Scottish Health Survey 2017 - volume one: main report

7. Physical Activity

Lucy Dean

Summary

• Adherence to the guidelines tended to decline with age, from just over three-quarters of those aged 16-44 (76-78%) to just over a quarter of those aged 75 and above (28%).
• Older adults were more likely than younger to have very low levels of activity (equivalent to less than half an hour a week of moderate exercise); half of all adults aged 75 and above (50%) compared to one in nine of those aged 16-44 (10-12%) had very low levels of activity.

• Adherence to the MVPA guidelines was more common among adults in less deprived areas, declining from 72% in the least deprived quintile to 56% in the most deprived quintile.
• Men spent around one and a half times as long as women doing any form of moderate to vigorous physical activity each week, an average of 15.1 hours for men compared to 9.9 hours for women.

• The proportion of children meeting the physical activity guidelines declined with age, from 45% of those aged 5-7 to 38% of those aged 8-10 to 28% of those aged 11-12 to 18% of those aged 13-15.
• Participation in sport was lowest for teenage girls (45% of those aged 13-15) and for pre-school boys (48% of those aged 2-4).

7.1 Introduction

There is widespread consensus around the evidence base for the health, economic and social benefits of physical activity with strong scientific evidence that sufficient, regular physical activity is beneficial for the health of body and mind. Physical activity improves the health of the heart; skeletal muscles; bones; blood; immune system and nervous system. Physical activity also improves psychological wellbeing; self-perception and self-esteem; and mood and sleep quality^[1],[2].

Furthermore, there is clear evidence that physical activity reduces the risk of over twenty five chronic health conditions, including coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal problems, and has secondary prevention benefits for many others^[3],^[4].

We also know that physical inactivity shortens life expectancy. The most recent global estimate is that inactivity is responsible for 9% of premature deaths, or 5.3m of the 57 million deaths that occurred worldwide in 2008^[5]. Physical inactivity is estimated to kill around 2,500 Scots each year and cause direct costs to the NHS of around £91m per year^[6]. Research suggests that high levels of moderate intensity physical activity (ie, about 60–75 min per day) seem to eliminate the increased risk of death associated with high levels of physical inactivity^[7].

The UK Chief Medical Officers' guidelines on recommended amounts of physical activity for adults were issued in 2011^[8]. Broadly, in adults, there is a dose-response relationship between physical activity and health, meaning greater benefits occur with greater participation. The largest reductions in disease risk occur at the lower end of the spectrum, implying the greatest benefits from a population health perspective arise from moving from inactivity to some level of activity. The available evidence to date on levels of activity suggests that any is better than none, some is good, and more is better^[9],^[10].

It is important to distinguish between different domains in which physical activity occur in order to assess potential benefits. Recent evidence suggests that while leisure time physical activities and transport-related physical activities (such as cycling) are associated with better mental health outcomes, other types such as household physical actvitiy had no relationship with mental health or ill-health and work-related physical actvitiy was associated with poorer mental health^[11].

Table 7A UK CMO physical activity guidelines (2011)

Age group	Guidelines
Early years – children under 5 years	Physical activity should be encouraged from birth, particularly through floor-based play and water-based activities in safe environments. Children capable of walking unaided should be physically active daily for at least 180 minutes (3 hours), spread throughout the day. Minimise amount of time spent being sedentary (being restrained or sitting) for extended periods (except time spent sleeping).
Children and young people aged 5 to 18	Should engage in moderate to vigorous activity for at least 60 minutes and up to several hours every day. Vigorous activities, including those that strengthen muscles and bones, should be carried out on at least 3 days a week. Extended periods of sedentary activities should be limited. Should be active daily.
Adults aged 19-64	Should engage in at least moderate activity for a minimum of 150 minutes a week (accumulated in bouts of at least 10 minutes) - for example by being active for 30 minutes on five days a week. Alternatively, 75 minutes of vigorous activity spread across the week will confer similar benefits to 150 minutes of moderate activity (or a combination of moderate and vigorous activity). Activities that strengthen muscles should be carried out on at least two days a week. Extended periods of sedentary activities should be limited.
Adults aged 65 and over	In addition to the guidance for adults aged 19-64, older adults are advised that any amount of physical activity is better than none, and more activity provides greater health benefits. Older adults at risk of falls should incorporate activities to improve balance and coordination on at least two days a week.

7.1.1 Policy Background

In common with many developed societies, Scotland faces increasing challenges to public health arising from lifestyle behaviours, wider social-cultural factors that prevent positive health choices being made and a modern environment that impacts on the health and wellbeing of individuals, families and communities.

We know that the drivers of good health are for the most part in our homes, schools and communities and that improving public health means creating the conditions where people have the hope and purpose to think better choices are available to them. That means looking to the deep-rooted causes of social and economic inequality which result in children born into Scotland's most deprived communities being likely to live for 20 fewer years in good health. It also means recognising that improving public health will require concerted effort across the whole of society.

The Scottish Government and COSLA have jointly published the Public Health Priorities for Scotland (2018)^[12], aimed at focussing action across the public sector and voluntary sector and in communities. The priorities are the first milestone in a wider reform of public health. Physical activity, in conjunction with eating well and maintaining a healthy weight, forms one of those priorities.

Following publication of the public health priorities, the Scottish Government has set out the actions that the Scottish Government and their partners are undertaking to encourage and support people in Scotland to be more active, more often in the Active Scotland Delivery Plan (2018)^[13]. This is part of a suite of strategies and action plans across the public health portfolio and builds upon the ambitions for a more active Scotland as set out by the Scottish Government in the Active Scotland Outcomes Framework^[14], published in 2014, with progress being reported across a range of indicators^[15]

The Delivery Plan sets out the Scottish Government's vision for a Scotland where people are more active, more often. This means physical activity becoming a routine part of everyone's daily life, whether that is through walking or cycling to work, school, or to the shops, through gardening or dance, through active play or formal sport, or through any activities which result in Scots sitting less and moving more.

The plan also sets out the Scottish Government's ambition to reduce physical inactivity in Scotland in line with the World Health Organization's (WHO) goal to achieve a relative 15% reduction worldwide by 2030^[16], as set out in the WHO Global Action plan on Physical Activity 'More Active People for a Healthier World'^[17], published in 2018.

7.1.2 Reporting on physical activity in the Scottish Health Survey

Physical activity continues to be a priority for the Scottish Government and is recognised as a key aspect of to the new NPF outcome that 'we are healthy and active'. SHeS is the source for monitoring the percentage of adults meeting the physical activity recommendations which is one of the indicators used to gauge progress on the overall outcome^[18].

Adult adherence to the guidelines on moderate / vigorous physical activity (MVPA) is presented in this chapter along with sport participation levels. Levels of child physical activity, both including and excluding school-based activities, and in child participation in sports and exercise are also presented.

The area deprivation data for physical activity are presented in Scottish index of Multiple Deprivation (SIMD) quintiles. To ensure that the comparisons presented are not confounded by the different age profiles of the quintiles, the data have been age-standardised. Readers should refer to the Glossary at the end of this Volume for a detailed description of SIMD and age-standardisation.

Supplementary tables on physical activity are available on the survey website^[19].

7.2 Methods and Definitions

7.2.1 Adult physical activity questionnaire

The SHeS questionnaire^[20] asks about four main types of physical activity:

• Home-based activities (housework, gardening, building work and DIY)
• Walking
• Sports and exercise
• Activity at work.

Information is collected on the:

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

7.2.2 Adherence to adult physical activity guidelines

Monitoring adherence to the revised guidelines (discussed in Section 7.1) required several changes to be made to the SHeS physical activity questions in 2012. Details of the amendments made to the module, and fuller details of the information collected about physical activity, are outlined in the 2012 SHeS annual report^[21].

The current activity guidelines advise adults to accumulate 150 minutes of moderate activity or 75 minutes of vigorous activity per week or an equivalent combination of both, in bouts of 10 minutes or more. These guidelines are referred to throughout this chapter as the MVPA guidelines (Moderate or Vigorous Physical Activity). To help assess adherence to this guideline, the intensity level of activities mentioned by participants was estimated. Activities of low intensity, and activities of less than 10 minutes duration, were not included in the assessment. This allowed the calculation of a measure of whether each SHeS participant adhered to the guideline, referred to in the text and tables as "adult summary activity levels". A more detailed discussion of this calculation is provided in the 2012 report^[22].

Table 7B Adult summary activity levels^a

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

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

To avoid overcomplicating the text, where descriptions are provided of the summary activity levels, they tend to refer only to moderate physical activity, although the calculations were based on moderate or vigorous activity as described above.

In 2017 data is reported on the level of participation in the last four weeks in physical actvitiy within four distinct domains:

• Heavy housework
• Gardening/DIY/heavy building work (or heavy manual work)
• Sports and exercise
• Walking
• Total (of all of the above)

For each of these domains the mean number of days in which adults have participated in the last four weeks is provided along with the mean number of hours spent doing each type of actvitiy at a time. These are compared for men and women and different age groups. This data was last reported on in the survey in 2011 although caution should be taken when comparing the results due to the revisions made to the physical activity module in 2012.

7.2.3 Child physical activity questionnaire

The questions on child physical activity are slightly less detailed than those for adults^[23]. No information on intensity is collected (with the exception of asking those aged 13-15 about their walking pace). The questions cover:

• Sports and exercise
• Active play including housework and gardening
• Walking

The questions were changed in the survey in 2017 to ask children which days (Monday to Sunday) in the previous week they participated in each different type of physical activity (as outlined above) and the amount of time they spent doing that particular activity on each of the specific days mentioned. In previous years children were asked to provide information on the average duration of sports and exercise activities for a typical weekday and typical weekend day. They were not asked to differentiate between different weekday or weekend days or to provide a specific duration for each separate day. This wording did not reflect childrens' physical activity guidelines which state that children should be active for at least 60 minutes every day. The two different methods of wording the questions provide very different estimates of children's physical activity. The questions were changed this year to provide an element of comparability with the Health Survey for England in which children are asked to provide the information based on every day in the last week^[24] (every 3 years).

Due to this revision in 2017 it is not possible to compare the data on the proportion of children in Scotland meeting the recommended minimum of 60 minutes moderate to vigorous physical actvitiy per day on average over the course of the last week to previous year's data from the SHeS. Whilst the new questions provide greater detail, it should be borne in mind that recall to this level of detail is likely to have some impact on the estimates. Issues around recall are also likely to have had some impact on the average day estimates from previous years when respondents were asked to provide an average time rather than the specific time on each day.

The questions about physical activity at school were also amended in 2017. Children at school were also asked about which days they were active at school and also the length of time they were active on each specific day. These questions followed a similar format to the non school time described above and therefore differ significantly from the previous method for collecting this data.

7.2.4 Adherence to child physical activity guidelines

For the purposes of calculating physical activity levels, it was assumed that all reported activities were of at least moderate intensity. Data on each of the different activities have been summarised to provide an overall measure of child physical activity. This summary measure takes into both the time spent participating in physical activity on each day in the last week. Each child's level of physical activity was assigned to one of three categories:

Table 7C Child summary activity levels

Meets guideline	Active on all 7 days for at least 60 minutes each day
Some activity	Active on all 7 days for between 30 and 59 minutes each day
Low activity	Active on all 7 days in last week or for an average of less than 30 minutes a day

7.3 Adult Physical Activity Levels

7.3.1 Summary activity levels since 2012

In 2017, amost two-thirds (65%) of adults met the guidelines for moderate or vigorous physical activity (MVPA) of at least 150 minutes of moderate physical activity, 75 minutes vigorous physical activity, or an equivalent combination of the two, per week. Additionally, 11% reported some physical activity, 4% reported low levels, and 20% reported very low levels. As shown in Figure 7A, the proportion of all adults meeting the guidelines was slightly higher than in 2012 (62%), although it has not changed significantly since 2013.

As in previous years, men were significantly more likely than women in 2017 to meet the guidelines on physical activity (71% compared with 60%). Figure 7A, Table 7.1

^aMeets moderate/vigorous physical activity guideline of 150 minutes of moderate, 75 minutes vigorous, or combination of both each week.

7.3.2 Summary adult physical activity levels, 2017, by age and sex

Physical activity levels among adults were significantly associated with age, with younger groups more likely than older age groups to meet the MVPA guidelines. Adherence to the guidelines was highest among those aged 16-44 (76-78%) and declined from 68% among those aged 45-54 to 28% among adults aged 75 and over. The pattern by age was similar for men and women.

The decline in activity levels by age among both men and women corresponded to increasing levels of very low activity (less than half an hour a week of moderate activity or the equivalent level of vigorous activity) as age increased. The proportion with very low activity levels increased from a range of 10-12% among the three youngest age groups (16-44) to 50% among adults aged 75 and over.

Physical actvity levels were higher for men than women across all age groups, as illustrated by Figure 7B. The greatest difference between men and women's adherence to the MVPA guidelines was in the youngest and oldest age groups: 89% of men aged 16-24 met the guidelines compared with 67% of women (22 percentage points difference) and 36% of men aged 75 and over met the guidelines compared with 22% of women (14 percentage points difference). Differences in the level of adherence to the guidelines between men and women were much smaller between the ages of 35 and 74 (5-7 percentage points). Figure 7B, Table 7.2

^a Meets moderate/vigorous physical activity guideline of 150 minutes of moderate, 75 minutes vigorous, or combination of both each week

7.3.3 Summary adult physical activity levels (age-standardised) since 2012, by area deprivation and sex

Adult physical activity levels were significantly associated with area deprivation. The age-standardised prevalence of adherence to the MVPA guidelines was highest among adults in the least deprived areas at 72%, and steadily declined with increasing deprivation to 56% among adults in the most deprived areas. As shown in Figure 7C, this pattern has been evident since 2012, with the proportion adhering to the guidelines declining as the area deprivation level increases.

The pattern is similar for both men and women. For men, the age-standardised prevalence of adherence to the MVPA guidelines declined from 77% in the least deprived areas to 63% in the most deprived areas in 2017. Among women, the age-standardised prevalence of adherence to the MVPA guidelines declined from 67% to 51%.

Similar to the pattern observed for age, the decline in adherence to the MVPA guidelines as deprivation increased largely corresponded to the

increasing levels of very low activity. The percentage of those with very low activity levels increased from 14% in the least deprived areas to 29% in the most deprived areas in 2017. This pattern was evident for both sexes and has been observed every year since 2012.

Figure 7C, Table 7.3

^a Meets moderate/vigorous physical activity guideline of 150 minutes of moderate, 75 minutes vigorous, or combination of both each week

7.3.4 Detailed adult physical activity levels, 2017, by domain and sex

Table 7.4 presents three different measures of participation for each of

the four types of activity outside of work covered in the interview (heavy housework; heavy manual work, gardening and DIY; brisk walking; sports and exercise), as well as for participation in any type of physical activity, by age and sex. It summarises:

• the total proportion of adults participating in the activity type for at least 10 minutes at a time in the four weeks prior to the survey;
• the mean number of days in the previous four weeks on which they participated in this type of activity, and
• the mean number of hours per week they spent participating in this type of activity.

Any activity

In 2017, 79% of adults (82% of men and 77% of women) participated in at least one 10 minute session of physical activity (intensity described above) during the four weeks prior to the survey. The average number of days on which any activity was conducted during that four week period (including those who did no activity) was 13.9 (15.3 for men and 12.7 for women). Adults were active for an average of 12.4 hours per week with men spending more time being active than women (15.1 compared with 9.9 hours).

For both men and women, levels of participation were higher among those aged 16-54 than among the older age groups. Among men participation was at its peak between the ages of 16-44 (92-95%) and then declined with each successive age category to its lowest point of 42% among those aged 75 and over. Among women the levels of participation in any activity were highest among those aged 25-34 (92%), declining with age to 40% among those aged 75 and over.

Figure 7D

A similar pattern of age and sex differences was evident for the mean number of days in the last four weeks that men and women had participated in any physical activity. The greatest differences between men and women were between the ages of 16-34; men aged 16-34 reported participating in any physical activity on an average of around 20 days of the last 28 (19.6-20.3), while women of the same age reported participating in physical activity on an average of 16 days (15.7-16.2). The mean number of days participated in physical activites were similar between men and women across the other age groups.

The average number of hours spent doing any physical activity per week was higher for men across all age groups compared with women by a factor of around 1.5 (with the exception of those aged 55-64). Men aged 16-54 averaged between 17.0 and 19.9 hours of physical activity a week, compared with between 11.3 and 12.7 hours per week for women of a similar age. Men aged 75 and above averaged 4.0 hours a week, compared with 2.4 for women of the same age.

Figure 7E

Heavy housework

Housework was the most common form of activity: 53% of all adults did at least one session of 10 or more minutes heavy housework in the preceding four weeks, compared with 44% who did at least one brisk walk of 10 minutes or more and 43% who participated in sport or exercise for 10 minutes or more. However, people spent much less time on average on housework than on these other activities. Adults, including those that did not do any housework, spent an average of one (1.0) hour a week on heavy housework, compared with three (3.0) hours walking and just under four (3.7) hours sport or exercise.

Participation in heavy housework varied significantly by age and sex. As reported in previous years, the proportion of women that participated in any heavy housework in the last four weeks was significantly higher than the proportion of men: 58% compared with 48%. A greater proportion of women performed at least some heavy housework during the four week period than did a brisk walk of at least 10 minutes or did any form of sport or exercise, and this was true for all age groups except the youngest. Among men, walking and sport or exercise were equally common as heavy housework (although partipation in sport or exercise was much more prevalent among the youngest age group and less so in the older ones).

Women spent nearly twice as much time as men doing heavy housework (an average of 1.3 hours a week, compared with 0.7 hours for men) and participated on a greater number of days (an average of 3.2 in the last four weeks compared with 2.1). In all age groups except the oldest (those aged 75 and over) women spent longer on housework on average than men.

All of the housework participation measures showed a bell-shaped pattern when compared across the age groups. For both men and women these measures peaked between the ages of 25-54 and decreased with age thereafter. Participation among these age groups was between 59% and 65%, on a mean of between 2.9 and 3.4 days during that period. The lowest level of participation was 30% among those aged 75 and over, having participated in heavy housework on a mean of 1.6 days in the last four weeks. Adults aged 35-54 spent the greatest number of hours, on average, doing heavy housework in the last four weeks (1.4) and those aged 75 and over spent the least (0.5), followed by those aged 16-24 (0.6).

Heavy manual work, gardening or DIY

Participation in heavy manual work, gardening or DIY was by far the least common actvitiy for both sexes, with only one in seven adults (14%) having done this in the previous four weeks. As in previous years, men were significantly more likely to have participated in this type of activity (21% compared with 8%). This difference was also evident in the other measures. On average, in the last four weeks men participated on 1.2 days for 0.9 hours per week. The comparative figures for women were 0.3 days and 0.2 hours.

Participation in gardening, DIY or heavy manual / building work in the last four weeks was higher for men than for women across all age groups with the largest difference among those aged 35-44: 31% of men compared with 8% of women (23 percentage points). Men aged 35-74 reported an average of between 1.1 and 1.4 hours a week of such manual work, compared with 0.5 hours or less for the younger and older age groups. The mean number of hours per week did not exceed 0.3 for women in any age group.

Walking

Less than half of all adults (44%) reported performing any brisk or fast pace walking for at least 10 minutes in the last four weeks^[25]. In 2017, a significantly higher proportion of men than women did any brisk or fast paced walking in the last four weeks (48% and 41% respectively) and spent a greater number of days on average participating in such an activity (9.3 compared with 7.8). Men also spent a significantly greater number of hours walking per week on average compared with women (3.4 and 2.7).

Levels of participation in walking were highest among the youngest age group (59% having done any brisk walking in the last four weeks) declining to 34% of those aged 55-64. Among those aged 65-74, 42% did at least one walk either at a brisk pace or that exerted them, as did 27% of those aged 75 or above.

A similar pattern could be seen for the average number of days over a four week period adults participated in walking, with the highest figures for those aged 16-24 (11.5), declining to 6.9 for those aged 55-64. Those aged 65-74 walked on an average of 7.3 days out of 28, and those aged 75 or above walked on an average of 4.6. The pattern for the number of hours spent walking was much flatter, with the average for all age groups, except the oldest, between 2.7 and 3.7 hours per week.

Sports and exercise

Less than half of adults (43%) had taken part in any sport or exercise in the previous four weeks (46% of men and 41% of women). Men had participated on more days on average in the last four weeks than women (6.9 versus 4.4 days), and for a greater number of hours per week (4.7 versus 2.8 hours).

For both sexes, all measures of participation were highest in the youngest age group. Men aged 16-24 participated in sport or exercise on an average of 11.6 days out of the previous 28, with three-quarters (75%) undertaking any such activity during the period. On average men of this age participated for 7.6 hours per week. The corresponding figures for women aged 16-24 were 7.2 days out of the previous 28, with 60% undertaking any sport or exercise, and an average of 4.7 hours per week. There was a general decline in participation with increasing age for both men and women in terms of overall levels, number of days and number of hours after the 35-44 age group.

7.4 Child Physical Activity Levels

In 2017, the survey questions on children's physical activity were changed to ask about the length of time spent on each type of physical activity on each day of the previous week. This was to enable calculation of whether children met the physical activity recommendation of a minimum of 60 minutes on each day of the previous week. Prior to 2017, the questions asked on how many days in the past week each type of activity was undertaken and the average time per day. Due to the different approach to collecting these measurements it is not possible to compare the 2017 estimates with those for previous years therefore no conclusions can be drawn about the trends or differences in physical activity prior to 2017. The physical activity recommendations are currently being reviewed across the UK. Once the results of that review are published a decision will be taken on the most appropriate way to measure children's physical activity in future surveys.

7.4.1 Proportion of children meeting daily physical activity guideline, 2017, by age and sex

Using the revised measurements of child physical activity, a third (33%) of children aged 5-15 were active at the recommended level of at least 60 minutes on every day of the week (including activity at school) in 2017. When school-based activities were excluded this figure was only slightly lower, at 32%.

Children's physical activity levels varied significantly by age, with younger children more likely than older children to meet the physical activity guideline. The proportion of children meeting the guideline was highest for those aged 5-7 (45% including activity at school and 43% excluding it). Adherence declined steadily with increased age, to 18% for those aged 13-15 (both including and excluding school-based activity).

Excluding activity at school, a higher proportion of boys than girls met the physical activity guideline (35% of boys compared with 29% of girls). This was driven by differences among the older age groups (42% of boys and 32% of girls met the guidelines at ages 8-10; 31% of boys and 21% of girls at ages 11-12; and 22% of boys and 11% of girls at ages 13-15), though it should be noted that these figures are based on relatively small sample sizes. Once activity at school was included, overall differences between boys and girls were not statistically significant (36% of boys and 31% of girls met the guidelines), with activity at school having the greatest effect on all children aged 11-12 (raising them from 25% to 28%) and girls aged 5-7 (up from 44% to 48%). Figures 7F and 7G, Table 7.5

7.4.2 Proportion of children participating in sport, 2017, by age and sex

In 2017, 67% of children aged 2-15 had participated in sport in the week prior to interview. Overall sport participation rates in 2017 were similar for boys and girls (67% and 66% respectively). Rates of participation in sports both for boys and girls peaked at the age of 8-10 (76% for boys and 79% for girls) and then declined to 70% among boys and 69% among girls at the age of 11-12. The level of participation in sports among girls then declined by 24 percentage points between the age of 11-12 (69%) and 13-15 (45%) compared to only a one percentage point decline for boys (from 70% to 69%).

Figure 7H illustrates the differences in levels of sports participation between boys and girls across different age groups; differences were only significant for the 13-15 age group. Figure 7H, Table 7.6

7.4.3 Proportion of children meeting physical activity guidelines and participation in sport, 2017, by area deprivation

Children's overall physical activity levels did not vary significantly by area deprivation.

There were, however, quite noticeable differences in children's level of participation in sport in the last week by area deprivation, as shown in Figure 7I. The rate of participation in sport among those aged 2-15 decreased as deprivation level increased, from 82% in the least deprived quintile to 52% in the most deprived quintile. This pattern was evident for both boys and girls although the drop in levels of participation among those in the 5^th (least deprived) and the 1^st (most deprived) areas was more pronounced among girls (36 percentage points) compared with boys (26 percentage points).

Figure 7I, Tables 7.7 and 7.8