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|5B Underage Alcohol Drinking
Description | Specific Indicators | Corresponding Outcomes from the Ontario Public Health Standards (OPHS) | Data Sources | Survey Questions | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Definitions | Cross-References to Other Indicators | Cited References | Other References | Changes Made | Acknowledgements
• Proportion of adolescents (age 12 to 18) that have consumed alcohol in the past 12 months
• Proportion of adolescents engaged in underage drinking
Corresponding Outcomes from the Ontario Public Health Standards (OPHS)
Outcomes Related to this Indicator
The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.
- Societal Outcome (Chronic Disease Prevention): An increased proportion of the population lives, works, plays, and learns in healthy environments that contribute to chronic disease prevention.
- Societal Outcome (Prevention of Injury and Substance Misuse): There is reduced incidence and severity of substance misuse and substance-related injuries, hospitalizations, disabilities, and deaths.
- Societal Outcome (Prevention of Injury and Substance Misuse): Sustained behaviour change by the public contributes to the prevention of injury and substance misuse.
Assessment and/or Surveillance Requirements Related to this Indicator
- The board of health shall conduct epidemiological analysis of surveillance data…in the area of alcohol and other substances (Prevention of Injury and Substance Misuse).
- The board of health shall conduct epidemiological analysis of surveillance data…in the area of alcohol use (Chronic Disease Prevention).
As footnoted in the Prevention of Injury and Substance Misuse program, “Substance misuse refers to the harmful use of any substance, such as alcohol…. The program name is meant to clearly articulate the need to address the prevention of the adverse health outcomes associated with substance use, the illegal use of alcohol and other substances (e.g. preventing alcohol from being served to minors…), and delaying the age of initial use of alcohol and other substances”.
Numerator & Denominator: Canadian Community Health Survey (CCHS)
Original source: Statistics Canada
1. Ontario Ministry of Health and Long-Term Care
2. Statistics Canada
Suggested citation (see Data Citation Notes):
1. Canadian Community Health Survey [year], Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care.
2. Canadian Community Health Survey [year], Statistics Canada, Public Use Microdata File, Statistics Canada.
The CCHS has an Alcohol Use module that asks a series of questions about alcohol consumption, including questions related to frequency and quantity. The Alcohol Use module was a core module in CCHS 2000-01, 2003, 2005 and 2007-08.
During the past 12 months, that is, from [date one year ago] to yesterday, have you had a drink of beer, wine, liquor or any other alcoholic beverage?
Yes, No, Don't Know, Refusal
Analysis Check List
- It is recommended that public health units use the Share File provided by the Ministry of Health and Long-Term Care rather than Public Use Microdata File (PUMF) provided by Statistics Canada. The Share File has a slightly smaller sample size because respondents must agree to share their information with the province to be included; however, the share file has more variables and fewer grouped categories within variables. The Share File is a cleaner dataset for Ontario analysis because all variables that were not common content, theme content or optional content for Ontario have been removed.
- There may be slight differences between results from the share file and data published on the Statistics Canada website for the Health Indicators because rates calculated for Health Indicators use the master CCHS data file.
- Not applicable respondents should be excluded; however, it is important to understand who these respondents are from the questionnaire skip patterns to be able to describe the relevant population.
- Users need to consider whether or not to exclude the ‘Refusal, ’Don’t Know’ and ‘Not Stated’ response categories in the denominator. Rates published in most reports, including Statistics Canada’s publication Health Reports generally exclude these response categories. In removing not stated responses from the denominator, the assumption is that the missing values are random, and this is not always the case. This is particularly important when the proportion in these response categories is high.
- Estimates must be appropriately weighted (generally the share weight for the CCHS) and rounded.
- Users of the CCHS Ontario Share File must adhere to Statistics Canada's release guidelines for the CCHS data when publishing or releasing data derived from the file in any form. Refer to the appropriate user guide for guidelines for tabulation, analysis and release of data from the CCHS. In general, when calculating the CV from the share file using the bootstrap weights, users should not use or release weighted estimates when the unweighted cell count is below 10. For ratios or proportions, this rule should be applied to the numerator of the ratio. Statistics Canada uses this approach for the tabular data on their website. When using only the Approximate Sampling Variability (CV) lookup tables for the share file, data may not be released when the unweighted cell count is below 30. This rule should be applied to the numerator for ratios or proportions. This provides a margin of safety in terms of data quality, given the CV being utilized is only approximate.
- Before releasing and/or publishing data, users should determine the CV of the rounded weighted estimate and follow the guidelines below:
- Acceptable (CV of 0.0 - 16.5) Estimates can be considered for general unrestricted release. Requires no special notation.
- Marginal (CV of 16.6 - 33.3) Estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning subsequent users of the high sampling variability associated with the estimates. Such estimates should be identified by the letter E (or in some other similar fashion).
- Unacceptable (CV greater than 33.3) Statistics Canada recommends not to release estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged with the letter F (or in some other fashion) and the following warning should accompany the estimates: "The user is advised that...(specify the data)...do not meet Statistics Canada’s quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid". These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.
- Caution should be taken when comparing the results from Cycle 1.1 (2000/01) to subsequent years of the survey, due to a change in the mode of data collection. The sample in Cycle 1.1 had a higher proportion of respondents interviewed in person, which affected the comparability of some key health indicators. Please refer to http://www.statcan.gc.ca/imdb-bmdi/document/3226_D16_T9_V1-eng.pdf for a full text copy of the Statistics Canada article entitled "Mode effects in the Canadian Community Health Survey: a Comparison of CAPI and CATI".
Method of Calculation
|Weighted number of respondents aged 12-18 years who have consumed alcohol in the past 12 months |
Weighted total population aged 12 - 18
| X 100|
• Sex: Male, female and total
• Geographic areas for: CCHS – all 36 Public Health Units.
Alcohol consumption is associated with a number of risks and health problems, as well as potential benefits. The 3 intermediate mechanisms are dependence, intoxication and biochemical effects (toxic and beneficial).1 The major burden of morbidity and mortality related to alcohol use falls into 2 main categories: injuries and chronic disease.
- There is a body of research that identifies harmful consequences of underage drinking. Some examples are school problems such as higher absence and poor grades; social problems such as fighting and lack of participation in youth activities; legal problems such as arrest for impaired driving or physically hurting someone while drunk; unwanted, unplanned, and unprotected sexual activity; abuse of other drugs; and changes in brain development that may have life-long effects.2 Also, naïve drinkers such as underage youth may be at greater risk of under-estimating the physiological effects of alcohol and experiencing alcoholic poisoning which has lead to sudden death in extreme cases.2
- Patterns of drinking are important. Higher volumes and heavier patterns of alcohol consumption are correlated with negative outcomes of alcohol use.3
- Many moderate drinkers do not experience serious adverse effects and moderate alcohol use can be protective against cardiovascular disease in limited circumstances.4 The health benefits are limited to middle-aged persons, and the benefits are achieved with as little as one standard drink every other day. The Low Risk Drinking Guidelines recommend against starting to drink or drinking more to achieve health benefits, as health benefits can be better achieved through other means.5
- People who reported starting to drink before the age of 15 were four times more likely to also report meeting the criteria for alcohol dependence at some point in their lives.6
- In the CCHS 2003, 2005 and 2007, the proportion of Ontarians aged 12 - 18 that consumed alcohol in the past 12 months remained stable at 41%.
- The legal drinking age in Ontario is 19.7
- Adolescents = ages 12 – 18
- CCHS defines an alcoholic drink as: one bottle or can of beer or a glass of draft, one glass of wine or a wine cooler, one drink or cocktail with 1 and a 1/2 ounces of liquor. This is not as precise as the definition from the Centre for Addiction and Mental Health (CAMH) which defines one standard drink as 13.6 g of alcohol or:
o 5 oz or 142 mL of wine (12% alcohol)
o 1.5 oz or 43 mL of spirits (40% alcohol)
o 12 oz or 341 mL of regular strength beer (5% alcohol)
Cross-References to Other Indicators
• Drinking in Excess of the Low-Risk Drinking Guidelines (Section 5B: Alcohol)
• Heavy Drinking Episodes (Section 5B: Alcohol)
• Drinking and Driving Prevalence (Section 5B: Alcohol)
• Alcohol-related injury and mortality from motor vehicle traffic collisions (Section 4C: Injury Prevention and Substance Abuse Prevention).
- Babor TF, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K et al. Alcohol: No ordinary commodity. Research and public policy. Oxford, UK: University Press, 2003.
- Centres for Disease Control and Prevention, United States Department of Health and Human Services. Quick stats on underage drinking. Available online at: http://www.cdc.gov/alcohol/quickstats/underage_drinking.htm?PHPSESSID=44521897cbb96945cead278f82ba303e (Accessed November 4, 2008)
- Centre for Addiction and Mental Health. Overview of Positive and Negative Effects of Alcohol Consumption – Implications for preventive policies in Canada. 2006.
- Bondy SJ, Ashley MJ, Rehm JT, Walsh G. Do Ontarians drink in moderation? A baseline assessment against Canadian low-risk drinking guidelines. CJPH 1999; 90(4):272-6.
- Centre for Addiction and Mental Health. Low - Risk Drinking Guidelines. Available online at: http://www.camh.net/About_Addiction_Mental_Health/Drug_and_Addiction_Information/low_risk_drinking_guidelines.html (Accessed May 7, 2009).
- National Institute on Alcohol Abuse and Alcoholism. Underage Drinking - Why Do Adolescents Drink, What Are the Risks, and How Can Underage Drinking Be Prevented? (Alcohol Alert, Number 67) Rockville, MD: U.S Department of Health and Human Services, 2006. Available online at: http://pubs.niaaa.nih.gov/publications/AA67/AA67.htm (Accessed October 15, 2008).
- Alcohol and Gaming Commission of Ontario. General Alcohol FAQ's. Available online at: http://www.agco.on.ca/en/t.tools/t3.1.general.alcohol.faqs.html#5
(Accessed October 15, 2008).
Type of Review-Formal Review or Ad Hoc?
Changes made by
Healthy Eating and Active Living subgroup of Core Indicators
- This indicator was originally titled "Current Alcohol Drinkers" and included adults as well as adolescents. In discussion with the Core Indicators Working Group and Subgroups, members discussed that Current Alcohol Drinkers is not very useful as an indicator on its own. It is more useful as a denominator for other alcohol-related indicators. After reviewing the proportion of current drinkers in the CCHS 2000/01, 2003 and 2005 among those 20 years and older by PHU, there was no clear pattern. This lack of a trend also suggested that it may not be critical to keep this indicator to monitor changes over time in the adult population. However, underage alcohol drinking is generally considered to be a risk behaviour and was thus considered to be a useful measure. All sections were updated to reflect the change in focus to underage alcohol drinking.
- A new section on Outcomes from the Draft Ontario Public Health Standards was added.
- The Rapid Risk Factor Surveillance System (RRFSS) includes adults aged 18 years and older. The current drinker indicator was modified to only include underage drinking and thus RRFSS was removed as an alternative data source.
- The indicator was modified to include youth 12 to 18 as compared to 12 to 19 to reflect underage drinking. The legal drinking age in Ontario is 19 years old. Analyses were conducted using CCHS 2005 to determine whether PHU level data could be released for this age category. The results indicated that counts for most PHU's were reportable.
June 29, 2009
Harleen Sahota on behalf of CIWG
- Removed an out-of-date point in the Analysis Check List on how the Health Indicators department at Statistics Canada handles 'Not Stated' respondents when using CCHS data.
| September 15,2011|| || Ahalya Mahendra|
- Added acknowledgement section
Natalie Greenidge, Durham Region Health Department Elsa Ho, Ministry of Health and Long-Term Care Peggy Patterson, Renfrew County and District Health Unit Harleen Sahota, APHEO
|Contributing Author(s)|| |
Jennifer Skinner, Haliburton, Kawartha, Pine Ridge District Health Unit
Carol Paul, Ministry of Health and Long-Term Care
Jennifer Jenkins, Halton Region Health Department
Bethe Theis, Cancer Care Ontario
Art Salmon, Ministry of Health Promotion and Sport