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Canadian Community Health Survey Canadian Community Health Survey – Cycle 2.2 (2004) – – Cycle 2.2 (2004) –

NutritionNutrition

Larry MacNabbHealth Statistics Division

Statistics CanadaAPHEO - 2005

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CCHS 2.2 - GoalCCHS 2.2 - Goal

Provide reliable, timely information about dietary intake, nutritional wellbeing 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 among a representative sample of Canadians at national and provincial levels.

Measure the prevalence of household food insecurity among various population groups in Canada.

Gather some anthropometric measurements for body weight measurement.

Collect data on selected health conditions and socio-economic and demographic characteristics of respondents.

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Sample DesignSample Design

Objectives estimate the distribution of usual dietary intake in terms

of food, food groups, dietary supplements, nutrients and eating patterns for the following 15 key domains of interest (Dietary Reference Intakes age groupings X sex):

– < 1 All– 1-3 All– 4-8 All– 9-13 M/F– 14-18 M/F– 19-30 M/F– 31-50 M/F– 51-70 M/F– 71 + M/F

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Target PopulationTarget Population

Target population for the survey individuals living in private occupied dwellings in the ten

provinces Exclusions: those living on Indian Reserves and Crown

Lands, residents of institutions, full-time members of the Canadian Armed Forces and residents of some remote areas

The Nutrition survey component covers approximately 98% of the Canadian population living in the provinces

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Sample AllocationSample Allocation

Total sample size: 30,000 responding units Two-step approach Step 1

1,120 units for each province (80 for each of the 14 DRI/sex groupings)

Note: the minimum 0f 80 units is not a requirement for the < 1

Step 2 The remaining 18,800 units are allocated to the provinces

using a power allocation scheme with a power q=0.70

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FramesFrames

Area Frame CCHS 2.1 Frame Buy-ins

Off-Reserve Aboriginals – National – CCHS 2.1PEI (top-up) – PEI Health RegistryOntario (7 Regions) – CCHS 2.1Manitoba (Children in 4 regions) – MB Health

Registry

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Data CollectionData Collection Four quarterly samples from January 2004 - December 2004 60-minute CAPI interview including the 24-hour recall and

physical measures for half the sample Anticipated response rate: 80%

• (85% for fresh sample and 75% for 2.1 sample of households) To allow for the calculation of the intra-individual variability

A second 24-recall for a subsample of 10,000 units (CATI) 3 to 10 days after the first interview preferably a different day of the week

A minimum of 125 individuals for each of the 15 DRI/sex groupings by Region (Atlantic, Quebec, Ontario, Prairies, BC)

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ContentContent

24 – Hour Dietary RecallUSDA Automated Multiple Multiple Pass

MethodologyGeneral Health Questionnaire

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24 Hour Dietary Recall24 Hour Dietary Recall

All foods eaten from midnight to midnight for the previous dayDetailsAmounts

Computer application developed by United States Department of Agriculture

In conjunction with Health Canada modified to represent Canadian marketplace

Translated into French

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Automated Multiple Pass Automated Multiple Pass MethodologyMethodology

5 step method designed to improve a respondents’ chances of recalling all foods eaten during the previous 24 hour period:1. Quick List

2. Forgotten Foods

3. Time and Occasion

4. Detail Cycle

5. Final Probe

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General Health General Health QuestionnaireQuestionnaire *General Health (age 12+) *Physical Activity (age 12+) Sedentary Activity (age 12 –

17) Measured Height and

Weight (age 2+) Self Reported Height and

Weight (10% sample, age 18+)

Vitamin and Mineral Supplements (all)

Household Food Security (all)

Children’s Physical Activity (age 6 to 11)

Fruit and Vegetable Consumption (age 6 mo.+)

Women’s Health (women age 9+)

*Chronic Conditions (all) *Smoking (age 12+) *Alcohol Consumption (age

12+) *Socio-Demographics (all) *Labour Force (age 15 – 75) Income (all)

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Age-Specific Interview Age-Specific Interview ProtocolsProtocols12+ - Non-Proxy6 to 11 – Assisted-Proxy (parent and

respondent)5 and Under – Proxy (parent only)

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Data Quality – Response Data Quality – Response RatesRates

1st Interview 2nd Interview

Overall Area Frame

Other Frames

Overall Area Frame

Other Frames

Canada 76.5 75.9 77.2 72.8 72.3 72.8

NL 83.3 84.6 80.5 79.9 81.7 79.9

PE 79.2 80.4 78.3 84.3 82.8 84.3

NS 78.6 78.6 78.6 77.5 75.8 77.5

NB 75.7 75.0 77.2 81.4 81.4 81.4

PQ 75.8 74.8 77.1 80.3 79.2 80.3

ON 72.7 71.6 73.9 67.1 64.8 67.1

MB 82.7 82.1 83.5 70.0 70.5 70.0

SK 77.1 75.5 79.5 70.7 70.0 70.7

AB 77.4 76.6 78.6 72.8 73.2 72.8

BC 77.1 76.2 78.3 61.9 60.4 61.9

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Data Quality – Number of Data Quality – Number of RespondentsRespondents

First Interview Second Interview

Canada 35107 10786

NL 1734 752

PE 1430 860

NS 1705 704

NB 1633 683

PQ 4780 1964

ON 10921 1647

MB 4194 921

SK 2041 894

AB 3021 767

BC 3648 1564

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Total Respondents by Age, 1Total Respondents by Age, 1stst Interview, Interview, Canada and Provinces – CCHS 2.2Canada and Provinces – CCHS 2.2

Total <1 1-3 4-8 9-13 14-18 19-30 31-50 51-70 71+

Canada 35107 289 2302 3359 4194 4766 3984 5689 6142 4382

NL 1734 16 85 132 211 223 182 331 406 148

PE 1430 9 63 113 175 173 188 247 290 172

NS 1705 15 118 179 219 245 192 272 321 144

NB 1633 15 104 147 174 216 188 292 341 156

QC 4780 34 325 505 579 685 517 846 913 376

ON 10921 84 705 988 1208 1325 1070 1557 1799 2185

MB 4194 46 349 443 560 623 478 669 632 394

SK 2041 12 135 218 231 300 238 316 343 248

AB 3021 26 183 295 366 430 474 542 481 224

BC 3648 32 235 339 471 546 457 617 616 335

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Total Respondents by Age, 1Total Respondents by Age, 1stst Interview Interview Ontario – CCHS 2.2Ontario – CCHS 2.2

Total <1 1-3 4-8 9-13 14-18 19-30 31-50 51-70 71+

Ontario 10921 84 705 988 1208 1325 1070 1557 1799 2185

Southwest 1660 16 101 144 186 192 163 220 257 381

Central South 1351 17 98 103 155 159 110 166 238 305

Central West 1712 14 108 183 198 238 223 234 242 272

Central East 1591 6 99 150 209 197 114 249 266 301

Toronto 1383 6 105 148 139 165 158 221 196 245

East 1526 14 95 116 158 186 140 241 249 327

North 1698 11 99 144 163 188 162 226 351 354

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Total Respondents by Age, 2Total Respondents by Age, 2ndnd Interview, Interview, Canada and Provinces – CCHS 2.2Canada and Provinces – CCHS 2.2

Total <1 1-3 4-8 9-13 14-18 19-30 31-50 51-70 71+

Canada 10786 65 768 755 1546 1569 1463 1512 1617 1491

NL 782 6 43 58 133 102 89 140 110 101

PE 860 2 51 50 131 103 137 132 137 117

NS 704 4 60 48 93 117 96 123 84 79

NB 683 1 46 53 87 95 110 80 109 102

QC 1964 13 140 142 290 290 270 269 289 261

ON 1647 9 96 123 211 198 207 238 269 296

MB 921 9 79 47 110 167 110 141 154 104

SK 894 2 88 73 146 155 99 89 106 136

AB 767 7 47 49 84 108 123 120 112 117

BC 1564 12 118 112 261 234 222 180 247 178

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Total Respondents by Age, 2Total Respondents by Age, 2ndnd Interview Interview Ontario – CCHS 2.2Ontario – CCHS 2.2

Total <1 1-3 4-8 9-13 14-18 19-30 31-50 51-70 71+

Ontario 1647 9 96 123 211 198 207 238 269 296

Southwest 247 1 16 14 30 27 26 33 44 56

Central South 190 1 12 16 27 20 20 18 35 41

Central West 263 1 18 31 36 29 48 35 34 31

Central East 236 2 13 10 35 41 19 38 25 53

Toronto 203 1 15 20 18 26 29 36 29 29

East 233 3 11 17 32 22 31 37 39 41

North 275 0 11 15 33 33 34 41 63 45

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Data Quality – Measured Data Quality – Measured Height and Weight (%)Height and Weight (%)

Total NL PE NS NB PQ ON MB SK AB BC

Measured – H/W 63 71 68 73 62 68 55 68 62 61 62

Refused 11 14 11 10 13 7 11 11 9 18 12

Respondent Not Available 6 4 4 4 5 5 6 7 4 6 6

Resp. too Tall 5 5 6 5 12 5 5 2 10 4 7

Equipment (NA, batteries) 5 0 0 1 1 8 11 0 4 0 0

Phone Interview 4 3 4 3 3 1 3 6 5 4 5

Interview Setting 2 1 2 2 1 1 3 2 2 3 4

Physical/Mental Condition 2 2 3 1 2 1 3 2 1 1 2

Data not stated 2 1 1 2 1 2 2 2 2 2 2

Other 0 0 0 0 0 0 1 0 0 0 0

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Phase 1 Release – July 6, 2005Phase 1 Release – July 6, 2005

Internet PublicationNutrition: Findings from the Canadian

Community Health Survey• Adult Obesity• Childhood Obesity

CANSIM tablesAdult Measured BMIChild Measured BMIFood InsecurityChildren’s Physical ActivityTeenage Sedentary Activity

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Measured Obesity Rates by AgeMeasured Obesity Rates by AgeCanada Health Survey - 1978/79, CCHS - 2004Canada Health Survey - 1978/79, 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

* *

* *

* *

* *

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Adult (aged 18+) Self-reported Chronic Adult (aged 18+) Self-reported Chronic Condition Prevalence by Weight ClassCondition Prevalence by Weight ClassCCHS - 2004CCHS - 2004

0

5

10

15

20

25

30

35

High Blood Pressure Diabetes Heart Disease

perc

ent

Normal WeightOverweightObese Class IObese Class IIObese Class III

F F

*

*

* *

*

**

* * *

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Adult Percentage Distribution of BMI (age 18+)1978/79 and 2004

0123456789

10

14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44

BMI (kg/m2)

Per

cent

1978/792004

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Adult Obesity Rates (Age 18+) by Fruit and Vegetable Adult Obesity Rates (Age 18+) by Fruit and Vegetable Consumption and Leisure Time Physical ActivityConsumption and Leisure Time Physical ActivityCCHS - 2004CCHS - 2004

0

5

10

15

20

25

30

35

Less than3 times per

day

3 to lessthan 5

times perday

5+ times aday

High Moderate Sedentary

perc

ent

Fruits and Vegetables Physical Activity

* *

*

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Teenage Percentage Distribution of BMI (age 12-17)1978/79 and 2004

0

2

4

6

8

10

12

14

BMI (kg/m2)

Per

cent

1978/792004

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Childhood Overweight and Obesity Rates (Age 2 to Childhood Overweight and Obesity Rates (Age 2 to 17) by Fruit and Vegetable Consumption17) by Fruit and Vegetable ConsumptionCCHS - 2004CCHS - 2004

0

5

10

15

20

25

30

35

Less than 3 times per day 3 to less than 5 times perday

5+ times a day

perc

ent

* *

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Childhood Overweight and Obesity Rates (Age 6 to 17) by Daily Childhood Overweight and Obesity Rates (Age 6 to 17) by Daily (Age 6 to 11) and Weekly (Age 12 to 17) Hours of Screen Time(Age 6 to 11) and Weekly (Age 12 to 17) Hours of Screen TimeCCHS - 2004CCHS - 2004

0

5

10

15

20

25

30

35

40

<= 1 1 to 2 2+ < 10 10 to19.9

20 to29.9

30+

perc

ent

Daily Screen Time Weekly Screen Time* *

*

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Ontario Measured Obesity Rates by Age and Region, 2004Ontario Measured Obesity Rates by Age and Region, 2004CCHS 2.2CCHS 2.2

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

ON SW CS CW CE TO E N ON SW CS CW CE TO E N ON SW CS CW CE TO E N ON SW CS CW CE TO E N

Overall

2 to 17

18 to 4445+

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Phase 2 ReleasePhase 2 Release

Currently assigning food codes to ~ 750,000 records In colloboration with Health Canada coding to Canadian

Nutrient File Nutritional profiles for each food will then be calculated

using a processing system designed by Health Canada for provincial nutrition surveys

Plan on releasing early 2006 Release approach will be similar to phase 1

Articles CANSIM Tables

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Microdata OutputsMicrodata Outputs

4 filesGeneral Health and Nutritional Summary dataVitamin and Mineral supplement details

• 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

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)

140

VMD Summary (A)

230

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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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) Vitmin D (MCG)

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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0

0.0001

0.0002

0.0003

0.0004

0.0005

0.0006

0.0007

0.0008

0 1000 2000 3000 4000 5000 6000 70000

0.0001

0.0002

0.0003

0.0004

0.0005

0.0006

0.0007

0.0008

0 1000 2000 3000 4000 5000 6000 7000

Intake Adjustment – Total Calories Consumed, Males Intake Adjustment – Total Calories Consumed, Males Age 31 to 50Age 31 to 50United States , CSFII (1994-86, 1998)United States , CSFII (1994-86, 1998)

σTotal = σInter Individual + σIntra Individual

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Proportion of Males Age 31 to 50 Consuming 3500+ Proportion of Males Age 31 to 50 Consuming 3500+ CaloriesCaloriesUnited States , CSFII (1994-86, 1998)United States , CSFII (1994-86, 1998)

Unadjusted – 15.1%Adjusted – 4.6%

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Training/Support/OtherTraining/Support/Other

Proper use of files Use of intake distribution software Health Canada – interpretation guide Working with CIHR on an RFA process to

fund researchers to analyse the data Working with STC Agriculture Division to

compare data with consumption data

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QuestionsQuestions

?

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Contact InformationContact Information

Larry MacNabb

Project Manager

Canadian Community Health Survey

Phone: (613) 951-4269

Email: larry.macnabb@statcan.ca