|5A Smoke-free Homes
Description | Specific Indicators | Corresponding Outcome(s) from the Ontario Public Health Standards (OPHS) | Corresponding Health Indicators from Statistics Canada and CIHI | Data Sources | Survey Questions | Alternative Data Sources | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Definitions | Cross-Reference(s) to Other Indicator(s) | Cited-References | Other References | Changes Made
- Proportion of people aged 12 and over who resided in households where smokers were asked to refrain from smoking in the house.
- Proportion of households where smokers were asked to refrain from smoking in the house.
- Smoke-free homes
- Smoke-free homes with children
Corresponding Outcome(s) from the Ontario Public Health Standards (OPHS)
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.
Outcome 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 disease of public health importance.
- Board of Health Outcomes (Chronic Disease Prevention): Priority populations adopt tobacco-free living.
- Societal Outcome (Child Health): An increased proportion of families provide safe and supportive environments for their children.
Assessment and Surveillance Requirement Related to this Indicator (Chronic Disease Prevention):
- The board of health shall conduct epidemiological analysis of surveillance data in the areas of comprehensive tobacco control.
Corresponding Health Indicator(s) from Statistics Canada and CIHI
Corresponding Health Indicator(s) from Other Sources
Centers for Disease Control (CDC)
· Proportion of the population reporting voluntary tobacco-free home or vehicle policies (Indicator 2.4.4)
National Advisory Group on Monitoring and Evaluation (NAGME)
· Proportion of population reporting exposure to secondhand smoke at home
· Proportion of population who report their home is smoke-free
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 Canadian Community Health Survey contains an Exposure to Second-Hand Smoke (ETS) module (core content in 2000-01, 2003, 2005 and 2007-08).
Exposure to Second Hand Smoke
Are there any restrictions against smoking cigarettes in your home?
How is smoking restricted in your home?
1) Smokers are asked to refrain from smoking in the house
2) Smoking is allowed in certain rooms only
3) Smoking is restricted in the presence of young children
4) Other restriction
For each option in the question:
ETS_6A - ETS_6D
ETSE_6A - ETSE_6D
ETSC_6A - ETSC_6D
ETSA_6A - ETSA_6D
There are derived variables to indicate the number of children in the household less than a specific age:
Number of persons in household less than 16 years of age
Number of persons,
Number of persons in household less than 12 years of age
Number of persons,
Number of persons in household less than 6 years of age
Number of persons,
Alternative Data Source(s)
The Rapid Risk Factor Surveillance System (RRFSS) contains a Tobacco – Home module (core module 2001-2008) and a Sociodemographics – Children module (core content 2001-2008). Question th2 in the Tobacco-Home module includes respondents who are non-smokers and are the only adult living in the household (t1=5 or t2=5 and nadults=1). RRFSS includes only adults ages 18+.
Which of the following best describes the rules or understandings about not smoking inside your home for visitors.
Would you say:
1) smoking is not allowed at all,
2) smoking is allowed for some visitors or sometimes, 3) smoking is allowed in certain areas of the home,
5) smoking is allowed except when children are present
Sociodemographics - Children
Next I would like to ask you about children. Do you have any children in your household aged 17 or younger?
Yes, No, Don't Know, Refused
How many children 17 years or younger, live in your household?
1-8 enter # of children, Nine or more children, Refused
(If dc2=1) Could you tell me how old that child is?
(If dc2=>2) Could you tell the ages of the children in your household aged 17 or younger.
[Enter age of nth child]
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 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 and rounded (See Indicator comments for notes on population versus household weighting for this indicator).
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. In general the simple computation of the C.I. for a proportion assuming SEp = sqrt(pq/n) and CI95% = p +/- 1.96*SEp is sufficient. However, if estimates are close to 0 or 100% and the simple computation confidence intervals include values less than zero or greater than 100 then the Fleiss 2nd edition computation for skewed estimates should be employed.
- 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 at http://www.rrfss.ca/ for more information about module questions and indicators.
Method of Calculation
Population residing in Smoke-Free Homes:
|Weighted number of people aged 12+ living in households where smokers are asked to refrain from smoking in the house |
Weighted total population aged 12+
| X 100|
Population with children in their household residing in Smoke-Free Homes:
|Weighted number of people aged 12+ living in households with children where smokers are asked to refrain from smoking in the house |
Weighted total population aged 12+ living in households with children
| X 100|
Smoke-Free Households:Smoke-Free Households with children:
|Weighted number of households where smokers are asked to refrain from smoking in the house |
Weighted number of households
| X 100|
|Weighted number of households with children where smokers are asked to refrain from smoking in the house |
Weighted number of households with children
| X 100|
- Geographic areas: CCHS - Public Health Units in Ontario; RRFSS - participating health units
- Households with Children: under 6 years, under 12 years, under 16 years
Exposure to second-hand smoke causes heart disease, cancers of the lung, nasal sinus, bladder, esophagus, mouth, throat, stomach, pancreas, cervix and kidney, chronic bronchitis, cataracts, pneumonia, acute myeloid leukemia, abdominal aortic aneurysm, periodontitis and reproductive effects in adults. In children, it causes sudden infant death syndrome, fetal growth impairment including low birth weight and small-for-gestational age, bronchitis, pneumonia and other lower respiratory tract infections, asthma exacerbation, middle ear disease, and respiratory symptoms.1,2,3
Exposure to second-hand smoke has also been linked to other adverse health effects where the relationships may be causal. These include: in adults - stroke, breast cancer, cervical cancer and miscarriages; and in children - adverse impact on cognition and behaviour, decreased lung function, asthma induction, exacerbation of cystic fibrosis.1,2,3
Skip patterns were different between CCHS 2000/01 and 2003. In Cycle 1.1, only non-smokers were asked questions about restrictions against smoking in the home. Beginning in 2003, all respondents except smokers who lived alone were asked. As a result, this question is not comparable between the two surveys unless analysis is limited to non-smokers. Because of differences in skip patterns between the two surveys, it is suggested that only 2003, 2005, and 2007 data be used.
Beginning in 2005 , the CCHS includes household weights (wts_shh), which should be applied when measuring the proportion of smoke-free households (rather than the proportion of the population who reside in a smoke-free household).
- Smoke-free home = a home where smokers are asked to refrain from smoking in the house
Cross-Reference(s) to Other Indicator(s)
- Ontario Tobacco Research Unit. Protection from second-hand tobacco smoke in Ontario: A review of the evidence regarding best practices. Toronto: University of Toronto, 2001. Available online at: http://www.otru.org/pdf/special/special_ets_eng.pdf.
- The Health Consequences of Smoking: a report of the Surgeon General. Atlanta, Ga: Dept. of Health and Human Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
- National Cancer Institute. Health Effects of Exposure to Environmental Tobacco Smoke: The Report of the California Environmental Protection Agency. Smoking and Tobacco Control Monograph No. 10. Bethesda, MD., U.S. Department of Health and Human Services, National Institutes of Health, 1999.
- Health Canada. Canadian Tobacco Use Monitoring Survey (CTUMS). Health Canada, 2008. Available online at: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/index-eng.php.
- Ontario Tobacco Research Unit. (2008, August). Indicators of Smoke-Free Ontario Progress. (Special Reports: Monitoring and Evaluation Series, 2006-2007 [Vol. 13, No. 2]). Toronto: Ontario Tobacco Research Unit. Available online at: http://www.otru.org/pdf/13mr/13mr_no2.pdf.
- Ontario Tobacco Research Unit - Monitoring Reports. Available online at: http://www.otru.org/special_reports.html.
- Staff G, Rogers T, Schooley M, Porter S, Wiesen E, Jamison N. Key outcome indicators for evaluating comprehensive tobacco control programs. Atlanta, GA: Centers for Disease Control and Prevention; 2005. Available online at: http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/key_outcome/.
- Copley TT, Lovato C, O'Connor S. Indicators for monitoring tobacco control: A resource guide for decision-makers, evaluators and researchers. On behalf of the National Advisory Group on Monitoring and Evaluation. Toronto, ON: Canadian Tobacco Control Research Initiative, 2006. Available online at: http://www.ctcri.ca/~ctcri/en/index.php?option=content&task=view&id=30&Itemid=49.
- Edwards R, et al. After the smoke has cleared : evaluation of the impact of a new national smoke-free law in New Zealand. Tob. Control 2008; 17e2.
- Fong, GT et al. Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey. Tob. Control 2006; 15;iii51-iii58.
Type of Review-Formal Review or Ad Hoc?
Changes made by
June 18, 2009
Cancer, Smoking and Sun Safety subgroup of Core Indicators.
- A new indicator of smoke-free homes with children was added.
- A new section on the Ontario Public Health Standards was added to replace the section on the Corresponding Mandatory Objectives from out-of-date Mandatory Health Programs and Service Guidelines.
- The sections: Corresponding Health Indicator(s) from Other Sources, Alternative Data Source were also added.
- The sections Analysis Check List, Method of Calculation, Basic Categories, Indicator Comments, Definitions, Cross-Reference(s) to Other Sections, Cited References and Other References were updated.
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.