|Short description of Indicator
||Percentage of Métis and non-Aboriginal adults (ages 20 and older) in Ontario who report that they are currently smoking, or were non-smokers exposed to second-hand smoke, or consumed vegetables and fruit less than 5 times per day, or were physically inactive during leisure time.
Percentage of Métis and non-Aboriginal teens (ages 12 to 19) in Ontario who were non-smokers exposed to second-hand smoke.
Percentage of Métis and non-Aboriginal adults (ages 19 and older) in Ontario who exceed cancer prevention recommendations for alcohol consumption.
Percentage of Métis and non-Aboriginal adults (ages 18 and older) in Ontario who were obese.
Percentage of Métis and non-Aboriginal adolescents (ages 12 to 17) in Ontario who were obese.
Percentage of Métis households in Ontario reporting food insecurity in the past 12 months (marginal, moderate or severe, combined)
|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, unhealthy eating, body fatness and physical inactivity) 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.
|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.
|Calculations for the indicator
||Current smoking (adults) = ((Weighted number of adults ages 20 years and older who smoke daily or occasionally) / (Weighted total population ages 20 years and older)) x 100
Second-hand smoke (adults) = ((Weighted number of adults ages 20 years and older who do not smoke daily or occasionally and are exposed to second-hand smoke in their home, vehicle or public spaces) / (Weighted total population age 20 years and older who do not smoke daily or occasionally)) x 100
Second-hand smoke (teens) = ((Weighted number of teens ages 12 to 19 years who do not smoke daily or occasionally and are exposed to second-hand smoke in their home, vehicle or public spaces) / (Weighted total population ages 12 to 19 years who do not smoke daily or occasionally)) x 100
Alcohol consumption (adults) = ((Weighted number of adults ages 19 years and older who exceed the maximum recommended alcohol consumption for cancer prevention) / (Weighted total population ages 19 years and older)) x 100
Obese (adults) = ((Weighted number of adults ages 18 years and older with BMI 30.0 or greater) / (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.
Obese (adolescents) = ((Weighted number of adolescents ages 12 to 17 years with BMI classified as obese by the Cole Classification System) / (Weighted total population ages 12 to 17 years)) x 100
Vegetable and fruit consumption - less than 5 times per day (adults) = ((Weighted number of adults ages 18 years and older eating vegetables (excluding potatoes) and fruit less than 5 times per day) / (Weighted total population ages 18 years and older)) x 100
- Respondents who reported consuming fruit juice more than once daily were considered as having consumed it only once.
Physical inactivity during leisure time = ((Weighted number of adults ages 20 years and older whose average daily expenditure in leisure time physical activities in the past 3 months is less than 1.5kcal/kg/day) / (Weighted total population ages 20 years and older)) x 100
- 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 Ontario Aboriginal identity population (on- and –off reserve) in the 2006 Census, using age groups 18 to 24, 25 to 44, 45 to 64, and 65 and older. This technique adjusts for the differing age distributions of Métis and non-Aboriginal Ontarians (Métis being younger), allowing us to compare estimates between the 2 populations without bias due to the differing age structures.
- Bootstrapping techniques were used to obtain variance estimates and 95% confidence intervals of all estimates. 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.
- Health Canada. Canadian Guidelines for Body Weight Classification in Adults. Health Canada: Ottawa. 2003.
- Statistics Canada. 2005. Bootvar: User Guide (Bootvar 3.1 – SAS version) (accessed February 10, 2015). Ottawa, Ontario.
- 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
||Direct standardization (by age) Standard population: 2006 Canadian census, Ontario Aboriginal Identity population
Trend estimates, by Aboriginal identity, age-standardized:
- Current smoking, adults (ages 20 years and older), Ontario, both sexes combined, by Aboriginal Identity 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014.
Sex estimates, by Aboriginal identity, age-standardized:
- Alcohol consumption, adults (ages 19 years and older), by sex and Aboriginal identity, 2007 to 2014
General analytic notes:
Adult modifiable risk factor estimates presented for Ontario were age-standardized to the 2006 Aboriginal Identity population using the age groups from the 2006 Census: 20 to 24, 25 to 44, 45 to 64, 65 and over (exceptions for the lowest age range are overweight and obesity and alcohol consumption, where 18 to 24, and 19 to 24 were used, respectively). Risk factor estimates presented by education and income were age-standardized to the 2006 Aboriginal Identity population for adults ages 25 and older.
||Canadian Community Health Survey half-survey annual waves 2007–2014. Statistics Canada, Ontario Share File, Ontario Ministry of Health and Long-Term Care.
- A person was classified as Métis if they self-identity as a Métis, or Métis in combination with any other Aboriginal identity (First Nation or Inuit), and are born in Canada, United States, Greenland, or Germany
- Non-Aboriginal Ontarians were categorized as non-Aboriginal if they did not identify as Aboriginal or if they were not born in Canada, United States, Germany, or Greenland.
Geography: boundaries for North and South Ontario were based on the Local Health Integration Networks (LHINS). LHINs 13 and 14 (North East and North West, respectively) represented “North residents". LHINs 1 to 12 represented “South residents."
Income quintile: Reported or derived household income for each respondent adjusted for household size and community, sorted from highest to lowest and divided into 5 categories (“quintiles") so that about the same number of Ontario households is in each category (about 20% in each). Quintile 1 includes approximately 20% of households with lowest incomes, and quintile 5 includes the approximately 20% of households with highest incomes.
Education: highest level of education attained by the respondent, according to 3 categories: less than secondary school graduation; secondary school graduation and/or some post-secondary education; and post-secondary graduation.
- Education and income were analyzed for adults ages 25 and older to restrict the sample to those who have likely completed their education and reached their adult socio-demographic status. Residence (based on LHIN) was analyzed for adults ages 20 and older.
- 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 and seniors.
- The definition of “adult" applies to individuals age 20 and over, with the exceptions of overweight/obesity at age 18 and over to match BMI classifications, and alcohol consumption for which the legal age for consumption is 19.
- Confidence limits are another measure of statistical variation and are calculated using a bootstrap technique. 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.
- Trends in percentages over time were analyzed using Joinpoint regression software (v.4.1.1).
Survey Questions – Canadian Community Health Survey
Aboriginal Identity (Socio-demographics characteristics module):
- Are you an Aboriginal person, that is, First Nations, Métis or Inuk/Inuit? First Nations includes Status and Non-Status Indians.
- 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 (sdcdabt)
- 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?
- In the past month, were you exposed to second-hand smoke, every day or almost every day, in a car or other private vehicle?
- In the past month, were you exposed to second-hand smoke, every day or almost every day, in public places (such as bars, restaurants, shopping malls, arenas, bingo halls, bowling alleys)?
Obesity (Height and weight module):
- How tall are you without shoes on?
- How much do you weigh?
- Are you pregnant?
Alcohol consumption (Alcohol use module):
- Questions on alcohol use during the past year and during the past week.
- Are you pregnant?
Vegetable and fruit consumption (Fruit and vegetable consumption module):
- How often do you usually drink fruit juices such as orange, grapefruit or tomato?
- Not counting juice, how often do you usually eat fruit?
- How often do you usually eat green salad?
- How often do you usually eat carrots?
- Not counting carrots, potatoes or salad, how many servings of other vegetables do you usually eat?
Physical inactivity (Physical activities module):
- Questions about whether an individual participated in any of a list of more than 20 specified physical activities, or any other leisure time physical activities, in the past 3 months, number of times the individual did the activity and amount of time spent.
- Statistics Canada calculates a Leisure Time Physical Activity Index (PACDPAI) with respondents classified as being "active," "moderately active" or "inactive" based on the total daily energy expenditure values (kcal/kg/day):
- Active - respondents who average 3.0 or more kcal/kg/day of energy expenditure
- Moderately active - respondents who average 1.5 to 2.9 kcal/kg/day
- Inactive - respondents with energy expenditure levels less than 1.5 kcal/kg/day
- 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).
- Statistics Canada. 2005. Bootvar: User Guide (Bootvar 3.1 – SAS version) (accessed September 30, 2014). Ottawa, Ontario.
- Joinpoint Regression Program, Version 4.1.1. August 2014; Statistical Research and Applications Branch, National Cancer Institute.
|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 was considered 'Aboriginal' only if they were born in one of these countries and self-identified as Aboriginal for all survey years (2007 to 2014). Respondents in survey years prior to 2011 who identified as Aboriginal and were born outside these countries are included with 'non-Aboriginal Ontarians'.
- The Canadian Community Health Survey (CCHS) excludes individuals living on Indian Reserves and on Crown Lands, institutional residents, full-time members of the Canadian Forces, and residents of certain remote regions.
- CCHS 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).