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

Contents:	Summary 1. Introduction 2. Attitudes to own health 3. Physical activity 4. Diet 5. Smoking 6. Alcohol 7. Mental Health 8. Oral health 9. Sexual health 10. Cannabis legislation Appendix

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.