c anadian c ommunity h ealth s urvey c ycle 2.2 (2004) – n utrition

CCanadian anadian CCommunity ommunity HHealth ealth SSurveyurvey

CCycle 2.2 (2004) –ycle 2.2 (2004) – N Nutritionutrition

ONTARIO DLI TRAINING 2006ONTARIO DLI TRAINING 2006

Guelph, April 10 – April 13, 2006Guelph, April 10 – April 13, 2006

Ingrid LedrouIngrid LedrouHealth Statistics DivisionHealth Statistics Division

Statistics CanadaStatistics Canada

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Presentation overviewPresentation overview

CCHS design – “.1’s” & “.2’s”CCHS 2.2 (2004) - Nutrition

general health component24-hour recall component

Data files – releases, Web, PUMF… on a “heavier note”…

CCHS DesignCCHS Design““.1’s” .1’s” vsvs “.2’s” “.2’s”

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CCHS - objectivesCCHS - 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 instrumentmeet specific health region data needsquick response to emerging issuesprovide focused survey content for key data

gaps (“.2’s”)

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CCHS - 2-year cycle design 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)

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CCHS - statusCCHS - 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 &

May 2006 PUMF x 2 ☺

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CCHS - statusCCHS - 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 ☺

CCHS 2.2 (2004) - NutritionCCHS 2.2 (2004) - Nutrition

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A brief historyA brief history

NutritionNutrition 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 measurementsCanada Health Survey, 1978-79, nationalCanadian Heart Health Surveys, 1986 to 1992,

different provinces

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A brief historyA brief history

CCHS 2.2 – Nutritionfeasibility study for CCHS focus content

on nutrition: initiated late 1999development begins: Spring 2002collection: Jan. – Dec. 2004first results released: July, 2005

• PUMF: December 2005complete release: Feb, 2006

• PUMF: ~ Fall 2006

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CCHS 2.2 - goalsCCHS 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

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CCHS 2.2 - objectivesCCHS 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

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Sample design - domainsSample 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

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Sample design - coverageSample 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

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Sample design - allocationSample 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

Buy-ins from ON, PEI, MAN and Health Canada Total sample size = 35,100 units

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CCHS 2.2 contentCCHS 2.2 content

Two components24-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)

– …

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CCHS 2.2 contentCCHS 2.2 content24-hour dietary recall24-hour dietary recall

All foods & beverages consumed during 24-hour period of referencemidnight to midnight the day prior to the

interviewdetails - whatamounts – how much

CAI applicationdeveloped by the United States Department of

Agricultureautomated multiple pass methodology

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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 report2. Forgotten Foods – anything else with that?3. Time and Occasion – when / group items4. Detail Cycle – describe, prep, additions, amounts, where5. Final Probe – any other food / beverage

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Second recallcalculate intra-individual variabilitysubsample of 10,000 units (CATI)3 to 10 days after the first interview, preferably a

different day of the weekminimum 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

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CCHS 2.2 contentCCHS 2.2 contentgeneral healthgeneral 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)

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Data collection - designData 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%

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Data cData collection ollection – sample sizes– sample sizes

1st interview 2nd interview

Canada 35,107 10,786

NL 1,734 752

PE 1,430 860

NS 1,705 704

NB 1,633 683

PQ 4,780 1,964

ON 10,921 1,647

MB 4,194 921

SK 2,041 894

AB 3,021 767

BC 3,648 1,564

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Data release(s) – 2 stepsData release(s) – 2 steps

CCHS 2.2 data are being released in two stepsStep 1: general health component

• except vitamin & mineral supplements

Step 2: 24-hour recall (nutrition) component• including vitamin & mineral supplements

– pending validation– release postponed

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Data release(s) – step 1Data release(s) – step 1

Step 1: General health component - July 6, 2005

Single flat file2 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

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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

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PUMF - Dec. 5, 2005Single 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

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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

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4 flat filesgeneral health and nutritional summary data file

• 1 record per respondentvitamin 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

General Health and Nutrition Summary File

Sample ID GEN

1111 x1112 x1113 x 15

Day 1 plus usual daily vitamin and mineral details (A + B)

xxx

Day 1 Food Detail summary (B)

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VMD Summary (A)

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Vitamin and Mineral Details

Sample ID # VMD1111 1 x1111 2 x1112 1 x1112 2 x1112 3 x

Food Details

Sample ID # Day Details

1111 1 1 x1112 1 1 x1112 … 1 x1112 40 1 x1112 1 2 x1112 … 2 x1112 25 2 x1113 1 1 x1113 … 1 x1113 15 1 x

Roll Up

Intake Day Summary

Sample ID Day Details1111 1 11112 1 401112 2 251113 1 15

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Data release(s) – step 2 Data release(s) – step 2 nutrition variablesnutrition 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

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Training & supportTraining & support

Proper use of data / filesUse of intake distribution softwareHealth Canada – interpretation guideSTC / CIHR RFA funding research

RDCs

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Data release(s) – obesityData release(s) – obesity

Body Mass Index (BMI)a measure of person’s weight in relation to

his/her heighthighly 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

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Data Release(s) – ObesityData 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 levelunderweight BMI < 18.5 increasednormal weight 18.5 < BMI < 24.9 leastoverweight 25.0 < BMI < 29.9 increasedobese class I 30.0 < BMI < 34.9 highobese class II 35.0 < BMI < 39.9 very highobese class III BMI ≥ 40.0 extremely high

Measured Obesity Rates by AgeMeasured Obesity Rates by AgeCanada Health Survey (1978/79) and CCHS (2004)Canada Health Survey (1978/79) and CCHS (2004)

0

5

10

15

20

25

30

35

2-5 6-11 12-17 18-24 25-34 35-44 45-54 55-64 65-74 75+

per

cen

t

1978/79

2004

F F

* *

* *

* *

* *

Obesity Rate Over Time, Age 18+Obesity Rate Over Time, Age 18+1978/79 – 20041978/79 – 2004

0

5

10

15

20

25

per

cen

t

Measured

Self-reported

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Contact InfoContact Info

Mario Bédard Ingrid Ledrou(613) 951-8933 (613) [email protected]

[email protected]

Data Access UnitPopulation Health Surveys (NPHS, CCHS)

Health Statistics DivisionStatistics Canada

[email protected]@statcan.ca

c anadian c ommunity h ealth s urvey c ycle 2.2 (2004) – n utrition

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