CCanadian anadian CCommunity ommunity HHealth ealth SSurveyurvey
CCycle 2.2 (2004) –ycle 2.2 (2004) – N Nutritionutrition
ONTARIO DLI TRAINING 2006ONTARIO DLI TRAINING 2006
Guelph, April 10 – April 13, 2006Guelph, April 10 – April 13, 2006
Ingrid LedrouIngrid LedrouHealth Statistics DivisionHealth Statistics Division
Statistics CanadaStatistics Canada
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Presentation overviewPresentation overview
CCHS design – “.1’s” & “.2’s”CCHS 2.2 (2004) - Nutrition
general health component24-hour recall component
Data files – releases, Web, PUMF… on a “heavier note”…
CCHS DesignCCHS Design““.1’s” .1’s” vsvs “.2’s” “.2’s”
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CCHS - objectivesCCHS - objectives
Provide timely, consistent, cross-sectional estimates of health determinants, health status and health system utilization across Canada
Sub-provincial geography (“.1’s”)100++ health regions
Flexible survey instrumentmeet specific health region data needsquick response to emerging issuesprovide focused survey content for key data
gaps (“.2’s”)
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CCHS - 2-year cycle design CCHS - 2-year cycle design
Year 1 – “General” 130,000 respondents stratified by health region Content
common optional sub-sample
Estimates for health regions, provinces, territories, Canada
Year 2 – “Focus” 30,000 respondents stratified by province Content
focus correlates 60+ minutes
Estimates for provinces, Canada (excluding territories)
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CCHS - statusCCHS - status
Cycle 1.1 (2000-2001) General content 130 000+ sample health region estimates initial release: May, 2002 PUMF ☻
Cycle 2.1 (2003) General content 130 000+ sample health region estimates initial release: June, 2004 PUMF ☻
Cycle 1.2 (2002) - focus Mental health & well being ~30 000 sample provincial estimates initial release: Sept., 2003 PUMF ☻
Cycle 2.2 (2004) - focus Nutrition ~30 000 sample provincial estimates Two-stage release: July 2005 &
May 2006 PUMF x 2 ☺
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CCHS - statusCCHS - status
Cycle 3.1 (2005) General content 130 000+ sample health region estimates 6-mth data release: Dec, 2005 full release: June, 2006 PUMF ☺
Cycle ? 4.1 ? (2006+) General content 130,000+ sample continuous ? HR estimates w/more flexibility staggered releases PUMF (24 months) ☺
Canadian Health Measures Survey (2006)
Cycle ? 4.2 ? (2008) Focus content aging ? PUMF ☺
CCHS 2.2 (2004) - NutritionCCHS 2.2 (2004) - Nutrition
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A brief historyA brief history
NutritionNutrition Canada, 1972
• last national population based data on food consumption and related nutrition assessment with physical and biological measurements
Health Canada’s provincial nutrition surveys, 1990’s
Physical measurementsCanada Health Survey, 1978-79, nationalCanadian Heart Health Surveys, 1986 to 1992,
different provinces
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A brief historyA brief history
CCHS 2.2 – Nutritionfeasibility study for CCHS focus content
on nutrition: initiated late 1999development begins: Spring 2002collection: Jan. – Dec. 2004first results released: July, 2005
• PUMF: December 2005complete release: Feb, 2006
• PUMF: ~ Fall 2006
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CCHS 2.2 - goalsCCHS 2.2 - goals
Provide reliable, detailed, and timely information on dietary intake, nutritional well-being and their key determinants
To inform and guide programs, policies and activities of federal and provincial governments as well as local health agencies
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CCHS 2.2 - objectivesCCHS 2.2 - objectives
Estimate the distribution of usual dietary intake in terms of foods, food groups, dietary supplements, nutrients and eating
patterns for a representative sample of Canadians at provincial and
national levels Measure the prevalence of household food insecurity among
various population groups in Canada Gather anthropometric measurements
body height and weight Collect correlate information
physical activity selected health conditions socio-demographic characteristics
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Sample design - domainsSample design - domains
Distribution of usual dietary intake for a representative sample at provincial and national levels 15 key domains of interest = Dietary Reference Intakes (DRI), as
specified by the American Institute of Medicine DRI age/sex groups:
– < 1 both sexes– 1 - 3 both sexes– 4 - 8 both sexes– 9 - 13 m - f separate– 14 - 18 m - f separate– 19 - 30 m - f separate– 31 - 50 m - f separate– 51 - 70 m - f separate– 71 + m - f separate
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Sample design - coverageSample design - coverage
Target population individuals, aged 0 +, living in private occupied dwellings
in each of the ten provinces exclusions:
• 3 territories• individuals living on Aboriginal Reserves and Crown Lands• residents of institutions• full-time members of the Canadian Forces• residents of some remote areas
Coverage ~98% of the Canadian population living in the provinces
Buy-ins target groups / geography
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Sample design - allocationSample design - allocation
Initial target sample size: 30,000 responding units Two-step approach
step 1• 1,120 units to each province• 80 for each of 14 DRI groups (minimum of 80 units is not a
requirement for the < 1 age grp) step 2
• remaining 18,800 units allocated to the provinces using a power allocation scheme (q = 0.70)
Two frames LFS area frame CCHS 2.1 frame
Buy-ins from ON, PEI, MAN and Health Canada Total sample size = 35,100 units
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CCHS 2.2 contentCCHS 2.2 content
Two components24-hour dietary recall component
• collect information on all foods & beverages during 24-hour period of reference
general health component• collect correlates & socio-demographics
– selected health conditions
– physical / sedentary activity
– vitamins & minerals supplements
– height & weight (self-reported, measured)
– …
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CCHS 2.2 contentCCHS 2.2 content24-hour dietary recall24-hour dietary recall
All foods & beverages consumed during 24-hour period of referencemidnight to midnight the day prior to the
interviewdetails - whatamounts – how much
CAI applicationdeveloped by the United States Department of
Agricultureautomated multiple pass methodology
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CCHS 2.2 contentCCHS 2.2 content24-hour dietary recall24-hour dietary recall
Modified to fit Canadian marketplace to account for differences in foods available
• beaver tails, poutine… in collaboration with Health Canada contains ~27,000 foods within look-up lists translated into French
Automated multiple pass methodology 5 steps designed to improve the respondent’s ability to
remember what foods and beverages were consumed during the 24-hour period of reference
1. Quick List – quick report2. Forgotten Foods – anything else with that?3. Time and Occasion – when / group items4. Detail Cycle – describe, prep, additions, amounts, where5. Final Probe – any other food / beverage
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CCHS 2.2 contentCCHS 2.2 content24-hour dietary recall24-hour dietary recall
Second recallcalculate intra-individual variabilitysubsample of 10,000 units (CATI)3 to 10 days after the first interview, preferably a
different day of the weekminimum of 125 individuals for each of the 15
DRI/sex groupings by region• Atlantic, Quebec, Ontario, Prairies, BC• 50 respondents ~ collapse by region not necessary
Intake distribution software
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CCHS 2.2 contentCCHS 2.2 contentgeneral healthgeneral health
General Health (12+) Physical Activity (12+) Children’s Physical Activity
(6 to 11) Sedentary Activity (12 - 17) Measured Height and
Weight (2+) Self Reported Height and
Weight (10% sample, 18+) Vitamin and Mineral
Supplements (all) Household Food Security
(all)
Fruit and Vegetable Consumption (6 mo.+)
Women’s Health (9+) Chronic Conditions (all) Smoking (12+) Alcohol Consumption (12+)
Socio-Demographics (all) Labour Force (15 - 75) Income (all)
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Data collection - designData collection - design
Four quarterly samples Jan. to Dec. 2004
60-minute CAPI interview including the 1st 24-hour recall and physical measures anticipated response rate: 80%
• 85% for fresh sample• 75% for 2.1 sample of households
Proxy interview protocols Respondents aged 12+: non proxy Aged 6 to 11: assisted proxy (respondent and parent) Aged 0 to 5: full proxy (parent only)
Responses rates 1st interview = 76.5% 2nd interview = 72.8 %
Item response rate for measured height and weight = 63%
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Data cData collection ollection – sample sizes– sample sizes
1st interview 2nd interview
Canada 35,107 10,786
NL 1,734 752
PE 1,430 860
NS 1,705 704
NB 1,633 683
PQ 4,780 1,964
ON 10,921 1,647
MB 4,194 921
SK 2,041 894
AB 3,021 767
BC 3,648 1,564
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Data release(s) – 2 stepsData release(s) – 2 steps
CCHS 2.2 data are being released in two stepsStep 1: general health component
• except vitamin & mineral supplements
Step 2: 24-hour recall (nutrition) component• including vitamin & mineral supplements
– pending validation– release postponed
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Data release(s) – step 1Data release(s) – step 1
Step 1: General health component - July 6, 2005
Single flat file2 sampling weights
• general• measured body height & weight
PUMF - Dec. 5, 2005 Internet Publication
“Nutrition: Findings from the Canadian Community Health Survey”
• 2 articles: adult and children obesity• CANSIM tables
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Data release(s) – step 1Data release(s) – step 1
I-Pub: “Nutrition: Findings from the Canadian Community Health Survey”2 analytical articles
• “Adult obesity in Canada: Measured height and weight”, Michael Tjepkema, STC
• “Overweight Canadian children and adolescents”, Margot Shields, STC
CANSIM tables• adult measured BMI, child measured BMI, food
insecurity, children’s physical activity, teenager’s sedentary activity
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Data release(s) – step 1Data release(s) – step 1
PUMF - Dec. 5, 2005Single flat file
• 2 sampling weights– general– measured body height & weight
Documentation• user guide• data dictionary• derived variables• syntax files / layouts (SAS & SPSS)
B20/20 utility x 2• user-defined tabulations
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Data release(s) – step 2Data release(s) – step 2
Step 2: Nutrition – May 18, 2006 Assigning food codes to ~ 750,000 records
with Health Canada coding to Canadian Nutrient File
calculate nutritional profiles for each food using a processing system designed by Health Canada for provincial nutrition surveys
Re-issue Step 1 data Intake distribution software ? No PUMF (including Step 1 data) – Fall 2006
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Data release(s) – step 2Data release(s) – step 2
4 flat filesgeneral health and nutritional summary data file
• 1 record per respondentvitamin and mineral supplements file
• 1 record per supplement reported• Pending validation• Release postponed
food details file• 1 record per food reported
day 1 and 2 intake summary file• 1 record per intake day
– 1 record for 2/3 of respondents, 2 records for 1/3 of respondents
General Health and Nutrition Summary File
Sample ID GEN
1111 x1112 x1113 x 15
Day 1 plus usual daily vitamin and mineral details (A + B)
xxx
Day 1 Food Detail summary (B)
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VMD Summary (A)
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Vitamin and Mineral Details
Sample ID # VMD1111 1 x1111 2 x1112 1 x1112 2 x1112 3 x
Food Details
Sample ID # Day Details
1111 1 1 x1112 1 1 x1112 … 1 x1112 40 1 x1112 1 2 x1112 … 2 x1112 25 2 x1113 1 1 x1113 … 1 x1113 15 1 x
Roll Up
Intake Day Summary
Sample ID Day Details1111 1 11112 1 401112 2 251113 1 15
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Data release(s) – step 2 Data release(s) – step 2 nutrition variablesnutrition variables
Protein Fat (total lipids) Carbohydrate, total Energy (kilocalories) Alcohol Mositure Caffeine Energy (kilojoules) Sugars (total) Fibre, total dietary Calcium Iron Magnesium Phosphorous Potassium Sodium Zinc Vitamin D (IU) Viitmin D (micrograms)
Vitamin C Thiamin Riboflavin Total Niacin Equivalent Vitamin B6 Total Folacin Vitamin B12 Folic Acid Cholesterol Fatty Acids, Saturated, Total Fatty Acids, Polyunsaturated, 18:2,
Linoleic Fatty Acids, Polyunsaturated, 18:3,
Linolenic Fatty Acids, Monounsaturated, Total Fatty Acids, Polyunsaturated, Total Naturally Occuring Folate Retinol, Activity Equivalents Dietary Folate Equivalent
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Training & supportTraining & support
Proper use of data / filesUse of intake distribution softwareHealth Canada – interpretation guideSTC / CIHR RFA funding research
RDCs
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Data release(s) – obesityData release(s) – obesity
Body Mass Index (BMI)a measure of person’s weight in relation to
his/her heighthighly correlated with body fat and is widely
used to indicate a person’s potential health risks Measuring BMI
metric:• BMI = weight (kg) / height (m)2
imperial:• BMI = weight (lb) / height (inches)2 x 703
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Data Release(s) – ObesityData Release(s) – Obesity
Body Mass Index (BMI)Canadian guidelines
• in keeping with those of the WHO, classifies BMI into six categories, each representing a certain level of risk to one’s health
Category BMI value Risk levelunderweight BMI < 18.5 increasednormal weight 18.5 < BMI < 24.9 leastoverweight 25.0 < BMI < 29.9 increasedobese class I 30.0 < BMI < 34.9 highobese class II 35.0 < BMI < 39.9 very highobese class III BMI ≥ 40.0 extremely high
Measured Obesity Rates by AgeMeasured Obesity Rates by AgeCanada Health Survey (1978/79) and CCHS (2004)Canada Health Survey (1978/79) and CCHS (2004)
0
5
10
15
20
25
30
35
2-5 6-11 12-17 18-24 25-34 35-44 45-54 55-64 65-74 75+
per
cen
t
1978/79
2004
F F
* *
* *
* *
* *
Obesity Rate Over Time, Age 18+Obesity Rate Over Time, Age 18+1978/79 – 20041978/79 – 2004
0
5
10
15
20
25
per
cen
t
Measured
Self-reported
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Contact InfoContact Info
Mario Bédard Ingrid Ledrou(613) 951-8933 (613) [email protected]
Data Access UnitPopulation Health Surveys (NPHS, CCHS)
Health Statistics DivisionStatistics Canada
[email protected]@statcan.ca