Scottish Health Survey 2012 - volume 1: main report

Footnotes

1. ScotCen Social Research, Edinburgh

2. University of Edinburgh.

3. MRC/CSO Social and Public Health Sciences Unit, Glasgow

4. NatCen Social Research, London

5. Scottish Budget Spending Review 2007, Edinburgh: Scottish Government, 2007. [online] Available from: <www.scotland.gov.uk/Publications/2007/11/13092240/0> See also: www.scotlandperforms.com

6. National Performance Framework: Changes to the National Indicator Set, Edinburgh: Scottish Government, 2012. [online] Available from: <www.scotland.gov.uk/About/scotPerforms/NIchanges>
See also: www.scotlandperforms.com

7. Dong, W. and Erens, B. (1997). The 1995 Scottish Health Survey. Edinburgh: The Stationery Office.

8. Shaw, A., McMunn. A. and Field, J. (2000). The 1998 Scottish Health Survey. Edinburgh: The Stationery Office.

9. Bromley, C., Sproston, K. and Shelton, N. [eds] (2005). The Scottish Health Survey 2003. Edinburgh: The Scottish Executive.

10. See: www.scotland.gov.uk/scottishhealthsurvey

11. See: www.scotland.gov.uk/About/Performance/Strategic-Objectives/healthier

12. See: www.scotland.gov.uk/About/Performance/scotPerforms/indicator/generalhealth

13. See: www.scotland.gov.uk/About/scotPerforms/indicator/wellbeing

14. Mental Health Strategy for Scotland: 2012-2015 Edinburgh: Scottish Government, 2012. www.scotland.gov.uk/Publications/2012/08/9714

15. Delivering for Mental Health. Edinburgh: Scottish Government, 2006. See: www.scotland.gov.uk/Resource/Doc/157157/0042281.pdf

16. Towards a Mentally Flourishing Scotland. Edinburgh: Scottish Government, 2009. Available from: www.scotland.gov.uk/Publications/2007/10/26112853/0

17. See: www.scotland.gov.uk/Publications/2003/09/18193/26508

18. Parkinson, J. (2007). Establishing a Core Set of National, Sustainable Mental Health Indicators for Adults in Scotland: Final Report. Glasgow: NHS Health Scotland. www.childreninscotland.org.uk/docs/NHSHealthScotlandCYPsmentalhealthindicatorsdraftframeworkconsultationdocument.pdf

19. Scotland's Mental Health: Adults 2012. Edinburgh: NHS Health Scotland, 2012. See: www.healthscotland.com/documents/6123.aspx

20. Caring Together: The Carers Strategy for Scotland 2010-2015. Edinburgh: Scottish Government, 2010. www.scotland.gov.uk/Publications/2010/07/23153304/0

21. The Future of Unpaid Care in Scotland. Edinburgh: Scottish Executive, 2006. www.scotland.gov.uk/Publications/2006/02/28094157/0

22. For information on the Short Breaks Fund see: www.sharedcarescotland.org.uk/short-breaks-fund.html

23. For information on the inclusion of the carers indicator in the GP contract see: www.scotland.gov.uk/Publications/2013/05/8702/2

24. For information about the Reshaping Care for Older People Change Fund, see: www.scotland.gov.uk/Topics/Health/Support-Social-Care/Support/Older-People/ReshapingCare

25. Stuart, F, and Patterson, E. (2010). Caring in Scotland: Analysis of Existing Data Sources on Unpaid Carers in Scotland. Edinburgh: Scottish Government. www.scotland.gov.uk/Publications/2010/07/23163626/11

26. See Scottish Health Survey 2011 supplementary web tables: www.scotland.gov.uk/Topics/Statistics/Browse/Health/scottish-health-survey/Publications/Supplementary2011

27. Getting it Right for Young Carers: The Young Carer's Strategy for Scotland: 2010-2015. Scottish Government, 2010. www.scotland.gov.uk/Publications/2010/08/16095043/0

28. The State of Caring 2013. Carers UK, 2013 www.carersuk.org/professionals/resources

29. Idler, E.L and Benyamini, Y. (1997) Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behaviour 38 (1), 21-37.

30. Hanlon, P., Lawder, R., Elders, A., Clark, D., Walsh, D., Whyte, B. and Sutton, M. (2007). An analysis of the link between behavioural, biological and social risk factors and subsequent hospital admission in Scotland. Journal of Public Health 29, 405-412

31. More information on WEMWBS is available at: www.healthscotland.com/scotlands-health/population/Measuring-positive-mental-health.aspx

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

33. Waldron, S. (2010). Measuring Subjective Wellbeing in the UK. London: Office for National Statistics.

34. Stewart-Brown, S. and Janmohamed, K. (2008). Warwick-Edinburgh Mental Well-being Scale (WEMWBS). User Guide Version 1. Warwick and Edinburgh: University of Warwick and NHS Health Scotland.

35. McManus, S. (2012) Chapter 1: General Health and Mental Wellbeing. In Rutherford, L. and Bromley, C. (eds.) The 2011 Scottish Health Survey - Volume 1: Main Report. Edinburgh, Scottish Government. www.scotland.gov.uk/Publications/2012/09/7854/0

36. In 2011 respondents were asked: 'Do you provide any regular help or care for any sick, disabled or frail person? Please include any regular help or care you provide within or outside your household.' [INTERVIEWER: Exclude any help provided in the course of employment.]

In 2012 the question was changed to: 'Do you look after, or give any regular help or support to family members, friends, neighbours or others because of either a long-term physical, mental ill-health or disability; or problems related to old age?' [INTERVIEWER: Exclude any caring that is done as part of any paid employment.]

37. An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland. Edinburgh: Scottish Executive, 2005. <www.scotland.gov.uk/Resource/Doc/37428/0012526.pdf

38. Rutherford, L. (2012). Chapter 2: Dental Health. In Rutherford, L., and Bromley, C. (eds.) The 2011 Scottish Health Survey - Volume 1: Main Report. Edinburgh, Scottish Government. www.scotland.gov.uk/Publications/2012/09/7854/0

39. Miller, M. (2009). Chapter 2: Dental Health. In Bromley, C., Bradshaw, P. and Given, L. (eds.) The 2008 Scottish Health Survey - Volume 1: Main Report. Edinburgh, Scottish Government. www.scotland.gov.uk/Publications/2009/09/28102003/0

40. The 2007 Better Health, Better Care action plan for improving health and health care in Scotland set out how NHS Scotland's HEAT performance management system (based around a series of targets against which the performance of its individual Boards are measured) would feed into the Government's overarching objectives. The HEAT targets derive their name from the four strands in the performance framework: the Health of the population; Efficiency and productivity, resources and workforce; Access to services and waiting times; and Treatment and quality of services.

41. NHS Scotland HEAT Targets Due for Delivery in 2010/11 - Summary of Performance. Edinburgh: NHS Scotland Performance and Business Management, 2012. www.scotland.gov.uk/About/scotPerforms/partnerstories/NHSScotlandperformance/HT201011

42. See: www.child-smile.org.uk/ for further details.

43. National Oral Health Improvement Strategy for Priority Groups: Frail Older People, People with Special Care Needs and Those Who are Homeless. Edinburgh: Scottish Government, 2012. http://www.scotland.gov.uk/Publications/2012/05/7031

44. Caring for Smiles: Guide for Trainers - Better Oral Care for Dependent Older People. Edinburgh: Scottish Government, 2010; and Smile4life: Guide for Trainers - Better Oral Care for Homeless People. Edinburgh, Scottish Government, 2011.

45. Grant, I., Springbett, A., and Graham, L. Alcohol attributable mortality and morbidity: alcohol population attributable fractions for Scotland, 2009. ISD Scotland/Scottish Public Health Observatory. <www.scotpho.org.uk/downloads/scotphoreports/scotpho090630_alcoholfractions_rep.pdf>

46. Mathers, C., Stevens, G. and Mascarenhas, M. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization; 2009. <http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf>

47. Beeston C., Robinson M., Craig, N and Graham, L. Monitoring and Evaluating Scotland's Alcohol Strategy. Setting the Scene: Theory of change and baseline picture. Edinburgh: NHS Health Scotland; 2011. <www.healthscotland.com/documents/5072.aspx>

48. Beeston, C., McAuley, A., Robinson, M., Craig, N., and Graham, L (on behalf of the MESAS project team). Monitoring and Evaluating Scotland's Alcohol Strategy. 2nd Annual Report. Edinburgh: NHS Health Scotland; 2012. <www.healthscotland.com/documents/6182.aspx>

49. York Health Economics Consortium. The Societal Cost of Alcohol Misuse in Scotland for 2007. Scottish Government; 2010. <www.scotland.gov.uk/Publications/2009/12/29122804/21>

50. Information Services Division. Alcohol Statistics Scotland 2011. Edinburgh: ISD Scotland; 2010. <http://www.alcoholinformation.isdscotland.org/alcohol_misuse/files/alcohol_stats_bulletin_2011.pdf>

51. Alcohol-related Hospital Statistics Scotland 2011/12. May 2013. Edinburgh: Information Services Division, NHS Scotland. Available from: <http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/2013-05-28/2013-05-28-ARHS2011-12-Report.pdf?9919375182>

52. Framework for Action: Changing Scotland's Relationship with Alcohol - Final business and regulatory impact assessment for minimum price per unit of alcohol as contained in Alcohol (Minimum Pricing) (Scotland) Bill. June 2012. Edinburgh: Scottish Government. Available from: <http://www.scotland.gov.uk/Topics/Health/Services/Alcohol/minimum-pricing/Impact-Assessment>

53. Carnie, J. and Broderick, R. Prisoner Survey 2011. Edinburgh: Scottish Prison Service. <http://www.sps.gov.uk/Publications/Publication-3696.aspx>

54. Changing Scotland's Relationship with Alcohol: A Framework for Action. Edinburgh: Scottish Government, 2009.

55. See: <www.scottish.parliament.uk/s3/bills/34-AlcoholEtc/index.htm>

56. See: <www.scottish.parliament.uk/s3/bills/34-AlcoholEtc/AlcoholBillsummary.pdf>

57. Changing Scotland's Relationship with Alcohol : A Framework for Action - Progress Report. February 2012. Edinburgh: Scottish Government. Available from: <http://www.scotland.gov.uk/Topics/Health/Services/Alcohol>

58. Alcohol (Minimum Pricing) (Scotland) Act 2012. See: <http://www.scottish.parliament.uk/parliamentarybusiness/Bills/43354.aspx>

59. SPICe Briefing 12/34. 17 May 2012. Alcohol (Minimum Pricing) (Scotland) Bill: Stage 3. Scottish Parliament Information Centre. Available from: <http://www.scottish.parliament.uk/parliamentarybusiness/Bills/43354.aspx>

60. Meier, P., Meng, Y., Hill-McManus, D. and Brennan, A. Model-Based Appraisal Of Alcohol Minimum Pricing And Off-Licensed Trade Discount Bans In Scotland Using The Sheffield Alcohol Policy Model (V 2):- Second Update Based On Newly Available Data. University of Sheffield; 2012 Available from: <www.shef.ac.uk/polopoly_fs/1.156503!/file/scotlandjan.pdf>

61. Maclennan B, Kypri K, Lamgley J, Room R. Non-response bias in a community survey of drinking, alcohol-related experiences and public opinion on alcohol policy. Drug Alcohol Depend 2012; 126 (1-2):189-94

62. Caetano R. (2001) Non-response in alcohol and drug surveys: a research topic in need of further attention. Addiction 96:1541-5.

63. Fartein Ask Torvik, Kamilla Rognmo, Kristian Tambs Alcohol use and mental distress as predictors of non-response in a general population health survey: the HUNT study. Soc Psychiatry Psychiatr Epidemiol. 2012 May; 47(5): 805-816. Published online 2011 May 5. doi: 10.1007/s00127-011-0387-3

64. Robinson, M., Beeston, C.. Monitoring and Evaluating Scotland's Alcohol Strategy (MESAS) - An update of alcohol sales and price band analyses. Edinburgh: NHS Health Scotland; 2013. Available from: <www.healthscotland.com/documents/21782.aspx>

65. Robinson, M., Geue, C., Lewsey, J., Mackay, D., McCartney, G., Curnock, E., Beeston, C. Monitoring and Evaluating Scotland's Alcohol Strategy: The impact of the Alcohol Act on off-trade alcohol sales in Scotland. Edinburgh: NHS Health Scotland; 2013. <http://www.healthscotland.com/documents/21101.aspx>

66. The Alcohol Consumption chapters from previous Scottish Health Survey reports are available via the Scottish Government website at <www.scotland.gov.uk/Topics/Statistics/Browse/Health/scottish-health-survey/Publications>

67. See for example the North West Public Health Observatory's Local Alcohol Profiles for England, which use these definitions - <www.nwph.net/alcohol/lape/>

68. Drummond, C., Deluca, P., Oyefeso, A., Rome, A., Scrafton, S., Rice, P. Scottish Alcohol Needs Assessment. London: Institute of Psychiatry, King's College; 2009.

69. Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B. and Monteiro, M.G. AUDIT - The Alcohol Use Disorders Identification Test - Guidelines for Use in Primary Care, Second Edition. Geneva: World Health Organization; 2001.

70. Reid, S. (2009). Chapter 3: Alcohol consumption. In Bromley, C., Bradshaw, P. and Given, L. [eds.] The 2008 Scottish Health Survey - Volume 1: Main Report. Edinburgh: Scottish Government. <www.scotland.gov.uk/Publications/2009/09/28102003/0>

71. For participants aged 16 and 17, details on alcohol consumption were collected as part of a special smoking and drinking self-completion questionnaire. Some 18 and 19 year olds also completed the self-completion if the interviewer felt it was appropriate. For all other adult participants, the information was collected as part of the face-to-face interview. The method of estimating consumption follows that originally developed for use in the General Household Survey and is also used in the Health Survey for England. For six types of alcoholic drink (normal strength beer/lager/cider/shandy, strong beer/lager/cider, spirits/liqueurs, fortified wines, wine, and alcoholic soft drinks), participants were asked about how often they had drunk each one in the past twelve months, and how much they had usually drunk on any one day. The amount given to the latter question was converted into units of alcohol, with a unit equal to half a pint of normal strength beer/lager/cider/alcoholic soft drink, a single measure of spirits, one glass of wine, or one small glass of fortified wine. A half pint of strong beer/lager/cider was equal to 1.5 units. The number of units was then multiplied by the frequency to give an estimate of weekly consumption of each type of drink. The frequency multipliers were:

Drinking frequency	Multiplying factor
Almost every day	7.0
5 or 6 times a week	5.5
3 or 4 times a week	3.5
Once or twice a week	1.5
Once or twice a month	0.375
One every couple months	0.115
Once or twice a year	0.029

The separate consumption figures for each type of drink were rounded to two decimal places and then added together to give an overall weekly consumption figure. The results were then banded, using the same bands as the ones used in the 1995 Scottish Health Survey and in all years of the Health Survey for England. The bandings for men are as follows:

1 Under 1 unit (less than or equal to 0.50 units)

2 1-10 units (over 0.50 units, but less than or equal to 10.00 units)

Over 10-21 units (over 10.00 units, but less than or equal to 21.00 units)

Over 21-35 units (over 21.00 units, but less than or equal to 35.00 units)

Over 35-50 units (over 35.00 units, but less than or equal to 50.00 units)

Over 50 (over 50.00 units)

The bands for women were similar, but with breaks at 7, 14, 21 and 35 units, instead of 10, 21, 35 and 50.

72. Koplan J.P. and Mackay J. (2012). Curtailing tobacco use: first we need to know the numbers. The Lancet 380 (9842):629-30.

73. ScotPHO Smoking Ready Reckoner - 2011 Edition. See: http://www.scotpho.org.uk/publications/reports-and-papers/868-smoking-ready-reckoner.

74. See: http://www.scotland.gov.uk/About/Performance/scotPerforms/indicator/smoking.

75. See: www.scotland.gov.uk/About/Performance/scotPerforms/indicator/mortality

76. National Performance Framework: Changes to the National Indicator Set Edinburgh: Scottish Government, 2012. www.scotland.gov.uk/About/scotPerforms/NIchanges See also: www.scotlandperforms.com

77. The 2007 Better Health, Better Care action plan for improving health and health care in Scotland set out how NHS Scotland's HEAT performance management system (based around a series of targets against which the performance of its individual Boards are measured) would feed into the Government's overarching objectives. The HEAT targets derive their name from the four strands in the performance framework: the Health Improvement of the population; Efficiency and Governance Improvements; Access to NHS services and waiting times; and Treatment and quality of services.

78. See: www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance/smokingcessation

79. Creating a Tobacco-free Generation: A Tobacco Control Strategy for Scotland. Edinburgh: Scottish Government, 2013. http://www.scotland.gov.uk/Resource/0041/00417331.pdf

80. Gray,A, & Leyland, A. (2009). Chapter 4: Smoking. In Bromley, C., Bradshaw, P. and Given, L. [eds.] The 2008 Scottish Health Survey - Volume 1: Main Report. Edinburgh: Scottish Government. www.scotland.gov.uk/Publications/2009/09/28102003/0

81. Matt G.E., Quintana P.J.E. & Hovell M.F. et al (2004) Households contaminated by environmental tobacco smoke: sources of infant exposures. Tobacco Control 13: 29-37. <www.ncbi.nlm.nih.gov/pmc/articles/PMC1747815/>

82. Matt, G.E., Quintana, P., Hovell, M. et al. Tobacco Smoke: Emerging Evidence and Arguments for a Multidisciplinary Research Agenda Environ Health Perspect. 2011 September; 119(9): 1218-1226. <www.ncbi.nlm.nih.gov/pmc/articles/PMC3230406/>

83. See: www.who.int/dietphysicalactivity/publications/fruit_vegetables_report.pdf

84. http://www.scotland.gov.uk/Resource/Doc/277346/0083283.pdf

85. Scotland's Health - A Challenge to Us All: The Scottish Diet. Edinburgh: The Scottish Office, 1993. www.healthscotland.com/documents/1181.aspx

86. Eating for Health: A Diet Action Plan for Scotland. Edinburgh: The Scottish Office, 1996.
http://www.scotland.gov.uk/Topics/Health/Healthy-Living/Food-Health/Eating

87. The Scottish Dietary Targets were originally set out in: Eating for Health: a Diet Action Plan for Scotland. (The Scottish Office, 1996) and were most recently reaffirmed in: Healthy Eating, Active Living: An Action Plan to Improve Diet, Increase Physical Activity and Tackle Obesity (2008-2011). (Scottish Government, 2008).

88. Towards a Healthier Scotland. Edinburgh: The Scottish Executive, 1999.

89. Improving Health in Scotland - The Challenge. Edinburgh: The Scottish Executive, 2003.
www.scotland.gov.uk/Publications/2003/03/16747/19929

90. Hungry for Success - A Whole School Approach to School Meals in Scotland. Edinburgh: The Scottish Executive, 2003.

91. Eating for Health - Meeting the Challenge. Edinburgh: The Scottish Executive, 2004.
www.scotland.gov.uk/Publications/2004/07/19624/39995

92. Better Health, Better Care Action Plan. Edinburgh: Scottish Government, 2007. http://www.scotland.gov.uk/Publications/2007/12/11103453/0

93. Healthy Eating, Active Living: An Action Plan to Improve Diet, Increase Physical Activity and Tackle Obesity (2008-2011). Edinburgh: Scottish Government, 2008. http://www.scotland.gov.uk/Publications/2008/06/20155902/0

94. Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight. Edinburgh: the Scottish Government, 2010. http://www.scotland.gov.uk/Publications/2010/02/17140721/0

95. Obesity Route Map: Action Plan - Version 1.0. Edinburgh: Scottish Government, 2011. www.scotland.gov.uk/Resource/Doc/346007/0115166.pdf

96. Roe, L., Strong, C., Whiteside, C., Neil, A. and Mant, D. (1994). Dietary intervention in primary care: Validity of the DINE method for assessment. Family Practice 11: 375-81.

97. Telford, R.D. (2007). Low physical activity and obesity: causes of chronic disease or simply predictors? Medicine and Science in Sports and Exercise. 39 (8), 1233-40.

98. Royal College of Psychiatrists. (2012). Physical Activity and Mental Health. Online. Available at: <www.rcpsych.ac.uk/expertadvice/treatmentswellbeing/physicalactivity.aspx>

99. Scottish Intercollegiate Guidelines Network. Non-pharmaceutical management of depression. A national clinical guideline. SIGN guideline no. 114. Edinburgh: SIGN, 2010.

100. Global Recommendations on Physical Activity for Health. Geneva: World Health Organisation, 2010. <www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.html>

101. Start Active, Stay Active - A report on physical activity for health from the four home countries' Chief Medical Officers. (web only). UK Department of Health, July 2011. <www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128209>

102. See: <www.who.int/dietphysicalactivity/factsheet_inactivity/en/index.html>

103. Foster, C and Allender, S. 2012. Costing the burden off ill health related to physical inactivity for Scotland. British Heart Foundation Research Group report for SPARCOll. NHS Health Scotland. <www.healthscotland.com/uploads/documents/20437-D1physicalinactivityscotland12final.pdf>

104. Physical Activity Task Force. (2003). Let's Make Scotland More Active: A Strategy for Physical Activity. Crown Copyright. Edinburgh.

105. Five-year review of 'Let's Make Scotland More Active' - A strategy for physical activity. Glasgow: NHS Health Scotland, 2009. <www.healthscotland.com/documents/3223.aspx>

106. Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008-2011). Edinburgh: Scottish Government, 2008.

107. Obesity Route Map: Action Plan - Version 1.0. Edinburgh: Scottish Government, 2011. <www.scotland.gov.uk/Resource/Doc/346007/0115166.pdf>

108. Health Analytical Services Scottish Government and Information and Statistics Division, NHS National Services Scotland. Indicators to Monitor Progress of the Obesity Route Map. Edinburgh: Scottish Government, 2011 <www.scotland.gov.uk/Resource/Doc/346011/0115167.pdf>

109. See: <www.scotland.gov.uk/About/scotPerforms/indicator/physicalactivity>

110. For more details see: <www.ltscotland.org.uk/curriculumforexcellence/index.asp>

111. For more details see: <http://www.sportscotland.org.uk/sportscotland/schools/Active_Schools/Active_Schools1>

112. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. [Online] www.health.gov/paguidelines/pdf/paguide.pdf.

113. Canadian Society for Exercise Physiology. 2011. Canadian Physical Activity Guidelines and Canadian Sedentary Behaviour Guidelines. [Online] www.csep.ca/english/view.asp?x=949.

114. Note that young people aged 16-18 are treated as adults in SHeS and complete the adult version of the physical activity questionnaire. The different methods used to measure physical activity in adults and children mean that it is not appropriate to combine the data from young people aged 16-18 and those aged 5-15 to provide estimates for the 5-18 age group. The early years recommendations are included for information. The survey does not measure physical activity in children under 2, nor does it ask about children's walking, so the early years recommendations cannot be measured via SHeS.

115. Allied Dunbar National Fitness Survey. London: Health Education Authority and Sports Council, 1992.

116. Home activities: Examples of 'heavy' gardening or DIY work classified as moderate intensity:

Digging, clearing rough ground, building in stone/bricklaying, mowing large areas with a hand mower, felling trees, chopping wood, mixing/laying concrete, moving heavy loads, refitting a kitchen or bathroom or any similar heavy manual work.

Examples of 'heavy' housework classified as moderate intensity:

Walking with heavy shopping for more than 5 minutes, moving heavy furniture, spring cleaning, scrubbing floors with a scrubbing brush, cleaning windows, or other similar heavy housework.

Examples of 'light' gardening or DIY work classified as light intensity:

Hoeing, weeding, pruning, mowing with a power mower, planting flowers/seeds, decorating, minor household repairs, car washing and polishing, car repairs and maintenance.

117. MET levels were assigned using the 2011 update to the Compendium of Physical Activities: Ainsworth, B. E., W. L. Haskell, S. D. Herrmann, N. Meckes, D. R. Bassett Jr., C. Tudor-Locke, J. L. Greer, J. Vezina, M. C. Whitt-Glover, And A. S. Leon. 2011. 2011 Compendium of Physical Activities: A Second Update of Codes and MET Values. Medicine & Science in Sports and Exercise. Vol. 43, No. 8, pp. 1575-158.

118. Sports and Exercise activities - Intensity:

Vigorous:

All occurrences of: squash, football, rugby, hockey, shinty, subaqua, backpacking, fives, kick-boxing, lacrosse, marathon running, polo, racket ball, skipping.

Sports coded as vigorous intensity if they had made the participant breathe heavily or sweaty, but otherwise coded as moderate intensity: running/jogging, cycling, aerobics, keep fit, gymnastics, dance for fitness, weight training, swimming, tennis, badminton, exercises (press-ups, sit-ups etc), hillwalking/rambling, aquarobics, athletics, basketball, netball, canoeing/kayaking, climbing, horse riding, ice skating, martial arts inc Tai Chi, powerboating/jet skiing, rowing, sailing/windsurfing, skateboarding/inline skating, skiing/snowboarding, volleyball, American football, boxing, circuit training, field athletics, hiking, Territorial Army.

Moderate:

See 'vigorous' category b).

All occasions of: bowls, golf, cricket, surfing/ body boarding, table tennis, waterskiing, curling, abseiling/ parasailing, adventure playground, archery, assault course, baseball/softball, battle re-enactment, croquet, diving, dog training, drumming (in a group), fencing, hitting punch sack, juggling, Kabadi, motor sports (i.e. motor-cross, go-karting, etc.), rounders, skirmishing (war games), skittles, snorkelling, sumo wrestling, swing ball, trampolining, weight lifting, wrestling.

Sports coded as moderate intensity if they had made the participant breathe heavily or sweaty, but otherwise coded as light intensity: fishing/ angling, yoga/pilates, walking on a jogging machine/treadmill.

Light:

See 'moderate' category c).

All occasions of: snooker/ billiards/ pool, canal cruising (if resp responsible for working locks), darts, post natal exercise, shooting, toning table/bed.

119. For example, if participants' jobs were among a short list of particularly strenuous occupations (including, for example, miners and construction workers) and they described themselves as 'very physically active' at work, then their jobs were classified as involving 'vigorous' activity. Analysis of this method showed that the SOC code information assisted with the classification of work-based activity in only a very small number of cases, and that few people were classified as being vigorously active at work. As the SOC has undergone major revisions since the method was first devised, it was decided to simplify the classification method and base it solely on participants' assessments.

120. We are grateful to Prof Nanette Mutrie (University of Edinburgh), Prof Dawn Skelton (Glasgow Caledonian University) and the Scottish Physical Activity Research Collaboration for providing expert advice on the classification of muscle strengthening and balance improving activities:

Muscle strengthening potential of sporting activities:

Definitely muscle strengthening:

Swimming, athletics, sailing/wind surfing, skiing/snowboarding, horse riding, waterskiing, rowing, canoeing/kayaking, climbing

Potentially muscle strengthening:

Cycling, workout at a gym, aerobics, any other type of dancing, football/rugby, badminton/tennis, squash, exercises, ten pin bowling, yoga/pilates, aquarobics/aquafit, martial arts/tai chi, basketball, netball, lawn bowls, golf, hill walking/rambling, cricket, hockey, curling, ice skating, shinty, surf/body boarding, volleyball

121. Definitely balance improving sporting activities:

Cycling, workout at a gym, aerobics, any other type of dancing, football/rugby, badminton/tennis, squash, horse riding, aquafit/aquaerobics, jet ski, climbing, lawn bowls, golf, hill walking/rambling, yoga/pilates, athletics, basketball, netball, canoeing/kayaking, cricket, hockey, curling, ice skating, martial arts/tai chi, sailing/wind surfing, shinty, surf/body boarding, skiing/snowboarding, ten pin bowling, table tennis, volleyball, waterskiing

122. People in full-time work who said they were very active at work were assigned 1800 minutes (30 hours) per week of moderate activity, part-time workers were assigned 1050 minutes (17.5 hours). These estimates were based on the mean duration of non-sedentary time reported by full-time and part-time workers who were very active at work in the 2012 survey.

123. People in full-time work were assigned 20 sessions per month of moderate intensity activity at work, part-time workers were assigned 12 sessions. These estimates have been in use since the session-based recommendations were introduced.

124. Scholes, S. and Mindell, J. 2013. Is the adult population in England active enough? Initial results. Leeds: Health and Social Care Information Centre.

125. Tucker, J., Welk, G., Beyler, N. 20122 Physical Activity in U.S. Adults Compliance with the Physical Activity Guidelines for Americans. American Journal of Preventative Medicine. 40(4): 454-461.

126. Oude Luttikhuis, H. et al. (2009). Interventions for treating obesity in children. Cochrane Database of Systematic Reviews 1, CD001872.

127. Summerbell, C. D. et al. (2005). Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 3, CD001871.

128. Nathan, B. M. and Moran, A. (2008). Metabolic complications of obesity in childhood and adolescence: more than just diabetes. Current Opinion in Endocrinology Diabetes and Obesity. 15(1): 21-29.

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130. Grant, I., Fischbacher, C., and Whyte, B. (2007). Obesity in Scotland - An Epidemiology Briefing. Edinburgh: NHS National Services Scotland/Scottish Public Health Observatory. www.scotpho.org.uk/home/Publications/scotphoreports/pub_obesityinscotland.asp

131. Anstey, K. J., Cherbuin, N., Budge, M., and Young, J. (2011). Body mass index in midlife and late-life as a risk factor for dementia: a meta-analysis of prospective studies. Obesity Reviews 12(5): e426-37.

132. Xu, W. L., Atti, A. R., Gatz, M., Pedersen, N. L., Johansson, B., and Fratiglioni, L. (2011). Midlife overweight and obesity increase late-life dementia risk: a population-based twin study. Neurology 76(18): 1568-74.

133. Loef, M. and Walach, H. (2013). Midlife obesity and dementia: meta-analysis and adjusted forecast of dementia prevalence in the United States and China. Obesity 21(1): e51-5.

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136. Available from: www.keepwellscotland.com

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139. Available from: www.scotland.gov.uk/About/Performance/scotPerforms/indicator/birthweight

140. Available from: www.scotland.gov.uk/About/scotPerforms/indicator/healthyweight

141. The HEAT targets derive their name from the four strands in the performance framework: the Health of the population; Efficiency and productivity, resources and workforce; Access to services and waiting times; and Treatment and quality of services.

142. Available from: www.scotland.gov.uk/About/scotPerforms/partnerstories/NHSScotlandperformance/childhealthyweight

143. Parkinson, J. (2012). Establishing a Core Set of National, Sustainable Mental Health Indicators for Children and Young People in Scotland: Final Report. Glasgow: NHS Health Scotland. http://www.childreninscotland.org.uk/docs/NHSHealthScotlandCYPsmentalhealthindicatorsdraftframeworkconsultationdocument.pdf

144. The Frankfort Plane is an imaginary line passing through the external ear canal and across the top of the lower bone of the eye socket, immediately under the eye. Participants' heads are positioned with the Frankfort Plane in a horizontal position when height is measured using a stadiometer as a means of ensuring that, as far as possible, the measurements taken are standardised.

145. For a full review of obesity measures see: National Institute of Health and Clinical Excellence (2006). CG43 Obesity: Full Guideline, Section 2: Identification and Classification. www.nice.org.uk/guidance/index.jsp?action=download&o=38295

146. Romero-Corral, A. et al (2008). Accuracy of body mass index in diagnosing obesity in the adult general population. International Journal of Obesity 32: 959-966.

147. These cut-offs differ to those used in the previous surveys. In 1995 and 1998 the normal weight range was defined as 20-25 kg/m², in 2003 it was changed to 18.5-25 kg/m². From 2008 onwards the ranges are defined as set out below. This brings the definition in line with WHO recommendations. The impact of the change of definition is very marginal as very few people have a BMI measurement that is exactly 18.5, 25, 30 or 40 kg/m².

	2003	2008 onwards
Underweight	18.5 or under	Less than 18.5
Normal weight	Over 18.5 - 25	18.5 to less than 25
Overweight	Over 25 - 30	25 to less than 30
Obese	Over 30 - 40	30 to less than 40
Morbidly obese	Over 40	40+

148. WHO Obesity Factsheet. World Health Organization, 2009. www.who.int/mediacentre/factsheets/fs311/en/index.html

149. Prospective Studies Collaboration (2009). Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. The Lancet 373: 1083-96.

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151. NHS Consensus Development Conference (2006). Gastrointestinal surgery for severe obesity. Nutrition 12: 397-402.

152. Daniels, S. R., Khoury, P. R. and Morrison, J. A. (1997). The utility of body mass index as a measure of body fatness in children and adolescents: Differences by race and gender. Pediatrics 99: 804-807.

153. Lohman, T. G. (1986). Applicability of body-composition techniques and constants for children and youths. Exercise and Sport Sciences Reviews 14: 325-357.

154. Steinbeck, K. (2001). The importance of physical activity in the prevention of overweight and obesity in childhood: a review and an opinion. Obesity Review. 2: 117-130.

155. Hammer, L., Kraemer, H. Wilson, D. et al. (1991). Standardised percentile curves of body mass index for children and adolescents. American Journal of Diseases in Children 145: 259-263.

156. Cole, T., Freeman, J. V. and Preece, M. A. (1990). Body mass index reference curves for the UK. Archives of Disease in Childhood. 73: 25-29.

157. Cole, T., Freeman, J. V. and Preece, M. A. (1998). British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalised likelihood. Statistics in Medicine 17: 407-429.

158. Rolland-Cachera, M.F. (1999). Defining obesity in childhood. In: Guy-Grand, B. and Ailhaud, G. (eds.) Progress in Obesity Research: 8. Proceedings of the 8th International Congress of Obesity. London: John Libbey and Co.

159. Europe Overweight and Obesity in Children Task Force (2000). Overweight and Obesity in European Children and Adolescents. Causes and Consequences-Prevention and Treatment. Brussels: International Life Sciences Institute.

160. Cole, T., Bellizzi, M., Flegal, K. and Dietz, W.H. (2000). Establishing a standard definition for child overweight and obesity worldwide: an international survey British Medical Journal. 320: 1-6.

161. Chinn, S. and Rona, R. J. (2002). International definitions of overweight and obesity for children: a lasting solution? Annals of Human Biology. 29: 306-313.

162. This method has been developed by ISD Scotland, full details of the procedure are available on request from the Scottish Government Scottish Health Survey Team

163. Jotangia, D., Moody, A., Stamatakis, E., et al. (2005). Obesity Among Children Under 11. London: Department of Health in collaboration with the Health and Social Care Information Centre.

164. Reilly, J., Dorosty, A., and Emmett, P. (1999). Prevalence of overweight and obesity in British children: cohort study. British Medical Journal. 319: 1039.

165. Bundred, P., Kitciner, D. and Buchan, I. (2001). Prevalence of overweight and obese children between 1989 and 1998: population based series of cross sectional studies. British Medical Journal 322: 1-4.

166. Rudolf, M. C. J., Sahota, P., Barth, J. H., and Walker, J. (2001). Increasing prevalence of obesity in primary school children: cohort study. British Medical Journal 322: 1094-1095.

167. Reilly, J. J. (2002). Assessment of childhood obesity: National reference data or international approach? Obesity Research 10: 838-840.

168. Reilly, J. J., Wilson, M. L., Summerbell, C. D., and Wilson, D. C. (2002). Obesity: diagnosis, prevention, and treatment; evidence based answers to common questions. Archives of Disease in Childhood 86: 392-395.

169. See: http://www.sacn.gov.uk/pdfs/sacnrcpch_position_statement_bmi_thresholds.pdf

170. Primary 1 Body Mass Index (BMI) Statistics. School Year2010/11. Edinburgh: ISD, 2012: www.isdscotland.org/Health-Topics/Child-Health/Publications/2012-04-24/2012-04-24-BMI-Report.pdf?84266299010

171. Gray, L. and Leyland, A. (2012). Chapter 5: Obesity. In: Rutherford, L., Bromley, C. (eds.) The 2011 Scottish Health Survey - Volume 2: Children. Edinburgh: Scottish Government. http://www.scotland.gov.uk/Publications/2012/09/3327

172. Improving the Health and Wellbeing of People with Long Term Conditions in Scotland: A National Action Plan. Edinburgh: Scottish Government, 2009. www.scotland.gov.uk/Publications/2009/12/03112054/11

173. Lozano, R. et al. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet Vol 380. Issue 9859: 2095-128.

174. Chronic Obstructive Pulmonary Disease (COPD). Factsheet No.315. World Health Organization, 2012. : http://www.who.int/mediacentre/factsheets/fs315/en/

175. Better Heart Disease and Stroke Care Action Plan. Edinburgh, Scottish Government, 2009 http://www.scotland.gov.uk/Resource/Doc/277650/0083350.pdf

176. Diabetes Action Plan 2010: Quality Care for Diabetes in Scotland. Edinburgh, Scottish Government, 2010

177. Clinical Standards for Chronic Obstructive Pulmonary Disease Services. Edinburgh: NHS Quality Improvement Scotland, 2010. http://www.healthcareimprovementscotland.org/our_work/long_term_conditions/copd_implementation/copd_clinical_standards.aspx

178. Available from: http://www.gro-scotland.gov.uk/files2/stats/high-level-summary/j11198/j1119814.htm

179. Scottish Budget Spending Review 2007. Edinburgh: Scottish Government, 2007. <www.scotland.gov.uk/Publications/2007/11/13092240/0> See also: <www.scotlandperforms.com>

180. See: <www.scotland.gov.uk/About/Performance/scotPerforms/indicator/smoking>

181. See: <www.scotland.gov.uk/About/scotPerforms/indicator/physicalactivity>

182. See: <www.scotland.gov.uk/About/scotPerforms/indicator/healthyweight>

183. National Performance Framework: Changes to the National Indicator Set. Edinburgh: Scottish Government, 2012. <www.scotland.gov.uk/About/scotPerforms/NIchanges> See also: <www.scotlandperforms.com>

184. See: <www.scotland.gov.uk/About/Performance/scotPerforms/indicator/mortality>

185. Better Health, Better Care Action Plan. Edinburgh: Scottish Government, 2007 http://www.scotland.gov.uk/Publications/2007/12/11103453/0

186. Better Heart Disease and Stroke Care Action Plan. Edinburgh: Scottish Government, 2009. http://www.scotland.gov.uk/Publications/2009/06/29102453/0

187. Coronary Heart Disease and Stroke in Scotland - Strategy Update 2004. Edinburgh: Scottish Executive, 2004. http://www.scotland.gov.uk/Publications/2009/06/29102453/0

188. Scottish Intercollegiate Guidelines Network Risk Estimation and the Prevention of Heart Disease. SIGN guideline no. 97. Edinburgh: SIGN, 2007 <www.sign.ac.uk/guidelines/fulltext/97/index.html>

189. Scottish Intercollegiate Guidelines Network Management of Diabetes. SIGN guideline no. 116. Edinburgh: SIGN, 2010. <www.sign.ac.uk/guidelines/fulltext/116/index.html>

190. Diabetes Action Plan 2010: Quality Care for Diabetes in Scotland. Edinburgh: Scottish Government, 2010. < http://www.scotland.gov.uk/Publications/2010/08/17095311/0>

191. Scottish Intercollegiate Guidelines Network British Guideline on the Management of Asthma. A National Clinical Guideline. SIGN guideline no. 101. Edinburgh: SIGN, 2011. http://www.sign.ac.uk/guidelines/fulltext/101/index.html

192. Details of the Quality and Outcomes Framework are available from: <www.isdscotland.org/isd/3305.html>

193. Health in Scotland 2007 - Annual Report of the Chief Medical Officer. Edinburgh: Scottish Government, 2008. http://www.scotland.gov.uk/Publications/2008/11/26155748/0

194. See: <www.scotland.gov.uk/News/Releases/2011/02/21091044>

195. The HEAT targets derive their name from the four strands in the performance framework: Health of the population; Efficiency and productivity, resources and workforce; Access to services and waiting times; and Treatment and quality of services.

196. Better Health, Better Care Action Plan. Edinburgh: Scottish Government, 2009. http://www.scotland.gov.uk/Publications/2007/12/11103453/0

197. See: <www.scotland.gov.uk/About/scotPerforms/partnerstories/NHSScotlandperformance/Stroke>

198. See: http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance/HT201112

199. The question wording in 2008-2011 was: 'Do you have a long-standing physical or mental condition or disability that has troubled you for at least 12 months, or that is likely to affect you for at least 12 months?' The new wording was introduced as part of the Scottish Government's survey harmonisation process and is being included in SHeS, the Scottish Crime Survey and Scottish Household Survey from 2012 onwards.

200. In some previous SHeS reports, rates for each type were estimated by examining the age of onset of the condition and whether a participant was on insulin therapy at the time of interview. However, with increasing rates of type 2 diabetes in younger age groups, and increasing use of insulin to treat it, this classification method is no longer considered appropriate.

201. It should be noted that in common with the definition used since the 2003 report, diabetes and high blood pressure are not included in this definition of 'any CVD condition' (as they had been in 1995 and 1998), since they are risk factors for CVD.

202. For further information see: http://www.opsi.gov.uk/Acts/acts2005/ukpga_20050019_en_2

203. Lesieur H.R, Rosenthal M.D. (1991). Pathological gambling: A review of the literature (prepared for the American Psychiatric Association Task Force on DSM-IV Committee on disorders of impulse control not elsewhere classified). Journal of Gambling Studies 7, 1, 5-40.

204. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV); Wynne H.J. (2003). Introducing the Canadian Problem Gambling Screen. Edmonton, Canada: Wynne Resources.

205. American Psychiatric Association (2001). Substance-related and Addictive Disorders. http://www.dsm5.org/Pages/Default.aspx. Accessed 13.Aug.2013

206. Griffiths, M.D. (2007). (2007). Gambling Addiction and Its Treatment Within the NHS: A Guide for Healthcare Professionals. London: British Medical Association.

207. Potenza, M. N., Fiellin, D. A., Heninger, G. R., Rounsaville, B. J. and Mazure, C. M. (2002). Gambling. Journal of General Internal Medicine 17: 721-732. doi: 10.1046/j.1525-1497.2002.10812.x; Griffiths, M (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal 329(7474): 1055-1056.

208. Wardle, H. et al. (2010). British Gambling Prevalence Survey 2010. Birmingham: Gambling Commission.

209. The BGPS 1999 and 2007 used a paper self-completion booklet to collect data. In 2010, computer-assisted self-completion was used which allowed the questionnaire to have a more complex structure as more follow-up questions could be asked. As the Scottish Health Survey used a paper self-completion, the questionnaire structure and format of the 1999 and 2007 studies was followed.

210. Selection of the most appropriate solution was made based on both statistical and substantive considerations. This included an examination of 'goodness of fit' statistics. Recommended guidelines are that a model which fits the data well should have lower BIC, AIC and AIC3 values, although BIC has been highlighted as the most robust and consistent statistic to consider. Classification error should be low, meaning that the likelihood that someone does not really belong to the group they have been assigned is low, the model should have good stability meaning that it can be replicated and finally the resulting groups should make substantive sense.

211. Abbott, M., Volberg., R (2007) The measurement of adult problem and pathological gambling. International Gambling Studies, 6(2); 175-200.

212. This is with the exception of chasing losses which is rated on a scale ranging between 'never' and 'everytime I lost'.

213. Orford J., Wardle H., Griffiths M., Sproston K., Erens B., (2010). PGSI and DSM-IV in the 2007 British Gambling Prevalence Survey: reliability, item response, factor structure and inter-scale agreement. International Gambling Studies 10(1); 31-44.

214. The categorisation and screening of problem and pathological gambling has been reviewed and revised in the recently published DSM V. Main changes made were that the term pathological gambling was replaced with the term 'gambling disorder', that the crime criterion be removed from classification and that the threshold for identifying 'gambling disorders' be dropped from 5 (formerly the threshold for identifying pathological gamblers) to 4. However, the DSM V was not officially released at the time of Scottish Health Survey 2012 fieldwork. Therefore, this chapter uses the standards set by the DSM IV and replicates the scoring methods used in the BGPS series to allow comparisons to be made.

215. Some researchers have recommended that different (lower) thresholds should be used when identifying problem gamblers using the PGSI. However, these recommendations have not been universally accepted and are not currently endorsed by the original developers of the PGSI instrument. Therefore, this chapter uses the thresholds and categorisation recommended by the original developers and replicates the methods used in the BGPS, also allowing comparisons to be made.

216. Students and younger men in particular typically have higher rates of problem gambling, as do those in prison. There is also evidence from other jurisdictions that homeless populations have elevated rates of problem gambling compared with the general population. See Scarfe A. and Wilson, A. (2008). Addressing problem gambling in prisons: Good organisational reasons for programme success or failure. Presented at the 14^th International Conference on Gambling and Risk; Shaffer H., Freed C. and Healea D. (2002). Gambling disorders among homeless persons with substance use disorders seeking treatment at a community center. Psychiatric Services 53:1112-1117.

217. In the BGPS, the confidence intervals for these estimates were large as the sample size for Scotland was small. The confidence interval for DSM-IV problem gambling was 0.4%-2.8% and for the PGSI was 0.4%-2.8%. Estimates produced for this study are therefore well within this range and thus in keeping with estimates from the BGPS series.

218. LaPlante, Nelson and Gray have noted similar issues relating to breadth and depth of involvement among internet gamblers. See LaPlante D.A., Nelson S., and Gray H. (in press). Breadth and depth involvement: Understanding internet gambling involvement and its relationship to gambling problems. Psychology of Addictive Behaviors.