The Scottish Health Survey 2019- volume 2: technical report

Appendix C: Glossary

This glossary explains terms used in the report, other than those fully described in particular chapters.

Adverse Childhood Experiences (ACEs)

ACEs can be defined as stressful or traumatic experiences and events that occur during childhood (between 0 and 18 years of age). The questions used on SHeS are similar to those used in the original English 2014 and Welsh 2015 ACE surveys but without the questions on physical and emotional neglect. Additionally, to reflect the introduction of legislation related to smacking in Scotland, the words ‘This does not include gentle smacking for punishment’ used in the Welsh and English studies were removed from the question ‘How often did a parent or adult in your home ever hit, beat, kick or physically hurt you in any way?’.

For questions with a yes/no answer option, the answer ‘yes’ constitutes an ACE. For questions with never, once or twice, sometimes, often or very often, the answer ‘once or twice’ or more constitutes an ACE. This differs slightly from the Welsh and English surveys in one respect. In the Welsh and English surveys for the question ‘How often did a parent or adult in your home ever swear at you, insult you, or put you down?’, twice or more constituted an ACE. For sexual abuse, the two questions asked have been combined into a single ACE where a response of ‘once or twice’ to either or both of the questions constitutes an ACE. Only those who provided answers to all of the questions were included in the analysis.

Age standardisation

Age standardisation has been used in order to enable groups to standardisation be compared after adjusting for the effects of any differences in their age distributions.

When different sub-groups are compared in respect of a variable on which age has an important influence, any differences in age distributions between these sub-groups are likely to affect the observed differences in the proportions of interest.

Age standardisation was carried out, using the direct standardisation method. The standard population to which the age distribution of sub-groups was adjusted was the mid-2018 population estimates for Scotland. All age standardisation has been undertaken separately within each sex.

The age-standardised proportion p′ was calculated as follows, where p_i is the age specific proportion in age group i and N_i is the standard population size in age group i:

Therefore p′ can be viewed as a weighted mean of p_i using the weights N_i. Age standardisation was carried out using the age groups: 16-24, 25-34, 35-44, 45-54, 55-64, 65-74 and 75 and over. The variance of the standardised proportion can be estimated by:

Anthropometric measurement

See Body mass index.

Arithmetic mean

See Mean.

Alcohol Use Disorders Identification Test (AUDIT)

The AUDIT questionnaire was primarily designed to screen for levels of alcohol dependency or high-risk use. In line with the World Health Organisation guidelines on using the tool, responses to each of the ten AUDIT questions were assigned values of between 0 and 4. Scores for the ten questions were summed to form a scale, from 0 to 40, of alcohol use.

Bases

See Unweighted bases, Weighted bases.

Blood pressure

Systolic (SBP) and diastolic (DBP) blood pressure were measured using a standard method. In adults, high blood pressure is defined as SBP ≥140 mmHg or DBP ≥90 mmHg or on antihypertensive drugs.

Body mass index (BMI)

Weight in kg divided by the square of height in metres. Adults (aged 16 and over) can be classified into the following BMI groups:

BMI (kg/m²) / Description

Less than 18.5 / Underweight

18.5 to less than 25 / Normal

25 to less than 30 / Overweight

30 to less than 40 / Obese

40 and above / Morbidly obese

Although the BMI calculation method is the same, there are no fixed BMI cut-off points defining overweight and obesity in children. Instead, overweight and obesity are defined using several other methods including age and sex specific BMI cut-off points or BMI percentile cut-offs based on reference populations. Children can be classified into the following groups:

Percentile cut-off / Description

At or below 2nd percentile / At risk of underweight

Above 2nd percentile and below 85th percentile / Healthy weight

At or above 85th percentile and below 95th percentile / At risk of overweight

At or above 95th percentile / At risk of obesity

Cardiovascular Disease (CVD) Participants were classified as having CVD if they reported ever having any of the following conditions diagnosed by a doctor: angina, heart attack, stroke, heart murmur, irregular heart rhythm, ‘other heart trouble’. For the purpose of this report, participants were classified as having a particular condition only if they reported that the diagnosis was confirmed by a doctor. No attempt was made to assess these self-reported diagnoses objectively. There is therefore the possibility that some misclassification may have occurred, because some participants may not have remembered (or not remembered correctly) the diagnosis made by their doctor.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is defined by the World Health Organisation as ‘a pulmonary disease characterised by chronic obstruction lung airflow that interferes with normal breathing and is not fully reversible.’ It is associated with symptoms and clinical signs that in the past have been called ‘chronic bronchitis’ and ‘emphysema,’ including regular cough (at least three consecutive months of the year) and production of phlegm.

Clinical Interview Schedule-Revised (CIS-R)

See Revised Clinical Interview Schedule.

Cotinine

Cotinine is a metabolite of nicotine. It is one of several biological markers that are indicators of smoking. In this survey, it was measured in saliva. It has a half-life in the body of between 16 and 20 hours, which means that it will detect regular smoking (or other tobacco use such as chewing) but may not detect occasional use if the last occasion was several days ago. Anyone with a salivary cotinine level of 12 nanograms per millilitre or more was judged highly likely to be a tobacco user. Saliva samples were collected as part of the biological module.

Mean cotinine levels among non-smokers were calculated using the Tobit regression analysis method (see later).

Cardiopulmonary Resuscitation (CPR)

CPR is an emergency procedure that combines chest compressions with artificial ventilation in an effort to manually preserve brain function in a person who is in cardiac arrest.

Diastolic blood

When measuring blood pressure the diastolic arterial pressure is the lowest pressure at the resting phase of the cardiac cycle. See also Blood pressure, Systolic blood pressure.

Electronic cigarettes

Electronic cigarettes or e-cigarettes are battery-powered handheld devices which heat a liquid that delivers a vapour. The vapour is then inhaled by the user, which is known as ‘vaping’. E-cigarettes typically consist of a battery, an atomiser and a cartridge containing the liquid. Earlier models, often referred to as ‘cigalikes’, were designed to closely resemble cigarettes but there is now a wide variety of product types on the market. The liquid is usually flavoured and may not contain nicotine, although in most cases e-cigarettes are used with nicotine. Unlike conventional or traditional cigarettes, they do not contain tobacco and do not involve combustion (i.e. they are not lit). The questions about e-cigarettes were amended in 2016 to include the term ‘vaping devices’.

Food insecurity

Food insecurity is ‘the inability to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways, or the uncertainty that one will be able to do so’. Respondents answered three routed questions on food insecurity asking whether they had worried about running out of food, had eaten less than they should have or had actually run out of food in the last 12 months.

Frankfort plane

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. Informants’ 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.

General Health Questionnaire-12 (GHQ-12)

The GHQ-12 is a scale designed to detect possible psychiatric morbidity in the general population. It was administered to informants aged 13 and above. The questionnaire contains 12 questions about the informant’s general level of happiness, depression, anxiety and sleep disturbance over the past four weeks. Responses to these items are scored, with one point given each time a particular feeling or type of behaviour was reported to have been experienced ‘more than usual’ or ‘much more than usual’ over the past few weeks. These scores are combined to create an overall score of between zero and twelve. A score of four or more (referred to as a ‘high’ GHQ-12 score) has been used in this report to indicate the presence of a possible psychiatric disorder.

Reference: Goldberg D, Williams PA. User’s Guide to the General Health Questionnaire. NFER-NELSON, 1988.

Geometric mean

The geometric mean is a measure of central tendency. It is sometimes preferable to the arithmetic mean, since it takes account of positive skewness in a distribution. An arithmetic mean is calculated by summing the values for all cases and dividing by the number of cases in the set. The geometric mean is instead calculated by multiplying the values for all cases and taking the nth root, where n is the number of cases in the set. For example, a dataset with two cases would use the square root, for three cases the cube root would be used, and so on. The geometric mean of 2 and 10 is 4.5 (2x10=20, √20=4.5). Geometric means can only be calculated for positive numbers so zero values need to be handled before geometric means are calculated. See also Mean.

Health risk category

Health risk category is derived from BMI and waist circumference. BMI is derived from height and weight data collected in the main interview and waist circumference measurements are collected in the biological module. These measures are used in combination to estimate the proportion of adults who fall into each of the risk categories listed in the table below.

BMI Classification	'High' WC Men WC 94-102cm Women WC 80-88cm	'Very high' WC Men WC >102cm Women WC >88cm
Normal weight (BMI 18.5 - <25(kg/m2))	-	-
Overweight (BMI 25 - <30(kg/m2))	Increased	High
Obese
I - Mild (BMI 30 - <35(kg/m2))	High	Very high
II - Moderate (BMI 35 - <40(kg/m2))	Very high	Very high
III - Extreme (BMI 40+(kg/m2))	Extremely high	Extremely high

Reference: Scottish Intercollegiate Guidelines Network Management of Obesity – A National Clinical Guideline. SIGN guideline no. 115. Edinburgh: SIGN, 2010.

High blood pressure

See Blood pressure.

Household

A household was defined as one person or a group of people who have the accommodation as their only or main residence and who either share at least one meal a day or share the living accommodation.

Household Reference Person (HRP)

The HRP is defined as the householder (a person in whose name the property is owned or rented) with the highest income. If there is more than one householder and they have equal income, then the household reference person is the oldest.

Hypertension

See Blood pressure.

Ischaemic heart disease (IHD)

IHD is also known as coronary heart disease. Participants were classified as having IHD if they reported ever having angina, a heart attack or heart failure diagnosed by a doctor.

Loneliness

A question was included in the adult and young adult self-completion questionnaires to measure levels of loneliness experienced in the two weeks prior to being interviewed, with five answer options ranging from ‘all of the time’ to ‘never’.

Long-term conditions & limiting long-term conditions

Long-term conditions were defined as a physical or mental health condition or illness lasting, or expected to last 12 months or more. The wording of this question changed in 2012 and is now aligned with the harmonised questions for all large Scottish Government surveys.

Long-term conditions were coded into categories defined in the International Classification of Diseases (ICD), but it should be noted that the ICD is used mostly to classify conditions according to the cause, whereas SHeS classifies according to the reported symptoms. A long-term condition was defined as limiting if the respondent reported that it limited their activities in any way.

Mean

Most means in this report are Arithmetic means (the sum of the values for cases divided by the number of cases).

Median

The value of a distribution which divides it into two equal parts such that half the cases have values below the median and half the cases have values above the median.

Morbid obesity

See Body mass index.

NHS Health Board

The National Health Service (NHS) in Scotland is divided up into 14 geographically-based local NHS Boards and a number of National Special Health Boards. Health Boards in this report refers to the 14 local NHS Boards (See Volume 2: Appendix B).

Nicotine Replacement

The remedial administration of nicotine to the body by means other than tobacco, usually as part of smoking cessation.

Therapy (NRT)

Common forms of nicotine replacement therapy are nicotine patches and nicotine gum.

Obesity

See Body mass index.

Overweight

See Body mass index.

Percentile

The value of a distribution which partitions the cases into groups of a specified size. For example, the 20th percentile is the value of the distribution where 20 percent of the cases have values below the 20th percentile and 80 percent have values above it. The 50th percentile is the median.

p value

A p value is the probability of the observed result occurring due to chance alone. A p value of less than 5% is conventionally taken to indicate a statistically significant result (p<0.05). It should be noted that the p value is dependent on the sample size, so that with large samples differences or associations which are very small may still be statistically significant. Results should therefore be assessed on the magnitude of the differences or associations as well as on the p value itself. The p values given in this report take into account the clustered sampling design of the survey. See also Significance testing.

Quintile

Quintiles are percentiles which divide a distribution into fifths, i.e., the 20th, 40th, 60th and 80th percentiles.

Raised waist circumference

See Waist circumference.

Revised Clinical Interview Schedule (CIS-R)

Details on symptoms of depression and anxiety are collected via a standardised instrument, the CIS-R. The CIS-R is a well- established tool for measuring the prevalence of mental disorders. The complete CIS-R comprises 14 sections, each covering a type of mental health symptom and asks about presence of symptoms in the week preceding the interview. Prevalence of two of these mental illnesses - depression and anxiety - were introduced to the survey in 2008. Given the potentially sensitive nature of these topics, they were included in the nurse interview part of the survey prior to 2012, and in the computer-assisted self-completion part of the biological module from 2012 to 2019.

Questions on depression cover a range of symptoms, including feelings of being sad, miserable or depressed, and taking less of an interest and getting less enjoyment out of things than usual. Questions on anxiety cover feelings of anxiety, nervousness and tension, as well as phobias, and the symptoms associated with these.

References:

Lewis, G. & Pelosi, A. J. (1990). Manual of the Revised Clinical Interview Schedule CIS–R. London: Institute of Psychiatry; Lewis G, Pelosi AJ, Araya R, Dunn G. (1992) Measuring psychiatric disorder in the community; a standardised assessment for use by lay interviewers. Psychological Medicine; 22, 465-486.

Scottish Index of Multiple Deprivation (SIMD)

The SIMD is the Scottish Government’s official measure of area based multiple deprivation. It is based on 37 indicators across 7 individual domains of current income, employment, housing, health, education, skills and training and geographic access to services and telecommunications. SIMD is calculated at data zone level, enabling small pockets of deprivation to be identified. The data zones are ranked from most deprived (1) to least deprived (6505) on the overall SIMD index. The result is a comprehensive picture of relative area deprivation across Scotland.

This report uses the SIMD 2020 for the 2019 data (see https://www.gov.scot/publications/?term=SIMD&cat=filter&publicationTypes=statistics&page=1) and the SIMD 2016 for the 2016, 2017 and 2018 data.

Significance testing

Where differences in relation to a particular outcome between two subgroups, such as men and women, are highlighted in volume 1 of this report, the differences can be considered statistically significant, unless otherwise stated.

Statistical significance is calculated using logistic regression to provide a p-value based on a two-tailed significance test. One tailed-tests are used when the difference can only be in one direction. Two-tailed tests should always be used when the difference can theoretically be in either direction. For example, even though previous research has shown a higher prevalence of hazardous levels of alcohol consumption among men than among women, and we may expect this to be true in the most recent survey, a two-tailed test is used to confirm the difference.

Social capital

Social capital encompasses aspects of social connectedness via friend and kinship networks, trust in others, the ability to draw on support from others, as well as a sense of connectedness to places through involvement in the local community and the ability to influence local decisions.

Standard deviation

The standard deviation is a measure of the extent to which the values within a set of data are dispersed from, or close to, the mean value. In a normally distributed set of data 68% of the cases will lie within one standard deviation of the mean, 95% within two standard deviations and 99% will be within 3 standard deviations. For example, for a mean value of 50 with a standard deviation of 5, 95% of values will lie within the range 40-60.

Standard error

The standard error is a variance estimate that measures the amount of uncertainty (as a result of sampling error) associated with a survey statistic. All data presented in this report in the form of means are presented with their associated standard errors (with the exception of the WEMWBS scores which are also presented with their standard deviations). Confidence intervals are calculated from the standard error; therefore the larger the standard error, the wider the confidence interval will be.

Standard error of the mean

See Standard error.

Standardisation

In this report, standardisation refers to standardisation (or ‘adjustment’) by age (see Age standardisation).

Systolic blood pressure

When measuring blood pressure, the systolic arterial pressure is pressure defined as the peak pressure in the arteries, which occurs near the beginning of the cardiac cycle. See also Blood pressure, Diastolic blood pressure.

Tobit regression

This method assumes that the distribution of cotinine values below the level of detection follows the same pattern as those above the method of detection. Thus, as the mean levels of cotinine among those with a cotinine level of between 0.1 ng/mL and 12 ng/mL (the level at which someone is deemed to be a cotinine-validated smoker) fall, so too do the assumed mean levels of those with a cotinine level of below 0.1 mg/mL28. Because of this change in method, figures presented in the 2019 report differ from those presented in the 2017 report.

Unit of alcohol

Alcohol consumption is reported in terms of units of alcohol. A unit of alcohol is 8 gms or 10ml of ethanol (pure alcohol). See Chapter 4 of volume 1 of this Report for a full explanation of how reported volumes of different alcoholic drinks were converted into units.

Unweighted bases

The unweighted bases presented in the report tables provide the number of individuals upon which the data in the table is based. This is the number of people that were interviewed as part of the SHeS and provided a valid answer to the particular question or set of questions. The unweighted bases show the number of people interviewed in various subgroups including gender, age and SIMD.

Waist circumference

Waist circumference is a measure of deposition of abdominal fat. It was measured during the biological module. A raised waist circumference has been defined as more than 102cm in men and more than 88cm in women.

Weighted bases

See also Unweighted bases. The weighted bases are adjusted versions of the unweighted bases which involves calculating a weight for each individual so that their representation in the sample reflects their representation in the general population of Scotland living in private households. Categories within the table can be combined by using the weighted bases to calculate weighted averages of the relevant categories.

Warwick-Edinburgh Mental Well-being Scale

The WEMWBS was developed by researchers at the Universities of Warwick and Edinburgh, with funding provided (WEMWBS) by NHS Health Scotland, to enable the measurement of mental well-being of adults in the UK. It was adapted from a 40 item scale originally developed in New Zealand, the Affectometer 2. The WEMWBS scale comprises 14 positively worded statements with a five item scale ranging from ‘1 - None of the time’ to ‘5 - All of the time’. The lowest score possible is therefore 14 and the highest is 70. The 14 items are designed to assess positive affect (optimism, cheerfulness, relaxation); and satisfying interpersonal relationships and positive functioning (energy, clear thinking, self-acceptance, personal development, mastery and autonomy).

References:

Kammann, R. and Flett, R. (1983). Sourcebook for measuring well-being with Affectometer 2. Dunedin, New Zealand: Why Not? Foundation.

Information on measuring mental wellbeing using WEMWBS is available online from: https://warwick.ac.uk/fac/sci/med/research/platform/wemwbs