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Grampian Adult Lifestyle Survey 2002 Contents Page 1. Introduction 3 1.1 Aims and Objectives of the Survey 1.2 Survey Methods 1.3 Response Rate 1.4 Analysis 2. General Health and Primary Care 5 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. Food 9 3.1 Healthy Eating Score 3.2 Healthy Eating Score by Sex 3.3 Healthy Eating Score by Age Group 3.4 Healthy Diet 3.5 Consumption 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 1. 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/Leisure 23 6.1 Daily Activity 6.2 Regular Physical Activity 6.3 Reasons Given for Wishing to be More Active 7. Drugs 25 7.1 Information 7.2 Drug Misuse 7.3 Types of Drugs Taken 7.4 Reasons for Taking Drugs 8. Sexual Health 28 8.1 Lifestyle Changes 8.2 Sexually Transmitted Infection 9. Well-being 30 9.1 Dealing with Problems 9.2 Issues which cause Problems Conclusion 32 References 32 Appendix 33 2. 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 1 outlined in White Paper on Health, Towards a Healthier Scotland. • 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 2 sexual health. The Scottish Needs Assessment Programme (SNAP) 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. 3. 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. 4. 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 2 weight to height (BMI = weight in kg/ height in metres ). The following table indicates the BMI ranges associated with each category. BMI Underweight <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 respondents 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. Respondents who are overweight or obese by gender Years 1994,1998 and 2002 Percentages 1994 70 1998 58 2002 60 48 50 45 45 41 Percentage 37 40 30 20 10 0 Male Female 1994 45 37 1998 48 41 2002 58 45 Gender 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. 5. 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 Grampian 2002 Grampian 1998 Grampian 1994 professional % % % 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. 6. 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 Males Females professional % % 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 Grampian Grampian Grampian 2002 % 1998 % 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. 7. Lifestyle Changes Aberdeen Aberdeenshire Moray Grampian City % % % % 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 months 16-24 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. 8. 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 3 avoid illness and stay in good health. The Scottish Diet Action Plan 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 Score 0 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. 9. Score Category 0-16 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%). 3.3 Healthy Eating Scores by Age Group Healthy Eating Scores by Age-group Percentages 100% 80% Percentages 60% Most Healthy Intermediate 40% Least Healthy 20% 0% 16-24 25-34 35-44 45-54 55-64 65-74 Total Most Healthy 20.7 33.9 36.4 41.6 42.9 32.7 35 Intermediate 34.1 36.5 36.1 33.3 33 32.4 34.5 Least Healthy 45.1 29.6 27.5 25.1 24.1 34.9 30.5 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. 10. 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. Other Secondary University/ professional/ school – other No college technical Highers qualifications qualifications Total qualification % % % % % % 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. 11. 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. Consumption of Fruit and Vegetables by Gender and Year Portions 5 4.3 4 3.6 3.4 1994 Portions 3 2.6 2.5 2.1 1998 2 2002 1 0 Male Female 1994 2.1 2.5 1998 2.6 3.4 2002 3.6 4.3 Gender 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 12. 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. 3.7 Type of Spread 43.6% of respondents use a low fat spread compared with 44% in 1998 and 28% in 1994. More females (44.8%) than males (42.5%) used low fat spread and the percentage of respondents using a low fat spread increased with age. There was little difference in responses across the three Grampian areas. 3.8 Making Changes 39.5% of men and 47% of women have changed their diet in the last year. Of these 98.9% said they had tried to eat more oil-rich fish (percentages are based only on those who said that they had made changes.) 13. 3.9 Support and Advice to Improve Eating Habits Respondents were asked to indicate how helpful each of the following would be to them if they wanted to change their eating habits. Responses were as follows: Very Helpful Helpful Not Helpful % % % Healthy food at affordable prices 55.3 36.2 8.5 Encouragement & support from 43.9 44.8 11.3 family & friends Wider availability of ‘healthy food’ 38.8 50.0 11.3 More information on food labels 36.1 44.9 19.0 Advice and support from GP/ 27.7 52.6 19.7 dietician/Health Promotions/ Health Visitor A booklet giving advice and practical 27.0 54.8 18.2 tips Demonstrations on buying & cooking 22.3 44.3 33.5 healthy food Information in the media 17.5 55.6 26.9 A self help group 14.3 34.1 51.6 Encouragement & support at work 13.1 44.6 42.3 Healthy food at affordable prices was viewed as the most important single factor which could help respondents to make positive changes to their eating habits. 14. 4. Tobacco Smoking 4.1 Passive Smoking 8% of respondents said that they spend most of their day in the company of people who smoke. A further 27% spend some of their day where people smoke. The remaining 64% reported seldom being in places where people smoke. This compares with 60% in 1998 and means there are fewer people spending time inhaling other people’s tobacco smoke. 4.2 Smoking Status Respondents were asked which of the following statements relating to smoking best describes them. Responses were as follows: Males Females Total % % % Never smoked/tried once or twice 49.6 57.6 53.5 Given up smoking 23.9 20.6 22.3 Smoke some days 6.4 4.2 5.3 Smoke every day 20.1 17.7 18.9 Results indicate that 26.5% of males and 21.9% of females smoke. There have been small decreases in both male and female smokers since 1998 (3.4% for both genders). 4.3 Age Group The results showed differences in smoking according to age. People in the younger age groups were more likely to smoke than those in older age groups. Percentage currently smoking some or every day Age-group and gender Male 40 Female 30 Percentage 20 10 0 16-24 25-34 35-44 45-54 55-64 65-74 Male 32.1 33.7 23 23.8 24 19.8 Female 26.8 19.9 21.8 23.4 20.8 16.7 Age-group 15. The results, for males, were similar in all three local authority areas. However Aberdeen City is at least 3% higher for female smokers than the other two local areas. Aberdeen City Aberdeenshire Moray Grampian % % % % Males 26.8 26.0 26.3 26.4 Females 24.1 19.9 21.0 21.7 All respondents 25.5 23.0 23.7 24.1 4.4 Quantity of Cigarettes Smoked 23.4% of smokers are currently smoking more than 20 cigarettes per day. This is a 2.4% decrease since the 1998 survey. More now smoke only up to 9 cigarettes per day (40.7% compared with 28.1% in 1998). Quantity of cigarettes smoked 1998 and 2001 50 40 Percentage 30 1998 20 2002 10 0 Up to 9 10 to 14 15-19 20-39 40 or more 1998 28.1 23.9 22.1 23.9 1.9 2002 40.7 28.3 7.6 22.7 0.7 Quantity smoked The difference between the quantities of cigarettes smoked between males and females was significant, with analysis indicating that 28.1% of male smokers smoked 20 or more cigarettes each day compared to 19% of females. This represents a 5% decrease for males and a 0.6% increase for females since 1998. 16. 4.5 Reasons for Smoking Respondents were given a list of statements and asked to indicate which of the following reasons for smoking applied to them. The results were similar to 1998. 2002 1998 1994 Reason for smoking % % % Calms nerves and helps relaxation 67.9 66.7 80.8 Enjoy the taste 30.3 29.6 58.8 Relieves boredom 37.8 35.1 55.2 Helps concentration 17.4 21.1 41.6 Dependent on smoking 42.7 44 - Friends smoke 14.0 15.5 26.1 Smoking gives confidence 5.9 8.3 15.7 42.3% of respondents who smoke had tried to stop smoking in the 12 months prior to the survey. Responses varied with age group: the 16-24 year olds were most likely to have tried to give up smoking in the last 12 months (55.6%) and those aged 45-54 were least likely (30.3%). 4.6 Support to Stop Smoking The following table shows the top six responses that would be helpful if they wished to stop smoking: Very Important Important % % Will-power 88.0 8.6 Encouragement and support from family and friends 55.6 27.2 Pregnancy 51.2 16.1 Nicotine Replacement Therapy 35.0 32.4 Advice from your doctor or health care worker 25.4 39.2 Restrictions on smoking at work 29.5 27.0 Will-power was viewed as the most important factor in stopping smoking, followed by encouragement and support from family and friends. A stop smoking group (16.8%), Zyban (13.2%) and telephone helplines (6.8%) were among the least important factors for those wishing support. 73% of male smokers and 78% of female smokers would like to stop smoking 45% of those who smoked felt that smoking should not be allowed in public places. This question was not asked of non-smokers. 17. 5. Alcohol 5.1 Frequency of Alcohol Consumption Male Female All respondents % % % Never drink 10.0 17.2 13.6 Drink < 1/month 9.4 18.2 13.8 Drink monthly but not weekly 14.8 18.6 16.7 Drink at week-ends 19.5 16.5 18.0 Drink 1-2 days a week 15.6 12.3 14.0 Drink 3-5 days a week 21.3 13.1 17.2 Drink 6-7 days a week 9.5 4.0 6.7 Frequency of alcohol consumption Never drink 14% Drink weekly Drink < 37% 1/month 14% Drink monthly but not weekly Drink at week- 17% ends 18% Results indicate differences in the frequency of alcohol consumption between males and females. It is clear from the table that male respondents drink alcohol more frequently than female respondents. 66% of males usually drink at least once a week compared to only 46% of females. Survey results also indicated that respondents from Aberdeen City drank more, weekly and at weekends, than either Aberdeenshire or Moray, 58.3% compared to 55.1% and 54% respectively. As in the 1998 survey respondents from Moray drank the least. Frequency of alcohol consumption also varied with age. Respondents in the younger age groups drank more frequently than those in the older age groups. More respondents now drink at least weekly than in 1998, 1994 and 1990. 18. 2002 1998 1994 1990 % % % % Never drink/given up 13.6 11.4 13.7 18.0 Drink < 1/month 13.8 15.7 19.1 14.0 Drink monthly but not weekly 16.7 21.2 23.7 18.0 Drink at week-ends** 18.0 - - - Drink 1-2 days a week 14.0 28.3 27.5 39.0 Drink 3-5 days a week 17.2 16.4 12.0 11.0* Drink 6-7 days a week 6.7 6.8 4.0 * This figure from the 1990 survey represents Drink alcohol 3-7 days a week **Category, drink at week-ends, included in 2002 survey only 5.2 Alcohol Consumption in the Last Seven Days 71% of respondents had had an alcoholic drink in the seven days prior to the survey (77% of males and 65.% of females). Respondents who had consumed alcohol in the seven days prior to the survey were asked to indicate from a table the number of various types of alcoholic drinks they had consumed. The quantities of alcohol consumed were converted to units using the following criteria: Measure Description Strength 1 pint Normal strength beer/lager/stout/cider (e.g. 2 units McEwan’s lager, heavy) Bottle Lager eg. Bud, Becks, Stella Artios 1.5 units 1 pint/1 can Extra strong beer/lager/cider (e.g. Tennant’s 4 units super lager) 1 measure Spirits (e.g. gin, vodka) 1 unit 1 measure Martini/sherry 1 unit 1 medium glass Glass of table wine 1 unit 1 large glass 2 units Bottle Flavoured alcoholic beverages, eg. smirnoff ice, 1.5 units bacardi breezer, wkd 19. The Royal College of Physicians and the British Medical Association currently recommend the following as ‘sensible drinking’: • not more than 21 units of alcohol per week for men • not more than 14 units of alcohol per week for women • one to two alcohol-free days during the week Where people are drinking near the maximum sensible limit, it is preferable that this should be spread throughout the week. Categories used for weekly units consumed: Males Females Safe Up to 21 units Up to 14 units Hazardous 22-49 15-34 Dangerous 50 or over 35 and over Units of alcohol were calculated, and respondents categorised, depending on their levels of consumption. Results were then compared with those obtained from previous surveys. As the method for recording the level and frequency of alcohol consumption is more accurate than in previous surveys, it is possible that the previous levels and frequency of alcohol consumption were under-reported. Percent of respondents who drink weekly* and percent who are exceeding safe limits 60 55.9 51.5 50 Drink weekly 43.5 Exceeding 40 safe limits Percentage 30 20 20 20 11 10 0 1994 1998 2002 Drink weekly 43.5 51.5 55.9 Exceeding safe limits 11 20 20 Year *includes week-end drinng The percentage of respondents drinking at least weekly has increased since the 1994 survey as has the percentages exceeding safe limits. 20. 5.3 Alcohol Consumption levels by gender 2002 1998 1994 1990 % % % % M F Total M F Total M F Total M F Total None 23 36 29 23 36 29 14 26 20 12 22 17 Safe 51 51 51 51 52 52 68 70 69 68 74 71 Hazardous 20 11 16 20 11 16 15 4 10 17 4 10 Dangerous 5 2 4 6 1 4 3 0.3 1 3 0.4 1 1 The Government’s White Paper on Health, Towards a Healthier Scotland , set national targets, for 16-64 year olds, to be achieved by 2010, for the percentages exceeding weekly safe limits, of 29% for men and 11% for women. At the time of this survey these targets were already being met by men in Grampian (25.6%) but not by women (12.8%). As in previous surveys results indicate that male respondents who drink alcohol are more likely to have consumed more than the recommended levels of alcohol. Levels of alcohol consumption varied between each of the three local authority areas. 22.8% of respondents from Aberdeen City drank more than the recommended levels of alcohol compared to 17.8% of those from Moray and 17.1% of respondents from Aberdeenshire. 13.5% of respondents who did not feel that the amount of alcohol they drank was harmful to their health were actually drinking to a hazardous level, and a further 1.4% were drinking to a dangerous level. 20% of respondents had tried to cut down on their level of alcohol consumption in the year prior to the survey. 21. 5.4 Factors That Would Help Reduce Alcohol Intake Respondents were given a list of factors and were asked to indicate if they would find any of them helpful if they wanted to reduce the amount of alcohol they consumed. Responses were as follows: % Less stressful life 64.7 Encouragement and support from family and friends 60.7 More recreational/sports facilities at reasonable prices 54.1 A booklet offering advice and practical tips 43.8 Information from Health Promotions 39.8 Advice from a doctor or health care worker 37.7 Encouragement and support at work 22.6 Advice from Alcoholic advisory group 21.4 22. 6. Work/Sport/Leisure 6.1 Daily Activity Respondents were asked to indicate how active they are in a normal day. Males Females Grampian % % Respondents % In light activity (eg sitting at a desk) 40.3 39.0 39.7 In moderate activity (eg on you feet) 38.7 57.0 47.6 In heavy activity (eg heavy lifting) 21.0 4.0 12.7 There were noticeable differences between the sexes, with males more active than females. Since the 1998 survey, 6% more males and 11% more females spend their time in light activity with corresponding reductions in moderate activity. Results varied by local authority area and age group. Respondents living in Aberdeen City were least active, while those living in Moray were most active. Aberdeen City Aberdeenshire Moray % % % In light activity 47.0 36.0 30.7 In moderate activity 43.9 48.8 55.9 In heavy activity 9.1 15.2 13.4 6.2 Regular Physical Activity Regular physical activity means accumulating 30 minutes of moderate activity on most days of the week – it does not have to be 30 minutes all at once. All Males Females respondents % % % I am not regularly physically active and do 8.0 6.8 7.4 not intend to be in the next 6 months I am not regularly physically active but I 9.6 11.3 10.5 intend to be in the next 6 months I do some physical activity but less than 22.6 26.8 24.7 described at the start of the question I am regularly physically active but only 4.3 6.8 5.6 began in the last 6 months I am regularly physically active and have 55.4 48.3 51.9 been for longer than 6 months 23. Overall, 57.5% of respondents described themselves as regularly active and a further 24.7% did some physical activity. This is a 12.5% increase of Grampian respondents taking regular physical activity since the 1998 survey. Males were more likely than females to be physically active. 1 The Government’s White Paper on Health, Towards a Healthier Scotland , has set a new national target for the proportion of men and women aged 16-64 taking 30 minutes of moderate activity on 5 or more occasions each week – 50% of men and 40% of women to be taking 30 minutes each day moderate activity by 2005 and 60% of men and 50% of women to be taking 30 minutes each day moderate activity by 2010. At the time of this survey the 2005 target is already being met by both males and females and the 2010 target is being met by females while males are only 0.7% off their target. 6.3 Reasons Given for Wishing to be More Physically Active All respondents were asked if they would consider taking more exercise for any of the reasons listed. Among both sexes, desires to improve health or feel fitter/healthier were the main reason given for considering taking more exercise. All Males Females respondents % % % To improve health 93.5 96.5 95.0 To feel fitter/healthier 92.8 95.7 94.3 To prevent disease or ill health 90.0 93.1 91.5 To help you relax 84.2 88.3 86.2 To enjoy yourself 77.5 80.9 79.1 To lose weight 64.9 80.8 72.9 To look better 55.5 75.3 65.3 Younger respondents were more likely than older ones to state that they would consider taking more exercise to feel fitter/healthier, look better and/or for enjoyment. Those in the middle age range were more likely than younger and older respondents to mention prevention of disease and ill-health, weight loss and relaxation as potential motivating factors. Older respondents were more likely to exercise to improve health, feel fitter or help them relax. Lack of spare time at evenings and weekends was stated as the main reason which prevented respondents from being more physically active (55.9%), next was the fact they felt they took enough exercise, 34.2%, lack of money and not knowing what’s on were next at approximately 27%. Least problem was lack of transport. 24. 7. Drugs Lifestyle surveys conducted in Grampian prior to 1998 did not include questions on 4 drugs. However during 1995 a separate survey of drug misuse was carried out in Grampian among adults aged 16-44 years. Where comparisons are possible, the 1998 and 2002 lifestyle data has been re-analysed with the same age group to allow comparisons with this 1995 Grampian Drug Survey. 7.1 Information Respondents were aked where they obtained most of their information about drugs % TV Programmes/campaigns 84.9 Newspapers 64.1 Leaflets 33.4 Friends/family 30.1 Radio programmes 21.9 Health Promotions 19.7 GP/health worker 9.3 The Internet 8.0 As in the 1998 survey the four most popular sources of information were TV programes, newspapers, leaflets and family/friends. 7.2 Drug Misuse 21.6% of all respondents said that they had taken drugs. This figure varied by area. Results indicate that Aberdeen City has a higher perdentage of respondents who have tried drugs. Percentage who have taken drugs % Aberdeen City 25.6 Aberdeenshire 18.4 Moray 21.5 Grampian 21.6 Percentages also varied by sex and age group. Males were significantly more likely to have taken drugs than females (26.9% v 16.3%). 25. Percentage who had taken drugs by age group: Males Females All respondents % % % 16-24 46.4 32.1 39.6 25-34 44.9 30.9 38.0 35-44 29.4 13.6 21.5 45-54 18.6 10.2 14.5 55-64 5.6 4.3 5.0 65-74 1.4 1.5 1.5 The 1995 survey indicated that 72.2% of respondents aged 16-44 years had never used drugs. This figure has fallen to 67.8% in 2002. 7.3 Types of Drugs Taken Respondents who had never taken drugs were not required to complete any further questions and percentages given in the following tables are based only on the respondents who had taken drugs. Respondents were asked to give information on the types of drugs they had used and also how often these drugs are taken. This was done by asking respondents to complete the table shown below. In order to ensure that the information provided was accurate, a ‘dummy’ variable was included in the list. Those who claimed to have taken the dummy variable were excluded from further analysis. % of all Never Tried Stopped Take < Take Take % of users respondents taken once or taking 1/month monthly weekly who have who have twice taken drug tried drugs % % % % % % % % Cannabis 2.7 44.2 33.7 2.3 3.7 13.5 97.3 13.3 Amphetamines 54.8 29.0 14.2 1.1 0.2 0.6 45.2 6.3 Magic mushrooms 72.4 20.9 6.2 0.2 0.4 - 27.6 3.5 Ecstasy 68.4 15.6 11.4 3.3 0.9 0.3 31.6 4.4 Temazepam 90.7 6.0 2.2 0.3 0.2 0.6 9.3 1.3 Poppers 68.7 27.2 3.2 0.3 0.3 0.2 31.3 4.2 Solvents 88.8 8.7 2.6 - - - 29.1 1.6 Other painkillers 93.3 3.0 2.2 - 0.2 1.3 6.7 0.9 Of those reporting ever taking drugs, 97.3% had tried cannabis, 45.2% had tried amphetamines, 27.6% had tried magic mushrooms and 31.6% and 31.3% had tried ecstasy and poppers respectively. Only 2.0% of respondents who had tried drugs reported they had ever injected drugs (0.426% of all respondents). 26. 7.4 Reasons for Taking Drugs The following reasons were given for taking drugs: Percentage who took drugs for this reason To be sociable 56.4 Enjoy effect 53.7 To relax 50.5 Relieve boredom 28.1 Forget worries 26.0 Depressed/Anxious 17.7 When lonely 11.3 Dependant on drugs 4.6 Over half of drug takers said that they enjoy the effect drugs have on them, or take them to be sociable, or to help them relax. 27. 8. Sexual Health 8.1 Lifestyle Changes 15.9% of respondents claim to have changed their lifestyle in some way because of concerns about becoming infected with a sexually transmitted disease including HIV. Percentages varied by age group, indicating that younger people were more likely to have changed their lifestyle. There are differences between areas, with 19.8% in Aberdeen City having made changes compared to 13.5% in Moray and 13.1% in Aberdeenshire. Percentage who have made changes to their sexual lifestyle 16-24 27.3 25-34 28.0 35-44 16.1 45-54 9.1 55-64 4.5 65-74 2.4 Grampian 15.9 Lifestyle changes made are shown in the table below Percentage who have made the following changes Having only one partner 60.1 Use condoms with new partner 40.3 Find out more about a person before 25.9 having sex Having fewer partners 17.3 Not having sex 12.9 Avoid some sexual practices 9.5 28. 8.2 Sexually Transmitted Diseases 12.4% of respondents always use a condom when they have sexual intercourse compared to 59.6% who never use condoms. Of those who never use a condom 92% said this was because they had a long-term partner. Respondents were asked to agree or disagree with the following statements in order to assess their levels of knowledge: Percentage who gave correct answer: Aberdeen Aberdeen Moray Grampian City Shire % % % % Sexually transmitted infections can be True 79.1 72.2 76.1 75.6 passed on to an unborn baby Herpes virus (cold sore) on the lip can True 64.7 63.6 65.9 64.4 be transferred to the genital area Sexually transmitted infections can cause True 86.2 83.5 83.6 84.7 infertility Some forms of the wart virus can cause True 46.9 42.6 43.0 44.4 cancer of the cervix There has been a significant increase in knowledge of sexually transmitted infections since the 1998 survey, most categories having a 10% increase in correct answers with an approximate 20% increase in knowledge that sexually transmitted infections can cause infertility, across the three local authority areas. When asked where they would go for advice on sexual health, 92% said their GP with 57.8% saying the Family Planning Clinic whilst 32% said they would try the Internet. 29. 9. Well-Being Respondents were asked to indicate how they felt about the following: Very/Quite Mixed Very/Quite Happy Feelings Unhappy % % % Your physical wellbeing 63.4 29.1 7.4 Your mental/emotional wellbeing 69.1 23.3 7.6 Your overall quality of life 75.5 18.8 5.7 Your current standard of living 81.6 14.2 4.2 Your confidence in the future 64.8 29.4 5.8 Overall most respondents were happy with their lives, although some had mixed feelings and a few were unhappy. 9.1 Dealing with Problems As an indication of how best to promote mental health among people living in Grampian, a range of possible activities was provided which might help to deal with problems or stress. Respondents were asked to identify any activities they undertake. Males Females All % % respondents % Try to work out a solution 83.7 86.4 85.0 Try to see the problem in a different light 70.9 74.6 72.9 Talk to someone about the problem 60.0 72.1 66.0 Get more information about the problem 56.0 56.9 56.4 Listen to music 59.1 63.1 61.1 Work harder 50.1 47.6 48.9 Read 32.5 54.3 43.2 Stay away from others, keeping your feelings 46.8 45.8 46.3 to yourself Spend more time being sociable going out 33.6 41.0 37.2 with family and friends Do something creative 16.0 23.0 19.4 Ignore the problem 16.9 12.0 14.5 High percentages of respondents try to find a solution to their problems, try to see them in a different light or talk to someone about the problem. There were some differences in responses given by males and females, for example females were more likely to read (54%) than males (33%). 30. 9.2 Issues which cause problems in your life Respondents were asked which issues caused problems in their life. Males Females All respondents % % % Stress 50.4 53.6 51.8 Being overworked 32.9 28.7 30.8 The health of others 29.0 38.8 33.8 Your health 27.0 29.2 28.1 Family 20.0 34.3 27.1 Job insecurity 18.1 10.4 14.3 Relationships at work 16.3 15.7 16.0 Loneliness 13.4 21.9 17.6 Your standard of living 12.9 9.8 11.4 Your housing condition 9.5 8.7 9.1 Lack of community facilities in the area 8.7 8.3 8.5 Trying to find a job 9.0 7.5 8.2 Being unemployed 9.0 5.1 7.1 Being bullied 1.9 4.5 3.2 Violence 4.5 3.2 3.9 Sexual abuse in childhood 1.2 3.5 2.4 There were some differences between responses from males and females. Females were more likely to say that the health of others, family and loneliness cause problems in their life. Males were more likely to indicate that job insecurity, being overworked, trying to find a job and being unemployed cause them problems in life. Of respondents who said stress caused problems in their life, 40.4% said this stress was at work and 16.8% said it was at home, however, there was a 19% decrease, since 1998, of those respondents who said they suffered stress at work. 31. Conclusion The results of this survey are generally encouraging, especially in the areas of fruit and vegetables eaten, smoking, exercise and awareness of sexually transmitted diseases. These improvements demonstrate the benefits of working collaboratively with our partners in the NHS, local authorities, communities and industry to focus our efforts on issues identified within previous surveys. There are, however, a number of areas of concern including the trend in overweight and obesity, fewer eating healthy diets and increased exposure to sunburn. These results enable us to monitor progress when compared with earlier data and will also provide baseline information for future evaluation of health promotion initiatives. The on-going ability to access and reanalyse the raw data in depth provides enormous opportunities to inform the work of NHS Grampian and partner organisations. 1 Working Together for a healthier Scotland: a consultation document. Scottish Executive Feb 1998 2 Scottish Needs Assessment Programme (Scottish forum for Public Health Medicine) 3 Eating for Health, a diet action plan for Scotland, 1996 4 Grampian Drug Survey, Grampian Health Board, 1995 32. Appendix 1 National targets outlined in the White Paper on Health, Towards a Healthier Scotland , are detailed below. Headline Targets for Scotland Indicator Target Coronary Heart Disease Age standardised mortality rate Reduce by 50% between 1995 and 2010: ie from from CHD in people under 75 143 to 72 deaths per 100,000 population. years Cancer Age standardised mortality rate Reduce by 20% between 1995 and 2010: ie from from all cancers in people under 188 to 150 deaths per 100,000 population. 75 years Smoking Smoking among young people Reduce smoking among young people from 14% (12-15 year olds) to 12% between 1995 and 2005 and to 11% by 2010. Proportion of women who smoke Reduce the proportion of women who smoke during pregnancy during pregnancy from 29% to 23% between 1995 and 2005 and to 20% by 2010. Alcohol Misuse Prevalence of men and women Reduce incidence of adults exceeding weekly aged 16-64 exceeding weekly limits: limits of 21 and 14 units of - from 33% to 31% for men between 1995 and alcohol 2005 and to 29% by 2010. - from 13% to 12% for women between 1995 and 2005 and to 11% by 2010. Teenage Pregnancy Pregnancy rate among 13-15 Reduce by 20% between 1995 and 2010. year olds Dental Health Proportion of 5 year olds with no 60% of 5 year olds to have no experience of dental experience of dental disease disease by 2010. Second Rank Targets Diet See Scottish Diet Action Plan Retain targets for 2005 in Scottish Diet Action Plan. Smoking Rate of smoking among adults Reduce rate of smoking from an average of 35% (aged 16-64) in all social classes to 33% between 1995 and 2005 and to an average of 31% by 2010. Alcohol Misuse Frequency and level of young Reduce frequency and level of drinking from 20% people (12-15) drinking of 12-15 year olds to 18% between 1995 and 2005 and to 16% by 2010. Physical Activity Proportion of 11-15 year olds Increase proportion from 32% in 1994 to 40% in taking vigorous exercise 4 times 2005 and to 50% in 2010. or more weekly Proportion of men and women 50% of men and 40% of women to be taking 30 aged 16-64 taking 30 minutes of minutes of moderate activity on 5 or more moderate activity on 5 or more occasions each week by 2005 and 60% and 50%, occasions each week respectively, by 2010. Cerebrovascular Age standardised mortality rate Reduce by 50% from 1995 level by 2010. Disease from this disease in people under 75 years Dental Health Proportion of 45-54 year olds Less than 5% of 45- 54 year olds to have no with no natural teeth natural teeth by 2010. 33.
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