Adult khibai’til

Praatbs in the

Unitmi States and

Canada

The prevalence levels of 12 health

practices in the United States and Canada

are compared in this study smoking;

drinking status; average daily alcohol

consumption; physical activity; eating

breakfast; use of seatbelts and child

safety restraints; ownership of smoke

detectorq recency of blood pressure

checks, breast examinations, and Pap

tests; and practice of breast selfexamination. Data for two additional

variables—drinking and driving and blood

pressure awareneas—are shown for the

two countries, but the statistics cannot be

strictly compared. Data are presented for

four age groups by sex and for three

levels of education. Trends in smoking

and seatbelt use between 1979 and 1985

are also discussed.

Comparativesnd Intemstiomd

vii and H@8tth$tStiStiCS

Raports

Series5, No. 3

DHHS Publication No. (PHS) 88-1479

U.S. Department of Health and Human

Services

Public Health Service

Centers for Disease Control

National Center for Health Statistics

Hyattsville, Md.

May 1988
1 1

Copyright information

All material appearing In this report is in the publlc domain and may

be reproduced or copied without permission; citation aa to source,

however, is appreciated,

@&National Center for Health Statistics, T, Stephens and C. Schoenborn,

1988. Adult health practices in the United States and Canada. Vifa/

.wrd Hea/th Statistics. Series 5, No, 3. DHHS Pub. No. (PHS)

88-1479. Public Health Service. Washington: U.S. Government

Printing Office.

Library of Congress cataloging-in-publication data

Stephens, Thomas

Adult health practices in the United States and Canada

(Vital & health statistics. Serjes 5, Comparative international “Ital

and health atatistlcs reports ;

no, 3) (DHHS publication ; no. (PHS) 88-1 479)

8ibliographv p.

Supt. of Dots. no.: HE 20.6209:5/3

1. Health behavior— Untted Statea-Statistics.

2. Health behavior—Canada—Statistics. 3. Health

behavior— United States— History-20th century

4. Health behavior—Canada— Histo~—20th century.

5. Health surveys-United States. 6. Health surveys—

Canada. 7. United Statea— Statlstlcs, Medical,

8. Canada—Statistics, Medical. 1. Schoenborn,

Charlotte A. Il. National Canter for Health

Statistms (U. S.) Ill. Title. IV. Series: Vital

and health statistics. Series 5, Comparative

International vital health statistics reports ; no, 3.

V. Series DHHS publication ; no. (PHS) 88–1 479.

[DNLM: 1. Attitude to Health—Canada—statistics.

2. Attitude to Health— UnJted States—statistics.

3. Health Surveys-Canada. 4, Health Surveys-United

States. 5. Public Health—Canada—statistics.

6. Public Health—United States—statistics.

W2 A N148ve no.3]

RA407.3. S74 1988 362.2’097 86-1539

IS8N &840&0386-6

For sale 1)7 the Superinteu!lehl of l)owrnonl:, T;,S tl,, ~-ernment Printinc Offir(,, W:lshinxton, D C. ‘20402
National Center for Health Statistics

Manning Feinleib, M.D., Dr.P.H., Director

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for Analysis

and Epidemwlogy

Gail F. Fisher, Ph.D., Associate Din?ctorfor Planning and

Extramural Programs

Peter L. Hurley,Associate Din?ctorfor VW and Health

Statistics Systems

Stephen E. Nieberding,Associate Din?ctorfor Management

George A. Schnack,Associate Ditvctor for Data Processing

and Services

Monroe G. Sirken, Ph.D., Associate Director for Reseamh

and Methodology

Sandra S. Smith, Information Officer

Division of Health Interview Statistics

Owen T. Thornberry, Jr., Ph.D., Director

Deborah M. Wirm, Ph.D., Deputy Dixctor

Gerry E. Hendershot, Ph.D., Chie$ Illness and Disability

Sta&ics Branch

Robert A. Wright, Chie$ Utilization and Expenditure

Statistics Branch

Stewart C. Rice, Jr., Chiej Swvey Planniag and

Development Branch

Nehna B. Keen, Chiej Systems and ProgrammingBranch

Coop.mrdmof the U.S.Bureauof CUnder the legislation establishhrg the. Natiorraf Health Interview Survey, the

Pubfic Heafth SeMce is authorized to use, insofar as possible, the serviees or

facilities of other Fede@ State, or private agencies.

‘In mordmee with specifimtiorrs eat.abfished by the DivMon of Health

Interview Statistics, the U.S. Bureau of the Cemrs, under a emrtrrtctual

~gement, ptmticipated in pL3unirrgthe Nnrionaf Health Iuterview Survey and

rmlfecling the data
Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Scope of the report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

I Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Sources of 1985 data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Sources of 1979 data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Differences in the national populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Prevalence of health practices, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Smoking

7

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Alcohol use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Physical activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Daily breakfast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Seatbelts and child restraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Smoke detector ownership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Most recent blood pressure check... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Blood pressure awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Breast examination

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

. ..0..... . . . . . . . . . . . . . . . . . . . ...,,0.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Most recent Pap smear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Trends in selected health practices, 1979-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Smoking

17

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Seatbelt use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Discussion of results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

General methodological issues .,.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2CI

Summary of U.S.-Canada differences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2CI

Demographic patterns in healthpractices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

The value ofcomparative studies ofnational populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Conclusion . . . . , . . . . . . . . , . . . . . , . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . . . . . 26

List of detailed tables . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Appendixes

L TechnicaJ notes on methods . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . 37

IL Definition ofterms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

III. Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

...

Ill
List of text figures

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Percent of the adult population who were current smokers, by agti United States and Canada, 1985 . . . . . . . . . .

Percent of the adult population who were current drinkers, by age United States and Canada, 1985 . . . . . . . . . .

Percent of adult drinkers who on the average consumed 1.0 ounces or more daily of absolute alcohol (2 drinks or

more), by age United States and Canada, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of the adult population who drove after drinking, by age United States and Canad% 1985 . . . . . . . . . . . .

Percent of the adult population who were reg@rly active in leisure-time sports, by age United States and

Canad% 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of the adult population who rarely ate breakfast, by age United States and Canad% 1985 . . . . . . . . . . . .

Percent of the adult population who usually wore seatbelts, by age United States and Canada, 1985 . . . . . . . . . .

Percent of the adult population who owned 1 smoke detector or more, by age United States and Canada,

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of the adult population with a blood pressure test within the past 12 months, by age United States and

Canad~ 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of the adult female population with a breast examination within the past year, by age United States and

Canada, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of the adult female population with a Pap smear within the past 3 years, by age United States and

Canada, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Changes in percent of the adult population who were current smokers, by age and sex United States and Canada,

1979 and 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Changes in percent of the adult population who usually wore seatbelts, by age and sex United States and Canada,

7

8

9

9

10

11

12

13

13

15

16

17

1979 and 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

List of text tables

A. Population comparison: percent distribution of adults by educational levels, according to sex and age United

States and Canada, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

B. Population comparison percent distribution of adults by age, according to educational levels: United States and

Canada, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

c. Selected population characteristics United States and Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

D. Safety restraints percent distribution of children by frequency of restraint use, according to parents’ educational

levels United States and Canada, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...0 . . . . . . . . . . . . . . . . . . . . ., 12

E. Blood pressure awareness percent of adults in the United States who were aware that hypertension increases the

chances of heart disease and percent of adults in Canada who were aware of the need for blood pressure testing

in the absence of symptoms, by se> age, and educational levels United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . 14

F. Breast examination: percent distribution of women by frequency of breast self-examination, according to age and

educational Ievekx United States and Canada, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

G. Summary of health practices in the United States and Canada, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Symbols

--- Data not available

. . . Category not applicable

. Quant.~ zero

0.0 Quant’~ more than zero but less than 0.5

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

* Figure does not meet standard of

reliability or precision (more than 30

percent for United States or 33 percent

for Canada relative standard error)

# Figure suppressed to comply with

confidentiality requirements

iv
Acknowledgments

This report is the result of a collaborative effort by

individuals in the United States and Canada. The Canadian

tabulations were prepared by Prem Khosla, Analytical Services Division, Health and Welfare Canada, Irving Rootman, Health Promotion Directorate, Health and Welfare

Canada, arranged for the data processing and reviewed an

earlier version of the manuscript. The U.S. tabulations

were produced in the Office of Analysis and Epidemiology,

National Center for Health Statistics, by Ildy Shannon.

The National Health Interview Survey of Health Promotion and Disease Prevention was the collaborative effort

of a number of Federal agencies. The following agencies

provided partial funding andfor participated in the planning

and development of the questionnaire:

Department of Health and Human Services

Public Health Service

Office of the Assistant Secretary for Health

Office of Disease Prevention and Health Promotion

Office on Smoking and Health

The President’s Council on Physical Fitness

and Sports

Alcohol, Drug Abuse, and Mental Health Administration

National Institute on Alcohol Abuse and Alcoholism

National Institutes of Health

National Heart, Lung, and Blood Institute

National Cancer Institute

National Institute of Dental Research

National Institute of Child Health and Human

Development

Health Resources and Services Administration

Centers for Disease Control

Center for Prevention Services

Center for Infectious Diseases

Center for Environmental Health

Center for Health Promotion and Education

National Institute for Occupational Safety and

Health

Food and Drug Administration

Bureau of Foods

Department of Transportation

Office of Driver and Pedestrian Research

v
Adult Health Practices in

the United States and

Canada

by Thomas Stephens, Ph.D., Consultant in

social epidemiology and survey research,

Manotick, Ontario, Canada, and

Charlotte A. Schoenborn, M.P.H, National

Center for Health Statistics, Divisionof

Health InterviewStatistics

Introduction

Objectives

This report compares the 1985 prevalence levels of

several important health practices in the United States and

Canada and trends in two practices between 1979 and 1985

in both countries. The comparison is mainly a descriptive

one, although in many instances it is possible to suggest

possible reasons underlying differences in prevalence rates.

The objective for presenting these data is to provide a new

perspective for those engaged in health promotion.

Systematic comparisons in health practices between

two countries have not previously been available. Because

there are important similarities in the data collection methods and in the populations under study in this report, the

comparisons reported here should be little affected by

systematic error. Thus it should be possible, at least at a

general level, to compare the impact on health practices of

policies and programs in the two countries (for example, a

universal public health insurance system, seatbelt legislation, and high blood pressure education). Another advantage of intercountry comparison is that it allows

examination of demographic trends, such as the relationship between education level and health practices, in two

populations.(The relationship between level of education

and health practices is not only confirmed, but shown to be

much stronger in the United States,) Finally, these U.S.-

Canada comparisons of health practices should suggest

important avenues for further research with practical application. For example, there is no ready explanation for the

higher Canadian consumption of alcohol and tobacco, suggesting that ethnocultural factors may deserve further examination.

Scope of the report

The prevalence levels of 12 health practices are compared in this study smoking drinking status; average daily

alcohol consumption; physical activity eating breakfast use

of seatbelts and child safety restraints; ownership of smoke

detectors; receney of blood pressure checks, breast examinations, and Pap test~ and practice of breast

self-examination. These are all the practices for which

comparable data exist for 1985, the date of the most recent

comprehensive survey in each country. Data for two additional variables-drinking and driving and blood pressure

awareness-are shown for the two countries, although the

statistics cannot be strictly compared because the questions

in the two surveys measured slightly different aspects of the

behavior. By virtue of their relationship to morbidity and

mortality, these are the most important health practices to

study. For most practices, prevalence is presented for four

agegroups for each sex and for three levels of education.

Trend data for 1979 and 1985 are provided for smoking

and seatbelt use. These practices are the only ones for

which comparable data exist for the same two time points in

the United States and Canada.

1
Highlights

. There were fewer smokers per capita in the United

States than in Canada in 1985, Thirty percent of U.S.

adults smoked cigarettes, compared with 35 percent in

Canada. This difference was especially pronounced

among the young (ages 18-24 years) of both sexes.

Between 1979 and 1985, most age-sex groups in both

countries had reduced their levels of smoking.

. There was a higher proportion of drinkers in Canada

(82 percent) than in the United States (65 percent);

this difference was most marked among women (78

and 56 percent, respectively). Canadian drinkers were

also more likely than Americans to have an average of

two drinks or more (1 ounce or more of ethanol) daily.

. participation in regular sports or exercise was claimed

by 40 percent of adult Americans. This was 13 percentage points lower than the prevalence of regular activity

in Canada.

. Regular use of seatbelts and car restraints in the

United States in 1985 was less than half that of Canada.

The largest international difference was among those

with less than a high school education. Canadians in

this category were three times more likely to use

seatbelts than their U.S. counterparts. Both countries

showed marked improvements between 1979 and 1985

in the proportion of the population usually wearing

seatbelts, increasing by 16 and 18 percentage points in

the United States and Canada, respectively.

● A smaller percent of Americans than Canadians owned

smoke detectors in 1985:69 compared with 77 percent.

. About three-quarters of adults in both countries had

had a blood pressure check within the past 12 months.

Both populations displayed fairly high levels of basic

knowledge about hypertension.

● About 50 percent of women in the United States had

had a breast examination by a doctor or nurse within

the past 12 months; the corresponding figure for Canada was 69 percent.

. U.S. women were less likely than Canadian women (32

and 41 percent, respectively) to practice breast selfexamination on a monthly basis.

● The prevalence of Pap smear tests within the last 3

years was similar in both countries, at about three of

every four women.

● Although prevalence rates often vary between the

United States and Canada, relationships between

health practices and level of education were similar in

the two countries. Educational differences in health

practices were particularly strong in the United States.

Good health habits–not smoking regular physical

activity use of seatbelts and car restraints ownership

of smoke detectors; and regularity of breast examination, Pap smear, and breast self-examination-were

more common among better educated groups in both

countries. Of good health habits, only blood pressure

checks were unrelated to level of education. Current

drinking was the only apparently unhealthy habit found

to be associated with more education.

● Age-sex patterns also showed similarity between the

United States and Canada. In both countries, women

and older adults were likely to have somewhat better

health habits than were men and younger adults. The

exceptions, however, may be important, such as the

lower rates of seatbelt use by older compared with

middle-aged Americans and the similarity in drinking

prevalence among young Canadian men and women.
In this report, prevalence data horn two 1985 health

practice surveys are compared for the United States and

Canada. Furthermore, these data and data from similar

surveys conducted in 1979 are used to compare trends in

both countries. The major concern when making the international comparisons was to ensure that there was sufficient similarity in the methods of the surveys to rule out any

systematic bias. A brief description of the techniques employed in the four surveys is provided in this section, with

additional details in appendix I. Definitions of terms used in

this report are provided in appendix IL Question wording is

described in the appropriate section of the results, and the

instruments for the 1985 surveys are reproduced in appendix III.

Sources of 1985 data

The principal sources of data for this study were two

large population surveys carried out at approximately the

same time, with similar methods and subject matter and

nearly identical sample designs (NCHS, 1986% Health and

Welfare Canada, in press). The U.S. data are fkom the 1985

National Health Interview Survey (NHIS) of Heakh Promotion and Disease Prevention (HPDP). NHIS is conducted by the National Center for Health Statistics, with

field work carried out by the U.S. Bureau of the Census.

The Canadian data originate from Canada’s Health Promotion Survey, carried out by Statistics Canada for Health and

Welfare Canada. Both surveys were intended to monitor

health practices in their respective populations and to

provide data for planning health promotion activities; both

are scheduled to be repeated in 1990.

A number of important similarities exist between the

U.S. and Canadian surveys. These arose not so much from

coordinated planning as from shared objectives and a common understanding about the best means to collect data on

these topics. The most important area of similarity involves

the target populations. In both cases these were the adult,

national, civilian noninstitutionalized populations. One

adult per family was selected in the U.S. survey, and one

per household was selected in Canada. Response rates

were high for both surveys-90 percent in tie United States

and 82 percent in Canada.

In the United States, 33,630 persons age 18 years and

over living in approximately 35,000 NHIS sample households participated. In Canada 11,181 persons age 15 years

and over living in 13,649 households were interviewed.

Data presented in this report have been weighted to reflect

the 1985 populations in the two countries, and these

weights have been adjusted to take into account persons

selected but not participating in the survey. The average

weight (or number of persons represented by each sample

person) is 5,085 for the U.S. survey and 1,752 for the

Canadian survey.

The principal difference between the methods of these

two surveys was in the data collection process. Although the

survey respondent was interviewed at home in both cases,

the interview was conducted in person in the United States

and by telephone in Canada. This has two implications for

the results, both of them probably minor in impact. First,

some survey practitioners believe that greater candor and

accuracy are obtained in telephone responses (Marcus and

Crane, 1986). However, the survey subject matter was not

found to be particularly sensitive for most people, and any

advantages or disadvantages of telephone data collection

are likely to be minor. Second, the telephone technique

used in Canada naturally excluded households without

telephones. This amounts to only 3 percent of households.

The inhabitants of these households were disproportionately young, unemployed males (Health and Welfare Canada, 1985). Because the data in this report are presented by

sex and age group and because sample weights are adjusted

for these and other characteristics, the impact on the

comparisons should be minimal.

All data presented in this report are from the public

use microdata tapes available from the respective survey

sponsors (Health and Welfare Canada, 1985; NCHS, unpublished). Where differences are described in the results

section, these have been assessed by t-test and are significantly different with p <.05.Appendix I describes how the

standard errors were calculated for this purpose.

Sources of 1979 data

Health surveys had been carried out routinely in the

United States prior to 1985 and at irregular intervals in

Canada. Only a limited number of surveys have collected

information consistently over time, and only in 1979 were

there surveys in the United States and Canada that collected data on health behaviors similar to those found in the

1985 surveys. (In the United States, the 1977 and the 1983

3
National Health Interview Sufveys also included questions

on health practices.)

Wave I of the National Survey of Personal Health

Practices and Consequences (NCHS, 1981,, 1982) was-a

telephone survey of 3,025 persons who constituted a probability sample of U.S. adults ages 20-64 years living in

households. Data collection was carried out by a research

contractor in the spring of 1979, and the response rate was

about 81 percent. The disproportionately high number of

women in the responding sample does not present a problem for this report because the data are shown separately

for each sex.

The. Canadian data for 1979 are from the Canada

Health Survey (Health and Welfare Canada and Statistics

Canada, 1981; Statistics Canada, unpublished). This was a

multimethod survey, employing an in-person interview,

self-completed questionnaire, physical measurements, and

blood sampling, carried out in the home. The data reported

here are from the self-completed questionnaire; questionnaires were completed by 23,791 persons ages 15 years and

over (15,239 ages 20-64 years). Data collection extended

from July 1978 through March 1979, and the design consisted of a national probability sample of households in

which all members within the appropriate age limits were

selected for participation. The response for the questionnaire was 87 percent of those in interview households.

4
Differences in the

national populations

Although data in this report are presented by age, sex,

and educational level, it is important to compare the composition of the U.S. and Canadian populations for characteristics that may affect the comparisons of health practices.

Table A shows the distribution of the two national

populations by age-sex groups and educational levels. The

education distributions of the two countries are quite different: Overall, Canadians were about 10 percentage points

less likely to have a high school diploma. The proportion

with college or university education, however, was very

similar (about 37 percent) in the two countries. This applies

equally to men and women, but not to all age groups.

Young Americans (ages 18-24 years) are less likely than

their Canadian age peers to be college educated, while the

reverse holds for ages 35-64 years-a fact to be remembered when making age-specific comparisons between the

two countries.

When interpreting educational differences shown in

this report, the age composition of each of the education

groups should be kept in mind (table B). Americans with

less than a high school education are skewed toward the

older age groups, relative to their Canadian counterparts,

who have a higher proportion in the middle age groups.

Among college graduates, the Canadians have somewhat

higher proportions in the younger age groups than do

i%uerican graduates.

In addition to these differences in age and education,

there are other contrasts between these two countries that

serve as a context for interpreting the results in this report.

Some of these are shown in table C. The United States is

the fourth most populous nation on earth, with a population almost. 10 times that of Canada. Moreover, because the

land mass of Canada is the second largest in the world, the

difference in population density is vast-Canada’s being

one-fifteenth that of the United States.

Differences in ethnocultural characteristics between

the United States and Canada are also apparent. Twelve

percent of U.S. adults are black and 85 percent are whitq in

Tablo A. Population comparison: percent distribution of adults by educational levels, according to aex and age: United States and

Canada, 1985

H@hschool

Totet Not conrpfeted Completed College or unkwsity

United United United United

Sex and age stares Canada States C2urada states Canada states Canada

Percent dletribution

Allpersons layearsend over . . . . . . . . . . . . 100.0 100.0 24.3 34.4 39.0 28.7 38.7 38.9

Men

Allagw . . . . . . . . .. o. . . . . . . . . . . . . . . KKr.o 100.0 23.8 33.3 35.7 27.0 40.5 39.7

18.19 p . . . . . . . . . . . . . . . . . . . . . . . . 100.0 lW.O 30.0 32,8 53.7 32.3 16.3 35.1

~24w . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 14.5 19.9 42.4 30.3 43.1 49.9

25-34 yaare . . . . . . . . . . . !........ . . . . 100.0 lCQ.O 12.1 19.3 38.5 31.6 49.4 49.1

35-44 yaar3 . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 14.0 28.0 34.3 33.5 51.6 40.5

4!M4yaers. . . . . . . . . . . . . . . . . . . . . . . . 100.0 lCO.O 28.9 40.5 32.2 20.4 40.9 39.2

S5-64yaars . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 34.5 53.1 33.4 19.1 32.2 27.6

85-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . Ico.o 100.0 45.1 59.4 31.0 17.1 23.9 23.4

75yaareand over . . . . . . . . . . . . . . . . . . . . 100.0 100.0 84.7 66.3 17.2 16.3 18.2 17.4

Women

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 24.7 35.5 42.0 ~.2 33.3 34.2

16-19 Yws.. . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 30.2 14.7 54.8 46.4 15.0 36.9

W24~ . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 14.6 17.2 43.6 31.4 41.8 51.4

2!H4yaarS. . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 13.4 18.3 426 35.9 44.1 45.6

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 15.5 31.5 43.4 31.5 41.1 37.0

45-54 years . . . . . . . . . .. $...... . . . . . . 100.0 100.0 25.3 49.2 45.4 28.3 29.3 22.6

!w34yeers. . . . . . . . . . . . . . . . . . . . . . . . lCQ.O 100.0 31.7 53.8 43.9 28.4 24.4 17.8

85-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 42.7 80.7 37.1 18.5 20.2 20.8

75yeers6nd over . . . . . . . . . . . . . . . . . . . . 100.0 100.0 57.8 88.0 23.9 14.5 18.3 19.4

5
Table B. Population comparison: percent distribution of adults by age, according to educational level= United States and Canada, 1985

H@h school

Tots/ Not completed Completsd Coltege or unh.wslly

UnMd Unksd Urdted LJnnsd

Age states Canada States Canada states Canada states Canada

Percent dlsttibution

Allperson 18yesraand over . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0 ICQ.O 100.0

16-19 years . . . . . . . . . . . . . . . . . . . . . . . . 4.3 4.4 5.3 3.0 5.9 6.0 4.3

20-24 years . . . . . . . . . . . . . . . . . . . . . . . . 11.8 13.0 7.1 7.0 13.0 13.9 12 17.8

25-34years . . . . . . . . . . . . . . . . . . . . . . . . 23.8 24.2 12.5 13.2 24.8 28.5 30.3 31.2

35-44years . . . . . . . . . . . . . . . . . . . . . . . . 18.4 19.2 11.2 16.0 18.4 21.2 23.1 20.2

4554yeara . . . . . . . . . . . . . . . . . . . . . . . . 13.1 13.7 14.0 17.9 13.1 11.6 12.4 11.4

55-64years . . . . . . . . . . . . . . . . . . . . . . . . 12.9 12.4 17.5 19.2 12.9 10.3 9.9 7.6

6!5-74years . . . . . . . . . . . . . . . . . . . . . . . . 9.7 8.6 17.5 15.3 8.6 5.5 5.8 5,2

75yearsendover . . . . . . . . . . . . . . . . . . . . 8.0 4.3 14.9 8.3 3.3 2.3 3.0 2.2

Table C. Selected population characteristicw United States and

Canada

Charactetistbd UrrK9d States Canada

Total resktent population.. . . . . . . . . .

Population densily, persons per square

kilometer . . . . . . . . . . . . . . . . . . .

Average annual population growth

rate, percent, 1980-65-U.S.;

1961–66-Canada . . . . . . . . . . . . . .

Percapilaincome, U.S.dollars. . . . . . .

Life expectancy at birth:

Males . . . . . . . . . . . . . . . . . . . . .

Femafes . . . . . . . . . . . . . . . . . . .

Infant mortality,deaths psrl,o(k)ltve

births. . . . . . . . . . . . . . . . . . . . . .

EIderiydepandencyratb, lOS1.. . . . . .

Percent of all deaths due to

Heartdisease . . . . . . . . . . . . . . . .

Cancer . . . . . . . . . . . . . . . . . . . . .

Trafficaccktents . . . . . . . . . . . . . . .

Physicians perl0,000population. . . . . .

Percapita heatth care expenditures, U.S.

dolla&1983-U.S.; 1961-Canada . .

23S,740,000

39.3

.s13,::

71.2

76.2

10.6

14.3

37

22

2

21.3

$1,504

Z25,354,~

2.5

$11,5%

71.3

79.6

7.9

17.3

26

26

3

18.8

$1,001

lDataarefor1985 unless otherwise Indlcatad.

219fj&

SourceSHealIhand WelfareCanadELl 08Zeeereference list. NationalC.enter

for Health StafIstlcs, 198i7 see reference list. Statkstlcs Canada, 126Z Stattstlcs

Canape, Health Divlsbn, 1985 and 196Zsee reference list. U.S. Bureau of the

Census, 198Z sea reference I!st.

Canada, the white population accounts for over 98 percent

of the total. Although the majority of the white population

in both countries derives from Europe, in Canada 25

percent speak French as their first language and the country is officially bilingual. Partly as a consequence of this ,

large population of French background, a larger proportion

of Canadians than Americans is Roman Catholic (47 and

33 percent, respectively) and a smaller proportion is Protestant (41 and50percent, respectively).

Despite these differences in population composition,

both countries have been similarly exposed to demographic

forces such as aging of their populations and increases in

the elderly dependency ratios over the last 25 years (Statistics Canada, 1987). There are also similarities in the organization of the health care systems, based on a feefor-semice method of payment that is conducive to the use

of highly technieal and specialized services. A major difference, however, is the existence of a universal health insurance system in Canada that provides coverage for hospital

and physician care. As a percent of gross national product,

in 1985 Canada spent 8.8 percent on health carq the

comparable figure for the United States was 10.7 percent.

Life expectancy at birth is the same for males in both

countries, but is 1.4 years higher for females in Canada

than in the United States (table C). The increase for both

sexes over the past 5 years has been greater in Canada,

where the infant mortality rate is also lower, by 2.7 per

1,000 live births (Statistics Canada, 1987). The major

causes of death are heart disease and cancer in both

countries; however, heart disease accounts for a higher

proportion of all deaths in the United States and cancer is

less common than in Canada.

6
Prevalence of health

practices, 1985

Consistency of definition was the overriding consideration in carrying out the analyses for this study, As a result,

the findings for either survey in this report may be less

detailed than those available elsewhere and represent just a

fraction of the variables covered by each survey. However,

it is possible to make comparisons on several important

health practices.

A common format has been adopted for the presentation of results. For most of the health practices, a figure

compares the prevalence of the principal category of interest for four age groups for men and women in the United

States and Canada. A detailed table provides the data for

additional categories and for three levels of education. In a

few cases, text tables are used where a figure is not

appropriate for displaying the data, and there is no corresponding detailed table. Where differences are noted and

discussed in the text, these have been found statistically

significant (probability of the differences being due to

sampling error is no greater than 5 percent, and is usually

no larger than 1 percent). The method for testing the

difference between proportions is explained in appendix I.

All data are, of course, cross-sectional in nature. Thus

the frequently observed associations between health practices and chronological age may be due to maturation

processes, generational effects, selective survival, or a combination of these and other factors, The current data are

not adequate for distinguishing among these possible explanations.

Smoking

Of all the health practices one might consider studying

in a population, cigarette smoking is undoubtedly the most

important. Although substantial declines have been re-

.ported in recent years (Collishaw, 1987; NCHS, 1986b),

smoking remains the number one cause of preventable

death and disease (Richmond, 1979). A comparison of

rates in the United States and Canada may shed some light

on the relative success of policies employed to limit smoking in these two countries.

Current smokers were more prevalent in Canada (35

percent) than in the United States (30 percent). The United

States had a smaller proportion of smokers in most age

groups for both sexes and at all three levels of education

(table 1). The most pronounced differences were among

women and those 18-24 years of age (figure 1). Young men

and young women were more likely to be current smokers

60

1

~ UnitedStatesmen

~ UnitedStstes wxnen

10

1

Q~

1S-24 2s-44 4s-64 65 and wer

Age in years

SOURCES caned= Canada’sHedUIRun&m Suvey, 19tW(kited States Nah)el

HealrhInten’iawsurvey,19s5.

Fkwe 1- Percent of the edult po@e60n who were current dgarette

emok~ by ege: United States end Cenec4 19S5

in Canada than in the United States, by about 10 percentage points.

Despite these systematic differences between the populations of the two countries, the relationships between

smoking, age, and sex were similar in both countries.

Overall, men were more likely than women to be smokers,

except at 18-24 years of agq in this group women were

more likely to smoke than men in the United States and in

Canada. Also seen in both countries was a drop in the

proportion of smokers with increasing amounts of education, although in Canada the drop was observed only in the

college-educated group. The highest rate of smoking by

7
men was at ages 25-44 years in both countries, after which

there was a steady decline. A&ong women, however, there

was a noteworthy difference. Although female smokers

were about equally prevalent in all age groups up through

age 64 years in the United States, in Canada they were

more prevalent at ages 18-24 years, and progressively less

prevalent in older age groups. In fact, young Canadian

women had the highest proportion of smokers (41 percent)

of any age-sex group in the two countries.

Discussz’on-For both surveys virtually identical questions were used, with the exception that more detail was

collected on nonsmokers in the United States. The questions are well established, having been used with minor

variations in both countries for many years. The more

favorable rates in the United States maybe attributable to

more antismoking public education, the profile given this

issue by the U.S. Surgeon General, and more extensive

restrictions on smoking in public places such as restaurants

and airplanes. In both countries similar prohibitions exist

on advertising tobacco products in the mass media. The fact

that more women than men smoke only at ages 18-24 years

suggests that the recent targeting of young women by

cigarette manufacturers (Ernster, 1985) is experiencing

some success in both countries.

Alcohol use

The use of alcohol may be second only to smoking in

the attention it receives from regulators and health educators. As with smoking, a comparison of the prevalence of

alcohol consumption in the United States and Canada may

reveal something about the effectiveness of each country’s

control measures.

For this purpose, individuals were classified qs current

drinkers, lifetime abstainers, and former drinkers (see appendix II for definitions of terms). As table 2 shows,

current drinkers were substantially more common in Canada (82 percent) than in the United States (65 percent), a

difference that was found in every age-sex group.

Female drinkers contributed disproportionately to this

intercountry difference because they were more prevalent

in Canada by 23 percentage points. In contrast, the prevalence of male drinkers in Canada was 10 percentage points

higher than in the United States. Young women (ages 18-

24 years) accounted for the largest difference between

countries; they were 27 percent more likely to be current

drinkers in Canada than in the United States (91 versus 64

percent) (figure 2).

In the United States and Canada, drinking was more

likely among persons under age 45 years, males, and the

well educated (table 2). Both sex differences and educational differences in drinking prevalence were greater in the

United States than in Canada.

Most Americans who were not current drinkers described themselves as lifetime abstainers (27 percent),

rather than former drinkers (8 percent) (table 2). In Canada, the lifetime abstainers accounted for a much smaller

proportion of the population than in the United States and

8

100-

90-

e41-

70-

80-

fj

!l

~ so-

%

!!

n.

40-

30-

20 -1

30

i

o----o Canadianwomen

‘~

1s+4 2s-44 6Sand over

Again yaara

Rgure2. Percent of theedukpopabam whower8wn’entdrjllk~by

agw Unbd States d Csna@ 128S

were actually outnumbered by the former drinkers. Men in

the two countries were about equally likely to be former

drinkers (9 percent), whereas Canadian women were about

twice as likely as their U.S. counterparts to have given up

drinking (12 and 6 percent, respectively).

Canada not only had a higher proportion of current

drinkers, but Canadian drinkers were slightly more likely to

be heavier drinkers (14 percent), averaging two drinks or

more daily, than their U.S. counterparts (12 percent) (table

3). In the United States, the largest proportion of heavier

drinkers was among those with less than a high school

education; in Canada, high school graduates consumed the
~ United States men

~ Unitad Stateswomen

●----O Canadian men

0---.0 Canadien women

0.. --%

‘---O-------*, \

\

\

\

\\

‘M \

‘b

‘~

16-24 2544 45-64 65 and over

Age In years

Figure3. Percent ofadult drinkers whoonthe average consurnedl.O

ounce or more dally of absolute alcohol (2 drinks or morek by age:

United States and Cenadaj 19S5

highest average daily amount of alcohol (table 3). However,

in neither country was heavier consumption typical; 86-88

percent of drinkers average less than two drinks daily. (See

also figure 3,)

Drinking and driving is a problem that has received a

vast amount of publicity in the United States and Canada in

recent years, yet adequate population statistics on the

extent of this practice have not been readily available.

Although health surveys are now starting to collect this

information, it is not yet in a consistent form that permits

ready comparison. Questions in the two 1985 surveys,

though different, shed some light on the prevalence of

drinking and driving in the two countries.

Seventeen percent of U.S. adults admitted in 1985 to

driving within the past year after “they perhaps had too

much to drink” (table 4). In Canada, 25 percent reported

they had driven in the past month “within two hours of

drinking any amount of alcohol.” Strict comparisons of

prevalence rates are ruled out by the different wording of

the questions. However, in both countries, drinking and

driving was more prevalent among men than women and

among younger adults than older persons. The only exception to this age pattern was among Canadian men; for this

group, drinking and driving was most prevalent among

those ages 25-44 years (figure 4). In both countries, driving

50 ~ United States men

1

~

United Statea women

●----- Canadian men

o----O Canadian women

1S-24 25& 45-64 65 and over

Age in years

NOIE See definitionsofdrinkinginapperdii.

Figure 4. Percent of adult drinkers who drove after drinking by agc

United States and Canadej 1985

after drinking was least likely to be reported by those with

less than a high school education.

Discussion —Question wording on type of drinker varied in the hvo surveys, producing a stricter definition of

lifetime abstainer in Canada (no drinks ever) than in the

United States (never had 12 or more drinks in any one

year). This undoubtedly explains some, but probably not

all, of the 20 percentage point greater prevalence of lifetime

abstainers in the United States. More important, the definitions of current drinker are comparable in the two surveys (at least one drink in the past 12 months). There are

no obvious differences in policies or programs to explain

the 17 percentage point higher prevalence of current drinkers in Canada. However, the higher drinking prevalence in

Canada parallels the findings for smoking-the young have

among the highest prevalence levels. This is not surprising,

considering the consistent associations between smoking

and drinking reported elsewhere (Berkman and Breslow,

1983; Stephens, 1986).

Estimates of average daily consumption are based on

reports for the last 14 days in the United States compared

with the last 7 days in Canada and are limited to current

drinkers in both cases. Other things being equal, this should

mean that the proportion of drinkers in the “none” category should be lower in the United States. As shown in

table 3, the proportion of drinkers in the “no ounces”

cat egory was 16 percentage points lower in the United

States than in Canada. Distribution across the lighter,

moderate, and heavier categories is less likely to be affected

by this difference in the reporting period. The 14-day

9
reference period probably means the U.S. data are more

stable, but the impact on aggregate statistics should be

minor.

In the case of drinking and driving, the prevalence rates

cannot be compared because the questions were markedly

different. The U.S. definition was stricter because it referred to impaired driving which the Canadian one did not.

Further, the reporting period in the U.S. question was one

year, compared with the last month in Canada. Although

these differences would affect prevalence levels, a comparison of the demographic patterns was reasonable because

the behavior under examination was similar in both surveys.

Physical activity

Leisure-time exercise is a practice with a wide variety

of possible health benefits (Powell and Paffenbarger, 1985)

and one that has apparently been taken up with enthusiasm

in both the United States and Canada (Stephens, 1987). In

the United States, the President’s Council on Physical

Fitness and Sports was initiated in 1956 to promote physical

fitness of all Americans (President’s Council on Physical

Fitness and Sports, 1987). In Canada, the Participation

organization has been promoting exercise since 1971 (Contemporary Research Centre, Ltd., 1982).

Although detailed statistics on the prevalence of rigorously defined activity have recently been published for the

United States and Canada (Schoenborn, 1986; Stephens,

Craig and Ferris, 1986a), they are not available for both

countries for the same year. As a result, figure 5 and table

5 show summary indicators for 1985 that are reasonably

comparable.

In the United States, 40 percent of adults claimed that

they exercised or played sports regularly, compared with 53

percent in Canada who reported vigorous activity for at

least 15 minutes three times or more per week (table 5).

This tendency of Canadians to be more active was true of

most age-sex groups, especially for those 45 years of age

and over (figure 5).

In Canada, there was only a small difference between

the sexes in the reported prevalence of activity at ages 18-24

years, while in the United States, men were much more

likely than women to be active at this age. In Canada,

women were more likely than men to be active at ages

45-64 years. Both populations are characterized by a decline in physical activity with increasing age, with the notable exception of an increase for Canadian men at age 65

years and over.

In both countries, leisure-time activity increased with

higher levels of education (table 5).This was especially the

case in the United States, where there was a two-fold

difference in the prevalence of activity between the lowest

and the highest educational levels. In Canada, this gradient

was much less steep.

Discussion-The physical activity questions are worded

differently in the two surveys. Although the Canadian

question appears to be stricter, it is not certain that this is

the case. A more rigorous definition of physical activity

~ Unitad States men

~ Unit9d State8 women

●----* Canadian man

o ----O Cauradlanwomen

Q~

W24 25-44 45+4 65 and ovor

*in yaars

F~re5. Percent of theadultpoprdalkw whower’8qpkdy~vairr.

Iaisuretirnq byqe United States and Canu@ 1905

based on caloric expenditure was calculated from a detailed

inventory of activities (Stephens, Jacobs, and White, 1985).

By this approach, 27 percent of U.S. adults qualified as

active in 1985—expending 3 kilocalories or more per kilogram of body weight daily (Schoenborn, 1986). The comparable figure in Canada in 1981 was 25 percent (Stephens,

Craig and Ferns, 1986a), and this is likely to have increased

during the period 1981-85, judging by trends documented

elsewhere (Stephens, 1987). Moreover, 27 percent of Canadians age 15 years and over expended 4.5 kilocalories or

more daily on physical activity in 1985, according to the

nationwide General Social Survey (Statistics Canada,

1987). All of this suggests that the general conclusion, if not

the precise quantities, of figure 5 is correct, even though

physical activity tends to be higher in June, when the

Canadian data were collected.

Daily breakfast

Although eating a good breakfast on a regular basis is a

health practice that receives little attention from health

10
L

361

5

1

~ United States men

~ United States women

*---* c~n~~~n ~~

o --—O Canadian wornan

“~

‘t6-24 65 and wer

Age in yeara

F@4re6. Percent dtheaduttpOpdatiOn whomVate~$W

●ge: United Sbtee end x 1SS5

promoters, it is nevertheless associated with better health

including lower levels of mortality (Berkman and Breslow,

1983). Whether this is due to the salutary effects of breakfast alone, or whether a regular breakfast is indicative of

generally good nutritional habits is not clear, but it is

associated with good health independent of other practices

such as smoking, drinking, and exercise.

Collecting detailed data on dietary habits is complex

“and difficult, and the approaches adopted to assess breakfast consumption in the United States and Canada in 1985

were slightly different, The U.S. survey asked about the

frequency of breakfast, and the Canadian study obtained

the weekly frequency of five broad classes of breakfast

foods. This allowed a breakfast consisting of only coffee to

be eliminated from consideration, a qualification not routinely possible with the U.S. data. (In the U.S. survey, a

coffee-only breakfast was disregarded only when the interviewer was specifically asked whether or not coffee alone

should be considered breakfast.) Because of this difference

in the definition of breakfast, as well as in the frequency

categories provided to respondents, figure 6 concentrates

on those who generally missed breakfast-the category that

can be most readily compared.

Americans were less likely than Canadians to skip

breakfast (24 percent versus 29 percent, respectively). This

difference was found across most age-sex groups, although

some were not statistically significant. U.S.-Canadian differences were most pronounced for men ages 45-64 years

and women age 65 years and over.

In both countries, younger people (ages 18-44 years)

were more likely to miss breakfast than were middle-aged

or senior adults. In the United States, there was virtually no

male-female difference in the prevalence of this practice at

any age. In Canad% men and women differed somewhat in

their breakfast habits, and these sex differences varied with

age. In the youngest and oldest age groups, women were

more likely thfi men to skip breakfast. Among Canadians

ages 45-64 years, skipping breakfast was more prevalent

among men, but no sex difference was found for persons

ages 25-44 years. The relationship between skipping breakfast and level of education found in Canada did not occur in

the United States (table 6).

Discussion-The Canadian definition specifically eliminates a breakfast consisting of coffee only. This may

account for the 4-percentage-point difference between the

United States and Canada in missed breakfasts.

Seatbelts and child restraints

Motor vehicle accidents are the fourth leading cause of

death in the United States (NCHS, 1985a) and the seventhranked cause in Canada (Statistics Canadaj 1985). These

stark facts have led to the heavy promotion of seatbelt and

child restraint use through public education and, more

recently, through legislation.

Regular seatbelt use in the United States in 1985 was

less than half that of Canada. Slightly more than one-third

of American adults reported wearing their seatbelts

“usually;’ compared with more than three-quarters of

Canadians (table 7). Large differences were found for all

age groups, both sexes, and all educational levels. The

largest contrast is for those who have not completed high

school: For these, the prevalence of regular seatbelt use in

Canada was three times that of the United States.

United States-Canada comparisons of adults who reported never wearing seatbelts mirrored those for regular

users. About one-third of U.S. adults, compared with 13

percent in Canada, reported in 1985 that they never wore a

seatbelt.

Despite these large differences, there were simihw

demographic patterns in the two countries (figure 7).

Women were more likely than men in all age groups to be

regular seatbelt users, a discrepancy that diminished

steadily with increasing age in the United States, but not

Canada. In both countries, the young (18-24 years of age)

were least likely to wear seatbelts, although the steady

increase in prevalence of seatbelt use with age in Canada

was not seen in the United States.

11
~ United States man

~ United States women

●.—-. c~@~ ~n

0. —-+ c~~~ -~

‘~

18-24 25-44 45-64 65 and over

*in yeare

~ure 7. Percent of the adutf populaticmwho usually wore seatbela by

agw United States and Cans@ 1965

Like the findings for seatbelts, the use of child restraints (table D) was higher in Canada than in the United

States. Almost all Canadian parents (91 percent) claimed to

usually insist upon their children being buckled up, compared with half (52 percent) of U.S. parents. There was a

sharp increase in the use of child restraints with increasing

education in the United States, which did not hold in

Canada.

Discussion—The survey questions asking about the use

of seatbelts were nearly identical. Response categories

differed only slightly and are unlikely to have affeeted the

results (see appendix II for definitions). A much more

important explanation for the two-fold difference in prevalence is the existence of seatbelt legislation in Canada and

its absence in the United States in 1985. Approximately 90

percent of the Canadian population was subjeet to such

legislation at the time of the survey, and it was routinely

enforced with substantial fines for nommmpliance. The first

such legislation was introduced in the United States in

1985, and it was not initially enforced. It is possible that the

Canadian prevalence levels might be inflated because of ‘

reluctance to admit breaking the law. Observational studies

of seatbelt use suggest that the prevalence is somewhat

lower than self-reported (Arora, 1981).

Smoke detector ownership

The smoke alarm offers an effeetive and inexpensive

measure of protection against residential fires, which account for thousands of injuries and deaths annually, as well

as millions of dollars’ worth of property damage. The U.S.

and Canadian surveys asked similar questions about ownership of smoke deteetors, obtaining the information from a

responsible adult member of the household. Because the

Canadian survey did not identi@ the number of smoke

deteetors nor their working status, the findings are presented simply to show ownership of one or more devices,

Although smoke deteetor ownership is a household rather

than a personal characteristic, these data are presented by

respondent characteristics because of lack of comparable

household data for the two surveys.

Smoke detector ownership in the United States was

lower (69 percent) than in Canada (77 percent) (table 8), a

difference found at all age levels and most pronounced for

ages 18-24 years (figure 8). In both countries, the highest

rate of ownership was for ages 25-44 years.

There was a definite increase in the prevalence of

ownership with higher levels of education in the United

Table D. Safety restrain= percent distribution of children by frequency of restraint use, according to parents’ educational levek United

States and Canada, 1985

Total Usually Sometimes Never

United UnRed Unaed Un#sd

EUucatkvral Iewl States Canada Stafes Canada States Canada states Canada

Percent distributbn

Alleducatiinal levels . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 52.1 91.3 28.9 3.4 19.0 5.3

High ached:

Notcompleted . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 34.9 89.6

Completed . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1

I(X3.O

35.0

100.0 46.6 92.2 ::

College orurdversity . . . . . . . . . . . . . . . . . . . . . . .

2.4

100.0 100.0

23.0 z

61.3 91.8 27.3 4.4 11.4 3,8

12
~ UnitedStatesmen

~United Stataawcinan

s._-__O ~adian men

o--—OCanadlan women

Q“~

W-24 65 and over

Age inyears

F@m S. pwantofllte~~-owntilmke~-”

Ormbyew Unttedatetesende’madaalm

States; this was inconsistent in Canad% although the lowest

levels of ownership were among those with less than a high

school education.

Discussion —Although the U.S. survey collected more

detail about smoke detector ownership, the basic question

was very similar to the Canadian version. The comparison

shown here is for the number of smoke detectors owned,

regardless of their state of repair. Comparison of these data

with previously published data for the United States su~est

that approximately 9 percent of installed deteetors are not

working (NCHS, 1986a). This proportion is probably similar in Canada, although the information was not obtained

there. If there is a difference that requires explaining, it is

the 13-pereentage-point higher level of ownership by Canadian men ages 18-24 years. This may result from the

installation of smoke detectors in college dormitories or the

fairly widespread requirement for the devices in apartment

buildings. The lack of a uniform national standard for

smoke deteetor installation in either country leaves such

attempts at explanation in the realm of speculation. This

difference may also result from the fact that, at this age,

more Canadians than Americans were college educated

(table A), a factor that is positively associated with ownership.

Most recent blood pressure check

Hypertension is a condition affecting 31 percent of

Americans ages 18-74 years (Subcommittee on Definition

and Prevalence of the Joint National Committee on Deteetion, Evaluation, and Treatment of High Blood Pressure,

1985) and 23 percent of Canadians ages 20-69 years

(Stephens, Craig, and Ferris, 1986b). Because hypertension

is only detected with a blood pressure check, public education and medical practice have urged regular measurement

for several years.

Both U.S. and Canadian surveys asked similar questions concerning the respondent’s most reeent blood pressure check. Overall, the prevalence of blood pressure

checks within the past 12 months was slightly lower in the

United States (74 percent) than in Canada (76 percent)

(table 9). However, this difference was only statistically

significant for women, and was not equal across age groups

(figure 9). Young U.S. men were 11 percentage points

more likely than their Canadian counterparts to have had a

check within the past year. For older groups, it was the

Canadians who were more likely to have had a reeent

check, this was particularly true of women. In both countries, the likelihood of a recent blood pressure check increased with age. An exception was U.S. women ages 25-44

years who were less likely than women of other ages to have

had a blood pressure checkup within the past year.

Approximately three-fourths of individuals in the

United States and in Canada at all three educational levels

had had a blood pressure cheek within the past 12 months.

Dkusswn—The questions on time since last blood

pressure cheek were nearly identical in the two surveys.

Because there is no Canadian equivalent to the U.S. National High Blood Pressure Education Program, the nearequality in prevalence rates is surprising. It maybe that the

existence of universal health insurance in Canada compensates for the absence of a national high blood pressure

education program in that country. Additionally, beeause

/- /-

,/t

●❉❉ ~ UnitedStateamen

~ UnitedStateawoman

------ Canadianmen

o--4 OanadianWonwn

‘~

1S-24 45-M a5andovar

Age inywlra

F-9. Percent of the edit populationwith a blood preaaure test

withinthe paat 12 months by egt% United States and Canad% 1985

13
virtually all Canadians have U.S. television programming

available, and U.S. magazines are widely distributed in

Canad~ some of the impact of the U.S. education program

may also be felt north of the border.

Blood pressure awareness

Knowledge of the importance of hypertension and of

the need for regular checks is seen as important in the

United States and Canada because monitoring and control

depend heavily on individual initiative. Each country gained

important insights into the level of public knowledge

through their 1985 surveys, although the questions measured different aspects of awareness.

More than two-thirds of U.S. adults were aware that

high blood pressure definitely increases the chances of

heart disease (table E). This high prevalence of knowledge

was true for men and women, and for all age groups under

65 years. Among U.S. men and women ages 65 years and

over, a somewhat lower but still substantial proportion

(58-59 percent) was aware of the heart disease risk associated with high blood pressure. U.S. adults with a college

education were 20 percentage points more likely to appreciate the hazards of hypertension than those with less than a

high school diploma,

An important feature of hypertension is the lack of

overt symptoms. Thus Canadian adults were asked to consider the statement, “You only need to have your blood

pressure checked if you think you have a problem.” Over 80

Table E. Blood pressure awarenea~ percent of adults in the

United States who were aware that hypertension increases the

chances of heart disease ●nd percent of aduits in Canada who

were aware of the need for blood pressure testing in absence of

symptoms, by sex, age, and educational ievels: 1985

Blood prwsum awateness

incis@sedchartc&? Te.stir@in absence

ofheartdbasein ofsympbme ki

Sex age, and educatbrral level Unlled States Canada

All pers-ons18 years and over. . .

Men

Alleges . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . .

25-44 ye6rs . . . . . . . . . . . . . .

45-64 yeaf3 . . . . . . . . . . . . . .

65yeamand over . . . . . . . . . .

Women

Alleges . . . . . . . . . . . . . . . . .

18-24 yeers . . . . . . . . . . . . . .

25-44 year3 . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . .

65yeareand over . . . . . . . . . .

Educatbnal level

HQhschool:. . . . . . . . . . . . . .

Notcompleted . . . . . . . . . . .

Complekt. . . . . . . . . . . . .

Collqeorunlvereity. . . . . . . . .

66.4

66.0

65.3

71.9

6s.1

6S.6

66.9

67.2

72.9

70.9

6s.0

66.6

66.8

76.2

Percent

60.7

76.2

75.5

61.8

77.4

70.8

63.2

67.0

65.6

79.8

77.3

75.e

81.2

85.3

percent were aware of the need for blood pressure testing

in the absence of symptoms (table E). Women were more

likely than men (83 and 78 percent, respectively) to have

the correct view on this item. Differences among the age

groups were not large, although the oldest men were least

likely to see the need for a check in the absenw of any

complaint (71percent). As is true of the blood pressure

knowledge question on the U.S. survey, correct answers

were directly related to level of education, although the

difference between the lowest and highest educational levels was only 10 percentage points in Crmad~ in contrast to

the 20-percentage-point difference in the United States.

Breast examination

At the time these surveys were conducted, breast cancer was the leading form of cancer among women in the

United States (NCHS, 1985a) and Canada (Statistics Canada, 1987), accounting for about one-quarter of all female

cancer. Periodic breast examination by a physician or nurse

is widely recommended as an effective technique for early

detection. Both surveys asked women to report on their

most recent breast examination by a “doctor or other

health professional” (United States) or by a “doctor or

nurse” (Canada). The U.S. survey identified the interval

since the most recent examination, and the Canadian survey

simplY determined whether the examination was within the

past 12 months.

The prevalence of breast examination within 12 months

was lower in the United States (50 percent) than in Canada

(69 percent) (table 10). A substantial difference between

the tsvo countries was characteristic of all age groups.

Furthermore, there was a similar decrease in the probability of a recent test with increasing age in both countries

(figure 10). There was a tendency in both countries for the

prevalence of a recent breast examination to increase with

higher levels of education. In the United States and in

Canada, college-educated women were about 15 percentage points more likely than those with less than a high

school education to have had a breast examination within

the past 12months.

DiXUSSWn —Although the questions on breast

examination were similar, the U.S. survey collected more

detail and the response categories were worded slightly

differently. However, the shortest interval was similarly

described–’’less than 1 year” in the US. survey and

“within the past12 months” in the Canadian questionnaire.

Recall and other errors are likely to have been similar in

both surveys, suggesting that a substantial difference existed in prevalence of recent breast examination in the two

countries.

Despite controversy about its eflicacy, breast

self-examination (BSE) is widely promoted in the United

States and Canada (Baines, Wall, Risch, et al., 1986). Both

surveys asked women to report how often they perform

BSE. Monthly BSE was less common among U.S. women

(32 percent) than their Canadian counterparts (41 percent)
~ united States

o -—--O Canada

------ %,,

% \

“b,,\\

‘\\

1;24 2#44 45%.4 65aJo4ar

Age inyeara

Figwlo. Paroantoftila aduttfamalapopuwnt witttabraest

;x&inatiorr wfthhthe pastyear,by agw Unltad!itatosandCaner@

(table F). This was true at all age levels, especially ages

18-24 .vears where the .txevalence of breast self-examination

was 38 percent in Canada compared with 24 percent in the

United States. In both countries, a positive relationship

existed between prevalence of this practice and amount of

edueation; but in each case, the difference between the

least and most edueated women was only 5 percentage

points. The prevalence of women who never perform BSE

or only do it less often than every 3 months mirrored the

results reported above. The proportion of both groups was

higher in the United States.

Discussion-The line of questioning on BSE was

slightly different in the two surveys. In the United States,

women were first asked if they knew how to perform BSE.

Frequency was determined only for those professing knowledge. In the Canadian survey, all women were asked about

the frequeney with which they performed BSE regardless of

knowledge. Thus, the U.S. data in table F combine “don’t

know how” with “never.” This treatment of the data is

unlikely to affeet the proportions reporting monthly BSE,

suggesting that BSE has been more successfully promoted

in Canada.

Most recent Pap smear

Although less tlequent than cancer of the breast, cancer of the cervix is a significant cause of morbidity and

mortality. Early detection by regular Papanicolaou (Pap)

smears is the commonly advocated protective measure,

although there is no consensus about the optimal frequency

(Ameriean Cancer Society, 1980; American College of

Obstetricians and Gynecologists, 1980; Canadian Task

Force on the Periodic Health 13muination, 1979). Both

surveys asked women to report the interval since their most

recent Pap smear.

Annual cytologic screening is recommended by the

American College of Obstetricians and Gynecologists

(1980). For this interval, the prevalence of testing was

slightly higher in the United States (63 percent) than in

Canada (61 percent) (table 11). In both countries, women

ages 25-44 years were most likely to have had a Pap smear

within the past year. Women who had never had a test were

more prevalent in Canada, but the proportions were small

in both countries.

Tablo F. Breast ●xamination: percent distribution of women by frequency of breast eeif-examination, aooording to age and educational

Ievele: United States ●nd Canada, 1985

At leastOncaevery

Totat Month& 3 months Lessden New

United Unflsd Un/led Unlled Urdted

Age end eduostbnai Iewl Sate-s Canada W&s Csnac4 States Canada states Canada 3tates’ Canada

Percent d!stributlon

Allagea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 32.1 40.5 18.9 19.8 21.5 17.8 27.4 22.0

18-24 Y6xws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1W3.O 100.0 23.9 38.1 17.2 11.6 22.1 21.6 36.6 28.6

25-44 Y6818. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 33.5 39.6 21.3 23.7 24.7 17.0 20.4 19.8

45-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 36.9 45.6 19.1 22.3 19.2 15.6 24.6 16.3

66yeamand over . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 29.1 36.7 14.4 13.2 16.3 19.0 40.2 31.0

Edueatbnal level

HQhachool: . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Notoompletad . . . . . . . . . . . . . . . . . . . . . . . . . IWO 100.0 2e.3 38.1 13.6 20.0 16.4 17.0 38.9 24.9

Completed . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 IOQ.O 32.0 40.3 19.3 18.0 23.5 18.4 25.3 23.3

Collage orunlveralty . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 34.3 43.7 22.3 21.0 21.4 17.7 21.9 17.6

1includ6s “donl know.”

15
40

-1

I

~ UnlladStates

o -—--o Canada

30 1

T

“-

S5acdwaf

Agehyem

In both countries, better edueated women were more

likely to have had a Pap smear within the past year than

women with fewer years of schooling. This gradient with

education was steeper in the United States (21-pereentagepoint difference between the least and most educated

groups) than in Canada (16-percentage-point difference).

Figure 11 shows the prevalence of Pap smears within

the past 3 years, the interval recommended for most women

by the American Cancer Society (1980) and the Canadian

Task Force on the Periodic Health Examination (1979). As

was true of the l-year interval, there is a slightly greater

tendeney of American women in each age group to have

had a Pap smear within 3 years compared with Canadian

women the same age.

Dficussion-The questionnaire items on Pap smears

were similar in the two surveys, as were those about breast

examination, but the response options differed between the

United States and Canada. For U.S. women, the category

“within 12 months” in table 11 includes women who answered “1 year” (17 percent) and “in the last year” (46

pereent). Canadian women who had been recently tested

had to choose between reporting %vithin the past year” and

“last 2-3 years.” For this reason, the more reliable comparison is for the cumulative total of women tested within the

past 3 years, as shown in figure 11. The differences revealed

here, although statistically significant, are minor in real

terms, and suggest that women in both countries have been

equally sensitized to the need for regular sereenin~ particularly in the age group 25-44 years.

F~ll. Percent ofitieaduR femdapo@abn vdha Papmw

wilIlintha paat3yDar&byafpx Unaedstataaand-wss

16
Trends in selected

health practices,

1979-85

Although the previous section of this report provided

comparable data on many important health practices, some

limitations were encountered because of lack of comparable data. This problem is much more severe when the

desire is for international comparisons at more than a

single time point. Nevertheless, data are available for both

countries for 1979 to describe smoking and seatbelt use.

Although limited in scope, such comparisons are useful for

making inferences not only about changing situations but

also about the possible reasons for such changes. Unfortunately, the education variable for the Canadian survey in

1979 does not provide the same categories as for the U.S.

survey, and the data for the United States for 1979 are

available only for persons 20-G4 years of age.

Smoking

Figure 12 shows the changing prevalence of current

smokers in three age groups similar to those shown in

earlier tables. Most groups show a decrease from 1979 to

S4.4

50.0

36.2

Us. Canada U.S. Canada U.S.

32.5

fl

31.3 :%

m

:~:fj

........

:=

::::::::

..-.-...

y-:>

........

:=

~

::%

51.0

43.0

Us. Canada U.S. Canada Us. Canade

20-24 25-44 45-64 20-24 2%44 45+4

Male Female

Age in yeara and aex

Fguro 12. Changes in percent of the adult population who were eurrmt amokersj by age and amc United Statea and Canada 1979 and 19S5

17
1985; overall, this change is greater in Canada (9 percentage points) than in the United States (2 percentage points)

(table 12). However, initial prevalence was much higher in

Canada (46 percent) than in the United States (35 percent).

In 1979, substantially higher levels of smoking were found

among Canadians than among Americans in all age-sex

groups.

The largest decrease between 1979 and 1985 in the

prevalence of smoking was among the youngest group of

Canadians (14 percentage points for men and 10 percentage points for women). U.S. men and women of the same

age did not change their smoking. In the United States, the

greatest reductions in smoking prevalence were among

those 25-44 years of age.

Discussion-The 1979 data on smoking are based on

survey questions similar to those used in 1985, thus question wording and response categories should not be a

source of bias in these trends. Survey administration techniques differed, as noted earlier-telephone interviewing

for the 1979 U.S. and 1985 Canadian surveys,

self-administration for the 1979 Canadian data, and

in-person interviewing for the 1985 U.S. questions on

13.

❑✚✎✚✎✚✎✚✎✚✎✚ ✚❊✛✚❞✚✞❙ ✚❆❉❞❞ ✎✚✎✚✎✚✞❞✎✚✎✚ ✎

1979

✚✎❞❞✚✚✚✚✚✚✚✚✚✚✚

1985

✎

63.8

28.2

Us. Us.

75.6

Canada Us.

74.5

34.6

Us.

83.6

26.7

Us.

20-24 25-U 4s-64 20-24 25-44 45-64

Male Female

Age in yaara and aax

Changesmpenxmtofthe adti pOpIMOII who WI* wore aeatbelti by age and sex: Unftad Stetes ●nd Cane@ 1972 and 1S6S

18
smoking. There is no reason to suspect that these variations

would have a systematic impact on the results. The prevalence for smoking in Canada in 1979 (46 percent of adults)

is higher than other Canadian smoking statistics for the

period, but these other statistics evidently were biased

downward by proxy reporting (Health and Welfare Canada

and Statistics Canada, 1981, p. 48). The decline in smoking

between 1979 and 1985 reported here is entirely consistent

with longer term trends reported elsewhere and trends

based on more data points (Collishaw, 1987; NCHS,

1986b). It is apparent that the antismoking campaigns in

the United States and Canada have had an impact. The

appearance of greater impact in Canada maybe a statistical

artifact resulting flom the higher initial prevalence.

Seatbelt use

There were sharp increases in the use of seatbelts in

the United States and Canada between 1979 and 1985

(table 13), The prevalence of those reporting “usual” use

almost doubled (20 to 36 percent) in the United States in

Canada, the rate of increase was more modest but the

absolute gain was also impressive (61 to 79 percent).

Figure 13 shows that all age-sex groups increased their

frequency of seatbelt use. In both countries, the largest

gains were registered by women, especially those ages

25-44 years in the United States and ages 20-24 years in

Canada.

In the United States and Canada, there were large

reductions over this period in the proportions reporting

that they never wore seatbelts (table 13). In the United

States, increases were found in occasional use and usual

use between 1979 and 1985. In Canada, the proportion of

people who were occasional users grew relatively little,

which may suggest that most people who started to wear

seatbelts did so on a regular basis.

Diwussion —There are no meaningful differences between 1979 and 1985 in the wording of questions on

seatbelt use in either the United States or Canada; methods

of administration varied as explained for smoking trends.

Thus, the increases in reported seatbelt use in both countries cannot readily be attributed to methodological

sources. As is true of the 1985 data for Canada, reported

use may be inflated because of respondents’ hesitation to

admit breaking the law. The reason why this reluctance

should have been greater in one year than the other is not

obvious. The increase in seatbelt use from 1979 to 1985 is

more readily explained by extensive public education efforts

in the United States and by new provincial legislation

covering an additional 10 percent of the Canadian population. Canadian data for the use of child restraints in 1978

(Verreauk, Stulginskas, Keyl, et al., 1982) suggest increases

in use paralleling that for seatbelts.

19
Discussion of results

General methodological issues

One difference in survey methods has been noted in

the earlier discussion of specific results. As described in the

methods section, the U.S. National Health Interview Survey

of Health Promotion and Disease Prevention was conducted by personal interview in the respondent’s homq

Canada’s Health Promotion Survey was conducted by interview over the telephone. Some might claim that the comparative anonymity of the telephone interview is more

conducive to candid answers (Marcus and Crane, 1986).

However, because the subject matter of the surveys was not

particularly sensitive, with the possible exception of questions on alcohol use, this difference in data collection

techniques should not have had a systematic impact on the

results.

Nor is there any indication that either 1985 survey

suffered in any significant manner from bias in the sample

design or response to request to participate in the survey.

Both surveys covered the civilian noninstitutionalized

household populations of their respective countries, and the

response rates were high in both instances-90 percent in

the United States and 82 percent in Canada.

The survey’s sponsor was clearly identified to participants as the national health department in both surveys,

and assurances of confidentiality were provided. In short,

while the usual nonsampling errors related to recall and

social desirability might have affected some responses to

some questions in both surveys, this is not likely to have

occurred in a fashion that would systematically influence

the comparisons.

There are some differences, noted earlier, in the population structure of the United States and Canada. One of

these is racial and ethnocultural composition, and the other

is a slightly higher level of education in the United States.

Because most good health practices become more common

with increasing amounts of education, the difference between the educational levels of the two populations may

contribute to the higher prevalence of some good practices

in the United States compared with Canada. This effect is

probably minor, considering the small magnitude of the

differences in education and the imperfect associations

between health practices and education level, It is more

difficult to assess the importance of the higher proportion

of black persons in the United States or of Roman Catholics in Canada. Because the health practices described in

this report constitute part of a “lifestyle: it is likely that

these are influenced by cultural factors and not merely level

of education. The nature of this influence requires further

study.

Notwithstanding these differences in population composition and in the techniques used to collect data, there

appear to be differences in the prevalence of several health

practices that cannot be dismissed as statistical artifacts.

There are also consistent patterns of relationships between

health practices, education, and age that appear to be valid.

Summary of U.S.-Canada

differences

Table G summarizes the prevalence of 12 health practices among U.S. and Canadian adults of all ages. The

figures that are italicized indicate in which country good

health practices were more common. Treating differences

of less than 5 percent as equal for all practical purposes,

reveals that three good practices (not smoking, not drinking

alcohol, and not skipping breakfast) were more common in

the United States, six were more frequent in Canada

(regular physical activity, using seatbelts and child restraints, owning smoke detectors, having a breast examination within the past year, and performing breast

self-examination at least monthly), and three were equal

(having a recent blood pressure checkup, having a recent

Pap smear, and being a heavier alcohol drinker).

Table G. Summary of health practicea in the United States ●nd

Canada, 1985

Practb3 Unf?sdStates Canada

Percent

Regulerlysmoke . . . . . . . . . . . . . . . . . . 30

CurrenUydrink . . . . . . . . . . . . . . . . . . . . 65

2 drinks or more daily average. . . . . . . . . . 12

Regularly active physically . . . . . . . . . . . . 40

Rarely eat breetdast . . . . . . . . . . . . . . . . 24

Usually wearseatbelts. . . . . . . . . . . . . . . 36

Children usually wear restraints. . . . . . . . . 52

Ownlsmoke detector ormora . . . . . . . . . 69

Blood pressure checked within 1 year. . . . . 74

Breast examination wtthin 1 year . . . , . . . . w

PapsmearwHhln 3yeers . . . . . . . . . . . . . 78

Pertorm breast sslf-examination at least

monthly . . . . . . . . . . . . . . . . . . . . . . . 32

35

a2

14

53

22

E

77

76

69

76

41

20
Such a summary gives equal weight to all the practices,

an approach that is not very meaningful because there are

wide vari~tions in the contributions the practices make to

averting disability and premature death. In this regard, the

data reveal that each country was relatively exposed to a

different significant hazard-a higher proportion of smokers in Canada and less frequent use of seatbeks and child

restraints in the United States. It is notable that both

countries have made important moves in these areas since

19S5, In Canada, legislation has been introduced to sharply

curtail tobacco advertising, in the United States, there has

been rapid exTansion of seatbelt legislation since the first

law was introduced in 1985, and it appears to be having the

desired effect on seatbelt use (Pace, Thailer, and

Kwiatkowski, 1986),

The summary in table G suggests the following conclusions about health practices in the United States and

Canada in 1985:

1.

2,

3.

4,

Practices related to consumption are healthier in the

United States, whether the consumption is noxious

(tobacco and alcohol) or beneficial (breakfast).

Safety-related practices (seatbelt use, car restraint use,

and smoke detector ownership) are more common in

Canada.

Self-care practices (physical activity and breast selfexamination) are followed by a higher proportion of

the population in Canada.

Two out of three disease-prevention practices that

require the participation of ~ health car~ professional

(blood pressure check and Pap smear) are about

equally common in the United States and Canada.

This last finding is perhaps the most surprising of all

because there is no cost disincentive to these practices in

Canada because of its universal health care insurance. In

the United States in 1985, the proportion of population

enrolled in health maintenance organizations (the closest

equivalent to the Canadian system) was less than 10

percent of the total (NCHS, 1986c). This suggests that

free care is not the only effective means to encourage the

regular use of preventive services, a conclusion also

reached in the Rand Health Insurance Experiment (Lurie,

Manning, Peterson, et al., 1987).

In a more general sense, these U.S.-Canada comparisons suggest that universal health insurance may be unrelated to personal health behaviors. It has been argued that

such insurance, being equitable by definition, may be less

likely to promote good health habits than a system with

differential premiums based on actual behavior, such as not

smoking (Fielding, 1977). Whatever the impact of health

insurance on health practices, it is apparent from several

examples in this report (the reduction in smoking and

increase in seatbelt use over a period of time in both

countries, the relatively high rate of regular physical activity

in Canada, and the large proportion of both populations

with a recent blood pressure check) that the health practices in a population can be favorably affected by deliberate

health promotion efforts.

Demographic patterns in health

practices

Although prevalence levels vary between the United

States and Canada on a number of health behaviors, tie

relationships between sociodemographic characteristics

and good health practices are generally similar in the two

countries. Most striking in this regard is the association

between level of education and good health practices, which

exists for most of the practices examined in this report,

including smoking; type of drinker; level of physical activity

use of seatbelts and child restraints; ownership of smoke

detectors; and regularity of breast examination, Pap smear,

and breast self-examination. The prevalence of recent

blood pressure checks is equal across all educational levels

in both countries. Typically, good health practices are most

characteristic of the college-educated group and least frequent among those adults who have not completed high

school; an important exception to this was alcohol consumption.

This persistent association may reflect inequality of

access to health information or services; barriers to acting

upon health knowledge; a sense of helplessness or lack of

control (Bandura, 1986); a lack of social support (Berkman

and Breslow, 1983); or other factors of an economic, social,

or psychological nature. All of these have been implicated

in other studies of health behavior, but none can be examined here because comparable data are lacking. However, it

is apparent that this association between health behavior

and educational level is generally stronger in the United

States than in Canada. Moreover, if age were taken into

account in comparing education groups, this would further

steepen the education gradient in the United States compared with Canada.

There is also striking consistency in the age-sex relationships across a number of health behaviors in the United

States and Canada. For example, even though prevalence

levels of smoking and drinking are higher in Canada, in

both countries young women are more likely to smoke than

young men, and men of all ages are more likely than

women to drink, especially to drink more heavily. Similarly,

although physical activity is more common in Canada than

in the United States, in both countries women are more

likely than men to be active at ages 45-64 years, and the

proportion of men who are active increases at ages 65 years

and over, reversing a steady decline from younger years.

Although a smaller proportion of Americans in every age

group own smoke detectors, the highest rate of ownership

in both countries is for ages 25-44 years. The stability of

these patterns is undoubtedly due to similar cultural influences in the two countries, especially the role of the mass

media and their treatment of health issues. This is accentuated by the fact, noted earlier, that most Canadians have

access to U.S. television programming, read U.S. magazines, and are familiar with U.S. popular culture.

Because patterns of health behavior are so consistent

from one practice to the next and from one country to the

other, the rare exceptions are instructive. These exceptions

21
suggest that extraordinary factors may be at work and that

these may deserve the attention of health promotion professionals. For example, a fair generalization is that the

practices of women are more healthful than those of men of

the same age, and this is about equally true in both

countries. One exception, particularly in the United States,

was the tendency for women to be less physically active than

men. A more striking exception is the higher prevalence of

smoking among young women compared with men, as

noted earlier, and the fact that young Canadian women

were as likely as men of the same age to be current

drinkers. The potential role of advertising in changing the

smoking habits of young women has already been noted.

A second generalization is that good health practices

are positively associated with age. This is true of the

prevalence of smokers and current drinkers, driving after

drinking, re@ar breakfast, and blood pressure tests. These

associations may be a result of generational differences,

maturation over time, selective survival, or some combination of these and other ‘factors. With the cross-sectional

data available for this study, a definitive explanation is not

possible. However, the use of seatbelts is less common

among older Americans than younger ones, and the ownership of smoke detectors declines with age in both countries,

This implies that health promotion efforts related to safety

should not be restricted to the young.

22
The value of

comparative studies of

national populations

In addition to what it may reveal about the health

practices of Americans and Canadians, this study demonstrates the value of comparisons between populations.

These benefits would be realized in any comparative study

based on data from reasonably similar populations collected by reasonably similar means.

In the present case, it is possible to identi& six distinct

outcomes of this comparative analysis:

1. IdentijYc&”on of important i.mues-A theme of this report has been the consistency of patterns in the relationship of health practices to age, sex, and education.

Because of these strong patterns, which transcend national borders and which are found despite differences

in overall prevalence levels, exceptions deserve further

attention. Exceptions to well-established patterns suggest extraordinary forces at work, often to the detriment of a specific group. Cases in point are smoking by

young women, drinking by young Canadian women,

and safety-related practices by those ages 65 years and

over. Each of these is an area deserving attention by

those responsible for health promotion policy and programs.

2, IdentiOcati”onofprobable cause-For some of the practices studied here, there appear to be clear explanations for different prevalence levels because they

correspond in plausible ways to known differences

between the two countries. The best example is the

large difference in the prevalence of seatbelt and child

restraint use, corresponding to the differences in legislation that prevailed in 1985. Unfortunately, practices

that differed markedly and for which there were clear

explanations were relatively few in number. Nevertheless, where clear explanations were found, they provide

important guidance for health promotion planning.

3. Identification of uncetiai”ncause-Some other practices

studied here were found to be different in the United

States and Canada, with no obvious reason. Examples

include smoking, alcohol consumption, and ownership

of smoke detectors. These differences do not appear to

result from methodological factors, yet there are no

apparent policy or program differences to explain these

findings, Further study of U.S. and Canadian regulations potentially having an impact on these behaviors is

needed. With regard to alcohol and tobacco consumption, factors that should be investigated include aspects

of availabilitysuch as legal age, pricing, bar and store

hours, marketing practices including advertising, and

government’s role in retailing. To explain the differences in the ownership of smoke detectors, a study of

municipal, State, and provincial regulations would be

invaluable.

4. Need to examine impact of ethnocultural differences—

Despite basic similarities in the populations of the U.S.

and Canada, there are distinct differences in racial,

ethnic, and religious composition. A full examination of

these differences and their possible relationship to

health practices is beyond the scope of this report.

However, it is apparent that this would be a complex

topic. For example, one might be tempted to attribute

the higher overall prevalence of smoking in Canada to

the fact that the French-speaking population is more

likely to smoke than English Canadians (Health and

Welfare Canada, in press). Because there is a high

correlation between smoking and drinking (Stephens,

1986), the fact that about one-fourth of the Canadian

population is French-speaking (Statistics Canada,

1987c) should also account for the higher overall prevalence of current drinkers in Canada. Unfortunately

for this theory, there is a lower, not a higher than

average, proportion of current drinkers among FrenchCanadians (Health and Welfare Canada, in press).

Further examination of this issue of ethnocultural differences may lead to important insights into the best

strategies for health promotion in different populations.

5. Need to reduce operational inconsistencies-In a number of areas in this report, U.S.-Canada comparisons

were made difficult by minor inconsistencies in operational definitions of key terms. Sometimes this resulted

from the wording of questions, such as for driving after

drinking at other times, it resulted from using different

response categories for the same question, such as the

time intervals to report most recent Pap smear and

breast examination. Other minor variations can inhibit

comparisons, such as the different definitions for lifetime abstainer or the different reporting period for

calculating average alcohol consumption. Interviewers

in both countries (or in different States, provinces, or

municipalities) would do well to minimize these differences before conducting further surveys. Greater uniformity of approach would ensure that any future

report on trends over time would not be restricted to

examining just two practices, as this report was.

23
6. Identijic&”onof needed operah”onalrefinements-The provements are possible are the Canadian question on

comparisons in this study have been informative in smoke detectors and the U.S. question on breakfast.

another way. For some practices, refinements are pos- Judging from the results presented earlier, it is impossible that would produce more unambiguous findings. tant to be able to qualilj smoke detectors as in working

This would be an important feature of any future order and breakfast as ecmsisting of more than just

survey, regardless of any wish to compare practices in coffee, and to be able to do this on a routine basis.

different populations. Two questions for which im24
Conclusion

This comparative study of health practices among the examining program and policy developments in both counU.S, and Canadian adult populations has revealed some tries. The challenge for health promotion implied by this

important differences in prevalence levels. Inconsistence study is to find methods for encouraging healthy behavior

in survey methods and differences in population composi- in populations despite strongly entrenched patterns associationmay qualify, but almost certainly do not vitiate, these ated with age, sex, and education.

conclusions. This su~ests that specialists may profit from

25
References

American Cancer Society. 1980. Report on the Cancer-related

Checkup. New York. February 8, 1980.

American College of Obstetricians and Gynecologists. 1980.

Statement of the Task Force on Periodic Cancer Screening for

Women. Washington, D,C.

Arora, H. R. 1981. Seatbelt use by Canadian drivem. Technical

memorandum TMSE8101. Ottawa Road and Motor Vehicle

Traffic Safety, Transport Canada.

Baines, C. J., C. Wall, H. A. Risch, et al. 1986. Changes in breast

self-examination behavior in a cohort of 8,214 women in the

Canadian National Breast Screening Study. Cancer 57(86):1209-

16.

Bandur~ A. 1986. Self-Efficacy. Social Foundations of Thought

and Action, edited by A. Bandura. Englewood CM& N.J.: Prentice Hall.

Berkman, L. F. and L. Breslow. 1983. Health and Whys of Living:

The Alameda County Study. New York Oxford University Press.

Canadian Task Force on the Periodic Health Examination. 1979.

The periodic health examination. Canadian Medical Association

Jozanal 121:1193-1254.

Clark, W. B. and L. Midanik. 1982. Alcohol use and alcohol

problems among U.S. adult% results of the 1979 survey. Alcohol

and Health Monograph 1: Alcohol consumption and related problems. Washington: U.S. Government Printing Office.

Collishaw, N. E. 1987. ‘l’rends in Canadian tobacco consumption,

1980-1986. Chronic Diseases in Canada 8(1):13-4.

contempora~ Research Centre, Ltd. 1982. Behavior and attitude

toward physical activity among Canadians. Results of a national

survey conducted for Participation. Toronto: Participation.

Emster, V. L. 1985. Mixed messages for women A social history

of cigarette smoking and advertising. New York State Journal of

Medicine 85(7):335-40.

Fielding, J. 1977. Health Promotion-some notions in search of

a constituency. Ametican Journal of Public Health 67(11):1082-85.

Health and Welfare Canada, 1987. National Health E3penditum

in Canada 1975-1985. Ottawa Health and Welfare Canada.

Health and Welfare Canada, Analytical Services Division. 1985.

HeaZth Promotion Survey microdata docume ntation and usefs

guide. Ottawa Health and Welfare Canada.

Health and Welfare Canada and Statistics Canada. 1981. The

Health of Canadians: Report of the Canada Health Survey. Ottawa

Minister of Supply and SeMces.

Health and Welfare Canada, eds. In press. Canada’s Health

Promotion Survey Technical Repoti. Ottawa The Minister of

Supply and Services Canada.

Johnson, P., Armon, D., Polich, S. and Stambul, H. 1977. U.S.

adult drinking practices time trends, social correlates and sex

roles. Working note prepared for NL4AA. Contract No. ADM281-76-0020. Santa Monic% Ca. Rand Corporation.

Lurie, N., W. G. Manning, C. Peterson, et al. 1987. Preventive

care Do we practice what we preach? American Journal of Public

Health 77:801-4.

Malin, H., R,W. Wilson, and G.D. Williams. 1985.1983 NHIS

Alcohol/H&kh Practices Supplemen~ Preliminmy Findings. Proceedings of the 1985 PuMic Health Conference on Records and

Statistics. DHHS Pub. No. (PHS) 86-1214. Public Health Service.

Hyattsville, Md.

Marcus, A. C. and L. A. Crane. 1986. Telephone surve~ in public

health research. Medical Cm 2497-112.

Moore, T.F. 1985. Redesign of the National Health Interview

Survey. Statistical Methods Division Methodological Memorandum Series. Report Number CB/SMD/MM/85/02. Unpublished

technical paper. U.S. Bureau of the Census.

National Center for Health Statistics, E. Bakunuth and S. Shapiro,

1965a. Health interview responses compared with medical

records. Vital and Health Statistics. Series 2, No. 7. PHS Pub. No.

1000. Public Health SeMce. Washington: US. Government Printing Office.

National Center for Health Statistics, C.F.. Cannell and F. J.

Fowler, Jr. 1965b. Coraparison of hospitalization reporting in

three survey procedures. Vital and Health Statktics. Series 2, No.

8. PHS Pub. No. 1000. Public Health Sewice. Washington: U.S.

Government Printing Office.

National Center for Health Statistics, W. G. Madow. 1967. Interview data on chronic conditions compared with information derived from medical records. Vital and Health Stat&tics. Series 2,

No. 23, PHS Pub. No. 1000. Public Health SCMCC.Washington:

U.S. Government Printing Office.

National Center for Health Statistics, C. F. Cannel], F. J. Fowler,

Jr., and K. H. Marquis. 1968. The influence of interviewer and

respondent psychological and behavioral variables on the reporting in household interviews. J&al and HeaZth Statistics, Series 2,

No. 26. PHS Pub. No. 1000. Public Health Setice. Washington:

U.S. Government Printing Office.

National Center for Health Statistics, D.A. Koons. 1973. Quality

control and measurement of nonsampling error in the Health

Interview Survey. Etal and Health Statistics. Series 2, No. 54.

DHEW Pub. No. (HSM) 73-1328. Health Services and Mental

Health Administration. Washington: U.S. Government Printing

Office.

National Center for Health Statistics, K Danchik. C. A. Schoenbom, and J. Elinson. 1981. Highlights from Wave I of the

26
National Survey of Personal Health Practices and Ccmsequenccw

United States, 1979. VW and Health Statktics. Series 15, No. 1.

DHHS Pub: No. (PHS) 81-1162. Public Health SeMce. Washington. U.S. Government Printing Office.

National Center for Health Statistics. 1982. Public use data tape

documentation. Wave I and Wave II of the National Survey of

Pemontd Health Practices and Consequences, 1979-80. Public

Health Service. Hyattsville, Md.

National Center for Health Statistics. 1985a. Health, United States,

1985. DHHS Pub. No. (PHS) 86-1232. Public Health SeMce.

Washington U.S. Government Printing Office. (table 16).

National Center for Health Statistics, M. G. Kovar and G. S. Poe.

1985b. The National Health Interview Survey design, 1973-84,

and procedures, 1975-83. Vitaland Health Statistics. Series 1, No.

18, DHHS Pub. No. (PHS) 85-1320. Public Health SeMce.

Washington U.S. Government Printing Office.

National Center for Health Statistics, O. T. ThomberV, R. W.

Wilson, and P.M. Golden. 1986a, Health promotion data for the

1990 Objectives, Estimates from the National Health Interview

Survey of Health Promotion and Disease Preventioru United

States, 1985. Advance Data Fmm ~taf and Health Statistics, No.

126. DHHS Pub. No. (PHS) 86-1250. Public Health SeMce.

Hyattsville, Md.

National (hter for Health Statistics, P. M. Golden. 1986b.

Prevention profile, Healt~ United States, 1986. DHHS Pub. No.

(PHS) 87-1232, Public Health Service. Washington U.S. GovernmentPrinting Office. (figure 14).

National Center for Health Statistics. 1986c. HeaZth,United States,

1986. DHHS Pub, No. (PHS) 87-1232. Public Health SeMce.

Washington U.S. Government Printing Office.

National Center for Health Statistics, A. J. Moss and V. L.

Parsons, 1986d. Current estimates from the National Health

Interview Survey, United States, 1985. Vitaland HeaZthStatistics.

Series 10, No. 160. DHHS Pub. No. (PHS) 86-1588. Public Health

Service. Washington: U.S. Government Printing Office.

National Center for Health Statistics. 1987, Advance report of

final mortality statistics, 1985. Monthly VW Statistics Report. Vol.

36, No, 5. Supp. DHHS Pub. No. (PHS) 87-1120. Public Health

Service. Hyattsville, Md.

National Center for Health Statistics Unpublished. Public use

data tape documentation. Health Promotion and Disease Prevention supplement to the 1985 National Health Intemiew Suwey.

Public Health SeMce. Hyattsville, Md.

Pace, B. W., R. Thailer, and T. G. Kwiatkowski. 1986. New York

State mandatory seatbelt use law Patterns of seatbelt use before

and after legislation. Journalof Trauma261031-3.

Powell, K, E, and R. S. Paffenbarger, Jr. 1985. Workshop on

epidemiologic and public health aspects of physical activity and

exercisw A summaxy. Public Health Repom 100(2):118-26.

President’s Council on Physical Fitness and Sports. 1987. Washington The President’s Council on Physicat Fitness and Sports.

Richmond, J. B. 1979. Healthy people The Surgeon-General’s

report on health promotion and disease prevention, DHEW

(PHS) Pub. No. 79-55071. Public Health Semite. Washington:

U.S. Government Printing Office.

Schoenbom, C. 1986. Health habits of U.S. adults, 1985: The

“Alameda 7“ revisited. Public Health Repo* 101:571-80.

Schoenbom, C. A. 1987. Findings from the National Health

Interview Survey. Evaluation and the Health Professions. Special

Issue Devoted to Research on Preventive Behavior: An Overview.

10(4):438-459.

Statistics Canada. 1987. Report on the demographic situation in

Canadz 1986. Ottawa Minister of Supply and SeMces Canada.

Statistics Canada. Unpublished. Canada Health Survey Data Userk

Gzude. Ottawa.

Statistics Canada, Health Division. 1985. Mortality Summary list

of causes. Vital Statistics Volume ~, 1985. Ottawa Statistics

Canada (Catalogue No. 84-206).

Statistics Canad% Health Division. 1987. Major causes of death at

different ages, Canad~ 1985. Chronic Diseases in Canada 8(1):15.

Statistics Canadz Housing, Family, and Social Statistics Division.

1987. Health and Socitd Supportj 1985. General Social Survey

Analysis Series. Ottawa Minister of Supply and Smvices Canada.

(Catalogue No. 11-612, No. 1).

Stephens, T. 1986. Health practices and health status Evidence

from the Canada Health Survey. American Joumaf of Preventive

Medicine 2(4):209-15.

Stephens, T. 1987. Secular trends in adult physical activity Exercise boom or bust? Research Quarterly for Exenxke and Sport

58(2):94-105.

Stephens, T., C. L. Craig, and B. F. Ferris. 1986a. Adult physical

activity in Canada Findings from the Canada Fitness Suwey I.

Canadian Journal of Public Health (77):285-90.

Stephens, T., C. L. Craig, and B. F. Ferris. 1986b. Adult physical

fitness and hypertension in Canada Findings tkom the Canada

Fitness Survey II. Canadian Journal of Public Health (77):291-5.

Stephens, T., D. R. Jacobs, Jr., and C. C. White. 1985. A

descriptive epidemiolow of leisure-time physical activity. Public

Health Repotis 100(2):147-58.

Subcommittee on Definition and Prevalence of the Joint National

Committee on Detection, Evaluation, and Treatment of High

Blood Pressure. 1985. Hypertension prevalence and the status of

awareness, treatment, and control in the United Statex Final

report, 1984. H~ertension 7(3):457-68.

U.S. Bureau of the Census. 1986. StatisticalAbstracts of the United

States: 1987 (107th edition). Washington, D.C.

Verreauk, R., J. Stulginskas, P. Keyl, et al. 1982. Use of automobile seat restraints by children in two Canadian cities. Canadian

Medical Association Journal 126:1163-7.

Waksberg, J. 1978. Sampling methods for random digit dialing,

Journal of the Ame?ican StatisticafAssociation 73(361):40-6.

27
List of detailed tables

1. Cigarette smoking percent distribution of adults by

smoking status, according to sex, age, and educational

levels: United States and Canada, 1985 ............. .......

2. Alcohol use: percent distribution of adults by iype of

drinker, according to sex, age, and educational levels:

United States and Canada, 1985 .............................

3. Alcohol use percent distribution of current drinkem by

average amount of absolute alcohol consumed daily,

according to sex, age, and educational levels United

States and Canada, 1985 .......................................

4. Alcohol use percent distribution of adults by frequency

of driving after drinking, according to sex, age, and

educational levels United States and Canada, 1985 ....

5. Physical activity percent distribution of adults by participation in regular physical activity, according to sex,

age, and educational Ievel.s United States and Canada.

1985 ............ .......... ......... .................................

6. Eating breakfast: percent distribution of adults by regularity of eating breakfast, according to sex, age, and

educational levels: United States and Canada, 1985 ....

7. Seatbelt use percent distribution of adults by regularity

of seatbelt use, according to sex, age, and educational

levels: United States and Canada, 1985., ..................

8. Smoke detectors percent distribution of adults by ownership of smoke detectors, according to sex, age, and

29 educational levels: United States and Canada, 1985 .,,. 32

9. Blood pressure percent distribution of adults by time

since last test, according to sex, age, and educational

29 levels: United States and Canad~ 1985 .................... 33

10. Breast examination percent distribution of adult

women by time since last breast examination, according

to age and educationrd levels: United States and Cana30 d% 1985................................................... ......... 33

11. Pap sinew percent distribution of adult women by time

since last Pap test, according to age and educational

30 levelx United States and Canada, 1985 ............. ....... 34

12. Trends in smoking percent distribution of adults ages

20-64 years by type of smoker, according to sex and age

United States and Canada, 1979 and 1985 ................ 34

31 13. Trends in seatbelt use: percent distribution of adults

ages 20-64 years by regularity of seatbelt use, according

to sex and age: United States and Canada, 1979 and

31 1985 .......... ....... ............................................... 35

32

28
Table 1. Cigarette smoking: percent distribution of adults by smoking status, according to sex, age, and educational levels: United States

and Canada, 1985

Totali Current smoker

Sex, age, and

Nonsmoker2

aducetlonal level United states Canada United States Canada United States Canada

Percent distribution

All persons 18 years and over. . . . . . . . . . 100.0 100.0 30.1 34.6 69.9 65.4

Men

Alleges . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 32.6 36.3 67.4 63.7

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 2a.o 38.3 72.0 61.7

25-44years . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 36.0 40.1 62.0 59.9

45.64year8, ,, . . . . . . . . . . . . . . . . . . . 100.0 ICCLO 33.4 35.9 66,6 64.1

65yearsandover . . . . . . . . . . . . . . . . . 100.0 100.0 19.6 19.7 80.4 60.3

Women

Alleges . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 27.9 32.9 72.1 67.1

18-24years. . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 30.4 41.1 69.6 56.9

25-44years . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 3i.a 36.5 6e.2 63.5

45-64years . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 29.9 30.1 70.1 69.9

65yeareandover . . . . . . . . . . . . . . . . . 100.0 100.0 13.5 la.o 86.5 82.0

Educational level

High school:

Nolcompleled . . . . . . . . . . . . . . . . . . 100.0 100.0 35.4 3a.7 64.6 61.3

Completed . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 33.5 38.7 66.5 61.3

Collegaorunlversity . . . . . . . . . . . . . . . . 100.0 100.0 23.1 27.9 76.9 72.1

iTotal e~~ludes “nkno~~s.

2Allhough the U.S. survey made distinctions be~een former smoke~ and lie-long nonsmokers, this detail WSS not obtained in the Canadian SUlV8y.

Table 2. Alcohoi use: percent distribution of aduits by type of drinker, according to sex, age, and educational ieveis: United States and

Canada, 1985

Tots/l Liietime abstainer Former drinker Current drinker

Sex, age, and

educatbnal level United Sfates Canada UrritedSfates Canada United States Canada UrrMd States Canada

Allpersons leyears and over . . . .

Men

Alleges . . . . . . . . . . . . . . . . . . .

16-24yeare . . . . . . . . . . . . . . . . .

25-44yeare . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . .

65year8andover . . . . . . . . . . . . .

Women

Alleges . . . . . . . . . . . . . . . . . . .

16-24years . . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . . .

45-64years. . . . . . . . . . . . . . . . .

.65ye8rSandOVer . . . . . . . . . . . . .

Educatbnal level

High school:

Nolcompleted . . . . . . . . . . . . .

Completed . . . . . . . . . . . . . . . .

Coilegeoruniversity. . . . . . . . . . .

Percent distribution

100.0 100.0 27.2 7.3 7.6 10.4 65.2 82.3

100.0 100.0 14.6 4.3 9.3 9.2 76.1 66.5

100.0 100.0 le.6 2.1 2.2 5.4 79.2 92.5

100.0 100.0 10.9 2.7 5.8 5.5 83.3 91.7

100.0 100.0 14.4 5.9 13.8 14.6 71.8 79.5

100.0 100.0 22.0 10.2 20.3 16.6 57.6 73.1

100.0 100.0 38.4 10.1 6.1 11.6 55.5 78.3

100.0 100.0 33.7 3.1 2.2 5.7 64.1 91.2

100.0 100.0 31.9 6.6 4.9 7.9 63.2 65.5

100.0 100.0 39.4 12.8 8.0 13.9 52.5 73.3

100.0 100.0 56.2 23.4 9.7 24.4 34.1 52.2

100.0 100.0 40.5 12.7 12.7 15.9 46.6 71.4

100.0 100.0 27.0 5.1 6.9 6.6 66.1 66.2

100.0 100.0 18.5 4.0 5.0 6.5 76.5 e9.5

lTolal excludes unknowns.

21nlhelJnlted States, never had 12drinks ormorein any year. Incanada, nodrlnks ever in a lifetime.

29
Table 3. Alcohol ua~ percent distribution of currertt drinkera by avarage amount of abwlute alcohol consumed daily, according to sex,

age, and educational levels: United Ststea and Canada, 1985

L@hter Moderate

Totalf None (01-.21 Oz) (2?-.99 02) (I”ozz)

Se& age, and tJrrtted UnMd tJnked Urdted Urdted

educatkmal kwal stem Canada Statea Canada states Canada slates G.inada States Canada

Percentdtstrbutlon

All pereons 18 yearn and over . . . . . 37.1 17.2 29.5 31.1

Men

Allagae . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . .

45-64 yeare . . . . . . . . . . . . . . . . .

05yeareand over . . . . . . . . . . . . .

Women

AIlages . . . . . . . . . . . . . . . . . . .

18-24year8 . . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . .

65yeareandover. .,....... . . .

Educatbnel level

High school:

NotcompleIed . . . . . . . . . . . . .

Completed . . . . . . . . . . . . . . . .

Collegeoruniveretty . . . . . . . . . . .

100.0 100.0 21.6 37.4 11.8 14.3

100.0 Icm.o 17.9 2e.o 30.9 14.6 34.0 33.9

100.0 100.0 15.4 34.7

100.0 100.0 15.9 25.3

100.0 100.0 21.0 25.7

100.0 100.0 24.4 44.0

17.2

1e.3

16.0

18.1

16.4

22.5

24.2

22.9

23.0

16.2

28.2 11.5 38.1 29.6

31.9 14.9 38.2 37.0

31.3 15.2 29.6 36.1

29.6 17.3 27.8 22.5

100.0 100.0 28.1 46.3

100.0 100.0 23.3 39.1

Im.o ICs).o 25.3 44.5

100.0 100.0 27.3 54.0

100.0 100.0 31.1 49.5

44.7 20.0 24.0 28.1 5,3

5.0

3.e

7.2

7.9

5.6

8.5

4.4

6.7

*

41.6 23.0 30.2 29.4

47.5 20.5 23.3 30.5

43.9 15.7 21.6 23.7

39.3 22.0 21.7 25.4

100.0 100.0 26.9 43.1

100.0 100.0 23.9 38.9

100.0 100.0 17.3 33.5

33.7 15.5 24.9 2a.7

38.6 16.0 27.8 31.1

38.9 18.9 32.9 33.2

14.5

11.7

10.6

12.7

16.0

14.4

‘Total excludes unknowns.

NOTE Daily consumption is averaged over the lest 2 weeks in me United States and 7 days in Canada

Table 4. Alcohol use: percent distribution of adult drinkers by frequency of driving after drinking, according to aax, age, and educational

levels: United States and Canada, 1985

Totall No occasbns 2 Iorrnorwoccaebrrs

Sex, age, and

aducwonal level Unfed States Canada Urrlted States Canada Urrkad States Carlada

Percent distrlbutbn

Allpereons 18yeareand over . . . . . . . . . . 10Q.O 100.0 83.1 74.9 16,9 25.1

Men

Alleges . . . . . . . . . . . . . . . . . . . . . . . . 100.0

l&24years . . . . . . . . . . . . . . . . . . . . . . 100.0

2E-44years . . . . . . . . . . . . . . . . . . . . . . 100.0

45-64 yeans. . . . . . . . . . . . . . . . . . . . . . 100.0

65yearsand over . . . . . . . . . . . . . . . . . IOQ.O

100.0

100.0

100.0

100.0

lcm.o

77.6 85.1 22.4

37.5

26.9

11.0

2.5

34,9

37.4

42.2

27.1

12.2

82.5 62.6

73.1 57.6

69.0 72.6

97.5 67.8

Women

Allages . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0

Iwo

100.0

100.0

100.0

90.1 88.9 9.9

19.3

11.8

2.5

0.4

13.1

17.4

14.2

9.3

6.9

18-24 yeare. . . . . . . . . . . . . . . . . . . . . . IW3.O

25-44 yeare . . . . . . . . . . . . . . . . . . . . . . 100.0

45-64 yeara . . . . . . . . . . . . . . . . . . . . . . 100.0

65yeareand over . . . . . . . . . . . . . . . . . 100.0

80.7 82.8

88.2 85.8

97.5 90.7

99.6 93.1

Educational level

HQh school:

Notcompleted . . . . . . . . . . . . . . . . . . 100.0

Completed . . . . . . . . . . . . . . . . . . . . . 100.0

Collageorunivereity . . . . . . . . . . . . . . . . Iwo

100.0

100.0

100.0

88.7 80.2

82.9 75.1

82.0 71.4

13.3

17.1

18.0

19.6

24.9

28.6

‘Total excludes unknowns.

‘United States: driving ‘When you parhaps had too much to drink” in the past yeafi Canada driving in the past month, “wRhln 2 hours of drinking any amount of alcotrol.”

30
Tablo 5. Physical activity: percent distribution of adults by participation in regular physical ati-vity, according to sex, age, and

educational levels: United Statea and Canada, 1985

Totali Regularly aofivez

% w, and

Not regularly active

aducatbnal Ievet Untted states Canada Wted Stetas Canada Unltad Statas CWada

Atlpersons li3yeareend over . . . . . . . . . .

Men

Alleges . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeare . . . . . . . . . . . . . . . . . . . . . .

25-44 years, . . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . .. o . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . . . . .

Women

Alleges . . . . . . . . . . . . . . . . . . . . . . . .

18-24years . . . . . . . . . . . . . . . . . . . . . .

2544YwB . . . . . . . . . . . . . . . . . . . . . .

45-64years, , . . . . . . . . . . . . . . . . . . . .

05yearsendover . . . . . . . . . . . . . . . . .

Educatbnal level

H@hschool:

Notcomplebd. . . . . . . . . . . . . . . . . .

Completed . . . . . . . . . . . . . . . . . . . . .

CoIlegeorunlversity . . . . . . . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Iwr.o

Percent d~tribution

40.0 53.3

42.7 54.6

62.1 63.8

46.3 55.0

30.4 45.9

31.9 58.6

37.6 52.0

47.3 80.4

41.9 51.0

31.8 51.1

27.6 47.2

24.4 45.3

37.7 55.4

52.8 58.6

60.0

57.3

37.9

53.7

69.6

68.1

62.4

52.7

68.1

66.2

72.4

75.6

62.3

47.2

48.7

45.4

36.2

45.0

64.1

47.4

48.0

39.6

49.0

48.9

52.8

54.7

44.6

41.2

lTot~ e~~lude$ unknowns

xun~~ stat~ enswerw yes to “Do you exercise or play sporb ragulart~; Canada reported vigorous acttvily of at least 15 minutes duretbn 3 times or more weakly.

Table 6. Eating breakfast percent distribution of adults by regularity of eating breakfast according to sex, age, and educational levels:

Unfted States ●nd Canada, 1985

Toiell 5-7per Someiimas 2-4 per O-1pr

Sex age, and Daly In weak in in week h Rarely In weak in

educatbnal level United Stataa Canada United States Canada Urdted States Canada United States Canada

Percent distribution

All persons 18 years end over . . . . . 100.0 100.0 55.4 30.2 20.2 41.3 24.3 28.5

Men

Alleges . . . . . . . . . . . . . . . . . . . 100.0 100.0 54.4 22.0 20.4 42.1 25.2 28.9

18-24 years. . . . . . . . . . . . . . . . . 100.0 100.0 43.1 30.6 27.0 41.3 29.8

25-44 yeers . . . . . . . . . . . . . . . . .

26.1

100.0 100.0 43.7 23.2 25.0 43.7 31.4

45434 years, . . . . . . . . . . . . . . . .

33.1

100.0 100.0 62.3 22.4 16.3 40.4 21.4

65years andover. . . . . . . . . . . . .

30.2

100.0 100.0 e&7 47.2 6.0 41.0 7.4 11.7

Atlases . . . . . . . . . . . . . . . . . . . 100.0 100.0 56.4 31.5 20.0 40.5 23.6 28.1

18-24 years, ,,, . . . . . . . . . . . . . 100.0 100.0 39.4 23.9 30.5 43.9 30.1

25-44 years . . . . . . . . . . . . . . . . .

32.2

100.0 100.0 26.8 24.6 40.5 29.4

45-64 years . . . . . . . . . . . . . . . . .

32.7

100.0 100.0 & 35.7 16.2 41.7 21.4 22.6

135ysar sandover . . . . . . . . . . . . 100.0 100.0 88.4 48.3 6.0 34.2 7.6 19.5

Hbh school:

Notcomplekd, , .,, ..,..... 100.0 100.0 59.2 27.8 18.1 39.1 22.6 33.1

Completed . . . . . . . . . . . . . . . . 100.0 100.0 51.7 2e.5 21.8 39.8 26.5

COllsgeoruniversi l y, . . . . . . . .

30.7

100.0 100.0 56.8 33.2 19.9 44.4 23.3 22.4

lTOlal ~xc[udes Unknowns.

31
Table 7. Seatbeft use: percent dfatributfon of adults by regularity of seatbelt use, according to sex, age, and educational level- United

Statea and Canada, 1985

Totali Usually 3ometimes Never

Sex, age, and

aducetkmal level United States Canada Unttad Siat9s Canada United States Canada U-died States Canada

Percent distribution

All persons 18 years and over . . . . . lc#.o 100.0 35.8 78.9 32.1

Men

Allages . . . . . . . . . . . . . . . . . . . 100.0 100.0 33.8 74.9 32.5

16-24 yeers . . . . . . . . . . . . . . . . . 100.0 Iwo 26.6 66.7 36.0

25-44 years . . . . . . . . . . . . . . . . . 100.0 10Q.O 36.2 75.6 32.5

45-64 yeers . . . . . . . . . . . . . . . . . 100.0 IOQ.O 35.1 74.5 32.0

65yearsand over . . . . . . . . . . . . . 100.0 100.0 32.6 65.3 23.2

Women

Alleges . . . . . . . . . . . . . . . . . . . Icm.o Iwo 37.5 e2.e 31.7

16-24 years . . . . . . . . . . . . . . . . . 100.0 100.0 32.4 76.1 37.1

25-44 yeare . . . . . . . . . . . . . . . . . 100.0 100.0 41.2 63.3 31.2

45-64 years . . . . . . . . . . . . . . . . . 100.0 100.0 36.7 63.6 31.4

65ye6rsand over, . . . . . . . . . . . . 100.0 100.0 34.5 87.6 28.5

8.4

9.3

11.4

9.2

9.8

5.1

7.6

12.5

7.4

7.6

2.3

32.2

33.7

37.4

31.3

33.0

38.2

30.8

20.5

27.6

31.9

37.0

12.7

*5.8

21.9

15.1

15,7

9.6

9.6

11.4

9.3

12

Educatbnal level

High school:

Notcompleted . . . . . . . . . . . . . 100.0 100.0 24.8 75.0 26.9 9.3 46.2 15.7

Completed . . . . . . . . . . . . . . . . 100.0 1W.o 30.9 76.4 34.3 6.2 34.9 13.4

College orurdversity . . . . . . . . . . . 10Q.O 100.0 48.1 63.2 31.8 7.6 20.1 9.0

lTotal excludes unknowns.

Table 8. Smoke detectors: percent distribution of adults by ownership of smoke detectors, according to sex, age, and educational levels:

United Statea and Canada, 1985

TO!611 Own none Own 1 or more

sex age, and

aducatkxml level Unitad States Canada United States Canada Unltad States Canada

Percent distribution

Allpersons 18years Andover . . . . . . . . . . 100.0 100.0 31.4 22.8 66.6 77.2

Men

Allages . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 31.2 22.4 68.8 77.6

16-24 years . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 34.7 22.1 66.3 77.9

25-44 yeer3 . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 27.7 19.5 72.3 20.5

45-64years . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 32.3 24.1 67.7 75.9

65yearsandover . . . . . . . . . . . . . . . . . 100.0 100.0 38.4 30.1 63.6 69.9

Women

Alleges . . . . . . . . . . . . . . . . . . . . . . . . Iwo 100.0 31.6 23.1 86.4 76.9

16-24years . . . . . . . . . . . . . . . . . . . . . . 10Q.O Iwo 36.2 27.2 63.6 72.6

25-44yeare . . . . . . . . . . . . . . . . . . . . . . l&3.o Im.o 27.2 19.4 72.8 60.6

45-64yeare . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 33.5 24.8 66.5 75,2

65yearsandover . . . . . . . . . . . . . . . . . IM.O 1(20.0 34.9 26.5 65.1 73.5

Educational level

Hlghsohool:

Notcompletad . . . . . . . . . . . . . . . . . . 100.0 100.0 43.1 26.4 56.9 71.6

Completed . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 31.3 19.0 66.7 61.0

Collegeorunivers~ . . . . . . . . . . . . . . . . 100.0 100.0 23.7 20.4 76.3 79.6

‘Total excludes unknowns.

32
Table 9. Blood pressurw percent distribution of adults by time since last testj according to CCL age, and educational levels: United

Ststcs ●nd Canada, 1965

TotatJ Lessthan 12 months 1-2ywrs 0ver2yiws Never

S@flweand United United Unlled Untied tJnWd

aducatbnal tab’wt States Canada Statas Canada States Canada slates Canada stares Canada

Percent dlstributlcm

All persons 18 years and over . . . . . 100.0 100.0 73.8 76.4 19.2 11.0 6.6 9.5 0.3 3.1

Men

Alleges . . . . . . . . . . . . . . . . . . .

18-24 years. . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . .

4544years . . . . . . . . . . . . . . . . .

05yearssnd over . . . . . . . . . . . . .

Women

Alleges . . . . . . . . . . . . . . . . . . .

18-24 yesre . . . . . . . . . . . . . . . . .

25-44 yeat3 . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . .

65ya8re andover. . . . . . . . . . . . .

Educational level

HQh school:

Notcompleted . . . . . . . . . . . . .

Completed, . . . . . . . . . . . . . . .

College oruniverslty . . . . . . . . . . .

100.0 100.0 68.4 69.4 22.5 12.5 8.7 13.3 0.5 4.8

100.0 100.0 62.2 51.4 25.8 17.9 10.6 19.9 ● 10.6

100.0 100.0 63.4 67.7 26.4 14.0 9.9 14.6 ● 3.7

100.0 100.0 73.2 77.4 19.5 8.7 7.1 10.3 * *

IW).O lIX).O 82.2 85.6 12.1 7.5 5.7 4.8 ● *

100.0 100.0 76.7 63.2 16.4 9.5 4.8 5.8

100.0 1W.o 79.4 78.0 17.5 12.5 2.6 5.4

Iln).o 100.0 75.8 81.2 19.2 11:7 4.8 6.1

100.0 100.0 76.1 64.6 15.8 7.7 6.1 6.9

100.0 100.0 65.7 91.7 9.5 3.2 4.7 3.8

0.2 1.5

*

*

*

*

1.;

*

*

100.0 100.0 74.0 77.8 17.1 9.1 8.4 9.0 * 4.2

100.0 100.0 73.0 76.9 19.9 10.6 6.7 9.9 *

2.7

100.0 100.0 74.6 74.4 19.9 13.4 5.3 9.7 * 2.4

lTOtal excludes unknowns.

Table 10. Breast examination: percent distribution of women by time since last breast examination, according to age and educational

Iovels: United States and Canada, 1985

Toialq WiihJn12 months 1year ago 2 yams or more

Age and

educatkvmllevel UnttadStates Canada Unitedstates Cana& UnitedStates &nada UnMd Statas Canada

Percent distribution

Allagea . . . . . . . . . . . . . . . . . . . 100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

50.3

57.5

55.5

45.2

39.0

66.6 17.8 31.9

27.3

24.2

37.0

46.9

31.4

26.1

27.1

34.6

44.1

. . .

. . .

. . .

. . .

. . .

16-24 years . . . . . . . . . . . . . . . . .

26-44 years . . . . . . . . . . . . . . . . .

45-84 years . . . . . . . . . . . . . . . . .

05yaars andover . . . . . . . . . . . . .

73.9 15.2

72.9 20.3

65.2 17.6

55.9 14.1

Educalbnrd level

HQh school:

Noloompleted . . . . . . . . . . . . .

Completed., . . . . . . . . . . . . . .

Coltegeoruniversity, . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

100.0

41.7

60.0

57.0

60.7 15.2

70.1 18.8

75.2 18.3

43.1

31.1

24.6

39.3

29.9

24.6

. . .

. . .

. . .

‘Total excludes unknowns.

33
Table 11. Pap smean percent distribution of women by time since last Pap test according to age ●nd educational level- Unftad States

and Canada, 1985

Tctell Wthln 12 months 2-3 years ago 4ormcm years ago Mver

Age end UrrMt Unh3d UnWd UnMd lJn#evt

educwomrl tevel States Canada States Canada States Canada States Canada Staias Canada

Percent dlstributbn

Allages . . . . . . . . . . . . . . . . . . . 100.0 100.0 62.9 60.5 15.4 15.8 14.2 11.2 7.3 12.5

W3-24yearS. . . . . . . . . . . . . . . . . 100.0 100.0 71.2 67.3 6.5 7.5 1.3 * 21.0

2S-44years . . . . . . . . . . . . . . . . . 100.0 100.0 74.9

23.2

71.8 14.9 15.8 8.8 6.8 1.5

45-64 years . . . . . . . . . . . . . . . . . 100.0

5.6

100.0 55.0 53.1 19.6 20.1 21.7 18.8 3.7

65yearsand over . . . . . . . . . . . . . 100.0 lCK).O 38.2 32.7 18.6 ~7.8 28.6 21.3 14.7 2E

Educatbnel level

Hl@ school:

Notoompleted . . . . . . . . . . . . . 100.0 100.0 49.8 51.2 18.5 17.1 19.6 16.5 12.1

Completed .. . . . . . . . . . . . . . . 100.0

15.1

100.0 64.1 62.8 15.0 14.9 14.6 9.7 6,2

College orunlversity . . . . . . . . . . . 100.0

12.6

100.0 71.1 67.5 13.8 15.7 9.7 7,1 5.4 9.7

‘Total excludes unknowns.

Table 12. Trenda in smoking: percent distribution of ●dults ages 20-64 years by type of smoker, ●ccording to sex ●nd age: United States

and Canada, 1979 and 19S5

Currentsmoker Nonsmoker

Totalq UnitedStates Canada Un!ad Statas Canada

Sex and age lJnMd States Canada 19B 1983 1979 1965 1979 1935 19T2 196.5

Percent distributbn

All persons ages 20-64 . . . . . 100.0 100.0 35.4 33.3 46.1 37.0 64.6 66.7 53.9 63.0

Men

Alleges . . . . . . . . . . . . . . 100.0 100.0 39.0 35.5 49.9 38.8 61.0 64.5 50.1 61.2

20-24 year3 . . . . . . . . . . . . 100.0 100.0 30.9 31.0 54.4 40.0 69.1 69.0 45.6

25-44 years . . . . . . . . . . . . 100.0 100.0 43.3

60.0

33.0 50.0 40.1 58.7 62.0 50.0

45-64 yeare . . . . . .. . . . . . . 100.0 100.0 36.2

59.9

33.4 47.2 35.9 63.8 66.6 52.8 64.1

Women

Allages . . . . . . . . . . . . . . 100.0 100.0 32.9 31.3 42.4 35.2 67.1 63.7 57.6 64.8

20-24 year3 . . . . . . . . . . . . 100.0 100.0 31!3 32.5 51.0 41.5 68.7 67.5 49.0

25-44 years . . . . . . . . . . . . 100.0 100.0 34.6

58.5

31.6 43.0 36.5 65.4 88.2 57.0

45-64 years . . . . . . . . . . . . 100.0 Iwo 31.4

83.5

28.9 37.2 30.1 68.6 70.3 62a 69.8

lTotel excludes unknowns.

24
Table 13. Trends in seatbelt ua= percent distribution of adulte ages 20-84 yeara by regularity of aeatbelt use, according to aex and ag=

United States ●nd Canada, 1979 and 1985

Usuatty sometimes Never

Totali United States Canada Unhf States Canada LWad States Canada

Unltad

Sexandage States Canada f979 fsk% 1979 1985 1979 &@ f979 1985 19793 1965 1979 1985

All persons ages 20-64 . . 100.0

Men

Alleges . . . . . . . . . . . . 100.0

20-24 ye6ra. . . . . . . . . . 100.0

26-44 yeare. . . . . ..oo. 100.0

45-64 years . . . . . . . . . . 100.0

Woman

Alleges . . . . . . . . . . . . lW.O

20-24 yeare. . . . . . . . . . 100.0

25-44 yearn . . . . . . . . . 100.0

45-64 year% . . . . . . . . . 100.0

Percent distributbn

100.0 19.6 35.6 61.0 76.9 14.6 32.1 4.1 8.4 65.7 322 34.9 12.7

Im.o 19.8 34.7 58.3 73.4 13.6 32.8 4.5 9.9 66.8 32.4 36.2 18.7

100.0 18.3 28.2 47.2 13.7 36.4 7.2 12.1 68.0 35.4 45.7 24.1

100.0 18.9 36.2 60.0 % 15.4 32.5 4.5 9.2 65.7 31.3 35.8 15.1

100.0 22.0 35.1 65.8 74.5 10.7 32.0 2.8 9.8 67.3 33.0 31.4 15.7

10Q.O 19.5 36.7 62.6 82.8 15.3 32.0 3.7 7.8 65.2 29.3 33.7 9.4

100.0 17.6 34.6 50.1 76.9 13.9 36.0 5.4 9.7 68.5 29.4 44.5 11.3

Iwo 17.7 41.2 63.6 63.3 14.8 31.2 4.0 7.4 67.5 27.6 32.5 9.3

100.0 22.8 36.7 68.0 33.6 16.5 31.4 2.3 7.6 60.7 31.9 29.7 8.8

lTotal excludes unknowns.

%onWnes %ometlmee” end %cca8bnally.”

~in~l”d~ ‘Iseldom.))

35
Appendixes

Contents

I. Technical notes on methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 37

National Health Interview Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Statistical design of NHIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Collection and processing of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Health promotion and disease prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Reliability of estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Canada’s Health Promotion Sumey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Statistical desi~ of CHPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Collection and processing of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0 42

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Reliability of estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

The 1979 surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

IL Definition of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Terms relating to health practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Demographic terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

III. Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

NHIS 1985 Health Promotion and Disease Prevention Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

1985 Canadian Health Promotion Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Appendix tables

I. The 40 poststratification age-sex-race cells in the National Health Interview Survey of Health Promotion and

Disease Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..O . . . . . . . . 39

I-r. Estimated standard error parameters for the 1985 National Health Interview Survey of Health Promotion and

Disease Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

111, Estimated adult population by sex, age, and educational levels: United States and Canada, 1985,., . . . . . . . . . . . 40

IV, Households contacted and individual response rate, by area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$. 43

v. Crude sampling variabilities for the Canadian Health Promotion Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

36
Appendix I

Technical notes on

methods

National Health

Interview Survey

Background

This report is one of a series of statistical reports

published by the staff of the National Center for Health

Statistics (NCHS). It is based on information collected in a

continuing nationwide sample of households included in

the National Health Interview Survey (NHIS). Data are

obtained on the personal, sociodemographic, and health

characteristics of the family members and unrelated individuals living in these households.

Field operations for the survey are conducted by the

U.S. Bureau of the Census under specifications established

by NCHS. The U.S. Bureau of the Census participates in

the survey planning, selects the sample, and conducts the

interviews. The data are then transmitted to NCHS for

preparation, processing, and analysis.

Summmy reports and reports on special topics for each

year’s data are prepared by the staff of the Division of

Health Interview Statistics for publication in Series 10

publications of NCHS. Data are also tabulated for other

reports published by NCHS staff and for use by other

organizations and by researchers within and outside the

government. Since 1969, public use tapes have been prepared for each year of data collection.

It should be noted that the health characteristics described by NHIS estimates pertain only to the resident,

civiliannoninstitutionalized population of the United States

living at the time of interview. The sample does not include

persons residing in nursing homes, members of the armed

forces, institutionalized persons, or U.S. nationals living

abroad.

Statistical design of NHIS

General design

Data from NHIS have been collected continuously

since 1957. The sample design of the survey has undergone

changes following each decennial census. This periodic

redesign of the NHIS sample allows the incorporation of

the latest population information and statistical methodolow into the survey design. The data presented in this report

are from an NHIS sample design first used in 1985. It is

anticipated that this design will be used until 1995.

The sample design plan of the NHIS follows a multistage probability design that permits a continuous sampling

of the civilian noninstitutionalized population residing in

the United States. The survey is designed in such away that

the sample scheduled for each week is representative of the

target population and the weekly samples are additive over

time. This design permits estimates for high-frequency

measures or for large population groups to be produced

from a short period of data collection. Estimates for lowfrequency measures or for smaller population subgroups

can be obtained tlom a longer period of data collection,

The annual sample is designed so that tabulations can be

provided for each of the four major geographic regions and

for selected 1980 metropolitan statistical areas in the

United States. Because interviewing is done throughout the

year, there is no seasonal bias for annual estimates.

The continuous data collection also has administrative

and operational advantages because fieldwork can be handled on a continuing basis with an experienced, stable staff.

Sample selection

The target population for NHIS is the civilian noninstitutionalized population residing in the United States. For

the first stage of the sample design, the United States is

considered to be a universe composed of approximately

1,900 geographically defined primary sampling units

(PSU’S). A PSU consists of a county, a small group of

contiguous counties, or a metropolitan statistical area. The

PSU’S collectively cover the 50 States and the District of

Columbia. The 52 largest PSU’S are selected into the

sample with certainty and are referred to as

self-representing PSU’S. The other PSU’S in the universe

are referred to as non-self-representing PSU’S. These

PSU’S are clustered into 73 strata, and 2 sample PSU’S are

chosen from each stratum with probability proportional to

size. This gives a total of 198 PSU’S selected in the first

stage.

Within a PSU, two types of second stage units, referred

to as segments, are used. The first type, area segments, are

defined geographically and contain an expected eight

households. The second type, permit area segments, cover

geographical areas containing housing units built ailer the

1980 census. The permit area segments are defined using

updated lists of building permits issued in the PSU since

1980 and contain an expected four households.

37
Within each segment all occupied households are targeted for interview. On occasion, a sample segment may

contain a large number of households. In this situation the

households are subsampled to provide a manageable interviewer workload.

The sample was designed so that a typical NHIS sample for the data collection years 1985 to 1995 will consist of

approximately 7,500 segments containing about 59,000 assigned households. Of these households, an expected

10,000 will be vacant, demolished, or occupied by persons

not in the target population of the survey. The expected

sample of 49,000 occupied households will yield a probability sample of about 127,000 persons.

New features of NHIS sample redesign

Starting in 1985, the NHIS design incorporated several

new design features. The major changes include the following:

1.

2.

3,

3a

The use of an all-areaj%me. The NHIS sample is now

designed so that it can serve as a sample frame for

other NCHS population-based surveys. In previous

NHIS designs about two-thirds of the sample was

obtained from lists of addresses compiled at the time of

the decennial census; that is, a list frame. Due to U.S.

Bureau of the Census confidentiality restrictions, these

sample addresses could be used for only those surveys

being conducted by the U.S. Bureau of the Census. The

methodology used to obtain addresses in the 1985

NHIS area frame does not use the census address lists.

The sample addresses thus obtained can be used as a

sampling frame for other NCHS surveys.

The NHIS asfour panels. Four national subdesigns, or

panels, constitute the full NHIS. Each panel contains a

representative sample of the U.S. civilian noninstitutionalized population. Each of the four panels has the

same sampling properties, and any combination of

panels defines a national design, Panels were ccmstructed to facilitate the linkage of NHIS to other

surveys, and also to efficiently make large reductions in

the size of the sample by eliminating panels from the

survey.

Budgetary considerations required the NHIS sample to be reduced by 25 percent for the 1985 data

collection year. This was accomplished by dropping one

panel from the NHIS design. For 1985 the sample

consisted of 5,588 segments containing 44,000 assigned

households. Of the 36,300 households eligible for interview, 34,844 households were actually interviewed, resulting in a sample of 91,531 interviewed persons.

The oversamplingof blackpersons. One of the goals in

designing the current NHIS was to improve the precision of estimates for black persons. This was accomplished by the use of differential sampling rates in

PSU’S with between about 5 and 50 percent black

population. Sampling rates for selection of segments

were increased in areas known to have the highest

concentrations of black persons. Segment sampling

4.

5.

rates were decreased in other areas within the PSU to

ensure that the total sample in each PSU was the same

as it would have been without oversampling black

persons.

The reduction of the number of sampled PSU’S.Interviewer travel to sample PSU’s constitutes a large component of the total field costs for the NHIS. The

previous NHIS design included 376 PSU’S. Research

showed that reducing the number of sample PSU’S

while increasing the sample size within PSU’S would

reduce travel costs and also maintain the reliability of

health estimates (Moore, 1985). The design now contains 198 PSU’S.

i%e selection of two PSU% per non-se&representing

stratum. In the previous design, one PSU was select~

from each non-self-representing stratum. This feature

necessitated the use of less efficient variance estimation

procedures; the selection of two PSU’S allows more ‘

efficient variance estimation methodology (Moore,

1985). In both designs, the self-representing strata are

collapsed to form pseudo-PSU’s for variance estimation.

Collection and processing of data

The NHIS questionnaire contains two major parts: The

first consists of topics that remain relatively the same from

year to year. Among these topics are the incidence of acute

conditions, the prevalence of chronic conditions, persons

limited in activity due to chronic conditions, restriction in

activity due to impairment or health problems, and utilization of health care services involving physician care and

short-stay hospitalization. The second part consists of special topics added as supplements to each year’s questionnaire.

Careful procedures are followed to assure the quality

of data collected in the interview. Most households in the

sample are contacted by mail before the interviewer arrives,

Potential respondents are informed of the importance of

the survey and assured that all information obtained in the

interview will be held in strict confidence. Interviewers

make repeated trips to a household when a respondent is

not immediately found. The success of these procedures is

indicated by the response rate for the survey, which has

been between 96 and 98 percent over the years for the basic

health and demographic component.

When contact is made, the interviewer attempts to have

all family members of the household 19 years of age and

over present during the interview. When this is not possible,

proxy responses for absent adult family members are accepted, In most situations, proxy respondents are used for

persons under 19 years of age. Persons 17 and 18 years of

age may respond for themselves, however.

Interviewers undergo extensive training and retraining,

The quality of their work is checked by means of periodic

NOTE A listof referencesfollowsthe text.
observation and by reinterview. Their work is also evaluated by statistical studies of the data they obtain in their

inte~iews, A field edit is performed on all completed

interviews so that if there are any problems with the

information on the questionnaire, respondents may be

recontacted to solve the problem.

Completed questionnaires are sent from the U.S. Bureau of the Census field offices to NCHS for coding and

editing, To ensure the accuracy of coding, a 5-percent

sample of all questionnaires is recoded and keyed by other

coders. A 100-percent verification procedure is used if

certain error tolerances are exceeded. Staff of the Division

of Health Interview Statistics then edit the fries to remove

impossible and inconsistent codes,

The interview, field work, and data processing procedures summarized above are described in detail in Series 1,

No. 18 (NCHS, 1985b).

Health promotion and disease

prevention

One adult per family, 18 years of age or older, was

randomly selected from the total NHIS sample to participate in the 1985 special section on Health Promotion and

Disease Prevention (HPDP). Self-response was required

for this portion of the survey and callbacks were made as

necessary. A total of 33,630 interviews were completed for

the HPDP, representing an estimated response rate of 90

percent. The HPDP questionnaire covered a wide range of

health promotion topics including general health habits,

injury control, high blood pressure, stress, exercise, smoking, alcohol use, dental care, and occupational safety and

health.

In addition to “data collected from HPDP sample persons, data related to smoking in pregnancy were collected

for all women, aged 18-44 years, residing in NHIS sample

households, who were currently pregnant or had had a child

in the past 5 years. Data on breast feeding and child safety

were collected for all children of appropriate ages residing

in the household.

Estimation procedures

Because the design of NHIS is a complex multistage

probability sample, it is necessruy to reflect these complex

procedures in the derivation of estimates. The estimates

presented in this report are based upon 1985 sample person

counts weighted to produce national estimates. The weight

for each sample person is the product of five component

weights:

1. Probabilityof selection, The basic weight for each person is obtained by multiplying the reciprocals of the

probabilities of selection at each step in the design:

PSU, segment, and household.

NOTE A list of referencesfollowsthe text.

Table L The 40 poststratifkation

National Health Interview Survey

Diaeaae Prevention

aae-sex-race celis in

of- Health Promotion

the

B[ack A!l ottu?r

Age Male Female MaI.. Female

lS-19years . . . . . . . . . . . . . . . . . x x x x

20-24 yeare . . . . . . . . . . . . . . . . . x x x

25-29 years . . . . . . . . . . . . . . . . . : x x x

W+4yeare . . . . . . . . . . . . . . . . . X x x x

Z5-44yesre . . . . . . . . . . . . . . . . . x x x

45-49 years . . . . . . . . . . . . . . . . . x x 1 x

50-54 yeare . . . . . . . . . . . . . . . . . x x x

55-S4yeam . . . . . . . . . . . . . . . . . x x ; x

65-74 yeare . . . . . . . . . . . . . . . . . x x x x

75yearsand over . . . . . . . . . . . . . X x x x

2.

3.

4.

5.

Household nonresponse adjustment within segment. In

NHIS, interviews are completed in about 96 percent of

all eligible households. Because of household nonresponse, a weighting adjustment is required. The nonresponse adjustment weight is a ratio with the number of

households in a sample segment as the numerator and

the number of households actually interviewed in that

segment as the denominator. This adjustment reduces

bias in an estimate to the extent that persons in the

noninterviewed households have the same characteristics as the persons in the interviewed households in the

same segment.

First-stage ratio adjustment. The weight for persons in

the non-self-representing PSU’S is ratio adjusted to the

1980 population within four race-residence classes of

the non-self-representing strata within each geographic

region.

Adjustment forprobability of selection within household.

The weight for each NHIS HPDP sample person is

multiplied by the inverse of the person’s probability of

selection within the family. For example, in a family of

four adults, the sample person had a 1 in 4 probability

of selection, That person’s weight was then multiplied

by 4.

Poststratijkation by qe-ser-race. Within each of 40

age-sex-race cells (tab~ I), a weight is constructed each

quarter to ratio adjust the first-stage population estimate based on the NHIS to an independent estimate of

the population of each cell. These independent estimates are prepared by the U.S. Bureau of the Census

and are updated quarterly.

The main effect of the ratio-estimating process is to

make the sample more closely representative of the target

population by age, sex, race, and residence. The poststratification adjustment helps to reduce the component of bias

resulting from sampling frame undercoverage; furthermore, this adjustment frequently reduces sampling variance.

Reliability of estimates

Because NHIS estimates are based on a sample, they

may differ somewhat from the figures that would have been

39
obtained if a complete census had been taken using the

same survey and processing procedures. There are two

types of errors possible in an estimate based on a sample

survey Sampling and nonsampling errors. To the extent

possible, these types of errors are kept to a minimum by

methods built into the survey procedures (NCHS, 1973).

Although it is very difficult to measure the extent of bias in

NHIS, a number of studies have been conducted to examine this problem. The results have been published in several

reports (NCHS, 1965a, 1965b, 1967, 1968).

Nonsampling errors

Interviewing process— Information, such as the number

of days of restricted activity caused by the condition, can be

obtained more accurately from household members than

from any other source because only the persons concerned

are in a position to report this information. However, there

are limitations to the accuracy of diagnostic and other

information collected in household interviews. For example, for diagnostic information, the household respondent

can usually pass on to the interviewer only the information

the physician has given to the family. For conditions not

medically attended, diagnostic information is often no more

than a description of symptoms. Further, a respondent may

not answer a question in the intended manner because he

or she has not properly understood the question, has

forgotten the event, does not know, or does not wish to

divulge the answer. Regardless of the type of measure, all

NHIS data are estimates of known reported morbidity,

disability, and so forth.

Population estimates-The appendix tables include

population figures for specified categories. Except for overall totals for the 40 age, sex, and race groups, which are

adjusted to independent estimates, these figures are based

on the sample of households in NHIS, They are given to

provide denominators for computation of percents and for

this purpose they are more appropriate for use with the

accompanying measures of health characteristics than other

population data that may be available. With the exception

of the overall totals by age, sex, and race mentioned above,

the population figures differ from figures (which are derived from different sources) published in reports of the

U.S. Bureau of the Census. Official population estimates

are presented in U.S. Bureau of the Census reports in

Series P-20, P-25, and P-GO.

Rounding of mwnbers—In published tables, the figures

are rounded to the nearest thousand, although they are not

necessarily accurate to that detail. Derived statistics, such

as rates and percent distributions, are computed after the

estimates on which these are based have been rounded to

the nearest thousand.

NOTE A list of references follows the text.

Table Il.

National

Estimated standard error parameters for the 1985

Health interview Survey of Health Promotion and

Diseaae Prevention

Parameter

Estimated parameters

set CharacterM)c a b

i Population estimates for demographic,

socioeconomic, and health characteristics . . 0.01X004 6752.95

II Age-sex-race population based upon

combining tha pm.trattfleafion cells

oftable l . . . . . . . . . . . . . . . . . . . . ...0.0 0.0

Table Ill. Estimated adult population by sex, age, and

educational level= United Statea and Canada, 1985

.%x,age, and

aducetkwral level United Statas Canada

Total . . . . . . . . . . .

Men

18-24 years . . . . . . .

25-44 years . . . . . . .

45-64 yearS . . . . . . .

65 yeare and over. . .

Women

18-24 years . . . . . . .

25-44 yeare . . . . . . .

46-64 years . . . . . . .

85 years and over. . .

Educational level

High sohool:

Not completed . . . .

Completed . . . . . . .

College or university. .

Number In thousands

170,971 18,254

13,380

35,100

21,215

11,105

1,592

3,972

2,344

1,043

14,052 1,671

3,960

%% 2,426

15,939 1,349

41,430 6,264

68,476 6,232

62,s36 6,72$

Sampling errors

The standard error is primarily a measure of sampling

error, that is, the variations that might occur by chance

because only a sample of the population is surveyed. The

chances are about 68 out of 100 that an estimate from the

sample would differ from a complete census by less than

the standard error. The chances are about 95 out of 100

that the difference would be less than twice the standard

error and about 99 out of 100 that it would be less than 2Y2

times as large.

Individual standard errors were not computed for each

estimate in this report. Instead, standard errors were computed for a broad spectrum of estimates. Regression techniques were then applied to produce equations from which

a standard error for any estimate can be approximated. The

regression equations, represented by parameters a and b,

are presented in table II. Rules explaining their use are

presented in the section “General rules for determining

standard errors.” Population table III provides the denominators.

The reader is cautioned that this procedure will give an

approximate standard error of an estimate rather than the

precise standard error. The reader is further cautioned that

particular care should be exercised when the denominator

is small.

40
Generalrules for determining standard

errors

To produce approximate standard errors of NHIS

HPDP estimates, the reader must first determine the type

of characteristic to be estimated, that is, the parameter set

in table II to be used. The reader must then determine the

type of estimate for which the standard error is needed. The

type of estimate corresponds to one of four general rules

for determining standard errors. Examples of their use are

available (NCHS, 1986d).

Rule 1. Pewents when the denominator k not generated

by the postsbatification age-sewzzce classes (table I)–If p

represents an estimated percent, b is the parameter from

table 11associated with the numerator characteristic, and y

is the number of persons in the denominator upon which p

is based, then the standard error of p may be approximated

by

sE@)=~/@(loo-p) (1)

v

Y

Rule 2. Percents when the denominator is generated by

the postsbutijication age-sex-race classes (table I) —In this

case, the denominator has no sampling error. If percent p is

the ratio of two estimated numbers,p = x/Y (wherep may

be inflated by 100 for percents), with Y having no sampling

error, then the approximate standard error ofp is given by

the formula

SE (P) ‘p@+; (2)

In this report, the value of the denominator Y is always

provided, but the numerator value x is not published. For

these cases the value ofx maybe computed by the formula

nY

x‘%

Rule 3, Estimated number of people or events—For the

estimated number of people that can be derived from the

percents shown in this report, there are two cases to

consider. For the first case, if the estimated number is any

combination of the poststratification age-sex-race cells in

table I, then its value has been adjusted to official U.S.

Bureau of the Census figures and its standard error is

assumed to be 0.0. This corresponds to parameter set II in

table II. As an example, this would be the case for the

number of persons in the U.S. target population or the

number of black persons in the 18-44 year age group.

Although the race class “white” is not specifically adjusted

to U.S. Bureau of the Census figures, it dominates the

poststratification “all other” race class, and, consequently,

age-sex-’’all other” race combinations of table I can be

treated as age-sex-white combinations for the purpose of

approximating standard errors.

For the second case, the standard errors for all other

estimates of numbers of people such as the number of

people who eat breakfast daily are approximated by using

the parameter provided in table H and formula 3 below.

If the aggregate x for a characteristic has associated

parameters a and b, then the approximate standard error

for x, SE(x) can be computed by the formula

SE(X) = ( (w’+ bx (3)

Rule 4. Difference between two statktks (total and

percent) –If xl and x, are two estimates, then the standard

error of the difference (xl – Xz) can be computed as

follows:

SE(X1–xz) = / SE(X,)2+ SE(X,)2 –2r SE(X1)SE(XJ (4)

where SE(XI) and SE(XJ are computed using rules 1-3 as

appropriate and r is the correlation coefficient between xl

and X2.

Assuming r = 0.0 will result in an accurate standard

error if the two estimates are actually uncorrelated and will

result in an overestimate of the standard error if the

correlation is positive or an underestimate if the correlation

is negative.

Relative standard errors

Prior to 1985, relative standard error (RSE) curves

were presented in Series 10 reports for approximating

relative standard errors. For readers who wish to continue

using them, the following provides guidance. The relative

standard error (RSE) of an estimate is obtained by dividing

the standard error (SE) of the estimate by the estimate x

itself. This quantity is expressed as a percent of the estimate:

RSE =100=)

x

Canada’s Health

Promotion Surveyl

Background

Canada’s Health Promotion Survey (CHPS) was one of

several surveys on health-related topics conducted for

Health and Welfare Canada by Statistics Canada over the

past two decades (Health and Welfare Canada, in press).

With the exception of a regular series on smoking practices,

these surveys tend to be carried out at irregular intervals.

Consistency in question wording and sample design is relied

upon to provide data comparability.

NOTE A list of referencesfollowsthe text. lAdapted from Health and Welfare Canada (1985).

41
Wi[h the exception of the Canada Health Survey

(Health and Welfare Canada and Statistics Canada, 19S1),

which was a joint venture of the two Federal departments,

most of these surveys am conducted by Statistics Canada

under contract, according to specifications established by

Health and Wclfare C~nada. CHPS followed this pattern:

As the survey sponsor, Health and Welfare Canada established ohjcctives, took major responsibility for questionnaire design, carried out data analysis, published the survey

findings (Hwdth and Welfare Canada, in press), and prepared a data tape for public use (Health and Welfare

Canada, 19S5). Statistics Canada participated actively in the

survey clesibm,selected the sample, collected the data, and

carried out initial data processing.

As is true of the NHIS, the data from the CHPS

pertain to the resident, civilian noninstitutionalized population of C.m-tada alive at the time of the interview (June

1985). The sample does not include residents of nursing

homes, hospitals, other institutions, the Armed Forces, or

Canadians living abroad. The data in the present report

also exclude residents of the Northwest Territories, who

were surveyed at a later date by means of a personal

interview. These various exclusions account for about 3

percent of lhe total Canadian population.

Statistical design of CHPS

The target population for the Health Promotion Survey

was all persons 15 years of age and over living in Canada

with the exceptions noted above. Because the sampling

methodology used for the Health Promotion Survey was

random digit dialing, households (and thus persons living in

households) that do not have telephones were obviously

excluded from the surveyed population. This accounts for

less than 3 percent of the total population. However, the

survey estimates have been adjusted (weighted) to include

persons without telephones.

The Health Promotion Survey employed two randomdigit-dialing sampling techniques. For the 10 provinces, the

Waksberg method was used (Waksberg, 1978). For the

Yukon, the method used was elimination of non-working

banks.

The Waksberg method is a random-digit-dialing sampling technique that significantly reduces the cost of a

survey compared with dialing telephone numbers completely at random. The method employs a tsvo-stage sample

design that increases the likelihood of contacting households. The following describes the procedure for the 10

provinces.

First, a list of all telephone area code and existing

prefii number combinations was obtained for the survey

area. An up-to-date listing of all possible area code prefix

combinations was obtained; to these, all possible combinations of the next two digits were added (that is, all possible

banks of 100 consecutive numbers within existing area code

NOTE: A list of references folIows the texl.

prefii combinations). This resulted in a list of all the

possible first 8 digits of 10-digit telephone numbers in the

survey area. These eight-digit numbers formed the primary

sampling units.

A random selection was made of one of these cightdigit numbers and then the final two digits were generated

at random. This number (called a primary number) ww

called to determine whether it reached a household. If it

did not reach a household (that is, the number was not

assigned for use or was a business or institution), the

number was dropped from further consideration. If it did

reach a household, additional numbers (referred to as a

secondary number) were generated within the same bank.

These numbers were also called to determine whether they

reached a household. Secondary numbers were generated

on a continuing basis until (a) five additional households

were reached in each retained bank, (b) the bank was ,

exhausted, or (c) the survey period ended.

Primary numbers were generated continuously

throughout the survey period to yield the required sample

size within each province. An attempt was made to conduct

an interview with all primary and secondary households

reached.

This method is more efficient than “pure” random digit

dialing because there is a higher probability of reaching a

household if the telephone number for that houschokl is

within a bank of numbers that contains at least one othw

household. For the Health Promotion Survey, about 50

percent of secondary numbers called reached a household,

compared with only 16 percent of primary numbers called.

For the Yukon Territory, a list of all banks that contained at least one household (that is, all working banks)

was drawn up by the telephone company. The final two

digits of telephone numbers were generated at random

within these working banks. An attempt was made to

conduct an interview for each telephone number that

reached a household. Approximately 17 percent of the

telephone numbers called reached a household.

Two considerations governed the sample design. on

the one hand, good national estimates of the distribution of

various characteristics are needed for use by the Federal

government and national associations. On the other hand,

because much of the policy and program activity in health is

at the provincial and territorial level, better quality data mu

required at this level than are typically available from a

national household survey. The sample was, therefore,

allocated equally to the 10 provinces and the Yukon (1,000

each). One exception was Alberta, which had a target

sample of 3,300. The additional sample of 2,300 was located in Edmonton, and the cost of this supplement was

borne by that city’s board of health.

Collection and processing of data

After a household was successfully contacted, all members were listed and one who was at least 15 years of age

was selected at random. The interview was then conducted

with this selected person by telephone. If this person was

42
Table W. Households contacted and individual response rate, by

area

Proporikw Identit%d as Individual

Total ellgible households response rate

number

Area called Percent Number Percent Number

All areas . . . . . . . . . . . 40,357

Nmvfoundland. . . . . . . . 4,926

Prince Edward Island . . . 3,121

Nova6cotia . . . . . . . . . 3,038

New 13runswbk . . . . . . . 2,720

Quebec . . . . . . . . . . . . 1,874

Onkirlo. . . . . . . . . . . . 2,223

Manitoba . . . . . . . . . . . 3,674

Saskatchewan. . . . . . . . 4,510

Allxmti . . . . . . . . . . . . 7,128

Brfiish C.oIumbta. . . . . . 2,188

Yukon . . . . . . . . . . . . . 4,9.67

33.8 13,649 61.9 11,181

21.2 1,043 81.4 649

35.4 1,105 84.0 928

35.2 1,069 88.1 S20

40.9 1,113 86.0 958

53.9 1,010 83.8 846

47.1 1,046 72.3 756

27.4 1,006 82.3 630

21.0 948 81.6 774

47.1 3,359 81.4 2,733

49.9 1,091 82.4 899

17.3 667 60.5 690

not available to be interviewed immediately, an appointment was made for a later time. No proxy reporting was

accepted. The interview protocol will be found in appendix

111.

Inhxviews were conducted from Statistics Canada’s

eight regional offkes plus an additional office set up specifically for the Yukon component in Whitehorse, from June

3-21, 19s5. In some offices, the deadline was extended so

that more of the outstanding calls could be completed. All

interviews were conducted between &30 a.m. and 9:30 p.m.

local time during weekdays and during the day on

Saturdays. Interviewers were experienced Statistics Canada

regular staff, and generally were female. In addition to their

experience and training in the general conduct of interviews, they were specifically trained in telephone techniques

and in the subject matter of the CHPS. Supervisors monitored the interviewers on a daily basis to ensure that

procedures followed the specifications.

Table IV shows the results of the various stages of

contact with survey respondents. The overall response rate

was 82 percent; that is, out of the 13,649 households

contacted, 11,181 adult Canadians participated in the survey. As is generally true in household surveys, nonrespondcnts werw disproportionately male and young (age 15-24

years).

Nonresponse because of language difficulties, illness,

or absence of the seleeted person are some of the problems

inherent in a survey that does not allow proxy reporting.

Once a respondent was selected, if he or she could not

complctc the interview, no replacement was made. In some

cases, the selected person could not communicate in either

English or French, even though another household member

was able to respond.

The “No contact” type of nonresponse is a particular

problcm for telephone surveys. There is no way of knowing

whether these telephone numbers have reached a residence, which is eligible for the survey or a business or

institution, which is not. Every effort was made to call these

numhcrs many times. Statistics Canada also checked with

tekphonc companies concerning their status; however, a

residual 2 to 3 percent could not be determined.

Data capture was conducted in each of the regional

offices and transmitted to Ottawa. The data capture operators entered the data directly from the questionnaires into

a minicomputer. The data capture program allowed for a

valid range of codes to be entered for each question and

followed the flow pattern of the questionnaire based on

each entry. No editing was done to check for consistency

between questions at the data entry stage. It was possible

for operators to enter invalid data or to enter data that

violated the skip patterns of the questionnaire, but only

through the use of a specific override function after they

had been alerted that the entry was incorrect.

Following data capture, all survey reeords were subjected to an exhaustive computer edit. Partial nonresponse,

flow-pattern errors, and abnormally high or low responses

were identified. Records with missing or incorrect data

were assigned nonresponse codes or, in some cases, were

imputed from other parts of the same questionnaire. The

one exception to this was the selected person’s age and sex.

In some cases, these variables were imputed from another

record on the Health Promotion Survey file.

Estimation procedures

A self-weighting sample design is one for which the

weights for each unit in the sample are the same. For a

two-stage sample design, this happens if the first stage units

(that is, the Primary Sampling Units, PSU) are selected

using probability proportional to size sampling and a fised

number of units are selected within each selected PSU with

equal probability.

For the CHPS, the households within each province

were selected using this sampling scheme and, thus, the

sampled households within each province have identicaf

weights. The first stage sampling units were bank of

telephone numbers, and the second stage units were actual

telephone numbers corresponding to households within

those banks. Household weights differ from province to

province because a different sampling rate was used for

each province. This is because of the wide range in provincial population sizes combined with the desire of the survey

sponsor for equal sample sizes in all 10 provinces.

The following paragraphs outline the steps used in

weighting the Health Promotion Survey records.

1.

2.

3.

In the first stage of weighting, all households selected

into the sample within a given province were assigned

an identical weight.

The weights for households with more than one private

telephone number were adjusted downward to account

for the fact that such households have a higher probability of being selected.

The weights for responding households (that is, the

reeords on the file) were adjusted upward to account

for nonresponding households. This adjustment was

done independently within Census Metropolitan

area/non-Census Metropolitan area geographical classifications within each province. Weights were also

adjusted when fewer than the required number of

43
telephone numbers were generated within an area

because of reaching the end of the survey period. This

adjustment is based on the assumption that the households that were interviewed represent the characteristics of those that should have been interv~wed. To the

extent that this is not true, the estimates produced will

be somewhat biased.

4. A person weight was calculated for each person who

responded to the survey by multiplying the household

weight for that person by the number of persons in the

household who were eligible to be selected for the

survey.

5. In the last stage of weighting, the person weights were

ratio adjusted to agree with age-sex distributions projected from the Census of Canada. Census-projected

population counts were obtained for males and females

within each province and the Yukon for the following

age groups: 15-19, 20-24, 25-34, 35-44, 45-54, 55-64,

and 65 years and over. Inmates of institutions were

excluded from the census projections because this

group was not surveyed. For each of the resulting 154

classifications (11 x 2 x7), the person weights for

records within the classification were adjusted by multiplying by the ratio of the projected censuspopulation

count to the sum of the person weights of records in the

province-age-sex-group.

Reliability of estimates

The estimates derived from this survey are based on a

sample of households. Somewhat different figures might

have been obtained if a complete census had been taken

using the same questionnaire, interviewers, supervisors,

processing methods, and so forth, as those actually used.

The difference between the estimates obtained from the

sample and the results from a complete count taken under

similar conditions is called the sampling error of the estimate.

Although the exact sampling error of the estimate, as

defined above, cannot be measured from sample results

alone (otherwise a survey would be unnecessary), it is

possible to estimate a statistical measure of sampling error,

the standard error, from the sample data. Using the standard error, confidence intervals for estimates (ignoring the

effects of nonsampling error) may be obtained under the

assumption that the estimates are normally distributed

about the true population value. The chances are about 68

out of 100 that the difference between a sample estimate

and the true population value would be less than one

standard error, about 95 out of 100 that the difference

would be less than two standard errors, and virtually certain

that the difference would be less than three standard errors.

Because of the large variety of estimates that can be

produced from a survey, the standard deviation is usually

expressed relative to the estimate to which it pertains. The

resulting measure, known as the RSE of an estimate is

obtained by dividing the standard error of the estimate by

the estimate itself and is expressed as a percent of the

estimate.

Derivation of sampling variabilities for each of the

estimates that could be generated from the Health Promotion Survey would be an extremely costly procedure and,

for most users, an unnecessmy one. Consequently, crude

measures of sampling variability have been developed for

use (table V). This table has been produced using the RSE

formula based on a simple random sample. Because the

Health Promotion Survey estimates were made from a

two-stage cluster design, a factor called the design effect

was introduced into the formula. This factor accounts for

the increase in variance that results from using a two-stage

cluster design over a simple random sample.

The following rules should enable the reader to determine approximate RSE’S for aggregates (totals), percents,

ratios, differences between totals or percents, and diHerences between ratios.

Rule 1. Estimates of aggregates(totak) —The RSE for a

total depends only on the size of the estimated total itself.

On table V, locate the estimated total (in thousands) in the

left column of the table (headed “Numerator of percentage”) and follow the X’s across to the first figure encountered. This is the RSE.

Rule 2. Estimates of percents—The RSE of an estimated percent depends on the size of the percent and the

size of the group upon which the percent is based. Estimated percents are relatively more reliable than the corresponding estimates of the numerators of the percents,

particularly if the percents are 50 percent or greater. To

estimate the RSE of a percent, reference should be made to

the percent (across the top of table V) and to the numerator of the percent, in thousands (down the left side of the

table). The intersection of the appropriate row and column

gives the proper RSE.

Rule 3. Ratios-In the case where the numerator is a

subset of the denominator, the ratio should be converted to

a percent and rule 2 applied. In the case where the numerator is not a subset of the denominator, the RSE of the

ratio. of the two estimates is approximately equal to the

square root of the sum of squares of each RSE considered

separately that is, the RSE of a ratio:

x

r =— is

Y

RSE (r) = RSE(x)a + RSE(Y)2

This formula will tend to overstate the error if x and y are

positively correlated and understate the error if x and y

are negatively correlated.

Rule 4. Differences between totals or pexents–The

standard deviation of a difference between two estimates is

approximately equal to the square root of the sum of the

squares of each standard deviation considered separately,

That is, the standard deviation of a differenccx

d=x–yisequrdto

sD (d) =J&Fts13(x)]~ + ~RSE(Y)]’

44
Table V. Crude sampling variabilities for the Canadian Heafth Promotion Survey

[10 provincm Yukon Territory excfuded]

Numaretor C#

-tw

Esfhlafedpefwnt

h ihouamds 0.1 1.0 20 5.0 10.0 150 m.o 25.0 30.0 350 400 50.0 70.0 .W.o

1. . . . . . . . . . . . . . . . . . .

2. . . . . . . . . . . . . . . . . . .

3. . . . . . . . . . . . . . . . . . .

4. . . . . . . . . . . . . . . . . . .

5. . . . . . . . . . . . . . . . . . .

... . . . . . . . . . . . . . . . .

; . . . . . . . . . . . . . . . . . . .

e. . . . . . . . . . . . . . . . . . .

9. . . . . . . . . . . . . . . . . . .

10 . . . . . . . . . . ,. .,..,,

11 . . . . . . . . . . . . . . . . . .

12. , ..,,..,,...,,,,,

13 . . . . . . . . . . . . . . . . . .

14 . . . . . . . . . . . . . . . . . .

15 . . . . . . . . . . . . . . . . . .

16, . . . . . . . . . . . . . . . . .

17 . . . . . . . . . . . . . . . . . .

18, . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . .

2:::: :..........,..

21. .,........,..4,..

22 . . . . . . . . . . . . . . . . . .

23 . . . . . . . . . . . . . . . . . .

24 . . . . . . . . . . . . . . . . . .

25 . . . . . . . . . . . . . . . . . .

30 . . . . . . . . . . . . . . . . . .

35 ,,, ..,.,, . . . . . . . . .

40, . . . . . . . . . . . . . . . . .

45 .00 .,..., . . . . . . . . .

50 . . . . . . . . . . . . . . . . . .

55 . . . . . . . . . . . . . . . . . .

60

65::::::::::::::::::

70 . . . . . . . . . . . . . . . . . .

75 ,. . ,. , . . . . . . . . . , . .

lx) . . . . . . . . . . . . . . . . . .

85 , , . . . . . . . . . . . . . , . .

eil ,....,. . . . . . . . . . . .

95 . . m. . . . . . . . . . . , . . .

100 . . . . . . . . . . . . . . . . .

125 . . . . . . . . . . . . . . . . .

%::::::::::::::::

, , . . . . . . . . . . . . . . .

m . . . . . . . . . . . . . . . . .

. , . . . . . . . . . . . . . . ,

400 . . . . . . . . . . . . . . . . .

. . . . . . , . . . . . . , . . .

&

79:::::::::::::::::

I,ooo . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . .

g!% . . . . . . . . . . . . . . .

3,000 . . . . . . . . . . . . . . . .

4,000, . . . . . . . . . . . . . . .

5,000. . . . . . . . . . . . . . . .

6,W0 . . . . . . . 0........

7,W0.. . . . . . . . . . . . . . .

fi@o.... . . . . . . . . . . . .

9,600. ,, .,, . . . . . . . . . .

Io,ooo . . . . . . . . . . . . . . .

12,600 . , , . , . . . . . ., . . .

lS,OOO . . . . . . . . . . . . . . .

15a7

110.1

%

69.6

63.6

58.6

56.0

51.9

49.2

46.9

44.9

43.2

41.6

40.2

38.9

37.8

38.7

35.7

x

x

x

:

155.0 154.2 151.8 147.6 143.6 139.3

109.6 109.0 107.4 104.5 101.6 88.5

89.5 89.0 87.7 65.3 829 60.4

T?.5 77.1 75.9 73,9 71.8 5%7

69.3 69.0 67.9 66.1 84.2 623

63.3 63.0 620 6U.3 5&6 56.9

56.6 5S.3 57.4 64.3 527

54.8 54.5 53.7 ~ 50.6 49.3

51.7 51.4 50.6 49.3 47.e 46.4

~

33:0 32:9 3i4 31.5 30:6 29:7

323 322 31.7 2s.9 22.1

31.6 31.5 31.0 M 23.3 28.4

134.9 130.3 12S.6 120.7 110.2 85.3 49.3

95.4 222 88.8 85.3 77.9 eir.3

77.9 75.2 72.5 69.7 63.6 49.3 28.4

87.5 65.2 62.6 60.3 55.1 427 24.6

80.3 58.3 68.2 54.0 49.3 3.3.2 220

55.1 53.2 51.3 49.3 45.0 34.8 20.1

51.0 49.3 47.5 45.6 41.6 22.2 18.6

47.7 46.1 44.4 42.7 38.9 30.2

45.0 43.4 41.9 40.2 36.7 28.4

33.

7=”6 ‘ [

16.4

427 41.2 39.7 38.2 34.6 27.0 15.6

40.7 39.3 37.9 36.4 33.2 25.7 14.9

3a9 37.6 36.3 34.6 31.8 24.6 142

37.4 38.7 34.8 33.5 3n.6 23.7 13.7

36.1 34.8 X22 29.4 22.8 13.2

34.8 324 3f.2 28.4 220 127

33.7 I 32.6 31.4 30.2 27.5 21.3 12.3

327 31.6 30.5 2S.3 26.7 20.7 11.9

31.8 30.7 29.6 28.4 26.0 20.1 11.6

31.0 29.9 28.8 19.6 11.3

30.2 29.1 28.1 !% R 1!3.1 11.0

29.4 28.4 27.4 2?3.3 .24.0 18.6 10.7

28.8 27.8 2S.8 25.7 23.5 18.2 10.5

28.1 27.2 26.2 25.2 23.0 17.8 10.3

27.5 2&6 2S.6 24.6 225 17-A m i

x 31.0 2S.6 26.7 27.9 27.0

x

26.1 25.1

28.3 i% % 27.0 26.2 25.4

24.1 220 17:1 I

24.6

x

23.6 22.!3 720 9ni n

26.2 2al 25.7 25.0 24.3 23.6 228 2 2.0 21.2 20.4 18.6 I 14.4

5 20.9 20.3 19.7 19.1

a.e le.4 18.6 16.2 % JELI+w %

...

—- --- . , J5.6

x 24.5 24.4 24.0 227 220

x

21.3 :.8

23.1

19.9

23.0 226 z

19.1

21.4 2Q.8 20.1 19.4 18.7 I&o +

x 21.9 21.8 21.5

16.4

20.e 20.8 20.5 19

: 20.0 19.9 19.6 19.1 16.5 i

x

18.0 17.4

19.2 19.1

16.8 16.2

18.8 18.3 17.8 77.3 I

16.7 16.2 16.6

8.7

r 16.1

16.5 16.1 15.6

x 16.8 I 16.7 16.5 16.0

x 16.3 16.3 16.0 15.6

x 18.5 ia4 40.1 17.7

x 17.9 17,8

x 17.3 i7.2 % # “

x 16.9

15.5

i 13.9

x 127

x x

x x

x x

x x

x x

x

x ;

x

: x

x x

x x

x x

x

: x

x x

x x

x

;

x :

: :

15.8

15.4

13.8

12.6

10.9

9.8

8.9

8.2

x

x

x

:

x

x

x

x

x

:

x

x

x

x

x

15.6

15.2

13.6

124

10.7

9.6

8.8

6.1

7.6

7.2

6.8

6.5

x

x

x

x

x

x

x

x

x

x

x

x

x

15.2

14.8

13.2

121

10.4

9.3

8.5

7.9

7.4

7.0

6.6

5.4

4.7

3.8

x

f

x

:

x

x

x

:

15.6 15.1

15.1 14.7

14.7 14,3

14.4 13.9

12.8 125

11.7 11.4

10.2 9.9

9.1

8.3 E

7.7 7.4

7.2 7.0

6.6 6.6

6.4 6.2

6.1

E 4.4

3.7 3.6

3.2 3.1

x 25

x

x :

x x

x x

x

: x

x x

x x

x x

16.1

15.6

15.1

14.6

14.2

13.8

13.5

121

11.0

9.5

E

7.2

6.7

6,4

6.0

4.9

4.3

3.5

3.0

25

21

x

x

x

x

x

x

x

x

15.6

15.0

14.6

14.1

13.7

13.4

13.0

11.7

10.6

9.2

8.2

7.5

7.0

6.5

6.1

5.6

:

3.4

29

24

21

1.8

x

x

;

E

x

15.0

14.5

14.0

13.6

13.2

12.9

126

11.2

10.3

6.9

7.9

7.3

6.7

6.3

5.9

5.6

z

3.2

28

23

20

1.6

1.6

x

x

x

x

x

x

15.6

15.0

14.4

13.9

13.5

13.1

127

724

121

10.8

9.9

8.5

7.6

7.0

6.4

6.0

5.7

5.4

4.4

3.6

3.1

z

1.9

1.7

1,6

1.4

x

x

x

x

x

14.2

13.7

13.2

127

123

11.9

11.6

11.3

11.0

9.9

9.0

7.8

7.0

6.4

5.9

5.5

5.2

4.9

4.0

3.5

28

25

2.0

f.7

1.6

1.4

1.3

1.2

1.2

x

x

x

13.5

127

121

11.5

11.0

10.6

10.2

9.9

9.5

9.3

9.0

6.6

6.5

7.6

7.0

6.0

z

4.6

4.3

4.0

3.8

3.1

27

22

1.9

1.6

1.3

1.2

1.1

1.0

U

0.9

0.6

x

.-..

9.9

9.0

8.3

7.8

7.3

7.0

&8

6.4

al

z

5.5

5.3

5.2

5.1

4.9

4.4

4.0

3.5

3.1

H

25

23

22

1.8

1,6

1.3

1.1

2

0,7

U

0.6

0.5

0.5

0.4

0.4

NOTES: Sampling varlablliUes (relative standard errors) are In percents. To determine sampling variabilities for estimates of totals, locate the row closest to the estimated

Iolal. The left column gives Ihe sampling variability. To determine sampling variabilities for estimates of percents, use the row closest to the numerator of the percent and

the COIUMnCIOSeStto the percent, Sampling variabilities In this table are crude indicators and In general are higher than those that would be obtained using more exact

techniques. Under no circumstances are they official.

Relative standard errors (RSE’S) above the first cut-off line are unacceptably high; RSE’S below the first cut-oft line and above the second cut-off line maybe used with

CfiUtlOn; RSE’sbelow thesecond cut-off Ilne are acceptable.

The RSE’S shown In this table can be obtained with the following formula

RSE=\/(2423.3702) x(l-propalion)/numerator

The formula may be particularly helpful In cases where use of the table requires interpolation.

45
The RSE of d is approximately

RSE(d) = g

d

This formula is accurate for the difference between

separate and uncorrelated characteristics but is only

approximate otherwise.

Rule 5. Differences between ratios—In this case, rules 3

and 4 are combined. The RSES for the two ratios are first

determined using rule 3, and then the RSE of their difference is found using rule 4.

The 1979 surveys

Detailed discussions of the sample design and estimation procedures for the 1979 National Survey of Personal

Health Practices and Consequences and the 1979 Canada

Health Survey have been previously published (Health and

Welfare Canada and Statistics Canada, 1981; NCHS, 1981).

Readers desiring to carry out further analyses of the trend

data shown in this report are referred to these earlier

publications.

NOTE A list of references follows the text.

46
Appendix H

Definition of terms

Terms related to health practices

Amount of absolute alcohol—This is calculated from

the number of drinks reportedly consumed during a given

time period, assuming each to contain 0.5 ounce of absolute

alcohol (ethanol). Heavier drinkers consumed an average

of 1.0 ounces of ethanol (2 drinks or more) daily. Moderate

drinkers consumed an average of 0.22-0.99 ounces of ethanol daily (4-13 drinks per week). Lighter drinkers eonsumcd an average of 0.01-0,21 ounces of ethanol daily (3 or

fewer drinks per week). This classification scheme was

developed by Johnson et al. (1977) and has been used in

numerous other analyses (Clark and Midanik, 1982; Malin,

Wilson and Williams, 1985; Schoenborn, 19S6; Schotmborn, 1987).

Breahfast-U.S. survey respondents were simply asked,

“How often do you eat breakfast?” The Canadian survey

asked for the weekly frequeney of several categories of

breakfast food; “just coffee or tea” was included in the

same category as “nothing.”

Breast tzwninadon —The U.S. survey refers to examination by a doctor or other health professional; the Canadian one specifies a doctor or nurse.

Cumnt dtinker-A person who has had at least one

drink of an alcoholic beverage in the past 12 months,

Drrhking and drh~bzg—In the United States, the question asked was, “During the past year, how many times did

you drive when you had perhaps had too much to drink?”

The Canadian survey included the question, “During the

past month how many times have you driven within 2 hours

of drinking any amount of alcohol?”

Formerdrinker—In the United States, a person who has

had at least 12 drinks in any one year, but none in the past

year. In Canada, this refers to a person who has had at least

one drink in his or her lifetime, but none in the past year.

Life-long abstainer—In the United States, a person who

has not had at least 12 drinks in any one year. In Canada,

this refers to a person who has never had any alcoholic

beverages.

Regularly activeperson–In the U.S. survey, a person

answering positively to the question, “DO you exercise or

play sports regularly?” In Canada, persons were defined as

regularly active if they reported vigorous exercise (for

example, calisthenics, jogging, racquet sports, brisk walking) of at least 15 minutes’ duration at least 3-4 times

weekly.

Seatbelt use—’’Usually” includes “all or most of the

time” (United States) and “always” or “most of the time”

(Canada). “Sometimes” refers to “some of the time” and

“once in a while” (United States) and “sometimes” (Canada). “Never” is “never” in the U.S. survey and “rarely or

never” in Canada.

Smoking—This refers only to cigarettes. Current smokers include regular and occasional smokers; nonsmokers

may be either life-long abstainers or former smokers.

Demographic terms

Age—The age at last birthday.

Education-The number of years of schooling was

determined in the United States; a separate question specified if the highest year was completed. In the Canadian

survey, respondents were asked to check the category describing the highest level completed. The table category

which may not be strictly comparable for the two countries

is “completed high school.” This is because the number of

years to complete high school varies in Canada from 11

years (about 25 percent of the population) to 13 years

(about 35 percent), the balance requiring 12 years as in the

United States.

Parent’s education-For the United States, this term

refers to the highest level of education achieved by the

person designated “responsible adult in the household.”

This person is usually the father or mother but may be

unrelated to the child. For Canada, parent’s education

refers to that of the survey respondent. See questionnaire

(appendix III) for question on children’s use of seatbelts.

NOTE A list of references follows the text.

47
Appendix Ill

Questionnaires

0?,1s NO G937-CW2? ADmcwd Excires March 31, 196

mw HIS-I (SEI (19851

Im. s.m>

fiOTICE - Icfor.nwtim contaimsd on t5is form whch wouid permit icfentificcn~oyGf my ixikidual or cstatlAkmcnt has been colkcled with a wmrnntee that it will bmhnlrl in str!cl confidence, will be .ised on!y fo- rmmows

s:a:ed:crthisstucy.avdwiil no: bs disclosed or released IO othars w!thout ma corser,l O! lhe mew,dua! or :hs

U.S. DEPARTMENTOFCOkWERC .s$tablishrcm in accordnncc with s?ction 308(dl of the FubSc Hee.kh %-rvice Act (42 USC 242ml.

EVREAU OF THFCEW.U5

AEnWGASCOLLEmlNGA=WF~ THE I RT70

U.S. PuBLICHEALTHSERVICE 1. 3-7 2,. R.t3. Number ] 9-10 3. Sample T

I

NATIONAL ~~ALITEHylNTERVIEW

Wok —Of — books

4. Control number 114-16 ]17-201 e

Psu lSeoment I Serial

I I

I #

HEALTH PROMOTION AND DISEASE PREVENTION 5. p~~$~” ~ & sex

SUPPLEMENT BOOKLET

~ 7. Sample Person

number

I ❑ Male tan rrsme / First nrim~

2 ❑ Female I

B. FINAL STATUS OF SUPPLEMENTS ~ ~ Beginning tirna Ending time

o ❑ No person 18+ in this fsmily (Household page)

● . Section M [Household Respondent Section)

163-66 I 67 / 68-71 I 72

t a.m. I em.

Interviaw 2 p.m. 2 p.m.

I ❑ Complete interview [all appropriate items completed) 10. Interviewer identification ~

2 U Partial interview {some but not all appropriate items comp~ted) {Expla;n in notes) Name I Coda

Noninterview I

I

,

}

3 ❑ Refusal (Exp;a;n jn notes)

4 D Other

b. Sections N through V {Sample Person Section)

Interview

I ~ Complete interview [all appropriate sections completed)

2 ❑ Partial interview [some but not all appropriate sections

completed) (Explain in notes)

Nonintarview

3 D Refusal (Expkr;n in notes)

4 ❑ SP temporarily absent

5 ❑ SP mentally or physically incspable

a ❑ Other (Explain in notesJ

12!c

TRANSCRIPTION FROM COMPLETED HIS-I E

2. Telephone in household {Household page, question 11)

I ❑ Yes

I

11. FAMILY ROSTER

List all nondeleted family members 18+ by age

(oldest to youngest). Refer to sample selection lebel

and circle as appropriate. THEN circle Person No. in

item t 1 and mark “’W” box on HIS-1 for the selected

sample person.

w__+––– --------

121 I

I

~

3

.. . . . .

[

-—.

——-

20No

3. Education of SP (page 42, question 2a) L.lil 61-62 _f ___ ______________________, [___

00 D Never attended or kindargartan Ill I

Elem: 123456 78

5

I—- l-__j ------ . ----- --- —- ——--- 1---

High: 9 10 11 12

College: 1 2 3 4 5 6 +

-------------- —-------------------------------- ----

Finish gradelyear KJuastion 2b) UL

t ❑ Y6S

2mNo

4. Main Rata of SP (page 42, question 3nlb) &

1234 6- specify ~

6. Family home (page 46, question 8b) _

CODA Ioclf( 20UU

0106 llcl L 21CIV

02DC 12n M 22DW

03DD 13DN 23DX

04DE 1400 24~y

05DF 15iJP 2602

oaDG lalJ(l 2a •l 22

07Df’f 170R

Osnl lans

09DJ leC17

} Refer to HIS-1 (SB) page 4, questions 4a and b. Transcribe from HIS-I for the sample

person, if required(page20, questions 5a and b).

6

I

I

----- _———————- —------------

7

—---- ----------------- .-

8

I

----- --------------- ----

—--

----

,---

’61

FOOTNOTES
1 i

i RT77

Section M. PREGNANCY AND SMOKING Person Number _ 5-6

Refer to age and sex on HouseholdComposition Page.

Ml u Females18–44 in family (Enterpemonnumber ~No females 18–44 in

and name of all females 18–44; THEN 1) family (Section N)

Read to reapondant:

Thascnextfsw questionsreferto smoking●nd pregnancy●nd ●re●skedof womwa●ged

18-44. In thisfamily thequestionsrafarto (readnames).

1s. Am ●nyof thaeowomannowpregnant? ❑ Yes ❑ No (2) ❑ DK (2)

-------—- ..--- .----- —------ —- ——----—-- -.-—.———————————- ---- —————.—----—-—----————

b. Who Isthis? Mark box in person’s column. lb. , ❑ DK m

I❑ Yes.pregnant now

------------------------------------------------------- ——-. -— —-------------- —- —— —-----—

o. Anyone dsa? ❑ Yes (Reasklb imdc) H No

2=. Hava ●ny of thesewomen given birth to ● live born infant in tfmpast 5 years?

•l Yes ❑ No (M2J ❑ DK (&f2)

-.. ---- ——————----- ———---------------- ————————————-— —————-— ———————————. -

b. Who is this? Mark box h person’s column. 2b. !❑ Yes,child peat 5 years

e fJpK IzI=

—------------ .-. ..----------- ——— —--------------- ——-- -— —-- ..— — .—— ——— ——— ———--—- ——----------

C. Anyono sise? ❑ Yes (Reask 2b end c) ❑ No

!❑ Available, “Yes” in 2b (3J ~

M2

2~ Available, “Yes” in 1b (4}

Mark first appropriate box. ❑ 1b and 2b blank for all parsons (SectionN) M2 3~ Callback requ;red (NP)

.rC NonInterview (Cover pags, THEN NP)

e~ Other (NPI

3. [n what month and yaar waa your last child born? 3. 1

10-13

/19_

W,omh Year

4. Hava you smoked at least 100 cigarettesin your entira iifa? 4. ~ 1~]::, +(:~;;~mo~ingas~ed L_?4

I

22 NO (Mark ‘,Smoking asked’,

box, THEA’ td?!

1

5a, Do you smoke cigarettes rraw? 5a.

16

, id Yes (6)

I z~ No

. ...- —-- ———--—-- -.. -..-————- -.. ——____ —-- ! ..--. ————————-- ---———————-——-

b. About how long has it been since you lastsmoked cigarettesfairly rsgukrdy? b. I

H

I ~ Days ~6:18

2~ Weeks

.2 Months ‘M3)

Number & Years

\9913EI Never smoked regularly (M3}

6. On tha avarage, about how many cigarettes● day do you now smoke? 6. 19-20

Number

eo~ Leas than 1 per day

I

M3

ID‘“YEs” in 1b and ‘“Yes” in 5a (8) 21

Mark appropriate box. M3 20 “yea” in lb and “No” in 5a (7)

an Other (M4)

7. Haw you smoked cigamttas ●t any tima during this pregnancy? 7. I❑ Yes I 22

2U No (M4)

8. On the ● verage,about how many cigarattaaa day did you smoka BEFORE YOU 8. I

23–24

found out you wm’apregnant this time? Number

980 Oid not smoke regularly

9. On tha average, about how many cigarettesa day did YOUsmoke AFTER you 9. 1

2S-26

found out you wara pragnant thietime? — Number

990 Did not smoke regularly

M4 Markappropriate box. In “Yes” in 2b (10) I 27

M4

en Other (14)

10. Did you smoke cigarette at ali during the 12 months before your lastchild 10. I

2a

was born in (month and Veer in 3)? lU Yes

2= No {141

11. On tha ●verage, ●bout how many cigarettes● day did you smoka BEFORE you 11, I

found out you were pregnant?

29-30

Number

96~ Did not smoke regularly

2, On the average, about how many cigarettesa day did you smoka AFTER you 12. I

I

31-32

found out you ware pregnant?

, I SIS3RRGSW%I,Y

\ “o~, yone <,’lj

3. in ganeral, would you sny that you smoked cigarettesduring MOST of 13. [ ,~ye* \

33

that pragraaracy? :E \O

e~ Otner {M=,... - --,rvj

4. D}d ● doctor EVER advise you to quit or cut down on smoking? 14. I lr, Yes i 34

I ;::;

❑n !? =0=,.:.;5-16?, :, 9?!. ,: , 5.?., ---

49
r RT72

.. Section N. GENERAL HEALTH HABITS

i I

3-4

!

Sampla Person Number

t

I ❑ Cellback required (/-/h/d. n8ge) I

s

NI I

I

2 ❑ Noninterview (Cover page)

1 3 ❑ Availeble f1)

Read to respondent: I I

6

These questions ●a about gorwml hsalth pmctIcea. I

I

I ❑ Almost every day

1. How often do You eat breakfast - almost every day, 20 Sometimes

sometimes, rarely or nevar? I

3 ~ Rarely or never

2. including evening snacka, how often do you eat batwaen I f ❑ Almost every day 1 7

meals — almost mraryday, somat[mes, rerely or never? 2 LI Sometimes I

3 ~ Rarely or nevar

3. When you visit ● doctor or othor health profemlonel for 1

I Z Often I

s

routine care, is eating proper foods discussed oilerr, 1 2 E Sometimes

sometimes, rarely or never? 3 ~ Rarely’or never

I ~~ Don’t visitfor routine care

N2 I

Refer to page 46 or47, item R, of HIS-7. I

I ~ SP is Hhld. raap. (5)

a ❑ Other (4)

I

.

t

4a. About how tall are you without shoes? I Ll!kE

I — Feet — Inches I

------------- .. ——---— —------ -.-. .-- —-------------- .—--— —--

b. About how much do You weigh without ahoas? ‘----------m I

1

I — Pounds

Hand Card NI or r08d rtrsponaes for telephone irrterviaw. 16

I ❑ Don’t eat at bedtime 17

6. In your opinion which of tlmao ●m the TWO beatwaya to 2 ❑ Eat fewer oeloriea

lose weight? 3 ❑ Take diet pills

I

d ❑ Increaae physical activity

! 5 ❑ Eet NO fat

!

a D Eat grapefruit with each maal

6. Are you now trying to Ioeaweight? I

I Cl Yea I 1s

I 2 n No (9)

7. Are you eating fewer calories to loss waight? I

(

10

I •l Yes

I

1

2~No

I

8. Hava You inoreasad your physical acthdty to loge weight? I

20

I

I El Yea

i 2~No

9a. :~mti~hn~der youmelf overweight. underwei9h* or Just I

21

I

I ❑ Overweight

1 2 ❑ Underweight

J

(10)

3 ❑ About right

-— —---- .. —---- -.. -.---- —--------- —--------— —:___ ———--— ——---- . -------------------

=

b. would YOUsay You am vow overwei9htt somewhat Overwalght. ,

I ❑ Very overweight

or only a iittieoverweight? I 2 ❑ Somewhat overweight

3 ❑ Oniy a little overweight

I

10. On the average, how meny hours of slaep do you get in a

I 1 23-24 I

24-hour period? I

Hours

FOOTNOTES

50
Section N. GENERAL HEALTH HABITS – Continued

11. k there a particular clinic, health center, doctor’s office, ~ *❑ v~~ w

or other place that you uauaily go to If you are sick or

naad advica about your health? 2~ No (14)

12. What kktd of place k It - a clinic, ● haslth canter, a

: 26

hospital, ● doctor’s office, or soma other placte?

: ~ Doctor’s office (group practice or doctor’s clinic]

2 ❑ Hospital outpatient clinic

IF HOSPITAL k this an outpatientclink or tha amergerscymom? :

3 d Ss.mpla parson’s home

I 4 ~ Hospital cmergrmcy room

IF CLINIC: k thk a hospital outpatient clktic,a company I 5 ~ Company or industry clinic

clinic, or some othar kind of ciinic? a ~ Health center

s ~ Other (Specify)

13. ia there ONE particular doator you usually ses ●t (place in 12)? ~ I

27

I El Yes

/ 20No )

(N3)

Hand Card N2 or read reasons for telaphone intarview. I L?L

I ❑ Have two or more usual doctors or plecas depending

4. Whkh of thaaa iatfra MAiN raason you don’t have a particular !

on what iawrong

piaca you usuaiiy go? z ~ Hmren’t needad a doctor

I s ❑ Previous dootor no longer available

1 t C Haven’t been able to find the right doctor

B @ Recently moved to area

6 ~ Can’t afford medical care

8 ~ Other reason {Specify)

I I

N3 Refsr to sex. I C Mala (Saction Oj

29

I

z ❑ Female (75J

6. About how long has it baan sincmyou had a Pap ameartest? ~

Li?!?S

8 — Years

1

ge ~ Never

‘ 00 = Less than 1 year

6a. About how long haa it boon since you had a breast examination ~

32-33

by= doctor or othar haaith profaeeional? — Years

w = Never

/ 00 ~ Less than 1 ycw

---- . -------------- ——-. ---r ------------ -

b. 00 you know how to ●xamlna your own braast8for lumps? ~

.- ——— ——— —-------

t C Yes DC

:

2 ~ No (Section 0)

-, --------------------- ----1 --- ———— ---- .

c. About how many tlmea a yarrrdo you examina your Own breasts ~

- ~ ~~_3e

for fumps?

—

_ Timesperyeer I

! an ~ Other (SpecifyJ

/ e8 ❑ Naver

,

‘OOTNOT’ES

IMHw.l(sBI,lsc!sII Io.w.c4 Paae

51
Section O. INJURY CONTROL AND CHILD SAFETY AND HEALTH

r

I

01

I

Refer to househofd campositton. I g Children under 10 in family (})

37

I 2~ No children under 10 m Iamdy f03)

I

1

Read lo respondent I ~

Thaso qrmstlonswe about prwrsntinginjuriasto ohildrsn. t

I

Have you ●ver heard ●bout POlSt3N CONTROL CENTERS?

i ❑ Yes

2D No (2I

. . . .. ___ . .. . . .. . . .

!

Do you have tiretelephons number for ● Poison Control

~--- . . . . . . . . . .

1!3 Yes

~. “

“ Canter in your ●rea?

.—

I

2DN0

I 9nDK

There is ● medication called IPECAC (ip’ i kak) SYRUP : 1❑ Yes I

40

whrch is sometimas takestto cause vomiting aftm

som@fring poisonous is swallowed. Do you now hava

1 2DN0

mayIpwxc Syrup in this household? I ‘sDDK

1

I

02 1

47

Refer to household composition. 1D Children u“dw 5 i“ famlfy (3I

I 2❑ No children under 5 in family (03)

Have YOUheard dzoutchild safety soots, sometimes oallad I 1

42

car safety carriers,which are designed to carry chikfr=n

i

1•1 Yes

while they are riding in ● aar?

I

I

I

2❑ No (03J

Oid a doctor or other health professlsrrmlEVER tell you I

43 I

●bout the importance of using car safety seatsfor (yourl 1c! Yes

children? I z~No

I

I

03

t

44

Refer to household composition. 1❑ Cfrifdren under 18 in family {M)

I

I

z D No children tmdsr 1E in family fTO)

I RT73 I 3-4

Person Number _

s-o

04

First name

Enter person number end neme of all children under 1S; THEN mark box. 04

I ❑ Under5 (5) 1

7

205-17 (7)

When -- was brought home fmm tha hospitalfollowing birth, wae -- I

buckiad in ● car sefoty seat?

s. 1•l Yet

s

2D No

3D Not born in hospitaf

4❑ Didnl ride home in “car”’

9DDK

10 D-s -- now hava ● Car safeW s-t? tla. I Dyes I m

2DN0

sDDK 1

(7)

----. ------ ———--- ---

A Whenridinglnacw,i$ - “ ‘ ---------------------------------

~- , ~ *11O,~~t of~k ~ti

-- buckiad In ● oar safety seat●ll or most of tfm

---------------- -----

utima, some of the the, onoe in awhile, or mover?

2 U Seine of ths rims

1

(NP)

3❑ Once in ●whIkr

4 ~ Never

9DOK J

(7)

When rwi~ In ● car, dms ---- w-r o semtblt •~ O, most of the timer so- 1

of the time, once in ewhile, or nswr?

7. I❑ All or mostof the time tl

20 Some of the time

3❑ Once in swhile

4a Never

5a Uses chifd safety seat

900K

05 Refer to age. I ❑ Undet 5 (8) !

12

0s

8 ~ Other f06)

Head to respondent: I

13

i U Yes

{These next questions ● a ●bout brmmtftimg.)

8.

ZONO

Was –-ever breastfad? 9GOK }

{06)

Howoidwm —- whan -- COMPLE7ELY stopped breastfceding? s. 0000 Still bfeastfsd t

14-la

{

t ❑ Days

2 OWeeks

3 U Months

4❑ Yeara

Age

06

1

Respondent t Cl Chifd”sparent

%7

06

5•l Other

FOMA1+13.$lS~)11S,S114.21.

I

52
..—ltT74

Section O. INJURY CONTROL AND CHILD SAFETY AND HEALTH – Coratinuec d 3-4

O. Whan driving or rfdlng in a oar, do you wear a aettt belt I ~ All or mos: of the time ●ll or most of the time, some of the time, orroein I

●while, or novar? 2 ❑ Some of the time

I

3 ~ Once in awhile

-—

s

-

I 4 ~ Nevw

I s ~ Don’t ride in car

1

Read to respondent: 01 ;Zi Only 1 (lIc) ~

Tho naxt quastions am about this home.

1●. How many smoke datectoraam installad in this home?

I

_ Number (1 lb)

I m ❑ None

I Se ❑ Dl( 1(12)

------------ --- ——-—--- - —----------- ---——- ..--—---- ,-.

b. How many of them ●m now working?

.- —————————— - —-------- --

I

w

I _ Number (T 7cJ)

I

oo@ None (l If)

I

----- .--- — — ------------- --——-—— -l— ——-— ___________ -———----—— . -- T-- --

0. II it now working? I 1 P Yes

I

2~N0

s~DK 1

(llfJ

----- ------------------ . ------ ___ -_____: -..

d. How do you know [it is/they are] working? I

I

I

I

I

I

I

I

I

I

I

I

—-- ------ ..--- —____— ——--------

. . Anyotfwr way?

I

-- ——— ——— —— --

f. [la lt/Ara any of tfresmoke detectors] next to a aleepirtgarea? ,

#

I

--- —- —--------- ------

❑ Tested it/them

H It/they went off because of smoke

~ Ithhoy wcm off while cooking

❑ Changed the batteries

n The li~ht is on

, . .

- Beeps whsn bmrerv is low

❑ Other fS.cecifYJ

..- —-- —----------- ——— —— - .- —--

PI Yes (Reask 11 d and e)

d NO

. ..---- ——-------— —-. --——-

I 10

--—

2s. Do You know about what tha hot watar tempamture is in I I

19

tir18 hom8?

I D Yes

I 20 No (13J

-— —- —— -- . . --- —------------ -.. - _ -_______ +____ ---——.---——--————————- ——————-

b. About whet tempemttamISthe hot watar? ‘-=

_——-

Temperature

OR

ID High m

2D Low I

3D Medium

-— —-------- . --------------——— ..- ---... -–1-----------------------------

c. How dId you eetimate the hot water temperature? I ❑ The setting on hot water heater ------~

2 ❑ Tested with thermometer

3 ~ Guessed

o❑ Other LSpecify)

3. In the past 12 months, have vou (or has anyone in your I 1❑ Yes I

26

household) used a thermometer to test tha tamperatura

of tfw hot winter here?

2DN0 I

9t3 DK

!

0. ABOVE what tempmmturewiil hot water cause ecaid injuries? ~

26-2S

I _ Temperature

I

I gegn DK

OOTNOTES

53
I nT75

Sootion P. HIGH BLOODPRESSURE Z-4

t

t. I ●mg~;~gto,,fld ● fist~~i” , ~~ch ~ ~ mayIZM•ff~a I

porcon”schwrcosof gottlng H~ART OISEA%E. 8

Hand Card P

I

I

I

Aftw [ road oxch orw, 20NMO If you think k dsfinitdy t

irrcmosos,~y Incroms, P?*Y dooo not, or

dofinitdy do,s not irwroaa ● pomorr”schaneas d

:

gtihtg hurl dlsoaso. FirctPROBABLY D&m~m&L:

I DEFINITELY PROBABLY ODES NOT

f INCREASES INCREASES INCREASE INCREASE 0%%

1

● . Clgwotto smoklrtg? [Givo MO c numbw fzom tha cud.} I 10 20 30 4C! 9D 1

●

. . . . . . . . ----- ----- ----- - .:-- ..-,..... -.

!

1

b. Worry or ●rxioty? I In 2 u. 3!3 ● II so I

s

..-. ;.

c. High bfood proscuro? /

I

10 2D 3G ‘cl 90 I

7

. . ----- ----- ---- -1------------ . . .

1

!

d. Diabmw$? 10 in 3CI 40

:

SC I

8

. .

I

.,

!

● . Bdnu VERY ovorwdf#M7 1

$0 20 an 4n SD L

s

. . . . . ----- ------ ----- ----- ----- :------- ------ ----- ---. ---~-,. ----- -.-,,-

t. Overwork?

I

I 10 2U 3D 40 so [

10

—---- ----- ------ ------- ------ ___ -:-------------------------------- -----

g. Orfddng Coffn with coffo&to7 I

tn 2U 30 413 so [

11

-- ---- ---- ____ _-

---------------: --- ‘ ----------------- ---------------

h. Emtirrgt diet high fn ●zimol fat? 1 10 20 30 4n *CI I

12

...--> -. ..-. . . .. . . . . ____ ____ ---- ____ ,____ ---- ----- -- ---- ---— —--- ---- ---- -

I

L Family hbtory of heart dboooa? I

10 2U 30 40 90 [

13

. ..- ----- ----- ,---- -

-----------------/--- ‘ -------------- -------------

---- -

j. High ottdoot0701?

I

I .1 c1 20 30 [

I

40 *IJ 14

!. Tho fotlowlns oordtbrs uo rohted to h8vins ● STROKE. In your ;

I

Opir)lon,Whkh of then

I D Diab.tos lC

COmstkmsMOST kmmmna ●

chwzcosof -WIZW ● ztroka - dbbcwz, hlglr bkod P==-: \

a❑ Highbloodpmscum

high ehclootmol? 3D H~h chokctarol

;

sDDK

3. Which ono of tho followl oubotonom kt food b MOST oftort

1

3

1

●tcocIatmtwith HIGH BL OD PRESSURE - codk(m,. 1

I Cl Sodium

1*

ehoktmol or sugar? I 2 ❑ Cholastwol

I

!

3nsug8r

I s ❑ Othzr fSpocify)

I

I

sODK

C. Hawy~EVERk tibyetir~~h~ti pfn~l ~ I

thctycuhod h~omoIon. oomotS~ccUodhl@ fArrxt~ 7;

17

1 cl Yos

2U No (12)

I 3 ~ Only dur”w prognanq, (12)

6. Wom you tofd two or mom DIFFERENY Umoz thatyouhad I

1

1s

hyp.-dozr or tdgh bfood pmssum?

I

I

I Cl Yes

I ZONO

I snDK

6. Am you NOW toklng ●ny modlchro pmccrifzd bya docta for i 1 u Yoz (8) I

10

your hyputonchn w hi#t blood pmocuro? I

20No

7-. Was any m=ikkto EVER pmmribod bys dootocfor your I

hypoztoiwlon or hi@r blood gwooaum? /

ao

1❑ Y*S

I

I

z ❑ No (8)

b. Dtiadoct@tivko youto*toptokktg tttomodickn7

t

I

I D Yes i

21

I 2i3No

1.

FOOTNOTES

-“... .“C. .... ,,”, .,_,,,-., ,.___M.-...,l ....-”.

54
Section P. HIGH BLOOD PRESSURE - continued

8. SocaUaeof your hypatwwion or high btood prossura. 8. Diet to tosswaight? b. Cut down on salt w ! c. Exerciso?

has ● doctor or othor health profosaiormlEVER sodium kn your diet? ;

?dvisod yOUto -

I ~ Yes (9) “m

... .. .

t ~Yes -(9) -..4 I ~: Yes (9) ~- 24

2 ~ No (8b) 2 ~ No (8C) [ 2 [-]No {71)

—. .,. .—.-—

9. Hsvs YOUEVER followod this ●dvics? I G Yes (10)

-–==== ,,No ,,1:= 1~: Yes (10)

2 ~ NO (8b) ‘2. i No (8C) 7

—.. . . . .

10. Aro you NOW !ollowhtg this ■dvice?

1 , 1 J

la. Do you ttill have hypwtwwlon or high blood pwssuro? ~

31

t C Yes(12)

1 2UN0

I 9Z?DK

b, Is this condition complotofy cured osis It undsr control? ~ I n Cured

I 3Z

I 2El Undercontrol

1

I QDDK

aa. ABOUT how long has it b~wrsine- YOMLAST had your ]

{

2 n Days ix~k

biood prm$urs taken by ● doctor or other hadth 3 ❑ Weeks

pr0f4sBi0nd?

Number 4 r3 Months

5 •l Years

. . . . . . . . . . . . . . . . . . . . . . . . .

b. Blood pmssuro is usually glv.rt ●s OIWnumbw ovor

snothor. Wsrs you told what your blood prosmrrewas,

In NUMBERS?

---- ------ _______ ,. _.. -------- ____ -

c. What was your blood pr9ssurw in NUMBERS?

. . . . . . ... . . _________________________

d, At that time, was your bfood pressure hfgh,

low, or normal?

13. Do YOU NOW hsvo di~batas or sugar dlahtes?

14. Havq you wmr baorrtoid by ● doctor or othor hadth

~Q@onal that yOUhad h~h choiostorol?

16,Do you hava ●ny kkndof hbart conditlcn or hamt

troubla?

9SSI0DK

OCUCINeverJ

(13)

------ . . . . . .-

: ❑ Yes

2nNo

SIDDK }

(12d)

------ ----- . . . . . I

“v“36

----------------------------------------------l

I

999999U DK

c

40-42 -_- ————___________ ________________ ----- _________

43

I ❑ High

2❑ Low

3❑ Normal

6n Other (Specify)

9DDK

t C Yes I

44

I

znNo

s ~! Other(Specify)

I ❑ Yes I

45

2fl No

16. Havs you ●vu had a stroko? 1!3 Yes I

47

I 2DN0

I

30TNOTES

1

~H12.1t2Sl llS#51[*25451

55
SectiossQ. STRESS —

Readto respondmt:

●8

-—

Thoea next qusstiorsswa ●bout stsass. : !L~A lot

1. During tfw paat 2 wooks, would you say tfmt you ‘ ? (~ Moderate

●xpwiencod ● tot of stress, ● modmato ●mount of * ~JRrrlative!vhttle

stresc, rolstivaly Iftth ●sass, or almost no etroscat ●11? 4 g Almost none

, c ~ DK what stress IS f3)

t. In the past Year,how much ●ffaot has strew hsd on Your ; lti Alot I 49

hsalth - ● lot, somq hardly ●ny or norm? I 217 Some

; ~ ~ Hardly any or none

1n. In tho past ysar. did you think ●bout weking hdp for anY LSO

porconal os●motkwmlproblems from fmnily w frhntts? , ~UYes —

~ 2!3N0

. . . . . . . . . . ... . .. . . . . . . . .. . . .

b. from a hslping profossiorml or wsalf-halp sroup? ~ tLI Ye, lXI ZDNO

QI

JrJ “hlo”in 3a and 3tJLSectjonR) ~

Refer to 38 andb

,

: 8riOther 14)

I

-

1*. I

: ●l

b. I

Dkdyou ●ctually s-k ●ny twlp? [ ,CJYes

~ ?~~No f-see:ionl?)

. ..-. . . . .. .. .. . . -- 1 . . ..- . . . .. .

From whom did you seak hdp?

Number up to four items in the orifor rnendond.

I __ %N;e”’ember ‘r El

!

Do not read list.

Friend IIzl l—

t— %VChoi~ist IzKl

i

l— Fsychkdrist m

I

I Psychiatric social

t

I

_ worker m

I

I Othermental

l— healthprotessicmal ~

!

I _ ?dedweldoctor @l I

I

l— Rehgksuscounselor ~

I

I Alcoholics

I_ AnOnvmOus El

1

. .

. ..- --------

Gamblers

Anonymous ~

~ Weigh! Watchers ~

_ Counselorat work E

_ Counselorat school =

_ Probationoffices w

Ottrer(SKify~

m—

~

B

t

.------- .—-- ------------ - -------- -------- . ..----- —---- -.——-.. -------------- ------ --------

c. Anyone Am? ; O Yes (Reesk 4b and d

! iiNo ~

Section R. EXERCISE 3-*

~ ~ , ~ Sp i5 ~hy~i~ally hand)cagped (Describein foo~tes. Tf+EN1J

RI ~ 8n t3:hw (2) — —.

la.

b.

c.

Readto respondent: i I-X

These mostquvstkms us ●bout physical ●xercis*. Handcakmrfar. ~

ht the past 2 wcaks(ouWNedontit calendar),beginning I

Monday fdateJand endhtg this past Sunday (dafel,havt you

I ICJYW

dons ●ny ●x6rchee, amwta.~ PbYsJc~lv ~t~-~**s? j ?~ No (3, pege 73)

. ---- ----- .“- ------ ----- -------- ------- --- +----” “------ ‘“-- - -

..- . .

What wwe tha~?

Recordon nextpage, THEN ?c.

1

-- .-—---- . . .. . . .. ... . . . ----------------------- J -------------------- . . .. . ----------- -----

An@ring .1s8? ~ ~ ~es (Reasklb and c)

: n No (2M

‘OOTNOTES

..—— —-. —....— ——- ---.— —.— I* ++,s3KSIB, .19W !6 .& *S ,

56
Section R. EXERCISE – Continued

NOTE - ASK ALL OF 2a BEFOREGOINGTO2b– d. NOTE: ASK 2f2– d FOR EACH ACTIWTY MARKED “YES” IN 2a

.- ...- -—.——- ..

head to respondent: Th9so mxt qu*stions ●m b. How many times in

I I

c. On tha ●varag-. ●bout d. {What usuall~ happened to your

●bout physical ●xwcisa. Hand caJendar.

* ‘ ~~sgbzz

tfm paSt 2 waaks did

‘a, tn the past 2 waaks (cdined on thatcalandm], you lpl@ao/doJ

bolnning Monday, @s@ ●sd wzding this pxst (activity in 2a)?

iacrwiw in 2.4?; Did you have ●

Sund8y, (date). have you donb wry (of the

following~wcisos, sports. or physically

●CtiVS hobbi~s) - YES NO

—— .-.

{1)Walking for 6XWCiSS? Ird 2U (1)—— Times 2n Moderate 4n None

Refer to age.

R2 1 n SPis 75+ (23} ~ \

o D Other (2) I

(2) Jogging or running? I I: ~ r?

ii’

!: ;=j~ --:”;I!E;

1 .??...

(3 I Hiking? ,1! 2!!

(4) Gardening or ymd wozk? I r: z D —-.

(S) Awobic$ or ●orcbic

! ~~ ~37-3a !39-41 I i : Small

dancing? lr: 2 :-1 (5) ____ ..__ Times

-—. —

—— __ Wwtes 2 ! ! hhterate

L43 i44_45 &_4a

(6) Other dancing? lrl 2iTl [6) —.– Time.

5

I : -j snl~ll

. .. ... . . Minutes 2 ! ; Moderate

(7) Cafhthenic: of (@nerd so S1-S2 53-55 1 I ; Small

●Xwcisa? IC32LI (7) — TImss _ Minutes z L Moderate

. . . . .

67 ‘- - 68-SB ‘“ - ‘--

(8) t30if?

“’h-i; -1 ~ ;Ma”

!020 (8) — Tim.= — Mhuxes 2 ~ Moderate

. . . . ----- ----- ------ ---- -... . . . . . _

94

-. .-.. ------- --

(9) Tennis?

6s–44

1020 (w _ Times ~,nu:y=i “-,‘2~-sma;l D Moderate ~~

. . . . --- . . . .

7s 72-73

‘----1

I 74.->6

[10) Bowling? t132n {1OI Times

1 rJ small

—— Milwtes z U Moderate

(11)Biidwt?

78’” -l

Inzn L (11) I%nas — wiles

112)Swimming ff wat.r . “ - -; ❑“”~~ L.EL ‘.”--- ”-” }

2 Ii MOderale ● : ; NOWZ

~ - 19S:”W

M,NI,$= ; ~ ;~&,=

::pzl-x.

●x*rci$a.? (12) — Times

. . ------ --- ____ ____ ----- ., ___ ____ --- ----- ___

193-xa

[13) Vaga? 1C12CI

3DLar9sk

(13] —_ Ttmes — Minutes 2 D Modarate 4DNOI-IS

R3 Refer’0a~.I u SPis65-74 (23/ +ya ❑ IOth.sr (14)

s

● ~ / S–11

[14) Wdght Nfting or training?,n ,n (141 — Times

I U Smstl

— Min.tss

3 ❑ Laqe &

2 D Moderate 4 G None

“-1 ------------- ..______ 1s____ _____ 4 -i---- 94-1s ‘“” ‘“”” --””i18_18’ - - ‘- ‘ ----- ””-----

~g%:k

11S) Baskstbcll? (16)

1•l Small

1C12D — T.. __ Mites z ❑ Modarate

‘E:?2Z:$24 (16) Bcaxbdt or softbcft?

[17) Football?

(18) Soocer?

-------- ---. _-. __-.T:!!=~

(19) Vdtxybdl?

[201H81JMLTcrxvtbxfL

:::-q:,z;:8,z;zq$5’$$ ......

------,, ---------- --------- ----------,

{21I ttkating?

----- . . . . . --

(22I Skiing?

..-. ----- . ...,.,

(231 ;;;c~~d.mm.mmrry {ot@e) ●X02dSX8, apoets. as

hobLxax ksthxpxst2wxaka

(that I hsvan’t mentienxd)? Anythfng .1ss?

------ ----- ------

&--_ -------@,&j

.- -Ii,+.

I

I

I L3Small

(23)

.I~ Large

— Tmas — khms 2 G Moderate 4 u None I

57
Section R. EXERCISE - Continuad

J

i. DCDyou ●xorciso or play sports rogukdy? 1s

: l.i Yes .-. .—

z :2 NO /5}

t. Far how long have you ●xerciaador played

{

! [~ Days,

es.

sports regukriy?

2r~ Weeks

3 ~~ Months

—.. ——..

Number t ~J YearS

● . Would you say that you ●ra ph~sically mora sactiva.Iaaa I [~ More active I B9

active, or ●bout ●s ●ctiva ● othor pwaons your ●SO? 2~ Lee.$a~~i”e

3 ~ About as active (R4)

a ~ Other fSpecify) (R4)

. . ------ . . .. . . . :

b. Isthat [a lot more or a 11ss1.morola lot leasor a Iittlalam] ●ctlrfa? : $~ A lot more

,.,. .’

2 ~ A httle more

3 ~1 A lot less

4 ~ A little less

t

I

R4

Refer co “W#Wb” boxes in C 1 on HIS. 1. w -

I I ❑ Wa or Wb box marked (6.s1

!

s @ Other 16c)

,

,

● . How much hmrdphysical work is rsquirad on your job? I ~ Great deal

1 92

Would you say ● swatdo=l, ● modorata amount, ● Iittfa, 1

or norm?

z ❑ Moderate amount I

3 ~ A little

i

I }

(7)

4 ~ None

.-. . -.-, . . . . . . . .;-- .- ..- ----- ----- -.. --- -.

b. About how many hours par dxy do You petform hard physkal ~ -

work on your job? I %mrs (7)

-. --.” . . . .. .. . . . . . ----- ; ---------------

C. How much h~rd phy~;c81w~~ is raqrriradin your main d~ily I

.

I D (%?at deal

.,-. i6-

●ctivity? Would you say 8 great deal, a modwate ●mount, ■ I

IMI*, or non-? I 2 D Moderata amount

I 3El Alittle I

}

(7)

4 n None

----- ----- --------- ._-_i-._---.-_-_-_-- ------------------ ---d-

. &ut how many hours p.r day do vou psrform hard phys-mal ~

~,3:<,-

wosfrin your m=in dsily activity? 1 —— Hours 1

Read to respondent:

I

1

98

Thasa rmxfquestions ma about swengtfteningtha heart :

●nd lungs through ●xerciao. Daya

;

● . How many days a waak do you think ● paraon should sxorciso I

8[ 10ther LS@cify). ------ .-—

to strengthen tha heart ●nd lungs? 9C?DK

b. For how many minutes do YOU think ● person sh’~~ “

,

I ~8,?ll_

●xwcise on EACH occasion so that tha haart●nd IunQs

●rmstrmgthansd? ! Minutes

: 999~ OK

.-- —---- ------—- ---- . . . . . . 1 . . .

Hand card RI

. . ----- -------- ------- .

%Q.L

!.

c. (During those (number in 7bJ mfnutas), How fast do you

think ● person’s heart rataand braathbtg should fsato I

strengthen the hart ●nd ftmgs7

Do VW think that tha haart ●nd broatbing rata should ba -

I

I o No faster than usual

:

no faster than usual, 2 D A little faster than usuel (

● Iittfe fastar than usual, I 3 ~,i A lot fasler but talking is possible

● lot faatar but talkkrg is possibls, I 4 n So fast that talking is not possible

so fast that talkhzgk not possible? I

I 9cl DK

OTNOTES

58
-“-.. s.. w. ..,. .-..

,

S1 Refer to ‘“Smoking asked” box on HIS- 1.

! 1 :-} “.%Oking asked”” !20. marked (4] L__!z _

e ‘-”: Other (IJ

Read to respondent: I 16

Thoso nextqumtions ●re about smokirqfcigamttas.

———

I G Yea

1. Have you smokod ●t I@mxt100 cigarettesfn your ●mire Iifo? ~ 2~;N0 i4J

2?. Do you smofm cigmatws now? t I 3 Yes (3) i7

1 z~)No

J

b. About how tong has it bowt since you last smoked cigarettes I

‘ B–*O

fakiv ragularlv? /

1

{}

..:

I : Days

z c; Weeks (4)

~ ~ MOnth~

Number 4 G Years

1

i 99B [.] Never smoked regularlv (4J

,

a. On the ●rmrqfq zbout how nwny dfpettaa ● day do I

you now smoka?

1 00 ~ Lessthan 1 Der dav 13-*2

:

.—— Number

I

4. ~d~)T.ltm.lfyoutMnkC#GARET7ESMOKlNQdsflnhe~ ~

● ● next que@ons ●m ●bout smoking ckgnrottas.} (Hand

Inctoasas, probablv inrmaaos, probablv does not, w definitely

PROBABLY DEFINITELY

dws not inorssse ● pwson’o chmtecs of gettingthofoflowlng

I DEFINITELY PROBABLY DOES NOT 00ES NOT DKINO

problsnw, first -

I INCREASES !NCREASES INCREASE

1

INCREASE OPINION

● Emphy80mx? (Ghm me a numbs? from iho card.) =

. . ..- ---- . ..-. . . . .. . . . . . . . . ;. !Q_... -.. -:?.. - . . . ..’.9.. ---- .!~. -... _.. _’-Q ______

b. Bl*ddcr rmtcor? I 1!3 2E 3 $~ 4C ,@ E

.,. . . . . . . . . . ------ ------ -- . -- 4 . . -. - .. . . . .. ------ -. ..- - .-. ------- - -

e. Canosr of the larynx (Iar’inks) or voica box? I 10 2 c-1 ail 6 la 90 m

----- .----- ,. .- . .._ . --------------- i----- ..- ...- -.. ----- ----- .

I

----- -----

d. Catsracts? 1 ID 20 3ci 4CI 90 m

. . . . . . ------ .. -,---- .---- .. .i -

------- -.--- ----- ----- ----- . . . . . ---, ----- --

9. Cmtowofthoesophagus?

I

I

,~ Zr 3C 40 Sc ~~

1

f. Chroerkfwoncfdtis? I

9l] z i; ‘n 4 ii 90 $&

. -.. . . . . . . . . . . . . . .. . . --- /.. -., ------ ----- -- ------- . ----- ----- -__. . _

s. Gallamoes? 10 2U 3 LT 4 U 90 E

“.. . I . .- _,------------------ . . . -

h. Lung oanow? 1 lcl 2n 3U ,Q 9U E

I

S2 Refer to ape.

~

I

t Cl 5P ia under 45 (4;)

I 2 Cl SP is 45 + (S3)

1

Reed 10 respondent: I

Dooe cigcmtw smoking during pragnxncy dofinftaly incroasa, 1,DEFINITELY

F#I;A~;~ DEFINITELY

PROBABLY

proksablvEncroase,probebfv not or dofhritelynot hcr-aaa the ,

00ES NOT OKINO

I INCREASES INCREASES INCREASE INCREASE OPINION

chances Of -

I

i. Misoardzga? I

,~ 2n 3[1 ~n 911 E

.-. . . .. . . . . . . . . -!.

j. Stillbirth?

I

III 2 :1 I

312 4 [1 90 E

. . . . . . . . . .

.1. . . . . . . .

k. Pmmalure birth?

I

In 1 [J 3U 4 [.3 9D Ec

:

1, Low birth weight of the newborn?

,. ,

la 2,, 3 l-. ! 4[1 ~-

1

~ ~.i ““

I ._

I

Sa. If ● woman Sxkssbirth control pills, is efm more likalv to havo I

● ●t?oiwif ah. smoims than if sha dots not srnoim?

,’l Yes

L-z

I

z [~ No

9~jDK }

1s3)

.:. I

b. ::gk~h more likely or sommuhct mora Ukolv to have > TJMuch more

27 L—.

I

I

2 !~ Somewhat more I

S3

I [_

Re?er to 1.

I ❑ ‘<Yes” in 1 /6)

2a

I

a D Other (Section ~)

S. Oii ● doctor EVER ●dwim you to quit or cut down on smoking? ;

~

I Cl Yes

I

2~N12

I

sUDK
1

2

3

4

5

e

7

a

I

Fa

Section T’. ALCOHOL USE

Read ro respondent:

I

I

30 1

These next questions ● ro ●bout drinking ●lcohofic bwaragas. ;

Included m= fiquor such m whiskay. rum. gin, or vodka, and !

beer, ●nd wine, ●nd ●ny othor typo of ●lcoholic fmwarago. I

I ● . In YOUR ENTIRE LIFE hava you had ●t Imst 12 drinks of ANY : 1Cl Yes

kind of ●lcohofic bavcr~ga? ~ L]No (Id)

1

1

b. in ANY ONE YEAR havs you had ●t I=ast12 drinks of ANY kind ~ 1L.iYes al

of ●lcoholic bmnwago? 2 r~No (Id)

:

c. Hawcyou had ●t I-ast one drink of Lw*r. wine. w liquor during ; t D Yes [2) 32

the PAST YEAR?

..— —

1 2~N0

1

d. What is your MAIN r~ason for not drinking (in the past year)? [

00n No needhrot necessary

1

I

,

I

I

I

I

1

I

1,,

; 33-34

01 u Don’t care forkiislike it

02 ~ Medical/health reasons

02 U Religious/moral reasons

of n Brought up not to drink (9)

as D Costs too much

1

06 ~ Family member an alcoholic or problem drinker

07 D infrequent drinker

I os n Other (Specify) ——.

!. in tho past 2 WEEKS (outiined on that cdmxfar), beginning I 01014 iEvery day) 1208—9 23‘:] 3 3s-36

Monday (dare) xnd ●riding this pa-t Sunday (dare), on I 02013-14 ‘1308 24~2—3

how manis did you drfnk wry ●lcohotic-rages. 1

such ●s beer, wirm, or liquor?

1 03013 14[, ] 7—B 2s:12

I 04m12–13 1507 26C11-2

Uselist to probe, if nacessary. I 05012 1S0 6-7 2?C1

I

06D11–12 17D6 00 ~ None/Never (4}

I 07~11 tan 5—6 ss~ DK

I

I

O8EI1O-11 ~eCl5

[ O9EI1O 20CI4–5

I 1009–10 2104

I 11❑ 9 2203-4

1. On the (number/n 2) dayc that you drank ●lcoholic bsvarages, I

how merrydrink o! ❑ Twelve or more onU Three or four ~

s did you harmp-r day, on tho ●voragm? I 02 D Seven to eleven 09 U Three

Use list to probe, if nkessmy. I

I 03 ~ Six IO~ Two or three

I 04 ❑ Five or six II IJ TWO 1

! 05 D Five 12Cl One or two

I 06 ❑ Four or fiv6 1300ne

1 07 ❑ Four wpJDK

la. Was tfm ●mount of your drinking during that 2-WEEK period ~ I

‘m

typicai of your drinking during tho past 12 months? I El Yes (5J

I 2DN0 I

. .. . ---- ---- ----- -.

b. W& *, ●m~unt-of your drink~ng&s;ng that 2-WEEK p.rlod

+ ---------- ---------- -

. . .

t LX.C 1~ More mom or lassthan your drinking during tha past 12 month=? 1

1 2 ❑ Less I

i. During tho past 12 months, in how many MONTHS dtd you I

havo ●t ieaston. drink of ANY ●icohotio bevarage?

41-42

:“

Months

;. During [thet month/those month31,on how many DAYS dkf YOU ~ I

43-4s

have 9 or mora drinks of ANY ●icoholic bevwago? I Days

1

I 000 n None or never

‘. During [that monthhfmaa montfw], on how many DAYS did YOU : 46-.48

havs 5 or more drinks of ANY ●lcohofic bevarago? (Inciudo the , Deys

(number in 6) days you hsd S or more drinks.} I

000❑ None 01 never i

). During the past year, how many tlmosdld you drlvo when I

40-s1

you h~d pwfmps too much to drink? 1

1 Times

I

, 000 ❑ None

I ssa ❑ Don’t drive 1

‘OOTNOTES

,H~.l12u ,,s35,,4.25.85,
Section T. ALCOHOL USE – Continued

s. (Hand Card T) Tell me if you think HEAVY ALCOHOL DRINK. /

ING dofbrlfcly increaees,probably increases, probably does

not, or definitely does not increasea parson’s chances of

gattlrrgtha following problems. First —

I

PROBABLY DEFINITELY

I DEFINITELY PROBABLY DOESNOT DOESNOT DKINO

INCREASES INCREASES INCREASE INCREASF OPINION

I

● . Throat canrxr? (QIv* me a number from the card.)

I

t lG 2C 3r 40 ,Ci CEC

----- ---— . .—— - ___ __ ;__––– —--—— ——. . -—- ____ _.. . ---—

I

b. Cirrhosis of tha Iivar? In Zri 30 & ~ ~r. —E

---- ---- ______ ____ _... ____ _____ .- -— -- -— -- ___ ___ .- —--

c. ffladdw cancer? I

Ig 2C 3il 40 9U ~

I — ..-— -.. —____ ___ ----- ____ _ ~__-_-– --————- ___ .--— — ____ _____ _

I

d. Canoor Of tho mouth? /

lE 2D 30 40 9U ZzC

-.-—— -.. _____________ ____ -_ L___– – __________ .-- —- --—— _____ __

I

● . Arthrltle? r 10 2ZI. 30 4n 91-i E

------------ _____ -. _____ _.

:, --—--- -— —--—--- -———--—- .

—-— —.- --

f. Blood clots? In 20 3 .n 4G 90 ~

TI

Ls!L

Refer to age.

I ~ SP isunder45 (99)

2 Cl SP is45 + (Section U)

!

I

Reed to respondent: #

I

Does heavy drinking during pregnancy cfefh-ritefyincreese, I

PROBABLY !)EF!NITELY

probably increase, probably not or definitely not incraase DEFINITELY PROBABLY DOESXOT 00ES NOT DKINO

the chancas of -

INCREASES INCREASES INCREASE INCF15ASE OPINION

g. Miscarriage? -c 23 32 4a F

90 —

-——. ----- ---- -— --- ____ ___ ... .,. ______ _ -— --- --- -—- -— --

I

h. Mental retardation of the newborn? ! *C 23 3 L’ &m ! 60 9n _

----- ------- _-, - ____ __.. ----- --- —-- ---—— - ------ —.— ---

r

L Low bbth wdght of tha newborn? I

10 2C 3G 4CI efl E

-—- ------ . -——— ___ _— ___ _- } ---------

-— —---— ——- _

1

—-- -— --

]. Birth defects? t In 2CI 30 4G 9P C3c

I

10a. Have you ●var haard of FETAL ALCOHOL SYNDROME? ,

I

I ~ Yes

&

I 2 L~ No (SectionU)

——- ---- ______ ---- ____ _____ ______ __,, ,._ ____ _

b. In your opinion, which ONE of tha following bast daacribes

.- —-- ——. —__ _

I

Fetal Alcohoi Syndroma -

M

a baby is born drunk, or born I

●ddictad to alcohol, or born with cartain birth dafects? I G Drunk I

z❑ Addictedto alcohol

3 ❑ Wth certainbirthdefects

I

FOOTNOTES

.=..-.. . .............. .. . .

rnge16 .- “,..,,..,,!..,, ,,U.,J.W
Section U. DENTAL CARE

1. This next question is about prevmttingTOOTH DECAY. Hand f

Card U. After I read each of the following, tell me if you think it

PROJ..:LY DEF~~;ELY

I DEFINITELY PROBABLY DKINO

is definitely impofiant, probably important, probably not, or ; IMPORTANT IMPORTANT IMPORTANT IMPORTANT OPINION

definitely notimpohant inpreventing TOOTH DECAY. First- ,

● . Saaing= dentist regularly7 (t3ivemea number from thecard.) ~ In 2E 3n 40 9P E

-— —— —-. .— — --------------- I ---- ——— —- .-------- ---——— —---- . . .

f

b. Drinking water with fluoride from earlychildhood? ,

l!Z 20 31Z 4E 90 U!!L

I

---- —---- ------ -—----------—- . ----- . .. ..--. — ------------ ---- —-- .— --- ---- ---- --

c. Regular brushing ●nd flossing of the teeth?

I

_ ------J-_ :g

2CI 3r 4CI F9n —

--—— —— -- ---- ---- --——— ——- . . . . .. ---- -- ---- --—- ---

I

d. Using fluoride toothpaste or fluoride mouth rfnse? I

10 25 3E ~ i-’ 93 U!?_

--- ----— ———— --—-—— ————— ----- -1- -————- --- -. -- . . --—- -- —-- --—.

1

e; Avoiding between-meal aweetk?

I

In 22 3L ‘~ 92 “&

1

I

2. Now I’m going to ask ●bout preventktg GUM DISEASE. In I

your opinion, how Important or not important is aech of the ~

following in preventing GUM DISEASE? First — 1

I

a. Seeing a dentist reguleriy?

.—

I

lL 23 3? .,3 ,2 _

70

-——- —. -———---— —--— ——---- --- .1 ---- -- --——— ---- ---- -.

b. Drinking water with fluoride from eariy childhood?

I

10. z r. 30

~ ~. ! 73 9LI —

r

_.. —- —--- ---- -—————--- -., ,.. -------- ---- --—- ----- —--- -----

I

c. Regular brushing and flossing of the teeth? I lE 2P 3EI $E 93 E

——— - -- —— —-- ---- -— —--- --- -- —-— --- . . ...- ———— -— --- -- --

I

I

d. Using fluoride toothpaste or fluoride mouth rinse? Ilz 2C 30 4n 90 E

I

--———— -.. --------------— --- 4-- —-- —— —----- .—— ——— ——- ---- --- ---

I

e. Avoiding between-meal sweets? I In 2D 30 4D rJ3 m

3. In your opinion, which of the following is the MAIN cause of ; I ❑ Tooth decay L?.!!-

tooth lose in CHILDREN - tooth decay, gum diseese, or injury ,

tothe teeth? 2 ❑ Gum disease

I

3 ~ Injuryto the teeth

4. [n your opinion, which of tha following is the MAIN cause of

I

tooth loss in ADULTS - tooth decay, gum disease, or injury to ~

t ❑ Tooth dacay ~

the teeth? 2 ❑ Gum disease

I 3 ❑ Injuw to the teeth

5a. Have you ever heerd of DENTAL SEALANTS? 1 I ~Yes

~

I

2 g No (Section V)

---- --——— ———- --- _--l. -—-— -- -& .. —-—- ---- ---- ---

b. Which of the following BEST describes the purpoee of dental I I ❑ prevent gum disease l-x

seelants - to prevent gum disease, to prevent tooth decay, or \

to hold denturee in place?

2 ~ Pravent tooth decay

3 ~ Hold dentures in piece

‘OOTNOTES

!

RMI’llsliaw {19s51 nc-, s 8,

--- . . —.. . .-. —

Page 17

62
-H?i

Section V. OCCUPATIONAL SAFETY A?JD HEALTH ! 3-4

1

VI

L5_

Refer to “Wa/Wb” boxes (n Cl on HIS-7. ; I ~ Wa orWb box marked (7)

; a Cl Other (Cover page)

Read to respondent: I

s

Them questions are about your present job. I

1a. In your present]ob, are you exposed to any SUBSTANCES

1 ~!2Yes

that could ●tdarrgrsryour health, $uch as chemicals, dusts, 2E!N0

}

12J

fumee, or gasoe? ‘J~DK

----- . . . . . -.,------------—- ___________

b. Whet substances are you axpoaad to that could

endsngar your health?

Enter eachsubstwrce in a separate column.

Any others?

--------------- ------------------

Ask ?Cfor each response in lb.

c. How can (response in lb) endanger your health?

Recordverbatim resporsels),

Any other way?

.—-—- .———————-- --------- ------ - —----------

SUBSTANCE 1 SUBSTANCE 2

i 7-8 17-18

.———- -————————- -

-i

“~9–wi ------------------

23 CIDK m

28, in your present job, rareyou exposed to any WORK

CONDITIONS that could endenger your heelth, such as

1 a !’ss

~ 3-4

loud noise, extreme beet or cold, physical or mental

-

;:}:} (3)

&

atresa,or radiation?

.———________________

b. What work conditions trreyou exposerfto ths;~;~~ ––––––––– ~--”

..———___________ ~.

●rrdangaryour health? won!< cc! FmmorJ 1

I WCRI: CGNDITION2

Entereschworkconrr’irionin a aepsrate column. , 6-7 116–17

Any others?

! —---—- ------- l==!=== c.

Ask

How

2C

can

for

(response

aachresponse

in 2b)

in

endangar

2b.

------

your

———

health?

—-- -.————— ________ _ Record verber;m response(s).

Any othetway7

?9r DK I

ss~DK

3a. In your present Job ate you exposed to eny risku of I C Yes : 66

●ccidents or injuries? 2E. NO

s~DK )

{CeverPage:

—----------------------------- ..->-- -———--————- .

b. What (othar) risks of accidartts or injuries ara you

..-. -- ———--------

‘67-86

●xpoeed to?

Recordver!mtlm response(s).

I

----- --- .-. .- — _____________________ ______________ --. _____

a. Any o:hars? Z Yes Fkask 26 mo cl

E iuc ‘1

TDKj :Cae- ‘age!
I* St.isticsCanadS SatistiiueCsnsda

HEALTH PROMOTION SURVEY W] - mj - ml ,~[

Tdsphons Numbsr

LkwNo.

~

rst I would like to ask you a few quesIn generalj compared to other persona your age

20 Very good

30 Good

40 Fair

50 Poor

Do you agree or disagree with the following

statement? Compared to most people my age I

make more of an effort to improve my health.

60 Agree

70 Disagree

*O No opinion

Do you think there is anything you personally

should do to improve your physical health?

10 Yes 20 No ~ Goto6

What ix the most important thing you personally

should do?

90 Exercisemore

40 Improve eatinghabits

60 Loseweight

60 Stopsmoking

7() ~u~ drug usdmedications

.90 Cut down on drinking

‘O Other (specify)

Is there anything stopping you from making this

improvement? (Mark all that apply)

OK) No

o~o Roblem notserious,noUrg’encY

OSOLackoftime

040 kck of self discipKne,energy

‘O Toodepressed

MO Don$tILOOWhow to get started,lack knowledge

‘O Peerpremure

08() Lackof supportfromfamily or friends

090 Don’twantto changecurrenthabits

100 Toodiffiiult

1*O Too costly

*20 Other (specify)

Do you tliink there is anything you personally

all:~s$ do to improve the way you cope with

10 Yes 20 No ~ Geto9

What is the most important thing you think you

should do? (Markonly mostimportant)

10

20

3(-J

4(-J

50

60

70

80

Exereisemore

Learntorelax,worryless

Getout moreoften,makenewfriends,socialii

Changejobs, move, leave home, change situation

Reducedruguselmedicatione

Reducealcoholuse

Spendmoretimewithfiimilyendclose friends

Other(specify)

Is there anything stopping you from making this

improvement?

010 No

o’2(3 problemnot serious,no urgencY

030

040

0s0

060

070

Of@

090

100

11(-)

12(-J

Lackoftime

Lackof selfdisapline, energy

Toodepressed

Don’tknowhowto get Etarted,lack know~edgs

Peerpressure

Lackof supportfromfamily or friends

Don’twantto changecurrenthabits

Too diiicult

Too costly

Other (spasify)

1. In general would you say you’re...

10 very happy

20 Pretty happy

“sO Not too happy

10. Would you describe your life se...

40 Very stressful

50 Fairly streseful

$() Not very stressful

70 Not at all stressful

2-5400-140.1:2-4-65TBKTREG.B14069-26

64
1. Are there health topicsabout which you feelyou

need moreinformation?

80Yes ‘c) No —Cicto13

2 On which of the following health topics do you

feelyou need moreinformation?

Yes No

Nutrition 010 020

High blood pressure 030 040

Mentalhealth OS(-J 26(-J

Smoking 070 al o

Alcohol 030 100

Mer@ana 11(-J U’o

Safety end accident 130 14(-j

prevention

Phe next few questions are about your

:urrent physical condition.

& How tall are you without shoes?

mm 0’ KIIl

feet I inches centimetres

14. How much do you weigh?

IIKIIl”m

pounds kilograms

[5. How much would you like to weigh?

IzUIl or ICCU

pounds kilograms

70 Don’t know

,6. Are you limited in thekind or amount of activity

you can do because of a iong term physical

condition or health problem? By long term I

meana conditionthathas lasted or is expected to

last more than 6 months.

‘O Yes 20 No ~ 0oto18

[7. Are your activities limited...

Yes No

At home 30 40

At work or school 50 80

In otheractivitieseuchas 70 00

leisuretimepursuitsor

transportationtoor from

work

l& ‘Whhe:$yd you last have your blood pressure

10 Last 6 months

20 6-12 months

‘O Onetotwoyears

40 Morethan i!years

60 Xever

}

(30to 22

‘O Don’t know

9. As far as youknow isyour blood pressure high?

70 Yee

80Xo

}

Goto22

90 Don’tknow

O. Are you currently doing anything to control

your blood preesure?

‘O Yes 20 No ~ ooto22

1. what are you doing? (Markall that appiy)

010

030

030

04(-J

060

OS(-J

070

080

090

100

Medketion

Quitsmokmg

Exercise

Weightloss

Sodiumrestriction

Otherdiet change

Relaxation

Reducealcohol use

Other (epecKy)

Don’tknow

2. Do you agree or disagree with the folIowing

statement? You only need to have your blood

pressure checked if you think you have a

probIem.

10 Agree

20 Disagree

sO No opinion

‘he next few questions are about exercise.

3. Exercise includee vigorous activities such as

calisthenics, jogging, racquet sports, team

sports, dance classes, or ~ walking. Do you

feel you get as much exercwe as you need or less

than you need?

40 As muchas needed

50 Less than needed

60 hn’t know

4. How many times per week do you exercise for at

least 1Sminutes?

10 Daily

20 b6 times a week

30 z-4 times a week

40 1-!2 times a week

SO ~SB th~ once a week

60 Never

70 ~n’t know

W. Would you say you are physically more active,

about the same or less active than other persons

your age?

10 Moreactive

20 Aboutthe same

30 Lessactive

40 Don’tknow

55400.14C.1

65
1. Do you think that getting more exercise would

improve your health . . .

‘C) A great deal

60 A moderate amount

70 A little

80 Not at ail

‘O Don’t know

he next few questions are about smoking.

~. At the present time do you smoke cigarettes?

10 Yes 20 No ~ Goto31

L Do you smoke cigarettes reguiarly, that is usually everyday or cecasionaiiy, not everyday?

go Regularly 40 Occasionally

3. In the past year has anyone asked YOU t-c not

smoke around them?

50 Yes 60 No ~ ooto31

h Where has thie happened? Anywhere else?

(Mark all that apply)

10

20

30

4(-J

50

60

70

1.

At school

At work

Inacar

Restaurant

In your own home

in a house other thanyour own

Other(siwcify)

Now I’d like your opinion on some statements

about smokimr. Tell me whether You agree or

disagree with &ach of the followin#- -

Children are more iikeiy to

start smoking if their

parenta smoke

Peopie are too concerned

about the effect on their

health of other people

smoking

Most non-smokers don’t

mind when peopie smoke

in their presence

Women should not smoke

during pregnancy

Non-smokers should be

provided with a smoke-free

area where they work

Smokers should ask permission before smoking in

the presence of others

Smoking heips you stay

slim

Die- No

Agree agree opinion

010 020 coo

040 060 q

070 660 0$0

100 110 120

130 140 150

160 170 160

190 200 210

Z. DO you think that a person who quits after ten

years of heavy smoking reduces the risk of

getting a disease related to smoking . . .

10 A great deal

20 A moderate amount

30 Aiittie W

40 NotataU

50 Mn’t know

L Do you ever feel unpleasant effects from the

cigarette smoke of others?

‘O Yea 70 No

t. Have you ever asked someone not to smoke?

80 Yes ‘~ No ~ ooto36

5. Where was that? Anywhere else? (Mark all that

apply)

1(J

20

3(-J

40

50

60

70

80

in restaurant

At work

At school

Inacar

Public transportation(bus, airplane)

in your own home

Ina houseother thanyour own

Other (specify)

?OW I would like to ask some questions

Lboutalcohol consumption.

& In the next questionswhenwe use the word

drink it meamx

One boffle of beer or glass of draft

One smaii glass of wine

One shot or mixed drink with hard iiquof

Have you ever taken a drink of beer, win% liquor

or other aicohoiic beverage?

‘O Yes 20 No ~ Goto44

17. In the past 12 months, have you taken a drink of

beer, wine, liquor or other alcoholic beverage?

30 Yes 40 No ~ Go”toU

B. During the past 12 months, how often, on

average, did you drink alcoholic beverages?

Waait...

10

2(-J

3(-J

4(--J

50

60

Every day

46 times a week

2-3times a week

Once a week

Once or twice a month

Less often than once a month

8.5400-140.1

66
19. (a)

(b)

(c)

(d)

(e)

Thinking back over the past 7 days, on how

many of these days did you have any

alcoholic drinks?

n 80 Ncme ~G0t040

On how many of these days did you have 2 or

more drinks?

D 80 None —--.Go to40

On how many of these days did you have 4 or

more drinks?

m 80 None ~@~40

On how many of these days did you have 8 or

more drinks?

On how rn~y of these days did you have 12 .-

or more drinks?

m 80 None

LO. Would you say that this is more, lessor about the

same amount that you usually consume during a

week?

10 More

20 LS8S

‘O Same

41. During the past month how many times have you

driven within two hours after drinking any

amount of alcohol?

m

880 Don’tdrive ~oo to 44

990 Don’t know

42. About how many drinks can ~ have, over a 3

hour period, before ~ would worry about your

abiity to drive?

n

‘O Don’tknow

43. There is a legal limit to the amount of alcohol ~

can have in your blood when driving. How many

drinks do you think yqI can have over a period

of three hours before you are over the legal limit?

n

’90 Don’t know

44. In the pagt 12 months, have you been with a

friend or relative whom you thought had too

much to drink to drive safely?

‘O Yes

60No

}

ooto47

TO Don’tknow

45. On the most recent occasion did you attempt to

prevent this person horn driving?

80 Yes 90. No - Goto47

6. What did you do? (Mark all that apply)

10 Drove them home Yo~self

20 Askd gomeone to drive them home

so Asked them to take a taxi

40 Hid their ser keys

50 Served coffee

60 Kept the perxm at Your ‘Qme

70 Other (specify)

L7. How many drinks do you think a person can

have per week, without endangering lddher

health over the long term?

m

‘O Don’tknow

Now I’d like your opinion on some statements

about drinking. Please tell me, whether you

agree or disagree?

Die- No

Agree agree opinion

Moderate drinking can be 010 020

good for your health

On social occaeions I often 040 0s0

feel obligated to have a

drink, even when I would

rather not

Most drinkers do not suffer ‘O 080

health problems as a re6ult

of their drinking

Most people don’t mind if 100 110

you get intoxicated once in

awhile

I’d rather pay for a taxi 130 140

than see a friend drive after

drinking

030

0s0

0s0

120

150

wow I would like to ask about your use

]f drugs.

i% In the past 12months have you used

sleeping pills? 010 Yes

020 No

Pep pills, stimulants? 030 Yes

‘O No

Tranquilisers such se 050 Yes

vaiium? MO No

Cocaine? 070 Yes

‘c) No

Marijuana or hsehieh? ‘O Yes

100 No

iO. DO you think that occasional use of marijuana

will affect a persons’ physicai or mental health?

40 Yes

50 No

}

Goto52

60 Don’tknow

6-5400.140.1

67
S1. What effects do you think it would have?

(Mark all that apply)

01(-J

02(3

030

04(3

060

060

070

080

060

10C)

Relaxationor otherpositiveeffects

Addiction/leadsto harder drugs

Memoryloss, brain damage

Othermental or behavioral effects

Lung damage

Oeneticproblemdsterility

Otherphysicel health problems

Increase/riskof accidentsor injury

Other (specify)

Don’t know

L’”henext few questions are about safety.

62. On average, about how many miles or kilometres

per week do you travel in a private vehicle . . .

As a driver?

EElzlor EUElz

miles kilometres

30 Don’t know

53. On average, about how many miles or kilometres

per week do you travel in a private vehicle . . .

As a passenger?

EUUl ‘r EEUEl

miles kilometres

60 Don’t know

54. How often do you use seatbelts when you ride in

a car? (Readresponses)

10 Always

20 Most of the time

30 Sometimes

40 Rarely or never

5& When you are driving a car do you insist that the

children with you have their seatbelt fastened or

are in carseats? (Read responses)

10 Always

20 Most of the time

30 Sometimes

40 Rarely or never

60 Don’t drive

60 Dontt drive with children ~ Car

56. In the past 3 years have you taken any training

to admhister &st aid?

70 Yes soNo

S-5400-140.1

7. Can you administer cardio-pulmonary

resuscitation, sometimes celled CPR?

10 Yes 20 No

R Would you agree or disagree with the following

statement? It is worth learning CPR even

though few people ever have to use ik

30 Agree

40 Disagree

50 No opinion

9. DOyou have the following in your home?

Yes h’o

A first aid kit 10 2(J

A smoke detector 30 4(-J

A tire extinguisher 50 6(-J

60. Interviewercheckitem

Respondentix Fe~e ?’0 —---4 eto61

Male 80 ~oo to 66

Fhe next questions are about health

wactices.

il. In the past 12 months have you had your breasts

examined by a doctor or nurse?

10 Yes 20 No

12. Have you ever been shown how to examine your

breasts?

30 Yes 40 No

;3. How often do you examine your own breasts?

Would you say...

CO At least once a month

80 OncOevery 2-3 months

70 Lessoften

80 Never

M. How often do you think a woman should

examine her own breasts?

10 At leastonce a mOdh

20 once every 2-3 months

sO Lessoften

40 Never

so Don’t know

;!5. When was the last time you had a PAP smear test

for cancer 7

10 Wlthii thepast year

20 Last2-3yeara

‘O More than 3 yeara

40 Never

50 Don’t know
I’he next few questions are about social

relationships.

W. About how many people, including relatives, do

you consider to be your friends, that is, people

yous- socially on a regular basis?

a

W. Of the people you see socially how many smoke

cigarettes? (Readrespmses)

10 None

20 A few

30 About half

40 Mod or dI

s O Don’t know

W How many would you say drink toomuch?

(Readresponses)

10 None

20 Afew

‘O About half

40 Most or all

50 Don’t know

B9. How many of your friends use marijuana regularly? (Readresponses)

*O None

20 Afew

30 About half

40 Most or aII

50 Don’t know

10. HOWmany of your fkiends exercise regularly?

(Roadresponses)

10 None

20 Afew

30 About half

40 Most or all

50 Don’t know

m How many do you consider ta be your close

friends, that is, people you could tnlk to if you

needed help or had a probIem? (Readresponses)

10 None

20 Afew

30 About half

40 nr05t or alI

SO Don’t know

7!2. What is your current marital status?

10 Married(including common-law)

20 Smgldnever married

30 Separated

40 Divorced

1

ooto74

50 Widowed

1S. Does your spouse do any of the foilowing?

Yes No

Exercise regularly 010 020

Smoke cigarettes 02Q 040

Drink too much 050 060

Overeat 070 080

Use tranquilizers such .ssvalium ~0 100

Smoke marijuana 110 120

rhe next questions are about nutrition.

‘4 In tbe hat week on how many days Cld you have

the following for breakfast?

Nothing or just coffee or tea n

Egg% bacon, ham or other meat n

Breads, pastries, pancakes or cereak n

Fruit or juice El

Cheese milk or other dairy products m

MAre there any foods which you think you should

limft or avoid, for the sake of your health?

10 Yes 20 No ~ ooto77

16. Of the following types of food, which one do you

feel is the most important to limit or avoid for the

sake of your health? Food that is.. .

30 High in cholesterol

40 High in fat

50 High in sugar

60 High in sah

70 Don’tknow

‘7. Are there any foods which you think you should

eat more often for the sake of your health?

‘O Yes ‘O No ~ Goto79

~8. Of the following types of food, which one do you

feel is the most important to eat more often for

the sake of your health? Foods such as...

10 l?mitsand vegetables

20 Whole grain cereals

30 ~ ~d fik products

40 Meatlfishlpoultry

60 Don’t know

69
9. I will now read aliet of health topick For each one I’d like your opinion about how important you feel it is

,@ the govemmen~ to deal with each topic. TelI me on a scale from 1 to l% with 1 b&ng not at all

~poti-t and 10 being extremely importank

‘Notstall “Extremely Don’

important . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..imptiti knw

1234567 8910

Drug use 010 020 0s c) 040 060 080 070 080 090 100 110

Smoking 120 L?(-J 140 160 160 170 1s0 19(-J 200 210 22~

Alcohol problems 230 240 250 260 270 280 290 300 310 32 c) 330

High blood pressure 340 360 360 370 S80 390 400 410 420 420 440

ChiId health 460 480 470 4S0 490 500 610 520 530 540 550

Eating habits S60 WC) 560 690 600 610 620 630 640 660 360

Mental health 610 660 1390 700 710 720 730 740 760 760 77 (-J

Accident prevention 780 790 800 610 820 830 840 860 880 670 880

in the home

Accident prevention 890 900 910 920 920 940 960 960 S’?(J 980 99 (-J

at work

Accident rwevention 1oO(J 10Q 1020 1030 1040 10S0 1060 1070 1080 1090 1100

on the ro~d

O. Do you agree or disagree with the following

statements?

Dk- No

Agree agree opinion

Following a healthy diet is 10 20 30

expensive and time consuming

I’d rather be overweight 40 50 60

than have ta give up many

of the foods I like

Skipping breakfast is an 70 80 ‘O

effective way to control or

reduce your weight

1. Do you think that you could improve yo~r health

by changing your eating habits?

10 Yes

20 No

30 Don’t know

?iually a fe-w questions about yourself.

)2. What is the highest grade or level of education

you have ever completed?

10 No schooling

20 Elementary

30 Some

40 Completed }

50 Some

60 Completed }

70 Some

80 Completed }

Secondary

Community college,

techmrel college,

CEGEP, nurse’s training

University

or

teacher’s college

gO Other education or training

33. What language do you speak at home most

often?

10 English

20 French

30 Other

M. What is the postal code for this dwelling?

~ ~ 40 Don*tI-mow

55. How many telephone% counting extensions, are

therein your dwelling?

10 One ~Goto90

20 Two or more

M. Do all the telephones have the same number?

30 No

40 Yes ~ Goto90

87. How many different numbers are there?

,m

36. Are any of these numbers for business use only?

50 No ~Goto90

60 Yee

89. How many are for business use onIy?

m

3-5400-140.1

70
IO. Which of the following best describes your main

activity during the Iaat 12 months? Were you

mainly . . .

10

20

30

40

5(-J

60

Working at a job or ~Ck) to 92

business

Looking for work —---M20t091

A student )

Retired

Keeping house [

Go to 96

Other (specify) )

1. Did you have a job at any time during the last 12

months?

10 Yes 20 No — 0oto96

)2. For whom dohlid you work?

11, ,,, ,,, ,,, ,,, ,,, ,,1

1,, ,,, , !,,,,,,,,,,,,]

B. ~~ kind of business, industry or service iefwas

[I I,, I,, ,,, ,,, ,,, ,,, J

/ 1,,,,,,,,,,,,,,,,,,1

& What kind of work doldid you do?

1111, ,1,,1,1,,,,,,,,1

1,, ,,, ,,, ,,, ,,, ,,, ,,{

M. How many persons does this company employ?

Include persons in all branch locations of the

company. Are there . . .

30 OverlOO

40 Between 60 and 100

5(3 Between 10and49

60 Under10

‘O Don’tknow

)6. Inthehnstf iveyearsh aveyoub eenunemployed

for 8 year or longer?

10 Yes 20 No

97. Interviewercheck item:

If code 1in question90 ‘C) ~Goto98

I Otherwise 4(--J~Go to 104

98. Are you aware of any safety or accident prevention programs at your place of work?

50 Yes 60 No 70 Don’t know

M. Are you aware of any other programs to improve

health, physical fitness or good nutrition?

10 Yes 20 No ‘O Don’tknow

[60. In the past year, have you seen or received any

information about health topics at your place of

work? (e.g. posters, bulletin boards, pamphlets,

etc.)

40 Ye8 50 No _ 00 to 102

.01. Have you found the information helpful?

60 Yes 70No

02 Is smoking restricted ‘m your place of work . . .

10 Completely

20 Incertainplaces

30 Not at au

40 Don’t know

103. Do you think your pIace of work is an appropriate place to promote good health habits?

50 Yes

60 No

70 Don’t know

[04. Do you think schools are an appropriate place

ta promote good health habita?

10 Yes

20 No

30 Don’t know

.05. What was your household’s total income from

all sources before taxes and deductions for

1984?

13TlTJ300 40 Don’t know

106. What is the single most important thing you

have done in the past year to improve your

health?

010

020

030

040

0s0

060

07(-J

Nothing ~ &Jto 109

Increasedexercise

Lost weight

Improvedeatinghabite

Quit smokingheducedamount smoked

Reduceddrug/medicationuse

Drankless alcohol

os O Had bl~ pressure checked

090 Attemptedtocontrol blood preesure

10C) Le~ned to manage stress

110 Reduced stress level

120 Receivedmedicaltreatment

130 Other (specify)

S-5400.140.1

7’!
107. Wide from improving your health, was there 109. Considering the health topics we’ve discussed

any other reason that you decided to do this? in this questionnaire, is there anything you

w to d% to improve your health in the next

10 Yes

year? (Mark ali that apply)

010 Nothing

020 Increaseexercise

20 No ~ootolo9 030 Loseweight

040 Improveeatinghabits

050 Quit smokingheduceamount smoked

10S. What was the other reason? 060 Reducedrug/medicationuae

1,, ,,, ,,, ,,, ,,, ,,, , I

070 Drink less alcohol

080 Have bloodpressurechecked

1,, ,,, ,,, ,,, ,,, ,,, , 1

09(3 At@mpt to controlbloodPressure

100 ~arn @ managestress

11, ,,, ,,, ,,, ,,, ,,, , 1 *10 Reducestress level

lZO Receive me&lcaltreatment

1111111 !I, ,,, I,, ,, I I 130 Other(specify)

DOMMENTS

72 *u. S.GovernmentPrinting Office 1988: 201-855/80001

S-5400-140.1
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures—Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the data collection methods used. They also include definitiona and

other material necessary for understanding the data.

Data Evaluation and Mathods Research—Studies of new

statistical methodology including experimental testa of

new survey methods, studies of vital atatistica collection

methods, new analytical techniques, objective evaluations

of reliability of collected data, and contributions to

statistical theory. Studies also include comparison of

U.S. methodology with those of other countries.

Analytical and Epidemiological Studies—Reports presenting analytical or interpretive studies based on vital

and health statistics, carrying the analysis further than

the exposito~ types of reports in the other series.

Documents and Committee Reports-Final reports of

major committees concerned with vitel and health statistic and documents such as recommended model vital

registration laws and revised birth and death certificates,

Comparative International Vital and Health Statistics

Reports-Analytical and descriptive reports comparing

U.S. vital and health statistics with those of other countries.

Data From the National Health Interview Survey-Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other

health-related topics, all based on data collected in the

continuing national household interview survey.

Data From the National Health Examination Survey and

the National Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement

of national samples of the civilian noninstitutional ized

population provide the baaia for (1) estimates of the

medically defined prevalence of specific diseases in the

United States and the distributiona of the population

with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships

among the various measurements without reference to

an explicit finite universe of persons.

Data From tha Institutionalized Population Surveys-Discontinued in 1975. Reports from these surveys are included in Series 13,

Data on Health Resources Utilization—Statistics on the

utilization of health manpower and facilities providing

long-term care, ambulatoy care, hospital care, and family

planning services.

SERIES 14,

SERIES 15.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

Data on Health Resources: Manpower and Facilities—

Statistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

Data From Special Surveys-Statistics on health and

health-related topics collected in special surveys that

are not a part of the continuing data systems of the

National Center for Health Statistics.

Data on Mortality-Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses;

and statistics on characteristics of deaths not available

from the vital records based on sample surveys of those

Data on Natzrlity, Marriage, and Divorce—Various statistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analysea by demographic variables; geographic and time

series analyses; studies of fertility; and statistics on

characteristics of births not available from the vital

records based on sample surveys of those records.

Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys

based on vital records are included in Series 20 and 21,

respectively,

Data From the National Survev of Family Growth—

Statistics on fertility, family formation and dissolution,

family planning, and related maternal and infant health

topics derived from a periodic survey of a nationwide

probability sample of women 15-44 years of age.

For answers to questions about this report or for a list of titlea of

reports published in these series, contact

Scientific and Technical Information Branch

National Center for Health Statistics

Centers for Disease Control

Public Health Service

Hyettsville, Md. 20782

301-436-8500
U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

3700 East-West Highway

Hysttsviile, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

THIRD CLASS MAIL

BULK RATE

POSTAGE & FEES PAID

PHS/NCHS

PERMIT No. G-281

DHHS Publication No. (PHS) 88-1479, Series 5, No. 3