1. Canadian Community Health Survey
Larry MacNabb
CCHS Dissemination Manager
Yves Béland
CCHS Senior Methodologist

2. Health Survey Program Overview
Part 1
Health Survey Program Overview

3. Objectives Aid in the development of public policy;
Understand the determinants of health;
Collect data on the economic, social, demographic, occupational and environmental correlates of health;

4. Objectives
Increase the understanding of the relationship between health status and health care utilization;
Follow a panel of people to reflect the dynamic processes of health;
Provide a means to supplement content or sample;

5. Health Surveys Program
We have a family of surveys covering 3 disctinct populations:
NPHS Households component covers individuals in each of the 10 provinces, both longitudinally and cross-sectionnally over the first 3 cycles, and will continue covering the longitudinal panel starting with cycle 4.
The territories are covered by the NPHS North over the first 3 cycles, and then by the CCHS .
The population in long term health care institutions is covered by the NPHS Institutions component.
Recently, the Health Information Roadmap has highlighted more areas where policy makers would like more data, specifically for smaller geographical areas (health regions). To address these needs we ’re engaged in doing another survey, the CCHS. This survey is strictly cross-sectional and will replace Households component of the NPHS, as well as cover the North.

6. Health Information Roadmap Initiative
Collaboration between Canadian Institute for Health Information (CIHI), Statistics Canada & Health Canada
Answer two basic questions:
How healthy is Canada’s health care system?
How healthy are Canadians?
Canadian Community Health Survey (CCHS)

7. CCHS Objectives
Provide timely, consistent, cross-sectional estimates of health determinants, health status and health system utilization across Canada
Sub-provincial levels of geography (136 Health Regions)
Flexible survey instrument
meet specific health region data gaps
develop focused survey content for key data gaps
quick response to emerging issues

8. Health Surveys Program
Since 2000
We have a family of surveys covering 3 disctinct populations:
NPHS Households component covers individuals in each of the 10 provinces, both longitudinally and cross-sectionnally over the first 3 cycles, and will continue covering the longitudinal panel starting with cycle 4.
The territories are covered by the NPHS North over the first 3 cycles, and then by the CCHS .
The population in long term health care institutions is covered by the NPHS Institutions component.
Recently, the Health Information Roadmap has highlighted more areas where policy makers would like more data, specifically for smaller geographical areas (health regions). To address these needs we ’re engaged in doing another survey, the CCHS. This survey is strictly cross-sectional and will replace Households component of the NPHS, as well as cover the North. 

9. Population Health Surveys
NPHS CCHS
Longitudinal  Cross sectional
National and  National, provincial, territories
provincial levels & health regions levels
One respondent  One or two respondents per household per household
Core, focus, buy-in  Health region selection of
and supplements optional health modules

10. CCHS Overview & Content Summary
Part 2
CCHS Overview
&
Content Summary

11. CCHS Consultation Partners
Consultations with stakeholders about the content is another component of the CCHS that makes this health survey so unique and different from the NPHS.
Stakeholders include:
Regional, Provincial, & Federal health agencies
CIHI (Canadian Institute for Health Information)
other Health researchers
Advisory committee

12. 1999 Consultations 17 workshops, 225+ participants Topic rankings
Final Report
common and optional content
target youth and seniors
smaller health regions
in-depth examination of issues

13. CCHS Survey Design Year 1 Year 2 130,000 respondents
stratified by health region
Questionnaire content
common content
optional content selected by health regions
Estimates for health regions, provinces and Canada
Year 2
30,000 respondents
stratified by province
Questionnaire content
focus content
additional general content
60+ minutes
Estimates for provinces and Canada

14. CCHS Content 1.1 Cycle 1.1 Questionnaire (45 min.):
Common Content (30 minutes):
Priority topics
for all Health Regions
Optional Content (10 minutes):
specific modules selected by individual Health Regions
Standard Socio-demographic content (5 minutes)

15. Health Region Sample CANADA 136 NF 6 3,870 SK 11 8,009
Prov. #HRs n Prov #HRs n_
NF 6 3,870 SK 11 8,009
PE 2 3,651 AB ,456
NS 6 5,319 BC ,302
NB 7 4,996 YT
QC 16 22,667 NT 1 1,001
ON 37 39,278 NU 1 707
MB 11 8,470
sample size (n) = 131,535
Voici le nombre de régions socio-sanitaires, divisées par province, pour lesquelles nous allons produire des estimés fiables.
Les définitons géographiques des régions ont été déterminées entre Statistique Canada et les provinces. Elles représentent dans la plupart des cas les juridictions responsables pour la définition et la gestion des services de santé.
Dans certaines provinces, ces régions portent le nom de région socio-sanitaire. Dans d’autres, elles portent le nom de région de santé ou région de service de santé.
CANADA 136

16. CCHS Health Regions

17. Health Regions

20. Cycle 1.1 - Common Content Injuries Alcohol Mammography
PAP smear test
Patient Satisfaction**
Physical activities
PSA test
Restriction of activities
Smoking
Tobacco alternatives
Two-week disability
Household composition & housing
Income
Labour force
Socio-demographic characteristics
Administration
Alcohol
Alcohol dependence / abuse
Blood pressure check
Breastfeeding
Chronic condition
Contacts with mental health professionals
Exposure to second hand smoke
Flu shots*
Food insecurity
Fruit & vegetable consumption
General health
Health care utilization
Health Utility Index (HUI)
Height / Weight

21. Cycle 1.1 Optional Content
Ongoing problems
Physical check-up
Recent life events
Sedentary activities
Self-esteem
Sexual behaviours
Smoking cessation aids
Social support
Spirituality
Suicidal thoughts and attempts
Use of protective equipment
Work stress
Breast examinations
Breast self examinations
Changes made to improve health
Child & adult stressors (traumas)
Dental visits
Depression
Distress
Driving under influence
Drug use
Eye examinations
Home care
Mastery
Mood

22. Optional Content Selection

23. Cycle 1.1- Optional Content

24. Part 3 Outputs Microdata Tabular Statistics Analytical Products
Client Support

25. Microdata Public Use Microdata File Master File Statistics Canada
Research Data Centers
Remote Access
Share File
Health Canada
Provincial/Territorial Ministries of health
Health Regions (3rd Party Sharing)
Public Use Microdata File
Free 136 Health Regions & sharing partners

26. Microdata
Variables
Records
PUMF
Share
Master

27. Share File contains no identifiable information
Share File Production
Master File
Maintained by Statistics Canada
Record for every respondent
ID Link Share
A Y Y
B Y N
C N Y
D N N
Share File
Ministries of Health/Share partners
Only respondents who agree to share
ID Link Share
A Y Y
C N Y
Share File contains no identifiable information
Name
Address
Date of Birth
Health Care number

28. Public Use Microdata File
PUMF
Available to public
Aggregated data
Geography (<70 k)
Age groups vs. single year of age
Other aggr/suppr
ID Link Share
A Y Y
B Y N
C N Y
D N N
Microdata Release Committee
Group of Statistics Canada experts on maintaining respondent confidentiality
Master File
ID Link Share
A Y Y
B Y N
C N Y
D N N

29. Data Linkage Master & Link File Share File Administrative Date
ID Link Share HC#
A Y Y Y1
B Y N Y2
C N Y N
D N N N
Share File
ID Link Share
A Y Y
C N Y
Administrative Date
HC# Name Add
Y1 Joe 123
Link ID File
By Request Only
Healthcard# and linkage info
Random ID links to share
ID Link Share HC#
A Y Y Y1

30. Sharing Agreement Statistics Canada - Ministry of Health
Statistics Canada will share individual survey responses collected for the Canadian Community Health Survey with the Ministry of Health
Only responses for individuals agreeing to share their information will be provided

31. Usage of Shared Data Only statistical aggregates may be published
Respondent information can not be linked to administrative health records without consent to do so from a survey respondent

32. Usage Continued
Information can not be released before the official release by Statistics Canada
Aggregates released must not identify a person, business or organization directly or indirectly

33. Confidentiality of Data
Shared information is to be treated as confidential and must be protected

34. Third Party Sharing
Ministry can share with health regions individual survey responses without any names, addresses or identifying numbers if
Written agreement between Ministry of Health and Health Region
Health Region can maintain same level of security and protection as required of the Ministry of Health including any Provincial requirements

35. Microdata Files Fixed Record ASCII share file (text)
File input statement/record layout (SAS, SPSS)
Variable Format (SAS, SPSS)
Variable Value Format (SAS, SPSS)
Bootstrap Weights
Bootstrap Programs

36. Microdata Documentation
Background
Objectives
Content
Sample Design
Data Collection
Processing
Data Quality
Tabulation Guidelines
Approx. Sampling Variability Tables
Weighting
File Usage

37. Microdata Documentation Appendices
Questionnaire
Record Layout
Data Dictionary
CV Tables
Derived Variable Specifications

38. Tabulation Guidelines
Type of estimate CV Guidelines
Acceptable Unrestricted release
Marginal Unrestricted release but with warning cautioning users of the high sampling variability (Identified by E).
Unacceptable > No release
(Flagged with F).

39. Tabulation Guidelines (CV Look-up Estimates)
Must ensure users do not infer greater accuracy than possible with approximate variances:
Estimates in main body of a table rounded to nearest 100;
Subtotals and totals derived from unrounded data and then rounded to nearest 100;
Averages, proportions and rates derived from unrounded and then rounded to 1 decimal place;
Cells based on < 30 respondents should be suppressed
Approximate CV reported

40. Tabulation Guidelines (Bootstrap Variance Estimation)
Exact estimate of variance
Unrounded estimates in main body of a table;
Unrounded subtotals and totals;
Averages, proportions and rates should be derived from unrounded and then rounded to 1 decimal place;
Cells based on <10 respondents should be suppressed
CV should be reported

41. CCHS Variable Naming Convention
Variable names are created from information re: type of data
Example: Qu. 8B, Depression Module, cycle 1.1 (DP_Q08B)
8 characters in length Ex.: DPSA_08B
1-3 module/section name DPS (depression)
4 survey cycle A (cycle 1.1)
5 variable type _ (underscore=coll data)
6-8 question number 08B

42. CCHS Variable Naming Convention
Position 1, 2 & 3: Section Name
CCC: Chronic Conditions
INC: Income
LBF: Labour Force
PAC: Physical Activities
SMK: Smoking
SXB: Sexual Behaviour
etc.

43. CCHS Variable Naming Convention
Position 4: Survey Number
only one digit
use of alphabetical symbols rather than numbers to limit confusion
Cycle  number  Alph. A B C
etc.

44. CCHS Variable Naming Convention
Position 5: Variable Type
_: collected variable
D: derived variable
F: flagged variable
G: grouped variable

45. CCHS Variable Naming Convention
Position 6-8:
questionnaire number / variable name
corresponds to the question number in questionnaire
ex.: Q03  03; Q02  02
ordered options use a letter to represent the corresponding options
ex.: Q15, 1st option  15A
Q15, 3rd option  15C

46. Master File Data Access
Remote Access
Submission by
Master dummy files
 s/year with  1.5 program/
On-site Access (ROs, RDCs)
Deemed employee of STC
20 active research teams in Ros; 16 in RDCs
Custom tabulations (cost recovery)

47. Organization of Electronic Data
Health Region
Profiles
Free
Simple
Canadian Statistics
Free
Canada Level Detail
Health Indicators
Free
Detailed Health Region
Information
New approach to organizing data holdings at Statistics Canada
CANSIM II will be used as the data warehouse from which most electronic data products are produced
Cansim II
Data Warehouse
$ for Download

48. Tabular Statistics CANSIM II main dissemination vehicle
minimum one table for every CCHS questionnaire module
Counts and confidence intervals
Province, Health Region, Age and Sex
Canadian Statistics
Corporate Community Profiles
ePubs such as Health Indicators

49. Analytical Products Health Reports 13.3 - March release
Based on data received during first six months of collection
National level results focusing on new CCHS content
Effect of sense of community belonging on self-perceived health status
Socio-demographic factors affecting winter fruit and vegetable consumption
Unmet health care needs

50. Analytical Products Daily - May 8, 2002 Data Officially Released
Analysis focusing on
Obesity
Physical Activity
Unmet health care needs

51. Other Analytical Products
Joint Statistics Canada & CIHI Publications
How Healthy are Canadians?
Health Care in Canada

52. Client Support
Health Statistics Division & Advisory Services Division client services through head and regional offices
Regular updates and enhancements to CCHS website
Customisable workshops covering all aspects of the CCHS
Content, Sample Design, Weighting, Data Quality, Release Guidelines, Bootstrap Variance Estimation

53. Future CCHS Cycles Cycle 1.1 Cycle 2.1 (Final Planning)
General content
sample
Health region estimates
Spring 2002 release
Cycle 2.1 (Final Planning)
Summer 2004 release
Cycle 1.2 (In the field)
Focus content (mental health)
sample
provincial estimates
Fall 2003 release
Cycle 2.2 (Proposed)
Focus content (nutrition)
Fall 2005 release

54. CCHS Description

55. WEB SITE
NPHS and CCHS Questionnaires and documentation are available on our web site at: