C anadian C ommunity H ealth S urvey C ycle 2.2 (2004) – N utrition

1. Canadian Community Health SurveyCycle 2.2 (2004) – Nutrition ONTARIO DLI TRAINING 2006 Guelph, April 10 – April 13, 2006 Ingrid Ledrou Health Statistics Division Statistics Canada

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

3. CCHS Design “.1’s” vs “.2’s”

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. 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) CCHS - 2-year cycle design

6. 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 & May 2006 PUMF x 2 ☺ CCHS - status

7. 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 ☺ CCHS - status

8. CCHS 2.2 (2004) - Nutrition

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

10. A brief history • CCHS 2.2 – Nutrition • feasibility study for CCHS focus content on nutrition: initiated late 1999 • development begins: Spring 2002 • collection: Jan. – Dec. 2004 • first results released: July, 2005 • PUMF: December 2005 • complete release: Feb, 2006 • PUMF: ~ Fall 2006

11. CCHS 2.2 - goals • Provide reliable, detailed, and timely information on dietary intake, nutritional well-being and their key determinants • To inform and guideprograms, policies and activities of federal and provincial governments as well as local health agencies

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. Sample design - domains • Distribution of usual dietary intake for a representative sample at provincial and national levels • 15 key domains of interest = Dietary Reference Intakes (DRI), as specified by the American Institute of Medicine • DRI age/sex groups: • < 1 both sexes • 1 - 3 both sexes • 4 - 8 both sexes • 9 - 13 m - f separate • 14 - 18 m - f separate • 19 - 30 m - f separate • 31 - 50 m - f separate • 51 - 70 m - f separate • 71 + m - f separate

14. Sample design - coverage • Target population • individuals, aged 0 +, living in private occupied dwellings in each of the ten provinces • exclusions: • 3 territories • individuals living on Aboriginal Reserves and Crown Lands • residents of institutions • full-time members of the Canadian Forces • residents of some remote areas • Coverage • ~98% of the Canadian population living in the provinces • Buy-ins • target groups / geography

15. Sample design - allocation • Initial target sample size: 30,000 responding units • Two-step approach • step 1 • 1,120 units to each province • 80 for each of 14 DRI groups (minimum of 80 units is not a requirement for the < 1 age grp) • step 2 • remaining 18,800 units allocated to the provinces using a powerallocation scheme (q = 0.70) • Two frames • LFS area frame • CCHS 2.1 frame • Buy-ins from ON, PEI, MAN and Health Canada • Total sample size = 35,100 units

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

17. CCHS 2.2 content24-hour dietary recall • All foods & beverages consumed during 24-hour period of reference • midnight to midnight the day prior to the interview • details - what • amounts – how much • CAI application • developed by the United States Department of Agriculture • automated multiple pass methodology

18. CCHS 2.2 content24-hour dietary recall • Modified to fit Canadian marketplace • to account for differences in foods available • beaver tails, poutine… • in collaboration with Health Canada • contains ~27,000 foods within look-up lists • translated into French • Automated multiple pass methodology • 5 steps designed to improve the respondent’s ability to remember what foods and beverages were consumed during the 24-hour period of reference • Quick List – quick report • Forgotten Foods – anything else with that? • Time and Occasion – when / group items • Detail Cycle – describe, prep, additions, amounts, where • Final Probe – any other food / beverage

19. CCHS 2.2 content24-hour dietary recall • Second recall • calculate intra-individual variability • subsample of 10,000 units (CATI) • 3 to 10 days after the first interview, preferably a different day of the week • minimum of 125 individuals for each of the 15 DRI/sex groupings by region • Atlantic, Quebec, Ontario, Prairies, BC • 50 respondents ~ collapse by region not necessary • Intake distribution software

20. 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) CCHS 2.2 contentgeneral health

21. Data collection - design • Four quarterly samples • Jan. to Dec. 2004 • 60-minute CAPI interview • including the 1st 24-hour recall and physical measures • anticipated response rate: 80% • 85% for fresh sample • 75% for 2.1 sample of households • Proxy interview protocols • Respondents aged 12+: non proxy • Aged 6 to 11: assisted proxy (respondent and parent) • Aged 0 to 5: full proxy (parent only) • Responses rates • 1st interview = 76.5% • 2nd interview = 72.8 % • Item response rate for measured height and weight = 63%

22. Data collection – sample sizes

23. Data release(s) – 2 steps CCHS 2.2 data are being released in two steps • Step 1: general health component • except vitamin & mineral supplements • Step 2: 24-hour recall (nutrition) component • including vitamin & mineral supplements • pending validation • release postponed

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

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

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

36. Data release(s) – step 2 • Step 2: Nutrition – May 18, 2006 • Assigning food codes to ~ 750,000 records • with Health Canada coding to Canadian Nutrient File • calculate nutritional profiles for each food using a processing system designed by Health Canada for provincial nutrition surveys • Re-issue Step 1 data • Intake distribution software ? No • PUMF (including Step 1 data) – Fall 2006

37. Data release(s) – step 2 • 4 flat files • general health and nutritional summary data file • 1 record per respondent • vitamin and mineral supplements file • 1 record per supplement reported • Pending validation • Release postponed • food details file • 1 record per food reported • day 1 and 2 intake summary file • 1 record per intake day • 1 record for 2/3 of respondents, 2 records for 1/3 of respondents

38. Roll Up

39. 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 Data release(s) – step 2 nutrition variables

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

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

42. Data Release(s) – Obesity • Body Mass Index (BMI) • Canadian guidelines • in keeping with those of the WHO, classifies BMI into six categories, each representing a certain level of risk to one’s health Category BMI value Risk level underweight BMI < 18.5 increased normal weight 18.5 < BMI < 24.9 least overweight 25.0 < BMI < 29.9 increased obese class I 30.0 < BMI < 34.9 high obese class II 35.0 < BMI < 39.9 very high obese class III BMI ≥ 40.0 extremely high

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

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

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