Health Education Research Advance Access originally published online on June 15, 2004
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Health Education Research, Vol. 19, No. 4, 373-379,
August 2004
© 2004 Oxford University Press
The health and lifestyle of Scottish fishermen: a need for health promotion
1 Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY and 2 NHS Occupational Health Service, NHS Grampian, Foresterhill Lea, Grampian University Hospitals Trust, Aberdeen AB25 2YZ, UK
3 Correspondence to: T. Lawrie; E-mail: gppc{at}aberdeen.ac.uk
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Abstract |
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It has long been known that fishing is one of the most dangerous occupations. In the year 2001, 33 boats were lost and 10 fishermen killed in UK waters. Despite the dangerous nature of the occupation, very little research has been conducted on fishermen's health and safety. The few studies that have been conducted are spread widely around the globe, and tend to focus on mortality rates and accidents. Few studies considered fishermen's lifestyle behaviours. To address this gap in current knowledge research was conducted to gain an understanding of health and lifestyle issues affecting Scottish fishermen. Data was collected using a postal questionnaire survey in the Scottish fishing population and health diaries in a small subsample. High rates of smoking were prevalent and passive smoking was a considerable problem. Fewer fishermen drank alcohol compared to the general population, but fishermen lacked knowledge about what safe levels of alcohol consumption were. Diet was lacking in fruit and vegetables, and meals were eaten at very erratic intervals. Fishermen may benefit from health promotion and education in the areas of smoking, diet and alcohol consumption.
It has long been known that fishing is one of the most dangerous occupations. In the year 2001, 33 boats were lost and 10 fishermen killed in UK waters. Despite the dangerous nature of the occupation, very little research has been conducted on fishermen's health and safety. The few studies that have been conducted are spread widely around the globe, and tend to focus on mortality rates and accidents. Few studies considered fishermen's lifestyle behaviours. To address this gap in current knowledge research was conducted to gain an understanding of health and lifestyle issues affecting Scottish fishermen. Data was collected using a postal questionnaire survey in the Scottish fishing population and health diaries in a small subsample. High rates of smoking were prevalent and passive smoking was a considerable problem. Fewer fishermen drank alcohol compared to the general population, but fishermen lacked knowledge about what safe levels of alcohol consumption were. Diet was lacking in fruit and vegetables, and meals were eaten at very erratic intervals. Fishermen may benefit from health promotion and education in the areas of smoking, diet and alcohol consumption.
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Introduction |
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It has long been known that fishing is one of the most dangerous occupations. In 2001, 33 boats were lost and 10 fishermen killed in UK waters (Marine Accident Investigation Branch, 2002
). Studies in the UK fishing population have shown little improvement in mortality over time (Reilly, 1985). Some measures have been taken by the industry to address safety such as risk assessments, compulsory inspections every 4 years and mandatory training in key areas. However, health issues have not been systematically addressed through service initiatives or research.
A previous international literature review of the fishing industry revealed that there have been limited studies conducted among fishermen (Matheson et al., 2001a). The majority of studies focused on mortality rates and accidents. Many of the studies were of poor methodological quality and focused on specific aspects of fishermen's health (Rix et al., 1982; Driscoll et al., 1994). It is difficult to generalize from studies external to the UK and Scotland. Fishermen in other parts of the world are often involved in different types of fishing than in Scotland, and may experience different health and safety problems. Additionally, the majority of studies were conducted 10 years ago and several over 20–30 years ago (Moore, 1969; Dalgaard et al., 1972; Cadenhead, 1976), further reducing their relevance to the present day.
One particular methodological issue was raised by some studies. Their unusual working patterns (Moore, 1969), involving long periods of time at sea and only short periods of time on shore, make fishermen difficult to contact and thus a challenging population for research recruitment.
A combined qualitative/quantitative needs assessment was conducted in order to address the deficit in current knowledge of fishermen's health and lifestyle. This paper will focus on lifestyle issues, including smoking, alcohol consumption and diet.
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Methods |
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Questionnaire design
A questionnaire survey (The Fishermen's Health and Lifestyle Survey) was developed after extensive content-setting interviews with fishermen, and consultation with industry representatives, an Occupational Physician, a Health Promotion specialist in Health in the Workplace and staff of the main Scottish training college for fishermen.
The questionnaire explored a range of health and safety issues, including diet, smoking, alcohol consumption, illicit drug use, prescribed drug use, medical emergencies and injuries at sea. Demographic details such as age and occupation were collected, as well as information on type of boat worked on, size of crew and number of boats worked on during career.
In a pre-piloting exercise, 18 fishermen attending college were given questionnaires to complete. Feedback was obtained on the ease of completion, appropriateness of questions, understanding of questions and time to complete the questionnaire.
Following this, minor changes were made to the wording of some questions and then a postal pilot was undertaken to simulate the real conditions of using the questionnaire.
Questionnaires were sent to a 5% (n = 43) random sample of skippers listed in the Scottish Fishermen's Federation (SFF) Handbook and Diary. A covering letter explaining the research and a postage reply-paid envelope were enclosed. A 58% response rate was achieved and none of the fishermen reported any difficulties completing the questionnaire. Only skippers were included in the pilot because the research team had access to skippers' names from the SSF Handbook and how to contact crew was still being considered. Once crew members were identified there was not enough time to include them in the pilot exercise.
There is no single database in the public domain that lists all Scottish fishermen. Fishermen were therefore identified through a combined approach including fish-selling offices and the SFF Handbook, which lists the names and addresses of 900 fishermen (skippers only). Fish-selling offices act as agents for the skippers selling their catch and calculating the crew's wages. Twenty-seven fish-selling offices in Scotland were contacted, and 21 supplied names and addresses, giving a response rate of 78%. A final list of 2011 names was used as the sampling frame.
A questionnaire, explanatory covering letter and reply-paid envelope were posted to 2011 fishermen (all at their home address). Two numbered reminders were sent after intervals of 2 weeks and a further final anonymous reminder.
Health diaries
The health diaries were designed to help gain a more detailed understanding of the issues of fishermen's diet, sleep, injuries at sea, smoking and alcohol consumption. In the health diaries, fishermen were asked to record daily their sleep patterns, what they ate and drank, how much they smoked, how much alcohol they consumed, and if they had been unwell, taken medicines or had experienced an injury. This allowed for a more detailed analysis of these areas.
Data management and analysis
Returned questionnaire data was entered into a database (SPSS) for analysis. The analyses used simple descriptive statistics such as means with SDs, frequencies and 
2 where relevant to test for associations between categorical variables.
Health diaries were analysed using qualitative content analysis. For example, comments written under diet were grouped into breakfast, main meal, drinks, snacks and time meal was taken, and then analysed. For themes like smoking, the average amounts smoked at home and at sea were calculated.
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Results |
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A final response rate of 57% (1150) was achieved. Only 10 fishermen completed health diaries due to logistical problems recruiting fishermen.
Smoking
Of the respondents, 38.4% (n = 442) were current smokers (detailed results are shown in Table I).
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Fishermen smoke significantly more when they go to sea (P < 0.001). The vast majority of smokers, 88.1% (N = 391), thought their present levels of smoking were harmful to their health and 82.3% (N = 363) of smokers stated they would like to give up smoking.
Alcohol consumption
Respondents were asked about their alcohol consumption; 80.6% (N = 927) of respondents drank alcohol and 6.7% (N = 62) of those that drank thought their present level of consumption was harmful to their health.
Of the fishermen, 12.2% (N = 141) were drinking over the recommended safe weekly limit of 21 units. Fishermen were also asked about their consumption of alcohol at sea. Only 1.1% (N = 12) of fishermen reported drinking alcohol at sea, but none reported drinking more than 3 units a day at sea. See Table II.
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The questionnaire asked fishermen who drank if they knew ‘how many units of alcohol is considered to be safe and sensible for a male to drink in a week?’. Results are shown in Table III.
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Only 5.4%(n = 50) were aware that 21 units is considered the safe weekly limit of alcohol consumption for a male.
Diet
The perceptions fishermen had about their own diet were examined by asking about consumption of fruit and vegetables as a marker of the quality of their diet: 6.3% (N = 72) perceived their diet as excellent, 23.8% (N = 274) as very good, 42.4% (N = 488) as good, 21.7% (N = 250) as fair and only 4.7% (N = 54) as poor. Table IV shows how often fishermen consumed fruit and vegetables at sea and at home.
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Only 23% of fishermen reported eating fruit and vegetables more than once a day at sea and only 29% at home. Fishermen ate significantly less fruit and vegetables when they went to sea (P < 0.001).
Ten Fishermen completed health diaries and kept a detailed record of their diet. They recorded what they had to eat for their main meals, any snacks they had and what they had to drink whilst at sea. Table V shows an example of two fishermen's diet.
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The times that meals were taken are highlighted in italics; the times snacks and drinks were taken was not recorded. Of note was the erratic timing of meals—often eaten late at night or very early in the morning. Fishermen recorded drinking large quantities of carbonated drinks and coffee.
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Discussion |
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Identifying the sample for the main survey proved problematic as the only existing comprehensive list of Scottish fishermen was a tax book held by the Inland Revenue, which contained details of approximately 4000 fishermen. This was not available to the research team due to confidentiality issues. Ideally, the research team wanted to be able to define and identify the whole population of fishermen so that a sample could be randomly identified to receive the questionnaire. However, there was no mechanism to do this. Limitations of available data to draw the study-sampling frame meant that the whole occupational cohort of Scottish fishermen could not be used and it is difficult to assess how representative the actual sample was.
Two sources of data were available: skippers who were members of the SFF as listed in the SFF Handbook and fish-selling offices data. The high number of skippers in the SFF Handbook meant skippers were over-represented in relation to other groups. The representativeness of the crew population depends on whether there was any bias or pattern among the fish-selling offices that did not provide data. Analysis of geographical location and size of these offices did not indicate any such bias or pattern, although Shetland fishermen may have been under-represented, as one large fish-selling office in Shetland did not participate. Although fishermen were asked to give their occupation, it is possible that on smaller boats, with a crew of three or four, fishermen perform several tasks.
This survey, like previous studies in this population, raised a major methodological issue (Moore, 1969), which is the difficulty in defining and tracing the population. Fishing populations are a mobile, self-employed group that spend long periods away from home, making it difficult to contact them. The problem of recruiting fishermen was particularly evident during the health diary component of the research. It proved challenging to contact fishermen, due to a lack of telephone contact details and because they spent most of their time at sea. These difficulties may well have inhibited previous research among this population.
Results showed 38% of respondents smoked. Smoking levels were compared with data from the Grampian Lifestyle Survey (Grampian Health Board, 1998), Grampian being the region where the majority of Scottish fishermen live, and the Scottish Health Survey (Scottish Office, 1998). These found that 29% of the Grampian male population smoke (Grampian Health Board, 1998) and 34% of the Scottish male population smoke (Scottish Office, 1998). The mean number of cigarettes smoked by fishermen was 20 daily at home and 28 daily at sea, compared to a mean of 18 daily among Scottish males (Scottish Office, 1998). This suggests that fishermen smoke more than other Scottish male smokers.
However, some caution is needed when comparing results. The Scottish Health Survey found 34% of males smoked; however, if smoking prevalence is broken down by social class there are wide variations, e.g. only 13% of Scottish males smoke in social class 1 compared to 45% in social class 5 (Scottish Office, 1998). Unfortunately, a breakdown of smoking by social class was not available from the Grampian Health and Lifestyle Survey. According to the Registrar General's classification scheme, fishermen belong to social class 5, semi-skilled manual (Mayhew, 1997). This means that smoking amongst fishermen (38% smoke) is lower than other Scottish males belonging to social class 5 (45% smoke). However, not all fishermen easily fit in to social class 5. Skippers operate complicated machinery and navigation equipment as well as manage their own boat and staff. Skippers fit more appropriately in to social class 3 (skilled manual). The smoking prevalence among Scottish males from social class 3 (manual) is 38%. As our sample over-represented skippers this might suggest smoking rates amongst fishermen are similar to other males from the same social class.
A high proportion of fishermen that smoked (88%) thought their present level of smoking was harmful to their health and 82% of them wanted to give up smoking. This is encouraging when compared to 61% of Scottish smokers who want to stop (Health Education Board Scotland, 1997).
Another issue raised was passive smoking. There were no questions asking directly about this issue, but five fishermen raised it in the comments section of the questionnaire. They stated that due to the confined space of a fishing boat everyone onboard is exposed to smoke whether they smoke or not. It is perhaps surprising that not more fishermen raised the issue of passive smoking. This may indicate a need for health education on the dangers of passive smoking among this population. One recent study into the impact of passive smoking conducted in the US suggests the ratio of deaths is approximately one non-smoker dying from illness caused by second-hand smoke exposure for every eight smokers who die from diseases caused by tobacco use (Miner and Crutcher, 2002). If these figures are correct the effects of passive smoking in the confined space of a fishing boat are potentially very serious. Legislation banning smoking from enclosed areas of fishing boats should be considered. Fishermen that smoke should do so on deck or in a designated, well-ventilated area that would help reduce others' exposure to smoke.
Questionnaire findings found 81% of fishermen drank alcohol. Interestingly, data from the Grampian Lifestyle Survey (Grampian Health Board, 1998) and the Scottish Health Survey (Scottish Office, 1998), although not directly comparable because the question was asked slightly differently, shows higher levels of drinking among males in Grampian (93%) and Scottish males (94%). Results also show the vast majority of fishermen reported drinking below 21 units per week. These comparisons suggest that the fishing population may have a lower prevalence of alcohol consumption than the general Scottish male population. This could be linked to religious beliefs regarding alcohol abstention in some fishing communities. Fishermen's declared levels of alcohol consumption need to be viewed with caution. Fishermen commonly spend 10 days at sea and are only home for 2–3 nights before going back to sea. This may facilitate binge drinking, and although a large proportion of fishermen reported drinking below the safe weekly limit, the alcohol consumed by some fishermen is likely to be consumed in 1–2 nights, which could still be a hazard to their health. The vast majority of fishermen reported they did not drink at sea. It is possible that some fishermen under-reported their drinking levels.
When fishermen were asked about their knowledge of the recommended weekly alcohol consumption guidelines, 66% stated they did not know the safe weekly limit. Only 5% (n = 50) of those that drink gave the correct answer of 21 units and this compares to 20% of the Scottish general population that were aware of the recommended safe weekly limit of alcohol consumption (Health Education Board Scotland, 1997). Fishermen should be targeted with health promotion initiatives raising awareness of safe levels of drinking and the dangers associated with binge drinking.
Results show that 72.5% of fishermen thought their diet was either good, very good or excellent, with only 4.7% perceiving their diet as poor. However, when fishermen were asked how often they consume fruit and vegetables, it appears that their diets are not as good as perceived. Only 29.7% ate fruit and vegetables more than once a day when at home and only 23.2% when at sea. This compares to 37% of males amongst the Scottish population (Health Education Board Scotland, 1997). Results also show 35.6% either ate fruit and vegetables less than once a week or never, compared to 18% of males in the Scottish population (Health Education Board Scotland, 1997). This suggests that the majority of fishermen fall considerably short of the daily recommended five portions of fruit and vegetables per day. This may be limited due to a lack of storage facilities on boats for such fresh produce.
Health diary entries show that food was often fried (particularly breakfast) and snacks with a high fat content were frequently eaten. The timing of meals was often erratic and, interestingly, results from the questionnaire showed a high proportion of fishermen were taking medication for gastrointestinal problems (Matheson et al., 2001b), which could possibly be linked to poor diet and erratic timing of meals.
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Conclusion |
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Health promotion and education initiatives should be conducted to raise fishermen's awareness of the dangers of passive smoking and they should be made aware of the existing services that are provided to help smokers quit. Legislation should be considered to ban smoking below deck or to at least develop a code of best practice that would reduce levels of passive smoking. Fishermen should be made aware of safe drinking levels and the dangers of binge drinking, and it should be made illegal to board a boat under the influence of alcohol. Fishermen should be encouraged to eat more fruit and vegetables, especially at sea, and should be encouraged to try and regulate their meal times as much as possible.
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Acknowledgments |
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We would like to thank FISH (Fishing Industry Safety and Health) for funding the research. We would also like to thank all the fishermen who took part in the study for their co-operation.
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References |
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Received on December 12, 2002; accepted on August 2, 2003
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