Health Education Population Survey (HEPS) 1996-2003

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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

7. Smoking

Smoking is the single largest preventable cause of illness and premature death in Scotland and is a major risk factor for CHD and cancer‚ contributing to approximately 30% of all cancer deaths. Passive smoking also has health implications for non-smokers in terms of increased risk of CHD‚ lung cancer and asthma. For health education‚ the aims are to educate people about the harmful effects of smoking‚ to motivate and enable smokers to quit‚ and to improve access to smoke free environments (HEBS‚ 1995). In Scotland‚ preventative health education activities have focused on school age children and young people. For adults‚ the main efforts are around encouraging smokers to quit‚ using a combination of media communications that publicise the services of the telephone helpline‚ Smokeline (since 1992)‚ and extending the network of local smoking cessation services and the use of nicotine replacement therapy (since 1999). More recently (since 2003)‚ educational efforts have turned to increasing awareness of the harmful effects of passive smoking and changing attitudes to‚ and the availability of‚ smoke-free environments.

7.1 Risk behaviour

Respondents were asked whether they smoked nowadays‚ even if only occasionally (Table 7.1).

Table 7.1: Percentage of regular smokers‚ by age/social grade/DEPCAT

%	1996	1997	1998	1999	2000	2001	2002	2003
All	36	33	32	35	–	32	29	29
Sex
Men	36	32	32	40	–	32	30	29
Women	37	34	31	30	–	32	30	29
Age
16-24	32	25	34	47	–	25	32	27
25-34	48	43	34	44	–	36	33	36
35-44	35	35	31	38	–	35	35	34
45-54	37	36	36	28	–	29	29	26
55-64	29	25	33	27	–	38	25	29
65-74	32	25	15	17	–	26	16	17
Social grade
AB	16	16	13	17	–	11	14	13
C1	28	26	22	35	–	23	27	26
C2	37	40	36	30	–	34	31	34
D	47	42	47	52	–	52	42	33
E	54	48	52	37	–	53	42	44
DEPCAT
1-2	24	20	21	34	–	19	21	19
3-5	37	33	31	34	–	26	31	30
6-7	43	45	47	41	–	52	35	39
Base: all respondents	1810	1795	1794	880	–	1757	1742	1720

Significant changes (p<0.05)

Around one in three respondents said they smoked regularly (slightly higher in 1996) and around 4% said they smoked occasionally. Men and women were equally likely to be regular smokers. There was no clear pattern for age differences. There was no significant change in the overall prevalence of smoking over time‚ although it had decreased significantly for the 25-34 and 45-54 age groups. The figures for 2002 and 2003 suggest there may be a downward trend in smoking prevalence‚ but longer-term data are needed to confirm this.

Data on smoking trends for adults aged 16-64 years from the Scottish Household Survey (SHoS) do‚ however‚ also indicate a downward trend between 1999 and 2002 (Figure 7.1). For men‚ the smoking rate has decreased from 36% in 1998 to 31% in 2002‚ with an apparent decline among men in deprived areas‚ but little change among women. The overall adult smoking rate is about 2% lower in HEPS than the Scottish Household Survey‚ probably because of the inclusion of adults up to the age of 74 years.

Fig 7.1: Adult cigarette smoking trends in Scotland‚ 1996-2003

Fig 7.1

Base: all respondents

In all years‚ there was a clear social grade gradient‚ with the highest prevalence observed for social grade E. There was a similar gradient by DEPCAT area. This is clearly illustrated in Figure 7.2 overleaf using 2003 data.

Fig 7.2: Percentage of regular smokers‚ by social grade/DEPCAT‚ 2003

Fig 7.2

Differences were also found between light‚ medium and heavy smokers (Table 7.2). Light smokers were defined as those who smoked fewer than ten cigarettes per day‚ medium smokers as those smoking between ten and 19 per day and heavy smokers as those smoking 20 or more cigarettes per day.

Table 7.2: Number of cigarettes smoked per day‚ by sex

%	1996	1997	1998	1999	2000	2001	2002	2003
All	10	10	11	23	–	13	15	12
Light (<10 per day)
Medium (10-19 per day)	41	47	43	43	–	46	49	42
Heavy (20+ per day)	49	43	46	33	–	41	36	43
Men
Light (<10 per day)	9	6	10	30	–	13	13	11
Medium (10-19 per day)	43	46	39	47	–	46	49	42
Heavy (20+ per day)	48	48	51	24	–	40	37	47
Women
Light (<10 per day)	10	13	12	15	–	12	15	12
Medium (10-19 per day)	39	47	48	39	–	45	49	43
Heavy (20+ per day)	50	39	41	46		43	34	45
Base: regular smokers	658	588	566	308	–	563	512	530
Base: male smokers	317	266	283	172	–	281	246	227
Base: female smokers	341	321	283	136	–	282	266	303

Overall‚ there were relatively few light smokers. Whilst between 1997 and 1999 men appeared to be more likely than women to be heavy smokers‚ this was no longer the case in the period 2001-3. There was a generally consistent pattern for age in this respect (Table 7.3). Heavy smoking increased with age until the 45-54 age group‚ then declined for older respondents. There were no clear patterns of difference for social grade or DEPCAT.

Table 7.3: Percentage of heavy smokers‚ by age

%	1996	1997	1998	1999	2000	2001	2002	2003
All	48	43	46	33	–	41	36	46
16-24	27	27	21	12	–	16	13	25
25-34	50	33	40	24	–	26	36	46
35-44	59	59	52	51	–	49	35	55
45-54	60	53	60	54	–	67	51	52
55-64	57	45	58	45	–	33	46	50
65-74	31	38	48	34	–	63	39	35
Base: regular smokers	658	588	566	308	–	563	512	530

It is difficult to assess change over time as the number of respondents who are regular smokers is relatively small and so the figures are subject to considerable fluctuation year on year.

7.2 Motivation

Most regular smokers either wanted to cut down or quit smoking. Around half of all regular smokers tried to cut down or quit at some time (Table 7.4). Only around a fifth were not contemplating changing their smoking behaviour‚ and heavy smokers showed very similar results in this respect.

Table 7.4: Motivation to cut down or quit smoking

%	1996	1997	1998	1999	2000	2001	2002	2003
Regular smokers
Not contemplating	22	20	23	16	–	16	17	24
Would like to	31	32	27	32	–	26	35	27
Have tried	48	48	50	52	–	58	48	49
Heavy smokers
Not contemplating	20	22	22	16	–	18	19	21
Would like to	36	40	32	41	–	34	43	34
Have tried	44	38	46	44	–	49	38	44
Base: regular smokers	658	588	566	308	–	563	512	530
Base: heavy smokers	323	253	259	103	–	233	183	235

Main points

A clear social gradient in smoking patterns is apparent by social grade and deprivation‚ with respondents from social grade AB showing the lowest prevalence.
There was no significant change in the overall prevalence of smoking over time‚ except in the 25-34 and 45-54 age groups where smoking has decreased significantly.
Most regular smokers are motivated to cut down or quit smoking; there has been no significant change in levels of motivation over time.

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