Present: Mary-Anne Pietrusiak, Durham Regional Health Unit (Chair)
                Hyewon Lee-Han, Population Health Service, Public Health Branch
                Jo-Anne Peterson, Kingston, Frontenac-Lennox and Addington Health Unit
                Ruth Sanderson, Bruce-Grey-Owen Sound Health Unit
                Terry Delmore, Halton Regional Health Department
                Carol Paul, IPE Branch, Ministry of Health
                Jessie Wong, IPE Branch, Ministry of Health
                Doug Manuel, Federal Field Epidemiologist, Ministry of Health

Others: Jill Mallon, Toronto Public Health, North York Office

Corresponding Member: Dr. Vivek Goel, ICES

Regrets: Patrick Seliske, Waterloo Regional Community Health Department
                Nam Bains, Health Information Partnership, Eastern Ontario Region
                Vic Sahai, Northern Health Information Partnership
                Julie Stratton, Perth District Health Unit

Chapters on Mortality, Behavior and Health, Sexual Health and Child Health were reviewed and edited in order to clarify and expand on the agreed indicators from the previous PHIWG meetings.

Corrections to the indicators are to be e-mailed to Mary-Anne as simple text attachments.

2.0 MORTALITY (Doug Manuel)

• Avoidable Mortality from Specific Diseases

The indicator title has been changed from Avoidable Mortality to Avoidable Mortality from Specific Diseases.

Within the Description section, a comment will be included that Avoidable Mortality will be reported by SMR and Crude Rates. Also, the Method of Calculation will change to reflect SMR and Crude Rate.

The Indicator-Specifics Comments section will be expanded. Because of small numbers, it is important to note that it might be better to group disease categories together. Also, not all available mortality is included.

The group had a lengthy discussion on whether to include this indicator in the core set, or if it should be added to a Special Interest section. It was decided that this indicator would stay in the core set for the draft at least.

• Health Expectancy

The indicator definition in the Description section will be expanded.

Data Distributor section: Spreadsheet is available (Doug Manuel). It will soon be on the CEHIP website. The APHEO site could be linked to it.

Basic Categorization: The Health Utilities Index question from the OHS 90 and OHS 96/97 will be used to calculate the health-adjusted life expectancy.

In the Usage section, the sentence, To examine the compression/expansion of morbidity will be expanded upon.

Mary-Anne and Hyewon invited Doug to lead an APHEO workshop to discuss the methodological issues surrounding this indicator some time in the future.

This indicator is to stay in as a core indicator.

• Life Expectancy

In the Description section, the definition should read, "Life expectancy is the average length of time that an individual will live if subjected to the mortality experience for the specified population and time period."

Data Distributor section should read, "Spreadsheet available from the CEHIP website: (link from APHEO site); HELPS, Public Health Branch."

Indicator-Specific Comments - The last sentence defining Life Expectancy should be deleted, since it has been added to the Description section. This section should also note that Life Expectancy can be calculated for different age groups (i.e. at birth, at age 65 years and older).

(See handout from Carol Paul with OHS 96 variable labels)

• Daily Cigarette Smoking

The indicator title will be changed from Smoking Status to Daily Cigarette Smoking

The Description has been changed to "Proportion of adults who are current daily cigarette smokers. Adults is defined as a person who is 20 years and over. The changes in this indicator reflect the Mandatory Guidelines. Included in this indicator, is "Smoking Status among Teens"; it will no longer be a separate indicator.

Basic Categorization: OHS 90 and OHS 96/97 use different definitions of smoking status.

In the Data Sources section, the variable for this indicator has been changed to F05Q10 for OHS 90 and SMC6_2 for OHS 96/97. Because of differences in skip patterns, the derived variables of the OHS 90 and OHS 96/97 cannot be compared. As a result the question "At the present time do currently smoke cigarettes daily, occasionally, or not at all" will be used so that comparisons are valid.

In the Comments on the Ontario Health Survey section, changes have been made to the sentence stating the number of PHUs in Ontario, from 43 to 42. Add a note expanding the sentence, "Twenty-three health areas were sampled. All PHUs were sampled and grouped into 23 areas."Also, expand on the sentence, "The OHS 90 and OHS 96 may not be comparable because of differences in geographical areas and question wording, and/or skip patterns."

• Population Living in Smoke Free Homes

Indicator title has been changed from, Proportion of Smoke Free Homes to Population living in Smoke Free Homes.

The Description section should read, "Proportion of people aged 12 and over who reside in households where no one smokes regularly in the home."

Method of Calculation: {number of people are 12 + who live in a household where no one smokes regularly inside the house/total number aged 12+ years}*100

Data Sources: OHS 96/97 only.

Indicator-Specific Comments: The sentence, "Low birth weight in babies is more common among those whose mothers were exposed to environmental tobacco smoke during pregnancy" should be referenced.

4.0 FAMILY HEALTH: SEXUAL HEALTH (Ruth Sanderson)

• Youth Sexual Activity

The Indicator title had been changed from Youth Sexual Activity Rate to Youth Sexual Activity.

Description section should read, "Proportion of the population aged 15-19 years who have reported ever having sexual intercourse FACE="WP TypographicSymbols,Courier New">"

Data Sources: The variable label for this indicator is, 'SHS6_1'.

Other Categorizations: "Geographic areas: health area", should be included.

Indicator-Specific Comments: "Exclude missing responses", should be included.

• Age of Sexual Debut

Description section should read, "Proportion of the population aged 15-59 who had their sexual debut before age 20."

Method of Calculation: {number of population aged 15-59 in a specific age group reporting having first sexual intercourse before age 20/total number of population in a specific age group}*100

Basic Categorization: categories include: 1) No sexual debut, 2) Debut under 19, 3) Debut age 19 and over.

Other Categorizations: Geographic areas: health area.

Age groups: 15-24, 25-44, 45-59.

Data Sources: OHS 1996, Question SHS6_2.

Ruth to ask sexual health staff if age 20 should be the cutoff for this question, or if the age should be lowered. Age group categories to correspond with teenage pregnancy.

• Number of Sexual Partners

Description: "Proportion of the population aged 15-59 according to the number of sexual partners they reported having in the past 12 months"

Method of Calculation: {number of people aged 15 to 59 having intercourse with a given number of partners/total number aged 15 to 59}*100

Data Sources: OHS 96/97 SHS6_3, "Had sexual intercourse in the past 12 months"
OHS 96/97 SHS6_4, "Number of partners (sexual intercourse)"

Other Categorizations: Geographic Areas: health area.

Age groups: 15-24, 25-44, 45-59.

• Condom Use Among Those at Risk For STDs

Indicator title has been change to include "..Those at Risk for STDs"

Age categories have been added to the definition in the Description Section. "Percentage of the population aged 15 to 59 reporting having had 2 or more sexual partners in the past 12 months while in relationships that lasted less than a year, categorized by their condom use (always, usually, occasionally, never) at risk for STDs."

Method of Calculation: {number aged 15-59 at risk by condom use frequency in the past year/total number aged 15-59 at risk}*100

There is some confusion regarding the sample of people that have answered this question. Because all the questions in the OHS are linked, only the people who have answered yes to a previous question are eligible to answer this question. Ruth will map out the question, and get back to the group. This will define who is "at risk".

• Condom Use The Last Time Among Those at Risk For STDs

Title has been changed to include .Those at Risk for STDs

Description: "Proportion of the population having 2 or more sexual partners in the past 12 months while in relationships that lasted less than a year, categorized by whether they used a condom the last time they had sex."

Method of Calculation: {number aged 15-59 at risk by condom use the last time they had sex/total number aged 15-59 at risk}*100

Other Categorizations: Geographic areas: health areas

Indicator-Specific Comments: make a note that those who responded "always use" to the question about frequency of using condoms were automatically assumed to have used condoms the last time. Similarly those who said they never use condoms were assumed to have not used them the last time.

5.0 CHILD HEALTH (Ruth Sanderson)

• Selected Causes of Death in Children and Adolescents

Title changed to include Adolescents in the title

Description: "The number of deaths in children aged 0-19 per 100,000 children at risk, by age group, for a specific cause, in a given time period."

Respiratory and Infectious Diseases may be added to the Basic Categorization section.

It is also important to mention suicide as a cause of death in adolescents. The Indicator-Specific Comments section should include a note that suicide rates can be found in the mental health section.

References to be added.

• Selected Causes of Hospital Morbidity in Children

Method of Calculation: {number of hospital separations by ICD-9 chapter/total population}*100

Include Respiratory and Infectious disease in the Basic Categorizations section.

It is also important to mention attempted suicide as a cause of morbidity in adolescents. The Indicator-Specific Comments section should include a note that attempted suicide rates can be found in the mental health section.

• Breast Feeding Initiation

Description: The proportion of women who breast-fed their last baby.

Method of Calculation: {number of women aged 15 to 49 who breast fed their last baby /total number of women aged 15 to 49}*100

Basic Categorization: Age Groups, 15 to 34 years, 35 to 49 years.

Data Sources: OHS 96 Question GHS6_24

Indicator-Specific Comments should explain that 15-34 year olds are more likely to have had their baby recently.

References to be added.

• Delete Breast-feeding Duration Indicator – the question was not included in our portion of the OHS 96/97 but was part of the Alberta survey. We have no data on breast-feeding duration.

• DMF/def Index

The years of the dental survey will be investigated, as well as whether the survey was conducted for JK or kindergarten students since this is to reflect school entry.

Indicator-Specific Comments section should include a sentence explaining that the DMF/def indicator is a reflection of general health.

Doug to investigate this indicator

Next Meeting:
October 15, 1998
9:30-3:30
North Board Room, (Public Works), 4^th Floor
North York Civic Centre