Canadian Community Health Survey (CCHS) - Annual Component Survey Overview - DLI Halifax Training May 9th, 2019

Overview Survey Overview Content overview through the years Important changes about 2015 redesign 2015-16 CCHS PUMF1 Future modernizations 1 – Public Use Microdata File

Survey overview - history Started with Health Information Roadmap -1999 Adoption of an indicator framework Health behaviours Health surveillance Access to health care system CCHS annual program and focus content program Governing committee – Canadian Population Health Survey Program Health Canada, Public Health Agency of Canada Expert groups

Survey Overview - Objectives Health surveillance at the national, provincial and sub-provincial levels Analysis on small populations and rare characteristics  Readily available data to a diversified user community in a timely fashion Flexible survey instrument

Survey Overview: Design Residents of private households aged 12 and over Exclusions: Aboriginal reserves / settlements institutions (health institutions, prisons, religious institutions, convents, etc.) members of Canadian Forces Residents of certain very remote areas Coverage (general) ~97% of targeted population Designed to provide reliable estimates at the health region level with two years of data

Survey overview: Health Regions Administration of health in the provinces is divided into health regions. PEI and territories each are designated as their own single HR For CCHS 2015-2016, data was collected for 104 HRs in the provinces, in PEI and in each territory, totalling 108 HRs This is the lowest level of geography on the PUMF, after some grouping* HRs are grouped on PUMFs to ensure a minimum population size that prevents disclosure. Because of uniqueness of the geography, La Région du Nord du Québec (HR 2410) is dropped from PUMFs entirely.

Survey overview: Collection The CCHS is collected by interviewers using a computer based questionnaire: 20% in person, and 80% by telephone Respondents aged 12-15 interviewed alone with parental consent 2.5% of cases completed by proxy The collection method (in person vs on the phone) is important to know, given that there can be bias in reporting when speaking to the interviewer for each mode. The 2.5% proxy cases were only allowed for instances where the selected respondent was not able to answer, due to a physical or mental health condition. Some questions were not asked in proxy interviews. Users will see a higher rate of ‘not stated’ for these questions.

Survey overview: Data processing During the interview, questions get skipped for various reasons and need coding: Non-response Interview incomplete Question not relevant “Other – specify” responses are sometimes recoded to a response category Derived variables are added to the file based on responses These cases are coded as “Not stated” Coded as “Not applicable” When a person says no or refuses to say if they have asthma (CCC_Q031), then the question on having asthma symptoms or attacks in the past year (CCC_Q035) is skipped. In the case of the ‘No’ asthma response, Q035 is coded as ‘not applicable’. For the refusal case, we don’t know if they have asthma, so Q035 is set to ‘Not stated’.

Survey overview: Weighting Each respondent represents themselves and others in the population The sample weight WTS_M indicates the population represented by each respondent Weights have been adjusted for non-response and calibrated to match population estimates: HR*sex*age group Age groups for calibration are 12-17, 18-34, 35-49, 50-64, 65+. If you are creating estimates with more refined age groups, just note that you may not align with population estimates from the census for the same geography.

Survey overview - content Three main types of content in survey Core: all years, all respondents Theme: certain years, all respondents Optional: certain years, certain provinces/territories Other content not available through DLI: Buy-ins Rapid responses Sub-samples

Survey overview – content plan

CCHS Redesign of 2015 Frame changes Collection methods Household survey frame for adults CCB for youth 12-17 Collection methods More telephone interviews overall (incl. for all youth respondents) Sample allocation more responsive to change Territorial coverage only over 2-years

CCHS - PUMF details Previous two year PUMFs: Previous one year PUMFs: Cycle 1.1 (2000/2001) Cycle 2.1 (2002/2003) Cycle 3.1 (2004/2005) 2007/2008 2009/2010 2011/2012 2013/2014 2015/2016 Previous one year PUMFs: 2010 2012 2014 Beginning with 2015-2016, the CCHS will release only two-year PUMFs to avoid the extra disclosure risk associated with releasing composite file PUMFs. Only in the case when important one-year theme modules arise in the future will the team consider reintroducing one-year PUMFs.

Included core content for CCHS 2015-2016 PUMF Alcohol Use Chronic Conditions Contact with health professionals Exposure to Second-hand Smoke Flu Shots Fruit and Vegetable Consumption General Health Height and Weight Physical Activities for adults/youth Primary Health Care Providers Smoking Maternal experiences Administration Age Labour Force Main occupation Socio-demographics Some masking is applied to variables in these modules. Consult the PUMF documentation (record layout) for more details. One new variable loaded for 15-16 will be sexual orientation (SDC).

Included theme content for CCHS 2015-2016 PUMF Health behaviours Alcohol past week Drug methods* Sexual behaviours* Patient experience Insurance Home care* Mental health Consultation about mental health Suicidal thoughts and attempts* Health conditions Chronic conditions Theme 1 Modules not loaded – DRM (only releasing DV any drug use 12 months and lifetime). Some sensitive parts of SXB (age of first intercourse, most recent STI test). HMC now loaded for first time. SUI (only releasing lifetime and 12 month ideation). Because we are only creating two-year PUMF, the one year theme is not available. Only in cases when the province/territory chose that module as optional in the non-theme year (will be available on 15-16 for those P/Ts only).

Design for CCHS PUMF 2015/16 PUMF contains 109,659 records 1,199 variables Geography variables Province / territory of dwelling* Health region of dwelling (grouped) Canadian Active Living Environment (CANALE) Territories are not grouped on the 2015/2016 PUMF which was a statcan first

Canadian Active Living Environnent (CANALE) New variable for CCHS PUMF Provides additional geospatial value to the file Scores (1-5) each 2016 DA based on the active living environment (intersection/dwelling density, points of interest, and transit stops). To link to CCHS, 2011 DAs from the file were linked with 2016 DAs in CANALE file. Multiple matches were dealt with random selection proportional to population size. Included in pre-masking to prevent ungrouping of HRs

CCHS PUMF – disclosure control Geography / HR population size Minimum population size of 70,000 per health region 19 HRs grouped into 9 3 Territories not grouped this PUMF Results in 98 Health Regions or HR groupings Age of respondent 5 year age groups 20-24 -> 75-79 12-14, 15-17, 18-19 Supports research on Body Mass Index (BMI) and new physical activity content (PAA/PAY) Other indirect identifiers grouped or masked to prevent disclosure Industry is not included on the PUMF Occupation collapsed to 5 broad categories

CCHS 15-16 PUMF: Poisson bootstrap weights Previous PUMFs did not include bootstrap weights 2015-2016 PUMF includes Poisson bootstrap weights Each weight for each replicate is generated independently All bootstrap weights are strictly positive The Poisson bootstrap does not pose confidentiality concerns For the first time for the CCHS PUMF of 2015-2016, Poisson bootstrap weights are produced and will be disseminated for users to estimate their variances. The Poisson bootstrap does not pose confidentiality concerns. Each weights for each replicates are generated independently, and except for the initial survey weights step, the method does not use design information. This method have been approved and recommended by the HSMD technical committee. The effect on variance estimates will be negligible.

PUMF Package Data Bootstrap weights Documentation Beyond 2020 User guides CV tables Data Dictionary Derived Variables Errata Questionnaire Beyond 2020

2021 CCHS Redesign Objectives Transition to Electronic Questionnaires Revisit content and develop a new content plan Revisit the methodology Increase administrative data holdings Modernize with Statistics Canada 2020 Pilot

CCHS-Annual Contacts Content manager: Anne-Marie Vinette Anne-Marie.Vinette@canada.ca Dissemination Manager: Shawn Brule Shawn.Brule@canada.ca Collection Manager: Bernard Paquet Bernard.Paquet@canada.ca Project Manager: Amanda Wright Amanda.Wright@canada.ca Redesign Manager: Ed Rama Ed.Rama@canada.ca Section Chief: José Gaudet Jose.Gaudet@canada.ca

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