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CANADIAN HEALTH MEASURES SURVEY (CHMS): Introduction and Overview

CANADIAN HEALTH MEASURES SURVEY (CHMS): Introduction and Overview. Dr. Mark Tremblay, PhD Statistics Canada. Health information collected through self-report surveys or administrative records may be incomplete or inaccurate

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CANADIAN HEALTH MEASURES SURVEY (CHMS): Introduction and Overview

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  1. CANADIAN HEALTH MEASURES SURVEY (CHMS):Introduction and Overview Dr. Mark Tremblay, PhD Statistics Canada

  2. Health information collected through self-report surveys or administrative records may be incomplete or inaccurate Many variables cannot be assessed in the absence of direct physical measurements Directly measured variables can be reported on continuous scales Directly measured variables are more robust and objective Important health issues (metabolic syndrome, environmental toxins, physical inactivity) cannot be monitored without direct measures BACKGROUND

  3. To advance the Health Information Roadmap initiative: by addressing important data gaps and limitations in existing health information through direct physical measures of Canadians’ health physical fitness, height, weight, etc. blood and urine samples THE CHMS AIMS

  4. BODY WEIGHT CLASSIFICATION: SELF-REPORT VS DIRECT MEASURE 1. MacLellan et al. CJPH, 2004. 2. B.C. Nutrition Survey, 2004. 3. Campagna et al. NS Report, 2002; Tremblay and Willms. CMAJ, 2000. 4. Flegal et al. JAMA, 2002; Mokdad et al. JAMA, 2001.

  5. Forest plot of systematic review: BMI self-report-measured Connor-Gorber, Tremblay, Moher, Gorber. Obesity Reviews (in press)

  6. Direct Measure vs Self-report Physical Activity % meeting guidelines NHANES and BRFSS

  7. CHMS OBJECTIVES • Estimate the numbers of individuals in Canada with selected health conditions, characteristics, exposures • Estimate the distribution and distributional patterns of selected diseases, risk factors and protective characteristics • Assess the validity of prevalence estimates based on self- and proxy-reported information • Monitor trends based to the extent possible with available historical data

  8. CHMS OBJECTIVES • Ascertain relationships among risk factors, protection practices, and health status • Explore emerging public health issues and new measurement technologies • Collect a nationally representative sample of genetic material and other covariates for future genetic research • Potential platform and infrastructure for ongoing physical measures surveys and add-on studies • Share our experience with others

  9. This symbol represents interactions Conceptual Framework Neighbourhood/ Community Individual Household/ Family Health Behaviours Non Modifiable Determinants Modifiable Determinants Health Outcome Health Characteristics

  10. Lab Committee Health Canada PHAC Expert Advisory Committee Privacy Commissioners Statistics Canada Policy Committee CHMS Steering Committee CHMS Team NHANES Analysis Advisory Committee QA/QC Committee Stakeholders • Researchers • Agencies Physician Advisory Committee Research Ethics Board

  11. SURVEY PARAMETERS • Budget (with buy-ins) $35 million over 6 yrs • National estimates, n = 5,000 over 2 years • Atypical sample design (cost, logistics) • Ages 6-79 (6-11, 12-19, 20-39, 40-59, 60-79) • 2007-2009 in the field • Direct measures completed in mobile clinic

  12. Select a sampling frame Select clusters Set stand schedule; advanced stand preparation & public relations Select households Contact household Select respondent Informed consent Clinic measures Book in-home interview In-home interview & book clinic visit

  13. CHMS SITES 2007-2008 Municipality of Clarington, Ontario Collection dates:March 20–May 16, 2007

  14. CONSENT • Physical measuresTo participate in the physical measure tests, including providing samples of blood and urine • Lab reportTo receive a copy of the Report of Laboratory Tests • Reportable diseasesTo allow Statistics Canada to test blood for hepatitis B and C viruses and to contact respondent, as well as provincial authorities, if results are positive • BiostorageTo allow the storage of blood and urine for use in future health studies Reconsent children when they reach age 14 • DNA storageTo allow the storage of DNA for use in future health studies • Youth assentFor respondents under 14, to assent to take part in the survey

  15. QUESTIONNAIRE CONTENT • Health Status • General Health, Sleep, Height and Weight, Weight Change, Health Utility Index, Chronic Conditions, Hepatitis, Family Medical History, Oral Health Status, Phlegm, Pregnancy, Birth, Breastfeeding Information • Nutrition and Food • Grain, Fruit and Vegetable Consumption, Meat and Fish, Dietary Fat, Salt, Water and Soft Drink, Milk and Dairy Products • Medication Use • Medications, Other Health Products and Herbal Remedies • Health Behaviours • Physical Activities, Sedentary Activities, Smoking, Alcohol Use, Illicit Drug Use, Sexual Behaviour, Maternal Breast-feeding, Strengths and Difficulties • Environmental Factors • Exposure to Second-Hand Smoke, Sun Exposure, Housing Characteristics, Hobbies, Grooming Product Use • Socio-Economic Information • Socio-Demographic Characteristics, Education, Labour Force Activity, Income

  16. SITE REQUIREMENTSFOR TRAILERS • Location central to sample area • Minimum 60 ft. by 50 ft. to accommodate the trailers once parked • Electrical, water and telecommunications hook-ups nearby • Parking and/or public transit access • Contribution in kind for space and parking

  17. STAFFING • 1 mobile team • 7.5 “sites” per year • 20 measurement staff (manager, 2 Senior HMS, 4 HMS, 4 lab techs, 4 clinic coordinators, 2 dentists, 2 dental recorders, 1 site logistics officer) • 10 interview staff (plus manager) • Central support for • Advance arrangements • Public relations • Technical support • Training and retraining

  18. PHYSICAL MEASURES • Anthropometry • height, weight, waist and hip circumference, sitting height • 5 skinfolds • Cardiorespiratory Fitness • blood pressure, resting heart rate • modified Canadian Aerobic Fitness Test (step test) • spirometry • Musculoskeletal Fitness • hand grip strength • sit-and-reach flexibility • curl-ups • Physical Activity • accelerometry • Oral Health Exam

  19. BLOOD MEASURES • Diabetes • Fasting glucose • Fasting insulin • HbA1c • Cardiovascular Disease • HDL, LDL, total cholesterol, triglycerides, Apo B, Apo A-1 • Homocysteine • Fibrinongen • High Sensitivity C-reactive protein • Nutritional Status • RBC folate • Vitamin B12 • Vitamin D • Calcium

  20. BLOOD MEASURES • Infectious Disease Markers • Hepatitis A antibody • Hepatitis B (anti-HBs, anti-HBc, HBsAg) • Hepatitis C antibody

  21. BLOOD MEASURES • Environmental exposure • Lead, Cadmium, Manganese, Total mercury, Arsenic, Nickel, Copper, Zinc, Selenium, Uranium, Molybdenum • Inorganic Mercury (on those with high Total Mercury) • PBDE + Non-coplaner PCBs + Organochlorine pesticides (lipid adjusted and unadjusted) • Perfluorinated Compounds (PFHS, PFOS, PFOA) • General • CBC • Blood chemistry panel • Pristine over-sample for biorepository • DNA sample • Surplus blood

  22. URINE MEASURES • Lead, Cadmium, Manganese, inorganic Mercury, Arsenic, Nickel, Copper, Zinc, Selenium, Uranium, Molybdenum, antimony, vanadium • Phthalates and metabolites (11) • Organophosphate pesticides and metabolites (6) • Pyrethroid pesticides (5) • Phenoxy Herbicide (2,4-D) • Bisphenol A • Cotinine • Microalbumin • Creatinine • Iodine

  23. REPORTING TO RESPONDENTS • At end of clinic visit, respondents will receive results of their physical tests • Lab test results sent to respondents8 to 12 weeks after the clinic visit (with respondent’s prior consent) • Early reporting protocol in place for lab results beyond threshold values

  24. Infectious disease reporting process • Testing done only with respondent’s prior consent to the reporting of positive results • Lab will report a positive result for hepatitis B or C virus to CHMS medical advisor within 24 hours • Medical advisor will provide results and respondent information to provincial authorities within 48 hours • Medical advisor will contact respondent within three days by phone to provide result and counselling • Medical advisor will follow up by sending a letter and information brochures about the viruses to the respondent

  25. Respondent i h Respondent DATA FLOW Household Interviews Stats Can 8-12 wks <24 hrs Immediate feedback Mobile Clinics 2x / week <24 hrs Labs 1-4 wks Specimen Bank weekly Each stand

  26. Biological Specimen Flow Health Canada Chronic Disease Nutrition Québec Public Health Environmental Biomarkers NML Infectious Disease Biorepository Mobile Examination Centre

  27. Storage Proposal • Information on purposes of storage, access and right of withdrawal provided to respondents prior to collection • Storage of blood and urine: all consenting respondents (re-consent <14 years) • Storage of DNA: 20 years and above with consent • NML in Winnipeg selected as biorepository for indefinite storage • Access controlled by Statistics Canada

  28. De-identified samples stored at NML Application to access samples Priorities set in consultation with EAC, PHAC, HC, others Pre-screen by CHMS to ensure adherence to Statistics Canada Policies and Access Criteria Scientific Review Panel (e.g. CIHR) Research Ethics Board Review Policy Committee Review Approved projects posted on webpage prior to start Project begins with de-identified samples only

  29. ANALYTICAL POTENTIAL • 46 questionnaire modules containing 722 questions • Approximately 50 physical measures variables • Over 120 biospecimen analytes • About a dozen Environment Canada weather / pollution indicators • Potential linkage to health records

  30. Phase 1: Planning Phase 2: Data Collection Phase 3: Outputs 1- Background 2- Analytical Capacity Development ANALYSIS PLAN: Integrated Data Analysis and Priorities 2007 2009 2010 3- CHMS Data 4 Analytical Themes - Healthy Living - Environmental Biomarkers - Infectious Diseases - Chronic Diseases • Normative Data • Health Information Improvements • Health and its Determinants 4- Auxiliary Health Information • International Research • External Data Sources

  31. ANALYSIS PLAN Model for normative data CHMS Official Data Release ? 2009 Mar. 07 Mar. 09 2010 Timelines: Internal Publications Submission Data Collection External Publications Submission Production of Compendium Planning Commitment Final Drafts (no nbs) Translation Fill in Tables Interpretation Internal Review Production of Daily

  32. ANALYSIS PLAN

  33. CHMS OFFERS… Unique and nationally representative dataset Stored samples (serum, urine, DNA) for future research Experience and expertise Training opportunities Catalyst for developing a national biorespository strategy Potential leadership for domestic and international coordination and harmonization Comprehensive measurement scope Opportunity for continuity and expansion (additional content and / or geography)

  34. CHMS has the endorsement of Canadian Medical Association Canadian Dental Association Canadian Hypertension Society Canadian Lung Association Canadian Red Cross Dietitians of Canada Heart and Stroke Foundation of Canada And the support of Canadian Public Health Association The College of Family Physicians of Canada

  35. ADDITIONAL INFORMATION For more information on the CHMS, please contact the Statistics Canada regional office nearest you, call toll-free 1-800-263-1136or send an e-mail to chms-ecms@statcan.ca. Detailed information on the CHMS can also be found at www.statcan.ca/chms.

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