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Background The COVID-19 pandemic interrupted routine and preventive dental services until precautions could be implemented to limit virus transmission. Access to services for dental emergencies was maintained. The objective of this study was to describe the reported need for, access to, and receipt of oral health care in Canada during the first year of the pandemic. Data and methods The 2021 Survey on Access to Health Care and Pharmaceuticals During the Pandemic collected information from Canadians aged 18 years and older. Respondents were asked whether they needed (routine) dental care in the previous 12 months, whether they received that care, whether they experienced any mouth or tooth pain (indicative of a dental emergency), and whether and how COVID-19 affected service access. Results Of the 44.5% of Canadians who reported needing dental care in the 12 months before the survey, 5.8% did not receive the care they reportedly needed. Almost 20% of those with a reported need had their appointment cancelled, rescheduled, or delayed because of COVID-19, and this was more common for individuals with unmet dental care needs (46.9%) than it was for those who had received dental care (17.1%). For those requiring more urgent care, 23.3% of Canadians experienced pain in their mouth or teeth in the previous 12 months. Among those with dental pain, 64.2% sought treatment, and the majority (86.4%) received the treatment they needed. One-third (33.2%) avoided care for their dental-related pain because of fear of contracting COVID-19. Interpretation During the first year of the pandemic, many Canadians experienced cancelled or delayed dental services or did not receive the oral health care services they reportedly needed. Ongoing monitoring could help determine whether these COVID-19 service interruptions will have lasting effects on Canadians' oral health. [ABSTRACT FROM AUTHOR]

Background Accessibility of food retail in communities may play a role in shaping the food choices of local residents. However, previous studies have shown mixed results. This study examined associations between the local restaurant environment and the frequency of eating food from restaurants and intake of sugary drinks among Canadian children and youth. Data and methods The study cohort consisted of 23,776 participants (aged 1 to 17 years) in the 2019 Canadian Health Survey on Children and Youth who resided in large urban population centres across the Canadian provinces. Measures of geographic access to various restaurant types within walking distance of participants' residential areas came from the 2018 Canadian Food Environment Dataset. Poisson regression models with robust standard errors assessed associations between measures of absolute densities (number per km2) of full-service, fast-food and other restaurants, and the relative density of fast-food restaurants (as a percentage of total restaurants) with the frequency of eating food from fast-food or full-service restaurants and sugary drink intake in the previous seven days. Results After adjustment for a range of sociodemographic covariates, there were no consistent associations between absolute and relative measures of restaurant access and the frequency of eating food from restaurants or intake of sugary drinks. Interpretation Results reveal no consistent relationships between local restaurant exposures and the frequency of eating food from restaurants or sugary drink intake among Canadian children and youth. Efforts to create environments that foster healthy food choices among young people will remain important but will likely need to target multiple activity spaces beyond the local neighbourhood. [ABSTRACT FROM AUTHOR]

Introduction: The Canadian Community Health Survey (CCHS) - Nutrition 2004 (n=35,107; interview dates from January 2004 to January 2005) linked to the Canadian Vital Statistics - Death Database (CVSD) (2011) represents a novel linkage of a population-based, nationally representative nutrition survey with routinely collected mortality records (including date and cause of death). The linkage was done through individual tax data in Canada, and contains longitudinal records for 29,897 Canadians aged 0 years and older--1,753 of whom died--in the 10 provinces of Canada. The median follow-up time was 7.49 years, with 102,953 personyears among males and 114,876 person-years among females (unweighted), and included a special sampling survey weight (for linked data) to account for those who did not agree to share and link their information. The CCHS - Nutrition 2004 linked to CVSD has been used to evaluate associations between lifestyle and sociodemographic characteristics and mortality. Using these data, statistical methods have been developed and tested to control random and systematic measurement errors when evaluating the relationship between different dietary exposures (evaluated using repeated 24-hour dietary recalls) and health outcomes. The linked data are available through Statistics Canada's Research Data Centres. [ABSTRACT FROM AUTHOR]

Background Food insecurity linked to insufficient income is an important determinant of health. Whether the COVID-19 pandemic has exacerbated levels of food insecurity in Canada, particularly among vulnerable groups, is unclear. This study estimated the proportion of Canadians reporting experience of household food insecurity six to nine months into the COVID-19 pandemic, and drew comparisons with pre-pandemic levels. Data and methods Data on household food security status during the pandemic came from the population-based cross-sectional Canadian Community Health Survey (CCHS) collected from September to December 2020. Analyses were based on 26,831 respondents aged 12 and older residing in the 10 provinces. The Household Food Security Survey Module was used to categorize respondents' household food security status within the previous 12 months as food secure or marginally, moderately or severely insecure. The percentage of Canadians reporting some experience of household food insecurity was estimated for the overall population and for various sociodemographic groups. T-tests were used to draw comparisons with pre-pandemic rates from the 2017/2018 CCHS. Results In fall 2020, 9.6% of Canadians reported having experienced some level of food insecurity in their household in the prior 12 months, which is lower than the estimate of 12.6% from 2017/2018. Overall estimates were also lower in fall 2020 when examined within levels of household food insecurity (i.e., marginal, moderate or severe). The percentage of Canadians reporting experience of household food insecurity was either unchanged or lower than in 2017/2018 among sociodemographic groups vulnerable to experiencing income-related food insecurity, including renters and those with lower levels of education. Interpretation During the second wave of the COVID-19 pandemic in fall 2020, about 1 in 10 Canadians aged 12 and older reported experience of food insecurity in their household in the previous 12 months. This proportion was lower compared with 2017/2018, both overall and among several groups at higher risk of food insecurity. Monitoring household food insecurity will continue to be important during the COVID-19 pandemic and throughout the years of recovery ahead. [ABSTRACT FROM AUTHOR]

Background The 2019 Canada's Food Guide recommends the consumption of lower fat dairy products to reduce saturated fat (SFA) intakes. Objectives The objective of this study was to assess the impact of such recommendation on SFA intake at a population level in Canada. Methods Analyses were conducted based on dietary intakes from the nationally representative 2015 Canadian Community Health Survey–Nutrition (unweighted n  = 20,103). Dietary intake was assessed using 24-h dietary recalls. Food-based substitution modeling analyses were conducted by replacing all regular-fat dairy products reported by an equal amount of a corresponding lower fat dairy product. Regular-fat dairy products included milks ≥2% fat, cheeses >25% fat, and yogurts ≥2% fat. Corresponding lower fat replacement products were 1% fat milks, 10–25% fat cheeses, and <2% fat yogurts. The National Cancer Institute method was used to account for within-person variation in dietary intakes. Results Replacing all regular-fat dairy products consumed by Canadians (ages ≥2 y) by a corresponding lower fat product reduced the population's SFA intake from 10.8% of total energy intake (%E; 95% CI: 10.7%, 11.0%) to 10.0%E (95% CI: 9.8%, 10.2%). This reduction was mostly attributable to the milk and cheese substitutions (mean SFA reductions of −0.3%E each). The proportion of the population with an SFA intake <10%E was 34.7% (95% CI: 31.2%, 38.2%) before substitution and 51.5% (95% CI: 47.5%, 55.5%) after substitution. Conclusions This food-based substitution modeling analysis suggests that SFA intakes at a population level are slightly reduced if all regular-fat dairy products consumed by Canadians were replaced by a lower fat dairy product. Approximately half of the population would still consume SFAs in excess of 10%E even if all regular-fat dairy consumed were replaced by lower fat dairy. [ABSTRACT FROM AUTHOR]

Background Public health measures related to the COVID-19 pandemic have upended the way Canadians eat and shop for food. Since the pandemic began, many Canadians have reported consuming food away from home (FAFH) less often. FAFH tends to be less healthful than food prepared at home. Little is known about patterns of Canadians' FAFH consumption before the pandemic. This study used 2015 national-level nutrition data, the most recent available, to characterize patterns of FAFH consumption and selected markers of dietary intake. Data and methods National-level food intake data came from the first 24-hour dietary recall provided by 20,475 respondents aged 1 or older to the 2015 Canadian Community Health Survey-Nutrition. Mean daily intakes of selected food subgroups and nutrients, adjusted for total energy intake, were compared between those who had consumed any food in a restaurant on the previous day and those who had not. Estimates were generated overall and for eight age and sex groups. Results In 2015, overall, 21.8% of Canadians had consumed FAFH in a restaurant on the previous day. Eating out was most common among males aged 19 to 54 (27.7%) and least common among young children aged 1 to 5 (8.4%). Compared with Canadians who had not eaten out on the previous day, those who had eaten out had consumed, on that day, fewer servings of whole fruit; whole grains; dark green and orange vegetables; other vegetables (excluding potatoes); milk and fortified soy-based beverages; and legumes, nuts and seeds, on average. Those who had eaten out had consumed, on average, less fibre and total sugar, and more total fat, saturated fat and sodium on that day. There were few differences for meat and poultry, fish and seafood, and protein intake. Conclusions On the day that Canadians ate out in a restaurant, their dietary intake was generally less favourable than that of Canadians who did not eat out. If Canadians continue to eat at home more and to consume less FAFH, as early pandemic-period reports suggest, then results can be used to gauge the potential dietary implications of these shifts. [ABSTRACT FROM AUTHOR]

The family environment is an important influence on the health and behaviours of children. Few large-scale datasets include detailed and objectively measured health data about multiple individuals from the same family who are living in the same household. The Canadian Health Measures Survey (CHMS) is a repeating, cross-sectional survey that selects two members of a household--a child and a randomly selected older member of the household aged 12 to 79 years--with at least one child aged 3 to 11 years in residence. These paired respondent records, available in the CHMS relationship files, provide unique opportunities to researchers interested in examining associations between two members of the same household for health behaviours and outcomes. A range of pairings are captured in the relationship files (e.g., parent and child, siblings, grandchild and grandparent) with birth parent-child pairs being the most common. These paired respondent data are an important analytical asset of the CHMS and enhance the research potential of the survey significantly. [ABSTRACT FROM AUTHOR]

Background A larger share of ultra-processed foods and drinks (UPF) in the diet is increasingly linked with poor diet quality, weight gain and elevated risk of diet-related chronic disease. This study used 2015 national-level data, the most recent available, to characterize the intake of UPF among Canadians and to examine changes since 2004. Methods The 2004 and 2015 Canadian Community Health Surveys provided 24-hour dietary recall data for Canadians aged 2 or older. All food and drink items were classified according to type of food processing using the NOVA classification. The mean energy contribution of UPF (as a percentage of total daily energy intake) was compared across survey years for the overall population and for eight age-sex groups. The National Cancer Institute's methodology was used to assess the distribution of usual energy contributed by UPF. Results On average, UPF contributed 47.8% (95% CI: 47.3% to 48.3%) of total daily energy in 2004 and 45.7% (95% CI: 45.0% to 46.4%) in 2015 among the overall population, and more than half of total daily energy among children and adolescents. Both the mean energy contribution of UPF and their usual energy distribution shifted downward since 2004 for all age-sex groups, except among adults aged 55 or older. The energy contributions of soft drinks, fruit juices and fruit drinks declined, particularly among children and adolescents. Ultra-processed breads contributed more energy in 2015 for nearly all age-sex groups. Conclusions As in 2004, the overall dietary share of UPF in Canada remained high in 2015, but intakes of some UPF, particularly beverages, declined. The energy contribution of UPF remained highest among children and adolescents, and increased among adults aged 55 or older. [ABSTRACT FROM AUTHOR]

Background: Eating plenty of vegetables and fruits on a daily basis is the foundation of a healthy diet. This study investigated patterns in Canadians' vegetable and fruit consumption in 2015 and compared these with 2004 data. Data and methods: The 2015 Canadian Community Health Survey (CCHS) - Nutrition and the 2004 CCHS - Nutrition (Cycle 2.2) provided nationally representative 24-hour dietary recall data on Canadians' vegetable and fruit intakes. The frequency of consumption and the average quantity of daily intake for total vegetables, fruits and subgroups were calculated overall and by age and sex group for each survey year. The National Cancer Institute's methodology was used to assess the distribution of usual total vegetable and fruit intake and how it relates to recommendations in the 2007 Canada's Food Guide. Results: Overall, Canadians reported consuming fewer total servings of vegetables and fruits in 2015 (4.5 average daily servings) than in 2004 (5.3 average daily servings). Lower total fruit intakes were explained by significantly lower intakes of fruit juice across nearly all age and sex groups, resulting in a decline of 0.3 average total daily fruit servings in the overall population. Lower vegetable consumption was largely driven by lower intakes of potatoes and, to a lesser extent, lettuce. Intakes of whole fruits and other vegetables remained largely unchanged. In both years, the majority of Canadians did not usually consume the number of total vegetable and fruit servings recommended for their age and sex group in the 2007 Canada's Food Guide. Interpretation: Canadians reported consuming fewer vegetables and fruits in 2015 compared with 2004. This was largely driven by substantially lower consumption of fruit juice and, to a lesser extent, potatoes. These findings can serve as valuable baseline data to assess any changes in patterns of vegetable and fruit consumption in Canada. [ABSTRACT FROM AUTHOR]

Background: Beverage consumption, especially water, is critical to a healthy diet. The 2007 Canada's Food Guide (CFG) makes specific recommendations regarding the intake of water, fruit juice, milk and energy‑dense beverages. Earlier comparisons of 2004 and 2015 dietary data show that changing patterns in beverage intake can explain some of the changes in energy and sugar intake observed in the Canadian population. The objective of this study is to describe any changes in beverage consumption between 2004 and 2015, and how these changes relate to existing recommendations in the 2007 CFG. Data and methods: Data are from the Canadian Community Health Survey – Nutrition for 2004 and 2015. To estimate any change in the proportion of Canadians consuming a beverage the day before and the quantity consumed, 19 beverage categories were derived using the Bureau of Nutritional Science categories. The CFG classification was used to estimate the relative share of juice intake from total servings of vegetables and fruit, and the intake of milk from milk subcategories. The National Cancer Institute method was used to estimate usual intake.Results: Water intake was higher in 2015 than in 2004. Consumption of milk, fruit juice, and energy‑dense beverages such as fruit drinks and soft drinks was lower in 2015. Changes in water, soft drink and fruit drink consumption mostly reflect changes in the proportion of Canadians consuming these specific beverages the day before reporting, while changes in milk and fruit juice mostly reflect a change in the quantity consumed. In 2015, the majority of the population was consuming more whole vegetables and fruit than juice, which is in line with 2007 CFG recommendations. Interpretation: Beverage consumption patterns in Canada changed between 2004 and 2015. Some of these changes are in line with recommendations from the 2007 CFG, the food guide that was available at the time of the 2015 survey. [ABSTRACT FROM AUTHOR]

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 overreporters), 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. [ABSTRACT FROM AUTHOR]

Background: Self-reported and accelerometer-measured physical activity levels generally exhibit low correlation and agreement. The objective of this study is to compare estimates of physical activity among adults from a newly developed Canadian questionnaire with those obtained objectively by accelerometry. Data and methods: Data for 18- to 79-year-olds (N = 2,372) were collected in 2014 and 2015 as part of the Canadian Health Measures Survey (CHMS). Moderate-to-vigorous physical activity (MVPA) was reported on the household questionnaire by domain (transportation, recreation, and occupational or household) as part of the new Physical Activity Adult Questionnaire (PAAQ) and measured objectively using the Actical accelerometer. Correlation and mean difference analyses were used to assess the relationships between measured and reported physical activity variables. Linear regression was used to test the association between measured and reported physical activity and measures of obesity. Results: On average, Canadian adults reported more physical activity than they accumulated on an accelerometer (49 minutes versus 23 minutes per day). The highest correlation observed was between accelerometer-measured MVPA and the sum of self-reported recreation and transportation activity (R = 0.36, p < 0.0001). The sum of activity from all domains (recreation + transportation + occupational or household) exhibited a lower correlation with measured variables because the occupational or household domain was negatively correlated with MVPA (R = -0.04). The occupational or household domain was positively correlated with light-intensity physical activity (R = 0.20, p < 0.0001). Respondents in the least active quintile were more likely than those in the most active quintile to report more activity than was measured by the accelerometer. On average, the most active quintile reported less activity than was measured by the accelerometer. Interpretation: The newly developed Canadian physical activity questionnaire exhibited modest correlation and agreement with accelerometer-measured physical activity among adults. Accelerometers and questionnaires provide complementary information, about different aspects of physical activity (actual movement versus perceived time). Consequently, one should exercise caution in using estimates derived from these methods interchangeably. [ABSTRACT FROM AUTHOR]

Background: Estimates of energy intake are lower in 2015 compared with 2004. The difference observed is too large to be explained by a change in energy requirements or physical activity at the population level. Self-reported dietary intake is subject to misreporting and may explain part of this difference. The objectives of this study are to assess how misreporting has changed from 2004 to 2015 and to demonstrate how these changes may affect the interpretation of the national intake data of Canadians. Data and methods: Data from the 2004 Canadian Community Health Survey - Nutrition (CCHS - Nutrition) and the 2015 CCHS - Nutrition were used to estimate energy intake and requirements for all participants aged 2 or older. The ratio of energy intake to total energy expenditure requirements (EI:TEE) was used to categorize respondents as under-reporters (EI:TEE < 0.70), over-reporters (EI:TEE > 1.42) or plausible reporters (EI:TEE = 0.70 to 1.42). Descriptive analyses by category of respondent were conducted for respondents aged 2 or older who participated in the measured height and weight component. The main caloric sources that contributed to the difference in estimated energy requirements were used to show the impact of misreporting on the analysis. Results: The prevalence of under-reporters was 7.5% higher in 2015 compared with 2004, while the prevalence of over-reporters was 7.4% lower. There was no change in the prevalence of plausible reporters. Estimated energy intake from participants categorized as plausible reporters showed a difference of 84 kcal from 2004 to 2015, compared with a difference of 250 kcal for the entire sample. Estimated energy intake was lower in 2015 compared with 2004 across all categories of respondents for many foods, including sugar-sweetened beverages and milk, and was higher for only pastries and nuts. Interpretation: Misreporting changes will affect analysis and should, at a minimum, be acknowledged when comparing 2015 with 2004. Using a comparable category of plausible reporters or adjusting for reporting status are options that will allow a better comparison of these two datasets. [ABSTRACT FROM AUTHOR]

Background: Moderate-to-vigorous physical activity (MVPA) and sleep are positively associated with adult's health, while the association with sedentary behaviour (SED) is negative. Light-intensity physical activity (LPA) is emerging as an independent predictor of improved cardiovascular health. The health impacts of each of these factors have been examined in isolation, but interest has increased in associations between health and movement behaviours collectively. Data and methods: This analysis examines how reallocating time between movement behaviours is associated with obesity and with self-rated general and mental health. Data for 18- to 79-year-olds (n = 10,621) were collected from 2007 through 2015 as part of the Canadian Health Measures Survey. LPA, MVPA, and SED were measured using the Actical accelerometer. Body mass index (BMI) and waist circumference (WC) were directly measured. Sleep and general and mental health were self-reported. Results: Reallocation of 30 minutes from SED, LPA or sleep to MVPA was associated with a lower BMI and smaller WC, particularly for older and overweight/ obese individuals. Time reallocation from SED to LPA was associated with lower BMI and smaller WC in respondents who were aged 50 or older or who were overweight/obese. Time reallocated from SED to any other movement behaviour was associated with decreased odds of reporting poor/fair rather than excellent general health. Time reallocation from SED to LPA or to sleep, but not to MVPA, was associated with decreased odds of reporting poor/fair rather than excellent mental health. Interpretation: These findings confirm previous research indicating a strong association between MVPA and markers of obesity and health, particularly among older and overweight/obese individuals. This study also provides evidence that increasing LPA is an important health promotion message for these two subpopulations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The prevalence of overweight and obesity among children and adults has risen in Canada. Studies suggest that parent obesity is a risk factor for overweight and obesity in children. This analysis examines associations between biological parent and child body mass index (BMI) in a nationally representative sample of Canadian children. Methods: The analysis is based on data collected for 1,563 children aged 6 to 10 in the first three cycles of the Canadian Health Measures Survey (2007 to 2013). BMI was calculated using measured height and weight. Pearson correlation, logistic, and linear regression analyses examined associations between biological parent and child BMI and obesity status, controlling for other risk factors. Results: Biological parent and child BMI were correlated. When risk factors were taken into account, a child's average BMI increased as their parent's BMI increased. Parent BMI explained 2% of the variance in boys' BMI and 12% of the variance in girls' BMI. Boys and girls with a biological parent who was obese were at increased risk of being overweight or obese. Girls were also at increased risk of being overweight or obese if a biological parent was overweight. Interpretation: Children's body weight status is associated with that of at least one of their biological parents. Having an obese parent increases the risk of overweight or obesity among children in Canada. [ABSTRACT FROM AUTHOR]

Background: Parents influence the physical activity and sedentary behaviour of their children. This analysis examines associations between parental role modeling and support and children's physical activity and sedentary behaviour. Data and methods: The sample consists of 1,328 biological parent-child pairs from the first three cycles of the Canadian Health Measures Survey (2007 through 2013). Data on physical activity and sedentary behaviour were collected using a questionnaire and by accelerometer. Pearson correlation and linear regression analyses were completed to examine associations between parents' and children's measured physical activity and sedentary time and reported screen-based activities. Analyses were adjusted for variables indicating parental support and household lifestyle characteristics. Results: Accelerometer-measured physical activity and sedentary time were correlated in all parent-child pairs. Parents' measured moderate-to-vigorous physical activity (MVPA) was associated with children's MVPA (β = 0.28, p < 0.001). For every 20-minute increase in a parent's MVPA, the child's MVPA increased by 5 to 10 minutes. Parents' measured sedentary time was associated with that of their daughters on weekends, and with that of their sons during the after-school period. Parents' reported screen time was associated with that of their daughters. Interpretation: This study confirms parents' influence on their children's physical activity. Parental role modeling and support have independent effects on a child's level of physical activity. [ABSTRACT FROM AUTHOR]

Background: For preschool children, physical activity is associated with improved measures of health, while sedentary behaviour is associated with less favourable health outcomes. This study updates estimates of physical activity and sedentary behaviour among children aged 3 to 5, based on combined data from two cycles of the Canadian Health Measures Survey (CHMS) in order to calculate adherence to Canadian physical activity and sedentary behaviour guidelines. Data and methods: The data are from two independent samples that comprised the 2009-to-2011 (cycle 2) and 2012/2013 (cycle 3) CHMS. Accelerometry and a parent-administered questionnaire were used in both cycles on children aged 3 to 5. Accelerometer data, collected in 60-second epochs in cycle 2 and in 15-second epochs in cycle 3, were combined using an adjustment factor derived in an independent sample. Prevalence of adherence to the physical activity guidelines, according to the accelerometer data, was estimated based on a Betabinomial distribution. Adherence to the screen-time component of the sedentary behaviour guidelines was calculated using parent reports. Results are presented by personal and household-related covariates. Results: An estimated 73% of 3- to 4-year-olds and 30% of 5-year-olds met their respective physical activity guidelines. Screen-time targets were met by 22% of 3- to 4-year-olds and 76% of 5-year-olds. Interpretation: Because they rely on a larger sample size and stronger estimation methods, the findings of this study are more robust than previously published estimates. Results reveal room for improvement, particularly 5-year-olds' physical activity and 3- to 4-year-olds' screen time. [ABSTRACT FROM AUTHOR]

Background: International data show that the majority of children and youth are not sufficiently active. According to recent research, children who spend more time outdoors accumulate more daily moderate-to-vigorous physical activity and engage in less sedentary behaviour. However, the generalizability of these findings is uncertain, and few studies investigated whether outdoor time is associated with other physical and psychosocial health indicators. Data and methods: This study examined associations between outdoor time and measures of physical activity, sedentary time, and physical and psychosocial health in a nationally representative sample of 7-to-14-year-olds (n = 1,159) who participated in the 2012/2013 Canadian Health Measures Survey. Physical activity and sedentary time were measured with Actical accelerometers. Direct measures of height, weight, waist circumference, grip strength, blood pressure, cholesterol, and glycohemoglobin were obtained. The Strengths and Difficulties Questionnaire was used to assess psychosocial health. Relationships between outdoor time and physical health measures were examined with multi-variable linear regression models adjusted for age, sex, parental education, and household income. Logistic regression models controlling for the same variables were used for psychosocial health. Results: Each additional hour spent outdoors per day was associated with 7.0 more minutes of moderate-to-vigorous physical activity, 762 more steps, and 13 fewer minutes of sedentary time. As well, each hour outdoors was associated with lower odds of negative psychosocial outcomes (specifically, peer relationship problems and total difficulties score). Outdoor time was not associated with any of the measures of physical health. Interpretation: Children reporting more time outdoors are more active, less sedentary, and less likely to have peer relationship problems, compared with those who spend less time outdoors. [ABSTRACT FROM AUTHOR]

Background: Estimates of the prevalence of adherence to physical activity guidelines in the population are generally the result of averaging individual probability of adherence based on the number of days people meet the guidelines and the number of days they are assessed. Given this number of active and inactive days (days assessed minus days active), the conditional probability of meeting the guidelines that has been used in the past is a Beta (1 + active days, 1 + inactive days) distribution assuming the probability p of a day being active is bounded by 0 and 1 and averages 50%. A change in the assumption about the distribution of p is required to better match the discrete nature of the data and to better assess the probability of adherence when the percentage of active days in the population differs from 50%. Data and methods: Using accelerometry data from the Canadian Health Measures Survey, the probability of adherence to physical activity guidelines is estimated using a conditional probability given the number of active and inactive days distributed as a Betabinomial(n, α + active days , β + inactive days) assuming that p is randomly distributed as Beta(α, β) where the parameters α and β are estimated by maximum likelihood. Results: The resulting Betabinomial distribution is discrete. For children aged 6 or older, the probability of meeting physical activity guidelines 7 out of 7 days is similar to published estimates. For pre-schoolers, the Betabinomial distribution yields higher estimates of adherence to the guidelines than the Beta distribution, in line with the probability of being active on any given day. Interpretation: In estimating the probability of adherence to physical activity guidelines, the Betabinomial distribution has several advantages over the previously used Beta distribution. It is a discrete distribution and maximizes the richness of accelerometer data. [ABSTRACT FROM AUTHOR]

Background: Discrepancies between self-reported and objectively measured physical activity are well-known. For the purpose of validation, this study compares a new self-reported physical activity questionnaire with an existing one and with accelerometer data. Data and methods: Data collected at one site of the Canadian Health Measures Survey in 2013 were used for this validation study. The International Physical Activity Questionnaire (IPAQ) was administered to respondents during the household interview, and the new Physical Activity for Adults Questionnaire (PAAQ) was administered during a subsequent visit to a mobile examination centre (MEC). At the MEC, respondents were given an accelerometer to wear for seven days. The analysis pertains to 112 respondents aged 18 to 79 who wore the accelerometer for 10 or more hours on at least four days. Results: Moderate-to-vigorous physical activity (MVPA) measured by accelerometer had higher correlation with data from the PAAQ (r = 0.44) than with data from the IPAQ (r = 0.20). The differences between accelerometer and PAAQ data were greater based on accelerometer-measured physical activity accumulated in 10-minute bouts (30-minute difference in MVPA) than on all minutes (9-minute difference). The percentages of respondents meeting the Canadian Physical Activity Guidelines were 90% based on self-reported IPAQ minutes, 70% based on all accelerometer MVPA minutes, 29% based on accelerometer MVPA minutes accumulated in 10-minute bouts, and 61% based on self-reported PAAQ minutes. Interpretation: The PAAQ demonstrated reasonable validity against the accelerometer criterion. Based on correlations and absolute differences between daily minutes of MVPA and the percentages of respondents meeting the Canadian Physical Activity Guidelines, PAAQ results were closer to accelerometer data than were the IPAQ results for the study sample and previous Statistics Canada self-reported questionnaire findings. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Nutritional risk screening is typically done in clinical settings to identify individuals at risk of malnourishment. This article presents the first population-level assessment of nutritional risk based on a large national sample representative of Canadian householders aged 65 or older. Data sources and methods Data from the 2008/2009 Canadian Community Health Survey--Healthy Aging were used to estimate the prevalence of nutritional risk by selected characteristics. Factors associated with nutritional risk were examined with restricted and full logistic models. The distribution of responses on the SCREEN II-AB nutritional risk instrument is reported. Results Based on the results of the 2008/2009 survey, 34% of Canadians aged 65 or older were at nutritional risk. Women were more likely than men to be at risk. Among people with depression, 62% were at nutritional risk, compared with 33% of people without depression. Level of disability, poor oral health, and medication use were associated with nutritional risk, as were living alone, low social support, infrequent social participation, and not driving on a regular basis. Lower income and education were also associated with nutritional risk. Interpretation Nutritional risk is common among seniors living in private households in Canada. The characteristics of people most likely to be at nutritional risk provide evidence for targeted screening and assessment. [ABSTRACT FROM AUTHOR]

The 2007 to 2009 Canadian Health Measures Survey (CHMS) collected directly measured physical activity on seven consecutive days for a representative sample of the population aged 6 to 79. Based on the CHMS, half of the active minutes in a day are accumulated between 11:00 a.m. and 5:00 p.m. For children, the most active period is lunch-time (11:00 a.m. to 1:00 p.m.), and for teenagers aged 15 to 19, the after-school period (3:00 p.m. to 5:00 p.m.). Children and youth are more active on weekdays than on weekends. Active children and youth tend to accumulate more minutes of moderate-to-vigorous physical activity after school, whereas active adults do so at lunch time. [ABSTRACT FROM AUTHOR]

The accurate measurement of time devoted to physical activity, sedentary pursuits and sleep is diffi cult and varies considerably between surveys. This has implications for population surveillance and understanding how these variables relate to health. Methods This sample of children (n = 878) was from the 2007 to 2009 Canadian Health Measures Survey. Moderate- to-vigorous physical activity (MVPA), sedentary behaviour and sleep duration were assessed using both a questionnaire and an accelerometer. This article compared parentreported and directly measured physical activity, sedentary behaviour and sleep, and examined their associations, alone or in combination, with selected health markers in children aged 6 to 11. Results According to parent reports, the children in this study had an average of 105 minutes of MVPA, 2.5 hours of screen time and 9.7 hours of sleep per day; accelerometers recorded 63 minutes of MVPA, 7.6 hours of sedentary time and 10.1 hours of sleep per day. MVPA, measured by parent-report or accelerometry, was signifi cantly associated with body mass index. In a regression model, directly measured MVPA and sleep were signifi cantly associated with body mass index, and directly measured MVPA was signifi cantly associated with waist circumference. Parent-reported screen time approached a signifi cant association with body mass index. Interpretation Time estimates and associations with health markers varied between parent-reported and directly measured physical activity, sedentary behaviour and sleep in children. These differences are important to understand before the two measurement techniques can be used interchangeably in research and health surveillance. [ABSTRACT FROM AUTHOR]

According to the 2004 Canadian Community Health Survey--Nutrition, Canadians consumed an average of 110 grams (26 teaspoons) of sugar a day, approximately 20% of their total energy intake. While over 30% of this sugar came from vegetables and fruit, 35% came from the "other" foods category, which consists of items such as soft drinks, salad dressings and candy. The top ten sources of sugar accounted for approximately 85% of daily sugar intake. Beverages (milk, fruit juice, fruit drinks and regular soft drinks) represented 44% of the sugar consumed by children and adolescents, and 35% of that consumed by adults. Diabetics' average sugar intake was less than that of non-diabetics, but at 17%, exceeded the recommended 10% cut-off of total daily calories. [ABSTRACT FROM AUTHOR]

Background Osteoporosis is a bone disease that predisposes to fractures. Sufficient intake of calcium and vitamin D is recommended for prevention and treatment. Data and methods Based on 28,406 respondents aged 50 or older to the 2009 Canadian Community Health Survey (CCHS)--Healthy Aging, the population who reported being diagnosed with osteoporosis is profiled. Analysis of calcium and vitamin D intake is based on 10,879 respondents aged 50 or older to the 2004 CCHS--Nutrition. Frequencies, averages and cross-tabulations were produced to estimate the prevalence of diagnosed osteoporosis, dietary intake of calcium and vitamin D, the use of supplements, and total calcium and vitamin D intake. Associations between a diagnosis of osteoporosis and socio-economic, dietary and lifestyle factors were examined with multiple logistic regression. Results In 2009, 19.2% of women and 3.4% of men aged 50 or older reported having been diagnosed with osteoporosis; the 2004 rates were similar. Age, sex and household income were associated with the probability of reporting osteoporosis. In 2004, based on dietary and supplement intake, 45% to 69% of the population aged 50 or older had inadequate intake of calcium, and 54% to 66% had inadequate intake of vitamin D. Interpretation A large percentage of people aged 50 or older, particularly women, have osteoporosis. The prevalence of inadequate intake of calcium and vitamin D is relatively high. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Rising obesity rates and declining fitness levels have increased interest in understanding what underlies these trends. This article presents the first directly measured data on physical activity and sedentary behaviour on a nationally representative sample of Canadians aged 20 to 79 years. Data and methods Data are from the 2007 to 2009 Canadian Health Measures Survey (CHMS). Physical activity was measured using accelerometry. Data are presented as time spent in sedentary, light, moderate and vigorous intensity movement as well as steps accumulated per day. Results An estimated 15% of Canadian adults accumulate 150 minutes of moderate-to-vigorous physical activity (MVPA) per week; 5% accumulate 150 minutes per week as at least 30 minutes of MVPA on 5 or more days a week. Men are more active than women and MVPA declines with increasing age and adiposity. Canadian adults are sedentary for approximately 9.5 hours per day (69% of waking hours). Men accumulate an average of 9,500 steps per day and women, 8,400 steps per day. The 10,000-steps-per-day target is achieved by 35% of adults. Interpretation Before the CHMS, objective measures of physical activity and sedentary behaviour were not available for a representative sample of Canadians. The findings indicate that 85% of adults are not active enough to meet Canada's new physical activity recommendation. [ABSTRACT FROM AUTHOR]

Background To calculate total intake of a nutrient and estimate inadequate intake for a population, the amounts derived from food/beverages and from vitamin/ mineral supplements must be combined. The two methods Statistics Canada has suggested present problems of interpretation. Data and methods Data collected from 34,386 respondents to the 2004 Canadian Community Health Survey?Nutrition were used to compare four methods of combining nutrient intake from food/ beverages and vitamin/mineral supplements: adding average intake from supplements to the 24-hour food/beverage recall and estimating the usual distribution in the population (Method 1); estimating usual individual intake from food/ beverages and adding intake from supplements (Method 2); and dividing the population into supplement users and non-users and applying Method 1 or Method 2 and combining the estimates based on the percentages of users and non-users (Methods 3 and 4). Results Interpretation problems arise with Methods 1 and 2; for example, the percentage of the population with inadequate intake of vitamin C and folate equivalents falls outside the expected minimum-maximum range. These interpretation problems are not observed with Methods 3 and 4. Interpretation Interpretation problems that may arise in combining food and supplement intake of a given nutrient are overcome if the population is divided into supplement users and non-users before Method 1 or Method 2 is applied. [ABSTRACT FROM AUTHOR]

According to results from the 2004 Canadian Community Health Survey--Nutrition, Canadians get an average of 132 milligrams of vitamin C a day from food. About one adult in five has inadequate dietary intake of vitamin C. A third of Canadians take vitamin C supplements, which add 100 milligrams to total average daily intake. Supplement use lowers the overall percentage of adults with inadequate intake by 5 percentage points to 17%. Smokers, people who eat fruit and vegetables infrequently, and members of households with low income and low educational attainment tend to have relatively low vitamin C intake. [ABSTRACT FROM AUTHOR]