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

10. Oral health

Although poor oral health is not generally fatal‚ it is a common cause of pain‚ potentially leading to disability. It is an aspect of child health showing sustained health inequalities: in 1999‚ 72% of girls and 73% of boys living in deprived areas had dental cavities by age 5‚ compared to 39% of girls and 41% of boys living in affluent areas. Poor oral health limits personal choices and social opportunities‚ and diminishes quality of life in the same way as diseases of other body systems (HEBS‚ 1998b). These broader effects of poor oral health are illustrated by findings from the 1992/93 survey carried out as part of the Scottish Health Boards’ Dental Epidemiological Programme. This survey identified relatively high levels of problems associated with oral ill-health‚ such as oral pain and discomfort‚ difficulty in eating and poor appearance (Scottish Health Boards’ Dental Epidemiological Programme‚ 1993). The Scottish Needs Assessment Programme report on adult oral health also noted that most of the Scottish population experienced some form of oral disease during their lifetime (Scottish Forum for Public Health Medicine‚ 1997).

The main aims for health education in the area of oral health were identified in The Oral Health Strategy for Scotland (The Scottish Office‚ 1995) as to encourage people to eat a healthy diet‚ to use preventative measures and to make regular visits to the dentist. A revised Scottish policy on Towards Better Oral Health in Children was undergoing consultation in 2004 and recommends further action that could be taken.

10.1 Behaviour

Dentist attendance in past year

There was a significant increase over time in dentist attendance. In 1999 approximately two-thirds of respondents had visited the dentist in the past year‚ rising to almost three-quarters in 2003 (Table 10.1). Women were consistently more likely to have attended the dentist in the past year‚ although these differences were marginal on the whole (77% of women compared with 69% of men in 2003). Variation by age and social grade showed more marked patterns of difference.

The proportion of respondents visiting the dentist in the past year showed a notable decline with age. Those in the 16-44 age groups were most likely to have visited a dentist‚ but only around half of those aged 65-74 had visited a dentist in the last year. There appears to have been a general increase over time in attendance for those aged over 45 years‚ although this has been subject to some fluctuation‚ and the figure for the latter group in 1996 would appear to be unusually low so the observed trend should be treated with some caution.

There was a clear social class gradient with respect to this indicator. Respondents in social grade AB were most likely to have visited a dentist in the past year‚ although the proportion of those in social grade C2 appears to have increased over time.

Table 10.1: Percentage attending dentist in past year‚ by age/social grade/ DEPCAT

%	1996	1997	1998	1999	2000	2001	2002	2003
All	65	69	69	68	–	69	72	73
16-24	76	84	83	68	–	80	73	81
25-34	77	74	76	68	–	79	75	77
35-44	76	80	82	76	–	80	81	78
45-54	63	69	60	73	–	71	77	75
55-64	51	53	52	69	–	56	67	63
65-74	34	44	50	49	–	32	50	54
Social grade
AB	78	86	88	87	–	88	81	82
C1	72	71	72	72	–	72	74	79
C2	65	66	68	72	–	71	74	72
D	55	59	62	51	–	57	63	61
E	54	59	49	58	–	52	60	60
DEPCAT
1-2	69	78	80	72	–	81	81	82
3-5	64	69	69	67	–	67	72	71
6-7	65	64	59	67	–	67	64	67
Base: all respondents	1810	1795	1794	880	–	1757	1742	1720

Significant changes (p<0.05)

The gradient by age and social grade is illustrated below in Figure 10.1 using the 2003 data.

Fig 10.1: Percentage attending dentist in the last year‚ by age and social grade‚ 2003

Fig 10.1

Base: all respondents 2003 (1720)

The social gradient by DEPCAT has increased markedly with dentist attendance increasing in the more affluent areas and little change in levels of attendance in the more deprived areas. This gradient is illustrated in Figure 10.2 using the
2003 data.

Fig 10.2: Time trends in dentist attendance in the last year‚ by DEPCAT‚ 1996-2003

Fig 10.2

Base: all respondents

Attending for a routine check-up in past six months

A similar time trend and patterns of difference by age‚ social grade and deprivation were observed for this indicator (Table 10.2).

Table 10.2: Percentage attending dentist for routine check-up in past six months‚ by age/social grade/DEPCAT

%	1996	1997	1998	1999	2000	2001	2002	2003
All	34	40	41	40	–	41	45	43
Age
16-24	38	51	49	28	–	41	40	48
25-34	40	40	43	39	–	46	47	41
35-44	40	48	51	50	–	48	47	46
45-54	33	42	35	49	–	44	49	50
55-64	26	28	33	43	–	31	48	38
65-74	19	20	24	27	–	23	32	30
Social grade
AB	52	55	55	63	–	62	57	55
C1	41	43	48	44	–	46	48	48
C2	34	34	39	39	–	36	41	40
D	27	31	30	24	–	32	35	33
E	16	29	21	28	–	23	35	32
DEPCAT
1-2	40	50	53	44	–	55	57	56
3-5	34	40	42	40	–	42	44	42
6-7	28	29	20	33	–	27	32	32
Base: all respondents	1810	1795	1794	880	–	1757	1742	1720

Significant changes (p<0.05)

From 1997‚ approximately two-fifths of respondents had visited their dentist for a routine check-up in the past six months‚ representing a significant increase since 1996. Older respondents were less likely to have had a routine dental examination in the past six months and there was again a clear class gradient‚ with AB respondents being most likely to have done so. There was a similar pattern by DEPCAT‚ with those in the most affluent areas most likely to have had a routine check-up in the last six months and showing a greater level of increase over time.

Fig 10.3: Time trends in dentist attendance in the last year and routine appointments in last 6 months‚ 1996-2003

Fig 10.3

Base: all respondents

10.2 Motivation

The majority of respondents were intending to visit their dentist in the next six months. The proportion increased significantly from two-thirds in 1996 to three-quarters in the period 2002-2003 (Table 10.3). Those who had not visited their dentist in the past year were substantially less likely to intend to visit the dentist‚ indicating lower levels of motivation. Motivation does not appear to have increased over time for this group.

Table 10.3: Percentage intending to visit dentist in next six months

%	1996	1997	1998	1999	2000	2001	2002	2003
All	65	69	68	71	–	72	75	74
No visit in past year	29	25	21	31	–	32	30	36
Base size: all respondents	1810	1795	1794	880	–	1757	1742	1720
Base: no visit in past year	618	537	549	280	–	534	481	526

The observed patterns of difference suggest that people tend either to visit the dentist on a regular basis or very infrequently‚ possibly only when experiencing problems. This is supported by other analyses of HEPS data showing a clear association between the frequency of visiting the dentist and the reason for attending: the longer it had been since the last visit‚ the more likely it was that this visit had been due to respondents having problems with their teeth or gums (HEBS‚ 2000).

Main points

Significant increases were observed in the proportion attending the dentist in the past year‚ in the past six months for a routine check-up‚ and intended visits in the next six months.
Older people‚ those from lower socio-economic groups and the more deprived areas were less likely to have visited the dentist.

The inequalities gap has increased‚ with the rate of improvement in dental attendance much greater in the more affluent areas and little change observed in the more deprived areas.

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