SUMMARY OF KEY FINDINGS CONTENTS INTRODUCTION...2

the Scottish 1998 survey SUMMARY OF KEY FINDINGS CONTENTS INTRODUCTION...2 Conducting the Survey...2 Response to the Survey...2 Results...2 ADULTS...3 General Health...3 Dental Health...3 Use of Health Services...4 Cardiovascular Disease...4 Risk Factors...5 Cholesterol...5 Iron Deficiency...5 Blood Pressure...5 Wheezing and Asthma...6 Obesity...7 Accidents...8 Physical Activity...9 Cigarette Smoking... Drinking Alcohol...11 Eating Habits...12 CHILDREN...14 General Health...14 Dental Health...14 Use of Health Services...14 Blood Pressure...14 Wheezing and Asthma...14 Obesity...15 Accidents...16 Physical Activity...16 Cigarette Smoking...17 Drinking Alcohol...18 Eating Habits...18 1

INTRODUCTION Conducting the Survey Response to the Survey The Scottish Health Survey provides reliable information on the health and health-related behaviours of people living in private households. Among the Survey s aims are to estimate the prevalence of a range of health conditions and to monitor progress towards Scottish health and dietary targets. The 1998 survey is the second in a series which began in 1995 with a survey of adults aged 16-64. The main innovation in 1998 was the inclusion of children aged 2-15. Adults aged 65-74 were also asked to participate for the first time. Both surveys were commissioned by what is now the Scottish Executive Health Department and have been conducted jointly by the National Centre for Social Research and the Department of Epidemiology and Public Health, University College London. Each survey takes place at a fresh sample of addresses throughout Scotland. Interviewers call at each address to ask for co-operation, which is entirely voluntary. Within co-operating households, one adult aged 16-74 and up to two children aged 2-15 were selected for the 1998 survey, which involved an interview and a nurse visit. Interviewers collected information about: general health, longstanding illness and acute sickness; cardiovascular disease and related conditions; respiratory symptoms, including asthma; physical activity; eating habits; smoking and drinking; recent accidents; dental health; use of contraceptive pills and hormone replacement therapy; use of health services; demographic and other background details. They also measured height and weight. Nurses collected information about prescribed medicines, vitamins and recent gastro-enteritis. They measured blood pressure, lung function and waist, hip, mid-upper arm circumference and demi-span, as appropriate depending on the informant s age. They also collected saliva samples from those aged 4 and over and blood samples from those aged 11 and above. At least one interview was conducted at approximately 77% of all eligible households. A total of 9,47 adults and 3,892 children were interviewed, of whom 7,455 adults and 3,211 children were successfully visited by a nurse. This represented an overall response rate of 76% among adults, with 63% of all those eligible taking part in a nurse visit. The corresponding figures for children were 75% and 62%. Results This booklet presents selected key findings from the 1998 survey, including differences by gender, age and social class (defined according the household s chief income earner). A full report comprising 16 chapters and several hundred tables is published in two volumes. This report includes detailed comparisons of seven regions within Scotland and between Scotland and England. Although some noteworthy differences were recorded, similarities across regions and with England were more common. Comparisons are also made with the results of the 1995 survey. As one would expect, few significant changes emerged over what is, in terms of the health of the population, a relatively short period of time. 2

ADULTS General Health Three quarters of men and women aged 16-74 reported their general health to be good or very good. Four adults in ten had a longstanding illness, disability or infirmity that affected them over a period of time. The chart shows that the proportion of men and women with good health declines sharply among older age groups, while the number with a longstanding illness rises substantially with increasing age. Proportion Reporting Very Good/Good Health and Longstanding Illness, by Age 9 8 7 16-24 25-34 35-44 45-54 55-64 65-74 16-24 25-34 35-44 45-54 55-64 65-74 Very Good/Good Health Longstanding Illness Very Good/Good Health Longstanding Illness were more likely than men (18% compared with 13%) to report having had an illness or injury in the past two weeks which curtailed their normal activities. were also more likely again by 18% compared with 13% - to show signs of possible mental morbidity. Dental Health About two-thirds of men and women had only their own teeth, around one in five had a combination of false and natural teeth and 12% of men and 17% of women had all false teeth. The chart shows the rapid decline with age in the proportion of adults with only their own teeth, and the consequent increase in the numbers with entirely false teeth. Prevalence of False Teeth, by Age 9 8 7 16-24 25-34 35-44 45-54 55-64 65-74 16-24 25-34 35-44 45-54 55-64 65-74 Only Own Teeth All False Teeth Only Own Teeth All False Teeth were more likely than men to brush their teeth more than once a day (83% compared with 62%) and to attend a dentist once every six months (69% compared with 52%). 3

Use of Health Services Cardiovascular Disease As many as one woman in five had consulted a GP in the past two weeks (21% compared with 12% of men). GP consultation rates increased with age for men but not for women. Over a third of adults aged 16-74 had used hospital outpatient services in the past 12 months (38% of women and 35% of men); 13% of women and 9% of men had been inpatients in the past year. To establish the prevalence of a cardiovascular condition, informants were asked whether they had ever had any of the following confirmed by a doctor: angina, heart attack, stroke, heart murmur, abnormal heart rhythm, other heart trouble, diabetes or high blood pressure. The prevalence of any cardiovascular disorder was similar in men and women (24%). The chart shows the extent to which prevalence increases with age, reaching 58% of men and 51% of women aged 65-74. A large proportion of reported cardiovascular disorder consisted of a diagnoses of high blood pressure: almost half of both men and women who reported having had any cardiovascular disorder had only high blood pressure. Prevalence of Any Cardiovascular Disorder, by Age 16-24 25-34 35-44 45-54 55-64 65-74 Prevalence of Ischaemic Heart Disease (Heart Attack or Angina) or Stroke, by Social Class 9 8 7 6 5 4 3 2 1 I II IIINM IIIM IV V Six per cent of men and five per cent of women aged 16-74 reported ischaemic heart disease (IHD) that is, a heart attack or angina confirmed by a doctor. Prevalence of IHD was negligible up to age 44, then rose steeply to 27% of men and 17% of women aged 65-74. 4

A clear social class gradient (an increase from Social Class I to Social Class V) was found in the prevalence of both cardiovascular disease and ischaemic heart disease. The latter is illustrated in the accompanying chart. Risk Factors Cholesterol Cigarette smoking, high alcohol intake, physical inactivity and being overweight or obese are among the factors known (through other studies) to increase the risk of Cardiovascular disease (CVD). The prevalences of these factors are reported in other sections of this booklet. This survey is not designed to collect information about the presence of risk factors throughout people s lives, so cannot explore the impact of risks on rates of CVD. The survey did find that, generally, the prevalence of any risk factor at the time of interview was somewhat higher in those with a cardiovascular disorder than in those without, but with cigarette smoking and alcohol consumption being exceptions. without a CVD condition were more likely to be cigarette smokers (35% compared with %), while women without a CVD condition were more likely to consume above the recommended weekly alcohol limits (16% compared with 8%). Studies have shown that two types of cholesterol impact on rates of heart disease. Risk is increased by high levels of total cholesterol but low levels of high-density lipoprotein cholesterol (HDL-cholesterol). Iron Deficiency Blood Pressure Overall, 17% of men and 18% of women had a high level of total cholesterol (6.5 mmol/l or above). Among men the prevalence of raised cholesterol increased sharply between ages 25-34 and 35-44, then peaked within the 45-54 age group. Among women the prevalence of raised total cholesterol increased continuously with age. Consequently, the prevalence of raised cholesterol was higher in men than in women in central age groups, but higher among women in older age groups. This is consistent with an increase in cholesterol levels after the menopause. The proportion of informants with a low HDL-cholesterol level (less than 1 mmol/l) was three times higher in men (16%) than in women (5%). No clear pattern was observed by age. Haemoglobin was also measured in the 1998 survey. Low haemoglobin levels are commonly caused by iron deficiency that arises when the body s iron requirements are not being met, either due to excessive blood loss or inadequate dietary intake of iron. of childbearing age, due to menstrual blood loss and the increased demands associated with pregnancy, and elderly people are particularly vulnerable to iron deficiency. Overall, 2% of men and 8% of women had iron deficiency (haemoglobin levels of less than 13 g/dl in men and 12 g/dl in women). In men, the prevalence of iron deficiency was higher in the older age groups. In women, the prevalence of iron deficiency increased through the childbearing years from 7% in the 16-24 age group to 12% in the 35-44 age group; it then declined in the post-menopausal age groups, only to rise slightly in the oldest age group. Mean systolic blood pressure (SBP) was 132 mmhg for men and 127 mmhg for women aged 16-74; mean diastolic blood pressure (DBP) was 74 mmhg for men and 7 mmhg for women. Mean SBP increased continuously with age for both men and women, while mean DBP rose up to age 55-64 then fell slightly. 5

Wheezing and Asthma Prevalence of High Blood Pressure Using the 1998 Definition, by Age 8 7 16-24 25-34 35-44 45-54 55-64 65-74 16-24 25-34 35-44 45-54 55-64 65-74 The definition of high blood pressure among adults for the Health Survey is SBP greater than or equal to 1 mmhg or DBP greater than or equal to 9 mmhg or taking medicine for high blood pressure. A third of men and slightly fewer women had high blood pressure. The chart shows the huge extent to which the prevalence of high blood pressure increased with age. Of those who had high blood pressure, 35% of men and 46% of women were on treatment. Just under half of those on treatment had their blood pressure successfully controlled to below the threshold levels. The prevalence of high blood pressure varied somewhat with social class for women, with a notably low rate in Social Class I, a high rate in Social Class V and a very slight increase with social class between these two. This pattern was not found among men. One quarter of adults reported a history of wheezing. About fifteen percent of adults reported having wheezed in the 12 months before the interview. The chart (which includes children) shows distinctive age variations in rates of wheezing, with relatively high rates among young adults and those aged over 55, especially the oldest men in the survey. Prevalence of Wheezing in the last 12 Months, by Age (Moving Average of Five Age Years) 25 Hypertensive untreated Hypertensive treated Normotensive treated Hypertensive untreated Hypertensive treated Normotensive treated Per cent 15 5 4 9 14 19 24 29 34 39 44 49 54 59 64 69 Overall, a diagnosis of asthma made by a doctor was reported by 11% of men and 12% of women. The second chart shows that the age pattern for asthma differed to that for 6

wheezing: rates were high up to the early s then decreased rapidly in the late s and remained stable throughout adult life. The decrease was more marked in men than women, so that from the mid-s onwards women generally had higher prevalence than men. Prevalence of Doctor-Diagnosed Asthma, by Age (Moving Average of Five Age Years) 25 Per cent 15 5 4 9 14 19 24 29 34 39 44 49 54 59 64 69 For both sexes, those in manual social classes had higher prevalence of wheezing than those in non-manual social classes. Prevalence rates varied from around one in ten in Social Class I to around two in ten in Classes IV & V. Prevalence of doctor-diagnosed asthma showed a less clear social class gradient. Smoking was associated with higher prevalence of wheezing in the last 12 months, with heavy smokers well over twice as likely as non-smokers to have had this condition. However, the prevalence of doctor-diagnosed asthma did not seem to be affected by the informants smoking status, the figures showing little difference between smokers and non-smokers. Obesity Whether or not a person is overweight clearly depends not only on their weight but also on their height. The body mass index (BMI) is a common weight-for-height measure. It is calculated by dividing weight by the square of height (using metric measurements). Overweight and obese are defined by values of 25- kg/m 2 and over kg/m 2 respectively. Prevalence of Obesity and Overweight, by Age 8 7 M & W M & W M & W M & W M & W M & W 16-24 25-34 35-44 45-54 55-64 65-74 Male overweight Female overweight Male obese Female obese 7

One fifth of both men and women were obese. More men than women were overweight (43% versus 32%) and this was true for all but the youngest age group. In total, therefore, over half of men (62%) and women (54%) were either overweight or obese. The chart demonstrates that up to age group 55-64, increasing age means greater likelihood of being overweight or obese. In terms of social class, women in manual classes were more likely to be obese than women in nonmanual social classes. However, there was no clear relationship with social class among men. A measure of obesity around the waist, the waist-hip ratio (WHR), showed greater differences by social class (see chart). There was a clear social class gradient in the proportion of women with a raised WHRs (men >.95, women >.85), from 16% in Social Classes I and II to 26% in Social Classes IV and V. In men, the prevalence of raised WHR increased from 21% in Social Classes I and II to 28% in Social Class IIINM, but declined slightly thereafter. Proportion with Raised Waist-Hip Ratio (WHR), by Social Class with raised WHR 25 15 5 I & II III Non-manual III Manual IV & V Accidents The Health Survey covers accidents in the previous 12 months about which advice was sought from a doctor, nurse or other health professional. Overall, men had many more such accidents than women. The annual accidents rates were estimated to be 21 per men and 13 per women aged 16-74. The chart (which includes children) highlights that accidents rates were especially high for young men, but also that from about age 55 rates for women start to exceed those for men. Much of the difference between men and women was due to the number of work-based accidents, estimated at 11 per men in work but just 3 per women. Annual non-work accidents were estimated at 14 and 12 per men and women. Accidents were most commonly described as falls, slips and trips. The majority of accidents to women over 44 were of this type. were more likely than women to have accidents through sports or recreational activities and use of tools or equipment. While swelling, bruising, strains and cuts were the most common forms of injury, around one accident in seven resulted in broken bones or dislocated joints. About half of adults judged that their latest accident could have been prevented, most often by themselves. 8

Annual Accident Rate Per People (Moving Average of Five Age Years), by Age Annual accident rate 45 35 25 15 5 7 Male Female Physical Activity Work-based accidents were more common among adults in manual Social Classes (IIIM, IV & V). However, there was no clear relationship between social class and the non-work accident rate. Social Class of the informant has been used here, rather than that of the chief income earner, since this is more appropriate for analysis of workplace accidents. Physical activity promotes good health and can protect against a range of diseases. An internationally accepted guideline suggests that adults should take part in at least minutes of moderate activity on at least five days per week. The Health Survey asked about four types of activity - at home (housework, gardening, DIY), walks, sports and exercise, and at workin the four weeks before interview. Details of the frequency, duration and intensity of activity were used to calculate summary measures. Only activity of at least 15 minutes was counted. Proportion Active at Various Levels of Physical Activity, by Age 9 8 7 16-24 25-34 35-44 45-54 55-64 65-74 Low Medium High 16-24 25-34 35-44 45-54 55-64 65-74 Low Medium High While many men (38%) and women (27%) met the recommended or high level of activity, most did not. Around half of those who did not meet the guideline nevertheless undertook between one and four sessions of at least moderate activity per week. However, nearly a quarter of men and women did not take part in minutes of moderate or vigorous activity on any days in the past four weeks. As the chart shows, the proportion of men meeting the guideline - a high level of activity - decreased steadily with age. For women this decline began only after the age of 44. Conversely, the proportion in the least active group increased with age, reaching two-thirds in the oldest age group. 9

Cigarette Smoking in manual social classes were more likely than men in non-manual social classes to meet the guideline, reflecting their much higher levels of physical activity at work. Among women there was little difference between social classes in the proportions meeting the guideline. For both men and women, participation in walking and sports and exercise was lower in the manual social classes than in the non-manual classes. A third of both men and women aged 16-74 reported that they smoked cigarettes. The chart demonstrates that only among the oldest age group was the rate of smoking substantially lower. There was though a gradual decline with age among men aged 16-64, but this was not found among women. It should be noted that analysis of saliva samples suggested some under-reporting of cigarette smoking, particularly among those aged 16-24. Prevalence of Smoking, by Age 16-24 25-34 35-44 45-54 55-64 65-74 Heavy smoker Medium smoker Light smoker 16-24 25-34 35-44 45-54 55-64 65-74 Heavy smoker Medium smoker Light smoker The same chart also shows that heavy smoking - or more cigarettes per day is most common among middle age groups, whereas a relatively high proportion of younger smokers are light smokers (fewer than cigarettes a day). The second chart shows the strong social class gradient in the prevalence of cigarette smoking, with those in manual social classes being much more likely to smoke than those in non-manual classes. Prevalence of Cigarette Smoking (Age Standardised), by Social Class I II IIINM IIIM IV V

Drinking Alcohol Among smokers, men smoked an average of 17.5 cigarettes per day, while women smoked 14.9 cigarettes. There were sizeable age differences. Young adult smokers averaged 12 cigarettes per day, compared with 21 and 17 cigarettes per day among men and women smokers aged 45-54. Social class differences were also apparent, as smokers in manual social classes smoked more cigarettes than those in non-manual social classes. Over six in ten of all non-smokers and an even higher proportion of young non-smokers were exposed regularly to other people s cigarette smoke. This exposure to smoke was most commonly in public spaces, followed next by homes and then less commonly in the workplace. While drinking small amounts of alcohol can be beneficial, particularly for men aged over and for post-menopausal women, excessive drinking is a substantial threat to good health. Since 1995, government guidelines on sensible drinking have been given in terms of daily consumption, with the advice that men and women who regularly drink 3-4 and 2-3 units per day respectively are not putting their health significantly at risk. (A unit is, for example, half a pint of beer, a single measure of spirits or a small glass of wine.) Previous guidelines were expressed in terms of weekly consumption: 21 units per week for men and 14 for women were recommended as the upper limits for sensible drinking. For continuity, both health targets and this survey use this framework. are much more likely than women to exceed recommended weekly limits. In 1998, 32% of men and 14% of women reported usually exceeding the respective limits. As the chart shows, men and women in the youngest age group (16-24) were the most likely to exceed the recommended level. Thereafter, the proportions decline steadily with age. Proportion Drinking Above a Sensible Level, by Age 45 35 25 15 5 16-24 25-34 35-44 45-54 55-64 65-74 Estimated mean weekly consumption of alcohol was 19.1 units for men and 6.5 units for women. Mean consumption was higher among younger than among older adults. Only a small proportion of men (13%) and women (6%) drank almost every day, this habit being more likely among older than among younger adults. 11

With regard to social class, women in Social Classes I & II were the most likely to have exceeded the 14 unit limit, though they were still a good deal less likely to do so than men in these classes. The second chart also illustrates that there is no clear social class pattern among men in terms of the percentages exceeding the recommended level. However, other data revealed that men and women in manual classes were more likely than their nonmanual counterparts to have drunk a high number of units on their heaviest drinking day in the last week. Proportion Drinking Above a Sensible Level, by Social Class 35 25 15 5 I II IIINM IIIM IV V The extent of problem drinking was estimated through six potential indicators of dependence on or concern about alcohol consumption. Among adults who drank alcohol at all, 12% of men and 5% of women accepted two or more of these descriptions, which may signal problem drinking. More young people - and relatively few older informants - indicated cause for concern (16% of men and 8% of women aged 16-24 compared with 7% of men and 2% of women aged 65-74). Eating Habits In Scotland, eating habits are the second major cause (after smoking) of poor health. Informants were asked how often they ate a range of food types, from fresh fruit to fried food. Variations within the population were substantial, as illustrated by these key examples of patterns of eating: About three in ten men and two in ten women ate fresh fruit only once a week or less often. Five in ten men and six in ten women ate fresh fruit daily. Only around four adults in ten ate cooked green vegetables five or more times a week. Just one man and two women in ten ate raw vegetables this often, though another third or more did so two to four times weekly. Even so, a third of men and a quarter of women had raw vegetables or salad not even once a week. Half of women and sixty per cent of men usually ate white bread; half of those who ate breakfast cereal usually did not have a high fibre brand. Half of men and women did eat potatoes, pasta or rice daily and only one in twenty did not eat these food weekly. A little more than half of men and women ate white fish each week. Nearly as many - four in ten - ate oil-rich fish weekly, but one in three had this type of fish less than once a month or never. Just over half of men and women ate chocolates, crisps or biscuits daily; a third of men and a quarter of women drank (non-diet) soft drinks at least once a day. 12

Younger men and, to a lesser extent, women reported higher consumption rates for sugar, snacks, soft drinks, fried food, milk, meat and, as shown in the chart, white bread. Proportion Who Usually Eat White Bread, by Age 8 7 16-24 25-34 35-44 45-54 55-64 65-74 Consumption of healthy foods was a good deal more prevalent among adults in Social Classes I & II than among those in Classes IV & V. The second chart shows sizeable class differences in the proportions eating cooked green vegetables five or more times a week. Proportion Eating Cooked Green Vegetables More Than Once a Day, by Social Class I II IIINM IIIM IV V 13

CHILDREN General Health Ninety-four percent of boys and girls aged 2-15 had very good or good general health. Nevertheless, one in five had a longstanding illness (22% of boys and 18% of girls). The chart shows how little these rates vary by age of children. Nine per cent of children reported having had acute sickness in the past two weeks. Proportion of Children Reporting Very Good/Good Health and Longstanding Illness, by Age 9 8 7 Boys Girls 2-3 4-5 6-7 8-9 -11 12-13 14-15 2-3 4-5 6-7 8-9 -11 12-13 14-15 Very good/good health Longstanding illness Very good/good health Longstanding illness Dental Health The average age at which children first attended a dentist was two and a half, with nearly all children aged 6 and over having visited a dentist at least once. Among children who had attended a dentist, over half had had fillings and/or teeth taken out. Use of Health Services Blood Pressure Wheezing and Asthma Eleven percent of children had consulted a GP in the past two weeks and 6% of boys and 5% of girls had been a hospital inpatient in the past 12 months. Boys were slightly more likely than girls to have visited hospital as an outpatient in the past year (29% compared with 26%). Systolic blood pressure (SBP) rose with age and height for both boys and girls. Mean SBP rose from 5 mmhg in boys aged 5-6 to 116 mmhg in boys aged 13-15. For girls, mean SBP rose from 5 mmhg in the 5-6 age group to 112 mmhg in the 13-15 age group. There were no substantial sex differences in children s SBP. Mean diastolic blood pressure (DBP) was 55.8 mmhg for boys and 56.4 mmhg for girls. There was no clear relationship between mean DBP and age, height or sex of children. Agreed thresholds for high blood pressure among children are not available. One quarter of children aged 2-15 (27% of boys and 23% of girls) reported a history of wheezing. About fifteen percent reported having wheezed in the 12 months before the interview. An earlier chart in the Adults section (page 6) shows higher rates of wheezing in very young children (aged 2-6). 14

Overall, a diagnosis of asthma made by a doctor was reported by 19% of boys and 16% of girls, significantly higher than the rates for men and women. An earlier chart (page 7) shows that similar rates of asthma were found throughout childhood. A diagnosis of asthma was reported by around 7% of children who reported wheezing in the last 12 months, whereas the corresponding figure for adults was only 45%. Obesity Body mass index (BMI) values for children are not easily compared to those for adults, nor are there widely agreed definitions of overweight and obese for children. The chart shows that median BMI fell slightly up to ages six or seven years, then increased steadily with age. According to UK BMI reference values for obesity, the prevalence of obesity was 8% among boys and 7% among girls. There were no significant social class differences in children s median BMI. Childrens' BMI, by Age (Rounded Age) BMI kg/m 2 28 26 24 22 18 16 14 12 Boys 2 3 4 5 6 7 8 9 11 12 13 14 15 th ile th ile 9th ile BMI kg/m 2 28 26 24 22 18 16 14 12 Girls 2 3 4 5 6 7 8 9 11 12 13 14 15 th ile th ile 9th ile 15

Accidents The Health Survey covers accidents in the previous 12 months about which advice was sought from a doctor, nurse or other health professional. Overall, children had more such accidents than adults and boys had more accidents than girls. The annual accidents rates were estimated to be 25 per boys and 17 per girls. An earlier chart (page 9) shows a higher accident rate among boys throughout the age-range 2-15. Physical Activity Falls, trips and slips accounted for half of children s accidents, while nearly a fifth occurred during sports or recreational activities. Swelling, cuts and bruising were the most common types of injury. Nevertheless, a fifth of accidents to children aged 7-15 resulted in a broken bone, compared with one accident in twenty among the 2-6 age group. Informants judged that a little under half of accidents to children could have been prevented, usually by the children though by others for one accident in five. About half of accidents to school age children caused them to have time off school. Accident rates were above average for children in Social Classes IV and V. Physical activity is a fundamental part of a healthy lifestyle for children. The survey has four categories of activity: sport and exercise, active play, walking and, for those aged at least eight, housework/gardening. It covers activities of at least 15 minutes during the seven days before interview, excluding those which happened in school lessons. Around nine in ten boys (92%) and girls (88%) had participated in physical activity on five or more days in the preceding week, a proportion which varied very little by age. However, as the chart shows, the estimated amount of time spent on activities differed for boys and girls and according to age. Boys were estimated to have spent an average of 14 hours and girls 11 hours doing any of the physical activities. Among girls, especially teenagers, the number of hours of participation declined markedly with age. Age differences among boys were very modest, with just a slight fall in hours of participation among teenagers. Mean Number of Hours Spent Participating in Any Physical Activity in the Week Before Interview, by Age Hours 16 14 12 8 6 4 2 2-3 4-5 6-7 8-9 -11 12-13 14-15 Boys Girls Overall physical activity was summarised into three levels, high (an estimated or more minutes on 5 or more days in the last week), medium (-59 minutes on at least five days) and low (all others). A higher proportion of boys (73%) than girls (%) were active at the high levels. As the chart shows, the difference between boys and girls appears from around age 4. At first this was because boys aged 4-11 were especially likely to be highly active. From age 12, though, there was a very sharp decline in the proportion of girls active to a high level. By the age of 14-15, two thirds of boys but only just over a third of girls were active at the high level. At least as many girls had a low activity level. 16

Proportion of Children Active at Various Levels 9 8 7 Boys 2-3 4-5 6-7 8-9 -11 12-13 14-15 Low Medium High Girls 2-3 4-5 6-7 8-9 -11 12-13 14-15 Low Medium High Cigarette Smoking Although there were some differences in respect of specific activities, there was no consistent relationship between social class and the level of participation in physical activity. Around one in five children aged 8-15 claimed to have ever smoked a cigarette (though note that the presence of parents is likely to have caused under-reporting, even though answers were entered into a booklet by the children themselves). Of course, as the chart shows, older children were much more likely to have smoked than younger children. Among those aged 14-15, 38% of boys and 48% of girls reported that they had ever smoked compared with 9% of boys and 7% of girls aged 8-9. Negligible numbers of children aged 8-12 had smoked a cigarette in the previous week, or claimed to smoke cigarettes at least once a week. Slightly fewer than one in ten 13-15 year olds reported that they had smoked in the previous week. However, 16% of boys aged 13-15 and 15% of girls had saliva cotinine levels which indicated regular smoking. This underlines the under-reporting of smoking behaviour in this survey among this age group. Over eight out of ten children aged 8-15 had some exposure to cigarette smoke, most commonly in a home, including, for four children in ten, their own home. Proportion Ever Having Smoked a Cigarette, by Age 8 9 11 12 13 14 15 Boys Girls 17

Drinking Alcohol Children aged 8-15 were asked various questions on drinking alcohol. Although the questions were contained in a self-completion booklet to provide privacy in answering, it is possible that there was some under-reporting of drinking because the survey was conducted at home, with parents present. Some children may wish to conceal their drinking (and smoking) behaviour from parents and other adults. Overall, % of boys and 27% of girls aged 8-15 had experienced having a proper alcoholic drink (that is a whole drink, not just a few sips). As can be seen from the chart, for both boys and girls the proportions were quite low up to age 11 a bit above or a bit below one in ten. But from age 12 the proportions increased steeply, so that by age 15, two thirds of both boys and girls had experienced having a proper drink (67% and 68% respectively). Proportion Ever Had a Proper Alcholic Drink, by Age 7 8 9 11 12 13 14 15 Boys Girls Among children aged 13-15, 12% of boys and 9% of girls had had an alcoholic drink in the week prior to interview. This included 4% of boys and 2% of girls who reported having had six or more units of alcohol in that week. 18

Eating Habits As with adults, the eating patterns of children in Scotland vary a great deal. However, there are relatively few differences between boys and girls: Just over half of boys and somewhat more girls had fresh fruit daily, but a fifth of boys and one in eight girls had fresh fruit as little as once a week. Moreover, the latter proportions increased markedly with age. Only around three children in ten ate cooked green vegetables five or more times a week. Just % of boys and 16% of girls ate raw vegetables this often, though another % did so one to four times weekly. Even so, 45% of boys and 35% of girls had raw vegetables or salad not even once a week. A large majority of children usually ate white bread; over half of those who ate breakfast cereal usually did not have a high fibre brand. Half of children did eat potatoes, pasta or rice daily and only one in twenty did not eat any of these foods weekly. Nearly half of children ate white fish each week. However, as many girls and more boys had oil-rich fish less than once a month or never ate this type of fish. At least eight children in ten ate chocolates, crisps or biscuits every day, including four in ten who did so more than once a day. Fewer children, though still over one half, drank (non-diet) soft drinks at least once a day, including one in three who did so more than once a day. In general, patterns of eating as distinct from amounts - did not differ greatly according to children s age, though there were exceptions. For example, older boys consumed soft drinks more frequently, older girls were less likely to eat breakfast cereals but were more frequent eaters of raw vegetables or salad, and weekly eating of white fish by children declined with age. 19

Findings in this booklet are taken from: The Scottish Health Survey 1998 A survey carried out on behalf of the Scottish Executive Health Department Edited by Andrew Shaw, Anne McMunn and Julia Field Joint Health Surveys Unit The National Centre for Social Research and Department of Epidemiology and Public Health, University College London ISBN 1-84268-85-4 The full report (two volumes, price ) and further copies of this summary report are available from: The Stationery Office Bookshop 71 Lothian Road Edinburgh EH3 9AZ Tel: 87 6 55 66 The survey data (anonymised) will be lodged with the Data Archive at the University of Essex. CONTACT POINTS The Scottish Executive Health Department Health Improvement Strategy Division 3E(S), St Andrews House, Edinburgh EH1 3DG. Phone 131 244 23 or 25 Fax 131 244 26 Website www.show.scot.nhs.uk/scottishhealthsurvey/ National Centre for Social Research (formerly SCPR) 35 Northampton Square, London, EC1V AX. Telephone 7 2 1866 Fax 7 2 1524 Website www.natcen.ac.uk Department of Epidemiology and Public Health at the Royal Free and UCL Medical School 1-19 Torrington Place, London, WC1E 6BT. Telephone 7 679 17 Website www.ucl.ac.uk/epidemiology/jhsu/jhsu.html ESRC Data Archive University of Essex, Wivenhoe Park, Colchester, Essex CO4 3SQ. Telephone 16 871 Fax 16 873 Website www.data-archive.ac.uk