Scottish Health Survey - topic report: UK comparisons

APPENDIX A: QUESTIONNAIRE WORDING

This documents sets out the question wording for the data presented in each of the tables in the report. It highlights important differences between the countries in either the wording used or the way in which data are usually presented in the respective countries' reports. For based on very long sections of the questionnaire a summary description of the data collection method is given instead. The full questionnaires are available in each of the countries' Technical Reports. ¹, ², ³, ⁴

Table 1.1 Self-assessed general health, Scotland, England and Northern Ireland

• Scotland, England and Northern Ireland

How is your health in general? Would you say it was ...READ OUT…

1 ...very good,

2 good,

3 fair,

4 bad, or

5 very bad?

Table 1.2 Prevalence of long-term conditions, Scotland, England, Wales and Northern Ireland

• Scotland

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?

1 Yes

2 No

Does (name of condition) limit your activities in any way?

1 Yes

2 No

• England and Northern Ireland

Do you have any long-standing illness, disability or infirmity? By long-standing I mean anything that has troubled you over a period of time, or that is likely to affect you over a period of time?

1 Yes

2 No

Does this illness or disability/do any of these illnesses or disabilities limit your activities in any way?

1 Yes

2 No

• Wales

Do you have any long-term illness, health problem or disability which limits your daily activities or the work you can do? (Include problems which are due to old age)

Table 1.3 GHQ12 scores, Scotland, England, Northern Ireland

The General Health Questionnaire is a standardised 12 item instrument administered via self-completion. In Scotland and England it is part of the paper self-completion, in Northern Ireland it is a computer-administered self-completion. The question wording, and answer categories, are shown below.

GENERAL HEALTH OVER THE LAST FEW WEEKS

Please read this carefully:

We should like to know how your health has been in general over the past few weeks. Please answer ALL the questions by ticking the box below the answer which you think most applies to you.

Table 1.4 Prevalence of any CVD, any CVD or diabetes, IHD, IHD or stroke, Scotland, England and Northern Ireland

Data presentation

The data presented in Table 1.4 are based on a number of questions about various CVD conditions. The reports of the Scottish and English surveys each include the following summary measures:

• Any CVD (angina, heart attack, stroke, heart murmur, abnormal heart rhythm, 'other' heart trouble);
• Ischaemic heart disease - IHD - (angina, heart attack); and
• IHD or stroke (the preceding category plus stroke).

In addition, Scotland also reports:

• Any CVD or diabetes (the any CVD category plus diabetes).

Table 1.4 therefore includes a row of data for England reporting any CVD or diabetes that is not included in HSE reports. This variable is called CVDDef2. The syntax to derive it is published in the SHeS 2008 derived variable documentation available from the UK Data Archive (or on request from the authors of his report). All other items in the table are identical to those already reported for England.

Question wording

In Scotland and England each condition is asked about separately and follow-up questions are used to establish: 1) if the condition was confirmed by a doctor, and 2) if the condition was only present during pregnancy (for heart murmurs and diabetes).

• Scotland and England

Have you ever had angina?

1 Yes

2 No

Have you ever had a heart attack (including myocardial infarction or coronary thrombosis)?

1 Yes

2 No

And do you now have, or have you ever had...READ OUT ...a heart murmur?

1 Yes

2 No

...an abnormal heart rhythm?

1 Yes

2 No

...any other heart trouble?

1 Yes

2 No

Have you ever had a stroke?

1 Yes

2 No

Do you now have, or have you ever had diabetes?

1 Yes

2 No

(If had angina)

You said that you had angina. Were you told by a doctor that you had angina?

1 Yes

2 No

(If had a heart attack)

Were you told by a doctor that you had a heart attack (including myocardial infarction or coronary thrombosis)?

1 Yes

2 No

(If had abnormal heart rhythm)

Were you told by a doctor that you had abnormal heart rhythm?

1 Yes

2 No

(If had other heart trouble)

Were you told by a doctor that you had (name of 'other heart condition')?

1 Yes

2 No

(If had a stroke)

Were you told by a doctor that you had a stroke?

1 Yes

2 No

(If had diabetes)

Were you told by a doctor that you had diabetes?

1 Yes

2 No

(Women who have had diabetes)

Can I just check, were you pregnant when you were told that you had diabetes?

1 Yes

2 No

(Women who had diabetes when pregnant)

Have you ever had diabetes apart from when you were pregnant?

1 Yes

2 No

(If had a heart murmur)

You mentioned that you have had a heart murmur. Were you told by a doctor that you had a heart murmur?

1 Yes

2 No

(Women who have had a heart murmur)

Can I just check, were you pregnant when you were told that you had a heart murmur?

1 Yes

2 No

(Women who had a heart murmur when pregnant)

Have you ever had a heart murmur apart from when you were pregnant?

1 Yes

2 No

• Northern Ireland

In Northern Ireland the conditions were not asked about separately and were instead presented on a card. Diabetes only during pregnancy is excluded from the data in the table (people who mentioned this were followed up to confirm whether they had had diabetes at any other time). Unlike Scotland and England, heart murmur only during pregnancy was not excluded. Northern Ireland did not ask about abnormal heart rhythm, it is assumed that participants reported this as "other kind of heart trouble".

Have you ever been told by a doctor that you had any of the conditions on this card?

ANGINA

HEART ATTACK

HEART MURMUR

OTHER KIND OF HEART TROUBLE

STROKE

DIABETES (DURING PREGNANCY)

DIABETES (NOT DURING PREGNANCY)

ASTHMA

COPD OR CHRONIC OBSTRUCTIVE PULMONARY DISEASE E.G. CHRONIC BRONCHITIS / EMPHYSEMA OR BOTH DISORDERS

NONE "NONE OF THESE

Table 2.1 Estimated alcohol consumption level on heaviest drinking day in past week, Scotland and England

The data reported in Table 2.1 are based on a large number of questions and a complex method for converting alcohol types and volumes into units (which is summarised below and documented in full the technical reports of the 2008 Scottish and English Health Surveys). The two surveys use very similar questions. Wales also includes very similar questions about alcohol consumption but the method of administration is very different. In Scotland and England the questions are asked as part of the face to face interview (with the exception of all 16 and 17 year olds, and some 18-19 year olds in Scotland and some 18-24 year olds in England who use a self-completion booklet at the interviewers' discretion). In Wales, all the questions are administered via a self-completion booklet. Under-reporting of alcohol consumption in social surveys is known to be a problem and the Welsh data appear to show much higher levels of reported consumption in Wales than in Scotland and England. We judged that this was likely to result from the different method of data collection in Wales, rather than objective differences between the populations in the three countries.

Some other differences between Scotland and England are as follows:

• Scotland asks a section of questions about weekly drinking before asking about daily drinking.
• Scotland records consumption of alcopops in small cans or bottles, and bottles of 700ml. England and Wales do not include 700ml bottles.
• Both countries ask participants to report their wine consumption in glass sizes (125ml, 175ml or 250ml). In addition, Scotland uses pictures of wine glasses to help participants estimate this.
• The Scottish data uses a slightly different method of categorising people as either drinkers or non-drinkers. To make the base consistent between the two countries the HSE data were recoded using the SHeS convention (the syntax is available on request). As a result, there is a very slight difference in the percentages presented in this report compared with those in the main 2008 HSE report (Table 12.6). Note that the figures in this report are based on all adults aged 16 and over, the HSE report tables mainly present figures for all adults aged 16 and over who drank alcohol in the previous week.

Data collection in the Scottish and English surveys

The way in which the surveys estimate alcohol consumption changed significantly in recent years (from 2006 in England and from 2008 in Scotland). The following outlines the methods now used to collect and analyse the alcohol consumption data.

Both surveys measure daily consumption on the heaviest drinking day in the previous week. Scotland also measures usual weekly drinking and indicators of problem drinking.

Daily consumption was measured by asking about drinking in the week preceding the interview, and looked at actual consumption on the heaviest drinking day in that week. Participants aged 16 and over were asked whether they had drunk alcohol in the past seven days. If they had, they were asked on how many days and, if on more than one, whether they had drunk the same amount on each day or more on one day than others. If they had drunk more on one day than others, they were asked how much they drank on that day. If they had drunk the same on several days, they were asked how much they drank on the most recent of those days. If they had drunk on only one day, they were asked how much they had drunk on that day. In each case, the questions asked for details of the amounts consumed for each of the following six types of alcohol drink:

• normal beer, lager, cider and shandy
• strong beer, lager and cider
• sherry and martini
• spirits and liqueurs
• wine
• alcoholic soft drinks ("alcopops").

A follow-up question asked how much of each drink type they had drunk on that day. These data were converted into units of alcohol and multiplied by the amount they said they drank on that day (see below for discussion of this process).

Unit calculations and conversion factors

In the UK, a standard unit of alcohol is 10 millilitres or around 8 grams of ethanol. Information was collected about the volumes of alcohol participants had drunk on their heaviest drinking day in the week preceding the survey. The volumes reported were not validated but in response to growing concerns about the reliability of consumption estimates from studies such as this, and the increasing consumption of wine - especially amongst women - extra efforts were made to measure wine glass sizes. This was done in two ways. Firstly, participants who reported drinking any wine were asked directly what size of glass they had been drinking from. Secondly, in Scotland, showcards depicting glasses with 125ml, 175ml and 250mls of liquid were used to help people make more accurate judgements.

The following table outlines how the volumes of alcohol reported in the survey were converted into units (the 2008 Scottish health Survey Report provides full information about how this process has changed over time).

Type of drink	Volume reported	Unit conversion factor
Normal strength beer, lager, stout, cider, shandy (less than 6% ABV)	Half pint	1.0
	Can or bottle	Amount in pints multiplied by 2.5
	Small can (size unknown)	1.5
	Large can/bottle (size unknown)	2.0
Strong beer, lager, stout, cider, shandy (6% ABV or more)	Half pint	2.0
	Can or bottle	Amount in pints multiplied by 4
	Small can (size unknown)	2.0
	Large can/bottle (size unknown)	3.0
Wine	250ml glass	3.0
	175ml glass	2.0
	125ml glass	1.5
	750ml bottle	1.5 x 6
Sherry, vermouth and other fortified wines	Glass	1.0
Spirits	Glass (single measure)	1.0
Alcopops	Small can or bottle	1.5
	Large (700ml) bottle	3.5

Table 2.2 Self-reported cigarette smoking status, Scotland, England, Wales and Northern Ireland

Data presentation

The HSE report presents figures for regular cigarette smoking, this report has used the SHeS convention of presenting figures for all cigarette smoking (occasional or regular). The figures for ex and never smokers in England in Table 2.2 do not therefore match those presented in the HSE 2008 report Table 11.1.

Question wording

There are some differences between the ways these questions are asked in each country. The questions about current cigarette smoking in Scotland, England and Northern Ireland arrive at the same information but via a slightly different route. In Scotland, whether people have ever smoked cigarettes, cigars or pipes is coded directly at the first question. Ex-cigarette smokers are then asked how often they used to smoke. England asks a specific follow-up question to establish if ex-smokers were cigarette smokers, and if so how often they smoked them. Northern Ireland just asks all ex-smokers if they have ever smoked cigarettes, but does not ask how often.

As the questions asked of participants do not differ greatly this is unlikely to affect the comparability of the data collected. In particular, from the participants' perspective, the estimate of current cigarette smoking is arrived at in exactly the same way.

In Northern Ireland it is not possible to distinguish between regular and occasional ex-smokers. It is therefore possible that ex-occasional cigarette smokers in Northern Ireland will have been classified as never having smoked cigarettes, whereas in Scotland and England they would have been classified as ex-cigarette smokers.

Unlike the other three countries, the question in Wales asks about smoking in general rather than cigarette smoking in particular. People in Wales who only smoke pipes or cigars cannot be excluded from the estimate. The evidence from the other countries suggests that this group (of pipe and cigar smokers who do not smoke cigarettes) is likely to be very small.

• Scotland

May I just check, have you ever smoked a cigarette, a cigar or a pipe?

CODE ALL THAT APPLY.

1 Yes: cigarette

2 Yes: cigars

3 Yes: pipe

4 No

(If has ever smoked cigarettes, cigars or a pipe)

Do you smoke cigarettes at all nowadays?

1 Yes

2 No

(If smoked cigarettes in the past, but not a current cigarette smoker)

Did you smoke cigarettes regularly, that is at least one cigarette a day, or did you smoke them only occasionally?

1 Smoked cigarettes regularly, at least 1 per day

2 Smoked them only occasionally

3 SPONTANEOUS: Never really smoked cigarettes, just tried them once or twice

• England

May I just check, have you ever smoked a cigarette, a cigar or a pipe?

1 Yes

2 No

(If has ever smoked cigarettes, cigars or a pipe)

Do you smoke cigarettes at all nowadays?

1 Yes

2 No

(If smoked in the past, but not a current cigarette smoker)

Have you ever smoked cigarettes?

1 Yes

2 No

(If has smoked cigarettes in the past)

Did you smoke cigarettes regularly, that is at least one cigarette a day, or did you smoke them only occasionally?

1 Smoked cigarettes regularly, at least 1 per day

2 Smoked them only occasionally

3 SPONTANEOUS: Never really smoked cigarettes, just tried them once or twice

• Northern Ireland

Have you ever smoked a cigarette, a cigar or a pipe?

1 Yes

2 No

(If has ever smoked cigarettes, cigars or a pipe)

Do you smoke cigarettes at all nowadays?

1 Yes

2 No

(If smoked in the past, but not a current cigarette smoker)

Have you ever smoked cigarettes regularly?

1 Yes

2 No

• Wales

Which one of these best describes you?

Tick one only

I smoke daily

I smoke occasionally but not every day

I used to smoke daily but do not smoke at all now

I used to smoke occasionally but do not smoke at all now

I have never smoked

Table 3.1 Fruit and vegetable consumption, Scotland and England

The data reported in Table 3.1 are based on a large number of questions which are used to establish how many portions of fruit and vegetables were consumed on the previous day. The module was originally designed for use in the Health Survey for England and has been included in the Scottish Health Survey since 2003. The only difference between the countries is that SHeS asks about consumption of "pure fruit juice" whereas HSE asks about "fruit juice".

Measuring fruit and vegetable consumption

To determine the total number of portions that had been consumed in the 24 hours preceding the interview, the fruit and vegetable modules in both surveys asked about the following food types: vegetables (fresh, frozen or canned); salads; pulses; vegetables in composites ( e.g. vegetable chilli); fruit (fresh, frozen or canned); dried fruit; and fruit in composites ( e.g. apple pie). A portion was defined as the conventional 80g of a fruit or vegetable. As 80g is difficult to visualise, a 'portion' was described using more everyday terms, such as tablespoons, cereal bowls and slices. Examples were given in the questionnaire to aid the recall process, for instance, tablespoons of vegetables, cereal bowls full of salad, pieces of medium sized fruit ( e.g. apples) or handfuls of small fruits ( e.g. raspberries). In spite of this, there may be some variation between participants' interpretation of 'a portion'. These everyday measures were converted back to 80g portions prior to analysis. The following table shows the definitions of the portion sizes used for each food item included in the surveys:

Food item	Portion size
Vegetables (fresh, frozen or canned)	3 tablespoons
Pulses (dried)	3 tablespoons
Salad	1 cereal bowlful
Vegetables in composites, such as vegetable chilli	3 tablespoons
Very large fruit, such as melon	1 average slice
Large fruit, such as grapefruit	Half a fruit
Medium fruit, such as apples	1 fruit
Small fruit, such as plum	2 fruits
Food item	Portion size
Very small fruit, such as blackberries	2 average handfuls
Dried fruit	1 tablespoon
Fruit in composites, such as stewed fruit in apple pie	3 tablespoons
Frozen fruit/canned fruit	3 tablespoons
Fruit juice	1 small glass (150 ml)

Since the five a day policy stresses both volume and variety, the number of portions of fruit juice, pulses and dried fruit was capped so that no more than one portion could contribute to the total number of portions consumed. Interviewers recorded full or half portions, but nothing smaller.

Table 3.2 Summary activity levels, Scotland and England

The data presented in Table 3.2 are based on a large number of questions which are asked in both countries. The only difference between the countries is that the HSE question about work based activity includes voluntary and paid work. In SHeS only paid work activity is asked about.

However, the way the data are reported is very different. Adults are recommended to do at least 30 minutes of moderate activity on most days of the week, in bouts of at least 10 minutes at a time. The Scottish Health Survey includes bouts of 10-29 minutes in its summary measure of activity using a method first adopted in 2003 to count activities of 15-29 minutes. The Health Survey for England also measures activities that have lasted at least 10 minutes, but its summary measure excludes any activities below 30 minutes. ⁵

To make the data comparable between Scotland and England for this report, the HSE summary activity measure was re-derived using the SHeS method. This involved three changes:

• activity bouts of 10-29 minutes duration were included,
• employment activity levels were based on SOC90 rather than SOC2000 codes, and
• the exertion levels of other sporting activities were classified using the SHeS codeframe.

For these reasons the figures for England in this report differ to those published in the 2008 HSE report. Full details of how these changes were implemented are available on request.

The adult physical activity questionnaire

The adult physical activity module included in the Scottish and English surveys is based on the Allied Dunbar National Fitness Survey, a major study of physical activity among the adult population in England conducted in 1990. ⁶ The module examined:

• The time spent being active
• The intensity of the activities undertaken, and
• The frequency with which activities are performed.

Adult physical activity definitions

Types of activity covered

Four main types of physical activity were asked about:

• Home-based activities (housework, gardening, building work and DIY)
• Walking
• Sports and exercise, and
• Activity at work.

For the first three categories, participants were asked to report any activities lasting at least 10 minutes and to say on how many days in the past four weeks they had taken part in such activities. For walking, they were also asked on how many days they had taken more than one walk of at least 10 minutes. Where they had taken more than one walk, the total time spent walking for that day was calculated as twice the average reported walk time.

Those in full or part-time employment were also asked about activity at work. They were asked to rate how physically active they were in their job (options were: very physically active, fairly physically active, not very physically active and not at all physically active). Occupational activity was counted as 20 days in the last 4 weeks for full-time workers and 12 days for part-time workers. As noted above, in England these questions also covered voluntary work.

Intensity level

Each of the activities mentioned were classified into according to their intensity level in. The four categories of 'intensity' of physical activity were:

• Vigorous
• Moderate
• Light, and
• Inactive.

The physical activity recommendations for adults focus on engaging in at least moderate levels of physical activity for at least 30 minutes on most days of the week. The data reported here therefore focus on moderate and vigorous intensity activities.

Home-based activities were classified as either 'moderate' or 'light' depending on their nature. Participants were given examples of types of housework, gardening, building work and DIY which were described as either 'heavy' or 'light'. All cases of 'heavy' home-based activity were classified as being of 'moderate' physical intensity. Light gardening, building work and DIY were all classified as 'light' physical intensity. Due to its very low intensity, light housework was not included in the calculations of physical activity in this report. ⁷

For walking, participants were asked to assess their usual walking pace as 'slow', 'steady average', 'fairly brisk' or 'fast - at least 4mph'. Walks of 10 minutes or more at a brisk or fast pace were classified as being of 'moderate' intensity. Walks at slow or steady average pace were classified as 'light'.

The intensity levels of different sports and exercises were determined according to a combination of the nature of the activity and the participant's assessment of the amount of effort it involved. For example, all instances of playing squash or running/jogging were counted as 'vigorous' intensity. However, other activities, like swimming or cycling, were counted as 'vigorous' only if the participant reported that the effort involved was enough to make them 'out of breath or sweaty'; if not, they were classified as 'moderate' intensity. Similarly, other activities, like dancing, counted as 'moderate' if they made the participant out of breath or sweaty, but 'light' if not. ⁸

Activities at work were classified using a combination of (a) the participant's assessment of how active they are in their job (described above), and (b) the Standard Occupational Classification ( SOC) code assigned to their job type. 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. Otherwise, those who described their jobs as 'very physically active' were classified as 'moderately active' at work, as were those who considered themselves 'fairly physically active' but whose occupations were classed as involving heavy or moderate work (for example, shipwrights or refuse collectors). ⁹