.2 / 20.7 / 35.3
17% of respondents who felt that they had a healthy diet had their diet assessed as ‘least healthy’. In contrast 13% did not feel that they had a healthy diet although their diet was categorised as ‘most healthy’.
Females were more likely to feel that they have a healthy diet, as were those in the older age groups
3.5 Consumption of Fruit and Vegetables
Percentage of respondents consuming the following portions daily:
Portions / Fruit / Veg%
None / 5.7
One / 5.7
Two / 13.2
Three / 13.3
Four / 17.6
Five / 15.2
More than five / 29.3
The national target for daily fruit/vegetable consumption states that men and women should eat at least five portions of fruit/vegetables each day.
Results show that people are eating more vegetables and fruit and that 44.5% of respondents are meeting the target. At present, respondents consume on average 4 pieces of fruit and vegetables each day. In 1998 this figure was reported as 3 pieces. Since 1994 the average pieces of fruit and vegetables eaten by males and females has shown a significant increase.
Females consume more fruit and vegetables than men, consuming an average of 4.3 portions each day compared to 3.6 for men. In 1998 females consumed an average of 3.4 portions of fruit and vegetables and males an average of 2.6.
67% of respondents said that they eat breakfast between five and seven days a week. This percentage steadily increased by age group from 54.7% for 16-24 year olds to 81.2% among 65-74 year olds. Females were more likely to eat breakfast 5-7 days than
males (72% v 62%).
3.6 Milk Consumption
Respondents were asked which type of milk they consume - responses were as follows:
Males% / Females
%
Full cream milk / 24.4 / 15.5
Semi-skimmed milk / 66.1 / 68.7
Skimmed milk / 6.6 / 12.0
Other / 0.7 / 2.5
Percentage of respondents aged 16-64 years who consume the following type of milk:
Aberdeen City% / Aberdeenshire
% / Moray
% / Grampian
%
Full cream milk / 16.5 / 22.0 / 21.5 / 19.9
Semi-skimmed milk / 69.5 / 66.9 / 64.5 / 67.4
Skimmed milk / 10.8 / 8.0 / 9.4 / 9.3
Other / 0.6 / 1.0 / 1.7 / 1.0
The national target set to be achieved by the year 2001 indicates that 85% of women and 70% of men should consume semi skimmed or skimmed milk. At the time of this survey 80% of women and 72% of men were drinking semi-skimmed or skimmed milk. These results are similar to 1998, but considerably better than in 1994 (73% women and 63% men). Results are similar for all three local authority areas.