The Scottish Health Survey 2011 - volume 2: children

Introduction

Catherine Bromley

OVERVIEW OF THE CHILDREN'S VOLUME

Policy context

This report provides an overview of some of the key information collected about children's health in the recent Scottish Health Surveys. Children and health feature strongly within the Scottish Government's National Performance Framework.^[1],[2] The national outcomes^[3] of greatest relevance are:

• Our children have the best start in life and are ready to succeed.
• We have improved the life chances for children, young people and families at risk.
• We live longer, healthier lives.
• We have tackled the significant inequalities in Scottish society.

The National Performance Framework also includes objectives, targets and indicators that relate to the broader context within which children grow up, for example there are indicators about the quality of children's services and pre-school centres, increasing children's educational attainment, and reducing childhood deprivation. There are also indicators relating to more direct outcomes for children, such the target to increase the proportion of babies born with a healthy weight, and the proportion of children aged 2-15 with a healthy body mass index. The latter of these measures is monitored via the Scottish Health Survey (see chapter 5). More broadly, the survey's measures of children's physical health, mental wellbeing, and health-related behaviours such as diet and physical activity can be used to help assess the outcome "our children have the best start in life and are ready to succeed". Similarly, by looking at results over time, the outcome "we have improved the life chances for children, young people and families at risk" can also be assessed.

The Getting It Right for Every Child (GIRFEC) programme, launched in 2006, provides the supporting methodology for all Scottish Government policies concerning children. GIRFEC underpins the approach to child health, wellbeing and wider development that all agencies in Scotland have committed to follow.^[4] In 2008, the Scottish Government and COSLA jointly published their Early Years Framework^[5] which outlined a commitment to improving outcomes for children and young people. In the field of health, Scotland's Chief Medical Officer has been a vocal advocate for increasing the attention paid to the early years, stating that: "a healthy childhood is the foundation of a healthy life".^[6]

Although each of the chapters in this report covers a distinct topic, it is clear from the above discussion that children's health and development cannot be compartmentalised like this, and that policies to improve outcomes in childhood require a combination of specifically targeted initiatives nested within a broader strategic framework. Each of the following chapters start with a brief introduction of relevant policy initiatives specific to that area, but these should be considered alongside the higher level policies noted above.

The Scottish Health Survey

Children were first included in the Scottish Health Survey (SHeS) in 1998 and the 1998 and 2003 survey reports presented detailed results for children. In 2008 the survey began running continuously, and a contract is currently in place to continue this until 2015. To allow for the more frequent rounds of data collection, the sample size each year was reduced. As a consequence, rather than report detailed results for children each year based on the reduced sample sizes, it was decided to only include results for a selection of key child measures each year and to produce more detailed reports on child health when more years of data had accrued. This report is the first since 2003 to present results for children together in one volume (rather than interspersed with adult data). Although it is not an exhaustive account of children's health, this report covers more topics, and provides more detailed analysis, than was possible in the 2008, 2009 or 2010 reports. ^[7],[8],[9]

The detailed history of the study series, and the technical aspects of its conduct can be found in the introduction to Volume 1 (adults) and in Volume 3 (technical report). The following provides a snapshot of key information relating to the children's questionnaire.

Topics

Each survey in the series consists of main questions and measurements (for example, height and weight), plus modules of questions on specific health conditions. The principal focus of the survey series has always been cardiovascular disease (CVD) and related risk factors. As noted in Volume 1, CVD is a significant cause of death among adults in Scotland and is the focus of a significant number of health policies. Although CVD is, of course, very rare in children, there is growing evidence that the risk factors for chronic diseases like CVD, as well as health inequalities more broadly, can be evident in early childhood, or even earlier. ^{[10],[11],[12]} So while the survey is not designed to measure the prevalence of chronic conditions in children in the same way it does for adults, it collects important information about behavioural risk factors for poor health, and other important aspects of children's wellbeing and development. The SHeS series means that there are now trend data going back for over a decade, and providing the time series is an important function of the survey.

Sample design

Two samples were selected for the survey: a general population (main) sample in which all adults and up to two children were eligible to be selected in each household; and an additional child boost sample in which up to two children in the selected households were eligible to be interviewed but adults were not. The child boost was included to increase the number of children included in the survey. The majority of results presented in this report are based on data from children in the main and child boost samples together. However, analyses that draw on parental data are restricted to the main sample as the child boost did not include questions about parents' health and behaviours.

Data collection

Interviewing was conducted using Computer Assisted Personal Interviewing (CAPI). Children aged 13-15 were interviewed in the presence of a parent or guardian. Parents answered on behalf of younger children, who were nevertheless required to be present. In addition, those aged 13-15 were asked to complete a short paper questionnaire on more sensitive topics. Parents of any children aged 4-12 years were also asked to fill in a self completion booklet about the child's strengths and difficulties designed to detect behavioural, emotional and relationship difficulties in children. The results of these self-completion questionnaires are presented in Chapter 1.

Interviewers were also responsible for measuring the height and weight of children aged 2-15. These measurements are reported in Chapter 5.

Survey response and sample sizes

The following table sets out the numbers of participating households and children in the four most recent survey years. It also presents response rates for each year. Further details of all the 2011 figures are presented in Volume 3 of this report, information about the 2008-2010 surveys can be found in the previous SHeS reports. ^{[10],[11],[12]}

	2008	2009	2010	2011
Numbers participating:
Participating households (main & health board boost sample)	4,139	4,872	4,776	5,010
Participating households (child boost sample)	345	711	252	299
Child interviews (main sample)	1,239	1,519	1,422	1,314
Child interviews (boost sample)	511	1,088	371	380
Response rates:
% of all eligible households (main & health board boost sample)	61%	64%	63%	66%
% of all eligible households (child boost sample)	64%	69%	66%	65%
% of all eligible children	55%	61%	58%	59%

Data

Since addresses and individuals did not all have equal chances of selection, the data have to be weighted for analysis. The SHeS comprises of a general population (main sample) and a boost sample of children screened from additional addresses. Therefore slightly different weighting strategies were required for the adult sample (aged 16 or older) and the child main and boost samples (aged 0-15). Different weights were also created for the various combined datasets (described below). These are described in full in Volume 3.

The 2011 SHeS data will be deposited at the Data Archive at the University of Essex, from where earlier years' datasets and combined years datasets can also be obtained.

This report

This report is based on data collected in all the survey years to date (1998, 2003, and 2008 to 2011). It takes advantage of the continuous sample design since 2008 to include analysis based on a number of pooled datasets:

• The 2008, 2009, 2010 and 2011 surveys combined - this enables more detailed analysis of sub-groups to be conducted, for example by age group or socio-economic groups.
• The 2008/2009 and 2010/2011 surveys combined - these enable short-term trends to be examined, while still providing greater precision for the estimates than is the case with the single years' figures.
• The 2009 and 2011 surveys combined - some topics, such as accidents, were only included in the 2009 and 2011 survey years. The combined sample allows more detailed reporting of sub-group differences.

The 2011 SHeS report consists of three volumes, published as a set as 'The Scottish Health Survey 2011'. Volume 1 presents results for adults; Volume 2 presents results for children and covers the topics listed below. Volume 3 provides methodological information and survey documentation. These three volumes are available on the Scottish Government's SHeS website along with a short summary report of the key findings from Volumes 1 and 2. (www.scotland.gov.uk/scottishhealthsurvey).

Volume 2 contents: Children

1. General health and mental wellbeing
2. Accidents
3. Diet
4. Physical activity
5. Obesity

As in all previous SHeS reports, data for boys and girls are presented separately. Many of the measures are also reported for the whole child population. Survey variables are tabulated by age groups and, usually, Scottish Index of Multiple Deprivation (SIMD), National Statistics Socio-Economic Classification (NS-SEC), and equivalised household income. Trend data are presented, where possible, from the six surveys in the Scottish Health Survey series that included children (1998, 2003, 2008, 2009, 2010 and 2011). In some cases trend data are restricted to those aged 2-15 (the child age range common to all six surveys), for some measures trends are available for the full 0-15 age range (common to the 2003 survey onwards).