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Health Education Population Survey (HEPS): Update from 2004 Survey - Final Report

Summary

Background

  • This report presents an update on time trends in health-related knowledge, attitudes, motivations and behaviours in Scotland over the period 1996-2004, providing data from the Health Education Population Survey in 2004. This report focuses on areas where there has been a change, or consolidation of an earlier change, in 2004.
  • In 2004, 1784 interviews were achieved, representing a response rate of 2004.
  • More information on the survey can be found in the 1996-2003 HEPS report published by NHS Health Scotland.
  • While the aim of the analysis is to assess the degree of significant change in these indicators over time, the sample size and design mean that it is sometimes difficult to distinguish observed variations due to actual small changes from those due to random sampling error.

Overview – 2004 update

  • The belief that people can influence their own health continued to increase (82% in 2004)
  • The slight decrease over time in sedentary behaviour has been consolidated in 2004 (30%), although the apparent increase in protective behaviour in 2002/2003 has not (39%).
  • Reported consumption of fruit and vegetables and knowledge of recommended levels of consumption continued to increase. In 2004 one in three met the recommended levels and reported consumption increased for men and the lower social grades, both groups previously slower to change.
  • Smoking prevalence appears to have continued to decrease (27%) and this is backed up by the Scottish Household Survey.
  • The proportion of men exceeding the recommended alcohol limit appears to have fallen from a quarter to a fifth. However, motivation to cut down drinking has also dropped (23%), reversing a previously increasing trend.
  • There were no discernible changes in mental health over time, and the apparent increase in mental health disorder in 2003 appears to have been a random fluctuation.
  • 2004 saw consolidation of the increases observed previously in the proportion attending the dentist in the past year (74%), in the past six months for a routine check-up (48%) and intended visits in the next six months (77%).
  • There was a declining demand for more information on recognising the symptoms of STIs (20%), having an HIV test (13%), HIV transmission (9%) and emergency contraception (7%). There were more decreases in demand for the 16-24 age group than in previous years.
  • Seven in ten were aware that there had been a change in legislation but only four in ten knew that cannabis is still illegal to use and possess. Men, younger respondents cannabis users and those in the highest social grades were most likely to know the broad content of the legislation

Attitudes to own health

  • Three quarters of people felt that their health was good, although around a third reported a long-standing illness or disability and this has not changed over time.
  • Most people felt that they could influence their own health and this increased from 76% in 1996 to 82% in 2004.
  • As in previous years, those in the lowest social grades and, in particular, older people were least likely to think their health was good, most likely to report a long-standing illness and least likely to feel they have any influence over their own health. This means that those groups most in need of improvements to their health are also likely to be those who are least open to health education messages because they don’t believe they can influence their own health.

Physical activity

  • Three in ten adults were sedentary. Younger respondents were least likely to have a sedentary lifestyle, as were those from higher socio-economic groups.
  • The slight decrease over time in sedentary behaviour has been consolidated in 2004 (30%), although the apparent increase in protective behaviour in 2002/2003 has not (39%).
  • Men were more likely than women to achieve the recommended levels of physical activity, but no less likely to be sedentary.
  • Around one third were aware of the minimum daily recommended levels of moderate intensity physical activity; there has been no change in these knowledge levels. Only one in ten knew that moderate activity was recommended five times a week to stay healthy, with three in ten believing daily exercise was needed.
  • Those in the lower social grades were more likely to be sedentary and less likely to be aware of the recommended levels of moderate activity. However, they were most likely to walk more than 30 minutes on an average day, possibly out of necessity rather than as a health-related choice.
  • Levels of motivation to take more exercise remain largely unchanged from 2002 to 2004.

Diet

  • Consumption of fruit and vegetables was higher among women, older respondents and those from higher socio-economic groups.
  • There was continued increase among all respondents in terms of consuming the recommended amount of fruit and vegetables (reaching 33% in 2004) with the exception of the youngest age group (aged 16-24) and those living in more deprived areas.
  • In 2004 there have been particular increases in reported fruit and vegetable consumption for men and those in the lower social grades. These should be monitored in the future to determine if they will be sustained.
  • There have been continued increases in knowledge levels regarding the current recommendation for fruit and vegetable intake (63%).

Smoking

  • 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 appears to be a decrease in smoking prevalence over time, down from a third in 1997 to just over a quarter (27%) in 2004. Whilst this seems to be backed up by the Scottish Household Survey, future years’ data will help to confirm this trend.
  • Most regular smokers (80%) are motivated to cut down or quit smoking; there has been no significant change in levels of motivation over time.

Alcohol

  • Men were more likely to exceed the recommended weekly limits and to binge drink than women. In 2004, however, the proportion of men exceeding the recommended limit appears to have fallen from a quarter to a fifth.
  • There was a significant increase in knowledge levels regarding the recommended weekly limits between 1996 and 1997, but these levels are still relatively low and have shown no further significant increases. Women were more likely than men to be aware of the recommended limits for the first time in 2004.
  • A slight decrease in motivation to cut down alcohol consumption in 2004 (23%) means that levels of motivation are not significantly higher than they were in 1996, reversing the apparent increase in motivation recorded over the past few years.

Mental health

  • Women were more likely than men to report symptoms of potential mental distress.
  • There was a marked social gradient in symptoms of mental distress and disorder, with those living in more deprived areas and in social grade E reporting more symptoms.
  • There were no discernible changes over time, and the apparent increase in mental health disorder in 2003 appears to have been a random fluctuation.

Oral health

  • 2004 saw consolidation of the increases observed previously in the proportion attending the dentist in the past year (74%), in the past six months for a routine check-up (48%) and intended visits in the next six months (77%).
  • Older people, and those from lower socio-economic groups were less likely to have visited a dentist and there is no sign of the gap reducing between those in the highest and lowest social grades.

Sexual health information needs

  • There was a declining demand for more information on recognising the symptoms of STIs (20%), having an HIV test (13%), HIV transmission (9%) and emergency contraception (7%).
  • In 2004 there was a decrease in demand amongst those aged 16-24 for information on HIV/AIDS transmission (16%) and emergency contraception (9%).

Cannabis legislation

  • Seven in ten were aware that there had been a change in legislation but only four in ten knew that cannabis is still illegal to use and possess.
  • Men, younger respondents and those in the highest social grades were most likely to know the broad content of the legislation
  • Seven per cent of respondents said the legislation would make them more likely to use cannabis, rising to 22% of recent users of the drug. Correct understanding of the legislation had little effect on this.

1. Introduction

1.1 Background

The Health Education Population Survey (HEPS) monitors health-related knowledge, attitudes, behaviours and motivations to change among the adult population in Scotland. A report was published in 2004 presenting an overview of key findings and trends from HEPS data during the first eight years (1996-2003)1. The aim of this report on the 2004 survey data is to highlight any changes (or consolidation of earlier changes) in 2004. The report will also highlight key differences for socio-demographic groups using the 2004 data. The tables in Appendix C give further information on all the issues covered in the 1996-2003 report.

The survey was commissioned by NHS Health Scotland2. A core element of the work of NHS Health Scotland, and health promotion generally, is to increase public awareness of health-related risk factors and how to make the lifestyle changes necessary to reduce such risks. Health education, information and communications activities seek to influence people’s health-related knowledge and attitudes and to motivate and support the process of behaviour change. The main purpose of the survey is to collect the data required to monitor progress towards achieving this aim with respect to the priority topic areas identified in a series of policy documents on improving Scotland’s health (Health Education in Scotland, 1991; Scotland's Health - A Challenge To Us All, 1992; Towards a Healthier Scotland, 1999; Improving Health in Scotland - The Challenge, 2003). The indicators presented in this report concern knowledge, attitudes, motivation and behaviour/health status among adults in relation to the following topics:

  • attitudes towards own health
  • physical activity
  • diet
  • smoking
  • alcohol
  • mental health
  • oral health
  • sexual health (information needs).
  • cannabis legislation

This report excludes some topics included in the 1996-2003 report, as there have been no changes in 2004. These are:

  • perceptions of mortality, morbidity and risk
  • breastfeeding in public
  • drug use
  • sexual health behaviour and motivation

Appendix C contains tables covering all of the issues included in the 1996-2004 report, including those above excluded from the discussion in this report.

In addition to providing performance monitoring data for the public communications and educational aspects of health promotion, the information collected by HEPS contributes towards the planning and development of future health promotion initiatives.

 

1 NHS Health Scotland (2004) Health Education Population Survey 1996-2003. NHS Health Scotland, Edinburgh.

2 In April 2003, the Health Education Board for Scotland (HEBS) was merged with the Public Health Institute of Scotland (PHIS) to form NHS Health Scotland.

1.2 Methodology

1.2.1 The Survey

The survey is conducted by BMRB International. Fieldwork began in March 1996 and is carried out twice a year (March and September) in mainland Scotland. The survey was suspended for three waves during 1999-2000, resulting in a gap in data collection for the three survey waves covering September 1999, March 2000 and September 2000.

The survey is administered using computer assisted personal interviewing (CAPI) in respondents' homes, including a self-completion section for more sensitive information such as mental health, sexual health and drug use. Each survey wave has an achieved sample of approximately 900 people aged 16-74 years. Respondents are selected using a multi-stage clustered random sampling design with the Postal Address File as the primary sampling frame. A ‘rolling’ sampling procedure allows results to be combined from consecutive waves. The data are weighted to adjust for differing probabilities of selection and response bias with respect to sex and age. Most questions are asked using prompted closed-format response categories, and those asked using unprompted open-format are identified in the text.

Sample size and response rates

This report presents key data from all waves of the survey (1996-2004), using combined results for each year from the two waves of the survey conducted in that year. The exception to this is in 1999 when only one survey wave was carried out. The results for 1999 should therefore be treated with considerable caution since the much lower base will produce much greater levels of random variation. There was no survey in 2000. The number of achieved interviews and response rates with respect to the eligible sample are shown below for each year.

1996

1997

1998

1999

2000

2001

2002

2003

2004

Achieved interviews

1810

1795

1794

880

1757

1742

1720

1784

Response rate

72%

73%

72%

72%

71%

72%

72%

70%

1.2.2 Analysis

This report focuses on changes over time for key variables, both for the whole population and for subgroups with respect to sex, age, social grade and deprivation (base sizes for subgroups are given in Appendix B). Differences between years are tested for statistical significance using t-tests for means or hypothesis tests for proportions as appropriate. Unlike other significance tests, these tests also take into account the estimated design effect due to the sampling procedure (see 1996-2003 report for more details). The report describes observed changes and explicitly points out where such a change is statistically significant (p<0.05). Differences should not be considered statistically significant unless it is specifically stated. Any use of the term significant is taken to mean statistically significant, but the use of this term does not imply substantive significance or importance. Changes over time that are significant are indicated by shaded rows in the tables. It should be noted that given the relatively small size of some of these differences, some caution is recommended in interpreting and generalising from this data in the absence of other supporting evidence.

The significance tests have been applied to look for change between two points in time (e.g. between 1996 and 2004). The period of change considered will be specified in the text, and any change will be considered in context. If the apparent change is not supported by trends of change in between the two points in time, or by change being sustained in the longer term, or by evidence of change from other sources, then caution should be used in interpreting the apparent change.

It is also not appropriate to attribute observed changes definitively and solely to health promotion activity as many other factors (eg macro-economic change, commercial marketing) will influence health-related attitudes and behaviours.

1.2.3 Self Reported Behaviours

It is worth bearing in mind that the behavioural measures are self-reported, rather than observational. This is likely to mean some degree of under-reporting for behaviours such as alcohol consumption or over-reporting for behaviours such as physical activity or consumption of fruit and vegetables.

1.2.4 Classifications used

Age : In general, six age groups are used for analysis (16-24, 25-34, 35-44, 45-54, 55-64, 65-74). These are the standard groups used in presenting survey findings. However, in the absence of clear gradients, or in the case of small base sizes, results may be presented in terms of more aggregated age groups to clarify observed patterns of difference.

Social grade is used as a household-based proxy measure of social class. This classification is based on the normal occupation of the chief income earner in the household, which is categorised into AB (professional, managerial and technical), C1 (skilled non-manual), C2 (skilled manual), D (partly skilled and unskilled) and E (dependent on state and casual workers) (Market Research Society, 1991). The social grade of a retired person with a pension from their job is based on their previous normal occupation. The social grade of widows or widowers receiving a pension from their spouse’s job is based on the previous normal occupation of the spouse. For those unemployed for two months or less, social grade is based on their previous occupation - the longer term unemployed are graded as E. The main advantage of this classification system is that it provides a relatively stable population profile over time and all respondents can be assigned a social grade, unlike occupation-based systems such as the Registrar General’s Social Class based on Occupation which excludes the long-term unemployed, arguably one of the most materially and socially disadvantaged population groups.

Deprivation . DEPCAT is used as an area-based measure of deprivation. This is based on the Carstairs scores which are derived from census data and are a measure of “access to material resources which provide access to those goods and services, resources and amenities and of a physical environment which are customary in society”3 The scores do not apply to individuals but are summary codes applied at postcode sector level. The scores are a composite measure of four variables: overcrowding, male unemployment, low social class and having no car. The Carstairs scores are used to define seven DEPCAT groups, from 1 (the most affluent) to 7 (the most deprived). Carstairs scores are updated periodically when more up to date Census data are available, or when there are changes to postcode boundaries . The division of the scores into DEPCAT groups was first done in 1981on a pragmatic basis, using the first Carstairs scores. More recent DEPCAT groups have been achieved by dividing the population (according to the latest Carstairs scores) into seven new DEPCAT groups, each containing the same proportions of the population as those produced in 1981. The latest available DEPCAT scores were used for analysis in this report. For further discussion of DEPCAT, see the 1996-2003 report.

Motivation . Three mutually exclusive categories are used to classify respondents according to their motivation to change health-related behaviours. Those who:

  • have tried to change in the past year
  • want to change, but have not tried in the past year
  • have neither tried nor want to change.

Anyone who falls into either of the first two categories would be defined as “motivated to change”.

 

3 McLoone, P (2000) Carstairs Scores for Scottish Postcodes Sectors from the 1991 Census. Public Health Research Unit, Glasgow.

1.2.5 Tables and figures

When using tables and figures, the following points should be noted:

  • Percentages may not add up to 100 due to rounding, or the exclusion of don’t know responses where they only represent a small proportion of answers
  • Percentages are used throughout the report, irrespective of base size - for each percentage given, the number of individuals constituting the base is given in Appendix B and should be taken into account when interpreting the findings
  • Percentages less than 0.5% and greater than zero are denoted by ‘*’, while ‘-‘ denotes zero
  • The base for percentages consists of all respondents (including those for whom data are missing), unless explicitly stated.

Main points

  • This report presents an update on time trends in health-related knowledge, attitudes, motivations and behaviours in Scotland over the period 1996-2004, providing data from the Health Education Population Survey in 2004. This report focuses on areas where there has been a change, or consolidation of an earlier change, in 2004.
  • In 2004, 1784 interviews were achieved, representing a response rate of 2004.
  • More information on the survey can be found in the 1996-2003 HEPS report published by NHS Health Scotland.
  • While the aim of the analysis is to assess the degree of significant change in these indicators over time, the sample size and design mean that it is sometimes difficult to distinguish observed variations due to actual small changes from those due to random sampling error.

2. Attitudes to own health

How respondents view their own health provides relevant context for health education and promotion. The way people view their own health, and their ability to influence their own health, is likely to have an impact on how responsive they are to health education messages, and to the effort they would be willing to make to improve their health in the longer term. Moreover, self-assessed general health status has been shown to predict mortality independently of other factors and is used in Scotland as a measure of healthy life expectancy, along with limiting longstanding illness4. Whilst there has been no change in 2004 on some of these measures, this chapter has been included to provide context for chapters on specific health issues.

 

4 Information and Statistics Division Scotland (2004) Healthy Life Expectancy in Scotland. ISD Scotland, Edinburgh.

2.1 Self-reported general health

When asked how they would rate their own health three in four (77%) said it was very or fairly good. This has shown no change over time. As in previous years, self-reported health was worse for older people, those in the lower social grades and those living in the most deprived areas, as illustrated in Figure 2.1.

Figure 2.1 Percentage who feel their health is good by age/social grade/DEPCAT

Figure 2.1 Percentage who feel their health is good by age/social grade/DEPCAT

Base: all respondents 2004 (1784)


2.2 Long standing illness

For some respondents, self-perceived health is likely to be related to having a long-standing illness or disability. One in three respondents (33%) reported having some form of long-standing illness or disability. There was no consistent pattern of change over time. As in previous years, older people and those in the social grade E were most likely to report a long standing illness (Figure 2.2). It is worth noting that social grade E includes pensioners with no occupational pension.

Figure 2.2 Percentage with long standing illness by age/social grade

Figure 2.2 Percentage with long standing illness by age/social grade

Base: all respondents 2004 (1784)

2.3 Ability to influence own health

In addition to consideration of self-perceived health measures, it is equally important to consider how much control people feel they have over their own health. The perceived ability to influence one’s health is likely to have some impact on future changes in health behaviours, and ultimately on long-term health. In order for any specific health promotion activity to have an impact, it is fundamentally important that people believe that they will be able to influence their own health in order for them to be willing to take on board and act on the message. Indeed, encouraging people to believe that they can influence their health, and the health of their children, has been a central message of many health education campaigns in Scotland.

In 1996, 76% believed that they could do something to make their own life healthier; and this rose steadily over time, reaching 82% in 2004 (Figure 2.3).

Figure 2.3 Time trends in belief that can make their own life healthier (1996-2004)

Figure 2.3 Time trends in belief that can make their own life healthier (1996-2004)

Base: all respondents (2004:1784)

In keeping with the other measures, those in social grade E and, in particular, older people were less likely to feel they could do anything to make their own life healthier (Figure 2.4), reflecting the findings in previous years.

Figure 2.4 Percentage who believe they can do something to make their own life healthier by age/social grade

Figure 2.4 Percentage who believe they can do something to make their own life healthier by age/social grade

Base: all respondents 2004 (1784)

Main points

  • Three quarters of people felt that their health was good, although around a third reported a long-standing illness or disability and this has not changed over time.
  • Most people felt that they could influence their own health and this increased from 76% in 1996 to 82% in 2004.
  • As in previous years, those in the lowest social grades and, in particular, older people were least likely to think their health was good, most likely to report a long-standing illness and least likely to feel they have any influence over their own health. This means that those groups most in need of improvements to their health are also likely to be those who are least open to health education messages because they don’t believe they can influence their own health.

3. Physical activity

Physical activity is an important protective factor against coronary heart disease and a number of other diseases. It is also associated with mental and social well-being. The current two-stage approach in Scotland is based on guidelines highlighting the health benefits of moderate intensity physical activity, or ‘active living’. The ‘active living’ message aims to maximise public health gain by targeting those who are sedentary, and thus at most risk from coronary heart disease. This group is likely to be less responsive to the traditional exercise guidelines involving three 20 minute sessions of vigorous exercise per week, and would therefore benefit from more achievable targets in relation to moderate physical activity. Health education campaigns to introduce the health benefits of moderate intensity physical activity have focused on brisk walking and were first introduced in Scotland in 1996.

Three indicators were used to assess behaviour in relation to physical activity: the first was a measure of physical inactivity, while the two other indicators assessed opportunity for and levels of physical activity. Being sedentary, or physically inactive, is considered to be a risk factor for coronary heart disease, and thus is defined as a risk behaviour for the purposes of this report.

Respondents were asked a series of questions on the types of physical activity they do in an average week. The number of 30 minute sessions of moderate activity or 20 minute sessions of vigorous activity was used to derive a summary activity level, and those achieving the 5 or more sessions of moderate activity or 3 or more sessions of vigorous activity were classified as regular exercisers and meeting the recommended levels. Those with no such sessions of moderate or vigorous activity were defined as sedentary. The questions used to derive levels of sedentary behaviour were only asked of half of respondents in 2002 as a new WHO measure of physical activity was being trialled with the other half of respondents.

The amount of time respondents spend walking as part of their daily routine was used as a third indicator of physical activity. This measure does not include leisure time walking or any indication of intensity of exercise, and is used to assess opportunity and inclination for ‘active living’ type exercise.

The questions on physical activity can be found in Appendix A and the method used to derive the summary activity level in described in Appendix D.

3.1 Reported behaviour

Figure 3.1 shows change over time in the proportion of respondents with evidence of risk behaviour (sedentary), active living (walking 30 minutes per day) and protective behaviour (meeting the recommended levels of weekly activity).

Figure 3.1 Time trends in physical activity (1996-2004)

Figure 3.1 Time trends in physical activity (1996-2004)

Base: all respondents (2004:1784)

There is a sizeable target group for the first stage of the current approach to promoting physical activity since around three in ten of the Scottish adult population can be classified as sedentary. The apparent fall in the number of sedentary adults in 2002/2003 was only of borderline significance, but the results in 2004 confirm that this apparent fall has been sustained.

Around six in ten respondents reported walking at least 30 minutes on an average day. Whilst this figure has fluctuated over time, there has been no sustained change from 1996 to 2004. Similarly, whilst there appeared to have been an increase in the proportion achieving the recommended levels of physical activity in 2002/2003, this increase has not been sustained in 2004.

Figure 3.2 Percentage who are sedentary by age/social grade/DEPCAT

Figure 3.2 Percentage who are sedentary by age/social grade/DEPCAT

Base: all respondents 2004 (1784)

As in previous years, there are patterns of different in physical activity by age, social grade and deprivation. In general, older people and those in the lower social grades and more deprived areas are less likely to be physically active, as illustrated in Figure 3.2. The patterns for sedentary behaviour are mirrored by those for achieving the recommended levels of activity in terms of age, social grade and DEPCAT. In terms of sex, however, whilst men were more likely than women to achieve the recommended levels of physical activity (46% compared with 32%) they were no less likely than women to be sedentary.

The pattern is different for the measure of active living (walking at least 30 minutes per day). As in previous years, higher levels of walking were seen in the C1C2D social grades with lower levels for both the AB and E social grades. This is likely to be related to car ownership and access to public transport as discussed in the 1996-2003 report.

3.2 Knowledge and motivation

The knowledge indicator for physical activity used in HEPS is geared towards the old health education messages that emphasised the health benefits of accumulating at least 30 minutes of moderate intensity physical activity per day. More recently, however, the message has been revised to a frequency of at least five days a week and this is the measure that should be tracked in future research.

3.2.1 New Message

When asked how many times per week people needed moderate exercise to keep healthy, only one in ten (12%) gave the correct answer of five. Three in ten (30%) believed they needed to exercise seven times a week (i.e. every day), whilst 53% gave a figure below five. There was no clear difference in understanding by sex, age or social grade.

3.2.2 Old Message

Respondents were asked how many minutes of moderate activity, such as brisk walking or heavy gardening, they needed to do to keep healthy.

There has been no change in knowledge in 2004 with 30% able to give a figure of around 30 minutes. This was higher for those in the AB social grade (36%). Over half of respondents (55%) believed they needed more than 30 minutes per day to keep healthy; this belief could act as a disincentive to exercise.

There has been no change in motivation to increase physical activity since the increase in 2002 (Figure 3.3). Four in ten were not contemplating any change in their behaviour whilst 42% had tried to make a change and a further 18% would like to. As in previous years those who were sedentary we less likely to be contemplating change (50% not contemplating).

Figure 3.3 Time trends in motivation to increase physical activity (1996-2004)

Figure 3.3 Time trends in motivation to increase physical activity (1996-2004)

Base: all respondents (2004:1784)

Main points

  • Three in ten adults were sedentary. Younger respondents were least likely to have a sedentary lifestyle, as were those from higher socio-economic groups.
  • The slight decrease over time in sedentary behaviour has been consolidated in 2004 (30%), although the apparent increase in protective behaviour in 2002/2003 has not (39%).
  • Men were more likely than women to achieve the recommended levels of physical activity, but no less likely to be sedentary.
  • Around one third were aware of the minimum daily recommended levels of moderate intensity physical activity; there has been no change in these knowledge levels. Only one in ten knew that moderate activity was recommended five times a week to stay healthy, with three in ten believing daily exercise was needed.
  • Those in the lower social grades were more likely to be sedentary and less likely to be aware of the recommended levels of moderate activity. However, they were most likely to walk more than 30 minutes on an average day, possibly out of necessity rather than as a health-related choice.
  • Levels of motivation to take more exercise remain largely unchanged from 2002 to 2004.

4. Diet

Healthy eating is of particular relevance to health promotion given its implications for cardiovascular disease, cancers, oral health and the rising levels of childhood obesity. It has also been shown that high consumption of fruit and vegetables is associated with reduced risks of cardiovascular disease and certain cancers. The current dietary target for fruit and vegetables is to increase the current average intake to at least 400g (five portions) per day by the year 2005. There has been a high level of concerted health education activity across all sectors in Scotland focused on the 5-a-day message during the survey period.

For the purposes of this survey, eating fruit and vegetables daily is used as a proxy indicator of a generally healthy diet, since good nutrition has been found to be particularly strongly correlated with a high consumption of fruit and vegetables. Additional analyses of the HEPS data showing that respondents consuming fruit and vegetables daily had a healthier diet in terms of eating more complex carbohydrate and fish and less sugar and high-fat foods than other respondents, and were more likely to have tried to change their diet in the past year to improve their health.

4.1 Reported Behaviour

There has been a significant change over time in reported consumption of fruit and vegetables (Figure 4.1).

Figure 4.1 Time trends in fruit and vegetable consumption (1996-2004)

Figure 4.1 Time trends in fruit and vegetable consumption (1996-2004)

Base: all respondents (2004:1784)

For the first time in 2004, a higher proportion of respondents ate five or more portions of fruit and vegetables a day than ate no fruit and vegetables each day. On average people reported eating 3.6 portions per day which has risen from 2.8 in 1996. Clearly this is still some way short of the “five a day” target, but clear improvements have been made.

Table 4.2 Percentage eating at least five portions daily by sex/age/social grade/DEPCAT

%

1996

1997

1998

1999

2000

2001

2002

2003

2004

All

18

21

22

24

23

28

29

33

Sex

Men

14

17

16

22

16

21

21

27

Women

22

25

28

27

29

36

36

39

Age

16-24

12

15

15

9

15

15

19

18

25-34

12

20

17

20

23

26

28

32

35-44

19

17

22

33

23

30

27

36

45-54

22

24

25

28

26

32

34

39

55-64

27

28

27

35

20

35

34

37

65-74

22

25

29

24

34

30

31

38

Social grade

AB

27

23

35

44

35

41

47

45

C1

21

27

26

25

32

29

28

36

C2

18

17

15

20

15

20

28

33

DE

13

17

14

18

13

25

20

32

DEPCAT

1-2

27

27

30

28

28

40

41

36

3-5

17

20

20

25

26

27

27

35

6-7

15

18

16

18

12

19

20

21

Base: all respondents

1810

1795

1794

880

1757

1742

1720

1784

There are clear gradients in behaviour by sex, age, social grade and DEPCAT (Table 4.2). Women are still more likely than men to meet the targets, as are those in social grades AB and those living in the least deprived areas. Nevertheless, there has been significant improvement in almost all subgroups since 1996. The only exceptions are young people aged 16-24 and those living in the most deprived areas. This means that over the last nine years there has been a growing divergence between the under-25s and those aged 25+, and between those in the most and least deprived areas.

In 2004 there have been particular improvements for men and for the lower social grades – groups that had been slower to improve in the past. Given the small base sizes of the social grade groups it will be important to look at future data to see if these increases are sustained.

4.2 Knowledge and motivation

Whilst knowledge of the recommended daily consumption of fruit and vegetables has continued its increasing trend, there has not been an increase in motivation to increase consumption since 2001 (Figure 4.3).

Figure 4.3 Time trends in knowledge of recommended consumption and motivation to increase consumption of fruit and vegetables (1996-2004)

Figure 4.3 Time trends in knowledge of recommended consumption and motivation to increase consumption of fruit and vegetables (1996-2004)

Base: all respondents (2004:1784)

Six in ten give a figure of five or more as the recommended daily level of consumption, and almost all of these give the exact figure of five a day (57% of all respondents). As in previous years there are clear gradients by age, sex, social grade and DEPCAT (Figure 4.4). The differences by sex, social grade and depcat are in line with consumption, with men and the more deprived less likely to be aware of the recommendations. For age, however, whilst young people are consistently much less likely to meet the recommendations, they are no less likely to be aware of them than older people. In fact, those aged 55 or over are least likely to be aware of the recommendations, whilst being amongst the most likely to consume fruit and vegetables daily.

Figure 4.4 Percentage who know recommended consumption by sex/age/social grade/DEPCAT

Figure 4.4 Percentage who know recommended consumption by sex/age/social grade/DEPCAT

Base: all respondents 2004 (1784)

Main points

  • Consumption of fruit and vegetables was higher among women, older respondents and those from higher socio-economic groups.
  • There was continued increase among all respondents in terms of consuming the recommended amount of fruit and vegetables (reaching 33% in 2004) with the exception of the youngest age group (aged 16-24) and those living in more deprived areas.
  • In 2004 there have been particular increases in reported fruit and vegetable consumption for men and those in the lower social grades. These should be monitored in the future to determine if they will be sustained.
  • There have been continued increases in knowledge levels regarding the current recommendation for fruit and vegetable intake (63%).

5. 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. 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.

5.1 Reported behaviour

In 2004 27% of respondents said they smoked cigarettes regularly. This seems to confirm the downward trend in self-reported behaviour over time (Figure 5.1). This general trend was supported by data from the Scottish Household Survey (ShoS).

Figure 5.1 Time trends in adult cigarette smoking behaviour (1996-2004)

Figure 5.1 Time trends in adult cigarette smoking behaviour (1996-2004)

Base: all respondents (2004:1784)

Over time, there have been consistent social grade and depcat gradients in smoking. Figure 5.2 shows these figures for 2004.

Figure 5.2 Percentage of regular smokers by social grade/DEPCAT

Figure 5.2 Percentage of regular smokers by social grade/DEPCAT

Base: all respondents 2004 (1784)

As in previous years, four in ten smokers were heavy smokers (20+ cigarettes a day), with 16% smoking less than ten cigarettes a day.

5.2 Motivation

Most regular smokers were motivated to quit smoking, with 53% having tried and a further 27% who would like to. Only 20% of smokers were not contemplating giving up. This shows no change over time. Heavy smokers were equally motivated, although only four in ten (41%) had already tried to quit.

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 appears to be a decrease in smoking prevalence over time, down from a third in 1997 to just over a quarter (27%) in 2004. Whilst this seems to be backed up by the Scottish Household Survey, future years’ data will help to confirm this trend.
  • Most regular smokers (80%) are motivated to cut down or quit smoking; there has been no significant change in levels of motivation over time.

6. Alcohol

Alcohol is a major cause of liver cirrhosis and a risk factor for high blood pressure, several types of cancer and a number of other health problems. Excessive or inappropriate use of alcohol also increases the risk of accidents and crime, and is associated with a variety of social problems. The 2002 Scottish Executive Plan for Action on Alcohol Problems recognises this explicitly in its key priorities: reducing binge drinking and reducing harmful drinking by children and young people. Health education activities have been mainly focussed on young people, with HEBS Think About It campaign targeting 12-17 year olds and the Scottish Executive campaign targeting 16-25 year olds. Other health education work in Scotland has focused on raising awareness of alcohol problems in the workplace.

The current sensible drinking guidelines consist of daily benchmarks. However, because awareness of this is low, knowledge of recommended drinking limits is perhaps more realistically assessed in relation to the better-established weekly limits. The maximum recommended limits for alcohol consumption as set out in Towards a Healthier Scotland (The Scottish Office, 1999) are 14 units for women and 21 units for men per week. For the purposes of the survey, respondents were classified as ‘drinkers’ if they had consumed any alcohol in the past year.

6.1 Reported behaviour

Respondents classified as ‘drinkers’ were asked if they had drunk any alcohol in the past week and how much they had consumed of each type of alcohol. In relation to sensible drinking behaviour, 14% of respondents were classified as exceeding the recommended weekly limits described above, and this has remained fairly stable over time (Figure 6.1).

Figure 6.1 Time trends in exceeding recommended alcohol limits (1996-2004)

Figure 6.1 Time trends in exceeding recommended alcohol limits (1996-2004)

Base: all respondents (2004:1784)

Men were more likely to exceed the limits for their sex than women. In 2004, however, the proportion of men exceeding the weekly limits seems to have fallen from one in four to one in five. This is the result of a drop in the levels of consumption reported by young men, aged 16-34. A similar pattern was reported in 1998, but this drop was not sustained. Data from future years will help confirm whether this is the start of a genuine change in behaviour, or a fluctuation in one year’s data.

A second measure of excessive drinking is “binge drinking”. A binge drinking session is defined in HEPS as exceeding 16 units for men, or 10 units for women on one occasion. In 2004, 9% of respondents reported four or more binge drinking sessions in the past month, again higher for men (13%) than women (6%). There has been no change over time in this behaviour.

6.2 Knowledge and motivation

Respondents who had had an alcoholic drink in the past year (drinkers) were asked how many units of alcohol they thought was the recommended weekly limit for their own sex. This question was only asked in March 1996 and March 1997, and was then put to all respondents in 2001-2004. From 2001 onwards, respondents were able to give daily or weekly limits. For those giving daily limits, weekly limits were derived by multiplying their response by seven.

There has been no significant increase in awareness since 1997 (Table 6.2). One in four drinkers was aware of the recommended limits for their sex. There has been some fluctuation over time by sex, and in 2004 women were, for the first time, more likely than men to be aware of their recommended limit.

Table 6.2 Knowledge of recommended weekly limits for own sex

%

1996

1997

1998

1999

2000

2001

2002

2003

2004

All

Under limit

23

33

34

35

32

36

Exact limit (21/14 units per week)

9

23

20

20

21

24

Over limit

24

11

16

15

17

12

Don't know

44

33

32

30

30

29

Men

Under limit

19

28

26

29

36

39

Exact limit (21 units per week)

8

22

23

26

20

20

Over limit

19

10

14

11

20

15

Don't know

53

40

37

34

25

26

Women

Under limit

26

38

41

41

27

32

Exact limit (14 units per week)

9

23

16

15

23

28

Over limit

29

12

17

18

15

9

Don't know

36

26

26

26

34

31

Men exceeding weekly limits

Under limit

16

34

44

39

28

35

Exact limit (21 units per week)

12

29

13

16

22

28

Over limit

36

14

28

19

30

21

Don't know

36

23

16

26

20

16

Base: All who have had alcoholic drink in past year (March waves only 1996-1997)

903

893

1570

1545

1486

1452

Most drinkers were happy with their levels of alcohol consumption with 77% not contemplating reducing them. One in five (18%) had tried to reduce their drinking and a further 5% would like to.

Figure 6.3 Time trends in motivation to cut down alcohol consumption (1996-2004)

Figure 6.3 Time trends in motivation to cut down alcohol consumption (1996-2004)

Base: all drinkers (2004:1542), and all exceeding weekly limits (2004: 232)

At 23% the proportion of drinkers motivated to cut down is no longer significantly higher than the baseline figure in 1996 and has reversed the apparently increasing trend seen over the past few years. The same pattern was apparent for those who had exceeded the limits (Figure 6.3).

Main points

  • Men were more likely to exceed the recommended weekly limits and to binge drink than women. In 2004, however, the proportion of men exceeding the recommended limit appears to have fallen from a quarter to a fifth.
  • There was a significant increase in knowledge levels regarding the recommended weekly limits between 1996 and 1997, but these levels are still relatively low and have shown no further significant increases. Women were more likely than men to be aware of the recommended limits for the first time in 2004.
  • A slight decrease in motivation to cut down alcohol consumption in 2004 (23%) means that levels of motivation are not significantly higher than they were in 1996, reversing the apparent increase in motivation recorded over the past few years.

7. Mental Health

Mental health is an integral part of health as defined by the World Health Organization. The most common problems presented to GPs are linked to mental health and it is one of the top priorities for the NHS in Scotland. As life expectancy increases and treatment or prevention of the main causes of mortality improves, issues such as mental health and well-being become increasingly salient on the health agenda. In addition, material and social disadvantage can affect health through indirect psychosocial pathways, thus contributing to the added burden of morbidity and mortality attributable to behavioural factors5.

For health education, mental health has been a broad underlying theme of much public communications activity, especially those concerning young people’s decision-making. Stress in the workplace has been a more specific focus of preventive actions. In 2001, a new national programme was launched in Scotland to promote mental health and well-being which will attempt to reduce the rising levels of suicide among young people, particularly young men, and which features a public education campaign (See Me) to reduce the stigma associated with mental illness. A separate national survey of public attitudes to mental health, well-being and mental health problems was carried out by the Scottish Executive in 2002 (and was repeated in 2004) to provide population level information on a broad spectrum of mental health issues6.

5Marmot, M. and Wilkinson, R.G. (eds) (1999) Social Determinants of Health. Oxford University Press, Oxford.

6Scottish Executive (2002) Well? What do you think? Scottish Executive, Edinburgh.

7.1 Stress

There were no changes in the levels of reported stress in 2004. One in four (24%) reported large amounts of stress and four in ten (41%) reported harmful stress. As in previous years, women and those aged 35-54 were most likely to report stress.

7.2 Mental health status (GHQ12)

As in the Scottish Health Survey, the mental health indicator used in HEPS is the twelve-item version of the General Health Questionnaire (GHQ12) which consists of a list of symptoms of mental distress and is scored on a scale from zero to twelve, with higher scores reflecting the reporting of more symptoms. This questionnaire has been widely used in general population surveys in order to assess levels of potential psychological morbidity. The generally recommended threshold score for detecting potential psychiatric morbidity is two 7. For the purposes of this survey, a score greater than two is taken as an indicator of potential mental health distress. Consideration is also given to those with a score of four or more as an indicator of potential psychological disorder. The GHQ12 was part of the self-completion section of the questionnaire which approximately 5% of respondents refused to complete. The data in this section are based on those who completed the section.

Figure 7.1 Time trends GHQ12 scores (1996-2004)

Figure 7.1 Time trends GHQ12 scores (1996-2004)

Base: all answering self-completion section (2004:1523)

Despite an apparent increase in the proportion with higher scores in 2003, 2004 has seen a return to previous levels, showing no change in overall levels since 1996. The mean GHQ12 score in 2004 was 1.7, compared with 1.8 in 1996.

As in previous years, women were more likely than men to show signs of potential mental health distress on this measure (27% of women scoring over 2). Those in social grade E were again more likely than average to have a score over 2 (34%).

Main points

  • Women were more likely than men to report symptoms of potential mental distress.
  • There was a marked social gradient in symptoms of mental distress and disorder, with those living in more deprived areas and in social grade E reporting more symptoms.
  • There were no discernible changes over time, and the apparent increase in mental health disorder in 2003 appears to have been a random fluctuation.

7Goldberg, D.P. and Williams, P. (1988) A User’s Guide to the General Health Questionnaire. NFER-Nelson, Windsor

8. 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 having dental caries by age 5, compared with 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. 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. The Scottish Needs Assessment Programme 1997 report on adult oral health also noted that most of the Scottish population experienced some form of oral disease during their lifetime.

The main aims for health education in the area of oral health were identified in the 1995 Scottish Office document, The Oral Health Strategy for Scotland as to encourage eating a healthy diet, using preventative measures and regular visits to the dentist. A new Action Plan was published in March 2005 in which oral health is seen as an integral part of overall health improvement, underpinned by a free dental examination for all population groups (AnAction Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland, Scottish Executive, March 2005)

8.1 Reported behaviour

2004 saw further consolidation of the increasing trends in dental visits. Three in four (74%) reported visiting the dentist in the past year and almost half (48%) reported a routine check up in the past six months (Figure 8.1).

Figure 8.1 Time trends in dentist attendance (1996-2004)

Figure 8.1 Time trends in dentist attendance (1996-2004)

Base: all respondents (2004:1784)

As in previous years there was a clear gradient in attendance in the past year by age and social grade (Figure 8.2).

Figure 8.2 Percentage attending dentist in past year by age/social grade

Figure 8.2 Percentage attending dentist in past year by age/social grade

Base: all respondents 2004 (1784)

The gap between the youngest and oldest respondents has been closing over time, with the proportion of those aged 65-74 attending the dentist in the past year rising from 34% in 1996 to 57% in 2004. However, there is no evidence that the gap is closing between those from the highest and lowest social grades.

8.2 Motivation

Three in four respondents (77%) were planning to visit their dentist in the next six months although this falls to 35% of those who have not visited a dentist in the past year (Figure 8.3). In general, there has been an increasing trend over time in motivation, and this has been consolidated in 2004.

Figure 8.3 Time trends in intention to attend dentist (1996-2004)

Figure 8.3 Time trends in intention to attend dentist (1996-2004)

Base: all respondents (2004:1784) and all not visiting dentist in past year (2004: 485)

Main points

  • 2004 saw consolidation of the increases observed previously in the proportion attending the dentist in the past year (74%), in the past six months for a routine check-up (48%) and intended visits in the next six months (77%).
  • Older people, and those from lower socio-economic groups were less likely to have visited a dentist and there is no sign of the gap reducing between those in the highest and lowest social grades.

9. Sexual health

While the incidence of teenage pregnancy has been relatively stable over the past ten years, live birth rates among this group are relatively high in Scotland and the UK compared with other countries in Western Europe. It is also increasingly clear that socio-economic disadvantage can be both a cause and a consequence of teenage parenthood. At present, the major policy focus in sexual health includes reducing the incidence of teenage pregnancy and sexually transmitted infections (STIs), while recognising the need to address broader issues of sexuality and personal relationships in order to achieve this. The rising number of reported STIs among young people, particularly young women, is a growing cause for concern, although increased reporting may in part be explained by greater awareness of the symptoms of STIs and the risks of untreated infections, as well as willingness to seek treatment. While the extent of HIV infection has not proved as great as predicted, Towards a Healthier Scotland highlights the importance of continued vigilance with respect to sustained levels of new HIV infections. Existing research on teenage sexuality in Scotland has been synthesised and published as part of the HEBS Evidence into Action series, which draws out the implications for practice, policy and research8. A national strategy for Scotland on sexual health and relationships was published in January 2005 (Respect and Responsibility: A strategy and action plan for improving sexual health, Scottish Executive, January 2005).

Health education activities in this area have been primarily targeting young people via sex education in schools, encouraging condom use and providing information on STIs and HIV and advice and treatment services.

The Health Education Population Survey assesses self-reported changes in sexual behaviour, attitudes toward condom use and information needs on sexual health topics. These questions were asked in the self-completion section of the questionnaire. There have been no changes in behaviour or in attitudes towards condom use so these will not be discussed in this report, although figures are given in Appendix C. The focus will, instead, be on information needs.

8 Burtney, E. (2000) Teenage Sexuality in Scotland. HEBS, Edinburgh

9.1 Information needs

Respondents were asked if they had enough information on a number of sexual health topics. These questions were only asked in either March or September from 1996 to 2002.

Table 9.1 Proportion wanting more information on sexual health topics

%

1996

1997

1998

1999

2000

2001

2002

2003

2004

All

STIs

40

28

35

28

20

30

20

Having an HIV test

25

21

20

17

15

20

13

HIV/ AIDS transmission

22

16

18

15

14

17

9

Emergency contraception

19

15

17

11

10

11

7

16-24s

STIs

63

60

61

56

58

45

31

Having an HIV test

41

42

31

34

40

37

28

HIV/ AIDS transmission

24

12

25

23

31

28

16

Emergency contraception

41

27

20

20

28

23

9

Base size:All adults

850

862

827

774

823

1529

1523

Base size:16-24

105

83

91

114

108

172

187

Base: respondents answering the self-completion section - only one wave per year 1996-2002

Expressed need for information on each of these topics has been falling since 1996 and has fallen more sharply in 2004. Respondents were most likely to want information about STIs, with the 16-24 age group equally likely to want information on HIV tests. Only a minority wanted information on any topic. In 2004, those aged 16-24 were less likely to want information on HIV/AIDS transmission and emergency contraception.

Main points

  • There was a declining demand for more information on recognising the symptoms of STIs (20%), having an HIV test (13%) , HIV transmission (9%) and emergency contraception (7%).
  • In 2004 there was a decrease in demand amongst those aged 16-24 for information on HIV/AIDS transmission (16%) and emergency contraception (9%).

10. Cannabis legislation

In January 2004, new legislation was introduced on the classification of cannabis. Whilst it is still illegal to possess cannabis, the new leglislation downgrades the drug from category B to category C thus reducing the penalties for possession and use. The aim was to free up police time for dealing with category A drugs such as heroin and cocaine. The change puts cannabis on a par with anti-depressants and steroids. Under the new legislation, possession of small amounts is no longer considered an arrestable offence .

In 2004 a new module of questions was added to the HEPS questionnaire to look at awareness of changes in legislation and the likely effect of this new legislation on their behaviour Perhaps unsurprisingly, there seemed to be a lot of confusion over what the new legislation entails according to reports in the media.

10.1 Awareness of legislation

Seven in ten respondents (71%) claimed to be aware of a change in legislation regarding cannabis. There were differences by sex, age and social grade (Figure 10.1)

Figure 10.1 Percentage aware of legislation by sex/age/social grade

Figure 10.1 Percentage aware of legislation by sex/age/social grade

Base: all respondents 2004 (1784)

Women were slightly less likely than men to be aware of the legislation, and awareness was also lower for the over 55s and those in social grades C2 and DE.

When asked for their understanding of the legislation, there was clearly a lot of confusion (Figure 10.2).

Figure 10.2 Understanding of the legislation (spontaneous)

Figure 10.2 Understanding of the legislation (spontaneous)

Base: all respondents 2004 (1784)

Whilst the most frequently given answer was correct (34% knew it had been downgraded to category C), others gave a variety of answers. In total 41% gave a correct answer (cannabis is still illegal in some way) but 22% mistakenly believed that cannabis was still legal, at least in some situations.

Even after prompting there was still considerable confusion (Figure 10.3). Whilst half of respondents were aware that cannabis was still illegal but that the penalties were reduced, almost a quarter (23%) erroneously believed it to be legal, at least for personal use.

Figure 10.3 Understanding of the legislation (prompted)

Figure 10.3 Understanding of the legislation (prompted)

Base: all respondents 2004 (1784)

Figure 10.4 Proportion believing cannabis now illegal but penalties less severe (prompted) by sex/age/social grade

Figure 10.4 Proportion believing cannabis now illegal but penalties less severe (prompted) by sex/age/social grade

Base: all respondents 2004 (1784)

As for awareness of the legislation, awareness of the content of the legislation also differed by age, sex and social grade (Figure 10.4). Men were much more likely than women to know that cannabis was still illegal but the penalties were less severe. Awareness was highest for the under-45s and lowest for those aged 65+ and there was a clear social grade gradient.

10.2 Likely effect on behaviour

One in ten respondents (9%) had used cannabis in the past year, with a further 20% having used it at some point in the past. This makes it by far the most widely reported illegal drug to be used. One of the criticisms levelled at the legislation is that it may result in an increase in cannabis use. A misunderstanding of the legislation (e.g. as the legalisation of cannabis) could also have an impact on behaviour.

Under one in ten (7%) said that it would make them more likely to use cannabis. This rose to 11% of those who had ever used cannabis and to 22% of those who had used it in the past year. There was, however, no difference according to understanding of the legislation, although those who had heard of the legislation prior to the survey were slightly more likely to say it would make them more likely to use cannabis, irrespective of understanding (8% compared with 5% of those who had not heard of it).

Main points

  • Seven in ten were aware that there had been a change in legislation but only four in ten knew that cannabis is still illegal to use and possess.
  • Men, younger respondents and those in the highest social grades were most likely to know the broad content of the legislation
  • Seven per cent of respondents said the legislation would make them more likely to use cannabis, rising to 22% of recent users of the drug. Correct understanding of the legislation had little effect on this.

Appendix

The appendices are not available on-line. Please contact the Research Officer quoting 2000-2001 RE045 for more information.



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