The Scottish Health Survey 2024 - Volume 2: Technical Report

2.2 Chapter definitions

Note – The questionnaire and self-completion booklets are all available in the supporting documents section accompanying this publication. Unless otherwise stated the questions outlined below are included in the main questionnaire.

Due to space limitations, not all questions included in the 2024 questionnaire are included in the annual report. This is noted in the relevant sections below where applicable.

2.2.1 Chapter 1 – Mental health and wellbeing  

Eating behaviours and feelings related to food that could be indicative of a possible eating disorder

The five-item SCOFF questionnaire: a new screening tool for eating disorders - PMC[i], which assesses the possible presence of eating disorders and has been validated for use in the general adult population, was included in SHeS for the first time in 2024. The same approach was adopted as was used in the 2007 Adult Psychiatric Morbidity Survey (APMS)[ii] and the 2019 Health Survey for England (HSE)[iii] which amended the wording slightly to include the timeframe of ‘last year’ and amended the order of the questions. A score of 2+ on the SCOFF questionnaire indicates a possible eating disorder.

A follow-up question that was included in the APMS and HSE, which asked whether feelings about food interfered with aspects of daily life such as work or social life, was also included in SHeS.

These questions are asked of all adults aged 16+ and were added to the adult and young-adult self-completion booklets with a short introduction to explain their context.

General Health Questionnaire (GHQ-12)

GHQ-12[iv] is a scale designed to detect possible psychiatric morbidity in the general population. GHQ-12 is a widely used standard measure of mental distress and mental ill-health consisting of 12 questions on concentration abilities, sleeping patterns, self-esteem, stress, despair, depression, and confidence in the previous few weeks. Responses to each of the GHQ-12 items are scored, with one point allocated each time a particular feeling or type of behaviour is reported to have been experienced 'more than usual' or 'much more than usual' over the previous 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 here to indicate the presence of a possible psychiatric disorder. A score of zero on the GHQ-12 questionnaire can, in contrast, be considered to be an indicator of psychological wellbeing. GHQ-12 measures deviations from people's usual functioning in the previous few weeks and therefore cannot be used to detect chronic conditions.

These questions are asked of all adults aged 16+ and are included in the adult and young-adult self-completion booklets.

Loneliness

A question was included in the adult and young adult self-completion booklets to measure levels of loneliness experienced in the week prior to being interviewed, with five answer options ranging from ‘none or almost none of the time’ to ‘all or almost all of the time’. This differs from the question used prior to 2021 where the period asked about was two weeks.

Revised clinical interview schedule (CIS-R)

Depression and anxiety

Details on symptoms of depression and anxiety are collected via a standardised instrument, the CIS-R[v]. 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 Scottish Health 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[vi]. Since 2012 the questions have been included in the biological module where they are asked of adults aged 16+ in the self-completion . The change in mode of data collection may have impacted response, and comparisons of 2016/2017 figures and onwards with pre-2012 figures should be interpreted with caution. There is a possibility that any observed changes in prevalence across this period may reflect the change in mode rather than a real change in the population.

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.

Suicide attempts and self-harm

In addition to being asked about symptoms of depression and anxiety, participants were also asked whether they had ever attempted suicide.   

Those who said yes were asked if this was in ‘the last week, in the last month in the last year or at some other time?’ Note that this question is likely to underestimate the prevalence of very recent attempts, as people might be less likely to agree to take part in a survey immediately after a traumatic life event such as this. Furthermore, suicide attempts will only be captured in a survey among people who do not die by suicide.

Participants are also asked whether they have ever deliberately harmed themselves in any way but not with the intention of taking their own life. Those who said that they had self-harmed were also asked if this was ‘in the last week, in the last month, last year or at some other time’.

Since 2012 these questions have been answered via self-completion as part of the biological module. Prior to 2012 they were administered in the nurse interview, and any changes over time need to be interpreted with caution due to the change in mode.

Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)

The WEMWBS was developed by researchers at the Universities of Warwick and Edinburgh, with funding provided by NHS Health Scotland, to enable the measurement of mental wellbeing 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; mean scores are presented in the report. 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)[vii].

The scale was not designed to categorise individuals according to level of mental wellbeing, so cut-off points have not been developed[viii].

Strengths and difficulties questionnaire (SDQ)

The child Strengths and Difficulties Questionnaire (SDQ) aims to measure behavioural, emotional and relationship difficulties in children. It asks about 25 attributes which are used to devise a total SDQ score and scores for 5 sub-scales related to emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behaviour.

The SDQ was included in the 2024 survey questionnaire but it is not included in the annual report.

2.2.2  Chapter 2 – General health, cardiovascular conditions and caring

Cardiovascular conditions

Any cardiovascular disease (CVD) 

Participants were classified as having ‘any CVD’ if they reported ever having any of the following conditions confirmed by a doctor or other healthcare professional: angina, heart attack, stroke, heart murmur, abnormal heart rhythm, or ‘other heart trouble’[ix]. Participants were also asked whether they had experienced the conditions in the previous 12 months.

It is important to note that no attempt was made to verify these self-reported diagnoses objectively. It is, therefore, possible that some misclassification may have occurred because some participants may not have remembered (or not remembered correctly, or not known about) diagnoses made by their doctor or other healthcare professional.

Any CVD condition or diabetes

A summary measure of the following conditions: angina, heart attack, stroke, heart murmur, abnormal heart rhythm or diabetes, is presented in the tables as ‘any CVD condition or diabetes’.

Blood pressure/hypertension

Participants were defined as having self-reported doctor-diagnosed hypertension if they stated during the interview that they had been told by a doctor or other healthcare professional that they had high blood pressure.

Diabetes

Participants were classified as having diabetes if they reported a confirmed diagnosis by a doctor or other healthcare professional. Females whose diabetes occurred only during pregnancy were excluded from the classification. In 2018, a new question was introduced asking participants to report if they had been told they had Type 1 or Type 2 diabetes. Prior to 2018 no distinction was made between Type 1 and Type 2 diabetes in the interview.

Participants with doctor/healthcare professional diagnosis of diabetes were asked if they managed their condition with insulin and if they did, if they used an insulin pump.

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 or other healthcare professional.

IHD or Stroke

A summary measure of the two conditions is presented in the tables as ‘IHD or stroke’.

Stroke

Participants were classified as having a stroke if they reported ever having had a stroke confirmed by a doctor or other healthcare professional.

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 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 morbidity and mortality statistics are coded by clinicians using the codes for diseases, whereas SHeS asks respondents to self-report if they have any of these conditions. A long-term condition was defined as limiting if the respondent reported that it limited their activities in any way.

In 2024, a new question on whether any reported long-term condition has an impact on any of the following areas; vision, hearing, mobility, dexterity, learning or understanding or concentrating, memory, mental health, stamina or breathing or fatigue, socially or behaviourally, other was added.

Self-assessed general health

Each year, participants aged 13 and over are asked to rate their health in general with answer options ranging from ‘very good’ to ‘very bad’. For children under the age of 13 the question is answered by the parent or guardian completing the interview on their behalf.

Unpaid caring

Unpaid caring is defined for the purposes of this survey as looking after or giving any regular help or support to family members, friends, neighbours or others because of either long-term physical, mental ill-health, disability; or problems related to old age, apart from anything done as part of paid employment.

Participants aged 4+ (parents respond on behalf of children aged 4-12 years old) are asked the unpaid caring questions. Those reporting to be unpaid carers are asked follow-up questions about who they provide care for, how much time they spend caring, the impact of caring on employment and any support they receive as a carer.

2.2.3  Chapter 3 – Perimenopause and menopause 

If applicable, participants were asked questions about perimenopause and menopause. These questions were included in the SHeS questionnaire for the first time in 2024. 

Menopause refers to the time when menstrual periods stop due to loss of hormones produced by the ovaries. Menopause usually occurs between the ages of 45 and 55, but it can happen earlier. Perimenopause refers to the time leading up to the menopause, and is when an individual begins to experience fluctuations in hormone levels and may start experiencing menopausal symptoms along with changes to their menstrual cycle.

Questions covered menopause and perimenopause symptoms, early menopause and causes, symptom management, medical treatments, contact with health professionals and reasons for not seeking help.

2.2.4  Chapter 4 – Respiratory  

Asthma

Participants (including parents of children aged 0-12, and children themselves aged 13-15) were asked if a doctor or other healthcare professional had ever told them they had asthma. This question was asked in the 1998, 2003, 2008 and 2010 surveys, and has been included every year since 2012. No objective measures were used to confirm these reported diagnoses.

Participants were also asked about wheezing or whistling in the chest in the last 12 months. This question was unintentionally excluded from the 2023 survey and therefore no data is available for this question for that year.

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.

Each year since 2008, adult participants have been asked if they had ever had COPD, chronic bronchitis or emphysema confirmed by a doctor or other healthcare professional . No objective measures were used to confirm these reported diagnoses.  Those who reported doctor-diagnosed COPD were also asked what treatment or advice they had received.

Long COVID

Questions asked whether participants had had or thought they had had COVID-19 and how long their symptoms lasted. Long COVID was defined as currently experiencing symptoms more than 4 weeks after they first had COVID-19 that were not explained by something else.

It should be noted that due to changes in the question wording, the long-COVID data is not equivalent with that calculated and reported in the 2022 report, which reported on ever having had long covid. However, figures are comparable with those reported in the 2021 and 2023 reports.

Obstructive sleep apnoea

Sleep apnoea is a respiratory condition characterised by pauses or shallow breathing during sleep[x]. It is linked to other health problems including hypertension and heart disease.

Participants were asked if they had ever had sleep apnoea confirmed by a doctor or other healthcare professional and whether they had experienced sleep apnoea in the previous 12 months. These questions were included in the SHeS questionnaire for the first time in 2024.

2.2.5  Chapter 5 – Dental Health

Data on dental health is collected from adults aged 16+. In addition to collecting data on the number of natural teeth and presence of pain, a list of answer options from which participants can select as many as apply is used to collect data on issues they may be having with their mouth, teeth or dentures.

2.2.6  Chapter 6 – Diet and Food insecurity

Diet

Intake24

Intake24, an online 24-hour dietary tool, was first introduced as a means of collecting and analysing data on adult dietary intakes for the 2021 survey. This replaced previous methods of obtaining adult dietary data in SHeS and was repeated in 2024.

Intake24 was developed by Newcastle University, originally with funding from Food Standards Scotland and is licenced under the Open Government Licence. The tool is now maintained and developed in collaboration by Cambridge University (UK), Monash University (Australia) and Newcastle University (UK). The version of Intake24 used for SHeS (UK Locale, System Version 4, 2023) was provided and adapted by the University of Cambridge, based on the original, with technical advisory input from Newcastle University. Information about the development of the tool, reports and publications, as well as a demo of the tool, can be found on the Intake24 website.

Participants aged 16+ were introduced to Intake24 by their interviewer. Following their interview, participants were sent a secure URL via text or email and logged into Intake24 on their computer, laptop, tablet or smartphone. Participants who did not have internet access or who did not feel confidence completing the dietary recalls independently could request assistance. This was provided by the NatCen Telephone Unit who carried out assisted dietary recalls over the telephone.

Participants were asked to record in Intake24 everything they ate and drank the previous day. Intake24 includes an embedded database of foods with linked portion sizes and corresponding nutrient composition data taken from the National Diet and Nutrition Survey[xi] Nutrient Databank from which dietary intakes are automatically calculated. Participants are asked to select, as far as possible, their foods and drinks from the food list provided in Intake24. If they cannot find an exact match for the food consumed the tool prompts them to choose the closest matching item where possible. If the participant still cannot find a suitable match for their food they can report this as a missing food.

The majority of foods in Intake24 have a range of portion-size photo images that the participant can review and select the image closest to the amount they consumed. If there is no photo, there is the option to report portion size as household measures such as individual items, different spoon sizes, or small, medium or large servings. For drinks, there are images of cups and glasses with a slider to indicate volume or photos of bottles and cans.

There are prompts to remind respondents about common foods and drinks that might have been forgotten (for example, milk and sugar in tea or sauce on chips), built in checks to detect low reported energy intakes and low intake of drinks, and checks for large time gaps between eating occasions. Intake24 includes a custom spell checker which works to correct both phonetic misspellings and typing errors in the free text to enable comprehensive search functionality.

Other features of the system include:

• A video tutorial on how to complete a recall
• Contextual help buttons
• A telephone help request function, enabling the research team to contact respondents to talk them through issues they may be experiencing

For SHeS 2024, after each eating occasion, participants were asked to record where they had bought or obtained most of the food for that meal or snack in order to differentiate food and drink from the household grocery shop from that obtained from out of home sources such as restaurants and takeaways and ‘food on the go’. At the end of each dietary recall, questions prompted participants to record if their intake was typical for that day (and if not, the reason why), any special diet, and details of any dietary supplements taken.

Food and portion size codes are automatically assigned within Intake24 allowing the system to generate nutrient output at the individual food level. The raw Intake24 output was imported into a bespoke database to facilitate data checks and to assign foods reported as missing to an appropriate food code and portion size, using the original free text search term and missing food details provided by the participant. In the first few months of data collection, recalls were monitored to enable a count of the number with:

• 9 or fewer food or drink items
• 3 or fewer eating or drinking occasions
• completion time of under 3 minutes
• very low calorie intake (less than 400kcal) or very high (more than 4,000kcal)

The purpose of the measures was to indicate where there may have been issues related to data collection that required further investigation and to provide a set of checks that could be used to assess the tool’s performance against other UK surveys using Intake24.

At the end of the survey data collection, all recalls that contained less than 400kcal were reviewed. Case by case decisions were made as to whether recalls could be considered valid and complete, including, for example, checking if the respondent said they ate less than usual e.g. sickness. Four recalls were deemed to be incomplete and these recalls were removed from the dataset.

Boxplots were generated to review portion sizes and to identify any extreme outliers within each food group. Extreme outliers were identified from the boxplots as individual data points separate from the box and whiskers since they were more than 3 x IQR (Inter-quartile range: 75th percentile-25th percentile) from the nearest quartile for that intake (either the 25th or 75th percentile). These were examined on a case-by-case basis and reviewed in the context of the participant’s overall consumption. Portion sizes which were considered to be implausible, and potentially the result of errors in portion size selection, were adjusted. Adjustments were carried out in the bespoke dietary database by changing the portion code at the individual recall level.

Finally, boxplots were generated to identify any infeasible/extreme energy and nutrient values. Extreme outliers were looked at on a case-by-case basis. Extreme intakes that were considered to be the result of errors in portion size estimation or food composition in the NDB were adjusted, otherwise values were left in the dataset as they were assumed to reflect consumption by participants.

For participants who completed at least one recall, their average daily intake was calculated to enable comparisons with the Scottish Dietary Goals (SDGs). The proportion of adults meeting each SDG was also calculated.

Analysis of the Intake24 data for SHeS 2024 was undertaken using a ‘usual intakes’ approach, a method of estimating population habitual nutrient and food intakes that has been adopted for other research studies such as the National Diet and Nutrition Survey (NDNS)[xii]. Previously (for data for 2021) nutrient and food intakes were estimated by calculating the ‘day average’, which simply takes the average of each daily intake for each participant, but can result in misleading estimates of the prevalence of low or high intakes since the variance of the usual group intake is inflated by day-to-day variation in individual intake. The ‘usual intake’ method eliminates the intra-individual variability of the data and enables more appropriate estimation of ‘percentiles’ or ‘proportions above/below a threshold’ compared with the ‘day average’ method[xiii],[xiv]. This approach also allows for the inclusion of participants who completed a single dietary recall rather than requiring two dietary recalls which was the case for the ‘day average’ method used previously.

Data for 2021 has also been reanalysed using the usual intakes method and will be available on the UK Data Service archive, replacing the previous 2021 dataset.

Energy density (kcal/100g/day)

Energy density is based on the energy from foods and milk only (not the energy from other drinks).

Fibre intake

Fibre is measured by the American Association of Analytical Chemists (AOAC) methods. AOAC fibre includes resistant starch and lignin in the estimation of total fibre in addition to non-starch polysaccharides.

Free sugars intake

The definition of free sugars includes:

• All added sugars in any form
• All sugars naturally present in fruit and vegetable juices
• Purees and pastes and similar products in which the structure has been broken down
• All sugars in drinks (except for dairy-based drinks)
• Lactose and galactose added as ingredients

The sugars naturally present in milk and dairy products, fresh and most types of processed fruit and vegetables and in cereal grains, nuts and seeds are excluded from the definition[xv].

Fruit and vegetable consumption

SHeS gathered data on adult fruit and vegetable consumption between 2003 and 2019 as part of the main interview. However, estimations of portions of fruit and vegetables did not include the contribution from composite dishes, both homemade dishes and manufactured products.

In 2021 and 2024 dietary recall data, adult fruit and vegetable portions were calculated after disaggregation, that is they included these foods eaten as part of composite dishes, as well as their discrete portions, to provide more accurate estimates of total amounts consumed at an individual food level. For example, carrots may be eaten as an accompaniment to a main meal but they may also be consumed as an ingredient within a stew, together with additional vegetables such as onions and celery. In both 2021 and 2024, the ‘none/less than ½ portion category’ includes less than half a portion.

No diet data was collected for children in 2024 due to a separate Intake24 survey being undertaken with children on behalf of Food Standards Scotland in 2023/2024. Information on child fruit and vegetable consumption will be included in the 2025 survey.

Red and red processed meat intake

Red and red processed meat after disaggregation i.e. including the contribution from composite dishes, both homemade dishes and manufactured products.

SDGs

The SDGs provide the basis for the diet that will improve and support the health of the Scottish population[xvi]. Reporting against the total fat, saturated fat and free sugars goals below was updated in 2024 based on the Scientific Advisory Committee on Nutrition (SACN) recommendations[xvii] for expressing dietary energy from macronutrients.

Calories	Reduction in calorie intake by 120 kcal per person per day, and average energy density of the diet to be lowered to 125 kcal/100g by reducing intake of high fat and/or sugary products and by replacing with starchy carbohydrates (e.g. bread, pasta, rice and potatoes), fruits and vegetables.
Fruit and vegetables	Average intake of a variety of fruit and vegetables to reach at least five portions per person per day (>400g per day).
Oily fish	Oil rich fish consumption to increase to one portion (140g) per person per week.
Red meat	Average intake of red and red processed meat to be limited to around 70g per person per day. Average intake of the highest consumers of red and red processed meat (90g per person per day) not to increase.
Fats	Average intake of total fat to reduce to no more than 33% of energy excluding ethanol, average intake of saturated fat to reduce to no more than 10% of energy excluding ethanol and average intake of trans fatty acids to remain below 1% of energy.
Free sugars	Average intake of free sugars to not exceed 5% of total energy in adults.
Salt	Average intake of salt to reduce to 6g per day for adults.
Fibre	An increase in average consumption of the American Association of Analytical Chemists (AOAC) fibre for adults (16+) to 30g per person per day.
Total carbohydrate	Total carbohydrate to be maintained at an average population intake of approximately 50% of total energy with no more than 5% total energy from free sugars.

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’. In their self-completion booklet, participants aged 16+ 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.

2.2.7  Chapter 7 – Physical Activity  

Adherence to adult physical activity guidelines

The physical activity guidelines advise adults to accumulate 150 minutes of moderate activity or 75 minutes of vigorous activity per week or an equivalent combination of both, in bouts of 10 minutes or more. These guidelines are referred to as the Moderate or Vigorous Physical Activity guidelines (MVPA). To help assess adherence to this guideline, the intensity level of activities mentioned by participants was estimated.

Activities of low intensity, and activities of less than 10 minutes duration, were not included in the assessment. This allowed the calculation of a measure of whether each SHeS participant adhered to the guidelines, referred to in the text and tables as “adult summary activity levels”, see the table below. A more detailed discussion of this calculation is provided in the 2012 report[xviii].

Adult summary activity levelsª

Meets MVPA guidelines	Reported 150 mins/week of moderate physical activity or 75 mins vigorous physical activity, or an equivalent combination of these.
Some activity	Reported 60-149 mins/week of moderate physical activity, or 30-74 mins/week vigorous physical activity, or an equivalent combination of these.
Low activity	Reported 30-59 mins/week of moderate physical activity, or 15-29 mins/week vigorous physical activity or an equivalent combination of these.
Very low activity	Reported less than 30 mins/week of moderate physical activity, or less than 15 mins/week vigorous physical activity, or an equivalent combination of these.

 Only bouts of 10 minutes or more were included towards the 150 minutes per week guideline.

Adult physical activity questionnaire

The SHeS questionnaire[xix] asks about four main types of physical activity:

• home-based activities (housework, gardening, building work and DIY)
• walking
• sports and exercise
• activity at work

Information is collected on the:

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

Data was also collected as part of the 2024 survey regarding motivations for and barriers to increase participation in physical activity. These questions are asked on a modular basis of adult participants in core version A households.

Child Physical Activity Questionnaire

The questions on child physical activity are slightly less detailed than those for adults[xx]. No information on intensity is collected (with the exception of asking those aged 13-15 about their walking pace). The questions cover:

• sports and exercise

• active play including housework and gardening

• walking

Where appropriate, data are collected and reported for physical activity undertaken at and outside of school.

Sedentary time

Data are collected for adults and children on sedentary time on weekdays and weekends. Sedentary time is calculated from questions on time spent sitting at work, watching TV/another type of screen and/or time spent sitting doing other activities such as eating a meal, reading, napping etc. Sedentary time excludes those without a limiting illness or disability who said they were sedentary for more than 14 hours a day.

UK Chief Medical Officers (CMO) Physical Activity Guidelines (2019)

Age group	Guidelines
Early years – children under 5 years	Infants (less than 1 year): Physical activity is recommended several times a day (the more activity the better) in a variety of ways including interactive floor-based activity, e.g. crawling. Where infants are not yet mobile, at least 30 minutes of tummy time spread across the day and while awake is recommended along with movements such as reaching and grasping, pushing and pulling themselves over independently, or rolling over; more is better. Toddlers (1-2 years): At least 180 minutes (3 hours) per day of physical activity of any intensity is recommended for toddlers, including active and outdoor play. Pre-schoolers (3-4 years): At least 180 minutes (3 hours) per day of activity is also recommended for pre-school aged children, including a variety of active and outdoor play physical activities spread throughout the day. For this age group, this should include at least 60 minutes per day of moderate-to-vigorous intensity physical activity.
Children and young people aged 5 to 18	It is recommended that children and young people in this age group engage in moderate-to-vigorous intensity physical activity for an average of at least 60 minutes per day. The activities undertaken include those undertaken in a variety of settings such as school-based physical education, active travel, after school activities, play and sporting activities. Engagement in a range of activities and intensities over the course of a week is recommended in order to develop movement skills, muscular fitness and bone strength. This activity should be accompanied by as minimal an amount of sedentary time as possible, with any long periods of inactivity broken up with some physical activity, even if this is light in nature.
Adults aged 19-64	Daily physical activity is recommended for both physical and mental health benefits - the more the better but any activity is encouraged. This includes activities to develop and strengthen the major muscle groups, which can be achieved through activities such as heavy gardening, carrying heavy shopping, or resistance exercise. It is recommended that muscle strengthening activities are done on at least two days a week, but any strengthening activity is better than none. On a weekly basis, adults should undertake: at least 150 minutes (2 1/2 hours) of moderate intensity activity (such as brisk walking or cycling) or 75 minutes of vigorous intensity activity (such as running) or even shorter durations of very vigorous intensity activity (such as sprinting or stair climbing); or a combination of moderate, vigorous and very vigorous intensity activity. Sedentary time should be minimized as far as possible, breaking this up with at least light physical activity.
Adults aged 65 and over	Daily physical activity is also recommended for older adults for the maintenance of good physical and mental health, wellbeing, and social functioning. Even light activity offers greater health benefits than being sedentary, although the more daily physical activity that is undertaken, the better. Older adults should also undertake activities aimed at improving or maintaining muscle strength, balance and flexibility on at least two days a week, either on their own or combined with moderate aerobic activity. This should be accompanied by 150 minutes (two and a half hours) of moderate intensity aerobic activity, building gradually up to this where activity levels are currently lower.  Those who are already regularly active can achieve these benefits through: 75 minutes of vigorous intensity activity or a combination of moderate and vigorous activity Weight-bearing activities offer additional benefit in helping to maintain bone health. Where physically able, long periods of being sedentary should be broken up with light activity, or at least with standing.

Muscle strengthening

A second summary measure was calculated, to assess whether adults are meeting the guideline to carry out activities that develop or maintain strength in the major muscle groups on at least 2 days a week.

Nine different sports (swimming, athletics, canoeing, climbing, horse riding, rowing, sailing, skiing and waterskiing) were classed as always muscle strengthening, and other sports or exercises were classed as muscle strengthening if the participant reported that the effort was enough to make the muscles feel some tension, shake or feel warm. If the participant carried out such activities for at least 10 minutes on 2 or more days a week, on average, they were deemed to meet the muscle strengthening guideline. As this only includes muscle strengthening through sporting activity, reported levels may be an underestimate.

Muscle strengthening results are presented in the SHeS dashboard.

2.2.8  Chapter 8 – Smoking

Exposure to second-hand smoke

Exposure to second-hand smoke in adults was measured by asking respondents to self-report where they have been exposed to second-hand smoke and by analysing saliva samples for cotinine. Cotinine is a metabolite of nicotine indicating levels of exposure to tobacco or tobacco smoke for those not exposed to nicotine from other sources such as vaping or nicotine replacement therapy (NRT).

Detectable salivary cotinine levels greater than 0.1ng/ml and less that 12ng/ml indicate exposure to second-hand smoke for non-smokers who do not report other nicotine use.

Exposure to second-hand smoke for children is measured by the following:

• whether there is someone who regularly smokes inside the accommodation where the child lives, and
• parents’ and older children’s (aged 13-15) reports of whether children are exposed to smoke at home.

Exposure to second-hand vapour

Exposure to second-hand vapour from e-cigarettes or vaping devices was measured in adults and children (aged 13-15) by asking respondents to self-report where they have been exposed to second-hand vapour, and if they have, whether it bothers them. This question was added to the SHeS questionnaire in 2024.

Nicotine Replacement Therapy (NRT)

The remedial administration of nicotine to the body by means other than tobacco, usually as part of smoking cessation. Common forms of nicotine replacement therapy include nicotine patches and nicotine gum.

Nicotine Vapour Products (Electronic cigarettes/e-cigarettes/vapes)

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).

SHeS has gathered information on the use of e-cigarettes among the Scottish adult population since 2014, in response to their increased availability and high profile. The questions ask whether participants have ever used an e-cigarette as well as whether they currently use an e-cigarette. The questions about e-cigarettes were amended in 2016 to include the term ‘vaping devices’.

Smoking status

Smoking status categories reported are:

• current cigarette smoker
• ex-regular cigarette smoker
• never regular cigarette smoker
• never smoked cigarettes at all

Information on cigar and pipe use is collected in the survey but as prevalence is low these are not considered in the definition of current smoking.

Cotinine adjusted smoking status

The saliva cotinine adjustment adjusts original self-reported cigarette smoking levels by including those with cotinine levels in their saliva of 12ng/ml or above; this indicates that the individual is using nicotine either from tobacco, vaping, NRT or some other product (such as nicotine pouches). For self-reported non-smokers who report not currently using vapes or NRT products, this indicates exposure beyond what would be expected from contact with second-hand cigarette smoke and hence suggests misreporting of smoking behaviour in the main interview. 

Those who stated that they currently used either vapes or NRT products but did not currently smoke were excluded from the calculation of cotinine adjusted smoking prevalence estimates. This was because it was not possible to tell whether any raised cotinine levels among this group were due to vaping and/or NRT products alone, or additionally to unreported smoking.  As the 2024 survey did not ask about use of nicotine pouches, it was not possible to exclude those using these products from the analysis.

Questions on smoking behaviour

Questions on smoking have been included in SHeS since 1995. Some small changes were made to the questions in 2008 and 2012. These are outlined in the relevant annual reports[xxi],[xxii]. In 2024, a question on exposure to second-hand vapour was introduced.

The current questions in the survey focus on:

• current smoking status
• frequency and pattern of current smoking
• the number of cigarettes smoked by current smokers
• exposure to second-hand smoke
• exposure to second-hand vapour
• past smoking behaviour, current and ex-smokers
• quit attempts and desire to give up smoking
• medical advice on giving up smoking
• nicotine replacement therapy (NRT) use (including questions on NRT that led to successful cessation)
• Nicotine Vapour Products (NPVs) e.g. e-cigarettes/vapes (including as part of a quit attempt)

Adults aged 20 and over were asked about their smoking behaviour during the main interview. For those aged 16 and 17, information was collected in a self-completion booklet offering more privacy and reducing the likelihood of concealing behaviour in front of other household members. Those aged 18 and 19 could answer the questions either during the interview or via the self-completion booklet, at the interviewer’s discretion.

The self-completion questions were largely similar to those asked in the interview. However, given the age of the participants completing the self-completion questionnaire, questions on past smoking behaviour, desire to give up smoking and medical advice to stop smoking were excluded.

2.2.9  Chapter 9 – Alcohol

Calculating alcohol consumption

The guidelines on lower risk drinking are expressed in terms of units of alcohol consumed. Detailed information on both the volume of alcohol drunk in a typical week and on the heaviest drinking day in the week preceding the survey was collected from participants. The volumes reported were not validated. In the UK, a standard unit of alcohol is 10 millilitres or around 8 grams of ethanol (pure alcohol). In this chapter, alcohol consumption is reported in terms of units of alcohol.

There are numerous challenges associated with calculating units at a population level, not least of which are the variability of alcohol strengths and the fact that these have changed over time. The table below outlines how the volumes of alcohol reported in the survey were converted into units (the 2008 report provides full information about how this process has changed over time)[xxiii]. Those who drank bottled or canned beer, lager, stout or cider were asked in detail about what they drank, and this information was used to estimate the amount in pints.

Alcohol unit conversion factors

Type of drink	Volume reported	Unit conversion factor
Normal strength beer, lager, stout, cider, shandy (less than 6% Alcohol By Volume (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 (including champagne and prosecco)	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

Questions on alcohol

Questions about drinking alcohol have been included in SHeS since its inception in 1995. Questions are asked either face-to-face via the interviewer or included in the self-completion booklet if they are deemed too sensitive for a face-to-face interview (e.g. if being interviewed with a parent). All those aged 16-17 years are asked about their alcohol consumption via the self-completion booklet, as are some of those aged 18-19 years, at the interviewers’ discretion. The way in which alcohol consumption is estimated in the survey was changed significantly in 2008. A detailed discussion of those revisions can be found in the chapter on alcohol consumption in the 2008 report[xxiv].

UK Chief Medical Officers’ (CMO) Alcohol Guidelines

The UK CMO alcohol guidelines consist of three recommendations:

• a weekly guideline on regular drinking;
• advice on single episodes of drinking; and
• a guideline on pregnancy and drinking

According to the weekly guideline, adults are safest not to regularly drink more than 14 units per week, to keep health risks from drinking alcohol to a low level. If you do drink as much as 14 units a week, it is best to spread this evenly over three days or more. On a single episode of drinking, advice is to limit the total amount drunk on any occasion, drink more slowly, drink with food and alternate with water. The guideline on drinking and pregnancy, or planning a pregnancy, advises that the safest approach is not to drink alcohol at all[xxv].

Weekly consumption

Participants (aged 16 years and over) were asked preliminary questions to determine whether they drank alcohol at all. For those who reported that they drank, these were followed by further questions on how often during the past 12 months they had drunk each of six different types of alcoholic drink:

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

From these questions, the average number of days per week the participant had drunk each type of drink was estimated. A follow-up question asked how much of each drink type they had usually drunk on each occasion. These data were converted into units of alcohol and multiplied by the amount they said they usually drank on any one day[xxvi].

2.2.10  Chapter 10 – Obesity

Body Mass Index (BMI)

BMI is a widely accepted measure that allows for differences in weight due to height. It is defined as weight (kg)/square of height (m2). This has been used as a measure of obesity in SHeS since its inception in 1995. BMI has some limitations and does not, for example, distinguish between mass due to body fat and mass due to muscular physique[xxvii].

In 2024, standardised height and weight measurements were largely administered by an interviewer in-home.  For the small proportion of interviews conducted by telephone, participants provided estimated measurements.

For adults, both interviewer-administered and self-reported measures have been used to calculate estimated BMI. The self-reported data has been adjusted using adjustment factors based on a study of data from the Health Survey for England (HSE) and Active Lives Surveys which found that, on average, participants overestimated their height and underestimated their weight[xxviii].

Based on their BMI (calculated from self-reported height and weight), adult participants were classified into the following groups based on the World Health Organisation (WHO) classification[xxix]:

BMI (kg/m2)	Description
Less than 18.5	Underweight
18.5 to less than 25	Normal
25 to less than 30	Overweight, excluding obesity
30 to less than 40	Obesity, excluding morbid obesity
40+	Morbid obesity

The child BMI data included in the report and data tables is based only on those with interviewer administered measurements. Based on their BMI, child participants were classified into the following groups based on the World Health Organisation (WHO) classification.

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:

BMI (percentile)	Description
Above 2nd and below 85th	Within healthy range
At or below 2nd, at or above 85th	Outwith healthy range
At or above 85th, below 95th	At risk of overweight
At or above 95th	At risk of obesity

Waist Circumference

Waist circumference is a measure of deposition of abdominal fat. It is measured during the biological module. A raised waist circumference has been defined as more than 102cm in males and more than 88cm in females. In 2022, it was only possible to collect accurate information for waist circumference (WC) for a proportion of the version B sample interviews; therefore, some caution when making comparisons to 2022 due to the reduced sample size is advised.

2.3  A note about bases for males and females in the 2024 tables

From 2022, a question on participant’s sex has been included in the survey self-completion questionnaires for adults in addition to the usual approach of the household reference person providing this information for everyone in the household as part of the main CAPI interview.

Where the respondent completed a self-completion questionnaire, their response to the sex question here took precedence over the CAPI data.  However, in the self-completion questionnaire, the sex question included the option of ‘prefer not to say’. In addition, respondents could choose not to answer the question. Any such cases where the sex data was missing or ‘prefer not to say’ had been selected are not included in the breakdowns for males and females in the data tables but are included in the ‘All adults’ totals.  As such, base numbers for all adults may be greater than the sum of the male and female base numbers where these are reported separately.

For children, sex is provided by the household reference person. In cases where the sex question has not been answered the data is not included in the breakdowns for males and females in the data tables but are included in the ‘All children’ totals. As such, base numbers for all children may be greater than the sum of the males and females base numbers where these are reported separately.

References and notes