This section highlights variations in lifestyles across age groups, gender, social class and area of residence. There have been significant increases in the prevalence of lifestyles harmful to health between 1993 and 1999. Key changes are increases in the number of female smokers and of people who are obese.

Behaviours such as smoking, excessive alcohol consumption, unhealthy diet and low levels of physical activity play a key role in increasing the risk of a range of conditions including coronary heart disease, stroke and cancers. Early in 1999 the Health Authority undertook a Health and Lifestyle survey of the adult population across the district. The results of the survey highlight variations in lifestyle across age groups, gender, social class and locality of residence. Key results of the survey are outlined below and assist in identifying future action plans linked to the Health Improvement Programme.

Smoking

Smoking is a major risk factor linked to a range of diseases including coronary heart disease and stroke, cancers and respiratory diseases. The 1999 Health and Lifestyle survey showed that smoking prevalence among men in Portsmouth and South East Hampshire had not changed since 1993 (31%). Among women prevalence has increased by 1% to 26%. This compares with 30% of men and 27% of women smoking nationally. Although overall, men were more likely than women to smoke, the highest smoking prevalence (42%) was among young women aged 16 and 29.

The prevalence of cigarette smoking increased as social class decreased, from 22% of people in social classes I and II to 40% of people in social classes IV and V (Fig 2.2.1).

There was considerable variation in smoking prevalence across the local authority areas. Smoking prevalence ranged from 19% in Winchester (pt) and 18% in East Hampshire (pt) to 32% of people in Portsmouth City (Fig 2.2.1). In terms of primary care groups, people in Portsea Island primary care group were more likely to be smokers than those in the other three primary care group areas.

Nearly 60% of men and 70% of women who currently smoked said that they would like to give up, indicating that there is a significant market for a smoking cessation service. Those aged between 30 and 49 were the most likely to want to give up (69%) and those aged 65 and over the least likely (35%).

Teenage smoking has been identified as a key issue both locally and nationally. A smoking survey of Portsmouth and South East Hampshire 11 – 15 year olds was carried out in 1994. Twenty four schools participated. Nineteen per cent of the pupils surveyed said they smoked; 10% smoked regularly (smoking one or more cigarettes a week) and 9% smoked occasionally. Prevalence was higher among girls than boys, with 11% of girls being regular smokers compared with 10% of boys.

Over a third (33.7%) of teenage smokers indicated they would like to give up. Sixty seven percent indicated they would find it very difficult or fairly difficult to stop.

Alcohol

Excessive alcohol consumption has been identified as a key risk factor in coronary heart disease and stroke and a range of cancers. It is also strongly associated with the prevalence of accidents. The 1999 Health and Lifestyle Survey found that 90% of men and 80% of women in Portsmouth and South East Hampshire drank alcohol. The proportion of men who drink alcohol was highest amongst 30-49 year olds at 95%. Among women highest rates were found among 16-29 year olds at 92%.

Almost 39% of men and 20% of women in Portsmouth and South East Hampshire drink above sensible limits. This compares with 30% of men and 15% of women drinking above sensible limits nationally. The proportion drinking above sensible limits decreased with age and was highest among men aged 16 to 29 (54%). Analysis by social class (Table 2.2.1) revealed that people in social class III (manual) were the most likely to drink above sensible limits (39%) and those in social class III (non manual) were the least likely (23%).

Considerable variation in sensible drinking levels was revealed across local authority areas and primary care groups (Table 2.2.1). The proportion drinking above sensible limits was over twice as high in Portsmouth City (39%) as in East Hampshire (20%). In Portsea Island primary care group, 42% of people drank above sensible limits compared to 27% in Gosport primary care group, 26% in East Hampshire primary care group and 24% in the Fareham primary care group area.

Stress

The 1999 Health and Lifestyle survey found that 43% of people living in Portsmouth and South East Hampshire reported feeling stressed ?all or most of the time’ within the last three months. The most common sources of stress were job and work pressures, finances and relationship problems. There was considerable variation in reported stress by age group, with 55% of 16 to 29 year olds and 22% of people aged 65 and over.

Overall, there was very little variation between men and women in the proportion who reported feeling stressed. Among men and women aged between 16 and 29 however, there was a marked difference between the reported stress levels. Two thirds of women in this age group reported feeling stressed by at least one factor compared with 43% of men. Analysis by social class indicated that people in social class III (manual) were the most likely to report at least one stress factor “all or most of the time” (48%), while there was very little difference between the other socioeconomic groups.

In terms of locality, there was considerable variation in the proportion reporting stress, ranging from 35% of people living in Fareham to 47% of people living in Portsmouth City (Table 2.2.2).

People living in Portsmouth City were the most likely to report feeling stressed by their living conditions and immediate environment. They were the most likely to report the following stress factors: housing conditions (6%), neighbourhood (4%), air quality (5%), waste/litter (6%) and noise (7%). People in Gosport were the most likely to cite traffic (9%) and burglary in the area (18%).

People who indicated they had felt at all stressed were asked whether or not they felt that they had needed help or someone to talk to. One in two people answered “yes” to this question, with a higher proportion of women (59%) than men (41%). People in social class III (non-manual) were the most likely, and those in social classes IV and V the least likely to say they had needed help or someone to talk to. People in Fareham (47%) were the least likely to report that they needed help and people in Portsmouth City (53%) were the most likely.

Sources of support and advice varied by social class. People in social classes I and II were the most likely to say that they had spoken to their family, those in social class III (non manual) were the most likely to say that they had spoken to their friends and those in social class classes IV and V were the most likely to have spoken to a GP, counsellor or a psychologist or psychiatrist. General practitioners were the health professionals more often talked to.

Physical activity

The link between low levels of physical activity and increased risk of coronary heart disease is well established. The 1999 Health and Lifestyle Survey asked respondents how often they took vigorous, regular and light exercise lasting at least 30 minutes.

Sixty-three per cent of people in Portsmouth and South East Hampshire reported doing exercise of at least moderate intensity at least once a week. There was no difference between men and women. The proportion in this category decreased with age from 79% of people aged 16 to 29, to 35% aged 65 and over.

There was some association between level of physical activity and social class. People in social class IV and V were the most likely to engage in regular physical activity (Fig 2.2.2). People in social class III(M) were most likely to report being inactive (15%) compared to 9% of people in social class I and II and 10% of people in social class IV and V

There was little variation between localities in terms of levels of physical activity. People in Havant were the most likely to be classified as inactive, and those in Winchester the least. Men (13%) were more likely than women (8%) to report engaging in regular vigorous activity.

The link between regular physical activity and maintenance of optimum Body Mass Index (BMI) is well established. When physical activity levels were analysed by respondents’ BMI, it emerged that people who were classified as obese were more likely to be inactive.

Behaviour in the sun

The number of cases of skin cancer, compared with other forms of cancer has risen in recent years. Use of sunscreens and reducing exposure to the sun are key factors in decreasing the risk of skin cancer. The 1999 Health and Lifestyle Survey found that in Portsmouth and South East Hampshire, 25% of respondents said that a suntan was fairly or very important to them. Women aged 16 to 29 were the most likely to say that having a sun tan was important to them (48%) and women in the oldest age group were the least likely (12%).

People in social class III (non manual) were the most likely to rate having a suntan as important – 34% compared with a quarter of people in the other social class groups (Fig 2.2.3).

In terms of geographical variations people living in Havant were most likely to report that having a suntan was important (31%) and those living in Winchester (pt) and East Hampshire (pt) were the least likely (26%). Seventy per cent of people in Portsmouth and South East Hampshire said they used sun protection. Women were more likely than men to say they used sun protection (75% compared with 64%). There was an association with social class in that people in social classes I, II and III (non manual) were more likely than those in social classes III (manual), IV and V to use sun protection cream (Fig 2.2.3).

The proportion of people who reported wearing sun protection varied from 65% of people living in Winchester (pt) to 74% of people living in Fareham and East Hampshire (pt). Seventeen per cent of people in Portsmouth and South East Hampshire reported experiencing sunburn, lasting at least a day within the last 12 months. The figure decreased with age from 31% of people aged 16 to 29, to 5% of people aged 65 and over. Women aged 16 to 29 were the most likely to have been sunburnt in the 12 months preceding the survey (31%). People in social classes III (manual) (17 %), IV and V (21%) were more likely than those in social classes I and II (16%) and III (non manual) (17%) to report sunburn during the last 12 months.

Diet

Poor diet and obesity are key risk factors linked to coronary heart disease and a range of cancers. The 1999 Health and Lifestyle Survey asked Portsmouth and South East Hampshire residents about types of food eaten and attitudes towards diet and nutrition.

Overall, two patterns emerged across the district on diet. Women eat more healthily than men and older people eat more healthily than younger people. Women and older people were more likely to report eating white bread.

The frequency of eating chips decreased with age and was higher for men than women. Conversely, women and older people were the most likely to report eating fruit, vegetables or salad at least once a day. Twenty-five per cent of 16 to 29 year olds compared with 17% overall, said that they ate confectionery at least twice a day.

Thirty-seven per cent of men and 27% of women were found to be overweight. This compares with 36% of men and 24% of women being overweight in 1993. Fifteen per cent of women and 12 % of men were classified as obese. In the 1993 Health and Lifestyle Survey, 6% of men and 11% of women were obese. There was no clear pattern of association with social class. The proportion of overweight or obese people ranged from 41% of people in social class III (non manual) to 51% of those in social class III (manual).

There was very little difference in prevalence of overweight and obesity across the local authority areas.

Key Issues

Smoking

• Smoking prevalence in Portsmouth and South East Hampshire is close to the national rate at 31% for men compared to 30% nationally, and 26% for women, compared to 27% nationally.
• Smoking prevalence in Portsmouth and South East Hampshire has remained unchanged for men since 1993 and has increased by 1% for women.
• There is considerable variation in smoking prevalence across Portsmouth and South East Hampshire, with 32% of people in Portsmouth City to 18% in East Hampshire (pt).
• Smoking prevalence across Portsmouth and South East Hampshire increases as social class decreases, with 22% of people in social classes I and II and 40% in social classes IV and V.

Alcohol

• Thirty nine per cent of men and twenty percent of women in Portsmouth and South East Hampshire drink alcohol above sensible limits – compared nationally with 39% of men and 15% of women.
• There is considerable variation across Portsmouth and South East Hampshire with 39% of people in Portsmouth City drinking above sensible limits compared to 20% in East Hampshire (pt).

Stress

• Forty three per cent of people living in Portsmouth and South East Hampshire report feeling stressed ?all or most of the time’.
• There is considerable variation in reported stress by age group, with 55% of 16 to 29 year olds compared to 22% of people aged 65 and over.
• People in social class III (manual), were the most likely (48%) to report at least one stress factor all or most of the time.

Physical Activity

• Sixty three per cent of people in Portsmouth and South East Hampshire report doing exercise of at least moderate intensity at least once a week.
• People in social classes III (manual), 15%, and IV and V (10%) were the most likely to be classified as inactive.

Behaviour in the sun

• People in social class III (non manual ) were the most likely to rate having a sun tan as important – 34% compared with 25% in the other social groups.
• Seventy per cent of people reported in the Lifestyle Survey using sun protection – with women being more likely to use sun protection than men (75% compared with 64%).
• Women aged 16 to 29 were the most likely to have been sunburnt during the previous 12 months (31%).
• People in social classes III (Manual, 17%, IV and V (21%) were most likely to report sunburn during the last 12 months.

Diet

• Women in Portsmouth and South East Hampshire eat more healthily than men.
• Thirty seven percent of men and 27% of women were found to be overweight.
• The proportion of people who are obese has increased markedly over the past 6 years (12% of men and 15% of women in 1999 compared to 6% and 11% respectively in 1993).

Recommendations

• Health professionals in primary, secondary and community care services to continue to encourage patients to stop smoking, eat a healthier diet, take regular exercise and reduce alcohol intake.
• Use the evidence based Smoking Cessation Guidelines to develop a bid to establish a district Smoking Cessation Service from Tobacco White Paper monies.
• Ensure that smoking cessation advice is available to young adult smokers, particularly the 16 to 29 year old age group.
• Work with secondary schools and colleges to develop smoking cessation support for young people.
• Promote healthy lifestyles among the adult working population with local businesses and workplaces through the Healthy Workplace Award Scheme.
• Work with local authorities across the district to promote smoke free public places.
• Ensure Healthy Neighbourhood initiatives include the provision of public education and advice on healthy lifestyle issues and are targeted at areas of greatest need.
• Work with local authorities and primary care groups to ensure Healthy Living Centre bids address health and lifestyle issues and adopt community development approaches to improving health.
• Through local partnerships and Single Regeneration Budget Schemes promote economic growth and regeneration in the most deprived areas of South East Hampshire as a means of tackling sources of stress within the community.
• Ensure that local implementation of the national Healthy Schools Initiative focuses on working with schools and young people to develop a whole school approach to tackling health and lifestyle issues.
• Develop physical activity strategy in collaboration with local authorities and primary care groups which aims to 'get people moving' and utilises existing community facilities to encourage moderate exercise eg walking , swimming and cycling.
• Continue to provide public education on skin cancer awareness and ensure that young women aged 16 to 29 are a key target for awareness raising campaigns.
• Encourage the development of food co-operative schemes as a means of promoting healthy eating among people on a low income.

Produced by Ann Edmeades, IT Services, Hampshire County Council
for Portsmouth and South East Hampshire Health Authority
© Copyright Portsmouth and South East Hampshire Health Authority 1998
Last Updated 1st September, 1999