1. Canadian Community Health Survey Cycle 2.2 (2004) – Nutrition
ATLANTIC DLI TRAINING 2006
Wolfville, April 19 – April 21, 2006
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”…

3. CCHS Design “.1’s” vs “.2’s”
Objectives
Aid in the development of public policy;
Understand the determinants of health;
Collect data on the economic, social, demographic, occupational and environmental correlates of health;
Increase the understanding of the relationship between health status and health care utilization;
Follow a panel of people to reflect the dynamic processes of health (NPHS);
Provide a means to supplement content or sample
Provide the possibility of linking the information to other data sources (administrative data)

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”)
100++ 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 (2000-2001) Cycle 2.1 (2003)
General content
sample
health region estimates
initial release: May, 2002
PUMF ☻
Cycle 2.1 (2003)
initial release: June, 2004
Cycle 1.2 (2002) - focus
Mental health & well being
~ sample
provincial estimates
initial release: Sept., 2003
PUMF ☻
Cycle 2.2 (2004) - focus
Nutrition
Two-stage release: July 2005 & May 2006
PUMF x 2 ☺

7. CCHS - status Cycle 3.1 (2005) Canadian Health Measures Survey (2006)
General content
sample
health region estimates
6-mth data release: Dec, 2005
full release: June, 2006
PUMF ☺
Cycle ? 4.1 ? (2006+)
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 ☺

8. CCHS 2.2 (2004) - Nutrition Objectives
Aid in the development of public policy;
Understand the determinants of health;
Collect data on the economic, social, demographic, occupational and environmental correlates of health;
Increase the understanding of the relationship between health status and health care utilization;
Follow a panel of people to reflect the dynamic processes of health (NPHS);
Provide a means to supplement content or sample
Provide the possibility of linking the information to other data sources (administrative data)

9. A brief history Nutrition Physical measurements 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. 2004
first results released: July, 2005
PUMF: December 2005
complete release: Feb, 2006
PUMF: ~ Fall 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), as specified by the American Institute of Medicine
DRI age/sex groups:
< 1 both sexes
1 - 3 both sexes
4 - 8 both 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
Buy-ins from ON, PEI, MAN and Health Canada
Total sample size = 35,100 units

16. 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) …

17. 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

18. 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
Quick List – quick report
Forgotten Foods – anything else with that?
Time and Occasion – when / group items
Detail Cycle – describe, prep, additions, amounts, where
Final Probe – any other food / beverage

19. 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

20. CCHS 2.2 content general health
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)

21. Data 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%

22. Data collection – 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
Provinces in yellow are the ones with oversample

23. 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
pending validation
release postponed

24. 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

25. 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

35. 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

36. Data 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

37. 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
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

38. Roll Up

39. 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

40. Training & support Proper use of data / files
Use of intake distribution software
Health Canada – interpretation guide
STC / CIHR RFA funding research
RDCs

41. 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

42. 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
Category BMI value Risk level
underweight BMI < increased
normal weight 18.5 < BMI < 24.9 least
overweight < BMI < 29.9 increased
obese class I 30.0 < BMI < 34.9 high
obese class II 35.0 < BMI < 39.9 very high
obese class III BMI ≥ extremely high

43. Measured Obesity Rates by Age Canada Health Survey (1978/79) and CCHS (2004)* * * * * * * * F F

44. Obesity Rate Over Time, Age 18+ 1978/79 – 2004
Measured
Self-reported

45. Population Health Surveys (NPHS, CCHS) Health Statistics Division
Contact Info
Mario Bédard Ingrid Ledrou
(613) (613)
Data Access Unit
Population Health Surveys (NPHS, CCHS)
Health Statistics Division
Statistics Canada