1. 1.1.1
Definition
The number of new cases of cancer diagnosed during a defined period of time, per 100,000 people in a specified population
Calculation
Age-standardized mortality rates: weighted average of the age-specific (crude) rates, where the weights are the proportions of people in the corresponding age groups of a standard population. The current standard population in Canada for calculating age-standardized rates is the 1991 Canadian census population structure.
Most common cancers diagnosed in Ontario: numbers and proportion of total
Growth of cancer incidence: baseline risk, increasing cancer risk, population growth, population aging.
Analysis
Age-standardized incidence rates:
All cancers combined, Ontario, 1982–2006, by sex
Most common cancers, males (prostate, lung and bronchus, colon and rectum,) and females (breast, colon and rectum, lung and bronchus), 1982–2006
Selected cancers, males (liver and intrahepatic bile duct, thyroid) and females (cervix, liver and intrahepatic bile duct, thyroid), 1982–2006
Prostate, breast, colon and rectum, lung, 2004–2006, by LHIN, both sexes combined
Other incidence-based analyses:
Most common cancers diagnosed in Ontario, males, females, 2006 (numbers and proportions of total, not incidence rates)
Growth of cancer incidence in Ontario, 1982–2006: baseline risk, increasing cancer risk, population growth, population aging.
Considerations
Age-standardized incidence rates reflect the number new cases of cancer that would have been diagnosed if the age-specific rates observed in the given population had occurred in the standard population.
The use of a standard population allows for incidence rate trends and comparisons across jurisdictions by adjusting variations in population age distributions over time and across geographic areas.
Cancer definitions using SEER Recode may differ, especially for cancers of the colon and rectum and lung cancer, from definitions in other published analyses.
Because of changes in diagnostic practices or rules of coding and registration, interpretation of temporal trends must be done with caution.
Technical Specifications
Cancers were defined using U.S. Surveillance, Epidemiology and End Results (SEER) Recode definitions: see
Incidence was calculated using calculated using U.S. Surveillance, Epidemiology and End Results’ SEER*Stat software, version 6.5.2
“Selected cancers” rationale: thyroid cancer because of its rapidly increasing rate, especially in females, and cervix and liver because of related Cancer System Quality Index screening and clinical indicators.
Growth of cancer incidence attributed to increasing risk population growth, population aging:
baseline risk: number of new cases in 1982;
removed from actual incidence the proportion of the annual new cases for each year that would have occurred if population had continued as for 1982 in terms of:1) population growth; 2) age structure
Numerator
N/A
Denominator

2. 1.1.2
Definition
The number of new cases of cancer diagnosed during a defined period of time, per 100,000 people in a specified population
Calculation
Age-standardized mortality rates: weighted average of the age-specific (crude) rates, where the weights are the proportions of people in the corresponding age groups of a standard population. The current standard population in Canada for calculating age-standardized rates is the 1991 Canadian census population structure.
Most common cancers diagnosed in Ontario: numbers and proportion of total
Growth of cancer incidence: baseline risk, increasing cancer risk, population growth, population aging.
Analysis
Age-standardized incidence rates:
All cancers combined, Ontario, 1982–2006, by sex
Most common cancers, males (prostate, lung and bronchus, colon and rectum,) and females (breast, colon and rectum, lung and bronchus), 1982–2006
Selected cancers, males (liver and intrahepatic bile duct, thyroid) and females (cervix, liver and intrahepatic bile duct, thyroid), 1982–2006
Prostate, breast, colon and rectum, lung, 2004–2006, by LHIN, both sexes combined
Other incidence-based analyses:
Most common cancers diagnosed in Ontario, males, females, 2006 (numbers and proportions of total, not incidence rates)
Growth of cancer incidence in Ontario, 1982–2006: baseline risk, increasing cancer risk, population growth, population aging.
Considerations
Age-standardized incidence rates reflect the number new cases of cancer that would have been diagnosed if the age-specific rates observed in the given population had occurred in the standard population.
The use of a standard population allows for incidence rate trends and comparisons across jurisdictions by adjusting variations in population age distributions over time and across geographic areas.
Cancer definitions using SEER Recode may differ, especially for cancers of the colon and rectum and lung cancer, from definitions in other published analyses.
Because of changes in diagnostic practices or rules of coding and registration, interpretation of temporal trends must be done with caution.
Technical Specifications
Cancers were defined using U.S. Surveillance, Epidemiology and End Results (SEER) Recode definitions: see
Incidence was calculated using calculated using U.S. Surveillance, Epidemiology and End Results’ SEER*Stat software, version 6.5.2
“Selected cancers” rationale: thyroid cancer because of its rapidly increasing rate, especially in females, and cervix and liver because of related Cancer System Quality Index screening and clinical indicators.
Growth of cancer incidence attributed to increasing risk population growth, population aging:
baseline risk: number of new cases in 1982;
removed from actual incidence the proportion of the annual new cases for each year that would have occurred if population had continued as for 1982 in terms of:1) population growth; 2) age structure
Numerator
N/A
Denominator

3. 1.1.4 (3)
Definition
The number of new cases of cancer diagnosed during a defined period of time, per 100,000 people in a specified population
Calculation
Age-standardized mortality rates: weighted average of the age-specific (crude) rates, where the weights are the proportions of people in the corresponding age groups of a standard population. The current standard population in Canada for calculating age-standardized rates is the 1991 Canadian census population structure.
Most common cancers diagnosed in Ontario: numbers and proportion of total
Growth of cancer incidence: baseline risk, increasing cancer risk, population growth, population aging.
Analysis
Age-standardized incidence rates:
All cancers combined, Ontario, 1982–2006, by sex
Most common cancers, males (prostate, lung and bronchus, colon and rectum,) and females (breast, colon and rectum, lung and bronchus), 1982–2006
Selected cancers, males (liver and intrahepatic bile duct, thyroid) and females (cervix, liver and intrahepatic bile duct, thyroid), 1982–2006
Prostate, breast, colon and rectum, lung, 2004–2006, by LHIN, both sexes combined
Other incidence-based analyses:
Most common cancers diagnosed in Ontario, males, females, 2006 (numbers and proportions of total, not incidence rates)
Growth of cancer incidence in Ontario, 1982–2006: baseline risk, increasing cancer risk, population growth, population aging.
Considerations
Age-standardized incidence rates reflect the number new cases of cancer that would have been diagnosed if the age-specific rates observed in the given population had occurred in the standard population.
The use of a standard population allows for incidence rate trends and comparisons across jurisdictions by adjusting variations in population age distributions over time and across geographic areas.
Cancer definitions using SEER Recode may differ, especially for cancers of the colon and rectum and lung cancer, from definitions in other published analyses.
Because of changes in diagnostic practices or rules of coding and registration, interpretation of temporal trends must be done with caution.
Technical Specifications
Cancers were defined using U.S. Surveillance, Epidemiology and End Results (SEER) Recode definitions: see
Incidence was calculated using calculated using U.S. Surveillance, Epidemiology and End Results’ SEER*Stat software, version 6.5.2
“Selected cancers” rationale: thyroid cancer because of its rapidly increasing rate, especially in females, and cervix and liver because of related Cancer System Quality Index screening and clinical indicators.
Growth of cancer incidence attributed to increasing risk population growth, population aging:
baseline risk: number of new cases in 1982;
removed from actual incidence the proportion of the annual new cases for each year that would have occurred if population had continued as for 1982 in terms of:1) population growth; 2) age structure
Numerator
N/A
Denominator

4. 1.1.6 ()
Definition
The number of new cases of cancer diagnosed during a defined period of time, per 100,000 people in a specified population
Calculation
Age-standardized mortality rates: weighted average of the age-specific (crude) rates, where the weights are the proportions of people in the corresponding age groups of a standard population. The current standard population in Canada for calculating age-standardized rates is the 1991 Canadian census population structure.
Most common cancers diagnosed in Ontario: numbers and proportion of total
Growth of cancer incidence: baseline risk, increasing cancer risk, population growth, population aging.
Analysis
Age-standardized incidence rates:
All cancers combined, Ontario, 1982–2006, by sex
Most common cancers, males (prostate, lung and bronchus, colon and rectum,) and females (breast, colon and rectum, lung and bronchus), 1982–2006
Selected cancers, males (liver and intrahepatic bile duct, thyroid) and females (cervix, liver and intrahepatic bile duct, thyroid), 1982–2006
Prostate, breast, colon and rectum, lung, 2004–2006, by LHIN, both sexes combined
Other incidence-based analyses:
Most common cancers diagnosed in Ontario, males, females, 2006 (numbers and proportions of total, not incidence rates)
Growth of cancer incidence in Ontario, 1982–2006: baseline risk, increasing cancer risk, population growth, population aging.
Considerations
Age-standardized incidence rates reflect the number new cases of cancer that would have been diagnosed if the age-specific rates observed in the given population had occurred in the standard population.
The use of a standard population allows for incidence rate trends and comparisons across jurisdictions by adjusting variations in population age distributions over time and across geographic areas.
Cancer definitions using SEER Recode may differ, especially for cancers of the colon and rectum and lung cancer, from definitions in other published analyses.
Because of changes in diagnostic practices or rules of coding and registration, interpretation of temporal trends must be done with caution.
Technical Specifications
Cancers were defined using U.S. Surveillance, Epidemiology and End Results (SEER) Recode definitions: see
Incidence was calculated using calculated using U.S. Surveillance, Epidemiology and End Results’ SEER*Stat software, version 6.5.2
“Selected cancers” rationale: thyroid cancer because of its rapidly increasing rate, especially in females, and cervix and liver because of related Cancer System Quality Index screening and clinical indicators.
Growth of cancer incidence attributed to increasing risk population growth, population aging:
baseline risk: number of new cases in 1982;
removed from actual incidence the proportion of the annual new cases for each year that would have occurred if population had continued as for 1982 in terms of:1) population growth; 2) age structure
Numerator
N/A
Denominator

5. 1.1.7
Definition
The number of new cases of cancer diagnosed during a defined period of time, per 100,000 people in a specified population
Calculation
Age-standardized mortality rates: weighted average of the age-specific (crude) rates, where the weights are the proportions of people in the corresponding age groups of a standard population. The current standard population in Canada for calculating age-standardized rates is the 1991 Canadian census population structure.
Most common cancers diagnosed in Ontario: numbers and proportion of total
Growth of cancer incidence: baseline risk, increasing cancer risk, population growth, population aging.
Analysis
Age-standardized incidence rates:
All cancers combined, Ontario, 1982–2006, by sex
Most common cancers, males (prostate, lung and bronchus, colon and rectum,) and females (breast, colon and rectum, lung and bronchus), 1982–2006
Selected cancers, males (liver and intrahepatic bile duct, thyroid) and females (cervix, liver and intrahepatic bile duct, thyroid), 1982–2006
Prostate, breast, colon and rectum, lung, 2004–2006, by LHIN, both sexes combined
Other incidence-based analyses:
Most common cancers diagnosed in Ontario, males, females, 2006 (numbers and proportions of total, not incidence rates)
Growth of cancer incidence in Ontario, 1982–2006: baseline risk, increasing cancer risk, population growth, population aging.
Considerations
Age-standardized incidence rates reflect the number new cases of cancer that would have been diagnosed if the age-specific rates observed in the given population had occurred in the standard population.
The use of a standard population allows for incidence rate trends and comparisons across jurisdictions by adjusting variations in population age distributions over time and across geographic areas.
Cancer definitions using SEER Recode may differ, especially for cancers of the colon and rectum and lung cancer, from definitions in other published analyses.
Because of changes in diagnostic practices or rules of coding and registration, interpretation of temporal trends must be done with caution.
Technical Specifications
Cancers were defined using U.S. Surveillance, Epidemiology and End Results (SEER) Recode definitions: see
Incidence was calculated using calculated using U.S. Surveillance, Epidemiology and End Results’ SEER*Stat software, version 6.5.2
“Selected cancers” rationale: thyroid cancer because of its rapidly increasing rate, especially in females, and cervix and liver because of related Cancer System Quality Index screening and clinical indicators.
Growth of cancer incidence attributed to increasing risk population growth, population aging:
baseline risk: number of new cases in 1982;
removed from actual incidence the proportion of the annual new cases for each year that would have occurred if population had continued as for 1982 in terms of:1) population growth; 2) age structure
Numerator
N/A
Denominator

6. 1.1.8
Definition
The number of new cases of cancer diagnosed during a defined period of time, per 100,000 people in a specified population
Calculation
Age-standardized mortality rates: weighted average of the age-specific (crude) rates, where the weights are the proportions of people in the corresponding age groups of a standard population. The current standard population in Canada for calculating age-standardized rates is the 1991 Canadian census population structure.
Most common cancers diagnosed in Ontario: numbers and proportion of total
Growth of cancer incidence: baseline risk, increasing cancer risk, population growth, population aging.
Analysis
Age-standardized incidence rates:
All cancers combined, Ontario, 1982–2006, by sex
Most common cancers, males (prostate, lung and bronchus, colon and rectum,) and females (breast, colon and rectum, lung and bronchus), 1982–2006
Selected cancers, males (liver and intrahepatic bile duct, thyroid) and females (cervix, liver and intrahepatic bile duct, thyroid), 1982–2006
Prostate, breast, colon and rectum, lung, 2004–2006, by LHIN, both sexes combined
Other incidence-based analyses:
Most common cancers diagnosed in Ontario, males, females, 2006 (numbers and proportions of total, not incidence rates)
Growth of cancer incidence in Ontario, 1982–2006: baseline risk, increasing cancer risk, population growth, population aging.
Considerations
Age-standardized incidence rates reflect the number new cases of cancer that would have been diagnosed if the age-specific rates observed in the given population had occurred in the standard population.
The use of a standard population allows for incidence rate trends and comparisons across jurisdictions by adjusting variations in population age distributions over time and across geographic areas.
Cancer definitions using SEER Recode may differ, especially for cancers of the colon and rectum and lung cancer, from definitions in other published analyses.
Because of changes in diagnostic practices or rules of coding and registration, interpretation of temporal trends must be done with caution.
Technical Specifications
Cancers were defined using U.S. Surveillance, Epidemiology and End Results (SEER) Recode definitions: see
Incidence was calculated using calculated using U.S. Surveillance, Epidemiology and End Results’ SEER*Stat software, version 6.5.2
“Selected cancers” rationale: thyroid cancer because of its rapidly increasing rate, especially in females, and cervix and liver because of related Cancer System Quality Index screening and clinical indicators.
Growth of cancer incidence attributed to increasing risk population growth, population aging:
baseline risk: number of new cases in 1982;
removed from actual incidence the proportion of the annual new cases for each year that would have occurred if population had continued as for 1982 in terms of:1) population growth; 2) age structure
Numerator
N/A
Denominator

7. 1.1.9
Definition
The number of new cases of cancer diagnosed during a defined period of time, per 100,000 people in a specified population
Calculation
Age-standardized mortality rates: weighted average of the age-specific (crude) rates, where the weights are the proportions of people in the corresponding age groups of a standard population. The current standard population in Canada for calculating age-standardized rates is the 1991 Canadian census population structure.
Most common cancers diagnosed in Ontario: numbers and proportion of total
Growth of cancer incidence: baseline risk, increasing cancer risk, population growth, population aging.
Analysis
Age-standardized incidence rates:
All cancers combined, Ontario, 1982–2006, by sex
Most common cancers, males (prostate, lung and bronchus, colon and rectum,) and females (breast, colon and rectum, lung and bronchus), 1982–2006
Selected cancers, males (liver and intrahepatic bile duct, thyroid) and females (cervix, liver and intrahepatic bile duct, thyroid), 1982–2006
Prostate, breast, colon and rectum, lung, 2004–2006, by LHIN, both sexes combined
Other incidence-based analyses:
Most common cancers diagnosed in Ontario, males, females, 2006 (numbers and proportions of total, not incidence rates)
Growth of cancer incidence in Ontario, 1982–2006: baseline risk, increasing cancer risk, population growth, population aging.
Considerations
Age-standardized incidence rates reflect the number new cases of cancer that would have been diagnosed if the age-specific rates observed in the given population had occurred in the standard population.
The use of a standard population allows for incidence rate trends and comparisons across jurisdictions by adjusting variations in population age distributions over time and across geographic areas.
Cancer definitions using SEER Recode may differ, especially for cancers of the colon and rectum and lung cancer, from definitions in other published analyses.
Because of changes in diagnostic practices or rules of coding and registration, interpretation of temporal trends must be done with caution.
Technical Specifications
Cancers were defined using U.S. Surveillance, Epidemiology and End Results (SEER) Recode definitions: see
Incidence was calculated using calculated using U.S. Surveillance, Epidemiology and End Results’ SEER*Stat software, version 6.5.2
“Selected cancers” rationale: thyroid cancer because of its rapidly increasing rate, especially in females, and cervix and liver because of related Cancer System Quality Index screening and clinical indicators.
Growth of cancer incidence attributed to increasing risk population growth, population aging:
baseline risk: number of new cases in 1982;
removed from actual incidence the proportion of the annual new cases for each year that would have occurred if population had continued as for 1982 in terms of:1) population growth; 2) age structure
Numerator
N/A
Denominator

8. 1.1.10
Definition
The number of deaths attributed to cancer during a defined period of time per 100,000 people in a specified population
Calculation
Age-standardized mortality rates: weighted average of the age-specific (crude) rates, where the weights are the proportions of people in the corresponding age groups of a standard population. The current standard population in Canada for calculating age-standardized rates is the 1991 Canadian census population structure.
Analysis
All cancers combined, Ontario, 1982–2006, by sex
Most common cancers males (lung and bronchus, colon and rectum, prostate) and females (lung and bronchus, breast, colon and rectum), 1982–2006
Considerations
Age-standardized mortality rates reflect the number of deaths that would have occurred if the age-specific rates observed in the given population had occurred in the standard population.
The use of a standard population allows for mortality rate trends and comparisons across jurisdictions by adjusting variations in population age distributions over time and across geographic areas.
Technical Specifications
Cancers were defined using Surveillance, Epidemiology and End Results (SEER) Cause of Death Recode definitions:
Mortality was calculated using U.S. Surveillance, Epidemiology and End Results’ SEER*Stat software, version 6.5.2
Numerator
N/A
Denominator

9. 1.1.11
Definition
Five-year relative survival is the proportion of people alive 5 years after their diagnosis, adjusted for the deaths expected among members of the general population of the same age and sex.
Calculation
See Brenner H, Gefeller O. Deriving more up-to-date estimates of long-term patient survivial J Clin Epidemiolo 1997;40:211–6.
Analysis
For individuals observed in the period 2002–2006 and, for comparison, in the period 1992–1996
For 14 common cancers and for prostate, breast, colorectal and lung cancer, and by LHIN for these 4 major cancers
Considerations
All survival estimates have been age-standardized to make it possible to compare survival estimates from different times or geographic regions.
Temporal trends must be interpreted with caution because of changes in diagnostic practices and/or cancer coding and registration rules.
Relative survival is a useful population-based indicator of the burden of cancer and the variation in severity of different types of cancer. It does not necessarily reflect a person’s chances of surviving for a given time after diagnosis.
Cancer definitions using SEER Recode may differ, especially for cancers of the colon and rectum and lung cancer, from definitions in other published analyses of survival.
The Ontario Cancer Registry does not actively follow cases and so deaths may be missed. This, and the exclusion of individuals whose date of diagnosis is their date of death, may lead to overestimates of survival.
Technical Specifications
Survival has been estimated using the “period method.” This method observes, in the most recent time period possible, the survival of patients diagnosed in different calendar years, to better estimate the survival expected by newly diagnosed cases. (The traditional “cohort method” follows the survival of a group of patients diagnosed in a single calendar year or span of years. Because 5 years must pass before survival can be analyzed, the cohort method is a poorer estimate of current survival than the period method.)
Calculations are based on first primary cancers diagnosed in Ontario residents, excluding patients of unknown age at diagnosis, cancers where an autopsy was the method of diagnosis, and individuals whose date of diagnosis is their date of death (that is, who were only diagnosed at or following death).
Cancers were defined using U.S. Surveillance, Epidemiology and End Results (SEER) Recode definitions: see
Age-standardized survival was calculated by first calculating survival for 5 age groups (15-44, 45-54, 55-64, 65-74, 75-99) for each cancer disease site except prostate (15-54, 55-64, 65-74, 75-84, 85-99). The age-specific survival estimates were then weighted by the site-specific age distribution for cancers diagnosed in Canada,
The confidence intervals for the LHIN survival estimates were obtained by generating 1,000 bootstrap samples (full resamples), and selecting the 25th & 975th ordered results.
For the estimate, survival was measured in years from the date of diagnosis to the death date, the 100th birthday, or December 31, 2006, if alive. For the estimate, survival was measured in years from the date of diagnosis to the date of death, the 100th birthday, or December 31, 1996, if alive.
Censoring once individuals reach 100 years of age adjusts for potential data limitations, such as the fact that many people die in other jurisdictions without notification to Ontario.
Adjustment for the expected mortality of people of the same age in the general population of Ontario was carried out using Ontario life tables obtained from Statistics Canada covering the years of interest.
Numerator
N/A
Denominator

10. 1.1.17
Definition
The number of cases of cancer diagnosed during a specified period in people still alive on a given date, or the number of people alive on a given date who have been diagnosed with a specified previous period.
Calculation
See Definition and Technical Specifications
Analysis
Numbers calculated for prostate, breast, colorectal and lung cancers in Ontarians alive on January 1, 2007 and diagnosed during the preceding 10 years, and whether those cancers were diagnosed less than 1 year, 1-<5 years, or 5-10 years, before that date.
All-cancer prevalence for the number of Ontarians and percent of 2006 Ontario population still alive on January 1, 2007, and diagnosed with any cancer during the 10 years before that date (shown in table but not on graph).
Considerations
The Ontario Cancer Registry does not actively follow cases and so deaths may be missed. This may lead to overestimates of prevalence, especially for longer periods of time.
Cancer definitions using SEER Recode may differ, especially for cancers of the colon and rectum and lung cancer, from definitions in other published analyses.
Technical Specifications
Prevalence of prostate, breast, colorectal and lung cancers calculated as described in “Analysis”, using the counting method.
All-cancer prevalence also calculated on a person (rather than case) basis as described in “Analysis”.
Cancers were defined using U.S. Surveillance, Epidemiology and End Results (SEER) Recode definitions: see
Numerator
N/A
Denominator

11. 1.2.1
Definition
Smoking
Calculation
The percentage of Ontario adults who report that they are smokers, obese, not following low-risk alcohol drinking guidelines, physically active, consuming vegetables or fruit at least 5 times a day; the percentage of Ontario teens who report that they are smokers
Weighted number of people aged 20+ who are daily or occasional cigarette smokers and have smoked at least 1 cigarette in the past month / Weighted total population aged 20+  X 100
Weighted number of people aged who are daily or occasional cigarette smokers and have smoked at least 1 cigarette in the past month / Weighted total population aged  X 100
Teen smoking
Obesity
/Total population aged 18+ (excluding pregnant women and lactating women)  X 100
Weighted Population aged 18+ (excluding pregnant women and lactating women) with Body Mass Index of 30 or greater
Weighted number of respondents aged 19+ who exceed the low risk drinking guidelines/ Weighted total population aged 19+  X 100
Alcohol consumption
Weighted population aged 18+ with average daily energy expenditure in leisure activities over the past 3 months > or equal to 1.5 kcal/kg/day/ Weighted total population aged 18+  X 100
Physical activity
Vegetable and fruit consumption
Weighted population aged 18+ who consumed vegetables and fruits five or more times per day/Weighted total population aged 18+  X 100
Smoking, obesity, alcohol consumption, physical activity, vegetable and fruit consumption:
Analysis
Adults, province-wide, , 2003, 2005,
Adults, province-wide, by age group: 18 or 19 or 20 to 29 (see “Calculation” for bottom of each first age group according to specific risk factor), 30-44, 45-64, 65+,
Adults, by LHIN,
Adults, province-wide, by sex,
Percent of adult (20+) population who are non-smokers, not obese (excluding pregnant women; BMI less than 30), follow the CAMH low-risk drinking guidelines, who are active or moderately active, and consume vegetables or fruits 5 or more times daily, by LHIN by sex,
Considerations
Teen smoking, province-wide, 2000–2001, 2003, 2005, 2007–2008
LHINs ranked by percent of adult (20+) population practising healthy behaviours (that is, ranking high on healthy behaviours and low on unhealthy behaviours)
Note that the definition of “adult” varies across ages 18+ (to match the lower end of the age range for the obesity-physical activity-vegetable and fruit consumption indicators to the lower end of the age range for applying adult BMI obesity classifications, 19+ to match Ontario’s legal drinking age, and 20+ to match the smoking indicator with the Ontario public health indicators (see APHEO indicators under “Other jurisdictions”, below).
Teen smoking: This indicator does not capture “experimental” smokers among teens, or those teens at risk of becoming established smokers. These groups—which may overlap—may be important indicators of future percentages of established smokers. The Canadian Community Health Survey may be less valid for teen smoking levels than other surveys such as the Canadian Tobacco Use Monitoring Survey and the Ontario Student Drug Use Survey. It does appear, however, to show generally comparable levels and declines over time. Teen smoking percentages and population samples in the Canadian Community Health Survey are too low to assess by LHIN or for ages 12–14.
Smoking: This indicator does not account for how long someone has smoked, the amount or brand smoked, attempts to quit, or exposure to second-hand smoke.
Obesity: Current research suggests that measures of central adiposity (i.e., the amount of excess weight carried around the waist area) such as waist circumference or waist-to-hip ratio may be better indicators of cancer risk than body mass index for population level surveillance. The Canadian Community Health Survey (CCHS) relies on the self-reported height and weight of survey participants. Research suggests that respondents on self-reported surveys tend to understate their weight and overstate their height, resulting in a BMI that is too low. The prevalence of obesity based on measured height and weight was estimated for 2004 at 23% and 22% in Ontario men and women aged 18 and over respectively.
Alcohol: the CAMH low-risk drinking guidelines are slightly less restrictive than the cancer prevention guideline in the World Cancer Research Fund/American Institute for Cancer Research major 2007 report (Food, Nutirition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007), which recommends no more than 2 drinks a day for men and 1 drink a day for women. Alcohol consumption reporting is imprecise: drinks vary in size and alcohol concentration, respondents may underreport because of concern with social acceptability, and heavy drinkers are less likely to participate in population health surveys. While self-reports may underestimate and sales data may overestimate consumption, alcohol sales data generally show similar trends to the trends in consumption from CCHS data.
Physical activity is leisure-time physical activity, and so does not count physical activity at work or for transportation. Concerns exist as to the validity of CCHS leisure-time physical activity data, especially for monitoring trends over time: Katzmarzyk PT, Tremblay MS. Limitations of Canada's physical activity data: implications for monitoring trends. Can J Public Health. 2007; 98 Suppl 2:S
Vegetables and fruit: available evidence was insufficient to support a cancer prevention recommendation in terms of vegetable and fruit servings in the World Cancer Research Fund/American Institute for Cancer Research major 2007 report (Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR,2007). Note also that the CCHS variable measures frequency of consumption rather than servings, while dietary guidelines are usually present in terms of servings. A validation study of the fruit and vegetable module in the Ontario Rapid Risk Factor System Survey, which uses the same questions as CCHS, demonstrated that vegetable and fruit consumption measured in terms of times per day was a proxy for commonly recognized portions of total vegetable and fruit intake at the population level (i.e. times per day can be interpreted as equivalent to servings per day): Traynor MM, Holowaty PH, Reid DJ, Gray-Donald K. Vegetable and fruit food frequency questionnaire serves as a proxy for quantified intake. Can J Public Health 2006; 7(4):
Comparisons with other analyses of Canadian Community Health Survey (CCHS) data need to consider:
CCHS data file (master file, provincial share file, public use file);
actual CCHS sample (e.g or 2008 half-sample, or full sample);
exact definitions of numerator and denominator;
Technical Specifications
treatment of non-response categories (refusal, don’t know and not stated).
whether data are age-standardized and, if so, to what population;
Results are age-standardized to the 2001 Canadian population, using the age groups from the CCHS person-level sampling strategy by age: 12-19, 20-29, 30-44, 45-64, 65
Questions:
Calculations exclude individuals in non-response categories (refusal, don't know and not stated) from denominators
Responses in the CCHS full-sample Ontario Share File for
Obesity: (Height and weight module, Breastfeeding module): How tall are you without shoes on? and How much do you weigh? Are you still breastfeedng? Body Mass Index (BMI) is a ratio of weight to height (kg/m2), calculated by Statistics Canada and provided as a CCHS derived variable, except for pregnant women and individuals less than 3 feet or over 7 feet tall. Cancer Care Ontario analysis then additionally excludes lactating women.
Smoking (Smoking module): At the present time, do you smoke cigarettes daily, occasionally or not at all? and In the past month, on how many days have you smoked 1 or more cigarettes?
Alcohol consumption (Alcohol use modules) – several questions. The low-risk drinking guidelines were developed by a team of medical and social researchers from the University of Toronto and the Centre for Addiction and Mental Health (CAMH). The guidelines specify to drink no more than two standard drinks on any day with a weekly intake limited to 14 or fewer drinks per week for men and 9 or fewer for women.
Physical activity (Physical activities module) – questions about whether an individual has done any of a list of 20+ specified physical activities, or any other leisure time physical activities, in the past 3 months, number of times the individual did the activity, and amount of time spent. Statistics Canada then calculates a Physical Activity Index, classifying an individual as active, moderately active, or inactive, and provides it as a derived variable, based on total daily energy expenditure values, which in turn are based on activity type, frequency and duration. Give the cutoffs for the 3 activity classes
Vegetable and fruit consumption (Fruit and vegetable consumption module) – questions as to frequency of consuming fruit juice, fruit, green salad, potatoes, carrots, and other vegetables. Statistics Canada calculates daily consumption frequencies of these food types together, as a derived variable: total number of times the respondent eats fruits and vegetables.
Numerators shown separately for each risk factor in “Calculation”, above, and further specified in terms of CCHS questions or modules in “Analysis”, above
Numerator
Denominator
Obesity: Ontarians over the age of 18, excluding pregnant and lactating women.
Teen smoking: Ontarians aged 15-19
Smoking: Ontarians over the age of 20
Physical activity, Vegetable and fruit consumption: Ontarians over the age of 18
Alcohol: Ontarians over the age of 19

12. 1.2.3 (2)
Definition
Smoking
Calculation
The percentage of Ontario adults who report that they are smokers, obese, not following low-risk alcohol drinking guidelines, physically active, consuming vegetables or fruit at least 5 times a day; the percentage of Ontario teens who report that they are smokers
Weighted number of people aged 20+ who are daily or occasional cigarette smokers and have smoked at least 1 cigarette in the past month / Weighted total population aged 20+  X 100
Weighted number of people aged who are daily or occasional cigarette smokers and have smoked at least 1 cigarette in the past month / Weighted total population aged  X 100
Teen smoking
Obesity
/Total population aged 18+ (excluding pregnant women and lactating women)  X 100
Weighted Population aged 18+ (excluding pregnant women and lactating women) with Body Mass Index of 30 or greater
Weighted number of respondents aged 19+ who exceed the low risk drinking guidelines/ Weighted total population aged 19+  X 100
Alcohol consumption
Weighted population aged 18+ with average daily energy expenditure in leisure activities over the past 3 months > or equal to 1.5 kcal/kg/day/ Weighted total population aged 18+  X 100
Physical activity
Vegetable and fruit consumption
Weighted population aged 18+ who consumed vegetables and fruits five or more times per day/Weighted total population aged 18+  X 100
Smoking, obesity, alcohol consumption, physical activity, vegetable and fruit consumption:
Analysis
Adults, province-wide, , 2003, 2005,
Adults, province-wide, by age group: 18 or 19 or 20 to 29 (see “Calculation” for bottom of each first age group according to specific risk factor), 30-44, 45-64, 65+,
Adults, by LHIN,
Adults, province-wide, by sex,
Percent of adult (20+) population who are non-smokers, not obese (excluding pregnant women; BMI less than 30), follow the CAMH low-risk drinking guidelines, who are active or moderately active, and consume vegetables or fruits 5 or more times daily, by LHIN by sex,
Considerations
Teen smoking, province-wide, 2000–2001, 2003, 2005, 2007–2008
LHINs ranked by percent of adult (20+) population practising healthy behaviours (that is, ranking high on healthy behaviours and low on unhealthy behaviours)
Note that the definition of “adult” varies across ages 18+ (to match the lower end of the age range for the obesity-physical activity-vegetable and fruit consumption indicators to the lower end of the age range for applying adult BMI obesity classifications, 19+ to match Ontario’s legal drinking age, and 20+ to match the smoking indicator with the Ontario public health indicators (see APHEO indicators under “Other jurisdictions”, below).
Teen smoking: This indicator does not capture “experimental” smokers among teens, or those teens at risk of becoming established smokers. These groups—which may overlap—may be important indicators of future percentages of established smokers. The Canadian Community Health Survey may be less valid for teen smoking levels than other surveys such as the Canadian Tobacco Use Monitoring Survey and the Ontario Student Drug Use Survey. It does appear, however, to show generally comparable levels and declines over time. Teen smoking percentages and population samples in the Canadian Community Health Survey are too low to assess by LHIN or for ages 12–14.
Smoking: This indicator does not account for how long someone has smoked, the amount or brand smoked, attempts to quit, or exposure to second-hand smoke.
Obesity: Current research suggests that measures of central adiposity (i.e., the amount of excess weight carried around the waist area) such as waist circumference or waist-to-hip ratio may be better indicators of cancer risk than body mass index for population level surveillance. The Canadian Community Health Survey (CCHS) relies on the self-reported height and weight of survey participants. Research suggests that respondents on self-reported surveys tend to understate their weight and overstate their height, resulting in a BMI that is too low. The prevalence of obesity based on measured height and weight was estimated for 2004 at 23% and 22% in Ontario men and women aged 18 and over respectively.
Alcohol: the CAMH low-risk drinking guidelines are slightly less restrictive than the cancer prevention guideline in the World Cancer Research Fund/American Institute for Cancer Research major 2007 report (Food, Nutirition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007), which recommends no more than 2 drinks a day for men and 1 drink a day for women. Alcohol consumption reporting is imprecise: drinks vary in size and alcohol concentration, respondents may underreport because of concern with social acceptability, and heavy drinkers are less likely to participate in population health surveys. While self-reports may underestimate and sales data may overestimate consumption, alcohol sales data generally show similar trends to the trends in consumption from CCHS data.
Physical activity is leisure-time physical activity, and so does not count physical activity at work or for transportation. Concerns exist as to the validity of CCHS leisure-time physical activity data, especially for monitoring trends over time: Katzmarzyk PT, Tremblay MS. Limitations of Canada's physical activity data: implications for monitoring trends. Can J Public Health. 2007; 98 Suppl 2:S
Vegetables and fruit: available evidence was insufficient to support a cancer prevention recommendation in terms of vegetable and fruit servings in the World Cancer Research Fund/American Institute for Cancer Research major 2007 report (Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR,2007). Note also that the CCHS variable measures frequency of consumption rather than servings, while dietary guidelines are usually present in terms of servings. A validation study of the fruit and vegetable module in the Ontario Rapid Risk Factor System Survey, which uses the same questions as CCHS, demonstrated that vegetable and fruit consumption measured in terms of times per day was a proxy for commonly recognized portions of total vegetable and fruit intake at the population level (i.e. times per day can be interpreted as equivalent to servings per day): Traynor MM, Holowaty PH, Reid DJ, Gray-Donald K. Vegetable and fruit food frequency questionnaire serves as a proxy for quantified intake. Can J Public Health 2006; 7(4):
Comparisons with other analyses of Canadian Community Health Survey (CCHS) data need to consider:
CCHS data file (master file, provincial share file, public use file);
actual CCHS sample (e.g or 2008 half-sample, or full sample);
exact definitions of numerator and denominator;
Technical Specifications
treatment of non-response categories (refusal, don’t know and not stated).
whether data are age-standardized and, if so, to what population;
Results are age-standardized to the 2001 Canadian population, using the age groups from the CCHS person-level sampling strategy by age: 12-19, 20-29, 30-44, 45-64, 65
Questions:
Calculations exclude individuals in non-response categories (refusal, don't know and not stated) from denominators
Responses in the CCHS full-sample Ontario Share File for
Obesity: (Height and weight module, Breastfeeding module): How tall are you without shoes on? and How much do you weigh? Are you still breastfeedng? Body Mass Index (BMI) is a ratio of weight to height (kg/m2), calculated by Statistics Canada and provided as a CCHS derived variable, except for pregnant women and individuals less than 3 feet or over 7 feet tall. Cancer Care Ontario analysis then additionally excludes lactating women.
Smoking (Smoking module): At the present time, do you smoke cigarettes daily, occasionally or not at all? and In the past month, on how many days have you smoked 1 or more cigarettes?
Alcohol consumption (Alcohol use modules) – several questions. The low-risk drinking guidelines were developed by a team of medical and social researchers from the University of Toronto and the Centre for Addiction and Mental Health (CAMH). The guidelines specify to drink no more than two standard drinks on any day with a weekly intake limited to 14 or fewer drinks per week for men and 9 or fewer for women.
Physical activity (Physical activities module) – questions about whether an individual has done any of a list of 20+ specified physical activities, or any other leisure time physical activities, in the past 3 months, number of times the individual did the activity, and amount of time spent. Statistics Canada then calculates a Physical Activity Index, classifying an individual as active, moderately active, or inactive, and provides it as a derived variable, based on total daily energy expenditure values, which in turn are based on activity type, frequency and duration. Give the cutoffs for the 3 activity classes
Vegetable and fruit consumption (Fruit and vegetable consumption module) – questions as to frequency of consuming fruit juice, fruit, green salad, potatoes, carrots, and other vegetables. Statistics Canada calculates daily consumption frequencies of these food types together, as a derived variable: total number of times the respondent eats fruits and vegetables.
Numerators shown separately for each risk factor in “Calculation”, above, and further specified in terms of CCHS questions or modules in “Analysis”, above
Numerator
Denominator
Obesity: Ontarians over the age of 18, excluding pregnant and lactating women.
Teen smoking: Ontarians aged 15-19
Smoking: Ontarians over the age of 20
Physical activity, Vegetable and fruit consumption: Ontarians over the age of 18
Alcohol: Ontarians over the age of 19

13. 1.2.5 (3)
Definition
Smoking
Calculation
The percentage of Ontario adults who report that they are smokers, obese, not following low-risk alcohol drinking guidelines, physically active, consuming vegetables or fruit at least 5 times a day; the percentage of Ontario teens who report that they are smokers
Weighted number of people aged 20+ who are daily or occasional cigarette smokers and have smoked at least 1 cigarette in the past month / Weighted total population aged 20+  X 100
Weighted number of people aged who are daily or occasional cigarette smokers and have smoked at least 1 cigarette in the past month / Weighted total population aged  X 100
Teen smoking
Obesity
/Total population aged 18+ (excluding pregnant women and lactating women)  X 100
Weighted Population aged 18+ (excluding pregnant women and lactating women) with Body Mass Index of 30 or greater
Weighted number of respondents aged 19+ who exceed the low risk drinking guidelines/ Weighted total population aged 19+  X 100
Alcohol consumption
Weighted population aged 18+ with average daily energy expenditure in leisure activities over the past 3 months > or equal to 1.5 kcal/kg/day/ Weighted total population aged 18+  X 100
Physical activity
Vegetable and fruit consumption
Weighted population aged 18+ who consumed vegetables and fruits five or more times per day/Weighted total population aged 18+  X 100
Smoking, obesity, alcohol consumption, physical activity, vegetable and fruit consumption:
Analysis
Adults, province-wide, , 2003, 2005,
Adults, province-wide, by age group: 18 or 19 or 20 to 29 (see “Calculation” for bottom of each first age group according to specific risk factor), 30-44, 45-64, 65+,
Adults, by LHIN,
Adults, province-wide, by sex,
Percent of adult (20+) population who are non-smokers, not obese (excluding pregnant women; BMI less than 30), follow the CAMH low-risk drinking guidelines, who are active or moderately active, and consume vegetables or fruits 5 or more times daily, by LHIN by sex,
Considerations
Teen smoking, province-wide, 2000–2001, 2003, 2005, 2007–2008
LHINs ranked by percent of adult (20+) population practising healthy behaviours (that is, ranking high on healthy behaviours and low on unhealthy behaviours)
Note that the definition of “adult” varies across ages 18+ (to match the lower end of the age range for the obesity-physical activity-vegetable and fruit consumption indicators to the lower end of the age range for applying adult BMI obesity classifications, 19+ to match Ontario’s legal drinking age, and 20+ to match the smoking indicator with the Ontario public health indicators (see APHEO indicators under “Other jurisdictions”, below).
Teen smoking: This indicator does not capture “experimental” smokers among teens, or those teens at risk of becoming established smokers. These groups—which may overlap—may be important indicators of future percentages of established smokers. The Canadian Community Health Survey may be less valid for teen smoking levels than other surveys such as the Canadian Tobacco Use Monitoring Survey and the Ontario Student Drug Use Survey. It does appear, however, to show generally comparable levels and declines over time. Teen smoking percentages and population samples in the Canadian Community Health Survey are too low to assess by LHIN or for ages 12–14.
Smoking: This indicator does not account for how long someone has smoked, the amount or brand smoked, attempts to quit, or exposure to second-hand smoke.
Obesity: Current research suggests that measures of central adiposity (i.e., the amount of excess weight carried around the waist area) such as waist circumference or waist-to-hip ratio may be better indicators of cancer risk than body mass index for population level surveillance. The Canadian Community Health Survey (CCHS) relies on the self-reported height and weight of survey participants. Research suggests that respondents on self-reported surveys tend to understate their weight and overstate their height, resulting in a BMI that is too low. The prevalence of obesity based on measured height and weight was estimated for 2004 at 23% and 22% in Ontario men and women aged 18 and over respectively.
Alcohol: the CAMH low-risk drinking guidelines are slightly less restrictive than the cancer prevention guideline in the World Cancer Research Fund/American Institute for Cancer Research major 2007 report (Food, Nutirition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007), which recommends no more than 2 drinks a day for men and 1 drink a day for women. Alcohol consumption reporting is imprecise: drinks vary in size and alcohol concentration, respondents may underreport because of concern with social acceptability, and heavy drinkers are less likely to participate in population health surveys. While self-reports may underestimate and sales data may overestimate consumption, alcohol sales data generally show similar trends to the trends in consumption from CCHS data.
Physical activity is leisure-time physical activity, and so does not count physical activity at work or for transportation. Concerns exist as to the validity of CCHS leisure-time physical activity data, especially for monitoring trends over time: Katzmarzyk PT, Tremblay MS. Limitations of Canada's physical activity data: implications for monitoring trends. Can J Public Health. 2007; 98 Suppl 2:S
Vegetables and fruit: available evidence was insufficient to support a cancer prevention recommendation in terms of vegetable and fruit servings in the World Cancer Research Fund/American Institute for Cancer Research major 2007 report (Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR,2007). Note also that the CCHS variable measures frequency of consumption rather than servings, while dietary guidelines are usually present in terms of servings. A validation study of the fruit and vegetable module in the Ontario Rapid Risk Factor System Survey, which uses the same questions as CCHS, demonstrated that vegetable and fruit consumption measured in terms of times per day was a proxy for commonly recognized portions of total vegetable and fruit intake at the population level (i.e. times per day can be interpreted as equivalent to servings per day): Traynor MM, Holowaty PH, Reid DJ, Gray-Donald K. Vegetable and fruit food frequency questionnaire serves as a proxy for quantified intake. Can J Public Health 2006; 7(4):
Comparisons with other analyses of Canadian Community Health Survey (CCHS) data need to consider:
CCHS data file (master file, provincial share file, public use file);
actual CCHS sample (e.g or 2008 half-sample, or full sample);
exact definitions of numerator and denominator;
Technical Specifications
treatment of non-response categories (refusal, don’t know and not stated).
whether data are age-standardized and, if so, to what population;
Results are age-standardized to the 2001 Canadian population, using the age groups from the CCHS person-level sampling strategy by age: 12-19, 20-29, 30-44, 45-64, 65
Questions:
Calculations exclude individuals in non-response categories (refusal, don't know and not stated) from denominators
Responses in the CCHS full-sample Ontario Share File for
Obesity: (Height and weight module, Breastfeeding module): How tall are you without shoes on? and How much do you weigh? Are you still breastfeedng? Body Mass Index (BMI) is a ratio of weight to height (kg/m2), calculated by Statistics Canada and provided as a CCHS derived variable, except for pregnant women and individuals less than 3 feet or over 7 feet tall. Cancer Care Ontario analysis then additionally excludes lactating women.
Smoking (Smoking module): At the present time, do you smoke cigarettes daily, occasionally or not at all? and In the past month, on how many days have you smoked 1 or more cigarettes?
Alcohol consumption (Alcohol use modules) – several questions. The low-risk drinking guidelines were developed by a team of medical and social researchers from the University of Toronto and the Centre for Addiction and Mental Health (CAMH). The guidelines specify to drink no more than two standard drinks on any day with a weekly intake limited to 14 or fewer drinks per week for men and 9 or fewer for women.
Physical activity (Physical activities module) – questions about whether an individual has done any of a list of 20+ specified physical activities, or any other leisure time physical activities, in the past 3 months, number of times the individual did the activity, and amount of time spent. Statistics Canada then calculates a Physical Activity Index, classifying an individual as active, moderately active, or inactive, and provides it as a derived variable, based on total daily energy expenditure values, which in turn are based on activity type, frequency and duration. Give the cutoffs for the 3 activity classes
Vegetable and fruit consumption (Fruit and vegetable consumption module) – questions as to frequency of consuming fruit juice, fruit, green salad, potatoes, carrots, and other vegetables. Statistics Canada calculates daily consumption frequencies of these food types together, as a derived variable: total number of times the respondent eats fruits and vegetables.
Numerators shown separately for each risk factor in “Calculation”, above, and further specified in terms of CCHS questions or modules in “Analysis”, above
Numerator
Denominator
Obesity: Ontarians over the age of 18, excluding pregnant and lactating women.
Teen smoking: Ontarians aged 15-19
Smoking: Ontarians over the age of 20
Physical activity, Vegetable and fruit consumption: Ontarians over the age of 18
Alcohol: Ontarians over the age of 19

14. 1.2.6 (4)
Definition
Smoking
Calculation
The percentage of Ontario adults who report that they are smokers, obese, not following low-risk alcohol drinking guidelines, physically active, consuming vegetables or fruit at least 5 times a day; the percentage of Ontario teens who report that they are smokers
Weighted number of people aged 20+ who are daily or occasional cigarette smokers and have smoked at least 1 cigarette in the past month / Weighted total population aged 20+  X 100
Weighted number of people aged who are daily or occasional cigarette smokers and have smoked at least 1 cigarette in the past month / Weighted total population aged  X 100
Teen smoking
Obesity
/Total population aged 18+ (excluding pregnant women and lactating women)  X 100
Weighted Population aged 18+ (excluding pregnant women and lactating women) with Body Mass Index of 30 or greater
Weighted number of respondents aged 19+ who exceed the low risk drinking guidelines/ Weighted total population aged 19+  X 100
Alcohol consumption
Weighted population aged 18+ with average daily energy expenditure in leisure activities over the past 3 months > or equal to 1.5 kcal/kg/day/ Weighted total population aged 18+  X 100
Physical activity
Vegetable and fruit consumption
Weighted population aged 18+ who consumed vegetables and fruits five or more times per day/Weighted total population aged 18+  X 100
Smoking, obesity, alcohol consumption, physical activity, vegetable and fruit consumption:
Analysis
Adults, province-wide, , 2003, 2005,
Adults, province-wide, by age group: 18 or 19 or 20 to 29 (see “Calculation” for bottom of each first age group according to specific risk factor), 30-44, 45-64, 65+,
Adults, by LHIN,
Adults, province-wide, by sex,
Percent of adult (20+) population who are non-smokers, not obese (excluding pregnant women; BMI less than 30), follow the CAMH low-risk drinking guidelines, who are active or moderately active, and consume vegetables or fruits 5 or more times daily, by LHIN by sex,
Considerations
Teen smoking, province-wide, 2000–2001, 2003, 2005, 2007–2008
LHINs ranked by percent of adult (20+) population practising healthy behaviours (that is, ranking high on healthy behaviours and low on unhealthy behaviours)
Note that the definition of “adult” varies across ages 18+ (to match the lower end of the age range for the obesity-physical activity-vegetable and fruit consumption indicators to the lower end of the age range for applying adult BMI obesity classifications, 19+ to match Ontario’s legal drinking age, and 20+ to match the smoking indicator with the Ontario public health indicators (see APHEO indicators under “Other jurisdictions”, below).
Teen smoking: This indicator does not capture “experimental” smokers among teens, or those teens at risk of becoming established smokers. These groups—which may overlap—may be important indicators of future percentages of established smokers. The Canadian Community Health Survey may be less valid for teen smoking levels than other surveys such as the Canadian Tobacco Use Monitoring Survey and the Ontario Student Drug Use Survey. It does appear, however, to show generally comparable levels and declines over time. Teen smoking percentages and population samples in the Canadian Community Health Survey are too low to assess by LHIN or for ages 12–14.
Smoking: This indicator does not account for how long someone has smoked, the amount or brand smoked, attempts to quit, or exposure to second-hand smoke.
Obesity: Current research suggests that measures of central adiposity (i.e., the amount of excess weight carried around the waist area) such as waist circumference or waist-to-hip ratio may be better indicators of cancer risk than body mass index for population level surveillance. The Canadian Community Health Survey (CCHS) relies on the self-reported height and weight of survey participants. Research suggests that respondents on self-reported surveys tend to understate their weight and overstate their height, resulting in a BMI that is too low. The prevalence of obesity based on measured height and weight was estimated for 2004 at 23% and 22% in Ontario men and women aged 18 and over respectively.
Alcohol: the CAMH low-risk drinking guidelines are slightly less restrictive than the cancer prevention guideline in the World Cancer Research Fund/American Institute for Cancer Research major 2007 report (Food, Nutirition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007), which recommends no more than 2 drinks a day for men and 1 drink a day for women. Alcohol consumption reporting is imprecise: drinks vary in size and alcohol concentration, respondents may underreport because of concern with social acceptability, and heavy drinkers are less likely to participate in population health surveys. While self-reports may underestimate and sales data may overestimate consumption, alcohol sales data generally show similar trends to the trends in consumption from CCHS data.
Physical activity is leisure-time physical activity, and so does not count physical activity at work or for transportation. Concerns exist as to the validity of CCHS leisure-time physical activity data, especially for monitoring trends over time: Katzmarzyk PT, Tremblay MS. Limitations of Canada's physical activity data: implications for monitoring trends. Can J Public Health. 2007; 98 Suppl 2:S
Vegetables and fruit: available evidence was insufficient to support a cancer prevention recommendation in terms of vegetable and fruit servings in the World Cancer Research Fund/American Institute for Cancer Research major 2007 report (Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR,2007). Note also that the CCHS variable measures frequency of consumption rather than servings, while dietary guidelines are usually present in terms of servings. A validation study of the fruit and vegetable module in the Ontario Rapid Risk Factor System Survey, which uses the same questions as CCHS, demonstrated that vegetable and fruit consumption measured in terms of times per day was a proxy for commonly recognized portions of total vegetable and fruit intake at the population level (i.e. times per day can be interpreted as equivalent to servings per day): Traynor MM, Holowaty PH, Reid DJ, Gray-Donald K. Vegetable and fruit food frequency questionnaire serves as a proxy for quantified intake. Can J Public Health 2006; 7(4):
Comparisons with other analyses of Canadian Community Health Survey (CCHS) data need to consider:
CCHS data file (master file, provincial share file, public use file);
actual CCHS sample (e.g or 2008 half-sample, or full sample);
exact definitions of numerator and denominator;
Technical Specifications
treatment of non-response categories (refusal, don’t know and not stated).
whether data are age-standardized and, if so, to what population;
Results are age-standardized to the 2001 Canadian population, using the age groups from the CCHS person-level sampling strategy by age: 12-19, 20-29, 30-44, 45-64, 65
Questions:
Calculations exclude individuals in non-response categories (refusal, don't know and not stated) from denominators
Responses in the CCHS full-sample Ontario Share File for
Obesity: (Height and weight module, Breastfeeding module): How tall are you without shoes on? and How much do you weigh? Are you still breastfeedng? Body Mass Index (BMI) is a ratio of weight to height (kg/m2), calculated by Statistics Canada and provided as a CCHS derived variable, except for pregnant women and individuals less than 3 feet or over 7 feet tall. Cancer Care Ontario analysis then additionally excludes lactating women.
Smoking (Smoking module): At the present time, do you smoke cigarettes daily, occasionally or not at all? and In the past month, on how many days have you smoked 1 or more cigarettes?
Alcohol consumption (Alcohol use modules) – several questions. The low-risk drinking guidelines were developed by a team of medical and social researchers from the University of Toronto and the Centre for Addiction and Mental Health (CAMH). The guidelines specify to drink no more than two standard drinks on any day with a weekly intake limited to 14 or fewer drinks per week for men and 9 or fewer for women.
Physical activity (Physical activities module) – questions about whether an individual has done any of a list of 20+ specified physical activities, or any other leisure time physical activities, in the past 3 months, number of times the individual did the activity, and amount of time spent. Statistics Canada then calculates a Physical Activity Index, classifying an individual as active, moderately active, or inactive, and provides it as a derived variable, based on total daily energy expenditure values, which in turn are based on activity type, frequency and duration. Give the cutoffs for the 3 activity classes
Vegetable and fruit consumption (Fruit and vegetable consumption module) – questions as to frequency of consuming fruit juice, fruit, green salad, potatoes, carrots, and other vegetables. Statistics Canada calculates daily consumption frequencies of these food types together, as a derived variable: total number of times the respondent eats fruits and vegetables.
Numerators shown separately for each risk factor in “Calculation”, above, and further specified in terms of CCHS questions or modules in “Analysis”, above
Numerator
Denominator
Obesity: Ontarians over the age of 18, excluding pregnant and lactating women.
Teen smoking: Ontarians aged 15-19
Smoking: Ontarians over the age of 20
Physical activity, Vegetable and fruit consumption: Ontarians over the age of 18
Alcohol: Ontarians over the age of 19