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

Chapter 3: Attitudes (individual versus societal) around responsibility for harmful alcohol use, high tobacco use and in relation to those living with overweight or obesity

Perceptions of individual versus societal responsibility

SSA 2021/22 included six questions examining public attitudes towards who is considered responsible in relation to those experiencing harmful alcohol and high tobacco use and those living with overweight and obesity. The questions asked were:

How much do you agree or disagree that most people with serious drinking problems have only themselves to blame?

How much do you agree or disagree that people who are heavy smokers have only themselves to blame?

How much do you agree or disagree that most people who are overweight or obese have only themselves to blame?

The same question was asked in relation to problem drug use which has been reported on separately.

Alcohol use

Around two thirds (65%) either 'disagreed' or 'disagreed strongly' that those with serious drinking problems have only themselves to blame, while 17% 'agreed' or 'agreed strongly', see Figure 1.

Attitudes appear to have shifted over time. In 2013, 33% disagreed and 43% agreed.

Tobacco use

One third (33%) either 'disagreed' or 'disagreed strongly' that people who smoke heavily have only themselves to blame, while 44% agreed.

Weight

Less than half (46%) either 'disagreed' or 'disagreed strongly' that people who are overweight or obese have only themselves to blame, with just over a quarter (27%) in agreement.

Figure 1 shows that a clear majority disagree that harmful alcohol use is the result of individual choices. This is similar to the views expressed in relation to problem drug use with 62% disagreeing and 19% agreeing.^[47] In contrast, views around high tobacco use are much more mixed with a tendency towards agreeing that high tobacco use is about personal choice.

The public tended to consider that those living with overweight or obesity did not only have themselves to blame but around a quarter did not express a view either way (26%).

Variation in attitudes between different sub-groups

Patterns of response towards the questions differed by sex, age and educational attainment.

Sex

Men were more likely than women to agree that people have only themselves to blame with respect to those who 'smoke heavily' (48% versus 39%) and those who 'are overweight or obese' (34% versus 22%).

Age

Views were consistent across age groups with respect to those with 'serious drinking problems' and 'heavy smokers'.

Older people were more likely than younger people to agree that 'those who are overweight or obese have only themselves to blame' (35% among those aged 65+ years compared to 20% of those aged 16-34).

Educational attainment

People in Scotland with no formal qualifications were consistently more likely than those with at least a degree-level qualification to agree that the health issues considered were the result of individual choices, see Table 1.

The pattern of responses to each item on personal responsibility also suggests that individual perspectives on whether people are personally to blame for problems stemming from specific health behaviours or in relation to weight are remarkably consistent. Figure 2 shows that those who agreed that people with problem alcohol use 'have only themselves to blame' were also more likely to feel that people who smoke heavily 'have only themselves to blame' when compared with their counterparts who disagreed with the sentiment relating to alcohol. 89% of those who felt people with serious drinking problems 'have only themselves to blame' also felt that heavy smokers 'have only themselves to blame'. This compares to 31% of those that disagreed that people with serious drinking problems are personally to blame but agreed that heavy smokers were personally responsible.

Similarly, those who believed that people who smoke heavily 'have only themselves to blame' for their situation were also more likely to agree the same for those who drink heavily (36%) compared to only 2% for those who disagreed people who smoke heavily 'have only themselves to blame'. A similar consistency of view was also found in respect of problem drug use (see separate drug report).^[48]

Attitudes towards whether it is in all our interests to help people with harmful alcohol use, high tobacco use or living with overweight or obesity

Respondents were presented with two statements designed to explore attitudes towards giving help and support to people experiencing harmful alcohol use or those living with overweight or obesity:

How much do you agree or disagree that it's in all our interests to give help and support to people who have drink problems?

How much do you agree or disagree that it's in all our interests to give help and support to people who are overweight or obese?

Figure 3 shows that large majorities are in agreement that 'it's in all our interests to give help and support to people 'who have drink problems' (91%) or 'who are overweight or obese' (84%); 7% and 9% were neutral respectively and only 2% disagreed in relation to alcohol use and 6% in respect of weight.

In SSA 2013 a statement was included which asked if people agreed or disagreed whether 'it's in all our interests to help people who have drink problems'. Since 2013, attitudes appear to have changed. In 2013, 64% of people agreed compared to 91% in 2021/22, 8% disagreed and 19% neither agreed nor disagreed.

Variation in attitudes between different sub-groups

Variance was observed in relation to harmful alcohol use according to whether or not the public felt that people experiencing these issues 'have only themselves to blame'. A larger proportion (96%) of those who disagreed that people with harmful alcohol use have only themselves to blame, felt that 'it's in all our interests' to help people with harmful alcohol use, compared to 79% of those who agreed that people with problem harmful alcohol use were individually responsible.

Attitudes towards who is responsible for reducing levels of overweight and obesity in Scotland

A question was asked to assess public attitudes on who should be responsible for reducing levels of overweight and obesity in Scotland. The question was accompanied by a list of answer options from which respondents were instructed to select all that apply:

Which, if any, of the following people do you think should be responsible for trying to reduce the number of people in Scotland who are overweight or obese?

Table 2 shows the most commonly-selected option was 'individuals who are overweight themselves', with almost nine in ten (88%) selecting this option. Over eight in ten (84%) said that 'parents and carers' should be responsible, seven in ten (70%) selected 'food and drink manufacturers' and a similar proportion (68%) opted for 'doctors and nurses'. Slightly fewer (64%) indicated that 'the government' should be responsible, while six in ten (60%) selected 'supermarkets and other food retailers'.

Weighted base 1130; unweighted base 1130

A similar question was asked in SSA 2016 survey, although some caution is advised in making comparisons due to question wording differences and a different number of options to choose from, see Appendix A. The findings are also not statistically tested. That said, the proportion who felt that individuals who are overweight themselves are responsible has remained relatively similar at 85% in 2016 and 88% in 2021/22. Meanwhile the proportion who felt the government is responsible has potentially increased from 44% in 2016 to 64% in 2021/22. The proportion who hold food and drinks manufacturers at least partly responsible has also potentially increased from 58% in 2016 to 70% in 2021/22.

Further analysis was conducted to see to what extent people felt there was both societal and individual level responsibility or just societal or just individual. The responses were grouped into:

• Only individual responsibility – those who selected just one or more of the following: "individuals who are overweight themselves", parents/carers and/or "doctors and nurses"
• Only societal responsibility - those who selected just one or more of the following: "government", "food and drinks manufacturers", "supermarkets and other food retailers", schools and the media
• Shared responsibility - those who selected a mixture of the above two types of categories

A large majority of people (78%) felt it was the responsibility of both society and individuals to reduce the number of people 'who are overweight or obese' in Scotland. Of the remainder, a larger percentage (16%) felt it was just up to individuals compared to 4% who felt it was just up to society.

SSA 2016 found the same large majority (78%) considered responsibility to lie at both the individual and societal level. Some change has perhaps taken place though, with an increase in the proportion who feel that only individuals are responsible (from 7% to 16%) and a decrease in the proportion who think that only society are responsible (from 15% in 2016 to 4% in 2021/22).

Variation in attitudes between different sub-groups

Some variation by different subgroups was observed. For example, the youngest age group (age 16-34 years) appear a bit more inclined to regard reduction of obesity prevalence as just a societal responsibility (10%) compared to those age 65+ years (2%).

Those from the least deprived areas felt it was a combined societal and individual responsibility (85%) compared to those from the most deprived areas (68%), with those from the most deprived areas also the group more likely to think it should just be a societal responsibility (14% compared to least deprived 1%).