Canadian Community Health Survey

C

anadian

C

ommunity

H

ealth

S

urvey

Cycle 2.2 (2004) – Nutrition

ATLANTIC DLI TRAINING 2006

Wolfville, April 19 – April 21, 2006

Ingrid Ledrou

Health Statistics Division Statistics Canada

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

CCHS Design

“.1’s” vs “.2’s”

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

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”

 Estimates for provinces,

Canada (excluding territories)

CCHS - status

Cycle 1.1 (2000-2001)

 130 000+ sample

 health region estimates  initial release: May, 2002

 PUMF ☻

Cycle 2.1 (2003)

 130 000+ sample

 health region estimates  initial release: June, 2004

PUMF ☻

Cycle 1.2 (2002) - focus

 ~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 &

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+)

 130,000+ sample continuous ?  HR estimates w/more flexibility  staggered releases  PUMF (24 months) ☺

Canadian Health

Measures Survey

(2006)

Cycle ? 4.2 ? (2008)

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,

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

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

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

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

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

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

 Buy-ins from ON, PEI, MAN and Health Canada

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

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

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?

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

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)

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 %

Data collection – sample sizes

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

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”

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

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

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

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

General Health and Nutrition Summary File

Sample ID GEN

1111 x 1112 x

1113 x 15

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

x x x

Day 1 Food Detail summary (B) 1 40 VMD Summary (A) 2 3 0

Vitamin and Mineral Details

Sample ID # VMD 1111 1 x 1111 2 x 1112 1 x 1112 2 x 1112 3 x Food Details

Sample ID # Day Details

1111 1 1 x 1112 1 1 x 1112 … 1 x 1112 40 1 x 1112 1 2 x 1112 … 2 x Roll Up

Intake Day Summary

Sample ID Day Details

1111 1 1

1112 1 40

1112 2 25

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

Training & support



Proper use of data / files



Use of intake distribution software



Health Canada – interpretation guide



STC / CIHR RFA funding research

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:

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

Measured Obesity Rates by Age

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+ p er ce n t 1978/79 2004

F

F

*

*

*

_*

*

*

*

_*

Obesity Rate Over Time, Age 18+

1978/79 – 2004

Measured

Self-reported

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