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

2. 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”

4. 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. 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. 6 CCHS - Status Cycle 1.1 (2000-2001) General content 130 000+ sample health region estimates initial release: May, 2002 PUMF ☻ Cycle 2.1 (2003) General content 130 000+ sample health region estimates initial release: June, 2004 PUMF ☻ Cycle 1.2 (2002) - focus Mental health & well being ~30 000 sample provincial estimates initial release: Sept 2003 PUMF ☻ Cycle 2.2 (2004) - focus Nutrition ~30 000 sample provincial estimates Two-stage release: July 2005 & Feb. 2006 PUMF x 2 ☺

7. 7 CCHS - Status Cycle 3.1 (2005) General content 130 000+ sample health region estimates 6-mth data release: Dec, 2005 full release: June, 2006 PUMF ☺ Cycle ? 4.1 ? (2006+) General content 130,000+ sample continuous ? HR estimates w/more flexibility staggered releases PUMF (24 months) ☺ Canadian Health Measures Survey (2006) Cycle ? 4.2 ? (2008) Focus content aging ? PUMF ☺

8. CCHS 2.2 (2004) - Nutrition

9. 9 A Brief History Nutrition  Nutrition Canada, 1972 last national population based data on food consumption and related nutrition assessment with physical and biological measurements  Health Canada’s provincial nutrition surveys, 1990’s Physical measurements  Canada Health Survey, 1978-79, national  Canadian Heart Health Surveys, 1986 to 1992, different provinces

10. 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: Dec, 2005  complete release: Feb, 2006 PUMF: ~Spring 2006

11. 11 CCHS 2.2 - 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. 12 CCHS 2.2 - 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. 13 Sample Design - Domains Distribution of usual dietary intake for a representative sample at provincial and national levels  15 key domains of interest = Dietary Reference Intakes  DRI age/sex groups: – < 1both sexes – 1 - 3both sexes – 4 - 8both sexes – 9 - 13m - f separate – 14 - 18m - f separate – 19 - 30m - f separate – 31 - 50m - f separate – 51 - 70m - f separate – 71 +m - f separate

14. 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. 15 Sample Design - Allocation Initial target sample size: 30,000 responding units Two-step approach  step 1 1,120 units to each province 80 for each of 14 DRI groups (minimum of 80 units is not a requirement for the < 1 age grp)  step 2 remaining 18,800 units allocated to the provinces using a power allocation scheme (q = 0.70) Two frames  LFS area frame  CCHS 2.1 frame

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

17. 17 CCHS 2.2 Content Two components  24-hour dietary recall component collect information on all foods & beverages during 24- hour period of reference  general health component collect correlates & socio-demographics –selected health conditions –physical / sedentary activity –vitamins & minerals supplements –height & weight (self-reported, measured) –…

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

19. 19 CCHS 2.2 Content 24-Hour Dietary Recall Modified to fit Canadian marketplace  to account for differences in foods available beaver tails, poutine…  in collaboration with Health Canada  contains ~27,000 foods within look-up lists  translated into French Automated multiple pass methodology  5 steps designed to improve the respondent’s ability to remember what foods and beverages were consumed during the 24-hour period of reference 1. Quick List – quick report 2. Forgotten Foods – anything else with that? 3. Time and Occasion – when / group items 4. Detail Cycle – describe, prep, additions, amounts, where 5. Final Probe – any other food / beverage

20. 20 CCHS 2.2 Content 24-Hour Dietary Recall Second recall  calculate intra-individual variability  subsample of 10,000 units (CATI)  3 to 10 days after the first interview, preferably a different day of the week  minimum of 125 individuals for each of the 15 DRI/sex groupings by region Atlantic, Quebec, Ontario, Prairies, BC 50 respondents ~ collapse by region not necessary Intake distribution software

21. 21 CCHS 2.2 Content General Health General Health (12+) Physical Activity (12+) Children’s Physical Activity (6 to 11) Sedentary Activity (12 - 17) 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 (15 - 75) Income (all)

22. 22 Data Collection - Design Four quarterly samples  Jan. to Dec. 2004 60-minute CAPI interview  including the 1 st 24-hour recall and physical measures  anticipated response rate: 80% 85% for fresh sample 75% for 2.1 sample of households Proxy interview protocols  Respondents aged 12+: non proxy  Aged 6 to 11: assisted proxy (respondent and parent)  Aged 0 to 5: full proxy (parent only)

23. 23 Data Collection – Response Rates 1st Interview (%)2nd Interview (%) OverallArea Frame Other Frames OverallArea Frame Other Frames Canada76.575.977.272.872.372.8 NL83.384.680.579.981.779.9 PE79.280.478.384.382.884.3 NS78.6 77.575.877.5 NB75.775.077.281.4 QC75.874.877.180.379.280.3 ON72.771.673.967.164.867.1 MB82.782.183.570.070.570.0 SK77.175.579.570.770.070.7 AB77.476.678.672.873.272.8 BC77.176.278.361.960.461.9

24. 24 Data Collection – Sample Sizes 1 st interview2 nd interview Canada35,10710,786 NL1,734752 PE1,430860 NS1,705704 NB1,633683 PQ4,7801,964 ON10,9211,647 MB4,194921 SK2,041894 AB3,021767 BC3,6481,564

25. 25 Data Collection - Sample Sizes by Age - 1 st Interview (80 / DRI) Total<11-34-89-1314-1819-3031-5051-7071+ Canada3510728923023359419447663984568961424382 NL17341685132211223182331406148 PE1430963113175173188247290172 NS170515118179219245192272321144 NB163315104147174216188292341156 QC478034325505579685517846913376 ON1092184705988120813251070155717992185 MB419446349443560623478669632394 SK204112135218231300238316343248 AB302126183295366430474542481224 BC364832235339471546457617616335

26. 26 Data Collection - Sample Sizes by Age - 2 nd Interview (50 / DRI) Total<11-34-89-1314-1819-3031-5051-7071+ Canada1078665768755154615691463151216171491 NL7826435813310289140110101 PE86025150131103137132137117 NS7044604893117961238479 NB68314653879511080109102 QC196413140142290 270269289261 ON1647996123211198207238269296 MB92197947110167110141154104 SK894288731461559989106136 AB7677474984108123120112117 BC156412118112261234222180247178

27. 27 Data Collection - Measured Height and Weight (% item resp) TotalNLPENSNBQCONMBSKABBC Measured – H/W6371687362685568626162 Refused1114111013711 91812 Respondent Not Available64445567466 Resp. too Tall5565125521047 Equipment (NA, batteries)500118110400 Phone Interview43433136545 Interview Setting21221132234 Physical/Mental Condition22312132112 Data not stated21121222222 Other00000010000

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

29. 29 Data Release(s) – Step 1 Step 1: General health component - July 6, 2005 Single flat file  2 sampling weights general measured body height & weight PUMF - Dec. 5, 2005 Internet Publication  “Nutrition: Findings from the Canadian Community Health Survey” 2 articles: adult and children obesity CANSIM tables

30. 30 Data Release(s) – Step 1 I-Pub: “Nutrition: Findings from the Canadian Community Health Survey”  2 analytical articles “Adult obesity in Canada: Measured height and weight”, Michael Tjepkema, STC “Overweight Canadian children and adolescents”, Margot Shields, STC  CANSIM tables adult measured BMI, child measured BMI, food insecurity, children’s physical activity, teenager’s sedentary activity

40. 40 Data Release(s) – Step 1 PUMF - Dec. 5, 2005  Single flat file 2 sampling weights –general –measured body height & weight  Documentation user guide data dictionary derived variables syntax files / layouts (SAS & SPSS)  B20/20 utility x 2 user-defined tabulations

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

51. 51 Data Release(s) – Step 2 4 flat files  general health and nutritional summary data file 1 record per respondent  vitamin and mineral supplements file 1 record per supplement reported  food details file 1 record per food reported  day 1 and 2 intake summary file 1 record per intake day –1 record for 2/3 of respondents, 2 records for 1/3 of respondents

52. Roll Up

53. 53 Data Release(s) – Step 2 Nutrition Variables Protein Fat (total lipids) Carbohydrate, total Energy (kilocalories) Alcohol Mositure Caffeine Energy (kilojoules) Sugars (total) Fibre, total dietary Calcium Iron Magnesium Phosphorous Potassium Sodium Zinc Vitamin D (IU) Viitmin D (micrograms) Vitamin C Thiamin Riboflavin Total Niacin Equivalent Vitamin B6 Total Folacin Vitamin B12 Folic Acid Cholesterol Fatty Acids, Saturated, Total Fatty Acids, Polyunsaturated, 18:2, Linoleic Fatty Acids, Polyunsaturated, 18:3, Linolenic Fatty Acids, Monounsaturated, Total Fatty Acids, Polyunsaturated, Total Naturally Occuring Folate Retinol, Activity Equivalents Dietary Folate Equivalent

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

55. 55 Data Release(s) – Obesity Body Mass Index (BMI)  a measure of person’s weight in relation to his/her height  highly correlated with body fat and is widely used to indicate a person’s potential health risks Measuring BMI  metric: BMI = weight (kg) / height (m) 2  imperial: BMI = weight (lb) / height (inches) 2 x 703

56. 56 Data Release(s) – Obesity Body Mass Index (BMI)  Canadian guidelines in keeping with those of the WHO, classifies BMI into six categories, each representing a certain level of risk to one’s health CategoryBMI valueRisk level underweightBMI < 18.5increased normal weight18.5 < BMI < 24.9least overweight25.0 < BMI < 29.9increased obese class I30.0 < BMI < 34.9high obese class II35.0 < BMI < 39.9very high obese class IIIBMI ≥ 40.0extremely high

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

58. 58 Obesity Rate Over Time, Age 18+ 1978/79 – 2004 Measured Self-reported

59. 59 Contact Info Mario BédardIngrid Ledrou (613) 951-8933(613) 951-6567 mario.bedard@statcan.caingrid.ledrou@statcan.ca Data Access Unit Population Health Surveys (NPHS, CCHS) Health Statistics Division Statistics Canada cchs-escc@statcan.ca nphs-ensp@statcan.ca