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Modifiable Risk Factors in Inuit Methodology

Modifiable Risk Factors in Inuit
Short description of Indicator Percentage of Inuit in regions of Canada and non-Aboriginal adults in Ontario (ages 20 and older) who report that they are currently smoking

Percentage of Inuit non-smokers in regions of Canada and non-Aboriginal non-smokers in Ontario (ages 15 and older) who report being exposed to second hand smoke in the home

Percentage of Inuit adults in Canada in regions of Canada and non-Aboriginal adults in Ontario (ages 19 and older) who abstained from alcohol in the previous 12 months

Percentage of Inuit in regions of Canada and non-Aboriginal adults in Ontario (ages 18 years or older) who had excess body weight

Percentage of Inuit in regions of Canada and non-Aboriginal adults in Ontario (ages 16 years or older) living in food secure households
Rationale for measurement Modifiable risk factors are behaviours and exposures that can lower or raise a person's risk of cancer and that can be changed. Evidence confirms strong associations between major risk modifiers (commercial tobacco use, alcohol, body fatness, physical inactivity and unhealthy eating) and the risk of certain cancers. Reporting on risk factor prevalence in Ontario is important for effectively monitoring trends over time, supporting the development of health promotion strategies and evaluating outcomes of provincial and local interventions.

Food insecurity is associated with inadequate nutrition and eating too few servings of vegetables and fruit. Food security was used as a measure of a healthy diet due to its relationship with vegetable and fruit intake, and nutrition more broadly. Levels of food security also speak to the issues of food access and affordability facing Inuit communities. Food security, as defined by the Aboriginal Peoples Survey, measures whether Inuit households have the means to obtain a sufficient quantity of food and are not forced to regularly change their eating habits as a result of financial pressures.
Evidence/references for rationale Evidence supporting association between modifiable risk factors and cancer risk:
World Cancer Research Fund and American Institute for Cancer Research [Internet]. 2007. Food, nutrition, physical activity, and the prevention of cancer: a global perspective; [cited 2015 March 9]. Available from: https://www.wcrf.org/dietandcancer/resources-and-toolkit.

Parkin DM, Boyd L, Walker LC. 2011. 16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer. 105:S77-S81.

International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans. Volume 100E. A review of human carcinogens. Part E: Personal habits and indoor combustions. Lyon: International Agency for Research on Cancer; 2012.

Kirkpatrick SI, Tarasuk V. Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents. J Nutr. 2008;138(3):604-12
Calculations for the indicator Current smoking (adults) = ((Weighted number of adults 20 years and older who smoke daily or occasionally) / (Weighted total population ages 20 years and older)) x 100

Second-hand smoking (adults) = ((Weighted number of adults ages 15 years and older who do not smoke daily or occasionally, live in a household with at least 1 other person and are exposed to second-hand smoke in their home) / (Weighted total population ages 15 years and older who live in a household with at least 1 other person and who do not smoke daily or occasionally)) x 100

Alcohol abstaining (adults) = ((Weighted number of adults ages 19 years and older who abstained from alcohol in the previous 12 months) / (Weighted total population ages 19 years and older)) x 100

Excess body weight (overweight or obese - adults) = ((Weighted number of adults ages 18 years and older with BMI of 25 or more) / (Weighted total population ages 18 years and older)) x 100
 
  • Respondents who were pregnant at the time of the survey were excluded.
  • The calculation of BMI excluded respondents less than 3 feet (0.914 m) tall or those greater than 6 feet 11 inches (2.108 m). BMI is categorized using standard international weight cutoffs.[1]

General exclusions:

  • All calculations excluded respondents in the non-response categories (refusal, don't know, and not stated) for required questions.

General analytic notes:

  • All estimates of proportion for adults (apart from those for specific age groups) are age-standardized to the age distribution of the Inuit population living outside Nunangat from the 2006 Census, using age groups 15 to 24, 25 to 55, 55 to 64 and 65 and older. This technique adjusts for the differing age distributions of Inuit and non-Aboriginal Ontarians (Inuit being younger), allowing us to compare estimates between the 2 populations without bias due to the differing age structures.
  • Bootstrapping techniques with the appropriate multiplicative factor (Fay adjustment) were used to obtain variance estimates and 95% confidence intervals of all estimates.[2] [3] Statistics Canada requires estimates with coefficients of variation of 16.6% to 33.3% to be noted with a warning to users to interpret with caution, and estimates with coefficients of variation greater than 33.3% to be suppressed.[4]


References:

  1. Health Canada. Canadian Guidelines for Body Weight Classification in Adults. Health Canada: Ottawa. 2003.
  2. Statistics Canada. 2005. Bootvar: User Guide (Bootvar 3.1 – SAS version) (accessed February 10, 2015). Ottawa, Ontario.
  3. Statistics Canada. Aboriginal Peoples Survey, 2012: Concepts and Methods Guide. Ottawa: Statistics Canada; 2014. http://www.statcan.gc.ca/pub/89-653-x/89-653-x2013002-eng.pdf
  4. Statistics Canada. “Canadian Community Health Survey (CCHS) Annual component." Definitions, data sources and methods. Last updated June 17, 2011. https://www.statcan.gc.ca/eng/statistical-programs/document/3226_D74_T1_V1 (accessed February 10, 2015).
Standardized Rate Calculation N/A
Unit N/A
Data sources Canadian Community Health Survey (CCHS) half-survey annual release, 2012. Statistics Canada, Ontario Share File, Ontario Ministry of Health and Long-Term Care.

Aboriginal Peoples Survey (APS), 2012. Statistics Canada.
Time Frame N/A
Geographic Scale N/A
Denominator description N/A
Numerator description N/A
Considerations Inuit identity was defined as follows:

Inuit in Nunangat: In this report, this population is defined as respondents of the APS who identified as Inuit and were residing in the Inuit Nunangat region (Nunatsiavut, Nunavik, Nunavut and Inuvialuit regions) at the time of the 2011 National Household Survey.

Inuit outside Nunangat: In this report, this population is defined as respondents of the APS who identified as Inuit and were not residing in the Inuit Nunangat region (Nunatsiavut, Nunavik, Nunavut and Inuvialuit regions) at the time of the 2011 National Household Survey. Given the small numbers of Ontario Inuit respondents in the APS, the outside Nunangat population is used as a proxy for the Ontario Inuit population.

Inuit in Ontario: In this report, this population is defined as respondents of the APS who identified as Inuit and reported residing in Ontario at the time of the 2011 National Household Survey. When the numbers are reportable, cancer-related risk factors are shown for the Ontario Inuit population.

Non-Aboriginal Ontarians: In this report, this population is defined as respondents in Ontario who did not self-identify as Aboriginal, or who identified as Aboriginal, but were born outside of Canada, the United States, Germany or Greenland.

Other Notes:
  • For obesity, BMI classifications used here may be limited in determining health risks for muscular adults, naturally lean adults, young adults who have not reached full growth, seniors and certain racial/ethnic groups.[1]
  • The definition of “adult" applies to individuals ages 20 and over, with the exceptions of overweight/obesity at ages 18 and over to match BMI classifications.[1]
  • Confidence limits are another measure of statistical variation and are calculated using a bootstrap technique with the appropriate multiplicative factor (Fay adjustment). A difference in 2 percentages is statistically significant if the 95% confidence intervals of the 2 estimates do not overlap. This is a conservative approach to significance testing, but non-overlapping confidence intervals indicate that it is unlikely that the difference observed between the 2 groups is due to chance alone.

Survey Questions – Aboriginal Peoples Survey and Canadian Community Health Survey

Aboriginal Identity (Socio-demographics characteristics module):

  • Are you First Nation?
  • Are you Métis?
  • Are you Inuk/Inuit?
  • In what country were you born?

Non-Aboriginal Identity (Socio-demographics characteristics module):

  • Derived variable about Aboriginal identity
  • In what country were you born?

Smoking (Smoking module):

  • At the present time, do you smoke cigarettes daily, occasionally or not at all?

Second-hand smoke exposure (Smoking module):

  • Including both household members and regular visitors, does anyone smoke inside your home, every day or almost every day?

Obesity (Height and weight module):

  • How tall are you without shoes on?
  • How much do you weigh?
  • Are you pregnant?


References:

  1. Health Canada. 2003. Canadian Guidelines for Body Weight Classification in Adults. Last updated June 24, 2013. http://www.hc-sc.gc.ca/fn-an/nutrition/weights-poids/guide-ld-adult/qa-qr-prof-eng.php (accessed February 25, 2014).
  2. Statistics Canada. 2005. Bootvar: User Guide (Bootvar 3.1 – SAS version) (accessed September 30, 2014). Ottawa, Ontario. 
Data availability & limitations
  • As of 2011, the CCHS restricted the question about Aboriginal identity to those born in Canada, the U.S., Germany or Greenland. Therefore, an individual would have been considered 'non-Aboriginal' if they were NOT born in one of these countries and self-identified as Aboriginal in 2012.
  • CCHS and APS data on modifiable risk factors are self-reported. Respondents of self-reported surveys tend to under-report behaviours that are socially undesirable or unhealthy (e.g., tobacco use) and over-report behaviours that are socially desirable (e.g., vegetable and fruit consumption).
  • The APS does not have any questions related to vegetable and fruit consumption or physical activity.
  • Small sample sizes of Inuit living in Ontario necessitated the use of 'outside Inuit Nunangat' as a proxy for Ontario. Even in the 'Outside Inuit Nunangat' population, the sample size of Inuit was too small to report the prevalence of several risk factors in Inuit populations, and compromises on the definition of certain indicators were made. For example, we measured food security (as opposed to food insecurity) because the sample size for Inuit living outside Nunangat was too small to report on Inuit living in food insecure households.
CSQI Year 2019