Description | Specific Indicators | Ontario Public Health Standards (OPHS) | Corresponding Health Indicator(s) from Statistics Canada and CIHI |  Data Sources | Survey Questions | Analysis Check List | Method of Calculation |  Basic Categories | Indicator Comments | Cross-References to Other Indicators | Cited Reference(s) |  Changes Made |  Acknowledgements  

Description

• Proportion of population, aged 12 and over, who are frequent television or video viewers during their leisure time
• Proportion of population, aged 12 and over, who are frequent computer users during their leisure time 
• Proportion of population, aged 12 and over, who are frequent television or video viewers, computer users, and video game players during their leisure time

Specific Indicators

• Prevalence of frequent leisure-time television or video viewing (15 or more hours per week)
• Prevalence of frequent leisure-time computer use (11 or more hours per week)
• Prevalence of frequent leisure-time television or video viewing, computer use, and video games playing (15 or more hours per week)

• 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 endeavors 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.

Outcomes Related to this Indicator

• 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 (Chronic Disease Prevention): There is increased adoption of behaviours and skills associated with reducing the risk of chronic diseases of public health importance.
  

 Assessment and/or Surveillance Requirements Related to this Indicator

•  The board of health shall conduct epidemiological analysis of surveillance data...in the area of physical activity (Chronic Disease Prevention). 

http://www.ontario.ca/publichealthstandards

• None

Numerator & Denominator: Canadian Community Health Survey (CCHS)
Original source: Statistics Canada
Distributed by:

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

Survey Questions  

The Canadian Community Health Survey (CCHS) has a Sedentary Activities module (optional content) that includes questions related to typical sedentary activities during leisure-time over the past three months, including computer use, video games, television viewing and reading.  The module was selected by some health units in 2001 and 2003 and was theme content in 2007-2008.  Two derived variables are also available for total number of leisure-time hours per week spent in sedentary activities, including or excluding reading.

Analysis Check List

CCHS

• 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 (Coefficient of Variation, 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.

Method of Calculation 

Basic Categories

• Age groups for age-specific rates: 12-19, 20-44, 45-64, 65+.
• Sex: male, female, total.
• Geographic areas for: CCHS – Ontario, and all 36 Public Health Units. 
  

Indicator Comments

• Screen time is assessed by asking CCHS respondents the number of hours in a typical week over the past three months they spent watching television (including videos) and using a computer (including playing computer games and using the Internet). Respondents are instructed to report leisure-time hours only and to exclude time spent on activities at work or school.
• Video game use (i.e., CCHS question SAC_2) is not included as a specific indicator in the Screen Time Indicator.  This is because it is only asked for people 19 years old or younger (i.e. for ages 12-19 inclusively).  SAC_2 was developed as part of the National Population Health Survey in the mid-1990s and it was not documented why the age was limited to 19 years and younger.  It is suggested that, at the time the question was developed, video game use was largely restricted to those 19 years and younger.  Beginning with the 2011 CCHS, there is no longer an age restriction on the question.  For years preceding 2011, due to the small sample size and the small proportion of prolonged video game use (greater than 10 hours per week), video game use (SAC_2) is not reportable at the health unit level for most health units. However, as the popularity of video game consoles increases, it is important to monitor trends to assess whether this needs to be included in the Screen Time indicator. Health Units may want to analyze this information separately at this point. For ages 12-19, the derived variable, SACDTER, may be used to monitor total sedentary time excluding reading (TV viewing, computer use and video game use).
• These indicators do not take into account the overall number of leisure hours for each respondent. Thus they give an absolute measure of the amount of screen time, but not the relative amount of one’s leisure time that is dedicated to screen time.
• Screen-time activities, such as watching television or videos, using the computer, and playing video games, can compete with time for participation in physical activity. ^1,2 Also, screen-time activities may impact the development of social skills and/or impact the quality of relationships (e.g., less family time, interaction with others etc.). ^3,4
• Some studies have found that television viewing is associated with overweight and obesity among children. For example, the Centers for Disease Control and Prevention released an advertorial that highlighted such findings from the US National Health and Nutrition Examination (NHANES) III study.^5-7 Not only is television viewing a sedentary pastime, it also provides opportunities for snacking and exposure to advertising that may affect children’s food choices. A study of adults based on data from the 2007 CCHS found evidence that prolonged screen time (time spent viewing television and using computers) was positively associated with obesity, infrequent leisure-time physical activity and low consumption of fruit and vegetables. ⁸ In that study, multivariate models showed that associations between both measures of screen time and obesity were independent of the effects of leisure-time physical activity and low consumption of fruit and vegetables. The findings highlight the importance of considering screen time in the development of interventions to reduce obesity.
• A longitudinal study of high-school students’ changes in fitness, physical activity, and screen time found that those “with higher fitness levels at baseline were those who showed positive changes in PAI [Physical Activity Index], decreased screen time and had the lowest increase in BMI over three years compared with those who were low-fit at baseline”. ⁹
• In addition to overweight/obesity, an additional cause for concern is that some sedentary pursuits, most notably television and video games, have been linked to violent and aggressive behaviours, as well as substance use and abuse. Most of these negative health impacts are the consequence of inappropriate messaging (e.g., excessive sexual content and violence) that is inherent in many forms of media.¹⁰
• Canadian Paediatric Society recommends a maximum of two hours of television per day for children.¹¹
• The Canadian Society for Exercise Physiology (CSEP) released the Canadian Sedentary Behaviour Guidelines for Children and Youth in February 2011. The guidelines recommend children and youth aged 5-17 years should limit recreational screen time (television, computer, video games, etc.) to no more than 2 hours per day for health benefits. ¹² The Canadian Sedentary Behaviour Guidelines will be integrated with the Canadian Physical Activity Guidelines for Children and Youth (released in January 2011).
• The specific indicator “Prevalence of frequent leisure-time television or video viewing, computer use, and video games playing (15 or more hours per week)” was created to align better with Canadian Sedentary Behavior Guidelines.
• This indicator can be used to monitor total recreational screen time including TV/video viewing, computer use or video game use.
• The derived variable, SACDTER, is used for calculating this indicator.
• Before 2011, only those 19 years old and younger are asked about video game use.  Therefore, for ages 20 and over, SACDTER includes total time spending on watching TV/video, and using computer but not video game use for years preceding 2011.
• Because the total for those aged 20+ includes video game use beginning in 2011, results from 2011 and beyond cannot be compared to previous years.
• Active video games are video games that are designed to promote movement and interaction from the participant(s). Some examples include the Nintendo Wii, Sony’s Playstation and arcade type video games. Active video gaming is excluded in the Sedentary Behaviour Guidelines as there is large variability in the energy expenditure associated with these active games. The CCHS does not differentiate between sedentary and active video games; therefore this measure includes both sedentary and active video games.
• No guidelines have been proposed for adults. A variety of cut-points have been used for adults in the literature to define frequent viewing. The 15 and 11 hour (per week) cut-off points selected for the specific Screen Time Indicators of television viewing and computer use respectively, are consistent with papers by Statistics Canada, and align with the Canadian Sedentary Behaviour Guidelines for Children and Youth (<2 hours of sedentary activity per day).^{8, 13} Age-specific cut-offs were considered as frequent users varies across age groups, specifically, prevalence of frequent users increases with age for TV viewing and decreases with age for computer use. However, a single cut-off is recommended for this indicator in order to monitor trends over time.
• In 2007, 29% of Canadian adults were classified as frequent television viewers, and 15% as frequent leisure-time computer users.¹³ Prolonged TV viewing and computer use was also very common among Canadian young people. More than 60% of grade 6 to 10 students watched two or more hours of television per day and about half of them used the computer in their free time for two or more hours per day.¹
• Differences in sociodemographic characteristics were apparent, often in opposite directions for the two screen-time activities¹¹:
• Younger ages and higher levels of education were negatively associated with frequent television viewing, but positively associated with frequent computer use.
• Recent immigrants were less likely than people born in Canada to be frequent television viewers, but more likely to be frequent computer users.
• Among the working-age population, those employed full-time were less likely to be frequent viewers of television or frequent leisure-time computer users than were people who were not employed.^14,15
• In CCHS 4.1 (2007-2008), 'Not Stated' responses for time spent on a computer was 2.04%.  'Not Stated' responses for time spent watching television or videos was 2.20%. 

 

• Leisure-Time Physical Activity (Section 5C: Physical Activity)
• Adult Body Mass Index (Section 5D: Nutrition and Healthy Weights)
• Adolescent Body Mass Index (Section 5D: Nutrition and Healthy Weights)
• Vegetable and Fruit Consumption (Section 5D: Nutrition and Healthy Weights)

Cited Reference(s)

1. Boyce WF, King MA, Roche J. Healthy settings for young people in Canada. Ottawa, ON: Public Health Agency of Canada, 2008. Available online at: http://www.phac-aspc.gc.ca/dca-dea/yjc/ch3_51_54-eng.php (Accessed October 2009).
2. Wong, SL, Leatherdale, S. Association between sedentary behavior, physical activity, and obesity: inactivity among active kids. Preventing Chronic Disease. 2009:6(1):1-13.
3. Mutz DC, Roberts DF, Vanvuuren DP. Reconsidering the displacement hypothesis: television's influence on children's time use. Communication Research. 1993;20(1):51-75.
4. Engelberg E, Sjöberg L. Internet use, social skills, and adjustment. CyberPsychology Behavior. 2004;7(1):41-47.
5. VERB Youth Media Campaign, print advertorial.  Interrupt your child’s regularly scheduled programming to give them a healthier start on life.  Centers for Disease Control and Prevention.  Running date 2002 Aug 19-Oct 2 Available online at:  http://www.cdc.gov/youthcampaign/pressroom/article/decreasing-screen.htm (Accessed March 2010).
6. Crespo CJ, Smit E, Troiano RP, Bartlett SJ, Macera CA, Andersen RE. Television watching, energy intake, and obesity in US children: results from the Third NHANES. Arch Pediatr Adolesc Med. 2001 Mar;155(3):360-365.
7. Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of physical activity and television watching with body weight and level of fitness among children. The Journal of the American Medical Association, 1998 Mar 25;279(12):938-942. Available online at: http://jama.ama-assn.org/cgi/content/full/279/12/938 (Accessed April 2010).
8. Shields M, Tremblay MS. Sedentary behaviour and obesity. Health Reports (Statistics Canada, Catalogue 82-003-X) 2008 Jun;19(2):19-30.  Available online at:  http://www.statcan.gc.ca/pub/82-003-x/2008002/article/10599-eng.htm (Accessed November 2009).
9. Aires L, Andersen LB, Mendonça D. Changes in fitness, physical activity, fitness, and screen time: a longitudinal study in children and adolescents.  Nature Precedings: hdl:10101/npre.2009.3004.1 : Posted 30 Mar 2009. Available online at: http://precedings.nature.com/documents/3004/version/1 (Accessed March 2010).
10. Whitehead, Margaret. A typology of actions to tackle social inequalities in health. J Epidemiol Community Health. 2007 Jun;61(6):473-478.
11. Canadian Paediatric Society, Psychosocial Paediatrics Committee. Position statement: impact of media use on children and youth. Paediatrics & Child Health. 2003;8:301-6. Available online at: http://www.cps.ca/english/statements/CP/pp03-01.htm (Accessed November 2009).
12. Canadian Society for Exercise Physiology. Canadian Sedentary Behaviour Guidelines for Children and Youth. 2011 Feb. Available online at: http://www.csep.ca/english/view.asp?x=804 (Accessed June 2011)
13. Shields M, Tremblay MS. Screen time among Canadian adults: a profile. Health Report (Statistics Canada). 2008 Jun;19(2):31-43. Available online at: http://www.statcan.gc.ca/pub/82-003-x/2008002/article/10600-eng.htm (Accessed November 2009).
14. Foehr, EG. Media multitasking among American youth: prevalence, predictors and pairings. December 2006. The Kaiser Family Foundation. www.kff.org. Washington, DC.
15. Rideout, VJ, Foehr, UG, Roberts, DF. Generation M²: Media in the lives of 8- to 18-year-olds. January 2010. Henry J. Kaiser Family Foundation, Menlo Park, California.

Changes Made

Acknowledgements