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Health Education Population Survey (HEPS) 1996-2003

Contents:

Summary 1. Introduction 2. Scotland's health 3. Attitudes towards own health 4. Perceptions of mortality, morbidity and risk 5. Physical activity 6. Diet 7. Smoking 8. Alcohol 9. Mental health 10. Oral health 11. Drugs 12. Sexual health 13. Conclusions References Appendix 1: Questions analysed in overview Appendix B: Topics covered 1996-2003 Appendix C: Base sizes Appendix D: Physical activity levels

4. Perceptions of mortality, morbidity and risk

One of the main aims of health promotion is to ensure that people are aware of the major risks to their health and the means of achieving good health. For example, between 1996 and 2002 HEBS ran a public awareness-raising media campaign about the health risks associated with coronary heart disease, cancers and stroke (the Big 3 campaign) which featured core messages on the three diseases and a series of Top Tips ads related to specific actions to reduce the risk. This is now the focus of the Scottish Executive's healthyliving campaign, launched in 2003. A range of indicators was used in HEPS to assess knowledge levels in relation to the major causes of mortality and morbidity in Scotland as well as perceptions of personal risk and the preventability of ill-health.

 

4.1 Main cause of premature death

Respondents were asked in an open question what they thought was the main cause of premature death for people in Scotland (Figure 4.1).

Fig 4.1: Time trends in perceived main cause of death in Scotland, 1996-2003

Base: all respondents

Across all eight years covered by the survey, the majority regarded CHD as the main cause of premature death in Scotland. The salience of cancer has increased in recent years: the proportion mentioning cancer as the main cause of death in Scotland rose significantly between 1996 and 2003, while the proportion who identified CHD fell significantly from 1996 to 2001-3. Very few mentioned stroke at any time.

 

4.2 Perceptions of risk and preventability

The perception that CHD was a risk to personal health fell significantly over the eight years. The perceived risk from other diseases showed less clear trends with more fluctuation year on year. Although CHD is clearly regarded as the main cause of death among Scottish adults, more respondents felt personally at risk from cancer (Table 4.1).

Table 4.1: Perceived risk to own health

%	1996	1997	1998	1999	2000	2001	2002	2003
Cancer	66	64	66	66	-	61	63	69
CHD	61	54	52	56	-	49	50	53
Stroke	41	40	41	47	-	44	41	48
Mental illness/ depression	14	15	16	18	-	16	16	20
HIV/AIDS	5	5	4	3	-	5	3	3
Base: all respondents	1810	1795	1794	880	-	1757	1742	1720

Significant changes (p<0.05)

In terms of specific cancers, breast cancer was perceived as the greatest risk (around half of women), followed by lung cancer (around a third of all respondents). Smokers were more likely to feel at risk from lung cancer than other respondents, with three-quarters of regular smokers saying lung cancer was a risk to their personal health (Table 4.2). Men who smoked were more likely to feel at risk from lung cancer than women who smoked. While women were likely to be slightly lighter smokers than men, this does not explain the difference in perceptions - women who smoked heavily were less likely than men who smoked heavily to feel at risk from lung cancer.

Table 4.2: Perceived risk to own health from lung cancer, by sex (regular smokers)

%	1996	1997	1998	1999	2000	2001	2002	2003
All	76	76	77	77	-	72	76	78
Women	69	70	71	72	-	73	70	72
Men	84	83	83	80	-	72	83	84
Base: regular smokers	658	588	566	308	-	563	512	530

There was a difference in the perceived risk of breast cancer to women according to age. Women under 35 were most likely to believe they were at risk, with women aged 65 or over much less likely to believe they were at risk (Table 4.3). There was no evidence of consistent patterns of change over time.

Table 4.3: Perceived risk to own health from breast cancer, by age (women only)

%	1996	1997	1998	1999	2000	2001	2002	2003
All women	45	43	45	48	-	52	41	52
Age
16-24	57	54	51	61	-	68	61	64
25-34	57	53	58	42	-	67	46	65
35-44	46	54	49	46	-	53	39	54
45-54	43	42	54	69	-	52	45	48
55-64	41	23	31	38	-	34	30	47
65-74	20	18	18	28	-	25	21	23
Base: all women	925	954	916	449	-	894	886	992

Looking more closely at perceived risk of CHD by risk behaviours (Table 4.4), whilst it would appear that smokers are more likely to believe they are at risk than non-smokers, there are no similar consistent differences according to daily fruit and vegetable consumption or whether or not people meet the recommended physical activity levels.

Table 4.4: Perceived risk to own health from CHD, by smokers/not meeting recommended physical activity levels/not eating fruit and vegetables daily

%	1996	1997	1998	1999	2000	2001	2002	2003
All	61	54	52	56	-	49	50	53
Smoking
Regular	69	59	59	61	-	52	52	57
Non/occasional	56	51	49	54	-	48	48	51
Meeting recommended physical activity levels
Not meeting levels	65	55	54	52	-	54	52	52
Meeting levels	58	53	51	59	-	47	49	53
Eating fruit and vegetables daily
Not daily	63	52	54	57	-	47	43	50
Daily	59	55	51	56	-	50	53	53
Base: all respondents	1810	1795	1794	880	-	1757	1742	1720

Significant changes (p<0.05)

Most respondents felt they could reduce the risk of getting cancer, CHD and AIDS/HIV (Table 4.5). Fewer felt anything could be done to reduce the risk of a stroke, despite relatively simple measures that can be taken to reduce blood pressure. However, the latter proportion rose significantly from 40% in 1996 to 52% by 1998 and has remained at a similar level since.

Table 4.5: Percentage believing they can reduce the risk of disease

%	1996	1997	1998	1999	2000	2001	2002	2003
Cancer	91	94	94	93	-	92	94	94
CHD	80	81	80	76	-	83	82	80
HIV/AIDS	81	81	82	74	-	81	79	80
Stroke	40	48	52	48	-	51	51	55
Mental illness/ depression	20	23	23	19	-	26	26	26
Base: all respondents	1810	1795	1794	880	-	1757	1742	1720

Significant changes (p<0.05)

While the majority of respondents felt the risk of cancer could be reduced, this varied for different types of cancer (Table 4.6). Most felt something could be done to prevent the onset of lung cancer (over eight in ten) and skin cancer (around three in four). On the other hand, fewer felt anything could be done to prevent bowel (or colorectal) cancer (around a third) or breast cancer (around a quarter).

Table 4.6: Percentage believing they can reduce the risk of skin, bowel and breast cancer

%	1996	1997	1998	1999	2000	2001	2002	2003
Skin cancer	67	74	73	73	-	72	77	77
Bowel cancer	23	33	34	31	-	34	37	36
Breast cancer	23	30	25	29	-	29	26	25
Base: all respondents	1810	1795	1794	880	-	1757	1742	1720

Significant changes (p<0.05)

There were significant increases in perceptions of the preventability of both bowel and skin cancer between 1996 and 1997, and there is some evidence that these increases may have continued over the longer term. Both of these topics have been the focus of media attention over the years, and this is likely to have contributed to the observed shifts in perception. This is of particular note in the case of bowel cancer, where there has been considerable publicity given to the medical evidence regarding the association between diet and the disease.

Despite this increased awareness over time, there has been a consistent social grade gradient. Those in social grades DE were least likely to believe that something could be done to reduce the risk of skin cancer (66% cf. 87% of ABs in 2003) or bowel cancer (29% cf. 53% of ABs in 2003). In the same way, those in the lowest social grades (DE) were less likely to believe that the risk of CHD could be reduced (74% cf. 89% of ABs in 2003). This is in keeping with the finding that those in the lower social grades were less likely to feel they could influence their own health (see Section 3.3).

4.3 Risk factors for coronary heart disease

Respondents were asked how important they thought various actions were in reducing the risk of CHD (Table 4.7). Each action was classified as very important, fairly important or not very important.

Table 4.7: Factors considered very important in reducing risk of coronary heart disease

%	1996	1997	1998	1999	2000	2001	2002	2003
Quitting/cutting down smoking	78	80	82	84	-	83	80	80
Taking regular exercise	66	70	72	72	-	76	78	77
Eating a healthy balance of foods	58	63	62	62	-	67	66	65
Controlling weight	54	57	56	57	-	61	63	61
Reducing stress	54	53	51	51	-	49	51	51
Eating lots of fruit and vegetables	50	56	58	56	-	56	57	53
Stopping/cutting down alcohol consumption	42	42	44	44	-	44	42	43
Regular checks on blood pressure	45	44	42	45	-	43	43	44
Regular cholesterol checks	40	40	38	43	-	40	39	40
Base: all respondents	1810	1795	1794	880	-	1757	1742	1720

Significant changes (p<0.05)

Respondents tended to identify the three factors generally regarded as most important - cutting down smoking, regular exercise and eating a healthy balance of foods. Over half mentioned controlling weight, reducing stress and eating lots of fruit and vegetables. The proportion identifying the following three risk factors showed consistent and significant increases over time:

• regular exercise
• eating a healthy balance of foods
• controlling weight

The proportion identifying quitting/cutting down smoking as a CHD risk factor is much higher. Whilst this appeared to show a rising trend between 1996 and 1999, this increase was not sustained in more recent years, and was not significantly higher in 2003 than it was in 1996.

It appears that the health benefits of exercise, healthy eating and weight management are becoming more salient among the Scottish population. However, while the proportion mentioning eating lots of fruit and vegetables increased from 1996 to 1998, data from future years are needed to confirm whether the apparent decline observed in the period 2001-2003 is the beginning of a downward trend or the result of random fluctuation in the data.

Main points

• While coronary heart disease was seen as the main cause of premature death by most respondents, the numbers declined significantly between 1996 and 2003, as did the proportion of respondents considering CHD as a personal risk.
• Cancer was seen as a greater risk to respondents' personal health than CHD and there was a significant increase in the proportions mentioning cancer as the main cause of premature death.
• There were significant increases in the proportions believing it was possible to reduce the risk of stroke, skin and bowel cancer.
• Those in the lower social grades were least likely to believe it was possible to reduce the risk of a number of diseases including CHD, skin cancer and bowel cancer.
• There were significant increases in awareness levels regarding the importance of regular exercise, healthy eating and weight control in reducing the risk of CHD.