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Chapter 1: Introduction
Background
Tackling alcohol misuse and eliminating smoking have
long been regarded as essential components in the campaign
to improve Scotland's health. Both have been the focus of
renewed attention from politicians in Scotland and the rest
of the
UK in recent years. The current
political agenda reflects evidence on negative trends in
alcohol consumption (particularly among women and younger
age groups) and on the effects of passive smoking (or
'second-hand smoke'), as well as interest in policy
developments in other countries, particularly the smoking
bans introduced in the Republic of Ireland, New York and
elsewhere.
This report presents findings from the 2004
Scottish Social Attitudes Survey on a module of
questions designed to provide a deeper understanding of
attitudes towards alcohol and second-hand smoke in
Scotland. It also explores levels of public support for
current legislative proposals to tackle alcohol misuse and
restrict exposure to second-hand smoke.
The Research and Policy Context
Alcohol misuse in Scotland
Scotland has seen dramatic increases in alcohol-related
ill health and death in recent decades. Between 1997/98 and
2003/04, there was a 13% rise in the number of patients
admitted to a general hospital in Scotland with an
alcohol-related diagnosis and a 50% increase in the number
of women aged 25-44 admitted with alcoholic liver disease.
1 Since 1980, alcohol-related deaths have risen
from less than 1 in 100 deaths to 1 in 30 of all deaths in
Scotland.
2
In addition to rising concern about the health impacts
of alcohol misuse, there are high levels of concern about
the social effects of problem drinking
3 in terms of crime and disorder. While the
Nicholson Committee on Alcohol concluded that there was not
always a simple causal relationship between crime and
alcohol, it concluded that there 'is often a strong
correlation between alcohol and aggression'.
4 This is reflected in findings from the 1998/99
Youth Lifestyles Survey, which found that young adults who
got very drunk at least once a week were almost five times
as likely as those who got drunk less than once a month to
admit to fighting.
5
Recent media and political interest has focused
particularly on the social problems associated with binge
drinking and with underage drinking. Current Department of
Health Guidance defines a 'binge' as drinking double the
daily recommended maximum units (2-3 units for women and
3-4 for men). Alcohol Statistics Scotland 2005 states that
in 2003, 26% of Scottish men and 10% of Scottish women
reported exceeding double the daily benchmark on at least
one day in the previous week. The Scottish Schools
Adolescent Lifestyle and Substance Use Survey (
SALSUS) highlights the scale of drinking
among Scottish teenagers, with the 2004 survey finding that
40% of 15 year old boys and 46% of 15 year old girls had
drunk alcohol in the week before the survey.
6SALSUS also examines the proportion of
teenagers who have engaged in "harmful drinking" by asking
(a) whether they have been "drunk" and (b) how often they
have drunk five or more drinks on the same occasion. In
2004, half (53%) of 13 year-olds and three-quarters (74%)
of 15 year-olds had been drunk at least once, while a third
(31%) of 13 year-olds and over half (56%) of 15-year-olds
reported drinking five or more drinks on the same occasion
at least once in the 30 days prior to the survey.
Current Scottish policies on alcohol
misuse
The Scottish Executive's strategy for tackling the
problems of alcohol misuse is set out in its
Plan for Action on alcohol problems7, while legislative proposals to control the sale
and purchase of alcohol are contained in the current
Licensing (Scotland) Bill.
8 The
Plan for Action on alcohol problems identifies
reducing binge drinking and reducing harmful drinking by
children and young people as key priorities. It sets out
various strategies for tackling alcohol problems, including
working to achieve cultural change in attitudes towards
alcohol in Scotland, improved prevention and education
strategies, closing gaps in service provision for those
with alcohol problems, and introducing new protections and
controls to limit the sale and purchase of alcohol. Key
controls which the Scottish Executive hopes to introduce
via the
Licensing (Scotland) Bill include:
- Tightening the rules around 'irresponsible'
promotions, such as happy hours and two-for-one offers.
The Bill proposes to do this by providing that
licensees must sell drinks at the same price for at
least 48 hours
- Introducing a legal requirement for all licensees
to operate a 'no proof, no sale' policy where there is
any doubt over whether a person is over 18
- Allowing Local Licensing Boards discretion to
refuse licenses in areas which are already considered
'hot spots' in terms of numbers of licensed premises or
alcohol-related problems
The
Licensing (Scotland) Bill also contains proposals
to replace the current system of statutory opening hours
with a system in which there are no prescribed hours and
licensees would apply to the local Licensing Board for
particular opening hours. While the Bill includes a stated
'presumption against 24-hour opening in Scotland', this
measure has been widely interpreted in the media as
creating the potential for licensees to be granted longer
opening hours.
Smoking in Scotland
In 2003, around 28% of adults in Scotland were regular
smokers.
9 While long-term trends for Scotland and the rest
of the
UK show that the proportion of smokers
has fallen over time, according to the Chief Medical
Officer smoking remains the 'biggest cause of preventable
premature death and ill health in Scotland'.
10 An estimated 13,000 Scots die each year from
smoking-related illness. Smoking is strongly associated
with social class and deprivation.
NHS Health Scotland and Ash report that
the decline in smoking in recent years has 'mainly been
among more affluent people':
People in skilled manual and non-manual occupations
are as likely to smoke as professionals were 30 years
ago and the unskilled and unemployed continue to smoke
as much as ever.11
In recent years, issues surrounding the health impacts
of passive smoking or 'second-hand smoke' have received
increased attention. According to the Chief Medical Officer
for Scotland there is now increasing evidence of the health
risks of second-hand smoke:
Short-term exposure to tobacco smoke (…) has a
measurable effect on the heart of non-smokers: just 30
minutes' exposure is enough to reduce coronary blood flow.
In the longer-term, passive smokers suffer an increased
risk of a range of smoking-related diseases. Those exposed
to second-hand tobacco smoke in the home have a 25%
increased risk of heart disease and lung cancer.12
Current Scottish policies on second-hand
smoke
The
Smoking, Health and Social Care (Scotland) Bill
was introduced to the Scottish Parliament by the Health
Minister in December 2004 and, at the time of writing, the
first stage of the Bill had just been approved by the
Parliament. Part 1 of the Bill proposes a ban on smoking in
wholly enclosed public places in Scotland, which will
include pubs, bars and restaurants. As the Scottish
Parliamentary Information Centre (
SPICe) state in their briefing notes to
accompany the Bill:
Such a ban is controversial (…) because it will
make illegal, in certain places, an activity which is
in itself legal. (…) For some, a ban is seen as 'nanny
state' politics and an infringement of civil or
personal rights. For others, the public good and the
right of individuals not to be subjected to dangerous
and unpleasant substances overrides the right to smoke
in enclosed public spaces.13
Research aims and objectives
The Scottish Executive Health Department funded the
Scottish Centre for Social Research (ScotCen) to design a
module of questions for the 2004
Scottish Social Attitudes Survey (
SSA) to measure public attitudes
towards drinking and smoking. Based on annual rounds of
interviews with 1,600 people drawn using random probability
sampling, the aims of the
SSA are to facilitate the study of
public opinion and inform the development of public policy
in Scotland. Further details about the
SSA are provided below.
The 2004 Drinking and Smoking module was particularly
focused on trying to understand the role of alcohol in
Scottish Society, in order to help inform Scottish
Executive policies on reducing harm from alcohol misuse.
Key topics and questions the module addressed were:
Alcohol and Scottish culture
- Is alcohol misuse viewed as a problem for
Scotland?
- How is alcohol viewed in relation to 'Scottish
culture'?
- Is alcohol viewed as a 'social lubricant' by
Scottish adults?
Stigma and social acceptability
- Is being 'teetotal' socially accepted in
Scotland?
- What types of drinking attract most stigma or are
viewed as most socially acceptable by different groups
in Scottish society?
- Do people think there should be restrictions on
drinking alcohol in public places?
Alcohol and health
- How do people view the impact of alcohol on
health?
- What services would people recommend to those with
alcohol problems and how accessible are these services
perceived to be?
Alcohol and crime
- Is alcohol viewed as a mitigating or an aggravating
factor in relation to punishing crime?
Alcohol and young people
- To what extent is underage drinking viewed as
socially acceptable?
- What are people's views on the best strategies for
tackling the problems associated with underage
drinking?
Controlling the sale and purchase of
alcohol
- What are people's attitudes towards current
proposals on the sale and purchase of alcohol
(including proposals on opening hours, 'irresponsible'
promotions and 'no proof, no sale' policies)?
- How would the Scottish public react to heavier
taxes on alcohol to discourage heavy drinking?
Second-hand smoke
- What are people's experiences of and attitudes
towards second-hand smoke?
In addition to questions funded by the Scottish
Executive Health Department, ScotCen included two questions
on attitudes towards the ban on smoking in pubs and
restaurants in order to ensure that we have a robust,
baseline measure of attitudes towards the proposed ban. The
intention is that this question will be repeated in the
SSA in 2005 and 2006 (and possibly later
years) in order to track attitudes towards the ban over
time - will people be more or less in favour of the ban
after it comes into effect? Findings from these questions
are included in this report, in addition to findings from
questions funded by the Scottish Executive Health
Department.
The Scottish Social Attitudes Survey
The
Scottish Social Attitudes (
SSA) survey was launched by ScotCen
14 (part of the National Centre for Social Research) in
1999, following the advent of devolution. The
SSA involves 1,600 interviews annually,
with respondents selected using random probability sampling
to ensure that the results are robust and representative of
the Scottish population. In common with its sister survey,
the
British Social Attitudes (
BSA) survey (launched by the National
Centre in 1983), the
SSA aims to improve understanding of
public opinion to inform policy making. While
BSA interviews people in Scotland, these
are usually too few in any one year to permit separate
analysis of public opinion in Scotland (see Park,
et al, 2003 for more details of the
BSA survey).
SSA has a modular structure. In any one
year it will typically contain four or five modules, each
containing 40 questions. Funding for its first two years
came from the Economic and Social Research Council while
from 2001 onwards different bodies have funded each year's
individual modules. These bodies have included the Economic
and Social Research Council, the Scottish Executive and
various charitable and grant awarding bodies such as the
Nuffield and Leverhulme Foundations.
Further technical details of the survey methods and
response rates for 2004 are appended (Appendix 1), as is a
full copy of the Drinking and Smoking module questions and
topline results (Appendix 2).
Reporting conventions
Chapter structure
The chapters within this report follow a similar format.
Each starts by stating the key questions the chapter
addresses. This is followed by an introduction which
provides a brief overview of the topic matter. A set of key
points highlighting the chapter's main findings can be
found at the end of each.
Data analysis and presentation
This report is intended to be accessible to an
intelligent general audience with limited knowledge of
research or statistics. As far as possible technical terms
are either avoided or explained in 'lay terms' and figures
and tables are interpreted for the reader in the
accompanying text. Any statistical findings reported in the
text (for example, a difference between two percentages)
have been tested for statistical significance.
15
The main type of analysis presented in tables and
figures in this report is simple bivariate or
'crosstabular' analysis to show the relationship between
two variables. An example of this would be a table showing
attitude towards the seriousness of binge drinking
(variable 1) among respondents in different
age groups (variable 2). Details of some of the
classification variables used in the analysis, such as
social class and urban / rural residence, are included in
Appendix 1. Full versions of the tables are available from
ScotCen on request.
In many instances the decision as to what to present in
each table was taken after multivariate modelling using
logistic regression had been carried out. This kind of
modelling looks at the strength of the association between
one variable and a number of factors that might be related
to it, while controlling for the association that all of
the other indicators have with the variable of interest.
The results therefore make it possible to establish the
relative strength of the patterns of association between
variables, for example whether someone's age or their
education level is most closely associated with their views
on an issue. It also makes it possible to eliminate factors
which are not significant once other variables have been
controlled for. The results of these multivariate analyses
are not shown in this report but are available from ScotCen
on request.
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