SUMMARY OF DATA SOURCES FOR THE 2018 ACTIVE HEALTHY KIDS SCOTLAND REPORT CARD
This document provides detailed information on all the data sources that were considered when grading the indicators for the 2018 Active Healthy Kids Scotland Report
Card including 1) the data sources that were used to grade the indicators, why they were used, and provides a summary of the findings, and 2) the data sources that wereconsidered but were not used for grading and why they were not used (see red text in ‘findings’ column of tables). Gaps in Scottish data are also explained and links to alldata sources are provided. The grades are summarised in the ‘Active Healthy Kids Scotland Report Card 2018’, to access this document and the ‘Long-form Report Card2013’ (which provides more detail on the methods used for deriving report card grades) see www.activehealthykidsscotland.co.uk
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The purpose of this document was to search for and include information (in the tables) on all the data sources we considered for each indicator, even those we did
not use to grade an indicator.
We searched for evidence/data sources from March 2016 onwards (i.e. this is when we stopped searching for data sources for the 2016 report card). We also
searched for reports that had been published since March 2016 but the report used data from a survey conducted before March 2016.
To be used for grading, data needed to be recent (i.e. March 2016 onwards), nationally representative and affected by minimal bias (i.e. the method used tomeasure the indicator does not greatly overestimate or under-estimate the prevalence of the behaviour).
We have reported prevalence data for children and adolescents aged 2 to 18 years and also by age categories, gender and deprivation where possible.
If a data source did not analyse or report data in line with the benchmark then we have attempted to access and re-analyse the data according to the benchmark,we have described this where relevant.
The Global Matrix 3.0 (GM3.0), which is referred to throughout the document, compares Report Card grades from 48 nations including Scotland
www.activehealthykids.org. The grades for the 2018 Scotland Report Card differ slightly from the Scottish grades included in the GM3.0 as the 2018 Scotland Report
Card includes data for children under 5 years old (whereas the age range for the GM3.0 was 5-17 years) and additional indicators (diet and obesity).
The grades were determined by the % of children and adolescents meeting an evidence-based benchmark using the grading scheme below.
A = We are succeeding with a large majority of children (87%-93%)
A- = 80% to 86%
B+ = 74% to 79%
B = We are succeeding with well over half of children (67%-73%)
B- = 60% to 66%
C+ = 54% to 59%
C = We are succeeding with about half of children (47%-53%)
C- = 40% to 46%
D+ = 34% to 39%
D = We are succeeding with less than half of children (27%-33%)
D- = 20% to 26%
F = We are succeeding with very few of children (<20%)
INC = Incomplete Grade, where Scottish data were not available or were insufficient/inadequate to assign a grade1

Contents
Click on each link below to take you to the relevant indicator page
Indicator 1: Sedentary Behaviours .......................................................................................................................................................................................................... 3
Indicator 2: Overall Physical Activity ....................................................................................................................................................................................................... 7
Indicator 3: Organised Sport and Physical Activity ................................................................................................................................................................................. 11
Indicator 4: Active Play......................................................................................................................................................................................................................... 15
Indicator 5: Active Transportation ........................................................................................................................................................................................................ 20
Indicator 6: Physical Fitness .................................................................................................................................................................................................................. 22
Indicator 7: Diet ................................................................................................................................................................................................................................... 23
Indicator 8: Obesity.............................................................................................................................................................................................................................. 31
Indicator 9: Family and Peers ............................................................................................................................................................................................................... 37
Indicator 10: Community and Environment........................................................................................................................................................................................... 42
Indicator 11: Government .................................................................................................................................................................................................................... 48

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Indicator 1: Sedentary Behaviours
Benchmark: % of children and youth who meet the Canadian Sedentary Behaviour Guidelines (5-17 year olds: no more than two hours of recreational screen time per day;2-4 year olds: no more than one hour of sedentary screen time per day. Note: the Guidelines currently provide a time limit recommendation for screen-related pursuits, but
not for non-screen-related pursuits.
Summary of methods of measurement: Most sources of data used self/parent report of recreational screen time (i.e. TV viewing, gaming and other recreational screentime). One source used objectively measured sedentary time via accelerometers. At least two systematic reviews (Lubans et al see Active Healthy Kids Scotland Report Card
2013, longform, www.activehealthykidsscotland.co.uk and Prince-Ware et al 2017 ) concluded that the reliability of self or parent-reported sedentary time was unclear foralmost all self-report methods, but a few methods had some evidence of reasonable reliability. These reviews also concluded that most self –report and parent-reported
methods had not been validated, and so their accuracy is uncertain. For Scottish surveys it is unclear whether and to what extent measures of sedentary behaviour andscreen time are biased, so they can be used in the Scottish Report Card, but with caution. The most likely bias is underestimation of recreational screen time, thus estimatesof this behaviour used in Scottish surveys are probably conservative-i.e. exposure to screens may be higher than current Scottish estimates suggest. Time spent in otherimportant forms of sedentary behaviour (e.g. sitting) is not objectively measured in Scottish surveys, but probably very substantial based on objectively measured English
data which is readily generalisable to Scotland (e.g. Janssen et al 2016, Gateshead Millennium Study). Objectively measured sitting time typically accounts for over half of
waking time by age 6-7 years and this increases with age to over three-quarters of waking time by age 15 years, and with age the bouts of sitting become much longer withfewer breaks in sitting.
Gaps in Scottish data: One data source available for grading (the Scottish Health Survey, SHeS). The Scottish Health Survey measures screen time and non-screen time in 215 year olds annually, however the 2016 and 2017 surveys did not provide this information in their main reports (sedentary data are reported in 2017 webtables but not inline with the benchmark). The 2015 survey reported sedentary data (in their main report and supplementary tables) as mean time spent sedentary (i.e. screen and nonscreen time were combined) and % spending <3.5/4 hrs/day being sedentary. Thus, we re-analysed the 2016 SHeS screen time data using the correct threshold for 2-4
years and 5-15 year olds, further information provided in the table below. Overall, this is an important behaviour, the SHeS measure this behaviour annually and the data
should be reported according to evidence-based guidelines in their main report every year. There is a lack of data on % of 16 to 18 year olds meeting the benchmark and for
total sedentary time across childhood and adolescence, one study (McCrorie et al 2018) reports objectively measured sedentary time in 10 to 11 year olds.
Survey name, year data collected, name of the report andyear report published and link(s) to the document/survey

Details ofparticipants

Survey: Scottish Health Survey (SHeS) 2016
Publication: The Scottish Health Survey 2016: Volume 1: Main
Report (published October 2017)
http://www.gov.scot/Topics/Statistics/Browse/Health/scottishhealth-survey
Further data are available in supplementary web tables
http://www.gov.scot/Topics/Statistics/Browse/Health/scottish-

Nationally
representative
sample of 1346*
children (2-15 yrs).
*This is theunweighted bases forthis variable

Method of measurement(including the questions
asked in the survey tomeasure the indicator)
Method: Self-report measure
for children age 13-15 years
and parent proxy-reported
measure for children age 2-12
yrs.
Questions: Parents/Children
were asked: 1) Thinking first

Findings

Additional comments*Re-analysed data used forgrading because it fits thebenchmark and meets thethree criteria of being
recent, representative, noevidence of large bias.

*2016 sedentary data notreported in main report orwebtables. We accessed thedata via UK data service and reanalysed according to thebenchmark (using the correct
SHeS weighting variables).

3healthsurvey/Publications/Supplementary2015/Supplementary2016
Technical report provides info on data collected and thequestionnaires used in the survey
http://www.gov.scot/Publications/2017/10/4796/downloads

A copy of the SHeS
2016 data has been
deposited at the UK
Data Archive, 2017
data not available via
UKDS (checked 24th
Oct 2017)

of weekdays, how much time(not including nursery/school)on an average day do/does(you/child’s name) spend
sitting watching TV or anothertype of screen such as acomputer, games console or
handheld gaming device? 2)
And how much time (not incl
nursery/school) on an average
weekday do/does (you/yourchild) spend sitting down
doing any other activity, suchas eating a meal, reading, orlistening to music (otherexamples were given)? Also
asked these questions
thinking of the weekend.
Parent/child has to report
hours and mins (i.e. categories
not used)

Grade = D- (D grade forweekdays and F grade forweekends, 76% average ofweekdays and weekends),
D- overall, SES inequality
for weekday screen
time.**- 68% of 2-15 year olds
spent ≥2 hours/day (≥1hour/day for under 5s)
sitting watching a screen
on a week day (71% forboys, 65% for girls)- 83% at the weekend (84%for boys, 82% for girls)
Note: sig difference boys vsgirls wkday, NS for wkend
Screen time ≥2 hrs by age:
2-4yr (≥1 hr/day): 83% wkday,
87% wkend
5-7yr: 44% wkday, 72% wkend
8-10yr: 61% wkday, 84%
wkend
11-12y: 76% wkday, 87%wkend
13-15yr: 84% wkday, 89%
wkend
Note: sig for age wkday &wkend**For the GM3.0, we carried
the grade forward from the2016 Scottish report card as

we hadn’t re-analysed the
SHeS data at this point.
Note: The SHeS 2015 alsomeasured screen and nonscreen time, data reported in
the main report as time spentsedentary i.e. screen and nonscreen time combined and % ofchildren spending <3.5/4
hrs/day being sedentary thus
data not reported according to
the benchmark.
Note: the questions in the 2017
are the same as the previous
surveys, sedentary data notreported in main report, thewebtables report mean timeand % in quartiles for sedentary
time (i.e. screen and non-screen
time combined) thus notreported according to thebenchmark.

Screen time ≥2 hrs (≥1 hr/d
for under 5s) wkday by SIMD:
Least (5th): 58%
4th quintile: 67%
3rd quintile: 68%
2nd quintile: 71%
Most (1st): 78%
Note: sig for SIMD
Screen time ≥2 hrs (≥1 hr/d
for under 5s) wkend by SIMD
Least (5th): 84%

44th quintile: 80%
3rd quintile: 85%
2nd quintile: 85%
Most (1st): 83%
Note: not sig for SIMD

Survey: Scottish Schools Adolescent Lifestyle and SubstanceUse Survey (SALSUS) 2015
Publication: The main reports on smoking, alcohol and drugs
were published in 2016. Additional reports, including one on
lifestyle trends (‘Teenage life trends’) was published in 2017
http://www.gov.scot/Publications/2017/05/2301

A nationally
representative
sample of 25,304
children aged 13
years (S2) and 15
years (S4).

Method: A self-completion survey
administered by teachers in classunder exam conditions.
Question: Here is a list of things
that young people sometimes doin their free time, when they
aren’t at school. What about you?
Some of the items are screenrelated behaviours e.g. watch
dvds/films, go online, playcomputer games (items asked
separately). Responses are:everyday, most days, weekly, lessoften and never. Data reported as% doing each screen related
behaviour at least weekly basis(i.e. combined responses foreveryday, most days & weekly).

Data cannot be used forgrading because themethod only measuresfrequency of screen-related
behaviours not duration,
thus does not fit thebenchmark (i.e. % meeting
the guidelines of ≤ 2hrs ofscreen time/day for 5 to 17
year olds).

A nationally
representative
sample of 10 to 11
year old children.
2402 children took
part in GUS sweep 8interviews, 90%(n=2162) consented
to be contacted forthe accelerometer
study (known as
SPACES study), 1096
(51%) children took
part in theaccelerometer datacollection and 774
participants (427
girls, 357 boys) met

Method: Actigraphaccelerometers used tomeasure time spent sedentary(cutpoint<100 cpm). Data
presented for boys and girls,
SIMD and season.

Data cannot be used forgrading because data arelimited to one age groupand the benchmark is
screen time (i.e. %meeting the guidelinesof ≤ 2hrs of screentime/day)not sedentary time, thus
does not fit thebenchmark.

The 2015 questionnaire is available at
http://www.gov.scot/Topics/Research/by-topic/healthcommunity-care/social-research/SALSUS/Quest2015

Publication: McCrorie P, Mitchell R, Ellaway A. Comparison of
two methods to assess physical activity prevalence in children:
an observational study using a nationally representative
sample of Scottish children aged 10–11 years. BMJ Open2018;8:e018369. doi:10.1136/bmjopen-2017-018369
Survey: Data collection took place between May 2015 and May
2016.

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inclusion criteria (i.e.
provided at least 4
weekdays and at least
1 day of weekenddata) .
Survey: Growing Up in Scotland (GUS)
https://growingupinscotland.org.uk/about-gus/study-designand-methodology/

GUS is a longitudinalsurvey involving threenationally
representative cohortsof children: child cohort,birth cohort 1 (BC1) andbirth cohort 2 (BC2).
Child cohort: 2008/09
was the last year of datacollection, no further
collection planned. BC1:
the most recent datacollection periods (i.e.
from 2014 onwards)
were in 2014/15 (age 10
yrs/P6, sweep 8), a
short web and phonesurvey (web-cati)children in P7 (age 11yrs) & 2017/18 (age 12
ys/S1, sweep 9)
BC2: the most recent
data collection periods
were (i.e. from 2014
onwards) were in
2013/14 (age 3 yrs,
sweep 2) & 2015/16(age 5 yrs, sweep 3)

Method: TV viewing(Duration, time of day, whowith) and use of computer orgames console (not clear if
info collected on duration,and frequency) collected in
BC1 at age 10yrs/P6 (2014/15)& age 12yrs/S1 (2017/18) andBC2 at age 5 yrs (2015/16) andage 3 yrs (2013/14). Timespent online/on social media
collected in BC1 at age
12yrs/S1 (2017/18).

Data not used for grading
because it has not beenreported, it would need tobe obtained from the UK
Data Service (UKDS) andwould be limited to two
age groups as data only
available from UKDS for:BC1 age 10-11 years/P6(2014/15) and BC2 age 5
yrs (2015/16.
Data not available till theend the end of the year for:BC1 12yrs/S1 (2017/18)
and BC2 age 3 yrs 2013/14.

NOTE: this info was taken fromthe GUS topic guide and study
design info on website and the
topic guide sent by the GUS
senior researcher (i.e. the actual
questionnaires have not been
looked at). The GUS researcher
told me the data available in the
UKDS.

6

Indicator 2: Overall Physical Activity
Benchmark: % of children and youth who meet the Global Recommendations on Physical Activity for Health, which recommend that children and youth (5-18 years)
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity (MVPA) every day. Children under 5 years of age who are capable of walking unaided
should be physically active daily at any intensity for at least 180 minutes, spread throughout the day.
Summary of methods of measurement: Most sources of data used self/parent report of physical activity or MVPA. One source used accelerometers in 10 to 11 year oldchildren to measure time spent in MVPA and proportion meeting the guidelines.
Major gaps in Scottish data: No data on the proportion of young children (under 5 years of age) meeting the PA guideline of ≥180mins/day of any intensity PA; the Scottish
Health Survey (SHeS) applies the school-age PA guideline (i.e. ≥60 mins/day of MVPA) to the under 5s which is not the correct PA guideline for the age group. Lack of dataon compliance with the PA guidelines (≥60 mins/day of MVPA) in primary school aged children; the SHeS could not be used for grading as it assumes that all reported
activities were at least moderate intensity, thus compliance levels reported in the 2015 and 2016 SHeSs are substantially overestimated (see also Basterfield et al Arch Dis
Child 2008; 93: 1054-1058 and longform report cards in 2013 and 2016 www.activehealthykidsscotland.co.uk). The Health Behaviour in School-Aged Children survey (HBSC)
also uses self-reported measures of MVPA, but does measure intensity and has been validated (see longform report card from 2013 and more recent publication Hardie
Murphy et al BMC Public Health 2015; 15: 1080), thus providing more realistic estimates of compliance for 11 to 15 year olds that can be used for grading. The 2017 SHeS
provides a more realistic estimate of compliance because it reports the % of 5-15 year olds achieving ≥60 mins of MVPA every day of the week (which is in line with the PA
guidelines), whereas previous SHeS (e.g. 2015 and 2016) reported the % achieving ≥60 mins of MVPA on average, which is not in line with the PA guidelines, and produces amuch higher compliance. However, the 2017 SHeS still assumes that all reported activities were at least moderate intensity so could not be used for grading. Lack of datafor 16 to 18 year olds, the PA guidelines go up to age 18 but Scottish surveillance stops at age 15 in the HBSC and in the SHeS, adult PA guidelines are applied to 16-18 year
olds. Lack of objectively measured MVPA across childhood and adolescence, one study (McCrorie et al 2018) reports time spent in MVPA and proportion meeting theguidelines using accelerometers in 10 to 11 year olds.
Survey name, year data collected, name of the report andyear report published and link(s) to the document/survey

Details of participants

Survey: Health Behaviour in School-aged children (HBSC), thelast survey was 2014 (used in the 2016 report card) and thesurvey is conducted every 4 years, thus no new data since theprevious (2016) report card.
Publication: HBSC 2014 Survey in Scotland National Report(published in 2015)
http://www.cahru.org/content/03-publications/04reports/hbsc_nr14_interactive_final.pdf

A nationally representative
sample of 10,839 children
aged 11 years (P7), 13
years (S2) and 15 years(S4).

Method of measurement(including the questions
asked in the survey tomeasure the indicator)
Method: A self-completion
questionnaire administeredby teachers in class.
Measures MVPA using the
PACE+ Adolescent PA
Measure (Prochaska et al,Arch Peds Adol Med 2001),
which has evidence ofvalidity (see two supportive
validation studies cited in the

Findings

Additional comments

Data used for grading
because it fits thebenchmark (it measuresintensity, MVPA, andreports the % achieving≥60mins of MVPA on all 7days) & meets the threecriteria of being recent,representative, and noevidence of large bias.

No new HBSC data since the2016 report card. The grade
for this indicator has been
carried forward from the2016 because no data
sources since the previous
card have measured thisindicator according to thebenchmark. The HBSC 2014
was the data source used to7

2013 longform report cardand Hardie Murphy et al
BMC Public Health 2015)
Questions: A definition of
MVPA is provided along withsome examples of PA. Add
up all the time you spend in
PA each day. Over the past 7
days, on how many days
were you physically active fora total of at least 60 minutes
per day? (0, 1, 2, 3, 4, 5, 6, 7)

Publication: McCrorie P, Mitchell R, Ellaway A. Comparison of
two methods to assess physical activity prevalence in children:
an observational study using a nationally representative
sample of Scottish children aged 10–11 years. BMJ Open2018;8:e018369. doi:10.1136/bmjopen-2017-018369
Survey: Data collection took place between May 2015 and May
2016.

A nationally
representative sample of 1011 yr old children. 2402
children took part in GUS
sweep 8 interviews, 90%(n=2162) consented to becontacted for theaccelerometer study (known
as SPACES study), 1096 (51%)
children took part in theaccelerometer data collection
and 774 participants (427 girls,
357 boys) met inclusion
criteria (i.e. provided ≥4
wkdays and ≥ 1 day of wkenddata) .

Method: Actigraphaccelerometers used tomeasure % of children with≥60 min MVPA on each dayof wear (daily approach) and% of children with ≥60 min of
MVPA on average acrossdays of wear (averageapproach). Data presented
for boys and girls, SIMD andseason. Evenson cut-pointfor MVPA (>2296 cpm).

Summary: 18% of 11-15
yr olds achieved ≥60mins
of MVPA/day on all 7
days (21% of boys and
15% of girls). Grade = F
for adolescents% meeting guidelines by
age and gender:-11 yrs = 30%M, 21%F
-13yrs = 19%M, 13%F
-15yrs = 15%M, 11%F
Boys more likely to meet theguidelines than girls at all
three age groups.
% meeting the guidelines ishigher in 11 year olds, with amarked decrease between
ages 11 and 13, especiallyamong boys.
Data not reported bydeprivation.

Data cannot be used forgrading as limited to one
age group (10-11 yearolds). However, 11% of
10 to 11 year olds
achieved ≥60 mins of
MVPA/day on each day ofwear, which supports theF grade (based on HBSC
data, see above).
Grade = F for 10-11 year
olds

grade this indicator in the2016 report card

Note: in the SHeS 2017
(which reports the % meeting
the guidelines every day,though intensity notmeasured, see below), 28%
of 11-12 yr olds and 18% of
13-15 yr olds meet theguidelines so quite similar to
HBSC 2014.

The findings also show the
disparity in the % of children
meeting the guidelines using
the daily approach (11.1%) vs
the average approach(68.3%). According to thepaper, the sample is nationally
representative and the analyses
were weighted to represent the
population. They compared datafrom their weighted sample vs
the GUS-weighted sweep 8
sample (which was considered
to represent the populationfrom which it came). In general,
the weighting was successful
across all variables.

8

Survey: Scottish Health Survey (SHeS) 2016
Publication: The Scottish Health Survey 2016: Volume 1: Main
Report (published October 2017)
http://www.gov.scot/Topics/Statistics/Browse/Health/scottishhealth-survey
Further data are available in supplementary web tables
http://www.gov.scot/Topics/Statistics/Browse/Health/scottishhealthsurvey/Publications/Supplementary2015/Supplementary2016
Technical report provides info on data collected and thequestionnaires used in the survey
http://www.gov.scot/Publications/2017/10/4796/downloads

Nationally representative
sample of 1325* children(2-15 yrs).
*this is the unweighted
bases for this variable
A copy of the SHeS 2016
data has been deposited at
the UK Data Archive, 2017
data not available via UKDS
(checked 24th Oct 2017).

Method: Self-report measure of
PA for children age 13-15 years
and parent proxy-reported
measure of PA for children age
0-12 yrs.
Questions: Similar to previous
surveys, no information on
intensity is collected (except
those aged 13-15 are asked
about their walking pace). The
questions cover: Sports andexercise; Active play; Walking;Housework or gardening (forchildren ≥8 yrs). Parents/
Children were asked to provide
information on the duration ofthese activities for a typical
weekday and typical weekend
day i.e not asked to provide a
specific duration for eachseparate day. Data on each oftype of activity is summarised toprovide an overall measure ofPA, which takes into account the
average time spent in PA andthe number of active days in thelast week. Children were classed
as meeting the guideline =Active on 7 days in last week for
an average of ≥60 mins/day.

Data cannot be used forgrading because thesurvey does not measure
PA intensity and assumes
that all reported
activities are at least of amoderate intensity,
which substantiallyoverestimates the % ofchildren meeting theguidelines (this is thesame as the 2016 reportcard). In addition, thesurvey reports the % of 24 year olds meeting the≥60 mins/day MVPA
guideline, which is not
the correct PA guideline
for 2-4 year olds (i.e.
180mins/day of any
intensity PA). The same
issues occur in the 2015
SHeS.

Up to and including the 2016
survey, children were asked toprovide information on the
average duration of activities fora typical day and adherence tothe guidelines is calculated using
an average of at least 60
mins/day. In the 2017 survey,
the duration spent in each typeof PA on each day of theprevious week has beencollected. 33% of children aged
5-15 years achieved ≥ 60
minutes of MVPA every day of
the week (including activity at
school), data reported in main
report and webtables. Althoughthe 2017 survey produces amore realistic estimate ofcompliance, it still assumes that
all reported activities are at least
moderate intensity, so can’t be
used for grading.
Additional notes about 2017
SHeS: % of 2-4 year olds meetingthe 180 min/d guideline is notreported in main report orwebtables, the main reportdoesn’t mention this age groupat all (the web tables do but it’s
the 60min/d of MVPA guideline).
Compliance using the averageapproach has not been reported
in main report or web tables.

Survey: Growing Up in Scotland (GUS)
https://growingupinscotland.org.uk/about-gus/study-designand-methodology/

GUS is a longitudinal survey
involving three nationally
representative cohorts ofchildren: child cohort, birthcohort 1 (BC1) and birthcohort 2 (BC2).
Child cohort: 2008/09 was
the last year of data

BC1 age 10yrs/P6 2014/15: datacollected on: books and screen
time only (how many times inpast 7 days), involvement inorganised activities (but not sure
if info on frequency, intensityand duration collected) &household chores (again notsure if info on freq, intensity anddurn collected)

Data not used for grading
because the data has notbeen reported, it would
need to be obtained fromthe UK data service(UKDS), however it isunlikely that the PA datacollected could be used
to estimate compliance

Note: This info was takenfrom the GUS topic guide andstudy design info on website
and from the topic guide sentby the GUS researcher. I
have looked through the GUS
topic guide from the website
and the one sent by the GUS
senior researcher (but not the9collection, no further
collection planned
BC1: the most recent datacollection periods (i.e. from2014 onwards) were in
2014/15 (age 10 yrs/P6), a
short web and phonesurvey (web-cati) childrenin P7 (age 11 years) and2017/18 (age 12 ys/S1)
BC2: the most recent datacollection periods were (i.e.
from 2014 onwards) werein 2013/14 (age 3 years)
and 2015/16 (age 5 years

BC1 age 11 years/P7: datacollected on: Amount of timechild has done ‘active’ things
e.g. running, dancing,trampoline, riding a bike, kicking
a ball’ (as above) & involvement
in organised activities (as above)
BC1 age 12 yrs/S1 2017/18:
data collected on: involvement
in organised activities (as above)
BC2 age 5 yrs 2015/16: datacollected on: Read books, playedoutdoors, painting/drawing,
nursery rhymes/songs,
recognising letters etc, using acomputer/games console (Howmany times in last 7 days) but
footnote says ‘Only asks aboutsome of the activities listed’ &Amount of time child has done
‘active’ things e.g running,
dancing, trampoline, riding abike, kicking a ball (as above) &levels of PA from SHeS (can’t use
this as doesn’t measureintensity)
BC2 age 3 yrs 2013/14: datacollected on: Read books, playedoutdoors, painting/drawing,
nursery rhymes/songs,
recognising letters etc, using acomputer/games console (Howmany times in last 7 days) &amount of time child has done
‘active’ things e.g. running,
dancing, trampoline, riding abike, kicking a ball (as above)with the PA guidelines,
thus does not fit thebenchmark. Also, data
would be limited to two
age groups: BC1 age 10
years/P6 (2014/15) andBC2 age 5 yrs (2015/16.

actual questionnaires) to see
what would be relevant for
any of the AHKRC indicators
measured in any of thecohorts from 2014 onwards.
The GUS researcher told me
data available in the UKDS

Note: BC1 measured atage 10 years in 2014/15
were the cohort that took
part in the accelerometer
study, see McCrorie et al
above).
Data not available from
UKDS (but will be by theend of the year) for: BC1
age 11 years/P7 and12yrs/S1 (2017/18) andBC2 age 3 yrs 2013/14.

10

Indicator 3: Organised Sport and Physical Activity
Benchmark: % of children and youth who participate in organized sport and/or physical activity programmes. Note: the benchmark includes sport AND exercise/physicalactivities, so this indicator is not solely sport and the key word is ‘organised’ (i.e. the indicator is organised sport and physical activity). There is no recommendation for thefrequency/duration of organised sport and physical activity participation.
Summary of methods of measurement: All data sources used self/parent report.
Major gaps in Scottish data: Only one source (Scottish Health Survey) measured participation in organised sport & PA (in 2-15 year olds) according to the benchmark andthe prevalence estimate from this data source does not include participation in organised sport & PA within school lessons. Lack of data for 16 to 18 year olds.

Survey name, year data collected, name of the report and year reportpublished and link(s) to the document/survey

Details ofparticipants

Survey: Scottish Health Survey (SHeS) 2016
Publication: The Scottish Health Survey 2016: Volume 1: Main Report(published October 2017)
http://www.gov.scot/Topics/Statistics/Browse/Health/scottish-healthsurvey
Further data are available in supplementary web tables
http://www.gov.scot/Topics/Statistics/Browse/Health/scottish-healthsurvey/Publications/Supplementary2015/Supplementary2016
Technical report provides info on data collected and the questionnaires
used in the survey
http://www.gov.scot/Publications/2017/10/4796/downloads

Nationally
representative
sample of 1345*
children (2-15 yrs).
*this is theunweighted bases
for this variable
A copy of the SHeS
2016 data has been
deposited in the UK
Data Archive, 2017
data not available
via UKDS (checked
24th Oct 2017)

Method of measurement(including the questions
asked in the survey tomeasure the indicator)
Method: Self-report forchildren age 13-15 years
and parent proxy-reportfor children age 0-12 yrs.
Questions: The methodhasn’t changed since the2016 report card. No
information on intensity iscollected however intensity
isn’t mentioned in thebenchmark for thisindicator. Parents/Children
were asked: how many
weekdays & weekend days
did they do any sports or
exercise activities (notcounting things done aspart of school lessons) andhow long did they spend
doing these (this is for atypical weekday/weekend
day i.e. they did notprovide a specific duration

Findings

Additional comments

Data fits the benchmark as:
intensity is not mentioned in
the benchmark, thebenchmark is organised
sport and PA (i.e. not solely
sport) which the SHeS
measures (most of theexamples given areorganised sports & PA) )*For the GM3.0, the grade
was a B, based on 73% of
5-15 year olds (2-4 year
olds were not included).

Data used for grading
because it fits thebenchmark and meets thethree criteria of being recent,representative, and probably
relatively unbiased.
Grade = B, participation
was lower among children
from deprived areas*.
Summary: 68% of children
aged 2-15 years had
participated in sport and** Data on participation in
sports and exercise does notinclude sport and exercise
done in school lessons (i.e. thequestion says ‘not counting
things done as part of school
lessons’ however the schoolbased question combined alltypes of PA ‘how many days in
the last week did your child do
any activities (walking, sports,
exercise or other active
things) in lessons at school?’’
Further, the school-basedquestion only asks ‘in lessons
at school’ (i.e. PE)’ so ideallyrespondents should reportorganised sport/exercise done
within school but outwith
lessons (e.g. at lunchtime orafter school) against the11for each separate day). The
card (shown toparents/children) gives
examples of ‘sports andexercise activities’ andmost examples are oforganised sports andexercise which fits thebenchmark (but not all
examples are of organised
sport/exercise e.g. goingswimming, disco dancing).
Data reported as: the % ofchildren participating inany sport or exercise in thepast week; No. of days
children did 15+ mins ofsport or exercise (did thesame for 30+ mins)

Survey: Scottish Schools Adolescent Lifestyle and Substance Use Survey(SALSUS) 2015
Publication: The main reports on smoking, alcohol and drugs were
published in 2016. Additional reports, including one on lifestyle trends(title is ‘Teenage life trends’), was published in 2017
http://www.gov.scot/Publications/2017/05/2301
The 2015 questionnaire is available at
http://www.gov.scot/Topics/Research/by-topic/health-communitycare/social-research/SALSUS/Quest2015

A nationally
representative
sample of 25,304
children aged 13
years (S2) and 15
years (S4).

Method: A self-completion
survey administered byteachers in class under exam
conditions. 1st question: Have
you actively taken part in anyof these groups, clubs ororganisations during the last
12 months? One of theoptions was ‘Sports clubs,
gyms, exercise or dancegroups’. 2nd question: Here isa list of things that young
people sometimes do in their
free time, when they aren’t at

exercise in the past week
(70% for boys and 67% forgirls). Note: These figures do
not include organised sport &exercise done in school lessons
see comment next column**.
2017 SHeS, figure is 67%, withsimilar SES inequalities (sameissue about school lessons). The
2016 survey was used to grade
this indicator because we usedthe 2016 dataset to re-analyse
Active Play and Sedentary
Behaviours, the 2017 dataset
was not available at the time.
Participation by age & gender:
2-4yr: 52% (M 48%, F 56%)
5-7yr: 72% (M 69%, F 75%)
8-10yr: 79% (M 82%, F 77%)
11-12y: 75% (M 81%, F 69%)
13-15yr: 66% (M 74%, F 58%)
Participation (age 2-15 yrs) by
SIMD:
Least deprived (5th): 80%; 4thquintile: 70%; 3rd quintile: 67%;
2nd quintile: 67%; Most deprived(1st): 57%
Data for the first question
cannot be used for grading
because the duration is too longi.e. participation during the last
12 months
Data for the 2nd question cannot
be used for grading because thequestion is not measuring
participation in organised sportand PA (and only sport ismeasured, not organised PA)
which doesn’t fit the benchmark
and participation in sport at
school is not measured.

question on participation in
sports and exercise (notcounting things done as partof school lessons) but
whether respondents did thisis unclear [according topersonal contact with SHeS]
however it is likely that theywould report structured
activities done e.g. at an after
school club
-SHeS and ASOF report
participation in sport andexercise even though thefigures may not include school- data from 2014 SHeS were
not used in previous reportcards because the benchmark
was specifically organised
sport.

-

12

The technical report provides information on sampling, design,
weighting etc but no additional information on the questions relevant
to indicators in the report card

school. What about you? Oneof the items is ‘Do a sport e.g.
football, swimming’
Responses are: everyday,
most days, weekly, less often
and never. Data reported as %‘doing a sport’ on at least a
weekly basis (i.e. combined
responses for everyday, mostdays and weekly).

However, the findings(summarised below) are very
similar to those from the 2016
SHeS for this age group.
Summary: 66% of 13-15 yr olds
(75% for boys and 58% for girls)
reported ‘doing a sport’ on a
weekly basis
Participation by age, gender:
13 yr: 71% (M 77%, F 65%)
15 yr: 61% (M 72%, F 50%).

Survey: Growing Up in Scotland (GUS)
https://growingupinscotland.org.uk/about-gus/study-design-andmethodology/

GUS is a longitudinalsurvey involving threenationally
representative
cohorts of children:
child cohort, birthcohort 1 (BC1) andbirth cohort 2 (BC2).
Child cohort: 2008/09
was the last year ofdata collection, nofurther collection
planned. BC1: themost recent datacollection periods (i.e.
from 2014 onwards)
were in 2014/15 (age10 yrs/P6), a short
web and phonesurvey (web-cati) for
children in P7 (age 11yrs) & 2017/18 (age12 ys/S1). BC2: themost recent datacollection periods
were in 2013/14 (age
3 yrs) & 2015/16(5yrs)

Methods: data collected on‘involvement in organised
activities (but not sure if
info on frequency, intensityand duration is measured)’in BC1 at age 10yrs/P6(2014/15), age 11 years/P7
and age 12 yrs/S1(2017/18)

Data not used for grading
because the data has notbeen reported, it would need
to be obtained from the UKdata service, and would be
limited to one age group [i.e.
children in BC1 measured
age 10 yrs/P6 (2014/15)] as
data not available till the endof the year for: BC1 age 11
yrs/P7 and age 12 years/S1(2017/18).

NOTE: this info was takenfrom the GUS topic guideand study design info on
website and the topic guidesent by the GUS seniorresearcher (i.e. the actual
questionnaires have notbeen looked at). The GUS
researcher told me data
available in the UKDS

Survey: Scottish Household Survey (SHS) 2016
Publication: Scotland's People Annual Report: Results from the 2016
Scottish Household Survey (published September 2017)
http://www.gov.scot/Publications/2017/09/9979

Nationally
representative
survey, 10,470
households

Method: Households withsomeone aged from 8 to 21
years old were asked thequestions below.

Data not used for grading
because data reported for 8
to 21 year olds so adults areincluded. However, theNote: the 2017 SHS does
not have a chapter on
young people (the young
people questions are asked

13

The technical report for the 2016 survey was published in March 2018
and includes info on methodology and fieldwork e.g. overview ofsurvey, sample design, response rates, data collection methods
http://www.gov.scot/Topics/Statistics/16002/PublicationMethodology
The questionnaire for the 2016 survey is published separately
http://www.gov.scot/Topics/Statistics/16002/PublicationQuestionnaireinterviewcompleted (9,642
adult interviews
completed). Access
SHS data (incl datafrom 2016 survey)
via the Open Data
Platform(statistics.gov.scot)

Questions: Which, if any,of the activities on this carddoes the child/young adultregularly take part in?
Categories include: Any
sports or sporting activity
whether playedcompetitively or not.

method does not exactly fit
the benchmark as it
measures ‘any sport orsporting activity’ so it does
not mention ‘organised’ and‘organised physicalactivities’.

every 2 years), so no newdata for this indicator fromthe 2017 SHS.

14

Indicator 4: Active Play
Benchmark (any of the following could be used to grade this indicator): % of children and youth who engage in unstructured/unorganized active play at any intensity formore than 2 hours a day, % of children and youth who report being outdoors for more than 2 hours a day
Summary of methods of measurement: This indicator refers to participation in unstructured/unorganized physical activity/active play and time spent outdoors. Perceived
safety, access to, and availability of outdoor/indoor spaces and opportunities for PA are dealt with in indicator 7. All sources of data use self/parent report measures.
Major Gaps in Scottish data: One data source available for grading (the Scottish Health Survey, SHeS). The SHeS measures active play in 2-15 year olds but the main reports
and web tables for the 2015-2017 surveys did not report this indicator according to the benchmark, therefore we re-analysed the 2016 SHeS active play data according to
the benchmark (further information below). Biases in self/parent reports of active play are unclear. Lack of data on unstructured physical activity in 16 to 18 year olds, andon objective measures of active play and outdoor time across childhood and adolescence.
Survey name, year data collected, name of the report and year reportpublished and link(s) to the document/survey

Details of participants

Survey: Scottish Health Survey (SHeS) 2016
Publication: The Scottish Health Survey 2016: Volume 1: Main Report(published October 2017)
http://www.gov.scot/Topics/Statistics/Browse/Health/scottish-healthsurvey
Further data are available in supplementary web tables
http://www.gov.scot/Topics/Statistics/Browse/Health/scottish-healthsurvey/Publications/Supplementary2015/Supplementary2016
Technical report provides info on data collected and the questionnaires
used in the survey
http://www.gov.scot/Publications/2017/10/4796/downloads

Nationally representative
sample of 1345* children (215 yrs).
* This is the unweighted
bases for this variable.
A copy of the SHeS 2016
data has been deposited in
the UK Data Archive, 2017
data not available via UKDS
(checked 24th Oct 2017)

Method of measurement(including the questions
asked in the survey tomeasure the indicator)
Method: Self-report forchildren age 13-15 years andparent proxy-report forchildren age 0-12 yrs.
Questions: The methodhasn’t changed since the2016 report card. No
information on intensity iscollected however intensity
isn’t mentioned in thebenchmark. Parent/childasked: how many weekdays& weekend days did they do‘active things’ (not tocounting things done as partof school lessons) and how
long did they spend doingthese (for a typical
weekday/weekend day i.e.
they did not provide a
specific duration for each

Findings

Additional comments*Re-analysed data
used for grading
because it fits thebenchmark (i.e.
method measuresunstructured
activities) and meetsthe three criteria of
being recent,representative, noevidence of large
bias.

*2016 active play data has
not been reported
according to thebenchmark. We reanalysed the dataaccording to thebenchmark (using thecorrect SHeS weighting
variables). But the SHeS
categories for reporting
duration are 1.5hrs to <2hrs, 2 hrs to <2.5 hrs, 2.5hrs
to <3 hrs etc we used ≥2hrs
as the benchmark (rather
than >2hrs). However, as
the SHeS data doesn’t
include active play in school
lessons (see below) using≥2hrs is more conservativeand is close to thebenchmark.
**Adolescents were notexcluded, though they may
not ‘play’ this method

Grade = D (D- grade
for weekdays, C- forweekends, 33%
average of weekday
and weekend), D
overall***15

separate day). The card(shown to parent/child)gives examples of ‘active
things’ and the examples areof unorganised/unstructured
activities e.g. riding a bike,running about, playing active
games etc which fits thebenchmark. Parent/child has
to select the duration from alist of categories: <5 mins, 5mins to <15 minutes, 15mins to <30 mins, 30 mins to<1 hour, 1 hour to <1 ½
hours, 1 ½ hours to <2 hours,
2 hours to <2 ½ hours, 2 ½
hours to <3 hours, 3 hours to<3 ½ hours, 3 ½ hours to <4hours, 4 hours or more(please say how long). Data
reported as: No. of days inprevious week children did
15+ mins of active play and30+ mins- 26% of 2-15 year
olds** participated in
active play for ≥2
hrs/day on a weekday (28% for boys,
24% for girls), 40% at
the weekend (42%for boys, 38% forgirls). Note: No sig
difference boys vs girls
for wk day or weekend-2017 SHeS, thewebtables report
number of days active
playing (duration notprovided) so doesn’t fit
the benchmark and2017 dataset notavailable for re-analysis.
Also has same issue
about school lessons.
Participation in ≥2 hrs
by age:2-4yr: 47% weekday,
53% weekend
5-7yr: 26% weekday,
50% weekend
8-10yr: 22% weekday,
40% weekend
11-12y: 19% weekday,
30% weekend
13-15yr: 12% wkday,
19% weekend
Note: sig for age on
weekday & weekend
Participation in ≥2
hrs/wkday by SIMD:
Least (5th): 24%
4th quintile: 18%
3rd quintile: 33%

measures ‘active things’ i.e.
unstructured PA (e.g.
kicking a ball, riding a bike)which applies toadolescents.
***For the GM3.0, thisindicator was graded INC as
we hadn’t re-analysed the
SHeS data at this point- Data does not include
active things done in school
lessons (i.e. the question
says ‘not counting things
done as part of school
lessons’) however theschool-based question
combined all types of PA‘’how many days in the last
week did your child do any
activities (walking, sports,
exercise or other active
things) in lessons at
school?’’ Also, the schoolbased question only asks ‘inlessons at school’ (i.e. PE)’
so ideally respondents
should have reported
active things done within
school but outwith lessons
against the question on
participation in active
things (not counting things
done as part of school
lessons) but whether
respondents is unclear[according to personal
contact with SHeS]- SHeS and ASOF report
participation in active playeven though the figures
may not include school.
- data from 2014 SHeS
were not used in theprevious report card
because the benchmark for16

2nd quintile: 25% Most
(1st): 30%
Note: sig for SIMD

the previous report card
was ‘active outdoor play’,the SHeS measures indoor& outdoor active play.

Participation in ≥2
hrs/wkend by SIMD
Least (5th): 36%
4th quintile: 33%
3rd quintile: 51%
2nd quintile: 44% Most
(1st): 31%
Note: sig for SIMD

Publication: McCrorie P, Mitchell R, Ellaway A. Comparison of two
methods to assess physical activity prevalence in children: anobservational study using a nationally representative sample of
Scottish children aged 10–11 years. BMJ Open 2018;8:e018369.
doi:10.1136/bmjopen-2017-018369
Survey: Data collection took place between May 2015 and May 2016.

Survey: Scottish Household Survey (SHS) 2016
Publication: Scotland's People Annual Report: Results from the 2016
Scottish Household Survey (published September 2017)
http://www.gov.scot/Publications/2017/09/9979
The technical report for the 2016 survey was published in March 2018
and includes info on methodology and fieldwork e.g. overview ofsurvey, sample design, response rates, data collection methods
http://www.gov.scot/Topics/Statistics/16002/PublicationMethodology
The questionnaire for the 2016 survey is published separately
http://www.gov.scot/Topics/Statistics/16002/PublicationQuestionnaire

A nationally
representative sample of 10 to
11 year old children. 2402
children participated in GUS
sweep 8 interviews, 90%(n=2162) consented to becontacted for theaccelerometry study (known as
SPACES), 1096 (51%) children
took part in the accelerometerdata collection and 774
participants (427 girls, 357boys) met inclusion criteria (i.e.
provided at least 4 weekdays &at least 1 day of weekend data)

Nationally representative
survey, 10,470 householdinterviews completed (9,642
adult interviews completed)
Access SHS data (incl datafrom 2016 survey) via theOpen Data Platform(statistics.gov.scot)

The Spaces study alsocollected GPS data as wellas accelerometermeasures of PA so would
be able to use the GPSdata to provide info ontime spent outdoors,which would fit with thebenchmark ‘% of children
and youth who reportbeing outdoors for morethan 2 hours a day’

Data cannot be used
for grading as data
not available yet andwould be limited to asingle age group (10to 11 year olds).

Method: households withsomeone aged from 8 to 21
years old were asked thequestions below.
Questions: Which, if any, of theactivities on this card does thechild/young adult regularly takepart in? Categories include: Any
sports or sporting activity
whether played competitively
or not; any other outdoor
activities such as walking,angling, bird-watching, etc.
Multiple responses allowed.

Data cannot used forgrading because datareported for 8 to 21
year olds so adults
are included. Also,
the method does notmeasure the durationof outdoor activities
and the examples
given are not active
play, which doesn’t
fit the benchmark.

.

Note: the 2017 SHS
does not have achapter on young
people (these young
people questions are
asked every 2 years)
so no new data on thisindicator

17

Survey: Growing Up in Scotland (GUS)
https://growingupinscotland.org.uk/about-gus/study-design-andmethodology/

GUS is a longitudinal survey
involving three nationally
representative cohorts ofchildren: child cohort, birthcohort 1 (BC1) and birth cohort
2 (BC2).
Child cohort: 2008/09 was thelast year of data collection, nofurther collection planned. BC1:
the most recent data collection
periods (i.e. from 2014
onwards) were in 2014/15 (age10 yrs/P6), a short web andphone survey (web-cati)children in P7 (age 11 yrs) &2017/18 (age 12 ys/S1). BC2:
the most recent data collection
periods were in 2013/14 (age 3yrs) & 2015/16 (age 5 yrs

Methods: Data collected on‘Amount of time child has
done ‘active’ things e.g.
running, dancing,trampoline, riding a bike,kicking a ball’ (but not sure if
info on frequency andintensity collected) in BC1 atage 11 years/P7 and age 12
yrs/S1 (2017/18); BC2 at age
5 yrs (2015/16) and age 3 yrs(2013/14)

Data may fit thebenchmark as it
appears to measure theduration of
unstructured active
things however data has
not been reported, itwould need to beobtained from the UKdata service, and would
be limited to one agegroups as data only
available from UKDS for
BC2 age 5 yrs (2015/16).
Data not available tillend of the year for: BC1
age 11 years/P7 &12yrs/S1 (2017/18) andBC2 age 3 yrs (2013/14).

Survey: Health Behaviour in School-aged children (HBSC), the last
survey was 2014 (used in the previous report card) and the survey isconducted every 4 years, thus no new data/reports since the previous(2016) report card.

A nationally representative
sample of 10,839 children
aged 11 years (P7), 13 years(S2) and 15 years (S4).

Method: Self-reported measureof frequency and duration of
local greenspace use in thesummertime (i.e. not in the past
week/4 weeks) collected from
13 and 15 year olds (i.e. not 11
year olds). Questionnaires wereadministered from March-June,most returned in May, thus
some participants will havereported behaviour fromprevious year.
Questions: Frequency ‘Thinking of the summer
months, out of school hours
how often do you usually passthrough or spend time in any of
the following places in yourlocal area? Parks, play areas,
public gardens, woods, playing

Data cannot be used
for grading as it
specifically measures
time spent ingreen/natural
outdoor space (rather
than time outdoors
more generally), it
measures timeoverall in a week(rather than time perday) and somechildren may not bereporting recent
behaviour, overall themeasure does not fit
the benchmark.

Publication: HBSC 2014 Survey in Scotland National Report (publishedin 2015) http://www.cahru.org/content/03-publications/04reports/hbsc_nr14_interactive_final.pdf

NOTE: this info wastaken from the GUS topic
guide and study design
info on website and the
topic guide sent by the
GUS senior researcher(i.e. the actual
questionnaires have notbeen looked at). The GUS
researcher told me data
available in the UKDS

18

fields or sports pitches, golfcourses, beaches, canals, rivers
or by lochs or other types ofnatural open space, categories
ranged from <once a month toevery day. Duration – ‘Thinkingof the summer months, out ofschool hours how much timeoverall in a week do you usuallyspend in the following places inyour local area (see examples
above)? Categories ranged from
None to >=7 hrs/wk

19

Indicator 5: Active Transportation
Benchmark: % of children and youth who use active transportation to get to and from places (e.g., school, park, mall, friend’s house). All children and adolescents have tocommute to nursery/school and so potential for active forms of commuting is assumed to be 100%.
Summary of methods of measurement: all sources of data used self/parent report active travel (i.e. walking, cycling, scooting/skateboarding, and park & stride) tonursery/school.
Major gaps in Scottish data: Two sources of data available for grading (Hands Up Scotland Survey and Transport & Travel in Scotland), however data focuses on commute to
and from nursery/school (for 3 to 18 year olds), lack of data on active commuting to and from other places.
Survey name, year data collected, name of the reportand year report published and link(s) to the
document/survey

Details of participants

Survey: Hands Up Scotland Survey (HUSS) 2017
Publication: Travel to School in Scotland Hands Up
Scotland Survey 2017: National Summary Report(published May 2018)https://www.sustrans.org.uk/scotland/hands-upscotland-survey

Nationally
representative surveyof 41,845 nurserychildren and 473,160
school pupils (466,956
were state school
pupils, equating to
67.8% of all stateschool pupils enrolled
in Scotland)

Method of measurement(including the questions asked
in the survey to measure theindicator)
Method: Survey completed inclass, pupils of primary andsecondary school age areasked to respond to the survey
themselves, assistanceprovided to nursery children
or SEN school pupils if
required. Question: ‘How doyou usually travel to school ?’with 8 response options: Walk,
Cycle, Scooter/skate, Bus, Park& stride (driven part of theway by car and walk the rest),
Driven (car), Taxi, Other, whichis then categorised in thefollowing way:
Active travel: walking, cycling
and scootering or skating,Public sustainable travel: bus,
Multi-mode travel: park &stride Private motorised
travel: driven (car) and taxi.

Findings

Additional comments

Data used for grading as it fits
the benchmark (though only
covers active travel tonursery/school, not to otherplaces) and meets the threecriteria of being recent,representative, and probably
fairly unbiased- For the GM 3.0, 2016 HUSS data
was used and data for nurserychildren not included (thisindicator graded as C for GM
3.0)

Grade = C for primary andsecondary school pupils, Cfor nursery children
Summary: 49% of school
pupils usually commute
actively (42% walk, 4% cycle
and 3% scooter/skate), a
further 10% normally park &stride. 42% of nurserychildren usually commute
actively (35% walk, 3% cycle
and 4% scooter/skate), with afurther 4% by park & stride.
Figures above have been rounded.

Note: in this survey, walking,cycling, scootering or skating falls
into the active travel category,whereas park and stride falls into
the multimode travel category.
Also, the report says ‘48.8% ofschool pupils surveyed in 2017 said
they normally travel to school in an
active way, without any form of
motorised transport’ i.e. park andstride is not considered to be amode of active travel.

-a more detailed breakdown isavailable for travel mode byschool type (i.e. primary,20

Active travel by school age(note: figures below have beenrounded and do not include pupils
from SEN or independent schools)-53% primary & 43% secondary
travel actively-44% primary & 41% secondarywalk-5% primary & 1% second cycle-4% primary & 0.2% secondary
school pupils scooter/skate-13% primary & 4.5% secondarypark and stride

Survey: Transport & Travel in Scotland 2017
Publication: Transport & Travel in Scotland 2017, a
National Statistics Publication for Scotland (published
Sept 2018)
This document reports the results of the transport andtravel related questions (and travel diary) asked in the2016 Scottish Household Survey
https://www.transport.gov.scot/publication/transportand-travel-in-scotland-2017/

Nationally
representative subsetof the Scottish
Household Survey(SHS), data based on n=
1,830
parent/householder
reports.

Method: Householders withyoung people in the household
who are under the age of 18
and go to school were asked
the question below.
Question: How does [child]usually travel to school during
term time? 16 choices were
provided, the active travel
choices were walking andcycling. This question was also
asked in the ‘random adultinterview’ How do you usually
travel to work (orschool/college/University if in
FT education).

Data used for grading as it fits
the benchmark (though only
covers active travel tonursery/school, not to otherplaces) and meets the threecriteria of being recent,representative, and probably
fairly unbiased

secondary, SEN andindependent) and year group,from 2008 to 2017 and by local
authority but not by deprivation.

- travel by scooter/skating, and park
& stride not measured.
- a more detailed breakdown by

age is available)

Grade = C
Summary: 52% of children(52% of boys, 51% of girls)
walked to school and 1%
cycledActive commuting by age:
4-11 year olds: 58% walked, 1%
cycled12-18 year olds: 43% walked, 1%
cycledWalk to school by SIMD:
Most deprived (1st): 57%, 2nd
quintile: 59%, 3rd quintile: 47%,
4th quintile: 45%, least deprived(5th): 52%.

21

Indicator 6: Physical Fitness
Benchmark: Data on physical fitness indicators (e.g. cardiorespiratory fitness, grip strength, balance etc) should be interpreted using sex-specific and age-specific European
normative values from ‘Tomkinson et al European normative values for physical fitness in children and adolescents aged 9–17 years: results from 2 779 165 Eurofit
performances representing 30 countries Br J Sports Med Published (2017) 10.1136/bjsports-2017-098253’.
Major Gaps in Scottish data: There are no nationally representative data on indicators of physical fitness or motor competence in children and young people in Scotland.
Survey name, year data collected,name of the report and year reportpublished and link(s) to the
document/survey

Details of participantsMethod of measurement(including the questions
asked in the survey tomeasure the indicator)

Findings

We were unable to find any
nationally representative dataon indicators of physical fitness.
We also consulted with key
stakeholders from PEPASS,SportScotland, Active Scotlandetc, they were not aware ofnational data for this indicator.

Additional comments

Grade is the same as the grade forthis indicator submitted to theGM3.0)

Grade = INC

22

Indicator 7: Diet
Benchmark: % of children and adolescents consuming at least 5 portions of fruit and vegetables a day, % of children and adolescents meeting the Scottish Dietary Goals(SDGs) which were revised in 2016 (e.g. average intake of free sugars should not exceed 5% of total energy intake in children over 2 years, average intake of saturated fat
should not exceed 11% of total energy intake) https://www2.gov.scot/Topics/Health/Healthy-Living/Food-Health/DietaryGoalsScot
Summary of Methods of measurement: Self or parent report using 24-h recall for fruit and vegetable consumption and frequency of consumption of selected foods in the
Scottish Health Survey (SHeS), and 4-day non-weighed diet diary in National Diet and Nutrition Survey (NDNS). The Living Costs and Food Survey (LCFS) collects Scottish dataon household and eating out food and drinks purchases for every person >7 years of age in each household over a 14 day period using food diaries, which is used toestimate food consumption and nutrient intakes (in comparison to the 2013 SDGs) for a typical average household member (i.e. cannot be reported for children), further
detail provided in the table below. Other recent surveys include: an ‘assessment of the out of home food and drink landscape in Scotland (2015)’, which provides data on
the top 10 categories of food and drinks consumed out of home in Scotland in 2015 by children aged 0-12 years, and ‘monitoring of all food and drink purchased from retail(i.e. shops and supermarkets) for use within the home in Scotland (2010 – 2016)’, which provides data on the contribution of discretionary foods to total purchase ofenergy, fats and sugars (data cannot be reported for children). Data from these surveys cannot be used for grading as they do not fit the benchmarks described above,
however they do provide an insight into the (unhealthy) food and drink environment in Scotland, further information is provided in the table below.
Major gaps in Scottish data: The SHeS fruit and vegetable questions are semi-quantitative (which are used to estimate the % of 2-15 year olds meeting the 5-a-day
recommendation) but information on other foods describes frequency of consumption only and does not cover all foods and drinks (thus the data cannot be used toestimate the % of 2-15 year olds meeting/exceeding the SDGs). The NDNS provides comprehensive food and nutrient intake data for children, which is used to calculate
average intakes of sugar, saturated fat etc and can be compared with the SDGs but the % of children and adolescents meeting/exceeding the SDGs is not reported. In
addition, as only approximately 200 children in Scotland are included per year in the NDNS only four year averages (e.g. 2008/9-2011/12) are published. National Diet andNutrition Surveys 2012/13 to 2013/14, and 2014/15 to 2015/16 are not available separately for Scotland. The 2008/09 to 2011/12 NDNS was reported for Scotland, thiswas used in the previous 2016 report card and has been used to inform the 2018 report card due to the lack of appropriate data that fit the benchmarks from other surveys
and data are still fairly recent.

Survey name, year data collected, name of thereport and year report published and link(s) tothe document/survey

Details of participants

Survey: Scottish Health Survey (SHeS) 2016
Publication: The Scottish Health Survey 2016: Volume
1: Main Report (published October 2017)

Nationally
representative sample of1345* children (2-15
yrs).

Method ofmeasurement(including the questions
asked in the survey tomeasure the indicator)
intervieweradministeredquestionnaire for a)
fruit and vegetable

Findings

In 2016, mean daily fruit and veg
intake in 2-15 yr olds was 2.8 portions(2.7 for boys, 2.9 for girls), little change
since 2003). 13% of 2-15 year olds met

Additional comments

This indicator was notincluded in the GM3.023

http://www.gov.scot/Topics/Statistics/Browse/Health/scottish-health-survey
Further data are available in supplementary webtableshttp://www.gov.scot/Topics/Statistics/Browse/Health/scottish-healthsurvey/Publications/Supplementary2015/Supplement
ary2016
Technical report provides info on data collected andthe questionnaires used in the survey
http://www.gov.scot/Publications/2017/10/4796/dow
nloads*This is the unweighted
bases for this variable
The SHeS 2016 data has
been be deposited at the
UK Data Archive, 2017
data not available via
UKDS (checked 24th Oct
2017)consumption in
portions per day in theprevious 24h, withhousehold measuresused to give examplesof portions (80g),
interviewers record fulland half portions but
nothing smaller and b)
frequency of
consumption of 16
selected other foods
e.g. oily fish, processed
meat, non-diet softdrinks and high fibre
breakfast cereals using
nine frequency options(‘6 or more times a day’to ‘less than 1 time permonth or never’).

Times in the last week
this household ate main
meal together, reported
as % in each category(i.e. never, 1 or 2 times,
3 or 4 times and so on)
but how would wereport this i.e. whatfrequency would weuse? Also reported by
SIMD etc

the 5-a-day guideline (11% boys, 15%
girls) and 9% ate no fruit or veg (10%boys, 9% girls). Grade = F% meeting 5-a-day by age
2-4yr: 13% (M 11%, F 15%)
5-7yr: 12% (M 11%, F 13%)8-10yr: 15% (M 11%, F 20%)
11-12y: 15% (M 13%, F 18%)
13-15yr: 11% (M 12%, F 11%)% eating no fruit & veg by age

The 2017 survey measuresand reports all the same
variables as the 2016 survey
except for the first time, the2017 survey measures foodinsecurity (by SIMD and byhousehold type e.g. single
parent household, large
family etc) and vitamin andmineral supplement use in
adults and children is also
reported

2-4yr: 4% (M 6%, F 3%)
5-7yr: 7% (M 6%, F 8%)
8-10yr: 11% (M 12%, F 10%)
11-12y: 12% (M 11%, F 12%)13-15yr: 12% (M 16%, F 8%)
Mean portions/day by age
2-4yr: 3.0, 5-7yr: 2.7, 8-10yr: 2.9,
11-12y: 2.7, 13-15yr: 2.5% meeting 5-a-day by SIMD
least: 18% (M 15%, F 21%)
4th: 16% (M 16%, F 16%)
3rd: 10% (M 7%, F 12%)
2nd: 10% (M 7%, F 12%)
most: 11% (M 10%, F 13%)% eating no fruit & veg SIMD
least: 6% (M 8%, F 4%)
4th: 7% (M 5%, F 8%)
3rd: 10% (M 13%, F 8%)
2nd: 11% (M 14%, F 8%)
most: 12% (M 11%, F 12%)Children in the most deprived areas
had on average 2.5 portions/day (2.624

for girls, 2.5 for boys) vs 3.2
portions/day among children in theleast deprived areas (3.4 for girls, 3.0
for boys): Intake by SIMD not included inmain report, data from webtables

Frequency of eating other foods*
Processed meat ≥ 2 times/wk: 51%
Sweets or chocolates ≥ once/day: 49%
Biscuits ≥ once/day: 34%
Cakes ≥ 2 times/wk: 34%
Non-diet soft drinks ≥ once/day: 31%
Crisps/savoury snacks ≥ once/day: 33%
Chips ≥ 2 times/wk: 40%
oily fish ≥ once a week: 17%≥2 slices of high fibre bread/day: 31%
high fibre/low sugar cereal ≥ 5times/wk: 28%
The frequency of eating these foods
was similar boys vs girls except forprocessed meats (higher among boys)
The frequency of eating foods high in
fat and/or sugar (i.e. processed meats,
sweets/chocs, biscuits, non-diet softdrinks, crisp and chips are similar in 24 year olds vs older children. Among 24 year olds, 50% eat sweets/chocs atleast once a day, 35% eat biscuits atleast once a day, 40% eat chips at least
twice a week.
Frequency of eating foods by SIMD*
Marked differences in least vs mostdeprived for: processed meat (38%least vs 64% most), sweets/chocolates(44% least vs 56% most), biscuits (27%least vs 34% most), cakes (37% least vs
28% most), non-diet soft drinks (22%25

Survey: National Diet and Nutrition Survey Rolling
programme Results from Years 1-4 (combined) for
Scotland (2008/09-2011/12), published 2014
https://www.foodstandards.gov.scot/publicationsand-research/publications/national-diet-andnutrition-survey-rolling-programme-results-fromyears-1-4This report combines data from the years 2008-2012
to provide a sufficient number of children in Scotland.

National Diet andNutrition Surveys
2012/13 to 2013/14, and2014/15 to 2015/16 are
not available separately
for Scotland so datafrom these surveys
cannot be used forgrading. The 2008/09 to
2011/12 NDNS
mentioned in theprevious column wasreported for Scotland
and data from thissurvey was used in the2016 report card.

Methods: 4-day nonweighed diet diary

least vs 44% most), crisps (26% least vs
38% most), chips (29% least vs 45%most), oily fish (24% least vs 8% most),
high fibre bread (35% least vs 28%most), high fibre/low sugar cereal(40% least vs 15% most)
In 1.5-3 y olds the energy intake was
4.88 MJ/d in boys and girls combined.
The mean energy intake in 4-10 y olds
was 6.77 MJ/d in boys and 6.20 MJ/din girls, while for 11-18 y olds meanenergy intake was 8.42 MJ/d in boys
and 6.41 MJ/d in girls. Total fat as a %food energy was 33.9 % in boys an
33.85 in girls (1.5-18y). Saturated fatty
acids provided 13.2% food energy inboys and 12.9% food energy in girl,while non-milk extrinsic sugars (similar
to added sugars) provided 15.8%
energy in boys and 14.9% energy ingirls, with the highest values of 16.3%
seen in the 11-18y old boys.

Scottish Household Survey 2016 and 2017 do notmeasure diet

SALSUS 2015 does not measure diet
Survey: Growing Up in Scotland (GUS)
https://growingupinscotland.org.uk/about-gus/studydesign-and-methodology/

No new NDNS data since the2016 report card. The grade
for this indicator has been
carried forward from the 2016
because no data sources since
the previous card havemeasured this indicatoraccording to the benchmark.
The NDNS 2014 was the data
source used to grade thisindicator in the 2016 reportcard, along with the %meeting the 5-a-day guidelinefrom the SHeS.

Note: the 2017 SHS does nothave a chapter on young
people (think these questions
are asked every 2 years)
GUS is a longitudinalsurvey involving threenationally representative
cohorts of children: childcohort, birth cohort 1(BC1) and birth cohort 2(BC2).
Child cohort: 2008/09
was the last year of datacollection, no further
collection planned. BC1:
the most recent datacollection periods (i.e.

Method: One of the topics is‘Food and eating’. Data
collected on:
Frequency/Amount of
Snacks, Fruit and Veg, Crisps,
Soft Drinks and Control ofchild’s consumption of sugary
snacks outwith the home in
BC1 at age 10yrs/P6(2014/15) and BC2 at age 5
yrs (2015/16) andage 3 yrs (2013/14).

Data not used for grading because thedata has not been reported, it would
need to be obtained from the UK dataservice, however data would be
limited to two age groups as data only
available from UKDS for: BC1 age 1011 years/P6 (2014/15) and BC2 age 5
yrs (2015/16). Data not available till
the end the end of the year for: BC2
age 3 yrs 2013/14.

NOTE: this info was takenfrom the GUS topic guide andstudy design info on website
and the topic guide sent by
the GUS senior researcher (i.e.
the actual questionnaires
have not been looked at). The
GUS researcher told me data
available in the UKDS
It’s not entirely clear what has
been measured in terms ofintake/frequency and who the26

from 2014 onwards)
were in 2014/15 (age 10
yrs/P6, sweep 8), a short
web and phone survey(web-cati) children in P7(age 11 yrs) & 2017/18(age 12 ys/S1, sweep 9)
BC2: the most recent
data collection periods
were (i.e. from 2014
onwards) were in
2013/14 (age 3 yrs,
sweep 2) & 2015/16 (age5 yrs, sweep 3)

Survey: Living Costs and Food Survey (LCFS) data fromyears 2013 to 2015 published in:
1) Food Standards Scotland. Estimation of food andnutrient intakes from Living Costs and Food
Survey data in Scotland (2001 – 2015), interim
report published November 2017
http://www.foodstandards.gov.scot/publicationsandresearch/latest-estimation-of-food-andnutrient-intakes-interim-report
2) Estimation of food and nutrient intakes from foodpurchase data in Scotland 2001 – 2015, full reportpublished June 2018https://www.foodstandards.gov.scot/downloads/
D19-01_Final_Report_2001-2015_-_130618.pdf
3) Note: a lot of the data from the above
publications is reported in the FSS Situation
Report: The Scottish Diet: It needs to change 2018
updatehttps://www.foodstandards.gov.scot/downloads/
Situation_report_-_the_Scottish_diet__it_needs_to_change_-_2018_update_FINAL.pdf

The LCFS is an annual
survey and includes arepresentative sample ofhouseholds in mainland
Scotland, ~550
households (approx.
1300 people/year)

Data collected on
respondent's intake ofsnacks/crisps/soft drinks (itisn’t clear but assuming
respondent means parent) in
BC1 at age 10yrs/P6(2014/15) and BC2 at age 5
yrs (2015/16)
Also collects data on: theMain/Evening Meal (where,
who with) in BC1 at age
10yrs/P6 (2014/15) and BC2
at age 5 yrs (2015/16) andage 3 yrs (2013/14). Also
collects data on the Main
Meal (whether home cooked,
take away, restaurant etc) in
BC2 at age 5 yrs (2015/16).
Method: Provides robust
estimates of foodconsumption and nutrient
intakes from 2013 to 2015 in
Scotland. These reports also
include data from 2001 tolook at differences over timeand by SIMD.
The survey collects
information on household
and eating out food anddrinks purchases for every
person >7 years of age ineach household over a 14 day
period using food diaries.
Results are an estimate of atypical average household
member. Info is based onfood and drinks purchased
rather than actual
consumption, however waste
and other conversion factors
are used to estimate theamount of food that was
consumed for bothhousehold and eating out

respondent is, would need tolook at the actual
questionnaires for more info.

Data not used for grading as theresults are an estimate of a typical
average household member, thiscannot be reported for children or forparents.

This indicator was not includedin the GM3.0
Progress towards Scottish Dietary
Goals (SDG) is monitored mainly
using the LCFS data (except forthe calories goal, which ismonitored using data on
prevalence of overweight andobesity from SHeS and ofcommercial data on total calories
purchased (this is the otherreports ive looked at in thistable). Note: these publications
based on LCFS data measureprogress towards the 2013 SDGs
not the 2016 SDGs. The 2016
SDGs for sugar have changed, thegoal is now 5% and its free sugars
rather than NMES (free sugars
and NMES differ slightly), theinterim report and full reportreports intake of NMES rather
than free sugars. Free sugars are
all monosaccharides anddisaccharides added to foods by27

Survey and publication: An assessment of the out ofhome food and drink landscape in Scotland (2015)
https://www.foodstandards.gov.scot/publicationsand-research/publications/an-assessment-of-the-outof-home-food-and-drink-landscape-in-scotland
There’s a notes booklet to accompany this (which ismore informative than the report)
https://www.foodstandards.gov.scot/downloads/An_
assessment_of_the_out_of_home_market_in_Scotlan
d_2015_-_Notes_booklet.pdf
Note: some of the data* from the above publication isreported in the FSS Situation Report: The Scottish Diet:
It needs to change 2018 update
https://www.foodstandards.gov.scot/downloads/Situ
ation_report_-_the_Scottish_diet__it_needs_to_change_-_2018_update_FINAL.pdf

Data collected by Kantar
Worldpanel between
January 2010 andJanuary 2017, fromaround 2,625 Scottish
household panellists
each year. The data set
is robust in terms ofsample size, andrepresentation of theScottish population.
Children up to 16 were
only included, if
accompanied by an adult
who completed thesurvey on their behalf.
Unaccompanied children
were not represented
within this sample.

purchases. Results arereported as population
average intakes/mean daily
consumption per person offoods, nutrients, energy
density, food and drinks
indicative of diet quality etc.
Estimates mean foodconsumption and nutrient
intake for Scotland based onhousehold and eating out
food and drinks purchases.
Method: Database used tomeasure food and drink
purchasing behaviour out of
home. Consumers are asked
through an online survey
about their out of homeconsumption behaviour on
the previous day, and this isreported on a monthly basis.
The database captures
prepared food and drinksthat are consumed both on
and off the premises, fromrestaurants and retail outlets.
The total out of home foodand drink market is split into
Commercial and NonCommercial out of home
categories. Commercial
includes: Quick service
restaurants (QSR) e.g. QS
burger, fish and chip,
sandwich, bakery, coffee,
pizza/Italian, ethnic, retailand petrol station outlets;
Pubs; Full service including FS
traditional, ethnic,
pizza/Italian & café/bistro;
Travel/Leisure e.g hotels, instore restaurants, bars andclubs, motorway service
stations, ice cream shops &entertainment outlets.

the manufacturer, cook or
consumer, plus sugars naturally
present in honey, syrups andunsweetened fruit juices. Lactose
when naturally present in milk
and milk products is excluded.
The goal for fibre has alsochanged.

Data not used for grading as there are
no benchmarks, recommendations or
dietary goals to grade data against.
*FSS situation report uses data fromthis survey to report the top 10
categories of food and drinks
consumed out of home in Scotland in2015 for all ages and by children aged
0-12 years vs all ages (% incidence
reported).
*In Scotland many of the top food andbeverage items consumed out of thehome tend to be less healthy, andinclude Chips/French Fries,
Cakes/Biscuits/Pastries and RegularCola.
*Less healthy options such as Beef
Burgers and Chips, sugary drinks,Fried/Breaded Chicken and Ice Creamare consumed more frequently bychildren aged 0-12 yrs in the out ofhome market compared to all ages.
For example the incidence of regularcola is 10.1% for all ages in Scotland,
compared with 16.7% in children aged
0-12 yrs.

This indicator was notincluded in the GM3.0
The key findings of the report
include:the top 10 Food andBeverages consumed (incl
Burger, Regular Cola, Chips,
Juice Drinks, etc) out of homeby children aged 0-12 yrs in
Scotland in 2015 vs all ages (%incidence reported for each ofthese food and drink items).
Shows that children between
0-12 yrs consume these typesof foods more often out ofhome than adults i.e. %incidence for chips, burgers,
regular cola etc is higher forchildren 0-12 yrs than theoverall population.

28

Non-commercial includes:
Workplace outlets,
College/university, Vending
machines
Excluded are Hospital, schoolor prison meals, Events
catering‘Out of home’ refers to: Anyfood or drink purchased and
immediately consumed
outside the home and any
take-away or home delivered
food, such as pizzas.

In 2015, the average person in
Scotland visited an out of homeestablishment 177 times (similar to
average number of visits in GB)
Quick service restaurants (QSR) holdthe largest proportion of visits in
Scotland compared to any otherchannel out of home, and within QSR
the most popular sub channels are
Retail/Supermarkets, QS Burger, QS
Coffee and QS Ethnic.

The database measures:
Visits: The total number ofvisits made by everyone in
the sample. Meal Occasion:
One party is one mealoccasion, whether with only 1
person or more. Average visit
per capita: Number of visits
divided by the population.
Number of servings:
Whatever the size or portion,
one food item is one serving.
Incidence: The % of all visits
which contains a food item.

Survey and Publications: Monitoring retail purchaseand price promotions in Scotland (2010 – 2016)
published February 2018 by Food Standards Scotland.
The FSS previously published (in Jan 2016) data on
take home food and drink purchase in Scotland (20102015), this 2018 report updates previous key findings(I have looked at both reports)
https://www.foodstandards.gov.scot/publicationsand-research/publications/monitoring-retailpurchase-and-price-promotions-in-scotland-20102016
Note: some of the data* from the above publication isreported in the FSS Situation Report: The Scottish Diet:
It needs to change 2018 update

Method: The Food Standards
Scotland (FSS) dietary
surveillance programme
includes monitoring of retailfood and drink purchased
into the home in Scotland,
using market research datafrom Kantar Worldpanel. This
report provides information
on retail purchase and pricepromotions in Scotland
between 2010 and 2016.
Data is collected on all foodand drink purchased into thehome (panel members scan

Data not used for grading as theresults present purchase data onlyand does not necessarily equate toconsumption, also data cannot bereported for children or parents.
Examples of data reported:
Discretionary foods contributed
considerably to purchase of calories(24%), total fat (25%), saturated fat(28%), total sugar (37%) and sodium(11%).
Large reductions in sugar purchasedfrom soft drinks have been offset byThis indicator was not includedin the GM3.0
Note: The data refers to takehome (retail) purchase i.e. All
food and drink purchased fromshops/supermarket for use within
the home , i.e. all grocery
shopping. It excludes anythingwhich was purchased for
immediate consumption outside
the home (OOH) such as a
sandwich purchased at a shop ora meal purchased in a restaurant(evidence suggests spend OOH isincreasing and provides around29

https://www.foodstandards.gov.scot/downloads/Situation_report_-_the_Scottish_diet__it_needs_to_change_-_2018_update_FINAL.pdf

the barcodes of all products
purchased into the home),
which are then categorised.
Data on volumes of food anddrinks purchased are
combined with nutrition
information from productlabels to estimate totalpurchase of calories, fats,sugar and salt into the homein Scotland as well as inrelation to 73 food and drink
categories, also by SIMD andin relation to purchase on
promotion (see othercolumns for examples of datareported).

increases in sugar purchased fromother categories.
% of healthier (e.g. fruit, veg, oily fish)
and less healthy foods (e.g. ice cream,
confectionary) and drinks purchasedon price promotion. Around 36% of
the calories purchased fromshops/supermarkets are on promotion
and purchase on promotion is skewed
towards less healthy categories (a key
finding reported in the FSS situation
report).

11% of our calories). This dataalso excludes take-away food anddrink (including home delivered
take-away food). Thus, the data
is not a complete picture of
consumer food and drink
purchase in Scotland, andincludes purchase data only anddoes not necessarily equate toconsumption, as factors such aswaste and cooking losses havenot been accounted for.
Note: Data from this survey onsugars relates to total sugars andnot free sugars, which are thebasis of current dietary
recommendations. Obtaining
data on free sugars would requireconversion of total sugar data on
nutrition labels. However, formany discretionary productcategories it can be assumed thatthe majority (if not all) of thesugar contained within them is
free.

30

Indicator 8: Obesity
Benchmark: Obesity is an excess of body fatness (a level of body fatness which increases risk of disease) and so, ideally, the prevalence of obesity should be estimatedbased on body fatness measures from national surveys. In Scotland, as in most other countries, body fatness is not measured and a simpler proxy for body fatness, the Body
Mass Index (BMI) is used to estimate prevalence of obesity. BMI is much lower in children and adolescents than in adults and so for the age range 2-18 years, BMI should be
expressed relative to age and sex as a centile or SD score (SIGN 2003, 2010); for school-age children and adolescents these centiles or SD scores should be expressed or
calculated relative to UK 1990 reference data; for children aged up to 4 years the UK 1990 data have been replaced by growth standard data derived from the World HealthOrganisation multicentre growth reference study and so the WHO data and definitions should be used when estimating obesity prevalence of 2-4 year olds. Note that UK1990 reference data should not be used for toddlers and pre-school children, and adult BMI criteria (e.g. BMI > 30.0 to define obesity) should not be used until at least age
19 years.
Summary of Methods of Measurement: Two sources of data are available: the Scottish Health Survey (SHeS) measured height and weight in 2-15 year olds and the Child
Health Surveillance Programme measured height and weight in 5 year olds. Scottish Health Survey data for 16-18 year olds are reported separately and use adult BMI
criteria. The data sources used measured height and weight to calculate BMI, and for children and adolescents aged 2 to 15 years BMI data were interpreted using the UK
1990 BMI reference data. The data sources used BMI ≥ 85th percentile to define overweight and obesity and BMI ≥ 95th percentile to define obesity.
Major gaps in Scottish data: SHeS obesity prevalence data for older adolescents (16-18 year olds) are expressed using adult criteria, which is incorrect and substantially
underestimates the prevalence of obesity. SHeS data for 2-4 year olds are also expressed relative to UK 1990 reference data rather than the WHO multicentre growthreference. Obesity prevalence estimates from the SHeS are compromised further by the relatively small sample size in the survey, producing relatively unstable estimates ofprevalence and an inability to examine prevalence inequalities between subgroups. Regardless of how BMI is expressed or interpreted, systematic reviews have shown that
BMI provides highly conservative estimates of the prevalence of obesity (excessive fatness)-see Active Healthy Kids Scotland Report Card 2013 longform(www.activehealthykidsscotland.co.uk). The problem for surveillance is that the BMI has a moderately high false negative rate i.e. many children and adolescents who areexcessively fat have an apparently healthy BMI, thus Scottish surveillance data underestimates of the scale of the problem. BMI-for-age estimates were used to grade
obesity in 2018 as in previous years, but with the knowledge that this is a highly conservative perspective. There is a lack of data on obesity prevalence for 16 to 18 year
olds (since the SHeS used adult criteria rather than the UK 1990 reference data to define obesity in this age group) and for 2-3 year olds (the SHeS used the UK 1990 BMI
reference data instead of the WHO growth standard data to define obesity in children aged up to 4 years.)

Survey name, year data collected, name of thereport and year report published and link(s) tothe document/survey

Details of participantsMethod ofmeasurement(including the questions
asked in the survey tomeasure the indicator)

Findings

Additional comments

Survey: Scottish Health Survey (SHeS) 2016
Publication: The Scottish Health Survey 2016: Volume
1: Main Report (published October 2017)

Nationally
representative sample of1075* children (2-15
yrs).

Method: Measured height
and weight to calculate
BMI, interpreted using theUK 1990 BMI reference

Data are recent & from a nationally
representative sample, though BMI
based estimates of obesity prevalence
underestimate prevalenceThis indicator was not includedin the GM3.0
SHeS data do not use the correct
obesity definitions for 2-3 year31

http://www.gov.scot/Topics/Statistics/Browse/Health/scottish-health-survey
Further data are available in supplementary webtableshttp://www.gov.scot/Topics/Statistics/Browse/Health/scottish-healthsurvey/Publications/Supplementary2015/Supplement
ary2016
Technical report provides info on data collected andthe questionnaires used in the survey
http://www.gov.scot/Publications/2017/10/4796/dow
nloads*This is the unweighted
bases for this variable
The SHeS 2016 data has
been be deposited at the
UK Data Archive, 2017
data not available via
UKDS (checked 24th Oct
2017)data for all children aged
2-15 years. Nb. The WHO
growth standard data
should have been used forchildren aged up to 4
years. BMI ≥ 85th
percentile was used todefine overweight andobesity and BMI ≥ 95th
percentile was used todefine obesity.

substantially, thus not used forgrading.
Grade = INC
Summary: Among 2-15 year olds, 29%
were overweight incl obese (14% wereobese). 28% of boys and 29% of girls
were overweight incl obese (14% ofboys and 14% of girls were obese).
% overweight incl obese by age*
2-6 years = 25% (11% obese)
7-11 years = 29% (14% obese)
12-15 years = 33% (16% obese)
GIRLS*
2-6 years = 26% (14% obese)
7-11 years = 27% (10% obese)
12-15 years = 37% (19% obese)BOYS*
2-6 years = 25% (9% obese)
7-11 years = 31% (19% obese)
12-15 years = 29% (14% obese)*data by age not in main report, so
extracted from webtable
Prevalence of overweight incl obesity wassignificantly associated with SIMD
(according to the main report); highest in
the second most and most deprived
quintiles (32%-33%) and 25%-26% in lessdeprived quintiles (Note: this differs fromthe 2014 SHeS used in the 2016 reportcard, which found that being overweight(but not obese) was not associated withSIMD).
Obesity was not significantly associatedwith SIMD (according to the main report),
but the data shows (further detail below)that prevalence was higher (16%) in thesecond most and most deprived quintiles
vs 12% the least deprived quintile (Note:olds (which means theprevalence estimate is too low)and because BMI is conservative a large number of overly fat
children do not have a high BMI
Trends (wording from main
report): Prevalence ofoverweight incl obesity hasremained relatively stablebetween 1998 (29%) and 2016(29%), fluctuating between 28%
and 33% in the intervening years.
Prevalence of obesity is the samein 2016 (14%) as in 1998,
prevalence had been stable from2003 to 2014 (16% to 17%) but
has been steadily decreasing
since 2014 (17%), 15% in 2015,
14% in 2016 (significant decline
from 2014 to 2016), 13% in 2017.
This is an indication of adownward trend, the decline inprevalence of obesity in all
children has largely been driven
by the decline in prevalence
among boys from a peak of 20%
in 2011 to 12% in 2017.
-However, according to data fromthe CHSP (see below) the % ofchildren in P1 classed as
overweight (85th - <95th) andobese (≥95th) has remained
broadly similar/increased v
slightly (11.9% to 12.4% for
overweight, and 9.2% to 10.5%
for obese). From 2013/14 to
2016/17 (i.e. same time period as
the SHeS above), the prevalenceof overweight, and obesity has
been broadly similar (12.5% to12.4% for overweight, 10.1% to10.5% for obese), i.e. nodownward trend, unlike the32this differs from the 2014 SHeS used in the2016 report card, which found that from2009 to 2014 children in the least deprived
areas had the lowest levels of obesity andthose living in the most deprived areas had
the highest levels of obesity. Also, datafrom the CHSP, found that the % of P1children classed as overweight and inparticular obese increased as deprivation
increased, the sample size is much larger
for the CHSP dataset.
% (age 2-15 yrs) overweight incl obese by
SIMD (2015/16 combined**)Least deprived = 25% (12% obese)
4th quintile = 26% (14% obese)
3rd quintile = 25% (12% obese)
2nd quintile = 33% (16% obese)
Most deprived = 32% (16% obese)**data extracted from main report uses
combined data from 2015/16

Survey: Child Health Surveillance Programme School(CHSP School) Primary 1 Review: School Year 2016/17
Publication: ISD Scotland Body Mass Index of Primary
1 Children in Scotland School Year 2016/17 (publishedDec 2017) https://www.isdscotland.org/HealthTopics/Child-Health/Publications/2017-12-12/201712-12-P1-BMI-Statistics-Publication-Report.pdf
For data tables (including 95%CIs) see
http://www.isdscotland.org/Health-Topics/ChildHealth/Publications/datatables2017.asp?id=2070#2070

In school year 2016/17 a
total of 51,529 children
had valid height andweight measurements
recorded in Primary 1(83.5% of all children inPrimary 1).

Method of measurement:
Routinely collected height
and weight measurements
at Primary 1 healthreviews. BMI calculated
and interpreted using theUK 1990 BMI reference
data. BMI ≥ 85th
percentile was used todefine overweight andobesity and BMI ≥ 95th
percentile was used toData are recent & nationally
representative sample, though BMI
based estimates of obesity prevalence
underestimate prevalence
substantially, thus not used forgrading. Data are from a very large
sample of children in P1 (83.5% of allchildren in P1 provided a valid height
and weight measure).
Grade = INC

SHeS, although the CHSP only
measured one age group, thesample size is much bigger so wehave a lot more confidence inthese estimates.
-English data from the National
Child Measurement Programme
for P1 and P7 shows: a significant
downward trend from 2006/07
to 2016/17 in obesity prev andoverweight prev in reception
boys. But overweight prevalencein Reception girls show a newly
significant upward trend and nochange for obesity prev. There
are increasing trends in obesity
prev, with no change inoverweight prev in Year 6 boys
and girls. Analysis by Index ofMultiple Deprivation (IMD)
continues to show a widening
inequality gap in the overweight
and obese categories for allgroups – Reception boys andgirls, and Year 6 boys and girls.
The slope index of inequality forobesity is greater in Year 6 boys
and girls than in Reception boys
and girls, and has been widening
at a faster rate in Year 6 than in
Reception
This indicator was not includedin the GM3.0

Trends: From 2007/08 to
2016/17, the % of children in
P1 classed as overweight (85th- <95th) and obese (≥95th) has
remained broadly
similar/increased v slightly(11.9% to 12.4% for
overweight, and 9.2% to 10.5
for obese). From 2013/14 to

33

define obesity. P1 review
also measures gross motor
skills, social skills etc butthese are not in thebenchmarks.

Summary: 22.9% of P1 children were
overweight incl obese (boys 23.2%,
girls 22.6%); 12.4% were overweight(Boys 12.5%, Girls 12.4%) and 10.5%
were obese (Boys 10.7%, Girls 10.2%) .
Note: The gap between boys and girls has
narrowed over time (from 2007/08 to
2016/17).
Note: Can’t compare the above figureswith SHeS data because the age category
used in the SHeS is 2-6 years (and thewrong obesity definition is used for 2-3
year olds). In 2016/17, English data fromthe NCMP reported obesity prev at 10% forreception boys and 9.2% for reception girls,
so similar to above prev estimates.

% overweight incl obese bydeprivation
Least = 18.3% (11.2% OW, 7.1% obese)
4th = 20.9% (12.3% OW, 8.5% obese)
3rd = 22.8% (12.3% OW, 10.5% obese)
2nd = 24.9% (12.8% OW, 12.1% obese)
Most=26.4% (13.3% OW, 13.2%
obese). Report says ‘The percentage ofchildren classed as overweight and inparticular obese increased as
deprivation increased’ (doesn’t say if
this is significant).

2016/17 (i.e. same time
period as the SHeS above),the prevalence of overweight,
and obesity has been broadly
similar (12.5% to 12.4% for
overweight, 10.1% to 10.5%
for obese), i.e. no downward
trend (unlike the SHeS,
although the CHSP only
measured one age group, thesample size is much bigger so
we have a lot more
confidence in these estimates.
See the additional column
section of the SHeS above fortrends in English Reception
and Year 6 children from the
NCMP.
-The data tables report %overweight and % obese (and95%CIs) overall, by gender, by
SIMD from 2007/08 to 2016/17.
-Data also reported for each NHS
Board but data from NHS boards
with small numbers of children
measured should be interpretedwith care as the small numbers
may result in fluctuations in the%s from year to year (this may
apply to SHeS data esp whenreported by age or by SIMD)-There is variation in the timingof the Primary 1 measurement
across NHS Boards, thus child's
age at measurement can range
from 4.5 to 6.25 years. In
2016/17, 50% of children wereaged between 4.5 and 5.5 years
at the time of measurement, and
48% were aged > 5.5 years to
6.25 years. However, as BMI
centile results are adjusted forage, this variation has a negligible

34

Survey: Child Health Surveillance Programme PreSchool (CHSP-PS) 27-30 month review.
Publication: ISD report, Child Health 27-30 Month
Review Statistics Scotland 2016/17 (published April2018) http://www.isdscotland.org/HealthTopics/Child-Health/Publications/2018-04-24/201804-24-Child-Health-27m-review-Report.pdf?

The 27-30 month review
is usually provided byhealth visitors and wasintroduced in April 2013

Technical report (I looked at this too)
http://www.isdscotland.org/Health-Topics/ChildHealth/Publications/2018-04-24/2018-04-24-ChildHealth-27m-review-Technical-Report.pdf?
Child health reviews are also carried out at 13-15
month and 4-5 year, these were introduced in April
2017. ISD stated ‘not all health boards have
implemented these reviews yet. Most boards are now
carrying out 13-15 month reviews but less than half
are carrying out 4-5 year reviews, and we anticipate it
may be 2020 before these reviews are fully
implemented. Therefore there are no publications onthese as yet. Height and weight are captured, where
possible, at these reviews.

Methods: Assesses childdevelopment in 8 domains:
personal/social,emotional/behavioural,
speech/language/communica
tion, fine motor, gross motor,
vision, hearing, problem
solving and all parents
complete an ages and stages
questionnaire. Prior to April
2017 there were 9 domains,from April 2017 there areeight domains (some weremerged and problem solving
was added). It looks like from
April 2017, thequestionnaires used /infocollected and when (i.e. allparents vs if/when healthvisitors suspected a problem)
is more standardised than
before April 2017 i.e. NHS
Boards adopted different
approaches, such as using
different questionnaires(from a recommended list)
and some offeredquestionnaires to all
children/parents and others
administered them if/when aproblem was suspected.

No BMI data available. Data on childheight/weight/BMI has not beenreported in any of the docs mentioned
above. I spoke to ISD who said thefollowing ‘the completeness ofrecording of height and weight at the
27-30 month review varies between
boards. For children who were eligible
in 2016/17, 70% of children had a valid
height and weight recorded in
Scotland. We don't currently publish
information on this due to the low
completeness, but we hope this will
improve over time’. Also, it looks likeeach health board get BMI data for
their board but they don’t report it
publicly and its not reported at anational level yet.
Results from 2008/09 to 2011/12 were
published in 2014 and used in the previous
report card, there has been no new survey
or data on BMI for children andadolescents in Scotland since then (see thediet indicator for further info).

Survey: National Diet and Nutrition Survey (NDNS) for
Scotland.

Survey: Growing Up in Scotland (GUS)
https://growingupinscotland.org.uk/about-gus/studydesign-and-methodology/

I have looked through all the looked
through the full reports and related
documents (i.e. summary reports and datatables) published in April 2018, Feb 2017,
Dec 2015, Dec 2014 and they all report the
proportion of children with adevelopmental concern in any domain andin each of the developmental domains
assessed.

impact on the BMI distribution
rates.
The following document
https://www.gov.scot/Resource/0041/00410922.pdf from the
Scottish Government provides‘guidance on the 27-30 monthchild health review’ in relation to
the core issues which should be
addressed and recorded at the
27-30 month review, andstandardised methods ofassessment to ensure consistencyof practice across Scotland. It was
published in Dec 2012 (i.e. before
the review started) and says that,nutrition, healthy eating, PA andgrowth (i.e. child healthy weight)
are core issues that should becovered in the review ‘The 27-30
month review should provide allfamilies with consistent messages
on healthy eating, family meals,
physical activity, screen time, andadequate sleep’ and ‘all children
should be offered measurementof weight and height as part oftheir 27-30 month review andshould be plotted on theappropriate UK-WHO (0-4 years)
growth chart and returned aspart of the national dataset to(CHSP-PS).

GUS is a longitudinal survey
involving three nationally
representative cohorts ofchildren: child cohort, birthcohort 1 (BC1) and birthcohort 2 (BC2). Child

Method: Child height andweight measured in BC1 atage 10 years/P6 (2014/15)
and 12 years/S1 (2017/18)
and BC2 at age 3 years(2013/14) and 5 years

Data are recent & representative,
though BMI based estimates of obesity
prevalence underestimate prevalence
substantially, thus not used forgrading. Also, data not been reported,

Also measures parent’s
perception of child’s weight at
BC2 at age 5 years and at age 3
years and in BC1 at age 10
years/P6 and age 12 years/S1(though this is not in any of the35

cohort: 2008/09 was thelast year of data collection,
no further collection
planned. BC1: the mostrecent data collection
periods (i.e. from 2014
onwards) were in 2014/15(age 10 yrs/P6), a short web
and phone survey (webcati) children in P7 (age 11
years) & 2017/18 (age12
ys/S1) BC2: the most recent
data collection periods
were (i.e. from 2014
onwards) were in 2013/14(age 3 yrs) & 2015/16 (age5 yrs)(2015/16). Not clear if/how
BMI data have beeninterpreted to define obesity(i.e. UK 1990 BMI reference
data or WHO growthstandards for young
children).

it would need to be obtained from the
UK data service and would be limited
to two age groups as data only
available from UKDS for: BC1 age 10
years/P6 (2014/15) and BC2 age 5 yrs(2015/16). Data not available till theend the end of the year for: BC1
12yrs/S1 (2017/18) and BC2 age 3 yrs
2013/14. Although the CHSP is only
one age group, the sample size is muchbigger.

benchmarks) but again would
only be available from the UKDS
for two age groups.
NOTE: this info was taken fromthe GUS topic guide and study
design info on website and I also
checked the topic guide sent by
the GUS senior researcher (i.e.
the actual questionnaires havenot been looked at). The GUS
researcher told me data available
in the UKDS.

36

Indicator 9: Family and Peers
Benchmark (any of the following could be used to grade this indicator): % of family members (e.g. parents, guardians) who facilitate physical activity and sport
opportunities for their children (e.g., volunteering, coaching, driving, paying for membership fees and equipment), % of parents who meet the Global Recommendations on
PA for Health (i.e. adults accumulate ≥150 minutes of moderate-intensity aerobic PA/week or ≥75 minutes of vigorous-intensity aerobic PA/week or an equivalent
combination of MVPA, % of family members (e.g., parents, guardians) who are physically active with their kids, % of children and youth with friends and peers who
encourage and support them to be physically active, % of children and youth who encourage and support their friends and peers to be physically active. These were thebenchmarks for the Global Matrix 3.0, however since child and adolescent diet and obesity are indicators in the Scottish report card, we have extended the benchmark to
include estimates of parental diet and overweight/obesity.
Summary of methods of measurement: One data source available; the Scottish Health Survey 2015 (reported in main report) used combined data from 2012-15 to provide
information on the % of parents (of children aged 2-15 years) who 1) met the adult physical activity guidelines, 2) were overweight and obese, 2) met the 5-a-day fruit andveg recommendation (though we had to re-analyse the data to obtain the relevant information, see table below). Physical activity and diet were measured by self-report,height and weight were measured. Reliance on self-report methods increases risk of bias.
Major gaps in Scottish data: As noted above, only one data source provided information on relevant parental health behaviours and outcomes. Dietary and PA data are
self-reported and prone to biases which underestimates the scale of non-adherence to dietary and PA recommendations, and BMI provides a conservative estimate ofobesity prevalence (as in children), there is a high false negative rate, particularly in women, so that obesity is much more prevalent than would be suggested by prevalenceof high BMI. Lack of parental data for 16 to 18 year olds.
Survey name, year data collected, name of the report andyear report published and link(s) to the document/survey

Details ofparticipants

Survey: Scottish Health Survey (SHeS) 2015
Publication: The Scottish Health Survey 2015: Volume 1: Main
Report (published October 2016)
http://www.gov.scot/Topics/Statistics/Browse/Health/scottishhealth-survey
Parent PA data are not available in the supplementary tables
Technical report provides info on data collected and thequestionnaires used in the survey
http://www.gov.scot/Publications/2017/10/4796/downloads

Nationally
representative
sample of 1558
fathers and 2584
mothers*. This is theweighted bases forthese variables fromthe 2012-15 dataset,
results reported in
the 2015 main
report. The SHeS
2012-15 data has
been be deposited at

Method of measurement(including the questions
asked in the survey tomeasure the indicator)
Method for Parental PA:
Interview administeredquestionnaire measures timespent, frequency and intensity(i.e. MVPA) for four maintypes of PA: Home-based PA,
walking, Sports and exercise,
PA at work, which is used toassess the % of adults (aged
16 to 75+ years) meeting theadult PA guidelines (i.e. 150
mins of MPA or 75 mins of
VPA or a combination of both.

Findings

Additional comments

Data on the % of adults
meeting the PA guidelines
cannot be used for grading
as doesn’t fit thebenchmark ‘% of parents
who meet the adult PA
guidelines’. Furthermore,
the % of children meeting
the PA guidelines byparental PA cannot be used
for grading because 1) wecannot use the child PA
data (see overall PA

This indicator was graded as
INC for the GM 3.0 as we hadn’t
attempted to re-analyse the
SHeS data at this point*Note: We accessed the 201215 dataset and attempted to
extract data on the % offathers/mothers/parents
meeting the PA guidelines,
however there were someissues with the variables thatneeded clarification from the37

the UK Data Archive,2017 data notavailable via UKDS
(checked 24th Oct
2017)

The 2015 SHeS main report
combined data from 2012-15
to report the % of children
meeting the PA guidelines byparental PA (i.e. father
meets/does not meet the PA
guideline, mother meets/do
not meet the guideline).

indicator for further
details) and 2) we areinterested in the % ofparents/fathers/mothers
meeting the guideline NOT
by child PA.* We used theweighted bases from Table
7.5 in the 2015 main report(which used 2012-15
combined data) to obtainthe following estimates**

SHeS analysts but despite
several attempts we did notreceive a response to some ofour queries.
**Note: %s for parental PA
cannot be calculated by age or
SIMD as this data has not beenreported in the tables of the
SHeS main report and there are
no webtables for parental PA.

Grade = B+ for fathers and
B for mothers

Survey: Scottish Health Survey (SHeS) 2015
Publication: The Scottish Health Survey 2015: Volume 1: Main
Report (published October 2016)
http://www.gov.scot/Topics/Statistics/Browse/Health/scottishhealth-survey
Parent PA data are not available in the supplementary tables
Technical report provides info on data collected and thequestionnaires used in the survey
http://www.gov.scot/Publications/2017/10/4796/downloads

Nationally
representative
sample of 2850
parents*. This is theweighted bases forthis variable from the
2012-15 dataset,
results reported in
the 2015 main
report. The SHeS
2012-15 data has
been be deposited at
the UK Data Archive,2017 data notavailable via UKDS

Method for Parental fruit &veg consumption:interviewer- administeredquestionnaire for fruit andvegetable consumption in
portions per day in theprevious 24h, with householdmeasures used to give
examples of portions (80g),
interviewers record full andhalf portions but nothingsmaller. Data used to report
the % of adults meeting the 5a-day guideline. The 2015
SHeS main report combined
data from 2012-15 to report

Summary: 77%(1201/1558) of children(77% of girls, 77% of boys)
had fathers who met theadult PA guideline and 71%(1844/2584) of children(70% of girls, 72% of boys)
had mothers who met theadult PA guideline.
Data on the % of adults
meeting the 5-a-day
guideline cannot be used
for grading as we areinterested parental fruit &veg intake. Furthermore,child fruit & veg intake byparental fruit & veg intake
cannot be used for grading
because we are interested
in parental fruit & veg
intake NOT by child fruit &veg intake.* We used theweighted bases from Table
6.5 in the 2015 main report(which used 2012-15

This indicator was graded as
INC for the GM 3.0 as we hadn’t
attempted to re-analyse the
SHeS data at this point*Note: We accessed the 201215 dataset and attempted to
extract data on the % offathers/mothers/parents
consuming 5+ portions of fruit &veg/day, however there weresome issues with the variables
that needed clarification fromthe SHeS analysts but despite
several attempts we did not38

(checked 24th Oct
2017)

the % of children meeting the
5-a-day guideline by % ofparents meeting the 5-a-day
guideline.

combined data) to obtainthe following estimates**receive a response to some ofour queries.

Grade = D-**Note: %s of parents
consuming 5+ portions of fruit &veg/day cannot be calculated byage or SIMD as this data has notbeen reported in the tables of
the SHeS main report and there
are no webtables on parental
diet. However, the webtables
report this data for adults aged
16+ years (there isn’t a
breakdown by age), 26% of
adults in the least deprived
quintile met the 5-a-day
guideline vs 15% in the mostdeprived quintile.

Summary: 26% (733/2850)
of children (27% ofgirls,25% of boys) had
parents*** who consumed
5+ portions of fruit &veg/day***the highest of any
resident parent.

Survey: Scottish Health Survey (SHeS) 2015
Publication: The Scottish Health Survey 2015: Volume 1: Main
Report (published October 2016)
http://www.gov.scot/Topics/Statistics/Browse/Health/scottishhealth-survey
Parent PA data are not available in the supplementary tables
Technical report provides info on data collected and thequestionnaires used in the survey
http://www.gov.scot/Publications/2017/10/4796/downloads

Nationally
representative
sample of 2087
parents *. This is theweighted bases forthis variable from the
2012-15 dataset,
results reported in
the 2015 main
report. The SHeS
2012-15 data has
been be deposited at
the UK Data Archive,2017 data notavailable via UKDS
(checked 24th Oct
2017)

Method for Parental weightstatus: Measured height andweight used to calculate BMI.
Overweight (incl obese) wasclassified (using WHO
categories) as BMI of 25 andover and Obese as BMI ≥30.
The 2015 SHeS main report
combined data from 2012-15
to report child BMI categories
by parental BMI categories.

Data on the % of
overweight and obese
adults cannot be used forgrading as we areinterested parental
overweight and obesity.
Furthermore, child BMI
categories by parental BMI
categories cannot be used
for grading because we areinterested in the % ofparents who are
overweight and obese NOT
by child BMI.* We used theweighted bases from Table
8.7 in the 2015 main report(which used 2012-15
combined data) to obtainthe following estimates**
Summary: 74%(1550/2087) of children

This indicator was graded as INC
for the GM 3.0 as we hadn’t
attempted to re-analyse the SHeS
data at this point*Note: We accessed the 2012-15
dataset and attempted to extract
data on the % of children withoverweight and obese
fathers/mothers/parents however
there were some issues with thevariables that needed clarificationfrom the SHeS analysts but despite
several attempts we did not receivea response to some of our queries.
**Note: parental overweight andobesity cannot be calculated by age
or SIMD as this data has not beenreported in the tables of the SHeS
main report and there are no
webtables on parental BMI
categories. However, the webtables
report this data for adults aged 16+
years (there isn’t a breakdown byage), obesity prevalence was higher39

(73% of boys, 75% of girls)
had at least one parent***
who was overweight incl
obese. 38% (788/2087) ofchildren (36% of boys, 39%
of girls) had at least one
obese parent. Note: theseprevalence estimates areslightly higher than theprevalence estimates for all
adults aged 16+ years and for
adults aged (25 to 54 years)
64% for overweight incl obeseand 29% for obese.

Grade = D-, for 26% ofchildren, neither parent isoverweight or obese

Survey: Scottish Health Survey (SHeS) 2016
Publication: The Scottish Health Survey 2016: Volume 1: Main
Report (published October 2017)
http://www.gov.scot/Topics/Statistics/Browse/Health/scottishhealth-survey
Further data are available in supplementary web tables
http://www.gov.scot/Topics/Statistics/Browse/Health/scottishhealthsurvey/Publications/Supplementary2015/Supplementary2016

Nationally
representative sample
of 4,323* adults (≥aged
16 yrs), and 1561*
children (2-15 yrs).
*This is the overall
number of adults andchildren for the SHeS, it
is unclear how many
provided data for thisvariable.

Method: Self-report forchildren age 13-15 years andparent proxy-report forchildren age 4-12 yrs.
Questions: Parents of 4-12
year olds and those aged 1315 years were asked about
their knowledge of the PA
guidelines for the under 5s
and those aged 5-18 years.
They were asked to write

Grade = D overall forparental PA (B+), diet (D-)
and overweight incl obese(D-) combined, slightly
more weighted towards
the grade for overweight
and obesity since this isobjectively measured
whereas diet and PA are
self-report and may beoverestimated.
Data doesn’t fit any of thecriteria in the benchmark
for this indicator so not
used for grading.

in the most deprived (33%) vs theleast deprived (23%).
***Explanation of the parental BMI
variable (taken from the 2015 main
report): Information on children’s
BMI by parental BMI is based onchildren in the main sample whereat least one of their parents was
also interviewed and had a valid
BMI measurement. For householdswith BMI measures for two parents,
the measure of parental BMI was
based on whichever parent’s BMI
was the highest. If just one parent’s
BMI was measured this was used
for this analysis. For example, if
both parents were overweight orobese, or both were of normal
weight or underweight, the parental
BMI value matched that of bothparents. If one parent was
overweight and one was normal
weight, the parental BMI was takenfrom the overweight parent. In
households where one parent wasinterviewed, or just one parent
provided a valid BMI measurement,
the parental value matched thatparent’s BMI.

Also, data not in the main reportor web tables for 2016 or 2017
survey so data would need to beaccessed via the UKDS. Also, nostrong evidence linking parent’s
knowledge of the child PA
guidelines with % of children
meeting the guidelines and we
can’t perform this analysis
because we cannot use the datafrom the SHeS on % of children

40Technical report provides info on data collected and thequestionnaires used in the survey
http://www.gov.scot/Publications/2017/10/4796/downloads

The SHeS 2016 data has
been be deposited at
the UK Data Archive,2017 data not available
via UKDS (checked 24th
Oct 2017)

Survey: Growing Up in Scotland (GUS)
https://growingupinscotland.org.uk/about-gus/study-designand-methodology/

GUS is a longitudinalsurvey involving threenationally
representative cohortsof children: childcohort, birth cohort 1(BC1) and b]irth cohort 2 (BC2).
Child cohort: 2008/09
was the last year ofdata collection, nofurther collection
planned. BC1: the mostrecent data collection
periods (i.e. from 2014
onwards) were in
2014/15 (age 10
yrs/P6), a short web
and phone survey (webcati) children in P7 (age11 yrs) & 2017/18 (age12 ys/S1). BC2: themost recent datacollection periods werein 2013/14 (age 3 yrs) &2015/16 (age 5 yrs

down how much time per day
or could tick a box if they
didn’t have a child of that age(adults were also asked thisquestion i.e how muchtime/week do you thinkpeople your age are advised.…
Data collected on parent’s PA(though it is not clear if the PAdata collected can be used toestimate compliance with theadult PA guidelines) andscreen time (there is noscreen time recommendation
for adults) in BC2 age 5 years(2015/16).
Parent’s height and weight(measured) in BC1 age 10
years/P6 (2014/15) and BC2
age 5 years (2015/16).
Data collected on
respondent's intake ofsnacks/crisps/soft drinks (itisn’t clear but assuming
respondent means parent) in
BC1 at age 10yrs/P6 (2014/15)
and BC2 at age 5 yrs (2015/16)

meeting the PA guidelines (seeSHeS in Overall PA indicator)

Data on parent’s PA andscreen time not used forgrading as it has not beenreported, it would need to beobtained from the UK Data
Service (UKDS) and would be
limited to one age group [BC2age 5 years (2015/16)]. Also,
there is no screen time
guideline for adults and it’s
not clear if PA data could be
used to estimate compliancewith adult PA guidelines.

NOTE: this info was taken fromthe GUS topic guide and study
design info on website and the
topic guide sent by the GUS
senior researcher (i.e. the actual
questionnaires have not been
looked at). The GUS researcher
told me data available in the
UKDS

Data on parent’s height andweight and respondent's
intake of snacks/crisps/soft
drinks not used for grading as
data not been reported,
would need to be obtained
from the UKDS and would be
limited to two age groups:
BC1 age 10 years/P6(2014/15) and BC2 age 5 years(2015/16).

41

Indicator 10: Community and Environment
Benchmark (any of the following could be used to grade this indicator): % of children or parents who perceive their community/ municipality is doing a good job at
promoting physical activity (e.g., variety, location, cost, quality), % of communities/municipalities that report they have policies promoting physical activity, % ofcommunities/municipalities that report they have infrastructure (e.g., sidewalks, trails, paths, bike lanes) specifically geared toward promoting physical activity, % ofchildren or parents who report having facilities, programs, parks and playgrounds available to them in their community, % of children or parents who report living in a safeneighbourhood where they can be physically active, % of children or parents who report having well-maintained facilities, parks and playgrounds in their community thatare safe to use.
Methods of measurement: This indicator refers to perceived safety, access to, and availability of outdoor/indoor spaces and opportunities for PA in the local community,
not actual participation in active play, which is dealt with in indicator 4. All sources of data use self/parent report measures. One data source available for grading (theScottish Household Survey, data applies to 6 to 12 year olds). The Scottish Health Survey measures use of places for physical activity in 2-15 year olds but does not measureuse of places for PA in the community/neighbourhood thus data not used for grading.
Major Gaps in Scottish data: Biases in self/parent reports of perceived safety, access to and availability of spaces and opportunities for PA are unclear. Lack of data forchildren under 6 and over 12 years of age.
Overall, although access is high (A grade), we have based the grade more on safety, which is lower than access and varies by play area and whether child is alone (C+ grade)or with friends (B- grade).

Survey name, year data collected, name of the report and year
report published and link(s) to the document/survey

Details ofparticipantsMethod of measurement(including the questions
asked in the survey tomeasure the indicator)

Findings

Additionalcomments

Survey: Scottish Household Survey (SHS) 2016
Publication: Scotland's People Annual Report: Results from the 2016
Scottish Household Survey (published September 2017)
http://www.gov.scot/Publications/2017/09/9979
The technical report for the 2016 survey was published in March 2018
and includes info on methodology and fieldwork e.g. overview ofsurvey, sample design, response rates, data collection methods
http://www.gov.scot/Topics/Statistics/16002/PublicationMethodology
The questionnaire for the 2016 survey is published separately
http://www.gov.scot/Topics/Statistics/16002/PublicationQuestionnaire

Nationally
representative survey,
10,470 householdinterviews completed(9,642 adultinterviews completed,
22% of households
had children). Access
SHS data (incl datafrom 2016 survey) via
the Open Data
Platform(statistics.gov.scot)

Methods: The householdcomponent of the survey iscompleted by the householdreference person and a child is
randomly selected from all
household members under 16
and the household reference
person answers questions (seebelow) about that child, thefindings are reported in Chapter
13 of the main report ‘Young
People’. Questions: Householdswith a child aged 6 to 12 years
were asked the following
questions (also asked in the

Data used for grading because
the questions were asked tohouseholds with a 6-12 yr oldchild and they fit thebenchmark on perceptions ofsafety and access to PA
opportunities in theirneighbourhood, also meetsthe three criteria (recent,representative, & probably
fairly unbiased)

Grade is the same as
the grade for thisindicator submitted
to the GM3.0)
A number ofquestions on ratingsof neighbourhood,perceptions of safety
while walking in theirneighbourhood,walking distance toand satisfaction with42

2014 SHS and included in theprevious report card):a) access to each play area forchildren within theirneighbourhood, categories
were: playground, park, footballor other games pitch, field orother open space, school
playground, naturalenvironment/ wooded) multiple responses allowed.
Data reported as % having
access to each play area and %having access to at least one
play area.
b) the youngest age thathouseholds consider it would besafe for a child to play in eachplay area without supervisionc) % of households that think it
is very or fairly safe for children
to walk/cycle to each play areaon their own (used same
categories as above question
but also included streets/roads
around their home)d) % of households that think it
is very or fairly safe for children
to go to each play area with 2 or
3 friendse) % of households concerned
about children being bullied byother children while playing ineach play areaf) % of households concerned
about children being harmed byadults while playing in each playarea

Grade = B- (though access is
an A grade, safety is lower
and varies by play area andwhether child is alone (C+grade) or with friends (Bgrade). Also, for each play
area, access and perceptionsof safety are lower in moredeprived areas.
Summary:- 92% of households haveaccess to at least one playarea within theirneighbourhood: 56% haveaccess to a playground, 65%
to a park, 53% to a field orother open space, 50% to anatural environment/wooded
area (figures are similar to SHS
2014 results used in previous
report card).
-% of households that think it
is very or fairly safe forchildren to walk/cycle on
their own to each play area:
59% to a playground, 55% to apark, 57% to a field/otheropen space, 39% a naturalenvironment/wooded area,
56% for streets around thehome (most figures areslightly lower than SHS 2014
results used in previous reportcard)- % of households that think
it is very or fairly safe forchildren to go to each playarea with 2 or 3 friends: 66%
to a playground, 61% to anearest greenspaceetc were asked to all
households (i.e. notspecifically to parents
with children).
Note: the 2017 SHS
does not have achapter on young
people (thesequestions are asked
every 2 years) so no
new data for thisindicator
Additional data:- the youngest age
that households
consider it would besafe for a child to playwithout supervision ineach play area is 9
years for streetsaround the home, 10
years for playground,park, field/other open
space, 11 years fornaturalenvironment/wooded
area (figures are thesame for moredeprived areas andsimilar to 2014 SHS
results used inprevious report card)% of households whoare very or fairly
concerned aboutbullying by other43

park, 62% to field/other open
space, 44% a naturalenvironment/wooded area,
57% for streets around thehome (figures are slightly
lower than the SHS 2014
results used in previous card)- overall, perceptions of safety
are higher for each play area
when going with friends thanwhen children travel alone.
Perceptions of safety for thestreets/roads around the
respondent’s home are similar
with friends (57%) and alone(56%) but are 8%-9% lower inmore deprived areas, see
below (in previous report cardthey were 2-3% lower in moredeprived areas). For each play
area, access and perceptionsof safety are lower in moredeprived areas (see below)
Access to play areas by levelof deprivation:- 91% of households in the
20% most deprived urban
areas of Scotland had accessto at least one play area vs
92% of households in the restof the urban areas; howeveraccess to each play area waslower in the 20% mostdeprived urban areas vs therest of urban areas (e.g. 52%
vs 59% for playground, 46% vs
54% for field/other open
space, 36% vs 50% for naturalenvironment/wooded area).

children in each play
area: 37% for aplayground, 38% for apark, 35% for afield/other open
space, 40% for naturalenvironment/woodedarea, 26% for streetsaround the home (thisquestion wasn’t
included in previouscard)- % of households
who are very or fairly
concerned aboutchildren being
harmed by adults
while playing in eachplay area: 36% for aplayground, 37% for apark, 37% for afield/other open
space, 48% for naturalenvironment/
wooded area, 28% forstreets around thehome (figures similar
to the SHS 2014
results used inprevious card)% of households whoare very or fairly
concerned aboutbullying by otherchildren in each playarea is higher forhouseholds in the
20% most deprived
urban areas vs those44

Publication: McCrorie P, Mitchell R, Ellaway A. Comparison of two
methods to assess physical activity prevalence in children: anobservational study using a nationally representative sample of
Scottish children aged 10–11 years. BMJ Open 2018;8:e018369.
doi:10.1136/bmjopen-2017-018369
Survey: Data collection took place between May 2015 and May 2016.

A nationally
representative sample of
10 to 11 year oldchildren. 2402 children
took part in GUS sweep 8interviews, 90% (n=2162)
consented to becontacted for theaccelerometer study(known as SPACES), 1096
(51%) children took partin accelerometer datacollection and 774
participants (427 girls,
357 boys) met
inclusion criteria (i.e.
provided at least 4
weekdays and at least 1
day of weekend data) .

The Spaces study also has
Geographic Information
Systems (GIS) data which
provides information on thecharacteristics of a locationand can, therefore, provide
information on e.g.
neighbourhood safety,
access to parks, facilities,
amenities etc in children’scommunity.

Safety of play areas by levelof deprivation:- the % of households thatthink it is very or fairly safe forchildren to walk/cycle on theirown to each play area is lower
for households in the 20%
most deprived urban areas vsthose in the rest of the urban
areas (e.g. 48% vs 60% for
playground, 48% vs 57% forstreets around the home).
- the % of households thatthink it is very or fairly safe forchildren to go to each playarea with 2 or 3 friends islower for households in the
20% most deprived urban
areas vs those in the rest of
the urban areas (e.g. 59% vs
66% for playgrounds, 50% vs
58% for streets around thehome)Data cannot be used forgrading as data not available
yet and would be limited to asingle age group (10 to 11
year olds).

in the rest of theurban areas (e.g. 53%
vs 34% playground,
37% vs 24% forstreets around thehome)-% of households whoare very or fairly
concerned aboutchildren being
harmed by adults
while playing in eachplay area is higher forhouseholds in the
20% most deprived
urban areas vs thosein the rest of theurban areas (e.g. 53%
vs 32% playground,
37% vs 27% forstreets around the
home.

45

Survey: Scottish Health Survey (SHeS) 2016
Publication: The Scottish Health Survey 2016: Volume 1: Main Report(published October 2017)
http://www.gov.scot/Topics/Statistics/Browse/Health/scottish-healthsurvey
Further data are available in supplementary web tables
http://www.gov.scot/Topics/Statistics/Browse/Health/scottish-healthsurvey/Publications/Supplementary2015/Supplementary2016
Technical report provides info on data collected and the questionnaires
used in the survey
http://www.gov.scot/Publications/2017/10/4796/downloads

Survey: Growing Up in Scotland (GUS)
https://growingupinscotland.org.uk/about-gus/study-design-andmethodology/

Nationally
representative sample
of 4,323* adults(≥aged 16 yrs), and
1561* children (2-15yrs). * This is theoverall number ofadults and children in
the SHeS. These
additional questions(see next column)
were only asked to
Version A households(62% of the main
sample and it isunclear how many
provided data for thisvariable).
The SHeS 2016 data
has been be depositedat the UK Data
Archive, 2017 data notavailable via UKDS
(checked 24th Oct
2017)

Method: Self-report for children
age 13-15 years and parent
proxy-report for children age 012 yrs.
Questions: Additional questions
on ‘use of places for PA’ were
included in the 2016 child PA
module of the questionnaire(they were not asked in 2015).
Parents/children aged 13-15 yrs
were asked how often(everyday, 4-6 days a week, 23days a week, once a week etc)
in the past 4 weeks haveyou/your child made use of anyof the places listed on this card
for any of the physical activities
you have just told me about.
Places listed on the card
included: A woodland, forest or
tree covered park; an open
space or park, a country park
(not tarmac), pavement orstreets in local area, your homeor garden. Also asked ‘howoften’ for each place,
categiriues are every day, 4-6
days a week and so on.

The question asks about useof places for PA, which may fit
the benchmark on availability(i.e. the % of children or
parents who report having
facilities, programs, parks andplaygrounds available to themin their community), theindicator is ‘Community andEnvironment and most of theplaces listed in the SHeS
question do not say ‘in yourlocal area, community orneighbourhood except forpavements and streets andyour home or garden so thequestion does not fit thebenchmark i.e. not measuring
use of places for PA in theircommunity, thus data notused for grading. Also data
hasn’t been reported in main
report or suppl tables.

2016 data not beenreported in the main
report or thewebtables and thisinfo was not collected
in 2015. Thus would
need to access datafrom the UKDS (butthe question doesn’t
fit the benchmark)

GUS is a longitudinalsurvey involving threenationally representative
cohorts of children: childcohort, birth cohort 1(BC1) and birth cohort 2(BC2). Child cohort:
2008/09 was the lastyear of data collection,
no further collection
planned. BC1: the mostrecent data collection
periods (i.e. from 2014
onwards) were in
2014/15 (age 10 yrs/P6),

Method: One of the topics is‘Neighbourhood andCommunity’ however noquestions about this topic
were asked to BC1 from age
7-8 years onwards and toBC2 at age 5 years(2015/16). In BC2 at age 3
years (2013/14) datacollected on: Availability anduse of local facilities (but PA
not specifically mentioned),
Involvement in localgroups/activities (again PA

Data not used for grading
because it may not fit thebenchmark (see previous
column), also data would be
limited to one age group - BC2
at age 3 years (2013/14),
which has not been reported
and will not be available from
UKDS until the end of theyear.

NOTE: this info wastaken from the GUS
topic guide and study
design info on website
and the topic guidesent by the GUS
senior researcher (i.e.
the actual
questionnaires havenot been looked at).
The GUS researcher
told me data available
in the UKDS

This data was alsocollected in 2017 survey
and was reported in
webtables, but again
only two categories
relate to local area (i.e.
home/garden,
pavements & streets inlocal area). Data
reported for each place,but not sure what the
numbers represent,
think its % that haveused each place (i.e.
freq not reported), 73%
for home & garden, 91%
for pavement & streets46

a short web and phonesurvey (web-cati)children in P7 (age 11
years) & 2017/18 (age12
ys/S1)
BC2: the most recent
data collection periods
were (i.e. from 2014
onwards) were in
2013/14 (age 3 yrs) &2015/16 (age 5 yrs)

not specifically mentioned),
access to and use ofgreen/open space (not clear
if this is in local
neighbourhood/community).

47

Indicator 11: Government
Benchmark: a) Evidence of leadership and commitment in providing physical activity opportunities for all children and youth; b) allocated funds and resources for the
implementation of physical activity promotion strategies and initiatives for all children and youth; c) Demonstrated progress through the key stages of public policy making(i.e., policy agenda, policy formation, policy implementation, policy evaluation and decisions about the future).
Major gaps for this indicator: The major problem with Scottish policy is the gap between policy development and policy implementation. We have many creditable national
policies but evidence of implementation is lacking. Many of the indicators would be improved by the adoption and implementation of measures recommended in the
WHO ECHO Implementation Report 2017, and by mapping Scottish policy onto that framework.
For the Scottish Active Healthy Kids Report Cards in 2013 and 2016 (see short-forms and long-forms http://www.activehealthykidsscotland.co.uk/) we graded this indicator
B, largely because the benchmark for this indicator was not very specific and it was felt that Scotland has multiple relevant policies, strategies and targets. The B grade(rather than A) reflected concerns that policy implementation and evaluation had not progressed as well as policy formation. This was consistent with other high income
western countries in the International Active Health Kids Report Card in 2014 (Global Matrix 1.0) and in 2016 (Global Matrix 2.0, see https://www.activehealthykids.org/).
The number of relevant policies in Scotland has increased since 2016, but the benchmark has changed to place more specific emphasis on policy evaluation andimplementation.
The existing Scottish policy environment includes many relevant policies/strategies/targets established prior to the 2016 report card. New policy developments seem to be
the ‘Sugar Tax’ in 2018 and the Scottish ‘Health and Social Care Delivery Plan 2016’ – the latter is generic and is not specific to the indicators in the report card, butemphasises population wide-prevention and early intervention and so is consistent with the spirit of the report card and is a positive development. Implementation remains
uncertain. Other new policy developments since the last report card include: Programme for Government 2017-18 (relevance here is the plan to limit marketing ofobesogenic foods and drinks), Scottish Dietary Goals- revised in 2016 (e.g. reduced sugar intake target); Scotland’s Physical Activity Delivery Plan in 2018, Scotland’s Diet &Healthy Weight Delivery Plan in 2018; Everyday walking for a happier, healthier Scotland Strategy 2017-2020, Healthcare Retail Standard 2016-2017; Daily Mile Nation;
Funding for Women and Girls in Sport, Extension of free childcare hours for young children from 2019- might increase scope for PA promotion in pre-school in future. The
SHeS 2016 has a good section on policy background at the start of each chapter-main source of new policy info i.e. new policies or evidence of policy
modification/evaluation/implementation since the 2016 card.
The benchmark is in three parts and we have commented on each below:a) Evidence of leadership and commitment to providing PA opportunities for all children & youth. The text above/previous grades from 2013 and 2016 report cards
suggest that we have achieved some success in Scotland, as there are many relevant policies/strategies/targets in place and these are generally good. The relatively
high grades for PA environment in the past (e.g. high degree of perceived accessibility of spaces to be active/moderately high degree of perceived safety) suggest
there has been some leadership and commitment to providing PA opportunities. On its own this would definitely be a high pass grade (A or B).
b) Allocated funds and resources for the implementation of PA promotion strategies and initiatives for all children & youth. The keywords here seem to be‘implementation’ and ‘all’ . Implementation has been limited as noted in previous Scottish report cards, and the focus of implementation has not been on ‘all’ but
on specific target groups (specifically women and girls) and specific behaviours (PE and sport, rather than physical activity more generally), with exclusion of key
48

behaviours from public policy (notably sedentary behaviour). One keyword missing from the benchmark is ‘sufficient’ – whether sufficient funds/resources havebeen allocated is doubtful. On its own this would be a C- grade at best.
c) Demonstrated progress through the key stages of public policy making (i.e. policy agenda, policy formation, policy implementation, policy evaluation anddecisions about the future). As noted above and in previous Scottish report cards, physical activity has been high on the public policy agenda, and policy formation
has been creditable (including the new policies since the 2016 card summarised above). Evidence of implementation and evaluation has been lacking -there is little
evidence of critical process evaluation of the key policies (e.g. are they implemented effectively) and our main instruments for policy evaluation do not evaluate thekey outcomes- notably population levels of MVPA among school-age children and adolescents (we have no adequate surveillance of child or adolescent MVPA in
Scotland, see ‘Overall PA indicator above’, other than periodic HBSC surveys of 11-15y olds). Progress through the key stages of policymaking has therefore largely
stalled after stage 2 of the policymaking progress (and it is too early to tell if recent policies have been implemented and evaluated well). On its own performanceagainst this benchmark would merit a C- grade at best.
In summary, there is clear evidence of leadership and commitment to providing physical activity opportunities for children and youth (benchmark a). There is only
limited allocation of funds and resources for implementation of policy (benchmark b). Only limited progress through the key stages of public policymaking (policy
agenda; policy formation; policy implementation; policy evaluation; decisions about the future) has been demonstrated, with policy efforts stalling at
implementation and evaluation (benchmark c). OVERALL GRADE FOR GOVERNMENT = C

49