LOTHIAN HEALTH & LIFESTYLE SURVEY 2010 COMMUNITY HEALTH PARTNERSHIP FINDINGS: REPORT

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1 LOTHIAN HEALTH & LIFESTYLE SURVEY 2010 COMMUNITY HEALTH PARTNERSHIP FINDINGS: REPORT Directorate of Public Health & Health Policy NHS April

2 AUTHORS Pat Boreham John Forbes Annette Gallimore Laura Hay Phil Mackie Alison McCallum Jo Morling Steve Platt University of University of NHS NHS NHS NHS NHS University of PRODUCED BY: Directorate of Public Health & Health Policy, NHS and University of 2

3 CONTENTS EXECUTIVE SUMMARY 5 IMPLICATIONS 6 INTRODUCTION 7 BACKGROUND 7 GENERAL HEALTH & WELLBEING 9 PERCEPTION OF HEALTH 9 PERCEPTION OF FITNESS 10 PERCEPTION OF FITNESS 12 DENTAL HEALTH 12 DENTAL REGISTRATION 14 WELLBEING 15 PHYSICAL WELLBEING 16 MENTAL OR EMOTIONAL WELLBEING 17 QUALITY OF LIFE 17 SELF-HARM AND SUICIDAL THOUGHTS 18 ATTEMPTED TO TAKE OWN LIFE 19 SELF-HARM 20 COMPARISON WITH THE ADULT PSYCHIATRIC MORBIDITY SURVEY 21 USE OF HEALTH SERVICES 32 VISITS TO GP OR PRACTICE NURSE 32 OUTPATIENT ATTENDANCE 33 INPATIENT ADMISSIONS 34 ACCIDENT & EMERGENCY (A&E) VISITS 35 HEALTHCARE ASSETS 37 CARERS 37 NUMBER OF CARERS IN LOTHIAN 37 COMMUNITY 38 CONCLUSION 45 REFERENCES 46 APPENDIX I 47 APPENDIX II 48 APPENDIX III 51 LIFESTYLE 22 DIET AND NUTRITION 22 BODY MASS INDEX (BMI) 22 PERCEIVED EFFECT OF DIET ON HEALTH 23 SMOKING 24 SMOKING STATUS - TOBACCO 25 ALCOHOL CONSUMPTION 26 HOW OFTEN ON AVERAGE DO YOU DRINK ALCOHOL? 27 ON THE LAST DAY THAT YOU DRANK ALCOHOL, HOW MANY UNITS DID YOU DRINK? 28 DO YOU THINK YOUR PRESENT LEVEL OF DRINKING ALCOHOL AFFECTS YOUR HEALTH? 29 DRUG USE 30 WHEN DID YOU LAST TAKE AN ILLEGAL DRUG? 30 3

4 EXECUTIVE SUMMARY LOTHIAN HEALTH & LIFESTYLE SURVEY The aim of the Health & Lifestyle Survey 2010 is to find out more about the health of people in, to help identify what people need to enjoy the best possible health and to help improve health services. This report focuses on the results for the individual Community Health Partnerships/ Community Health & Care Partnership. Where possible, the findings are compared to those from the Health & Life Survey 2002 in order to identify health trends in. This report covers the key topics in the survey and is a selected analysis of the survey data. KEY POINTS GENERAL HEALTH AND WELLBEING The general perception of self-reported health is high across all Community Health Partnerships, 85.9% of respondents rating their general health as excellent, very good, or good. 77.3% of respondents rate their current fitness as good or reasonable. Adult dental health is improving in with an increase of 13.3% since 2002 in the percentage of adults with more than 20 natural teeth. has the highest levels of wellbeing, while has the lowest. The percentage of men stating they have made an attempt to take their own life is lower than that of women (4.6% compared with 7.4%, respectively). Women aged years in are the most likely to state they have self-harmed, 24.8% compared to 14.6% of men of the same age. BEHAVIOUR (LIFESTYLE) The percentage of adults in who are overweight or obese (calculated using self-reported height and weight) has increased 13.1%, from 45.3% in 2002 to 58.4% in The most deprived areas (quintile 1) in have the highest percentage of current smokers,36.4%, compared with 30.4% in the least deprived areas (quintile 5) in lothian. An average of 31% of respondents stated they drank alcohol at weekends and during the week, ranging from 24.6% of respondents to 34.6% in. 73% of respondents reported that they have never taken an illegal drug. 4

5 USE OF HEALTH SERVICES Almost half the respondents from each Community Health Partnership (46.4%) reported having been to see their GP or practice nurse once or twice over the past six months. Just over one third of respondents (37.5%) had attended an outpatient clinic over the past 12 months. residents were less likely to have been admitted to hospital as an inpatient over the previous year compared to the other Community Health Partnerships (12.4% in and 13% in, compared to 13.9% across ). Respondents from the most deprived areas across (quintile 1) were the most likely to have attended Accident & Emergency or casualty over the past six months (15.3%), while respondents from the least deprived areas (quintile 5) were the least likely (8.5%). HEALTHCARE ASSETS has the highest percentage of carers, 17.4%, while has the lowest, 13.3%. Over 90% of people in each Community Health Partnership agreed This is an area I enjoy living in. 44.1% of people living in the most deprived areas (quintile 1) saw vandalism, graffiti or deliberate damage to property as a very big or fairly big problem compared to 7.2% in the least deprived areas (quintile 5). Approximately 50% or more of all respondents felt that most of the time people try to be helpful rather than just look out for themselves. and respondents had the lowest percentage of respondents agreeing with the statement This area has good local transport, 76% and 76.3% respectively. IMPLICATIONS The Health & Lifestyle Survey 2010 is a snapshot of health across. It is compiled from responses to questions ranging from how people see their health, fitness and wellbeing, to their attitudes to aspects of the community in which they live. These results are compared to those from the Scottish Health Survey (SHeS, 2010) to indicate how health and wellbeing in compares on a national level. When compared to the Health & Life Survey, 2002 (LHLS, 2002) the results show changes within over the past eight years. 86% of respondents consider themselves in excellent, very good or good health. The survey results indicate that residents have better health in some aspects than the other Community Health Partnerships and that residents tend to experience slightly better health than in and lothian. Respondents from the most deprived areas report poorer health than those in the least, reflecting evidence on effect of deprivation on all aspects of health and lifestyle. Health trends since 2002 show an increase in the percentage of carers; improvement in dental health; a fall in the percentage of smokers; and a fall in the percentage of people who have used illegal drugs. However, the percentage of overweight and obese adults has increased across all Community Health Partnerships. s rising population indicates an expected increase in demand for health services (NRS Scotland, 2011). The population of is projected to increase by 24% between 2010 and 2035 (compared to a projected 10% across Scotland) (GRO Scotland, 2012). The findings from this survey can contribute towards awareness of changes in demand for services and help to target resources towards those who need them most. 5

6 INTRODUCTION LOTHIAN HEALTH & LIFESTYLE SURVEY The aim of the Health and Lifestyle Survey 2010 is to find out more about the health of people in. The different health needs of individuals result from factors including health behaviour, age, social and health inequalities and life circumstances. Gathering information on these areas can help to identify what people need to enjoy the best possible health and to help improve health services in. This report focuses on the results for each Community Health Partnership or Community Health and Care Partnership in : Community Health Partnership; Community Health Partnership; lothian Community Health Partnership; and Community Health and Care Partnership (see Figure 1). The data is considered by Community Health Partnership and, where data is sufficient and relevant, by age, gender and Scottish Index of Multiple Deprivation 1 (SIMD). The report contains four sections: GENERAL HEALTH AND WELLBEING LIFESTYLE USE OF HEALTH SERVICES AND HEALTHCARE ASSETS. Approximately 30,000 self-completion postal questionnaires were sent to a cross-sectional sample of adults aged years living in. The sample was randomly selected from the NHS Community Health Index database of all patients registered with a general practitioner (GP) in. The response rate was 46.5% (see Appendix III: Methodology). BACKGROUND LOTHIAN HEALTH & LIFESTYLE SURVEY The population in in mid-2010 was around 836,840 (NRS Scotland, 2011) and growing. A rising population can be expected to increase demand for health services. Information from the survey can contribute towards design of health services and the targeting of resources to best improve the health of the population and reduce health inequalities. The most deprived areas are characterised by poor health and lower life expectancy in comparison to the least deprived areas. Deprivation involves the lack of or decreased ability to access aspects of life including social participation, access to services and amenities as well as social participation. The 2010 survey follows on from the Health & Life Survey 2002 in providing a snapshot of the health and life circumstances of the population (NHS, 2002). Some of the questions are the same which means that direct comparisons can be made. New questions in the 2010 survey include questions on peoples views of the community they live in. 1 The Scottish Indices of Multiple Deprivation identifies small area concentrations of multiple deprivation across Scotland. Small areas (datazones) are ordered from 1 (the most deprived) to 6,505 (least deprived). The Scottish Indices of Multiple Deprivation is updated every three years. This report uses Scottish Indices of Multiple Deprivation Thirty-eight indicators are linked across seven domains: income, employment, health, education, skills and training, housing, geographic access and crime (Scottish Government, 2011a). The data reported in the Health & Lifestyle Survey 2010 is grouped into five quintiles ranging from quintile 1, the most deprived, to quintile 5, the least deprived. 6

7 There are two differences to be noted when comparing results between 2002 and 2010: In 2002 was divided into Local Health-Care Cooperatives not Community Health Partnerships. However the boundaries remain the same, except in where boundaries have merged to form a single Community Health Partnership. While there is one Community Health Partnership for, the 2010 survey data is presented for and which combine the old north Local Health-Care Co-operatives and south Local Health-care Co-operatives. Health & Lifestyle Survey 2010 results have been weighted so as to show more accurate estimates for the wider population, in making up for non-responses and matching up to the estimated population distribution across age groups (see Appendix III: Methodology). This differs from 2002 where non response percentages were reported alongside the responses. Where possible, the Health & Lifestyle Survey 2010 results are also compared to those of the Scottish Health Survey 2010 (SHeS, 2010) to see how compares with the rest of Scotland. The data for the Scottish Health Survey 2010 covers a wider age group, 16 years to 75 years and older compared with the Health & Lifestyle Survey 2010 which covers the age range years. FIGURE A: MAP OF LOTHIAN & COMMUNITY HEALTH PARTNERSHIP 7

8 GENERAL HEALTH & WELLBEING LOTHIAN HEALTH & LIFESTYLE SURVEY The survey asked a number of questions about general health, fitness, mental health and wellbeing. Health is not just about absence of disease, it is a state of complete physical, mental and social wellbeing and includes social and cultural factors and an individual s sense of control over their health and circumstances (WHO, 2012). Self-assessed general health is one of the key measures of the overall health status of a population and is a marker for health inequalities. As with physical health, mental health and wellbeing is a marker of health inequalities, and improving mental health is one of the Scottish Government s health priorities. KEY POINTS The general perception of self-reported health is high across all Community Health Partnerships, 85.9% of respondents rating their general health as excellent, very good, or good. 77.3% of respondents rate their current fitness as good or reasonable. Adult dental health is improving in with an increase of 13.3% since 2002 in the percentage of adults with more than 20 natural teeth. has the highest levels of wellbeing, while has the lowest. The percentage of men stating they have made an attempt to take their own life is lower than that of women (4.6% compared with 7.4%, respectively). they have self-harmed, 24.8% compared to 14.6% of men of the same age. PERCEPTION OF HEALTH: In general would you say your health is.? EXCELLENT VERY GOOD GOOD FAIR POOR How people perceive their health is linked to their individual health outcomes. The general perception of health amongst respondents across each of the Community Health Partnerships (CHPs) was high (see table 1.1) TABLE 1.1: PERCEPTION OF GENERAL HEALTH, BY CHP Excellent 13.1% 11.8% 12.4% 14.3% 16.2% Very Good 38.7% 35.5% 37.0% 41.7% 40.5% Good 32.6% 34.8% 35.5% 31.9% 30.6% Fair 12.1% 13.6% 11.4% 9.8% 9.9% Poor 3.4% 4.3% 3.8% 2.3% 2.8% had the highest percentage of respondents (87.9%) rating their health as good, very good or excellent, followed by (87.3%). respondents reported a slightly lower 82.1%. This echoes the findings of the Health & Life Survey 2002 where over 80% of people rated their health as good or better. At the other end of perception of health, respondents (17.9%) were most likely to report their general health as fair or poor. Women aged years in are the most likely to state 8

9 TABLE 1.2: Perception of general health, by SIMD and CHP QUINTILE 1 QUINTILE 2 QUINTILE 3 QUINTILE 4 QUINTILE 5 Total Excellent 7.5% 8.4% 8.4% 5.8% 14.4% 9.5% V. Good 31.0% 28.9% 30.5% 38.8% 27.2% 31.2% Good 35.6% 38.2% 42.0% 32.4% 32.5% 35.0% Fair 19.7% 17.3% 14.2% 17.5% 20.0% 18.0% Poor 6.2% 7.2% 5.0% 5.5% 6.0% 6.2% Excellent 10.7% 10.8% 10.6% 9.4% 9.8% 10.2% V. Good 34.0% 31.7% 32.1% 38.0% 37.9% 35.0% Good 35.8% 34.3% 38.0% 39.0% 35.2% 36.6% Fair 14.2% 17.0% 14.0% 11.1% 12.6% 13.7% Poor 5.4% 6.1% 5.2% 2.4% 4.6% 4.6% Excellent 13.3% 10.1% 13.2% 14.9% 13.0% 12.8% V. Good 40.4% 39.9% 38.8% 42.7% 42.1% 41.0% Good 31.0% 34.6% 32.5% 30.5% 32.2% 32.2% Fair 12.0% 12.8% 11.1% 10.0% 10.3% 11.3% Poor 3.3% 2.5% 4.4% 1.8% 2.4% 2.7% Excellent 15.0% 17.8% 14.7% 19.3% 17.8% 17.8% V. Good 42.4% 38.3% 42.8% 41.4% 42.6% 41.5% Good 31.4% 33.6% 33.5% 31.5% 30.6% 31.7% Fair 9.6% 8.4% 8.0% 6.0% 7.5% 7.4% Poor 1.5% 1.8% 1.0% 1.8% 1.5% 1.6% Excellent 18.5% 17.4% 16.1% 17.8% 19.9% 18.6% V. Good 42.3% 47.5% 43.6% 45.5% 46.9% 46.0% Good 31.1% 28.0% 31.2% 27.9% 27.1% 27.9% Fair 12.1% 13.6% 11.4% 9.8% 9.9% 6.3% Poor 7.1% 6.4% 7.3% 7.7% 4.7% 1.2% Table 1.2 shows respondents perception of their general health, by Scottish Indices of Multiple Deprivation and Community Health Partnership. Across, the least deprived areas (quintile 5) had the highest percentage of respondents who stated their general health was excellent very good or good (92.5%). The percentage then decreased down to 75.7% for the most deprived areas (quintile 1). When the responses are considered by Community Health Partnership and Scottish Indices of Multiple Deprivation, the lowest percentage rating their general health as excellent, very good, or good is 74.1% for respondents from the most deprived areas (quintile 1) in both and. The highest percentage for respondents from the most deprived areas (quintile 1) is 80.9% in lothian. The highest percentage across all Community Health Partnerships by Scottish Indices of Multiple Deprivation is 93.9% for the least deprived areas (quintile 5),, followed by 92.9% for. PERCEPTION OF FITNESS: How would you rate your current level of fitness? VERY HIGH GOOD REASONABLE POOR VERY POOR Respondents were asked to rate their current level of fitness. It should be noted that while physical fitness relates to a lower risk of a number of health problems and the ability to carry out everyday activities in work and leisure, this question measured respondents perception of their fitness, not their levels of physical activity. The results report respondents perceived fitness for their age. Overall 83.3% rated their current fitness as very high, good or reasonable which leaves a total of 16.7% rating their fitness as poor or very poor. When these results are broken down by Community Health Partnership, the percentage rating their fitness as very high, good or reasonable ranged from 85.3% for to 78.9% for. Most respondents rated their current fitness as reasonable or good (see table 1.3). 9

10 TABLE 1.3: CURRENT LEVEL OF FITNESS, BY CHP Total Very High 5.7% 4.1% 5.3% 6.3% 7.0% 6.0% Good 33.6% 30.8% 32.8% 40.2% 40.3% 37.1% Reasonable 43.6% 44.0% 42.9% 38.8% 37.4% 40.2% Poor 13.9% 17.1% 15.9% 13.0% 12.4% 13.9% Very Poor 3.3% 4.1% 3.1% 1.7% 2.9% 2.8% These percentages do not decline much with age (see table 1.4). respondents aged years were only 1.4% less likely to see their current fitness as very high, good or reasonable compared with those aged years (82.6% compared with 84% respectively). and show a similar pattern. differs in that 79.1% of year olds compared to 71.3% of year olds perceived their fitness as very high good or reasonable. lothian is similar with 84% of year olds rating their fitness as very high, good or reasonable compared with 74.1% (65-74 year olds AGE AGE AGE Very High 5.0% 4.0% 6.9% 4.8% 7.3% Good 31.1% 28.5% 29.8% 35.8% 38.4% Reasonable 45.5% 44.3% 43.8% 41.1% 37.8% Poor 15.4% 19.2% 15.1% 15.4% 12.2% Very Poor 3.0% 3.9% 4.5% 3.0% 4.4% Very High 5.2% 3.5% 4.1% 6.6% 4.3% Good 33.1% 31.2% 38.5% 35.6% 40.3% Reasonable 42.9% 41.3% 39.6% 41.0% 38.4% Poor 14.4% 20.3% 16.1% 13.7% 13.5% Very Poor 4.5% 3.7% 1.7% 3.1% 3.5% Very High 2.6% 3.0% 2.8% 4.5% 4.2% Good 38.0% 29.9% 31.3% 39.6% 38.0% Reasonable 42.0% 38.4% 40.0% 40.7% 41.7% Poor 13.0% 21.5% 20.4% 12.0% 10.9% Very Poor 4.3% 7.3% 5.4% 3.2% 5.3% TABLE 1.4: CURRENT LEVEL OF FITNESS, BY CHP AND AGE AGE AGE AGE Very High 8.3% 2.9% 7.1% 10.2% 8.4% Good 33.3% 26.6% 33.5% 38.0% 36.4% Reasonable 42.4% 49.6% 43.4% 37.1% 41.3% Poor 14.1% 16.6% 14.1% 13.9% 12.8% Very Poor 1.9% 4.2% 1.9% 0.8% 1.2% Very High 6.0% 6.0% 5.7% 5.7% 7.9% Good 33.2% 34.5% 30.4% 46.5% 45.7% Reasonable 45.4% 42.5% 45.2% 38.3% 33.0% Poor 11.9% 11.6% 15.9% 9.4% 11.2% Very Poor 3.5% 5.3% 2.7% 0.0% 2.2% Very High 7.4% 4.4% 5.4% 6.5% 8.1% Good 34.1% 32.0% 32.5% 41.9% 40.9% Reasonable 42.9% 47.0% 45.1% 35.9% 35.2% Poor 13.5% 14.9% 14.6% 14.6% 13.6% Very Poor 2.2% 1.7% 2.4% 1.1% 2.2% Perception of current fitness as very high, good or reasonable is highest in the least deprived areas (quintile 5) at 90.1%, and then declines to 75.8% in the most deprived areas (quintile 1) (see table 1.5). TABLE 1.5: CURRENT LEVEL OF FITNESS BY SIMD QUINTILES (Q) Q1 - Most Deprived Q2 Q3 Q4 Q5 - Least Deprived Very High 3.4% 3.7% 6.5% 6.9% 8.1% Good 30.9% 31.0% 36.2% 41.8% 42.3% Reasonable 41.5% 41.2% 41.1% 38.2% 39.7% Poor 18.7% 19.5% 13.7% 11.6% 8.8% Very Poor 5.4% 4.7% 2.4% 1.4% 1.2% The Health & Life Survey 2002 asked the same question about perception of fitness (NHS, 2002). The findings of the two surveys are similar in that respondents have a 10

11 higher percentage reporting very high fitness levels compared to the rest of. However, the overall percentage reporting very high or good levels of fitness in 2010 are up slightly on 2002, as shown in table 1.6. TABLE 1.6: CURRENT LEVEL OF FITNESS, COMPARISON OF LOTHIAN HEALTH & LIFE SURVEY 2002 AND 2010 REPORTS BY CHP Very High 4% 6% 3% 4% 4% 5% 5% 6% 6% 7% Good 30% 34% 30% 31% 29% 33% 34% 40% 35% 40% Reasonable 46% 44% 45% 44% 48% 43% 43% 39% 42% 37% Poor 14% 14% 16% 17% 13% 16% 12% 13% 12% 12% Very Poor 4% 3% 4% 4% 4% 3% 4% 2% 3% 3% PERCEPTION OF FITNESS: Can you walk outside your home without help or aids? YES NO Most respondents across stated they were able to walk around outside their home without help or aids. and lothian had very slightly lower percentages, 94.8% and 94.6% respectively, compared with (97.4%) and (97%) (table 1.7). TABLE 1.7: ABILITY TO WALK OUTSIDE WITHOUT HELP OR AIDS BY CHP Yes 96.3% 94.8% 94.6% 97.4% 97.0% No 3.7% 5.2% 5.4% 2.6% 3.0% report a drop to 84.9% and 86%, respectively which means that 15.1% (lothian) and 14% ( ) of this age group need help or aids to walk around outside their home. TABLE 1.8: ABILITY TO WALK OUTSIDE WITHOUT HELP OR AIDS BY AGE AGE AGE AGE AGE AGE AGE Yes 99.4% 98.2% 99.4% 100.0% 99.4% No 0.6% 1.8% 0.6% 0.0% 0.6% Yes 99.0% 98.6% 97.1% 98.9% 98.9% No 1.0% 1.4% 2.9% 1.1% 1.1% Yes 98.9% 97.9% 96.7% 98.9% 97.8% No 1.1% 2.1% 3.3% 1.1% 2.2% Yes 96.1% 94.5% 95.9% 97.6% 96.2% No 3.9% 5.5% 4.1% 2.4% 3.8% Yes 93.0% 91.4% 93.5% 94.4% 94.6% No 7.0% 8.6% 6.5% 5.6% 5.4% Yes 91.9% 86.0% 84.9% 91.6% 91.7% No 8.1% 14.0% 15.1% 8.4% 8.3% DENTAL HEALTH DENTAL HEALTH Adults can have up to 32 natural teeth but over time people lose some of them. How many natural teeth, including crowns, have you got? As would be expected, when the responses are considered by age (see table 1.8) a slight decline in ability to walk around outside the home without help or aids can be seen in the oldest age group, years although percentages are still above 90% for and both areas. lothian and MORE THAN 20 TEETH BETWEEN 1-20 TEETH NO NATURAL TEETH Scotland has a poor record when it comes to oral health. Adults can have up to 32 natural teeth but may lose some of them over time for a variety of reasons e.g. tooth decay, gum disease or 11

12 trauma. A series of national targets set in 2005 in An Action Plan for Improving Oral Health and Modernising NHS Dental Services introduced the target that by % of all Scottish adults and 65% of those aged between 55 and 74 years would still have some of their natural teeth (Scottish Executive, 2005). It was therefore important that a measure of this was included in the Health & Lifestyle Survey Measuring oral health by the proportion of adults who have some natural teeth is a simple yet important technique, although as dental health has improved over time and fewer adults lose all their teeth, the measure is more effective if the number of teeth lost is obtained (Steele, Treasure, Pitts et al, 2000). The questionnaire asked respondents how many natural teeth they had, including crowns. Table 1.9 shows the responses by Community Health Partnership. had the highest percentage of respondents stating they had more than 20 teeth (85.9%) closely followed by with 84.8%. The lowest percentage of respondents with more than 20 teeth was in lothian, 74.3%. 7% of respondents reported having no teeth at all compared with 2.9% for. TABLE 1.9: NUMBER OF NATURAL TEETH BY CHP More than % 74.5% 74.3% 84.8% 85.9% Between % 18.4% 19.5% 12.2% 11.2% None 5.7% 7.0% 6.2% 3.0% 2.9% Table 1.10 shows that women are more likely to have more than 20 teeth (83.5%) compared with men (78.5%). An almost equal percentage of respondents stated they had no teeth, 4.4% of men and 4.2% of women. TABLE 1.10: NUMBER OF NATURAL TEETH BY GENDER Male Female More than % 83.5% Between % 12.2% None 4.4% 4.2% TABLE 1.11: NUMBER OF NATURAL TEETH BY SIMD (Q) AND CHP Q1 Q2 Q3 Q4 Q5 More than % 64.8% 67.3% 76.9% 72.7% Between % 25.4% 20.2% 16.7% 19.8% None 8.7% 9.8% 12.5% 6.5% 7.5% More than % 69.4% 70.0% 83.3% 85.9% Between % 21.7% 22.4% 13.1% 11.1% None 9.2% 8.9% 7.6% 3.6% 3.0% More than % 75.9% 75.3% 83.9% 84.3% Between % 17.1% 19.3% 13.7% 12.8% None 5.3% 7.1% 5.4% 2.4% 2.9% More than % 84.7% 81.9% 89.2% 88.8% Between % 11.3% 15.5% 8.7% 8.9% None 3.2% 4.0% 2.5% 2.1% 2.3% More than % 88.3% 78.3% 86.4% 90.8% Between % 10.5% 17.5% 11.7% 8.2% None 2.2% 1.2% 4.2% 2.0% 1.0% People living in the least deprived areas (quintile 5) are more likely to have more than 20 teeth compared to those in the most deprived (quintile 1). The highest percentage of respondents with more than 20 teeth, by Community Health Partnership and Scottish Indices of Multiple Deprivation, is 90.8% in the least deprived areas (quintile 5) in. The lowest percentage of respondents with more than 20 teeth is 64.8% in the most deprived areas (quintile 1) in (see table 1.11). These findings indicate an improvement in this aspect of adult oral health compared to the Health & Life Survey 2002 (NHS, 2002). Table 1.12 compares the total percentages for for 2002 and A total of 81.5% of respondents in 2010 reported having more than 20 natural teeth compared to 68.2% in The percentage of people reporting they had no natural teeth has fallen from 12.5% in 2002 to 4.3% in

13 TABLE 1.12: NUMBER OF NATURAL TEETH, COMPARISON OF LOTHIAN HEALTH & LIFE SURVEY 2002 AND More than % 81.5% Between % 14.2% None 12.5% 4.3% TABLE 1.13: NUMBER OF NATURAL TEETH, AGE 55 TO 74 YEARS Age More than % Between % None 13.3% The Scottish Health Survey 2010 reported that 89% of adults (aged 16 years and over) in Scotland had some natural teeth. The Health & Lifestyle Survey 2010 found that 95.7% of all respondents in (aged 18 years and over) had some natural teeth. The Scottish target of 65% of adults aged years to have some natural teeth was met for Scotland, 79% (SHeS 2010), and, 86.6% (LHLS 2010) (see table 1.13). This indicates that residents have a higher than average number of natural teeth compared to the rest of Scotland and have met both Scottish targets (Scottish Executive, 2005). DENTAL REGISTRATION Are you registered with a NHS dentist or a private dentist, or not registered with a dentist? NHS DENTIST PRIVATE DENTIST NOT REGISTERED If people are registered with a dentist, they are more likely to have regular check-ups and take care of their teeth. In An Action Plan for Improving Oral Health and Modernising NHS Dental Services a target was also set that by 2010 registration levels for year olds should increase from 40% to 60% and registration levels for people aged 75 years and over should increase from 28% to 40%. Including this measure in the Health & Lifestyle Survey 2010 therefore provides an indication of progress towards this target in (Scottish Executive, 2005). has the highest percentage of respondents registered with a NHS dentist, 72%, and the lowest registered with a private dentist, 15%. In comparison, has the lowest percentage registered with a NHS dentist, 54.8%, and the highest percentage registered with a private dentist, 32.5%. and lothian CHPs have the highest percentage of respondents not registered at all with a dentist, 14.4% and 14.3%, respectively (table 1.14). TABLE 1.14: DENTAL REGISTRATION BY CHP NHS dentist 54.8% 72.0% 63.9% 59.6% 61.1% Private dentist 32.5% 15.0% 21.8% 27.2% 24.5% Not registered 12.7% 12.9% 14.3% 13.3% 14.4% TABLE 1.15 DENTAL REGISTRATION BY SIMD QUINTILES (Q) AND CHP Q1 Q2 Q3 Q4 Q5 Total NHS dentist 60.1% 65.2% 64.0% 60.4% 62.9% 62.9% Private dentist 10.5% 14.0% 10.7% 14.4% 9.9% 12.4% Not registered 29.3% 20.8% 25.3% 25.1% 27.1% 24.7% NHS dentist 60.7% 70.7% 63.4% 61.7% 65.9% 64.6% Private dentist 22.8% 14.4% 18.5% 17.7% 12.4% 16.8% Not registered 16.6% 15.0% 18.1% 20.6% 21.7% 18.5% NHS dentist 52.8% 73.6% 64.7% 63.7% 63.9% 64.0% Private dentist 35.6% 16.4% 21.6% 23.3% 22.5% 23.8% Not registered 11.5% 10.0% 13.7% 13.0% 13.6% 12.2% NHS dentist 52.1% 77.3% 61.7% 60.7% 61.1% 62.6% Private dentist 40.5% 15.5% 29.3% 29.8% 28.2% 28.2% Not registered 7.3% 7.2% 9.0% 9.5% 10.6% 9.3% NHS dentist 49.6% 78.4% 65.8% 54.7% 57.3% 58.2% Private dentist 41.8% 14.6% 28.5% 38.9% 33.7% 34.2% Not registered 8.6% 7.0% 5.7% 6.4% 9.0% 7.6% 13

14 Table 1.15 shows dental registration by Scottish Indices of Multiple Deprivation and Community Health Partnership. The biggest difference between the most and least deprived areas is found with the percentage of people not registered with a dentist at all. When data is considered for each Community Health Partnership by Scottish Indices of Multiple Deprivation the percentage not registered with a dentist ranges from 29.3% in the most deprived areas (quintile 1) in, to 5.7%, in the least deprived areas (quintile 5) in lothian. Overall, people are more likely to be registered with a NHS dentist than a private dentist, and this likelihood increases in the least affluent areas. The average percentage registered with a NHS dentist is 62.9% in the most deprived areas (quintile 1) compared to 58.2% in the most affluent (quintile 5). The percentage registered with a private dentist ranges from an average of 12.4% in the most deprived areas (quintile 1) rising to 34.2% in the least deprived (quintile 5). The Health & Life Survey 2002 did not specify NHS or private dentist when asking the question about dental registrations (NHS, 2002). It reports that 80.8% of was registered with a dentist, while 19.2% was not. This indicates a rise in dental registrations in 2010 for residents with 86.4% stating they were registered with a dentist and 13.6% not registered at all. WELLBEING Mental and emotional wellbeing is as important as physical wellbeing to general health and overall quality of life. The following questions measure physical, mental and emotional wellbeing, and quality of life. WARWICK-EDINBURGH MENTAL WELLBEING SCALE (WEMWBS) The Warwick- Mental Wellbeing Scale was developed to measure the mental wellbeing of a group of people over time by using average (mean) scores to assess changes. It does not measure the level of wellbeing due to a general lack of knowledge of, and thus the lack of a cut-off point of, optimum wellbeing (NHS Health Scotland, 2011). The Warwick- Mental Wellbeing Scale scores mental wellbeing through a series of 14 positively worded sentences (see Appendix I). The respondent is asked to score each question according to how they feel using a scale of responses None of the time, rarely, some of the time, often, all of the time. Each response is then scored from one to five, five being the highest. Scores therefore range from 14 to 70, with 70 indicating the highest possible score of wellbeing and 14 the lowest. The Warwick- Mental Wellbeing Scale score for overall was 50 (table 1.16). Community Health & Care Partnership had the lowest score with 49 while the two areas scored the highest with 51 each. The Scottish Health Survey 2010 published Warwick- Mental Wellbeing Scale scores of 49.9 overall for Scotland (2008/9) (SHeS 2010). Scores for men and women are almost identical within each Community Health Partnership. However, when age is considered some differences appear. women aged years score 47 (the lowest score across all age groups) compared with a score of 52 for men. However, this is reversed for year olds with women scoring 51 and men, 48. Younger men aged between 18 and 34 years in score the highest, 53. Women from the same Community Health Partnership and age group score 51. TABLE 1.16: WEMWBS, BY CHP, AGE AND GENDER MALE Mean Mean Mean Mean Mean Age Age Age Age Age Age Total

15 FEMALE TOTAL Mean Mean Mean Mean Mean Age Age Age Age Age Age Total Age Age Age Age Age Age Total TABLE 1.17: WEMWBS BY CHP AND SIMD QUINTILES (Q) Mean Mean Mean Mean Mean MOST DEPRIVED Q Q Q LEAST DEPRIVED Table 1.17 shows the Warwick- Mental Wellbeing Scale by Community Health Partnership and Scottish Indices of Multiple Deprivation. Scores are lower for the most deprived quintiles, all quintile 1 residents having a score of 47, with the exception of with 48. The Warwick- Mental Wellbeing Scale score then rises up through the quintiles to an average score of 52 in quintile 5. The highest score overall is 53 in quintile 5,. PHYSICAL WELLBEING: Which face comes closest to showing how you feel about your general physical wellbeing just now? FIGURE 1.1: FACE SYMBOLS PHYSICAL WELLBEING Respondents were asked to choose one of five face symbols (figure 1.1 above) big smile little smile straight smile little frown or big frown which they felt came closest to showing how they felt about their general physical wellbeing at that time. Table x shows the results. Approximately 50% of respondents in each Community Health Partnership chose the little smile. This correlates with the Warwick- Mental Wellbeing Scales scores described above. The highest percentage of respondents choosing the big smile or little smile was in, 67.5%, compared with the lowest percentage, 60.4% in. This correlates with also having the lowest percentage of respondents choosing either the little frown or big frown (11.4%) compared with 15.2% in (see table 1.18). TABLE 1.18: PHYSICAL WELLBEING BY CHP Big smile 15.9% 14.2% 14.3% 16.0% 17.5% Little smile 49.2% 46.2% 47.0% 50.3% 50.0% Straight 22.6% 24.5% 24.6% 23.0% 21.1% Little frown 9.3% 10.8% 10.5% 8.5% 9.0% Big frown 3.1% 4.4% 3.6% 2.3% 2.4% 15

16 TABLE 1.19: PHYSICAL WELLBEING BY SIMD QUINTILE (Q) Q1 - Most Deprived Q2 Q3 Q4 Q5 - Least Deprived Big smile 12.1% 13.9% 15.9% 17.4% 19.1% Little smile 42.7% 44.8% 49.8% 53.3% 52.6% Straight 27.7% 24.8% 22.4% 20.0% 20.3% Little frown 12.5% 12.6% 9.2% 7.2% 6.4% Big frown 4.9% 4.0% 2.7% 2.1% 1.6% TABLE 1.20: MENTAL OR EMOTIONAL WELLBEING BY CHP Big smile 23.2% 21.8% 21.5% 21.6% 23.3% Little smile 42.3% 38.2% 40.6% 43.5% 43.5% Straight 20.9% 23.3% 24.3% 21.4% 20.5% Little frown 9.3% 10.6% 9.6% 10.3% 8.3% Big frown 4.2% 6.0% 4.0% 3.2% 4.4% When this data is considered by the Scottish Indices of Multiple Deprivation, the percentage who chose big smile or little smile to indicate how they felt about their physical wellbeing ranged from 54.8% in the most deprived areas (quintile 1) to 71.7% in the least deprived areas (quintile 5) (see table 1.19). MENTAL OR EMOTIONAL WELLBEING: Which face comes closest to showing how you feel about your general mental or emotional wellbeing just now? FIGURE 1.2: FACE SYMBOLS MENTAL OR EMOTIONAL WELLBEING Respondents were asked how they felt about their emotional or mental wellbeing, again being asked to choose the face symbol that came closest to how they felt (see table 1.20). The highest percentage of respondents choosing either the big or little smile was from (66.8%) while the lowest percentage was for, 60%. also had the highest percentage (16.6%) choosing the small or big frown, compared with 12.7% from. TABLE 1.21: MENTAL/EMOTIONAL WELLBEING BY SIMD QUINTILE (Q) Q1 - Most Deprived Q2 Q3 Q4 Q5 - Least Deprived Big smile 18.3% 20.5% 23.6% 24.1% 24.3% Little smile 36.8% 39.3% 41.1% 46.2% 45.5% Straight 24.6% 22.9% 23.0% 18.7% 20.4% Little frown 12.8% 11.5% 8.7% 8.2% 7.6% Big frown 7.6% 5.9% 3.7% 2.8% 2.2% Respondents from the most deprived areas (quintile 1) had the lowest percentage, 55.1%, rating their mental or emotional wellbeing as big smile or little smile compared to the less deprived areas in quintile 4 which scored 70.3% for these two ratings and the least deprived areas (quintile 5) which scored 69.8% (see table 1.21). QUALITY OF LIFE: Which face comes closest to showing how you feel about your overall quality of life just now? FIGURE 1.3: FACE SYMBOLS OVERALL QUALITY OF LIFE 16

17 TABLE 1.22: QUALITY OF LIFE BY CHP Big smile 24.2% 20.8% 20.6% 22.3% 25.6% Little smile 43.2% 44.3% 44.8% 48.0% 46.1% Straight 21.5% 20.9% 23.3% 20.0% 18.1% Little frown 7.7% 8.8% 7.8% 7.5% 6.9% Big frown 3.5% 5.2% 3.5% 2.2% 3.3% The questionnaire asked respondents to rate their overall quality of life, again using the face symbols (Figure 1.3). had the highest percentage of respondents selecting either big smile or little smile, 71.7%, while had the lowest percentage for these symbols, 65.1%, closely followed by lothian with 65.4%. The average for these ratings was 68.9% (table 1.22). TABLE 1.23: QUALITY OF LIFE BY SIMD QUINTILE (Q) Q1 - Most Deprived Q2 Q3 Q4 Q5 - Least Deprived Big smile 15.7% 19.1% 23.1% 26.7% 28.6% Little smile 40.7% 42.8% 46.3% 49.4% 48.8% Straight 24.9% 24.4% 19.9% 16.0% 16.7% Little frown 12.0% 9.4% 7.7% 5.6% 4.6% Big frown 6.7% 4.4% 3.0% 2.3% 1.2% Table 1.23 looks at these results by Social Indices of Multiple Deprivation. 77.4% of respondents from the most affluent areas (quintile 5) chose either big smile or little smile compared with 56.4% in the most deprived areas (quintile 1). SELF-HARM AND SUICIDAL THOUGHTS Suicide is one of the main causes of deaths in people aged under 35 years and suicide rates are higher for young men than for women (almost three times as high in 2011). Suicide rates are also significantly higher in the most areas of deprived areas of Scotland compared with the Scottish average (ScotPHO, 2012). Scotland has a higher suicide rate than England and Wales. The Scottish Government strategy and action plan Choose Life (Scottish Government, 2002) has set a national target to reduce the suicide rate between 2002 and 2013 by 20 per cent. The relationship between the risk factors for suicide is complex. They include risks and pressures in society e.g. poverty, alcohol and substance misuse; in communities e.g. neighbourhood deprivation and social exclusion; in individuals e.g. deprivation, lack of care and support in recovery from serious mental illness, abuse; relating to the response from services e.g. identification of people at risk of suicide. Self-harm is self-poisoning or injury, irrespective of the purpose of the act. There is no single risk factor that indicates probability of self-harm. Evidence suggests that most self-harm is not a suicide attempt, rather it is intended to help the person cope with circumstances in their life. Family and friends may remain unaware that an individual is self-harming (See Me, 2011; Scottish Government, 2011b). There is no definitive profile of the prevalence and incidence of self-harm in Scotland although there is some evidence around its prevalence in adolescents (Scottish Government, 2011b). The Health & Lifestyle Survey 2010 was the first time the Health & Lifestyle Survey has asked questions about selfharm and suicidal thoughts. This information can inform work to identify those who are at risk of suicide and self-harm, and suicide prevention work. The two questions on suicide and self harm in the Health & Lifestyle Survey 2010 have been used previously in the Adult Psychiatric Morbidity Survey in England (2000 and 2007) and in the Scottish Health Survey since 2008 (Singleton, Lee & Meltzer, 2000; McManus et al, 2007). However, the methods used in each survey differ. The Health & Lifestyle Survey 2010 was a self completion survey sent via the post. The Adult Psychiatric Morbidity Survey 2007 asked the questions twice; directly by an inter- 17

18 viewer face to face (to compare with the 2000 survey) and, later on in the same interview, through self completion using Computer Assisted Self Interview. The Scottish Health Survey asked the questions directly as part of a follow up interview with a nurse. In reporting the results for the Adult Psychiatric Morbidity Survey, the authors only analysed the self completion responses further in the belief that these responses were more accurate than data obtained face to face. While the self completion methods used by the Health & Lifestyle Survey (postal) and the Adult Psychiatric Morbidity Survey (computer assisted) do differ, they are much closer than the direct questioning methods used in the Scottish Health Survey (SHeS, 2010). Therefore, the comparison in the following section is between the Health & Lifestyle Survey and the Adult Psychiatric Morbidity Survey. This difference in method should be borne in mind when considering differences in the results between the two surveys (Bowling, 2005). From 2012 the Scottish Health Survey will also use computer aided self completion for these questions. ATTEMPTED TO TAKE OWN LIFE Have you EVER made an attempt to take your life by taking an overdose of tablets or in some other way? YES NO TABLE 1.24: ATTEMPTED TO TAKE OWN LIFE: LOTHIAN BY SIMD Yes No Q1 - Most Deprived 12.6% 87.4% Q2 8.6% 91.4% Q3 5.0% 95.0% Q4 4.3% 95.7% Q5 - Least Deprived 3.4% 96.6% Overall 6.3% of respondents said they had made an attempt to take their life at some point in their lives. As found by the Adult Psychiatric Morbidity Survey, attempts were more common in women than men, 7.4% of female respondents compared to 4.6% of men (Table 1.26) (Adult Psychiatric Morbidity Survey 6.9% female compared to 4.3% male) (McManus et al, 2007). Generally there is a decrease in reporting a suicide attempt with age from 8.9% of 18 to 24 year olds to 2.2 in the 65 to 74 year olds (Table 1.27). This was also the case in the Adult Psychiatric Morbidity Survey (7.3% aged 16 to 24 years; 2.7% of 65 to 74 year olds) (McManus et al, 2007). There was a clear gradient of response to this question by Scottish Indices of Multiple Deprivation score. 12.6% of those living in the most deprived quintile (quintile 1) reported having made an attempt to take their life, 8.6% for quintile 2, 5% for quintile 3, 4.3% for quintile 4, and 3.4% for the least deprived quintile (quintile 5) (see table 1.24). This reflects evidence that the suicide rate increases as socio-economic deprivation increases (Scottish Government, 2011b). The Community Health Partnership with the lowest percentage of respondents stating they had made an attempt to take their own life at some time was with 5.7% (see table 1.25). The highest percentage was 7.2% reported for. The percentage was 6.3%. TABLE 1.25: ATTEMPTED TO TAKE OWN LIFE BY CHP YES 5.7% 7.2% 6.1% 6.4% 5.9% NO 94.3% 92.8% 93.9% 93.6% 94.1% Table 1.26 shows the responses by Community Health Partnership and gender. While suicide statistics indicate that more men than women commit suicide (NRS Scotland, 2012), the survey data indicates more women than men in have stated they have made an attempt to take their own life, 7.4% of women saying this and 4.6% of men. One of the possible explanations for this is that men choose methods that mean they are more likely to succeed in taking their own life. The highest percentage of men or women stating they have attempted to take their own life is 8.8% of women in, 18

19 compared to 4.7% of men in that Community Health Partnership. The lowest percentage of women stating they have attempted to take their own life is 6.8% in. The highest percentage of men who stated this is 5.5% in and the lowest is 3.9% in both and. It should be noted that the numbers of people concerned are small. TABLE 1.26: ATTEMPTED TO TAKE OWN LIFE BY CHP AND GENDER Total Male Yes 3.9% 4.7% 4.5% 5.5% 3.9% 4.6% No 96.1% 95.3% 95.5% 94.5% 96.1% 95.4% Female Yes 6.8% 8.8% 7.2% 7.1% 7.2% 7.4% No 93.2% 91.2% 92.8% 92.9% 92.8% 92.6% TABLE 1.27: ATTEMPTED TO TAKE OWN LIFE, BY AGE AND GENDER Male Female Total Yes No Yes No Yes No Age % 96.4% 11.8% 88.2% 8.9% 91.1% Age % 95.1% 9.3% 90.7% 7.8% 92.2% Age % 94.9% 6.8% 93.2% 6.2% 93.8% Age % 93.5% 7.1% 92.9% 6.8% 93.2% Age % 96.0% 5.0% 95.0% 4.5% 95.5% Age % 97.8% 2.2% 97.8% 2.2% 97.8% Table 1.27 shows the responses to the question by age for. The youngest age group (18-24 years) had the highest percentage answering that they had attempted to take their own life, 8.9%. The percentage answering yes then declines through the age groups to 2.2% for those aged years. The gender difference is reflected here in the lower age groups with 11.8% of year old women compared to 3.6% of men of the same age stating they have attempted to take their own life. The difference between gender then declines with age. SELF-HARM Have you ever deliberately harmed yourself in any way but not with the intention of killing yourself? YES NO The survey also asked a question about self-harm, without the intention of suicide. Overall, 9.1% of respondents said they had deliberately harmed themselves in some way at some point in their lives. Again, the proportion in each age group declines with age (table 1.30). TABLE 1.28: SELF HARM BY SIMD Q1 - Most Deprived Q2 Q3 Q4 Q5 - Least Deprived Yes 13.7% 11.9% 8.6% 7.1% 6.3% No 86.3% 88.1% 91.4% 92.9% 93.7% Table 1.28 shows the responses to this question by Scottish Indices of Multiple Deprivation. It indicates that respondents from the most deprived areas are the most likely to self-harm, 13.7% in quintile 1 reporting they had deliberately harmed themselves at some time, compared to 6.3% in the least deprived areas (quintile 5). The Community Health Partnership with the highest percentage of respondents stating they have at some time deliberately harmed themselves but without the intention of killing themselves was with 10.7% answering yes. had the lowest percentage, 6.8%. The average across was 9.1% (see table 1.29). TABLE 1.29: SELF HARM BY CHP Yes 6.8% 7.9% 7.3% 9.7% 10.7% No 93.2% 92.1% 92.7% 90.3% 89.3% 19

20 Table 1.30 shows responses to the self-harm question by age and gender. Overall women are more likely than men to self-harm, 11% compared with 6.3%. As with suicide attempts, there is a noticeable difference between men and women for the youngest age group (18-24 years) with 24.8% of all female respondents in stating that they had deliberately harmed themselves without meaning to kill themselves, compared with a average of 14.6% for men in the same age group. The only age where the results show that men are more likely than women to self-harm is aged years. In general, the difference between gender and percentage of yes responses to this question decreases with age to less than 5% for the two oldest age groups (55 74 years). TABLE 1.30: SELF HARM BY AGE AND GENDER Male Female Yes No Yes No Age % 85.4% 24.8% 75.2% Age % 89.9% 18.3% 81.7% Age % 91.7% 7.3% 92.7% Age % 96.5% 7.1% 92.9% Age % 98.2% 2.6% 97.4% Age % 99.0% 1.0% 99.0% COMPARISON WITH THE ADULT PSYCHIATRIC MORBIDITY SURVEY There was no significant difference in the overall prevalence of self-harm between men and women in the Health & Lifestyle Survey However, young women were more likely than young men to report having ever deliberately harmed themselves: 17% of women aged 16 to 24 years reported this behaviour, compared with 7.9% of men in the same age group. This variation by sex was not evident in subsequent age groups. This corresponds with data from other sources about changes to the sex ratio in the occurrence of self-harm across the lifecycle (McManus et al, 2007). 20

21 LIFESTYLE LOTHIAN HEALTH & LIFESTYLE SURVEY KEY POINTS The percentage of adults in who are overweight or obese (calculated using self-reported height and weight) has increased 13.1%, from 45.3% in 2002 to 58.4% in The most deprived areas (quintile 1) in have the highest percentage of current smokers,36.4%, compared with 30.4% in the least deprived areas (quintile 5) in lothian. An average of 31% of respondents stated they drank alcohol at weekends and during the week, ranging from 24.6% of respondents to 34.6% in. 73% of respondents reported that they have never taken an illegal drug. DIET AND NUTRITION What we eat affects our health. The recommendation that everyone should eat five portions (80g each) of fruit and vegetables a day aims to ensure a healthy balanced diet and can help reduce the risk of a number of conditions such as coronary heart disease, some cancers, obesity, stroke, high blood pressure and type 2 diabetes (World Health Organisation, 2004; Scottish Government, 2010a). However, only approximately 20% of men and 23% of women in Scotland ate five or more portions of fruit or vegetables a day in 2010 (ScotPHO, 2012). The lack of a healthy diet is one of the causes of poor health and premature death in Scotland. In addition, Scotland along with many other countries in the developed world is experiencing high levels of obesity. 27.4% of adults aged years in Scotland were obese in 2010 (SHeS, 2010). This is expected to rise even higher by 2030 when it is predicted that 40% of adults in Scotland will be obese (Scottish Government, 2010a). To address and reduce this trend, there are a number of government policies in place contributing positively to healthy eating and healthy weight, including the Scottish Government and COSLA s (Convention of Scottish Local Authorities) Preventing overweight and obesity in Scotland: A route map towards healthy weight in February 2010 (Scottish Government, 2010a). BODY MASS INDEX (BMI) How tall are you without shoes?..feet INCHES OR.. M CM What weight are you without clothes?..stones..pounds OR..KG G Survey respondents were asked to report their height and weight. Body mass index (BMI) rates have been calculated from this data. It should be noted that self-reported height and weight is recognised as liable to inaccuracies, in particular the under reporting of weight. Using the self-reported height and weight data, the Health & Lifestyle Survey 2010 found that 40.1% of respondents fell within the normal weight range (BMI 18.5 <25). 58.4% were either overweight (BMI 25 <30) or obese (BMI over 30) (table 2.1). TABLE 2.1: BMI BY CHP Underweight BMI <18.5 Normal weight BMI 18.5 to <25 Overweight BMI 25 to <30 1.5% 1.1% 1.1% 2.0% 1.8% 38.4% 34.4% 37.4% 45.4% 44.1% 35.2% 38.1% 35.9% 34.0% 34.2% Obese BMI > % 26.5% 25.6% 18.6% 19.8% 21

22 residents had the highest percentage of respondents, 64.6%, whose self-reported height and weight put them into the overweight or obese category. In comparison, had the lowest percentage, 52.6%, whose selfreported height and weight indicated they were either overweight or obese. The Health & Life Survey 2002 also collected self-reported height and weight data. In % of respondents provided height and weight data which indicated they were overweight or obese, lower than the 58.4% reported in The increase in people categorised as overweight or obese is reflected in the data for people who provided information that put their BMI in the normal range in 2002 and This shows a decrease since 2002 in the percentage of people whose weight is in this category, from 45.3% in 2002 to 40.1% in The Scottish Health Survey 2010 BMI data was calculated from body measurements taken by a nurse which means this data is more accurate than that of the Health & Lifestyle Survey. It should be noted though that this data is from a different age group, years, than the Health & Lifestyle Survey, years. The Scottish Health Survey reported that 62.4% (ages years) of people in Scotland in 2010 were overweight or obese. PERCEIVED EFFECT OF DIET ON HEALTH Do you think that what you currently eat has any effect on your health? BENEFITS MY HEALTH A LOT BENEFITS MY HEALTH A LITTLE HAS NO EFFECT HARMS MY HEALTH A LITTLE HARMS MY HEALTH A LOT The survey asked respondents whether they thought what they ate had any effect on their health. The answers are shown in table 2.2 by Community Health Partnership. TABLE 2.2: PERCEIVED EFFECT OF DIET ON HEALTH, BY CHP Benefits a lot 25.9% 22.1% 23.8% 31.2% 28.7% Benefits a little 29.0% 30.3% 27.3% 30.1% 32.2% Has no effect 18.5% 18.4% 18.2% 15.6% 14.7% Harms a little 24.3% 26.6% 26.9% 21.1% 21.7% Harms a lot 2.2% 2.6% 3.8% 2.0% 2.7% had the highest percentage of respondents saying what they ate benefits their health a lot, (31.2%), with 30.1% stating it benefits their health a little. had the lowest percentage reporting that they felt what they ate benefits their health with 22.1% saying it benefits their health a lot and 30.3% saying it benefits their health a little. Overall, all Community Health Partnerships had 50% or more of respondents saying that what they ate is good for their health to some extent. Table 2.3 shows the responses by Community Health Partnership and by gender. Women are more likely across all Community Health Partnerships to report that what they eat helps their health a lot. has the greatest percentage difference, 7.8%, between men and women for benefits a lot compared to a 3.2% difference in. When the responses for benefits a lot and benefits a little are combined, the gender difference ranges from 5.3% for and, and 12.4% for. TABLE 2.3: PERCEIVED EFFECT OF DIET ON HEALTH BY GENDER MALE Benefits a lot 21.8% 20.2% 20.2% 28.2% 24.0% Benefits a little 29.9% 28.9% 27.6% 30.0% 29.5% Has no effect 22.3% 20.5% 23.7% 18.0% 20.5% Harms a little 24.3% 28.5% 25.6% 22.1% 24.1% Harms a lot 1.6% 1.8% 2.9% 1.7% 1.8% 22

23 FEMALE Benefits a lot 28.5% 23.4% 26.3% 33.3% 31.8% Benefits a little 28.5% 31.2% 27.2% 30.2% 34.1% Has no effect 16.2% 17.0% 14.3% 14.0% 10.8% Harms a little 24.3% 25.3% 27.7% 20.3% 20.1% Harms a lot 2.6% 3.1% 4.4% 2.2% 3.2% QUINTILE 5 Benefits a lot 35.2% 27.2% 26.7% 32.4% 35.8% Benefits a little 32.5% 34.2% 31.1% 32.1% 34.5% Has no effect 12.6% 11.2% 11.2% 14.5% 12.1% Harms a little 16.6% 26.8% 27.6% 18.9% 16.5% Harms a lot 3.1%.7% 3.4% 2.1% 1.1% TABLE 2.4: PERCEIVED EFFECT OF DIET ON HEALTH BY SIMD QUINTILE 1 QUINTILE 2 QUINTILE 3 QUINTILE 4 Benefits a lot 19.4% 14.2% 17.1% 24.8% 18.1% Benefits a little 24.6% 27.3% 25.9% 23.0% 25.9% Has no effect 25.6% 24.7% 21.8% 18.7% 20.3% Harms a little 27.4% 29.1% 29.3% 29.4% 31.0% Harms a lot 3.0% 4.6% 5.8% 4.1% 4.8% Benefits a lot 20.5% 20.2% 23.2% 30.6% 22.6% Benefits a little 25.8% 24.3% 27.1% 29.0% 30.5% Has no effect 21.2% 23.5% 20.3% 18.2% 16.7% Harms a little 29.3% 29.9% 26.5% 18.6% 25.5% Harms a lot 3.2% 2.2% 3.0% 3.6% 4.8% Benefits a lot 27.6% 25.8% 21.5% 32.0% 27.1% Benefits a little 29.9% 31.6% 27.1% 28.4% 34.7% Has no effect 16.9% 16.6% 21.2% 15.4% 14.6% Harms a little 23.5% 23.0% 26.1% 23.3% 20.9% Harms a lot 2.1% 3.0% 4.1%.9% 2.7% Benefits a lot 27.0% 26.9% 30.2% 33.1% 29.5% Benefits a little 31.2% 37.8% 25.8% 33.6% 32.5% Has no effect 18.9% 10.3% 13.8% 13.6% 13.9% Harms a little 22.2% 24.0% 26.3% 19.3% 21.6% Harms a lot.7%.9% 4.0%.3% 2.5% Two thirds (66%) of respondents in the most affluent areas (quintile 5) stated what they ate benefits their health compared with 44.3% in the most deprived areas (quintile 1). The percentage of respondents in the most affluent areas (quintile 5) who stated that what they ate benefited their health ( a lot or a little ) ranged from 70.3% in to 57.8% in lothian. In comparison, the answers to the same questions from the least affluent (quintile 1) respondents ranged from 47.8% for to 41.5% for (see table 2.4). Respondents saying what they ate harmed their health a little ranged from 27.6% to 16.5% in lothian and respectively, for the least deprived areas (quintile 5), and 31% to 27.4% in and respectively, in the most deprived areas (quintile 1). SMOKING Smoking is one of the main preventable causes of ill-health and premature death in Scotland (Scottish Government, 2008). It is a risk factor for cancer, coronary heart disease and stroke and is influential in around a quarter of deaths in Scotland. A number of actions have been taken over the past years to help support smokers to give up and to discourage people from starting to smoke. These include the ban on smoking in public places introduced in 2006, and the increase in the legal age from 16 to 18 years for buying tobacco introduced in 2010 and a commitment to no smoking on NHS grounds made in March 2013 (Scottish Government, 2010b). 23

24 SMOKING STATUS - TOBACCO Which one of these best describes you? CURRENTLY SMOKE USED TO SMOKE NEVER SMOKED Respondents were asked about their smoking status. Table 2.5 indicates that has the highest percentage of respondents (59%) who reported that they have never smoked while lothian has the lowest percentage at 50%. lothian had the highest percentage of current smokers, 21.2%, had the lowest, 17.2%. lothian also had the highest percentage, 28.8%, of respondents who used to smoke. TABLE 2.5: SMOKING STATUS, BY CHP Currently smoke Used to smoke Never smoked Total 19.7% 20.8% 21.2% 17.6% 17.2% 18.7% 27.2% 26.7% 28.8% 27.6% 23.8% 26.4% 53.1% 52.5% 50.0% 54.8% 59.0% 54.9% Table 2.6 shows the responses by Community Health Partnership and age. The youngest age group, years are the most likely to have never smoked (ranging from 62.5% of lothian respondents to 74.5% of respondents), but also have a slightly higher than average percentage of smokers compared to other age groups (19.5% compared with average of 18.7%). The difference with other age groups is explained by the low percentage of ex-smokers (ranging from 8.6% in, in comparison to 17% in and a average of 26.4%). The percentage of ex-smokers is much higher in the year age group, ranging from 21.4% in (up from 9.8% for year olds) to 24.4% in (up from 9.2% in year olds). However, while the rate of current smokers aged years is lower in, lothian and, it rises slightly for and. The oldest age group, years, is the least likely to currently smoke but also has the lowest total percentage of people reporting having never smoked (42.3% for ) year olds also have the highest percentage of ex-smokers ranging from 38.1% in to 45.8% in lothian. TABLE 2.6: SMOKING STATUS BY CHP AND AGE Currently smoke Used to smoke Never smoked Age % 23.4% 23.8% 18.5% 16.9% Age % 19.7% 17.7% 14.4% 17.3% Age % 19.6% 23.5% 18.0% 16.3% Age % 22.8% 23.5% 20.3% 20.8% Age % 21.4% 21.0% 19.4% 16.4% Age % 17.3% 15.6% 16.0% 14.6% Age % 9.2% 13.8% 17.0% 8.6% Age % 24.4% 23.4% 23.8% 23.4% Age % 29.1% 30.6% 28.0% 23.7% Age % 22.0% 26.6% 29.8% 24.1% Age % 34.1% 33.1% 35.5% 34.1% Age % 44.5% 45.8% 38.1% 41.0% Age % 67.5% 62.5% 64.5% 74.5% Age % 56.0% 58.9% 61.9% 59.3% Age % 51.3% 45.9% 54.0% 60.0% Age % 55.3% 49.9% 49.8% 55.0% Age % 44.6% 45.8% 45.0% 49.6% Age % 38.3% 38.5% 45.9% 44.4% TABLE 2.7: SMOKING STATUS BY SIMD AND CHP Q1 Currently smoke 31.2% 32.1% 30.4% 30.7% 36.4% Used to smoke 24.2% 24.4% 30.6% 27.8% 20.7% Never smoked 44.7% 43.5% 39.0% 41.5% 42.9% 24

25 Q5 Q4 Q3 Q2 Currently smoke 25.0% 23.0% 25.3% 24.1% 18.3% Used to smoke 25.2% 28.1% 27.7% 26.2% 27.5% Never smoked 49.8% 48.8% 47.0% 49.7% 54.2% Currently smoke 18.7% 18.3% 20.4% 16.5% 14.5% Used to smoke 29.3% 28.2% 32.4% 28.4% 23.8% Never smoked 52.0% 53.5% 47.2% 55.1% 61.7% Currently smoke 15.2% 10.1% 13.1% 12.6% 15.1% Used to smoke 25.3% 27.1% 27.2% 27.6% 22.9% Never smoked 59.5% 62.8% 59.7% 59.8% 62.0% Currently smoke 11.3% 8.9% 15.0% 10.7% 8.9% Used to smoke 30.5% 24.9% 25.9% 27.9% 24.7% Never smoked 58.1% 66.2% 59.1% 61.4% 66.4% The Scottish Health Survey 2010 measured cotinine levels in saliva (one of several biological markers that indicate smoking) in order to validate self-reported smoking behaviour (known to underestimate smoking prevalence) (SHeS, 2010). While it is difficult to directly compare smoking rates from the Scottish Health Survey with the Health & Lifestyle Survey due to the reporting for different age groups, it is still interesting to do so as the Scottish Health Survey results will be more accurate due to the cotinine measures than the survey (self-report only). The Scottish Health Survey 2010 reported that the smoking rate in Scotland in 2010 was 25% for those aged 16 years over. While an 18.7% smoking rate in in 2010 is less, it should be noted that this figure was self-reported and from a narrower age group, respondents aged 18 to 74 years (SHeS, 2010) and should be treated with caution. There is a clear difference between the most deprived (quintile 1) and least deprived areas (quintile 5) in the percentage of respondents who smoke, with the highest percentage of current smokers living in the most deprived areas (quintile 1), and the percentage then declining to the least deprived areas (quintile 5) which have the lowest percentage of current smokers. This is illustrated in table x which shows smoking status by deprivation within each Community Health Partnership. The most deprived areas (quintile 1) of have the highest percentage of current smokers, 36.4%. In contrast, only 8.9% of respondents in the least deprived areas (quintile 5) of were current smokers, a difference of 27.5% (see table 2.7). While the Health & Life Survey 2002 question on smoking had different categories of smoker than in 2010 however, some comparison can be made. The Health & Life Survey 2002 reported 53.7% as non-smokers (never smoked) in. This is slightly lower than the 2010 finding of 54.9%. The Health & Life Survey 2002 reported that 20.4% of people in smoked. In 2010 this figure is 18.7% indicating a small fall in the percentage of smokers (NHS, 2002). ALCOHOL CONSUMPTION Drinking too much alcohol can be harmful to health. Alcohol related health problems can affect people who regularly drink more than the recommended levels, even if no damaging effects are seen for years. Heavy drinking can lead to liver problems, increased risk of some cancers, high blood pressure and reduce fertility. It also can have an impact on mental and sexual health, and increase the risk of accidents (NICE, 2010). People who regularly drink more than the advised number of units (see below) are seen as at increased risk of developing a serious illness. Recommended sensible alcohol drinking guidelines in the UK: Men should not regularly drink more than 3-4 units a day Women should not regularly drink more than 2-3 units a day Men should not drink over 21 units in a week Women should not drink over 14 units in a week NHS Choices,

26 The Scottish Government also recommends at least two alcohol free days a week, even if someone is drinking within the above limits. In addition, a man who regularly drinks more than eight units a day or 50 units a week, or a woman who regularly drinks more than six units a day or 35 units a week, is seen as a higher risk drinker and more likely to develop health problems as a result of their alcohol consumption (Scottish Government, 2012; SHeS 2010). The questionnaire included the chart as a guide to the number of units of alcohol in specific drinks. It should be noted that selfreported alcohol consumption in surveys may be lower than actual alcohol consumption. This is for reasons that include recall and social reasons (a reluctance to acknowledge drinking above the recommended levels), under-representation of heavy drinkers in surveys, and individual understanding of drink size and strength (NHS Health Scotland, 2008). HOW OFTEN ON AVERAGE DO YOU DRINK ALCOHOL? An average of 31% of respondents in stated that on average they drank at weekends and during the week, the responses ranged from 24.6% of respondents to 34.6% in (see table 2.8). TABLE 2.8: FREQUENCY OF ALCOHOL CONSUMPTION, BY CHP Never 9.1% 10.7% 8.6% 8.0% 9.1% Special occasions 18.5% 22.6% 20.8% 14.6% 17.3% Less than once a week 17.9% 19.0% 17.8% 17.6% 16.5% Weekends 14.9% 16.5% 15.5% 12.5% 11.6% Weekends & midweek 28.0% 24.6% 28.0% 34.6% 33.6% Most days 9.3% 4.9% 6.9% 10.1% 9.7% Every day 2.3% 1.8% 2.3% 2.6% 2.2% When the responses for most days and every day are considered together, respondents had the highest percentage with 12.7% compared to 6.7% in. The indication that respondents are the least frequent drinkers is confirmed with 52.3% stating they drank either Never, Special occasions or Less than once week. had the lowest percentage of respondents, 40.2%, who drank less than once a week, on special occasions or never. Of the seven options given to respondents to indicate how often on average they drank alcohol, respondents were most likely overall to say they drank at weekends and during the week. TABLE 2.9: FREQUENCY OF ALCOHOL CONSUMPTION BY SIMD QUINTILE 1 Never 11.4% 13.2% 10.2% 12.9% 16.3% Special occasions 23.7% 29.9% 26.9% 21.4% 31.0% < once a week 23.6% 17.8% 17.6% 21.0% 14.8% Weekends 15.9% 17.2% 19.2% 12.1% 12.1% Weekends & midweek 19.0% 17.2% 20.9% 23.0% 19.2% Most days 5.6% 3.5% 3.2% 7.3% 4.9% Every day.8% 1.2% 2.0% 2.2% 1.8% 26