1. Statistics Canada • Statistique Canada
Canadian Health Measures Survey (CHMS): an introduction and overview
-today I would like to provide you with an introduction and overview of the CHMS, including:
-information on data that we have produced so far and
-information on the data to come
-opportunities to access the data
-an idea of the documentation available to help you use the data
Brent Day
Health Statistics Division
Statistics Canada
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2. Statistics Canada • Statistique Canada
CHMS OBJECTIVES
Explore emerging public health issues and new measurement technologies
Establish national baseline data on major health concerns
Determine relationships among risk factors, protection practices and health status
Assess the validity of self- and proxy-reported information
Assemble a nationally representative sample for storage in a biobank
-rotate content every second cycle so that if new technology or measures come up we can adapt; we allow for buy-in measures and new content
-objective measures on a wide variety of health-related topics
-self-report vs. actual examples; we ask height, weight and chronic conditions and also measure height and weight and blood/urine measures can help indicate chronic condition may not have been aware of
-not only take blood and urine at clinic but store indefinitely for future research
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3. HEALTH SURVEYS PROGRAM
CCHS Annual
CCHS Rapid Response
CCHS Focus Content
CHMS
Content
General health surveillance
Sample buy-ins
Emerging need - determined by client
Single content in-depth
HH information related to physical measures
Physical measures in MEC
Laboratory tests
Buy-ins
Sample size
65,000 respondents
11,000 respondents by 2 months collection period
27,000 respondents
5,700 respondents per cycle
Frequency
Annual
Up to 6 periods by year
Every three years
2 year cycle
Geography
Canada, provinces, territories & health regions
Canada & provinces
Canada only
Age groups
12+
Varies depending on survey
3 - 79
This table is helpful to help users know when to use CCHS vs CHMS data
A few highlights:
-emphasis on physical measures with the household information providing contextual information only; use CCHS when only self-reported household info is required as sample size is much larger
-Canada only; national estimates only, not designed for regional or provincial – very few exceptions (C1&C2 combined)
-3 to 11 year olds in CHMS

4. CHMS: ONE PROJECT, FOUR COMPONENTS
Household component – about 1¼ hours
Mobile Examination Centre (MEC) component – about 2 ¼ to 3 hours
Laboratory component – several external reference labs, one lab in the MEC
Biobank component - storage for future health research of : whole blood, plasma, serum, urine and DNA.
-time will vary according to eligibility for questionnaire modules/tests and whether or not 1 or 2 persons from the same household participated (about 40% of respondents in the survey have a family member also participating).
-with an additional trailer for cycle 4, we have more flexibility to do tests concurrently within the same family which will cut down on some of the length at the MEC
-as the survey goes on, the number of labs we have been working with has been growing as each one specializes in different measures and we are now close to 10 if we include the biobank projects
-there is an extensive consent process for the survey, including a consent form that respondents sign
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5. OVERALL RESPONSE RATES: CYCLE 3
All sites (%)
Households who provided a list of household members (as a percentage of households within the scope of the survey) 74
Respondents who completed questionnaire (as a percentage of total respondents selected) 88
Respondents who attended mobile clinic (as a percentage of respondents who completed questionnaire) 79
Overall combined response rate (combination of the three response rates above) 52
-response rates are quite high for the survey, especially considering the up to 4 hour time commitment for some 2-person households; respondents definitely seem to see value in the survey
-overall roughly represents the percentage of people who participated in all parts of the survey from who was eligible (.74*.88*.79)
-for more detailed information on how response rates are calculated, see Data User Guide
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6. SURVEY PARAMETERS: CYCLES 3 & 4
National estimates: n = 5,700 each cycle
Survey population aged 3 to 79
Direct physical measurements completed in mobile clinic over 2 years
Collection:
cycle 3 from Jan 2012 to Dec 2013
cycle 4 from Jan 2014 to Dec 2015
-currently in collection for cycle 4, with cycle 3 collection just completed
-collection for the survey has been pretty well continuous since its beginning in Mar 2007
-numbers are similar for cycles 1 and 2 except that 3 to 5 year olds only added to the survey in cycle 2
-most StatCan analytical products have been released for cycles 1 and 2 and dissemination for cycle 3 will start in the fall
-in some cases data from cycles 1 and 2 can be combined so that there is more sample to work with (up to 11, to 79 yr olds in both cycles combined) – an instructions document is available to help researchers and combined weight files need to be used
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7. SAMPLING STRATEGY: CYCLES 3 & 4
National sampling frame
(360 eligible collection sites)
Collection sites stratified in 5 regions
Covers about 96% of population
11 age/sex groups from age 3 to 79
Sample size (n = 5,700) to yield national estimates by sex/age group at 10% prevalence with coefficient of variation of 16.5%
Collection sites selected
Very similar sampling strategy for cycles 1 and 2; estimates for 3-5 yr olds cannot be broken down by sex; important to keep the limitation of sample size in mind when considering research projects using CHMS data
Sample allows for reliable national estimates for 11 groups at 10% frequency
3 to 5 both sexes
6 to 11 M & 6 to 11 F
12 to 19 M&F
20 to 39 M&F
40 to 59 M&F
60 to 79 M&F
Households selected
Respondents selected
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8. COLLECTION SITES: CYCLE 4
Terrace Kitimat
Edmonton
Saguenay
-there are 16 sites in each of cycle 3 and cycle 4, well distributed across the regions; here is cycle 4 as an example
-collection will end in December of this year and then cycle 5 collection will start in January next year
Fredericton
St Hyacinthe
Shelburne
Thunder Bay
Laval
Kelowna
Montreal
Regina
Brockville
Kitchener-Waterloo
Toronto (2)
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Hamilton

9. QUESTIONNAIRE CONTENT: CYCLE 3
The questionnaire content is to be used only in context with physical measures data and covers the following topics:
Health status
Nutrition and food
Medication use
Health behaviours
Environmental factors
Socio-economic information
-the household questionnaire content has remained relatively stable over the different cycles; a Content summary document is available that shows the changes that have happened for household, clinic and lab from cycles 1 to 8
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10. Statistics Canada • Statistique Canada
THE MOBILE CLINIC
-respondent does a typical household interview and then goes to a trailer up to 100 km away for physical measures
-of the respondents who do the household interview, about 79% agree to go to the clinic
-once at the clinic, there is a very high participation rate for specific tests and measures – well over 90% for all the tests
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11. Statistics Canada • Statistique Canada
THE MOBILE CLINIC
Trained health measure specialists and lab professionals – stations/rooms for different measures
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12. PHYSICAL MEASURES: CYCLE 3
Anthropometry
Standing height, sitting height, weight
Waist and hip circumference
Cardiorespiratory fitness
Resting blood pressure and heart rate
Spirometry
Fractional exhaled nitric oxide (FENO)
Muscular strength
Hand grip strength
Hearing assessment
Skin pigmentation
Physical activity
Accelerometer
Indoor air sampler
Tap water samples (taken from some randomly selected households)
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13. BLOOD AND URINE TESTS: CYCLE 3
General: Complete blood count (CBC), blood chemistry panel
Allergies
Cardiovascular health: C-reactive protein (high sensitivity), HDL, LDL, total cholesterol and triglycerides and fatty acids
Diabetes: Fasting, non-fasting and random glucose, fasting insulin and HbA1c
Environmental exposure: Metals (cadmium, lead and mercury (total and methyl)), acrylamide and volatile organic compounds (VOCs)
Infectious diseases: Hepatitis B and C
Nutritional status: Ferritin, red blood cell folate, vitamin B12, vitamin C and vitamin D
Reproductive hormones
Thyroid status
Urine
Environmental exposure: Metals (arsenic (speciated), fluoride and inorganic mercury), benzene metabolites, bisphenol A, organophosphate insecticides, polyaromatic hydrocarbons (PAHs), parabens, tobacco and triclosan
Kidney function: Creatinine and microalbumin
Nutritional status: Iodine
-we measure for a very wide range of substances in the blood and urine that are related to a wide variety of health conditions – over 200 tests
-only a few changes between cycles 3 and 4
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14. MICRODATA FILES (CYCLE 1)
Full sample file
Subsample files
Medication file
Content # obs Age covered
Household
questionnaire,
clinic and
laboratory
measures
done on all
respondents
5604 obs.
Ages 6 to 79
Medication
File
5604 obs.
Ages 6 to 79
Fasting measures , to 79
Inorganic mercury , to 79
PBDE / PCB , to 79
PFCs , to 79
-quite a few files are available using cycle 1 data (2007 to 2009)
-be aware that several files have fewer observations to work with (subsample files)
-some tests are done on fewer respondents usually due to the cost of the tests
Activity monitor , to 79
Phthalates , to 49
Nicotine , to 79
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15. MICRODATA FILES (CYCLE 2)
Full sample file
Subsample files
Medication file
Content # obs Age covered
Household
questionnaire,
clinic and
laboratory
measures
done on all
respondents
6,395 obs.
Ages 3 to 79
Medication
File
6,395 obs.
Ages 3 to 79
Fasting measures , to 79
Indoor air - hhld , N/A
Indoor air - person , to 79
Activity monitor , to 79
-again there are full sample and subsample files with the content quite similar to cycle 1 except that
indoor air was introduced to the survey
-2010 to 2011
Environmental blood 1, to 79
Environmental urine 2, to 79
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16. MICRODATA FILES (CYCLE 3) - Released
Full sample file
Subsample files
Medication file
Content # obs Age covered
Household
questionnaire,
clinic and
laboratory
measures
done on all
respondents
5,785 obs.
Ages 3 to 79
Medication
File
5,785 obs.
Ages 3 to 79
Fasting measures , to 79
Activity monitor , to 79
RBC fatty acids , to 79
Fluoride - hhld , to 79
-the data files are separated out a bit from previous cycles and if a researcher needs more than one file, the files will have to be merged using CLINICID
-2012 to 2013
Fluoride - person , to 79
VOCs - hhld , to 79
VOCs - person , to 79
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17. PLANS FOR MICRODATA FILES (CYCLE 3) To be released
Release date
Topic
July 15, 2015
Environmental lab blood and urine full sample data
Acrylamide subsample (environmental blood)
Methyl mercury subsample (environmental blood)
NNAL and glucuronides (environmental urine)
Environmental urine full sample data
Sept 16, 2015
Indoor air subsample - hhld
Indoor air subsample - person
Fall 2015
Medication full sample data (derived variables added)
Fall 2016
Pooled serum data file (50 environmental variables)
-a dissemination plan is available that provides more specific information on these files
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18. Statistics Canada • Statistique Canada
CHMS DOCUMENTATION
User guide
Survey content, procedures
Data quality, weighting
Data dictionaries
Information for all variables on the full sample and subsample files
Name, length, data type (character / numeric)
Location on the file, applicable values
Coverage statements
Univariate counts (weighted and unweighted; at RDC only)
Derived variables documentation
Sampling documentation
-virtually all StatCan products using cycles 1 and 2 data have already been released
-sampling document provides a bit more info that what is in the user guide
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19. CHMS DOCUMENTATION (CONT’D)
Instructions for combining multiple cycles of CHMS data
CHMS Bibliography
Electronic record of CHMS data releases and analytical products
Includes links to external articles and publications
Content summary document
Content topics in the survey by age for cycles 1 to 8
Information on how to access CHMS documentation on-line
-bibliography updated once a year – a new electronic version will be available on-line within the next couple of months
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20. RESEARCH DATA CENTRES (RDCs)
Access route for most researchers
Allows microdata access in universities across Canada, under research agreement, in a secure setting
CHMS microdata and supporting documentation, all Statistics Canada health survey microdata
Similar files at Health Canada & PHAC
-how to access CHMS data itself
-more information on the RDCs available at the link
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21. STATISTICS CANADA ANALYTICAL PRODUCTS
Health Reports journal articles
Peer reviewed, academic, fairly lengthy
Cycle 3 releases to come:
Prevalence of hearing loss year olds
Activity monitor results year olds
RBC fatty acids year olds
Health at a Glance articles
Moderate length
Cycle 3 release to come:
Volatile organic compounds year olds
Data tables
-though researchers have the potential to do their own research at the RDCs, StatCan also does a fair bit on their own
-all data releases must be released through StatCan’s Daily – hyperlinks included to access each product; many of the products are released at later dates than the corresponding data file(s); basic analytical text is also included in the Daily
-hearing – July 2015; activity monitor and RBC expected this fall
-VOCs in air, water and blood – May/June 2016
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22. STATCAN ANALYTICAL PRODUCTS (CONT’D)
Fact sheets
Plain language, basic descriptive analysis
Cycle 3 already released:
Blood pressure: 1. adults, 2. children and youth
Body composition/BMI: 1. adults, 2. children and youth
Chronic obstructive pulmonary disease
Metabolic syndrome
Cholesterol levels
Vitamins: 1. C, 2. D
Physical activity: 1. adults, 2. children and youth
Hearing loss
Cycle 3 releases to come:
1. Bisphenol A, 2. Tobacco use, 3. Lead, mercury and cadmium, 4. RBC fatty acids
-12 cycle 3 fact sheets have been released so far and 4 are to come
-2 pages on average, often with a couple of charts
-Bisphenol A, tobacco use and lead, mercury and cadmium fact sheets are to be released on July 15th and the RBC fatty acids fact sheet will be released in the fall
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23. DATA HIGHLIGHTS FROM CYCLE 3
11% of adults aged 35 to 79 measured airflow obstruction consistent with chronic obstructive pulmonary disease; however, 90% of these individuals were unaware of their condition
22% of Canadian adults aged 20 and older and 2% of children and youth aged 19 and younger suffer from high blood pressure
65% of Canadians aged 3 to 79 had vitamin D levels that are likely sufficient to fulfill the body’s requirement for optimal bone health while 25% were at risk for inadequate vitamin D and 10% were at risk for having a vitamin D deficiency
21% of Canadian adults aged 18 to 79 suffer from metabolic syndrome
38% of Canadian adults aged 18 to 79 suffer from dyslipidemia; however, half of those individuals were unaware of their condition
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24. Statistics Canada • Statistique Canada
Adults
-Almost 2 out of every 3 (62%) Canadian adults aged 18 to 79 were overweight or obese while 2% were underweight and 36% had a normal BMI
-The prevalence of obesity in the Canadian adult population has changed since the 1978/1979 Canada Health Survey.5 The prevalence of overweight Canadians did not change, but the proportion considered to be obese doubled (from 13% to 26%).
Children and youth
-31% of children and youth 5 to 17 years were overweight and obese while 68% had a normal BMI
-Boys (15%) were more likely to be obese than girls (11%); however boys and girls were equally likely to be overweight (19%)
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25. Statistics Canada • Statistique Canada
Adults
-Approximately one in five adults achieved the recommended 150 minutes of moderate-to-vigorous physical activity (in 10 minute bouts) set out by the Canadian Physical Activity Guidelines for adults and older adults. The percentage of adults meeting the guideline was lower in older age groups.
Children and youth
The majority of school-aged children and youth are not getting enough physical activity to meet the current Canadian Physical Activity Guidelines, only 13% of boys and 6% of girls were getting an average of at least 60 minutes of moderate-to-vigorous physical activity daily as recommended in the guidelines
Statistics Canada • Statistique Canada 25

26. Physical Activity Guidelines
-20% of adults aged 19 to 79 years had at least mild hearing loss in at least one ear (Chart 1). Hearing loss was more prevalent in older age groups. Hearing loss was roughly being unilateral (one ear) or bilateral (both ears)
-5% of children had at least mild hearing loss in at least one ear (data not shown) the vast majority being unilateral hearing loss
Physical Activity Guidelines 26
Source: Canadian Health Measures Survey, Statistics Canada 26

27. FUTURE CONTENT CYCLES 5-8
Neighbourhood environment
Sleep apnea
Hair (metals)
Saliva (DNA)
Vision
pQCT and mechanography
Cycles 7 & 8
Dual-energy x-ray absorptiometry (DXA)
Here is some of the main new content planned for the future – as we get closer to cycles 7 and 8, content will likely be added
Vision = visual acuity, visual field, retinal photography
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28. ADDITIONAL INFORMATION
For more information on the CHMS:
toll-free number:
Web site:
-we also do custom tabulations at a cost
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29. Statistics Canada • Statistique Canada
QUESTIONS?
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