Scottish Social Attitudes Survey 2021/22: Public attitudes on alcohol and tobacco use and weight

Chapter 4: Conclusions

This module of questions on the Scottish Social Attitudes Survey 2021/2022 aimed to explore levels of stigma and compassion towards people in society experiencing harmful alcohol use, high tobacco use, and people who are living with overweight and obesity. Questions also sought views on who should be responsible for helping them. As some of the questions have previously appeared on SSA surveys, we were also able to explore how attitudes have changed over time.

Since 2013, the Scottish public has become more likely to perceive harmful alcohol use as a societal rather than individual issue. The proportion agreeing that people with 'serious drinking problems have only themselves to blame' dropped from 43% to 17% between 2013 and 2021/22. The proportion of those who agreed that 'it's in all our interests to give help and support to people with drink problems' rose from 64% to 91% over the same period. This could be due to on-going work to raise awareness of the harms from alcohol and wider engagement around support available to those who need help.

Over the past two decades, Scotland has made considerable efforts to reduce smoking rates and has seen a substantial fall in smoking prevalence during this time. Smoking-related policy in Scotland has sought to make smoking less acceptable and health campaigns have focused on encouraging people who smoke to quit by publicising routes that can be used to support this. This may explain the more stigmatising views held towards those with high tobacco use compared with the attitudes towards problem drug or harmful alcohol use. The public were most likely to agree that people who smoke heavily (44%) 'have only themselves to blame' compared to 17% for people with harmful alcohol use.

It is encouraging that large majorities felt that 'it's in all our interests to give help and support to' people experiencing harmful alcohol use (91%) or people living with overweight or obesity (84%).

Views on who should be responsible for trying to reduce the number of people in Scotland who are living with overweight or obesity showed a large majority consider it is the responsibility of both individuals and society. This is consistent with the range of policies within the Scottish Government's 'A healthier future' policy plan.

There was some variation in attitudes by demographic characteristics. Those with the lowest level of educational attainment tended to consider that people 'only had themselves to blame' across all three health issues. Men viewed those with high tobacco use or those living with overweight or obesity as having 'only themselves to blame' more than women. Those over 65 years felt those living with overweight or obesity had 'only themselves to blame' more than those aged 25-34 years. Research has demonstrated that stronger beliefs that weight is controllable (the individual is responsible) is associated with higher weight stigma attitudes.^[49] This may mean that targeted efforts are required to address stigma in certain groups.

Those who held views about individual responsibility were shown to be consistent in their views across alcohol and smoking behavior, and drugs. Thus there may be some benefit across the different health issues if one area implements policy that addresses stigmatising views.

The evidence presented here can help to inform future policy direction for the Scottish Government and other organisations in Scotland which support the reduction of stigma towards people with harmful alcohol use, high tobacco use and those living with overweight and obesity. Repeating these questions in future surveys would allow us to continue to track changes in stigmatising attitudes in Scotland over time and measure the effectiveness of policy changes in these health areas.