Canadian Oral Health Survey - Cycle 1

Household composition (HHC) - Question identifier:HHC_Q05

Including yourself, how many people live at this address #{THISDATE}?
Number of people

• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10
• 11: 11
• 12: 12
• 13: 13
• 14: 14
• 15: 15
• 16: 16
• 17: 17
• 18: 18
• 19: 19
• 20: 20

Household composition (HHC) - Question identifier:HHC_Q10A

Beginning with yourself, provide the first name, last name and age of all the people who live in your household on #{THISDATE}.
First name

Long Answer Length = 25

Household composition (HHC) - Question identifier:HHC_Q10B

Beginning with yourself, provide the first name, last name and age of all the people who live in your household on #{THISDATE}.
Last name

Long Answer Length = 30

Household composition (HHC) - Question identifier:HHC_Q10C

Beginning with yourself, provide the first name, last name and age of all the people who live in your household on #{THISDATE}.
Age

Min = 0; Max = 999

Sex and gender (GDR) - Question identifier:GDR_R05

The following questions refer to each person's situation on #{THISDATE}, unless otherwise specified.

Sex and gender (GDR) - Question identifier:GDR_Q05

What was this person's sex at birth?

Sex refers to sex assigned at birth.

• 1: Male
• 2: Female

Sex and gender (GDR) - Question identifier:GDR_Q10

What is this person's gender?

Gender refers to current gender which may be different from sex assigned at birth and may be different from what is indicated on legal documents.

• 1: Male
• 2: Female
• 3: Or please specify

Sex and gender (GDR) - Question identifier:GDR_R15

Please verify that all of the information is correct.

#{HHC_Q10A} #{HHC_Q10B} (age #{HHC_Q10C})

Sex assigned at birth: #{__DT_SEX_E}
Gender: #{__DT_GDR_E]

If all the information is correct, press the Next button.
To make changes, press the Previous button.

Education (ED) - Question identifier:ED_Q05

What is the highest certificate, diploma or degree that you have completed?

• 1: Less than high school diploma or its equivalent
• 2: High school diploma or a high school equivalency certificate
• 3: Trades certificate or diploma
• 4: College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
• 5: University certificate or diploma below the bachelor's level
• 6: Bachelor's degree (e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B.)
• 7: University certificate, diploma or degree above the bachelor's level

Awareness and intentions (AWI) - Question identifier:AWI_R01

The Canada Dental Benefit is a temporary measure that currently allows eligible Canadian families to receive funds to seek dental care for children under 12 years of age.

While this benefit is in place, the Government of Canada is working towards the launch of the Canadian Dental Care Plan, whose eligibility will expand to all uninsured Canadians with an adjusted annual family net income of less than $90,000.

Adjusted family net income includes your or your spouse's or common-law partner's income from all sources, minus all allowable deductions from your total income for the year, including Universal childcare benefit (UCCB) and Registered Disability Savings Plan (RDSP).

The following questions are about the Canadian Dental Care Plan.

Awareness and intentions (AWI) - Question identifier:AWI_Q05

Prior to reading the information above, had you heard of the Canadian Dental Care Plan?

• 1: Yes, I had heard of it, and am well informed
• 2: Yes, I had heard of it, but am not well informed
• 3: No

Awareness and intentions (AWI) - Question identifier:AWI_Q10

Where have you heard about the Canadian Dental Care Plan?

Select all that apply.

• 01: News or media (e.g., TV, radio)
• 02: Social media or blog
• 03: Government website (e.g., Health Canada, Canada Revenue Agency)
• 04: Other internet site
• 05: Oral health professional (e.g., dentist, dental hygienist)
• 06: Other health care professional (e.g., family doctor)
• 07: Work or school
• 08: Friends or family
• 09: Other

Awareness and intentions (AWI) - Question identifier:AWI_Q15

Are you aware of who can enroll in the Canadian Dental Care Plan?

• 1: Yes
• 2: No

Awareness and intentions (AWI) - Question identifier:AWI_Q20

[Have/Do] you or someone in your household [already applied/intend to apply] to the Canadian Dental Care Plan?

• 1: Yes
• 2: No
• 9: DK

Awareness and intentions (AWI) - Question identifier:AWI_Q25

How likely is it that you or someone in your household will apply to the Canadian Dental Care Plan? Is it:

• 1: Very likely
• 2: Likely
• 3: Not very likely
• 4: Not likely at all
• 9: DK

Awareness and intentions (AWI) - Question identifier:AWI_Q30

Why is it not likely that you or someone in your household will apply to the Canadian Dental Care Plan?

Select all that apply.

• 01: Not eligible and/or will never be eligible
• 02: Do not need oral health care
• 03: Do not know who can apply
• 04: Do not know how to apply
• 05: The application process is time-consuming or too complicated
• 06: Unable to take time off to get oral care services
• 07: Cost of oral health care is too expensive even with the plan
• 08: Do not trust the government/government programs
• 09: Oral health services are not available nearby
• 10: Fear or dislike receiving oral health care
• 11: Other reason

Oral health status (OHS) - Question identifier:OHS_Q05

Do the following members of your household have at least one of their own natural teeth?

• 1: Yes
• 2: No
• 9: DK

Oral health status (OHS) - Question identifier:OHS_Q10

Do the following members of your household wear dentures, dental prosthesis, or false teeth?

Include:
- a fixed bridge
- a removable partial denture
- complete removable denture
- complete fixed denture on implants
- fixed crowns on dental implants

• 1: Yes
• 2: No
• 9: DK

Oral health status (OHS) - Question identifier:OHS_Q15

In the past 12 months, how often have the following members of your household had any persistent or on-going mouth pain?

Include pain in teeth, gums, tongue, jaw, jaw joints.

• 1: Often
• 2: Sometimes
• 3: Rarely
• 4: Never
• 9: DK

Oral health status (OHS) - Question identifier:OHS_Q20

Do the following members of your household have any untreated mouth problems?

Mouth problems are defined as any condition that causes pain or discomfort.

For example:
- abscesses
- gum issues such as pain and bleeding
- jaw pain; temporomandibular joints (TMJ)
- untreated cavities, fillings needing to be replaced
- tooth pain
- injuries
- mouth sores.

• 1: Yes
• 2: No
• 9: DK

Oral health status (OHS) - Question identifier:OHS_Q25

In the past 12 months, how often have the following members of your household avoided eating particular foods because of problems with their mouth?

Exclude avoiding certain foods because of allergies or orthodontic treatments.

• 1: Often
• 2: Sometimes
• 3: Rarely
• 4: Never
• 9: DK

Oral health status (OHS) - Question identifier:OHS_Q30

How often do the following members of your household usually brush their teeth or dentures?

• 1: Never
• 2: Less than once per day
• 3: Once per day
• 4: Two or more times per day
• 5: Not applicable
• 9: DK

Oral health status (OHS) - Question identifier:OHS_Q35

How often do the following members of your household usually clean between their teeth with dental floss or any flossing aid?

• 1: Never
• 2: Less than once per week
• 3: One or two times per week
• 4: Three or four times per week
• 5: Five or more times per week
• 9: DK

Oral health status (OHS) - Question identifier:OHS_Q40

When was the last time the following members of your household saw a dentist, denturist, dental hygienist or any other dental specialist?

Services may have been provided in any setting where the oral health professional is licensed to practice.

• 1: Less than one year ago
• 2: 1 year to less than 3 years ago
• 3: 3 years ago or more
• 4: Never seen an oral health professional
• 9: DK

Oral health care (OHH) - Question identifier:OHH_R01

Now a few questions about the cost of your dental care.

Oral health care (OHH) - Question identifier:OHH_Q05

In the past 12 months, have [you / you or other household members] avoided going to an oral health professional for your dental care due to the cost of care?

• 1: Yes
• 2: No
• 9: DK

Oral health care (OHH) - Question identifier:OHH_Q10

In the past 12 months, have [you / you or other household members] avoided getting any dental care recommended by an oral health professional because of the cost of care?

• 1: Yes
• 2: No
• 9: DK

Oral health care (OHH) - Question identifier:OHH_Q15

In the past 12 months, were there [any other / any] reasons that [you / you or other house] did not get dental care or treatment?

Select all that apply.

• 01: Did not feel it was necessary
• 02: Could not afford to pay up-front for the services and wait for the reimbursement
• 03: Could not afford to pay for the cost of the services that are not covered by insurance
• 04: Indirect costs (e.g., childcare, transportation)
• 05: Service not available in our area
• 06: There was a waitlist
• 07: Oral health professional office was not open at a convenient time
• 08: Afraid or anxious or do not like receiving oral health care
• 09: Unable to take time off from work
• 10: Too busy
• 11: Expected oral health problems to go away on their own
• 12: Other reason
• 13: Don't know

Risk factors and related conditions (RFC) - Question identifier:RFC_Q05

At the present time, how often do you use products that contain nicotine such as cigarettes, cigars, vaping products, chewing tobacco?

• 1: Daily
• 2: Occasionally
• 3: Not at all, but used to
• 4: Not at all, never have

Risk factors and related conditions (RFC) - Question identifier:RFC_R10

Now some questions about your oral health.

Risk factors and related conditions (RFC) - Question identifier:RFC_Q10

In general, how would you rate the health of your mouth? Would you say:

Include teeth or dentures, tongue, gums, lips, and jaw joints.

• 1: Excellent
• 2: Very good
• 3: Good
• 4: Fair
• 5: Poor

Risk factors and related conditions (RFC) - Question identifier:RFC_Q15

In the past 12 months, have you had bleeding gums when brushing your teeth?

• 1: Daily
• 2: Sometimes
• 3: Rarely
• 4: Never

Risk factors and related conditions (RFC) - Question identifier:RFC_Q17

In the past 12 months, how often have you had persistent dry mouth?

• 1: Often
• 2: Sometimes
• 3: Rarely
• 4: Never

Risk factors and related conditions (RFC) - Question identifier:RFC_Q20

How satisfied are you with the appearance of your teeth or dentures?

• 1: Very satisfied
• 2: Satisfied
• 3: Neither satisfied nor dissatisfied
• 4: Dissatisfied
• 5: Very dissatisfied

General health (GEN) - Question identifier:GEN_R01

The following questions are about health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

General health (GEN) - Question identifier:GEN_Q01

In general, how is your health? Would you say:

• 1: Excellent
• 2: Very good
• 3: Good
• 4: Fair
• 5: Poor

General health (GEN) - Question identifier:GEN_Q05

In general, how is your mental health? Would you say:

• 1: Excellent
• 2: Very good
• 3: Good
• 4: Fair
• 5: Poor

Oral health - insurance (INS) - Question identifier:INS_Q05

Are all or part of this person's dental expenses covered by any insurance plan or government program?

• 1: Yes
• 2: No
• 9: DK

Oral health - insurance (INS) - Question identifier:INS_Q10

What type of insurance plan or government program?

Select all that apply.

• 1: A plan through an employer (include plans that are partially paid or sponsored by an employer)
• 2: A private plan (include personally purchased plans)
• 3: A government paid plan (e.g. children or seniors dental program, RAMQ, First Nations and Inuit program)
• 4: A plan through college or university
• 5: Don't know

Oral health - insurance (INS) - Question identifier:INS_Q15

Do the following members of your household have to pay additional out-of-pocket expenses for dental care services?

• 1: Yes, considerable dental care expenses are not covered by a program or insurance plan
• 2: No, dental care expenses are covered by a program or insurance plan
• 9: DK

Indigenous identity (ABM) - Question identifier:ABM_Q01

Is this person First Nations, Métis or Inuk (Inuit)?

First Nations (North American Indian) includes Status and Non-Status Indians.
If "Yes", select the responses that best describes this person now.

• 1: No, not First Nations, Métis or Inuk (Inuit)
• 2: Yes, First Nations (North American Indian)
• 3: Yes, Métis
• 4: Yes, Inuk (Inuit)

Sociodemographic characteristics (PG) - Question identifier:PG_Q05

The following question collects information in accordance with the Employment Equity Act and its Regulations and Guidelines to support programs that promote equal opportunity for everyone to share in the social, cultural, and economic life of Canada.

Is this person?

Select all that apply.

• 01: White
• 02: South Asian ( (e.g., East Indian, Pakistani, Sri Lankan))
• 03: Chinese
• 04: Black
• 05: Filipino
• 06: Latin American
• 07: Arab
• 08: Southeast Asian (e.g., Vietnamese, Cambodian,
  Malaysian, Laotian)
• 09: West Asian (e.g., Iranian, Afghan)
• 10: Korean
• 11: Japanese
• 12: Other

Long-term conditions (DIS) - Question identifier:DIS_Q05

Do any of these persons identify as a person with a disability?

A person with a disability is a person who has a long-term difficulty or condition, such as vision, hearing, mobility, flexibility, dexterity, pain, learning, developmental, memory or mental health-related impairments, that limit their daily activities inside or outside the home such as at school, work, or in the community in general.

• 1: Yes
• 2: No
• 9: DK

Geographic region (PC) - Question identifier:PC_Q05

To determine which geographic region you live in, please provide your postal code.

Long Answer Length = 7

Data sharing agreements (DSA) - Question identifier:DSA_R01

To avoid duplication of surveys, Statistics Canada may enter into agreements to share the data from this survey, with provincial and territorial ministries of health. For Quebec residents, Statistics Canada may also enter into an agreement with the Institut de la statistique du Québec to share the same information.

Data sharing agreements (DSA) - Question identifier:DSA_Q01

Do you agree to share your information?

These organizations have agreed to keep the data confidential and use it only for statistical purposes.

Do you agree to share the data provided?

• 1: Yes
• 2: No