Canadian Community Health Survey Cycle 2.2 (2004) – Nutrition ACCOLEDS / DLI 2005 Data Workshops Saskatoon, Nov. 30 – Dec. 1, 2005 Mario Bédard Ingrid Ledrou Health Statistics Division Statistics Canada

2 Presentation Overview CCHS design – “.1’s” & “.2’s” CCHS 2.2 (2004) - Nutrition  general health component  24-hour recall component Data files – releases, Web, PUMF … on a “heavier note”…

CCHS Design “.1’s” vs “.2’s”

4 CCHS - Objectives Provide timely, consistent, cross-sectional estimates of health determinants, health status and health system utilization across Canada Sub-provincial geography (“.1’s”)  health regions Flexible survey instrument  meet specific health region data needs  quick response to emerging issues  provide focused survey content for key data gaps (“.2’s”)

5 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)

6 CCHS - Status Cycle 1.1 ( ) General content sample health region estimates initial release: May, 2002 PUMF ☻ Cycle 2.1 (2003) General content sample health region estimates initial release: June, 2004 PUMF ☻ Cycle 1.2 (2002) - focus Mental health & well being ~ sample provincial estimates initial release: Sept 2003 PUMF ☻ Cycle 2.2 (2004) - focus Nutrition ~ sample provincial estimates Two-stage release: July 2005 & Feb PUMF x 2 ☺

7 CCHS - Status Cycle 3.1 (2005) General content 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) - Nutrition

9 A Brief History Nutrition  Nutrition 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 measurements  Canada Health Survey, , national  Canadian Heart Health Surveys, 1986 to 1992, different provinces

10 A Brief History CCHS 2.2 – Nutrition  feasibility study for CCHS focus content on nutrition: initiated late 1999  development begins: Spring 2002  collection: Jan. – Dec  first results released: July, 2005 PUMF: Dec, 2005  complete release: Feb, 2006 PUMF: ~Spring 2006

11 CCHS 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

12 CCHS 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

13 Sample 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 age/sex groups: – < 1both sexes – 1 - 3both sexes – 4 - 8both sexes – m - f separate – m - f separate – m - f separate – m - f separate – m - f separate – 71 +m - f separate

14 Sample 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

15 Sample 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

16 Sample Design – Buy-Ins Buy-ins  Off-Reserve Aboriginals - Health Canada national - frame: CCHS 2.1 not identifiable in PUMF: “white” / “other”  P.E.I. provincial top-up - frame: P.E.I. Health Registry  Ont. 7 regions - frame: CCHS 2.1 PUMF: 7 –SW, Central-E, -S, -W, E, N, Toronto  Man. 4 regions – frame: Man. Health Registry PUMF: 3 –Burntwood/Norman/Churchill + Assiniboine/Parkland/Brandon, N & S Eastman/Interlake/Central, WInnipeg Total actual sample size: 35,100 units

17 CCHS 2.2 Content Two components  24-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) –…

18 CCHS 2.2 Content 24-Hour Dietary Recall All foods & beverages consumed during 24- hour period of reference  midnight to midnight the day prior to the interview  details - what  amounts – how much CAI application  developed by the United States Department of Agriculture  automated multiple pass methodology

19 CCHS 2.2 Content 24-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 report 2. Forgotten Foods – anything else with that? 3. Time and Occasion – when / group items 4. Detail Cycle – describe, prep, additions, amounts, where 5. Final Probe – any other food / beverage

20 CCHS 2.2 Content 24-Hour Dietary Recall Second recall  calculate intra-individual variability  subsample of 10,000 units (CATI)  3 to 10 days after the first interview, preferably a different day of the week  minimum 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

21 CCHS 2.2 Content General Health General Health (12+) Physical Activity (12+) Children’s Physical Activity (6 to 11) Sedentary Activity ( ) 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 ( ) Income (all)

22 Data Collection - Design Four quarterly samples  Jan. to Dec minute CAPI interview  including the 1 st 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)

23 Data Collection – Response Rates 1st Interview (%)2nd Interview (%) OverallArea Frame Other Frames OverallArea Frame Other Frames Canada NL PE NS NB QC ON MB SK AB BC

24 Data Collection – Sample Sizes 1 st interview2 nd interview Canada35,10710,786 NL1, PE1, NS1, NB1, PQ4,7801,964 ON10,9211,647 MB4, SK2, AB3, BC3,6481,564

25 Data Collection - Sample Sizes by Age - 1 st Interview (80 / DRI) Total< Canada NL PE NS NB QC ON MB SK AB BC

26 Data Collection - Sample Sizes by Age - 2 nd Interview (50 / DRI) Total< Canada NL PE NS NB QC ON MB SK AB BC

27 Data Collection - Measured Height and Weight (% item resp) TotalNLPENSNBQCONMBSKABBC Measured – H/W Refused Respondent Not Available Resp. too Tall Equipment (NA, batteries) Phone Interview Interview Setting Physical/Mental Condition Data not stated Other

28 Data Release(s) – 2 Steps CCHS 2.2 data are being released in two steps  Step 1: general health component except vitamin & mineral supplements  Step 2: 24-hour recall (nutrition) component including vitamin & mineral supplements

29 Data Release(s) – Step 1 Step 1: General health component - July 6, 2005 Single flat file  2 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

30 Data 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

40 Data Release(s) – Step 1 PUMF - Dec. 5, 2005  Single 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

50 Data Release(s) – Step 2 Step 2: Nutrition - Feb 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 ? Possible third weight (nutrition) ? ? Intake distribution software ? PUMF (including Step 1 data) – Spring 2006

51 Data Release(s) – Step 2 4 flat files  general health and nutritional summary data file 1 record per respondent  vitamin and mineral supplements file 1 record per supplement reported  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

Roll Up

53 Data Release(s) – Step 2 Nutrition 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

54 Training & Support Proper use of data / files Use of intake distribution software Health Canada – interpretation guide STC / CIHR RFA funding research  RDCs

55 Data Release(s) – Obesity Body Mass Index (BMI)  a measure of person’s weight in relation to his/her height  highly 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

56 Data 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 CategoryBMI valueRisk level underweightBMI < 18.5increased normal weight18.5 < BMI < 24.9least overweight25.0 < BMI < 29.9increased obese class I30.0 < BMI < 34.9high obese class II35.0 < BMI < 39.9very high obese class IIIBMI ≥ 40.0extremely high

57 Measured Obesity Rates by Age, Canada Health Survey (1978/79) and CCHS (2004) FF * * * * ** * *

58 Obesity Rate Over Time, Age /79 – 2004 Measured Self-reported

59 Contact Info Mario BédardIngrid Ledrou (613) (613) Data Access Unit Population Health Surveys (NPHS, CCHS) Health Statistics Division Statistics Canada