Background Physical activity is an important determinant of health and fitness. This study provides contemporary estimates of the physical activity levels of Canadians aged 6 to 19 years. Data and methods Data are from the 2007 to 2009 Canadian Health Measures Survey. The physical activity of a nationally representative sample was measured using accelerometers. Data are presented as time spent in sedentary, light, moderate and vigorous intensity movement, and in steps accumulated per day. Results An estimated 9% of boys and 4% of girls accumulate 60 minutes of moderate-to-vigorous physical activity on at least 6 days a week. Regardless of age group, boys are more active than girls. Canadian children and youth spend 8.6 hours per day-62% of their waking hours-in sedentary pursuits. Daily step counts average 12,100 for boys and 10,300 for girls. Interpretation Based on objective and robust measures, physical activity levels of Canadian children and youth are low.
Background Cigarette smoking is associated with adverse health effects, including cancer, respiratory illness, heart disease and stroke. National data on smoking prevalence often rely on self-reports. This study assesses the validity of self-reported cigarette smoking status among Canadians. Data and methods Data are from the 2007 to 2009 Canadian Health Measures Survey, a nationally representative cross-sectional survey of 4,530 Canadians aged 12 to 79. The survey included self-reported smoking status and a measure of urinary cotinine, a biomarker of exposure to tobacco smoke. The prevalence of cigarette smoking was calculated based on self-reports and also on urinary cotinine concentrations. Results Compared with estimates based on urinary cotinine concentration, smoking prevalence based on self-report was 0.3 percentage points lower. Sensitivity estimates (the percentage of respondents who reported being smokers among those classified as smokers based on cotinine concentrations) were similar for males and females (more than 90%). Although sensitivity tended to be lower for respondents aged 12 to 19 than for those aged 20 to 79, the difference did not attain statistical significance. Interpretation Accurate estimates of the prevalence of cigarette smoking among Canadians can be derived from self-reported smoking status data.
Background The 2009 to 2011 Canadian Health Measures Survey provides the most recent measured body mass index (BMI) data for children and adolescents. However, different methodologies exist for classifying BMI among children and youth. Based on the most recent World Health Organization classification, nearly a third of 5- to 17-year-olds were overweight or obese. The prevalence of obesity differed between boys and girls (15.1% versus 8.0%), most notably those aged 5 to 11, among whom the percentage of obese boys (19.5%) was more than three times that of obese girls (6.3%). These estimates indicate a higher prevalence of overweight/obesity among children than do estimates based on International Obesity Task Force cut-offs. Although the prevalence of overweight and obesity among children in Canada has not increased over the last decade, it remains a public health concern, given the tendency for excess weight to persist through to adulthood and lead to negative health outcomes.
Background The fitness of Canadian children and youth has not been measured in more than two decades, a period during which childhood obesity and sedentary behaviours have increased. This paper provides up-to-date estimates of the fitness of Canadians aged 6 to 19 years. Data and methods Data are from the 2007-2009 Canadian Health Measures Survey (CHMS), the most comprehensive direct health measures survey ever conducted on a nationally representative sample of Canadians. Descriptive statistics for indicators of body composition, aerobic fitness and musculoskeletal fitness are provided by sex and age group, and comparisons are made with the 1981 Canada Fitness Survey (CFS). Results Fitness levels of children and youth have declined significantly and meaningfully since 1981, regardless of age or sex. Significant sex differences exist for most fitness measures. Fitness levels change substantially between ages 6 and 19 years. Youth aged 15 to 19 years generally have better aerobic fitness and body composition indicators than 20- to 39-year-olds. Interpretation This decline in fitness may result in accelerated chronic disease development, higher health care costs, and loss of future productivity.
Background This article describes four key quality control and data reduction issues that researchers should consider when using accelerometry to measure physical activity: monitor reliability, spurious data, monitor wear time, and number of valid days required for analysis. Data source and methods Exploratory analyses were conducted on an unweighted subsample (n=987) of the accelerometry data from the Canadian Health Measures Survey. Participants were asked to wear an accelerometer for 7 consecutive days. Calibration, reliability, biological plausibility and compliance issues were explored using descriptive statistics. Results Ongoing calibration is an effective method for identifying malfunctioning accelerometers. The percentage of files deemed viable for analysis depends on participant compliance, the allowable interruption period chosen and the minimum wear-time-per-day criterion. A 60-minute allowable interruption period and 10-hours-per-day wear time criteria resulted in 95% of the subsample having at least 1 valid day, and 84% having at least 4 valid days. Interpretation Before the derivation of physical activity outcomes, accelerometry data should undergo standardized quality control and data reduction procedures to prevent mis-representation of the results. Incomplete accelerometry data should be handled carefully, and strategies to improve compliance in the field are warranted.
Background Vitamin D deficiency is a global health problem, but little is known about the vitamin D status of Canadians. Data and methods The data are from the 2007 to 2009 Canadian Health Measures Survey, which collected blood samples. Descriptive statistics (frequencies, means) were used to estimate 25-hydroxyvitamin D [25(OH) D] concentrations among a sample of 5,306 individuals aged 6 to 79 years, representing 28.2 million Canadians from all regions, by age group, sex, racial background, month of blood collection, and frequency of milk consumption. The prevalence of deficiency and the percentages of the population meeting different cut-off concentrations were assessed. Results The mean concentration of 25(OH) D for the Canadian population aged 6 to 79 years was 67.7 nmol/L. The mean was lowest among men aged 20 to 39 years (60.7 nmol/L) and highest among boys aged 6 to 11 (76.8 nmol/L). Deficiency (less than 27.5 nmol/L) was detected in 4% of the population. However, 10% of Canadians had concentrations considered inadequate for bone health (less than 37.5 nmol/L) according to 1997 Institute of Medicine (IOM) Standards (currently under review). Concentrations measured in November-March were below those measured in April-October. White racial background and frequent milk consumption were significantly associated with higher concentrations. Interpretation As measured by plasma 25(OH) D, 4% of Canadians aged 6 to 79 years were vitamin D-deficient, according to 1997 IOM standards (currently under review). Based on these standards, 10% of the population had inadequate concentrations for bone health.
This article describes the prevalence of overweight and obesity among Canadian children and youth aged 2 to 17, based on direct measurements of their height and weight. Data from 1978/79 and 2004 are compared, and trends by sex and age groups are presented. Data based on direct measurements are from the 2004 Canadian Community Health Survey (CCHS): Nutrition. Other information is from the 1978/79 Canada Health Survey and the 1999-2002 National Health and Nutrition Examination Survey, conducted in the US. The estimated prevalence of overweight and of obesity, including an overall rate reflecting both, was based on 2004 CCHS data for 8,661 children and youth whose height and weight were measured. In 2004, 26% of Canadian children and adolescents aged 2 to 17 were overweight or obese, and 8% were obese. Over the past 25 years, the prevalence of overweight and obesity combined has more than doubled among youth aged 12 to 17, while the prevalence of obesity alone has tripled. Children and youth who ate fruit and vegetables at least five times a day were substantially less likely to be overweight or obese than were those who ate these foods less often. The likelihood of being overweight/obese rose as "screen time" (watching TV, playing video games or using a computer) increased.
Background Systematic reviews and results of Statistics Canada surveys have shown a discrepancy between self-reported and measured physical activity. This study compares these two methods and examines specific activities to explain the limitations of each method. Data and methods Data are from cycle 1 (2007 to 2009) and cycle 2 (2009 to 2011) of the Canadian Health Measures Survey. The survey involved an interview in the respondent's home and a visit to a mobile examination centre (MEC) for physical measurements. In a questionnaire, respondents were asked about 21 leisure-time physical activities. They were requested to wear an Actical accelerometer for seven days after the MEC visit. The analysis pertains to respondents aged 12 to 79 who wore the accelerometer for 10 or more hours on at least four days (n = 7,158). Results Averages of self-reported leisure-time physical activity and moderate-to-vigorous physical activity measured by accelerometer were within a couple of minutes of each other. However, at the individual level, the difference between estimates could exceed 37.5 minutes per day in one direction or the other, and around 40% of the population met physical activity thresholds according to one measurement method, but not according to the other. The disagreement is supported by weak observed correlations. Interpretation The lack of a systematic trend in the relationship between the two methods of measuring physical activity precludes the creation of correction factors or being confident in using one method instead of the other. Accelerometers and questionnaires measure different aspects of physical activity.
Background Hypertension is estimated to cause more than one-eighth of all deaths worldwide. In Canada, the last national surveys to include direct measures of blood pressure (BP) took place over the years 1985-1992; hypertension was estimated at 21%. Data and methods Data are from cycle 1 of the Canadian Health Measures Survey, conducted from March 2007 through February 2009. The survey included direct BP measures using an automated device. Weighted frequencies, means and cross-tabulations were produced to estimate levels of hypertension awareness, treatment and control in the population aged 20 to 79 years. Results Among adults aged 20 to 79 years, hypertension (systolic BP higher than or equal to 140 or diastolic BP higher than or equal to 90 mm Hg, or self-reported recent medication use for high BP) was present in 19%. Another 20% had BP in the pre-hypertension range (systolic 120 to 139 or diastolic 80 to 89 mm Hg). Of those with hypertension, 83% were aware, 80% were taking antihypertensive drugs, and 66% were controlled. Uncontrolled hypertension was largely due to high systolic BP. Interpretation Hypertension prevalence is similar to that reported in 1992. Since then, the level of hypertension control has increased considerably.
Background: This study describes and compares the percentages of Canadian children and youth who adhere to different operational definitions of the moderate-to-vigorous physical activity (MVPA) recommendation of 60 minutes per day. Data and methods: Data for 6- to 17-year-olds (n = 5,608) were collected from 2007 through 2015 as part of the Canadian Health Measures Survey. MVPA was measured using the Actical accelerometer. The MVPA recommendation was operationalized as accumulating 60 minutes of MVPA every day, on most days, and on average. Results: Data from the most recent cycle of the Canadian Health Measures Survey indicate that 7% of children and youth accumulated at least 60 minutes of MVPA on at least 6 out of 7 days, and 33% achieved a weekly average of at least 60 minutes per day. Boys accumulated more MVPA than did girls, and 6- to 11-year-olds accumulated more MVPA than did 12-to 17-year-olds. Regardless of how adherence to the recommendation is operationalized, MVPA levels among Canadian children and youth did not change over the 9-year period from 2007 to 2015. Interpretation: The majority of Canadian children do not meet the physical activity recommendation, regardless of the operational definition used. However, the discrepancies between results based on different interpretations of the 60-minutes-per-day recommendation highlight the importance of explicitly reporting how recommendations are operationalized to avoid misinterpreting trends and comparisons.
Background: A large literature exists on the association between child abuse and mental health, but less is known about associations with physical health. The study objective was to determine if several types of child abuse were related to an increased likelihood of negative physical health outcomes in a nationally representative sample of Canadian adults. Data and methods: Data are from the 2012 Canadian Community Health Survey-Mental Health (n = 23,395). The study sample was representative of the Canadian population aged 18 or older. Child physical abuse, sexual abuse, and exposure to intimate partner violence were assessed in relation to self-perceived general health and 13 self-reported, physician-diagnosed physical conditions. Results: All child abuse types were associated with having a physical condition (odds ratios = 1.4 to 2.0) and increased odds of obesity (odds ratios = 1.2 to 1.4). Abuse in childhood was associated with arthritis, back problems, high blood pressure, migraine headaches, chronic bronchitis/emphysema/COPD, cancer, stroke, bowel disease, and chronic fatigue syndrome in adulthood, even when sociodemographic characteristics, smoking, and obesity were taken into account (odds ratios = 1.1 to 2.6). Child abuse remained significantly associated with back problems, migraine headaches, and bowel disease when further adjusting for mental conditions and other physical conditions (odds ratios = 1.2 to 1.5). Sex was a significant moderator between child abuse and back problems, chronic bronchitis/emphysema/COPD, cancer, and chronic fatigue syndrome, with slightly stronger effects for women than men. Interpretation: Abuse in childhood was associated with increased odds of having 9 of the 13 physical conditions assessed in this study and reduced selfperceived general health in adulthood. Awareness of associations between child abuse and physical conditions is important in the provision of health care.
Background This study validates cut-points for a frailty index (FI) to identify seniors at risk of a hospital-related event and estimates the number of frail seniors living in the community. The FI developed by Rockwood and Mitnitski defines levels of frailty based on scores of 0 to 1.0. Data and methods The cut-point validation was conducted using Stratum-Specific Likelihood Ratios applied to combined 2003 and 2005 Canadian Community Health Survey (CCHS) data, linked to hospital records from the Discharge Abstract Database (2002 to 2007). Based on the validated cut-points, frailty prevalence was estimated using 2009/2010 CCHS data. Results Seniors scoring more than 0.21 on the FI were considered to be at elevated risk of hospital-related events. Four additional frailty levels were identified: non-frail (0 to 0.1 to 0.30 to <= 0.35) (women only), and most frail (frail-group subset) (0.45 or more). The number of community-dwelling seniors considered to be frail was estimated at about 1 million (24%) in 2009/2010; another 1.4 million (32%) could be considered pre-frail. Frailty prevalence rose with age; was higher among women than among men; and varied by geographic location. Interpretation A cut-point of more than 0.21 can be used to identify frail seniors living in the community.
Background Estimates of obesity, based on body mass index (BMI) reveal that Canadian adults have become heavier over the past quarter century. However, a comprehensive assessment of fitness requires additional measures. This article provides up-to-date estimates of fitness levels of Canadians aged 20 to 69 years. Results are compared with estimates from 1981. Data and methods Data are from the 2007-2009 Canadian Health Measures Survey (CHMS). Historical estimates are from the 1981 Canada Fitness Survey. Means, medians and cross-tabulations were used to compare fitness levels by sex and age group and between survey years. Results Mean scores for aerobic fitness, flexibility, muscular endurance and muscular strength declined at older ages, and BMI, waist circumference, skinfold measurements and waist-to-hip ratio increased. Males had higher scores than females for aerobic fitness, muscular endurance and muscular strength; females had higher scores for flexibility. Muscular strength and flexibility decreased between 1981 and 2007-2009; BMI, waist circumference and skinfold measurements increased. Interpretation Based on results of the fitness tests and anthropometric measurements, many Canadian adults face health risks due to suboptimal fitness levels.
Background: Evidence from large, population-based studies about the association between neighbourhood walkability and the prevalence of obesity is limited. Data and methods: The study population consisted of 106,337 people aged 20 or older living in urban and suburban Ontario, who participated in the National Population Health Survey and the Canadian Community Health Survey from 1996/1997 to 2008. Based on their postal code, individuals were grouped into one of five walkability categories, ranging from very car-dependent to "Walker's Paradise," according to the Street Smart Walk Score (R), a composite measure of neighbourhood walkability. Logistic regression models, adjusted for demographic, socioeconomic and lifestyle characteristics, were used to estimate odds ratios relating neighbourhood walkability to overweight/obesity and physical activity. Results: Compared with residents of "Walker's Paradise" areas, those in very car-dependent areas had significantly higher odds of being overweight or obese. Despite similar levels of leisure physical activity among residents of all walkability areas, those in " Walker's Paradise" areas reported more utilitarian walking and weighed, on average, 3.0 kg less than did those in very car-dependent areas. Interpretation: Living in a low-walkability area is associated with a higher prevalence of overweight/obesity. Neighbourhood walkability is related to the frequency of utilitarian walking.
Background: Cadmium is a heavy metal found naturally in the environment that has been associated with negative health outcomes. The present study examines levels of blood cadmium (BCd), urinary cadmium (UCd), and the main sources of cadmium exposure among Canadians aged 20 to 79. Data and methods: The data are from cycles 1 (2007 to 2009) and 2 (2009 to 2011) of the Canadian Health Measures Survey (CHMS), including measures of BCd and UCd, markers of smoking status (self-reported and second-hand smoke exposure), and self-reported consumption of foods known to be high in cadmium. The relationship between sources of exposure and cadmium levels was examined descriptively. The magnitude of the contribution of different exposure sources was examined in regression models. Results: Age and smoking status were found to be the greatest contributors to BCd and UCd: older people and current smokers had the highest cadmium levels. Dietary exposure, while significant, was a modest contributor overall, but a more important source of cadmium among never-smokers. Interpretation: Smoking was the greatest contributor to cadmium levels among Canadians aged 20 to 79. Dietary differences explained a small percentage of variation in cadmium levels.
Background: Medical screening plays a role in explaining the healthy immigrant effect (HE) among immigrants newly landed in Canada. The 2002 Immigration and Refugee Protection Act (IRPA) modernized immigration selection by exempting certain immigrant categories (e.g., refugees and certain family-class immigrants) from inadmissibility on health grounds. This study examines the HE in the IRPA era by sex, with a focus on those categories affected by the IRPA. Data and methods: The linked Canadian Community Health Survey (CCHS)-Longitudinal Immigration Database (IMDB) was used to compare sex-specific age-standardized proportions of four health measures between Canadian-born and immigrants aged 20 to 65. overall and by duration since landing. Immigrants who landed within three years of the surveys from 2007 to 2014 were examined by sex and immigrant category. Logistic regression was used to further compare the HIE in the same immigrant sub-groups to the Canadian-born, controlling for age and selected confounders. Results: This study found the HIE in most selected measures for immigrants overall, as well as for those recent immigrants arriving under the IRPA, including the family class. Among refugees, the HIE was observed only in less severe chronic conditions; this was especially the case among females. As expected, a strong HIE was observed among economic-class principal applicants. These health advantages persisted even after adjustment for socioeconomic and health factors. For self-rated health, the advantage existed for some groups only after full adjustment. Interpretation: This study is a first look at the healthy immigrant effect under the 2002 Immigration and Refugee Protection Act by immigration category. Results corroborate the existing literature on the presence of the HIE among immigrants: the HIE was found to be much weaker among refugees.
Background: Prostate cancer is the most common type of cancer in Canadian men. Screening recommendations have changed substantially over the last 25 years. Since 2011 (United States) and 2014 (Canada), taskforce guidelines have recommended against screening using the prostate-specific antigen (PSA) test in low-risk men of all ages. This work reports on trends in prostate cancer incidence, mortality, and stage at diagnosis in Canada from 1992 to 2015. Data and methods: Prostate cancer incidence, mortality, and stage at diagnosis were retrieved from Statistics Canada's Canadian Cancer Registry and Canadian Vital Statistics - Death Database. Joinpoint analysis was used to examine trends over time. Results: The age-standardized incidence rate (ASIR) of prostate cancer peaked in 1993 and 2001, and declined thereafter. From 2011 to 2015, the ASIR declined by 9.3% per year. The age-standardized mortality rate (ASMR) decreased continuously from 1992 to 2015, but fell most rapidly (2.9% per year) after 2001. Data from two provinces show that, from 2005 to 2015, the rate of Stage I and Stage II cancers decreased by 3.2% per year, while the rate of Stage Ill and Stage IV cancers remained relatively stable. Interpretation: Incidence of prostate cancer has declined substantially in recent years. Most of the decline seems to be in localized cases (Stage I and Stage II). Changes in incidence have mirrored changes to PSA screening recommendations. Future work should continue to monitor trends over time at the national level, especially as they relate to screening recommendations.
Based on data from the 2012 Canadian Community Health Survey-Mental Health, past-year and lifetime marijuana use among the household population aged 15 or older in the 10 provinces was examined. In 2012, 42.5% of the population reported having ever used marijuana, and 12.2% reported use in the past year. At 33.3%, the prevalence of past-year marijuana use was higher among 18- to 24-year-olds than among other age groups (20.0% at ages 15 to 17, 15.6% at ages 25 to 44, 6.7% at ages 45 to 64, and 0.8% at age 65 or older). Past-year use was higher in British Columbia and Nova Scotia and lower in Saskatchewan, compared with the rest of Canada. While the overall percentage of people reporting past-year use in 2012 was unchanged from 2002, the percentage of males who had ever used marijuana rose from 47.0% to 49.4%; among females, the prevalence of lifetime use remained stable at 36%.
Background This study compares registry and non-registry approaches to linking 2006 Census of Population data for Manitoba and Ontario to hospital data from the Discharge Abstract Database (DAD). Data and methods Using a probabilistic linkage, the registry approach linked the census data to provincial health insurance registries, followed by a deterministic linkage to the DAD based on health insurance number (HIN). The non-registry approach used hierarchical deterministic exact matching based on three variables common to both files to link census data to the DAD. The approaches were compared in terms of linkage and coverage rates, sensitivity and specificity, and consistency of HINs on the linked records. Results Results of the registry and non-registry linkage approaches were similar. In Manitoba, 7% and 6% of census long-form respondents linked to the DAD with the registry and non-registry linkage approaches, respectively; in Ontario, the linkage rate was 5% for both approaches. With the registry approach, the linked census-DAD data represented 84% (weighted) of hospital admissions in the 2006/2007 DAD in both provinces, compared with 82% in Manitoba and in Ontario with the non-registry approach. Interpretation In the absence of access to provincial health insurance registries with which census data can be linked, a non-registry approach can be used to create a research-quality dataset.
Background: Free sugars are nutrients of public health concern that have been associated with negative health outcomes, including dental caries in children and excess weight gain. Since national-level free sugars data are not currently available for Canadians, total sugars intake was examined to understand sugars intake in the population. The objective of this analysis was to describe and compare total sugars consumption among Canadians in 2004 and 2015. Data and methods: Data are from the 2004 and 2015 Canadian Community Health Survey-Nutrition. Separate descriptive analyses of total sugars for children aged 2 to 18 (n=13,919) and adults aged 19 and older (n=31,156) were conducted by year and by misreporting status (under-, plausible and over-reporters), and the top sources of total sugars were identified. Misreporting status was studied to better understand differences in sugars intakes between survey years. T-tests were used to determine significant differences between survey years. Results: In 2015, the average daily total sugars consumption was 101 grams (24 teaspoons) for children aged 1 to 8, 115 grams (27 teaspoons) for children aged 9 to 18, and 85 grams (20 teaspoons) for adults. Sugary beverages, taken together, were the top source of sugars for all age groups. Total sugars consumption decreased from 2004 to 2015 overall, although not by misreporting status. Total sugars from food alone increased from 2004 to 2015, and total sugars from beverages alone decreased, regardless of age or misreporting status. Interpretation: The overall decrease in total sugars consumption from 2004 to 2015 may be explained by changes in misreporting. Total sugars from food alone increased, while total sugars from beverages alone decreased. This was true for all age groups and for plausible reporters.