The OBSP mammography rate is the total number of women aged 50-69 ever screened in the Ontario Breast Screening Program (OBSP) per population of women aged 50-69. Age-specific OBSP mammography rates are the number of women ever screened in the OBSP in a given age group per the population in that age group.

OBSP Mammography Rate:

total number of women aged 50-69 ever screen in the OBSP * k

total population of women aged 50-69

total number of women ever screen in the OBSP in an age group* k

total population in that age group

Proportion of people 12 and over who had alcoholic beverages in the last 12 months relative to the total population 12 and over in private households

Alcohol consumption presents a series of risks that have been well-documented: higher relative risks of mortality and morbidity, particularly due to cardiovascular disease, accidents, liver cirrhosis, malignant neoplasms, pneumonia and stroke. Alcohol consumption during pregnancy, particularly heavy use and binge drinking, are associated with Fetal Alcohol Syndrome. The proportion of current drinkers varies with age, sex, marital status and socioeconomic status. The frequency and quantity of drinking is thought to be associated with beliefs about the likelihood of drinking leading to health problems, the number of friends who drink, and attempts to reduce drinking.

Drinkers may be unable to accurately report the regularity of their drinking

Proportion of people aged 12 or over who reside in households where no one smokes regularly inside the house.

Numerous studies have linked environmental tobacco smoke (ETS) with lung cancer, heart disease, and other cancers such as cervical cancer. ETS also causes irritation of the eyes and of the mucous membranes of the nose, throat, and respiratory tract. The effect is especially prominent for children and people suffering from pre-existing conditions such as asthma and angina pectoris. Low birth weight in babies is more common among those whose mothers were exposed to environmental tobacco smoke during pregnancy. Respondents to surveys may be reluctant to admit that they or someone in the household smoke regularly. "Regularly" in question is open to perception.

Respondents to surveys may be reluctant to admit that they or someone in the household smoke regularly. This question was not asked in the 1990 OHS. "Regularly" in question is open to perception.

Proportion of current drinkers aged 12 and over who report having consumed 5 or more drinks on one occasion during the previous 12 months.

Current drinkers who engage in episodes of heavy drinking are at higher risk of developing alcohol-related problems. These people may not drink frequently and may have a relatively low daily average consumption; however, they tend to drink excessively on some occasions. Episodes of heavy drinking may lead to various health and social problems, including drinking and driving, and violence.

Individuals react differently to the same alcohol levels depending upon sex, body size and alcohol tolerance. Surveys do not permit these differentiations. There is no commonly agreed upon definition of heavy drinking in terms of the quantity and frequency of drinks a person consumes on one occasion. The 1996/97 OHS used 5 or more drinks on one occasion while the 1990 OHS used 10 or more drinks on one occasion. These are arbitrary categorizations. Comparisons between the surveys are not recommended. This indicator is sometimes referred to as binge drinking. Since the clinical definition of binge drinking is quite different, the indicator was renamed to episodes of heavy drinking.

Proportion of the population age 20 and older consuming 15 or more alcoholic drinks per week relative to the total population age 20 and older.

This indicator is derived from the number of drinks in the past week; it does not necessarily reflect what the respondent drinks per week. Heavy drinking is related to cirrhosis of the liver, poisoning, traffic collisions, coronary heart disease, cancer of the digestive and respiratory systems, psychosis, suicide, homicide, family violence, and social problems. Heavy drinkers have twice the overall premature death rate of people of the same age and gender in the general population. The proportion of heavy drinkers varies by age, sex, socioeconomic status, and levels of stress. Those most likely to be heavy drinkers are men in general, especially those aged 25-44, women aged 15-24, people with high incomes, working persons, blue-collar workers and those with a high level of stress.

The prevalence calculated for this indicator corresponds well to that obtained for alcohol dependency indices (CAGE and DSM-111) which are more complicated to interpret. Abundant consumption of alcohol is positively associated, directly or indirectly, with the following causes of morbidity or mortality: cirrhosis of the liver, poisoning, traffic accidents, suicide, homicide, family violence, social problems and problems in the workplace. The Framework for the Response to Alcohol and Drug Problems in Ontario identifies those drinking 15-34 drinks per week and those drinking 35 or more per week as being moderate and high risk, respectively, for developing alcohol related problems.

Individuals react differently to the same alcohol levels. These reactions are related to gender, body size and alcohol tolerance. Individuals react differently to the same alcohol level depending on sex, body size and alcohol tolerance. Since heavy drinkers are generally more difficult to reach in surveys, the proportion may be underestimated and overall drinking profile skewed. The perception of social approval/disapproval by respondents may affect the responses to survey questions on heavy drinking habits. This indicator is not an exact measure of the objective for the Mandatory Health Programs and Services Guidelines because it does not assess daily alcohol consumption but rather consumption in the past week (by adding up the amount consumed on each day).

Proportion of drivers aged 16 or over who drove a motor vehicle after drinking too much alcohol one or more times in the past 12 months.

Each year, driving under the influence of alcohol results in serious injuries to many people and costs billions of dollars in property damage, insurance costs and medical services.

Proportion of the population age 12 and older smoking cigarettes daily or occasionally relative to the total population age 12 and older.

Exposure to tobacco smoke presents a series of risks that have been well-documented: higher relative risks of mortality and morbidity, particularly due to cardiovascular and respiratory diseases and lung cancer. Smoking during pregnancy is associated with the risk of having low birth weight babies. Passive exposure to tobacco smoke also presents a health risk for non-smokers. The proportion of current smokers typically varies according to age, gender, marital status and socioeconomic status.

Smokers may be reluctant to admit they smoke because it is socially unacceptable or they may be unable to accurately report the regularity of their smoking habit. Many studies have nevertheless established a positive link between data reported in surveys and blood tests. When cigarette consumption observed in surveys is compared to the volume of cigarettes legally sold, an underestimate of between 25 to 30 percent is observed. This underestimate may be even higher because of cigarette smuggling. However, since the extent of the underestimation based on legal sales is constant over the years, cigarette consumption observed in surveys allows some estimate of trends over time.

The proportion of the population 12 and over who report consuming grain products, meat & alternatives, fruits & vegetables, milk products in amounts which meet Health Canada recommended levels, relative to the total population 12 and over.

The updated Nutrition Recommendations of Health and Welfare suggest that the Canadian diet should supply at least 5 servings of grain products, 2 servings of meat & alternatives, 5 servings of fruit & vegetables and 2 servings of milk products. Consuming a balanced diet rich in grain products and fruit and vegetables is regarded as health-enhancing since it decreases the risk of a number of adverse health outcomes including cardiovascular disease, obesity, several types of cancers, osteoporosis, and chronic liver disease.

Dietary intake is difficult to measure because it is complex and varies greatly on a daily, weekly and seasonal basis. Eating is such a part of the regular daily routine that people are often not very aware of their actual diets and may have difficulty in accurately reporting what they eat.

The percentage of energy as fat supplied in a diet relative to the total amount of energy obtained from total diet.

The updated Nutrition Recommendations of Health and Welfare Canada suggest that the Canadian diet should supply no more than 30% of energy as fat. High fat intake has been associated with a number of adverse health outcomes, including obesity, a number of cancers, and cardiovascular diseases.

Fat is only one of the components in a diet, carbohydrate and protein are also important. Dietary intake is difficult to measure because it is complex and varies greatly on a daily, weekly and seasonal basis. Eating is such a part of the regular daily routine that people are often not very aware of their actual diets and may have difficulty accurately reporting what they eat. Many assumptions are made about serving sizes and the fat content of individual foods in deriving total fat as percent of energy.

Proportion of people age 20 to 64 with a Body Mass Index greater than 27.0 relative to the total population age 20 to 64. The Body Mass Index (BMI) is defined as the ratio of body weight to height squared.

BMI is commonly used as a measure of health status. A BMI greater than 27.0 is associated with an increased risk of developing health problems, particularly hypertension, hyperlipidemia and coronary heart disease. The BMI scale represents a continuum where the risk of developing health problems increases with shifts away from the generally acceptable range. However, other factors that may not be captured by the BMI may also play important roles in identifying health risks such as distribution of fat and degree of muscularity. Combined with a measurement of the distribution of fat, the proportion of overweight persons becomes an even more powerful predictor of health problems, specifically ischemic heart disease (particularly before age 60).

The rates estimated in surveys are based on height and weight as reported by the respondents themselves. Since people tend to underestimate their weight and overestimate their height, the values of the index are probably artificially low. Studies estimate that obesity would be approximately one and a half times more prevalent if calculation were based on observed data. Exact weight may differ from stated weight due to a simple lack of information (not weighed recently, poorly calibrated scale in the home, recall bias, etc.). The BMI is not applicable to adolescents, adults over 65, and pregnant or breastfeeding women.

Proportion of people age 12 and older who report having participated in physical activities in the previous month relative to the total population age 12 and older.

Physical activity is generally accepted to be a healthy behaviour that reduces the risk of premature morbidity and mortality, particularly in relation to cardiovascular disease, hypertension, and osteoporosis. Physical activity is also associated with mental health, increased self-confidence and an improved sense of well-being. The frequency and duration of physical activity is thought to be associated with usual daily participation in leisure activities, and beliefs about physical activity and health.

In the 1996 Ontario Health Survey the following classifications of Physical Activity were created:

Active* : Those who averaged 3.0+ kcal/kg/day of energy expenditure. This is approximately the amount of exercise that is required for cardiovascular health benefit.

Moderate*: Those who averaged 1.5 - 2.9 kcal/kg/day. They might experience some health benefits but little cardiovascular benefit.

Inactive*: Those with an energy expenditure below 1.5 kcal/kg/day

Regular: Participates in physical activity lasting 15 minutes or more, 12 or more times per month

Occasional: Participates in physical activity lasting 15 minutes or more, 4 to 11 times per month

Infrequent: Participates in physical activity lasting 15 minutes or more, 0 to 3 times per month

Physical activity reduces the risk of premature morbidity and mortality, particularly in relation to cardiovascular disease, hypertension, and osteoporosis. Physical activity is also associated with positive mental health, leading to increased self-confidence and an improved sense of well-being. This variable classifies respondents based on their monthly frequency of physical activities lasting more than 15 minutes. Respondents were asked about whether they participated in the following leisure time activities in the past 3 months: walking for exercise, gardening or yard work, swimming, bicycling, popular or social dance, home exercises, ice hockey, ice skating, downhill skiing, jogging or running, golfing, exercise class or aerobics, cross-country skiing, bowling, baseball or softball, tennis, weight-training, fishing, volleyball, basketball, other. Respondents may have difficulty accurately recalling their activities in the past 3 months. Because the list of activities, and the time frame (past month versus past three months) are different in the 1990 OHS and 1996/97 OHS, comparisons are generally not recommended.

Proportion of the population aged 12 and over by level of energy expenditure.

Physical activity reduces the risk of premature morbidity and mortality, particularly in relation to cardiovascular disease, hypertension, and osteoporosis. Physical activity is also associated with positive mental health, leading to increased self-confidence and an improved sense of well-being. This variable classifies respondents based on their energy expenditure which takes into account the type of activity and its corresponding MET value, the frequency of activity, and the time per session. The MET is a value of metabolic energy cost expressed as a multiple of the resting metabolic rate. Thus, an activity of 4 METS requires four times the amount of energy than when the body is at rest. Respondents were asked about whether they participated in the following leisure time activities in the past 3 months: walking for exercise, gardening or yard work, swimming, bicycling, popular or social dance, home exercises, ice hockey, ice skating, downhill skiing, jogging or running, golfing, exercise class or aerobics, cross-country skiing, bowling, baseball or softball, tennis, weight-training, fishing, volleyball, basketball, other. MET values were assumed for each of these activities. Refer to the 1996/97 OHS documentation on derived variables for more information.

Respondents may have difficulty accurately recalling their activities in the past 3 months. Because the list of activities, and the time frame (past month versus past three months) are different in the 1990 OHS and 1996/97 OHS, comparisons are generally not recommended.

Percentage of population aged 15-59 having 2 or more sexual partners in the past 12 months while in relationships that lasted less than a year, always used a condom.

At risk for STDs is defined as those with two or more partners in the past 12 months who had one or more relationships last less than 12 months.

Efforts to prevent and control STDs have focused on advocating abstinence, curtailment of sexual activities, and the use of barrier methods and spermicides. The use of condoms has been found to be a safe, effective and acceptable method of reducing the risk of acquiring most anogenital STDs.

This indicator provides only a partial picture of the sexual behaviour of people who are sexually active. Because of the one-year reference period used in the OHS, memory lapse may have affected the reliability of the data. Because of the sensitivity of the question, some people may have been reluctant to answer openly.

The 1990 OHS asked similar questions "In the past year, how many sexual partners did you have?" and "In the past year, how often did you or your partner(s) use a condom as protection from sexually transmitted diseases?"; however, the age grouping is not comparable since the question was asked only of those aged 16+. As well, skip patterns were different in the 1996/97 OHS. Comparisons should be made with caution.

The 1996/97 OHS did not ask those who were married, living common-law or living with a partner about condom use unless they had two or more partners in the past year.

Self-reporting questions of this sensitive a nature may underestimate or overestimate the true prevalence in the population, depending upon the respondent's gender. Similarly, married people may not admit sexual relations with other partners.

All sexual health questions in the 1996/97 OHS were asked of those aged 15-59 years responding by non-proxy only.

The proportion of the sexually active population aged 15-59 and over who report having two or more sexual partners in the previous year, relative to the total population 15-59 and over who have had sexual intercourse.

Efforts to prevent and control sexually transmitted diseases (STD’s) have focused on advocating abstinence, curtailment of sexual activities and the use of barrier methods and spermicides. The risk of contracting a STD increases with exposure to the infective agents that are transmitted during sexual intercourse. Multiplicity of sexual partners is a well-established risk factor for many STDs. Women who have two or three sexual partners have been found to have a significantly higher risk of developing cervical cancer than women who have had 0 or 1 partner.

This indicator provides only a partial picture of the sexual behaviour of people who are sexually active . Because of the one-year reference period used in the OHS, memory lapse may have affected the reliability of the data. Because of the sensitivity of the question, some people may be reluctant to answer openly. All sexual health questions in the 1996/97 OHS were asked of those aged 15-59 years responding by non-proxy only. In the 1990 OHS, the sexual health questions were asked of those aged 16 and older. Comparisons should be done with caution. Self-reporting questions of this sensitive a nature may underestimate or overestimate the true prevalence in the population, depending upon the respondent's gender. Similarly, married people may not admit sexual relations with other partners.

Proportion of population aged 15-59 who had their sexual debut before aged 20.

Self-reporting questions of this sensitive a nature may underestimate or overestimate the true prevalence in the population, depending upon the respondent's gender.

All sexual health questions in the 1996/97 OHS were asked of those aged 15-59 years responding by non-proxy only.

In the 1990 OHS, the sexual health questions were asked of those aged 16 and older. Comparisons should be done with caution.

Proportion of population aged 15-19 years who report ever having had sexual intercourse.

Age at first sexual intercourse is a risk factor for many STD’s, and is thought to be associated with higher risk of unplanned pregnancy and abortive outcomes. In the 1990, Ontario Health Survey (OHS) participants were asked the following question: At what age did you first have sexual intercourse?

This indicator provides only a partial picture of the sexual behaviour of people who are sexually active. Because of the one-year reference period used in the OHS, inaccurate recall may affect the reliability of the data. The sensitivity of the question may make some people reluctant to answer openly.

The 1990 OHS asked a similar question; "At what age did you first have sexual intercourse?" The respondent replied with an age or "never"; however, the age grouping is not comparable with the 1996/97 OHS since the question was asked only of those aged 16+. Self-reporting questions of this sensitive a nature may underestimate or overestimate the true prevalence in the population, depending upon the respondent's gender. All sexual health questions in the 1996/97 OHS were asked of those aged 15-59 years responding by non-proxy only.

Proportion of women aged 18+ ever screened for cervical cancer relative to the total population of women aged 18+. And the proroportion of women aged 18+ who have been screened for cervical cancer in the past three years relative to the total population of women aged 18+.

 Cervical cancer is completely treatable if detected early. The use of the Papanicolaou (Pap) test is an effective means of reducing the incidence and mortality of cervical cancer in women. In 1989/90 the Task Force for Cervical Cancer Screening advised all sexually active women age 18 and older to participate in an organized cytology screening program. After the initial Pap test, a second one should be taken after one year, especially for women who commence screening after the age of 20. Provided the first two tests are satisfactory and without significant epithelial abnormality, women should generally be advised to be re-screened every three years to the age of 69. Women over 69 can be dropped from the screening program if there is sufficient evidence that previous smears have been satisfactory.  

The Ontario Cervical Screening Collaborative Group recommends the following cervical screening guidelines:

This indicator should be used in conjunction with the number of sexual partners and the age at first intercourse in order to assess the risk of cervical cancer. Women may be unable to accurately recall when they last had a test, particularly if it was more than a year earlier.

The questions differ in the 1990 OHS and the 1996/97 OHS. Although both surveys can be used when determining the percentage of women ever screened, only the 1996/97 OHS should be used for examining time since last Pap smear since different time ranges were given in the two surveys. Only the 1996/97 OHS has screened within last 3 years.

Women who have had hysterectomies are included in this indicator, even though they would not be at risk for cervical cancer and would thus not be screened. The 1996/97 OHS did ask respondents why they did not have a PAP smear in the past 3 years and hysterectomy was a option (variable WHC_26M). A total of 659 Ontario women responded in this way. However, the list was not read to respondents and some may have just said that it was not necessary without further explanation. As well, there was no way to identify women who had had hysterectomies in the 1990 OHS.

The Mandatory Health Programs and Services Guidelines refers to the percentage of women ever screened and to the percentage screened according to the guidelines of the Ontario Cervical Cancer Screening Group. An indicator for the latter is not easily obtained at a population level because frequency of screening depends upon a woman's past history of screens.

The proportion of women age, 16-49 and 50 to 69 by whether they ever had mammography screening. And the proportion of women aged 50-69 who had a mammogram in the past two years relative to the total population of women aged 50-69.

Breast cancer is the leading cause of cancer mortality for women in Ontario and one of the leading causes of all deaths in women after ischemic heart disease and strokes. The Ontario Breast Screening Program which has operated in Ontario since 1990 offers women 50 and older screening, a clinical examination and recall. Screening consists of clinical examination of the breasts by a trained nurse examiner, two-view mammography, and a one-on-one demonstration of breast self-examination by a nurse examiner.
Eligibility requires that participating women must be Ontario residents aged 50 or over who have no history of breast cancer or augmentation mammoplasty, have not had a mammogram within the last year and are free of acute breast symptoms. There is no upper age limit on screening in the OBSP. Mammography (x-ray of the breasts) can detect small cancers before they can be felt. Women over 50 years should have a mammogram every two years. The incidence of breast cancer is increasing and the absolute number of cases also increasing as the population ages. Since there are currently no established methods of breast cancer prevention, mortality reduction depends on early detection and appropriate therapy.

Memory lapse may have affected the reliability of the data because the reference period for this question is so large. There is a slight difference in the categories given in the 1990 OHS and the 1996/97 OHS. The 1990 OHS category includes who had a mammogram "2 years ago", whereas the 1996/97 OHS includes women who had a mammogram "less than 2 years ago". Given that few women would have had a mammogram exactly two years before and fewer would be able to remember the exact date, this discrepancy is unlikely to be a problem. Although Canadian guidelines suggest screening mammography begin at age 50, a substantial percentage of women report having had mammograms while in their forties, which is consistent with American recommendations. The 1996/97 OHS provided more information than did the 1990 OHS, allowing differentiation of screening and diagnostic mammograms.

Number of people age 16 and older who drive that insist while driving that their passengers wear seat belts relative to all persons per 100 population age 16 and older who drive.

Wearing seat belts has been mandatory in Ontario since 1976, when the province became the first jurisdiction in North America to enact legislation. Survey data from the Ministry of Transportation and Communications show that seat belt use has increased substantially as a result. In 1975, only 17 percent of drivers wore them compared to 77 percent one year later. In 1991, 85 percent of drivers wore them, compared to 81 percent of passengers. The use of seat belts represents an important means of reducing death and disability from motor vehicle accidents. People are more likely to use seat belts when driving than as passengers.

The 1996, OHS data may not accurately reflect the prevalence of insistence of seat belt use due to respondent’s desire to demonstrate compliance with legislation and social norms.

Proportion of livebirths under 2,500 grams relative to all live births. Newborns, weighing less than 2500 grams at birth are considered of low birthweight and those under 1500 grams are considered very low birth weight.

Low weight birth is an important factor relating to perinatal and infant health. It is also useful as an indicator of health status and social development. This indicator is influenced by human biology, age of the mother, physical and social environment factors as well as by lifestyle and use of health services.

Weight at birth is associated with prematurity. To control for this effect the low birth weight rate may be calculated by using only low weight infants carried to term. Weight at birth is also related to multiple births. To determine how multiple births affect the low birth weight rate, multiple births may be excluded.

Percent of population age 12 and older that perceives themselves to be in excellent, good or poor health. Respondents were asked to assess their own health status compared to other persons of the same age.

Although the perception of health status is a subjective judgement, there is a strong correlation between it and the presence of actual diagnosed health problems. In addition, studies have found that individuals who perceive their health to be poor have higher mortality rates compared to those who rate their health as good or excellent, when physical health and other factors are controlled.

Some systematic bias may exist in this indicator. Often people paint a more positive picture of their own health status than what they feel.

Proportion of residents reporting a selected health problem, relative to the total population in private households. Chronic health problems were reported by-proxy by one respondent for the entire household.

The proportion of the population with a given health problem is a subjective indicator of morbidity and general indicator of the health of a population. In the 1990 Ontario Health Survey respondents were shown a list of nineteen long-term physical health problems. For conditions such as arthritis and rheumatism, population surveys may be one of the best ways to estimate their prevalence. These conditions do not normally lead to death or hospitalization but nonetheless cause disability for people living in the community. The values obtained may vary with age, sex and socioeconomic status. Participants in the 1990 Ontario Health Survey were asked whether they had certain health problems. They were not asked whether a physician had told them they had a certain problem.

Chronic health problems were reported by proxy for all members of a household. That person may not have been aware of all the health problems of all of the people in the household. Underestimation of health problems is higher among men than among women. Estimates of the prevalence of selected chronic health problems can be determined only for those problems included on the list presented to survey participants.