1. Anyplace Youth Health Survey A guide to using the data

2. How It Began Regionalization and RHA legislation Interlake Health Promotion Committee –need to collect local data Youth Health School Reports – other RHAs ready to learn from each other

3. Building Capacity Partners came together: Common mandate for prevention of chronic diseases: IRHA, CCS, CCMB, H&SF, Alliance To develop an integrated knowledge system to inform local planning based on evidence. (MIKS) then Partners in Planning for Healthy Living SNOWMAN – conceptual framework

4. Goal of Surveillance To develop an integrated system of ongoing RFS at the community level: Is consistent and sustainable across province Is based on evidence Builds capacity to plan at all levels (school, community, region, province) Allows us to ‘learn as we go’

5. EVIDENCE-BASED PRACTICE -BASED EVIDENCE Regional Risk Factor Surveillance in Manitoba Reporting Evaluation Surveillance Best Practice Identification And Dissemination EVIDENCE - BASED PRACTICE PRACTICE - BASED EVIDENCE Knowledge Exchange Evaluation Surveillance Best Practice Identification and Dissemination Program Development

6. Surveillance in Manitoba The plan was to grow slowly as RHAs were ready but… A unique opportunity arose – HCM and MECY wanted to evaluate an upcoming MB PE/HE policy implemented in the fall of 2008 Required all partners to contribute: H&SF (grants) CCMB (data analyses) CCS (KEN) Support of MECY and HCM, Ministers write letter of support to superintendents

7. Survey Methodology

8. WHO and Surveillance

9. Methods Census of grades 9 to 12 in all schools (some schools incl. grades 6 to 8) Straight-forward, affordable & easy to manage Economies of scale (printing surveys, report production)

10. Survey: Youth Health Survey Survey tool was developed and implemented in the IRHA with local input 4 pages, 51 questions Multiple choice, machine-scannable 20-30 minutes to complete (short) Includes questions on tobacco, nutrition, physical activity, self-esteem and school connectedness

11. Self-Report Data were collected in Grade 6-12 classroom settings and findings are based on the self-reported responses of the students All student responses were kept confidential to encourage honesty in reporting

12. Implementation Partners: coordinated materials, protocols and assisted with data collections if needed (pooled resources) RHAs that had completed surveillance mentored those who had not (collaboration) Partners scanned surveys, data sent to CCMB for analyses and report generation Reports were sent back to the RHAs for dissemination RHAs own the data to use in their own program planning

13. The Feedback Reports Generated at school, school division, district, community, regional and provincial levels as requested Generated for each school except where adaptations were made for small schools to maintain the confidentiality of the students Templates originated in the Interlake Region and were modified to each region based on their needs

14. The Anyplace Feedback Report

15. General Information on Reporting Percentages do not always add to 100% due to rounding and missing data at times Where possible, findings were reported by grade and gender Where numbers were too small, results were not reported

16. Acknowledgments Acknowledgements are made by each region and include among others: The administrators, teachers, staff and students of all the school divisions who participated in the initial Youth Health Survey (YHS). CancerCare Manitoba, for their assistance in survey implementation, statistical programming, and data analysis. The Interlake Regional Health Authority for sharing their work in developing the survey tool and report template and their experience using them. Manitoba Education, Citizenship and Youth for promoting and supporting the data collection. The Assiniboine Regional Health Authority for their work on report template development and identification of best practice. The Knowledge Exchange Network (KEN) of the Canadian Cancer Society, Manitoba for the best practice information Manitoba Heart & Stroke Foundation for funding support to produce the surveys.

17. Contacts Contacts used in the reports depend on the Health Region involved and reflect the differing needs and structures of each region

18. Survey Response Rates Survey response rates are based on the number of completed surveys divided by school population (as of September of the year of participation) For the provincial report, response rates varied by region and the overall rate is an estimate based on available school populations

19. Report Highlights For easy reference, report highlights taken from throughout the document were compiled into a one-page summary at the beginning of the report

20. Section A: Physical Activity

21. Physical Activity Rates Students were asked the following for both hard and moderate activity:

22. Physical Activity PA can be estimated by kilocalories per kilogram of body weight per day (KKD) Using methodology from SHAPES the following formula was used: KKD = (Hard*6METS + Moderate*3METS) / 7 days

23. Physical Activity Example: If a student reported 3 hours and 15 minutes of hard activity and 5 hours and 30 minutes of moderate activity, their estimated KKD is 5.14. KKD = (3.25*6 + 5.5*3) / 7days = 5.14 KKD

24. Physical Activity in the Report Active students-those who expend >8KKD per day Moderately active students-those who expend 3-8 KKD per day Inactive students- those who expend <3 KKD per day In our previous example, the student is moderately active (5.14 KKD)

25. Physical Activity in the Report Results from Anyplace School

26. Physical Activity By Gender Example: If there are 100 males in grade 12 and 50 of them are classified as active then: Percent =( 50 active males / 100 males in grade ) * 100

27. Physical Activity in the Report Results from Anyplace School

28. Why is this important? Health Canada recommends that youth 10-14 years be physically active for a minimum of 90 minutes (6KKD) per day This is ~60 minutes of moderate activity, combined with ~30 of vigorous activity per day

29. Friends Who Are Active Students were asked how many of their closest friends are physically active Anyplace School results: # Friends who are Physically Active Active Students Moderately Active Students Inactive Students 0 3%4%8% 1 4%6%13% 2 7%16%5% 3 23%20% 4 or 5 63%52%50%

30. Strength Activities Students were asked on how many days in the last week they had participated in these activities The findings were separated into 0 days, 1 or 2 days and >=3 days and then further divided by gender

31. Strength Activities in Anyplace School

32. Why is this important? Canada’s Physical Activity Guidelines recommend that youth 15 years and older include strengthening activities in their routine 2-4 times per week

33. When Students are Active Students were asked: Percentages represent the students who responded that they were active for each respective time

34. Satisfaction With School Sports Anyplace School

35. Homework and Reading Graph represents two separate questions Students were given five time categories to choose from but these were collapsed into three categories in the graph

36. Homework and Reading Anyplace School

37. Physical Activity Issues Taught in School Students were asked: The graph represents the percentage of students that felt the subject was taught

38. Physical Activity Issues Taught in School Anyplace School

39. Recreation Activity Times In regard to recreation activities, students were asked: This question was analyzed in two parts— weekends and weekdays

40. Recreation Activity Times In the graph: The weekend bar represents the number of students who want to participate on weekends out of the total number of students The weekday bars represent the respective weekday times that students want to participate out of the total number of students who answered weekdays

41. Recreation Activity Times Anyplace School The three weekday bars should add to100% but often do not due to missing data

42. Section B: Healthy Eating

43. Eating Habits of Students Students were asked how many times over the previous week they had eaten a variety of fruits and vegetables These numbers were combined and divided by seven to produce an average daily intake of fruits and vegetables

44. Eating Habits of Students Example: If a student answered that they had drank fruit juice and eaten fruit, green salad, potatoes, carrots and other vegetables 4 times each day in the past week F&V per day = (4 + 4 + 4 + 4 + 4 + 4) / 7 days = 3 times per day

45. Eating Habits of Students Anyplace School

46. Body Weight and BMI Body Mass Index (BMI) is a measure of a person’s weight in comparison to their height BMI was calculated using the standard formula for adults When data was missing for either height or weight, the student was not included in BMI findings

47. BMI Formula for Adults Formula: BMI = weight (kg) / height (cm) 2 If a student reported their weight in pounds or their height in feet, these were converted for analysis

48. BMI Formula for Children (Provincial Report) BMI was calculated in the same way Based on CDC methodology, BMI was then assigned a percentile based on age and gender This percentile was converted to one of the three categories found in the report

49. Anyplace School Report

50. Section C: Smoking, Alcohol & Drug Use

51. Smoking Students were asked the following: Daily Smokers- students who answered “everyday” or “almost everyday” to this question

52. Smoking Occasional Smokers- students who answered “some days” or “1-2 days” to this question. Also those that answered “yes” without specifying a frequency or “no” but that they had smoked 100 or more cigarettes in their lifetime (previous question)

53. Smoking Total smokers represent the combination of occasional and daily smokers Non-smokers are everyone else including all students with missing data

54. Smoking in Anyplace School

55. How does this compare? The Canadian Tobacco Use Monitoring Survey (CTUMS) indicates that 20% of Manitoba youth aged 15- 19 smoke This can be approximately compared to the percentage of “total smokers” in Grade 9-12 at the individual school or regional level

56. Why Students Smoke? Due to large amounts of missing data in the non-smoker category, the focus of these two tables should be on the daily and occasional smoker categories

57. Obtaining Cigarettes Students were asked: Percents do not add to 100% because students filled in all that applied

58. Plans to Quit Smoking Analysis used the “total smokers” to assess their plans to quit smoking The seven original question categories were collapsed to the three used in the graph

59. Plans to Quit in Anyplace School

60. Alcohol Use in Anyplace School Students were asked on how many days in the last 30 they had at least one drink of alcohol

61. Binge Drinking Students were asked on how many days in the past 30 days that they had 5 or more drinks of alcohol in a couple of hours The percentage reported is based on the total number of students, not just those that had reported alcohol use in the previous question

62. Illegal Drug Use Students were asked on how many days in the last 30 days they had used illegal drugs All drugs were classified together The percentage reported is based on the total number of students

63. Drug Use in Anyplace School

64. Section D: School Connectedness & Well-Being

65. School Connectedness Students were asked:

66. School Connectedness in Anyplace School How strongly do you agree or disagree with the following statements? Percentage of Students Responding Agree/ Strongly Agree Disagree/ Strongly Disagree I feel close to people at this school 68%24% I feel I am part of this school 65%20% I am happy to be at this school 67%24% I feel safe in my school 64%23%

67. Feelings of Well-Being The sidebar percentage reported for athletic ability combines the students that answered excellent and good The sidebar percentage reported for school work combines the students that answered above average and average

68. Well-Being in Anyplace School

69. Feelings of Hopelessness In Anyplace School

70. FAQs Why was self-report chosen? Does the analysis take into account the most up-to-date Canadian guidelines for the various behaviours? Were First Nations students included in this survey?