• Prevalence of cell phone use while driving among motor vehicle drivers, 16 years of age and older (CCHS)
• Prevalence of hands-free cell-phone use while driving among motor vehicle drivers, 16 years of age and older (CCHS)
• Prevalence of cell phone use while driving among motor vehicle drivers, 18 years of age and older  (RRFSS)
• Prevalence of hands-free use among motor vehicle drivers, who use a cell phone when they drive, 18 years of age and older (RRFSS)
• Prevalence of text messaging while driving among motor vehicle drivers, 18 years of age and older (RRFSS)

• Proportion of motor vehicle drivers, 16 years of age and older, that "ever" use  a cell phone while driving (CCHS)
• Proportion of motor vehicle drivers, 16 years of age and older, that "often/sometimes" use a cell phone while driving (CCHS)
• Proportion of motor vehicle drivers, 16 years of age and older, that "often" use a hands-free cell phone while driving (CCHS)
• Proportion of motor vehicle drivers, 18 years of age and older, that send or read text messages "ever" while driving (RRFSS)
• Proportion of motor vehicle drivers, 18 years of age and older, that send or read text messages "every time/most times" while driving (RRFSS)

• Board of Health Outcome (Prevention of Injury and Substance Misuse): the board of health shall conduct epidemiological analysis of surveillance data....in the areas of injury and substance misuse outcomes, including road and off-road safety (of pedestrians, cyclists, drivers and occupants)...and drinking and driving.
• Board of Health Outcome (Foundational Standard): the public, community partners and health care providers are aware of relevant and current population health information

• The board of health shall conduct epidemiological analysis of surveillance data....in the areas of road and off-road safety 

• None

• None

Numerator & Denominator: Rapid Risk Factor Surveillance System (RRFSS)
Original source: Public Health Unit
Distributed by: Public Health Unit
Suggested citation (see Data Citation Notes): Rapid Risk Factor Surveillance System [month, year - month, year], Extracted: [month, year] 

* module not selected by any Ontario health region or not included in the CCHS survey year or question not included in the module

• 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 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"

• Users should refer to the most recent RRFSS Manual of Operations for a complete list of RRFSS analysis guidelines.
• Denominator Data - cell size less than 30 not to be released (based on unweighted data).
• Numerator Data - cell size less than 5 not to be released (based on unweighted data).
• Coefficients of variation (CV) should be calculated for every estimate. The following categories determine the release of the data:
• CV between 0 and 16.5:  estimate can be released without qualification.
• CV between 16.6 and 33.3:  estimate can be released with qualification:  interpret with caution.  High variability.
• CV greater than 33.3:  estimate should not be released, regardless of the cell size.
• 95% confidence intervals should accompany all released estimates. If estimates are close to 0 or 100% and a simple computation confidence intervals include values less than zero or greater than 100 then the Fleiss 2^nd edition computation for skewed estimates should be employed.
• Weighting:
• General household weight will be applied for questions related to the individual. 
• Household weight is to be applied for questions about households when we wish to determine the population/number of people affected. 
• Household weight is not to be applied for child proxy questions (bicycle helmet use, car seat safety), dog and cat immunization modules, or other questions that relate to the household rather than the respondent. 
• Household weights are not required to be recalculated for sub-population based questions; for example mammography in women ages 35+ years and 50-74 years.
• If the weights supplied with the data set (health unit wave specific, health unit cumulative total, all health units combined wave specific, all health units combined cumulative total) are not appropriate for the required analysis, then a time-specific weight must be calculated.  For example, a new weight is required for all seasonal modules.
• If the cell size of ‘Don't Know' responses is 5% or greater, ‘Don't Know' responses should be included in the denominator of the analyses and reported separately.
• If the cell size of ‘Refusal' responses is 5% or greater, ‘Refusal' responses should be included in the denominator of the analyses and reported separately.
• When an indicator is being compared between groups (e.g. health units, time periods, gender), if any one group has ‘Don't Know' and/or ‘Refusal' responses that are 5% or greater, ‘Don't Know' and/or ‘Refusal' responses should be included in the denominator of the analyses and reported separately for all groups.
• A provincial sample is not available with the RRFSS.
• Refer to the RRFSS Data Dictionaries for more information about module questions and indicators: http://www.rrfss.ca/

• Age groups:
• CCHS: 16-24, 25-44, 45-64, 65+
• RRFSS: 18-24, 25-44, 45-64, 65+
• Sex: male, female and total
• Geographic areas:
• CCHS data: Ontario, public health unit
• RRFSS data: RRFSS-participating health units that chose the 'Driving Status' and 'Cell phone Use and Text Messaging While Driving' modules. (Varies by wave/cycle. Check documentation)

• The use of cellular telephones in motor vehicles is associated with a quadrupling of the risk of a collision during the brief period of a call (1).
• Use of mobile phones is associated with an increased likelihood of serious road crashes resulting in hospital attendance, and the use of currently available hands-free devices does not seem to reduce the risk (2, 3).
• In Ontario it is illegal for drivers to talk, text, type, dial or email using hand-held cell phones and other hand-held communications and entertainment devices. Using a hands-free device is permitted as long as the device is placed securely in or mounted to the motor vehicle so that it does not move while the vehicle is in motion (4).
• Prior to 2007, CCHS data collection occurred every two years on an annual period. Data are available for the 2001, 2003 and 2005 periods. In 2007, major changes were made to the survey design with the goal of improving its effectiveness and flexibility through data collection on an ongoing basis. Data collection now occurs every year, from January through December, rather than every two years as was the case prior to 2007 (5).  
• "Driving and Safety" module is optional content in the CCHS and was selected as follows:
• 2000/2001 (cycle 1.1): not included in CCHS
• 2003 (cycle 2.1): all Ontario health regions
• 2005 (cycle 3.1): not included in CCHS
• 2007/2008: no Ontario health regions
• 2009/2010: all Ontario health regions

• Cellular Phone - a mobile telephone system using low-powered radio transmitters, with each transmitter covering a distinct geographical area (cell), and computer equipment to switch a call from one area to another, thus enabling large-scale car or portable phone service.
• Hands-free Device - an apparatus used with cell phones that permits the user to talk on the phone without holding it.

• Motor Vehicle Traffic Collisions Injuries (Section 4C. Injury Prevention and Substance Abuse Prevention)
• Alcohol-related Injury and Mortality from Motor Vehicle Traffic Collision (Section 4C. Injury Prevention and Substance Abuse Prevention)
• Seatbelt Use (Section 4C. Injury Prevention and Substance Abuse Prevention)
• Car Seat and Booster Seat Safety (Section 4C. Injury Prevention and Substance Abuse Prevention)

1. Redelmeier DA, Tibshirani RJ. Association between cellular telephone calls and motor vehicle collisions. N Engl J Med. 1997 [cited 2012 May 22];336:453-8. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJM199702133360701.
2. McEvoy SP, Stevenson MR, McCartt AT, Woodward M, Haworth C, Palamara P & R Cercarelli. Role of mobile phones in motor vehicle crashes resulting in hospital attendance: a case-crossover study. BMJ 2005 [cited 2012 Dec 24];331:428. Available from: http://www.bmj.com/content/331/7514/428.pdf%2Bhtml.
3. Ishigami Y, Klein RM. Is a hands-free phone safer than a handheld phone? J Safety Res. 2009 [cited 2012 May 22];40:147-64. Available from: http://people.stfx.ca/jmckenna/P100%20Student%20Docs/1st%20Term/ResearchAssign/KleinCellPhones.pdf.
4. Ontario Ministry of Transportation [homepage on the Internet]. Distracted driving frequently asked questions. 2009 [cited 2012 May 22]. Available from: http://www.mto.gov.on.ca/english/safety/distracted-driving/FAQs.pdf.
5. Statistics Canada [homepage on the Internet]. Ottawa: Statistics Canada. Canadian Community Health Survey 2010; 2012 Nov 27 [cited 2012 Dec 24]. Available from: http://www.statcan.gc.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SDDS=3226&lang=en&db=imdb&adm=8&dis=2.