Canadian Health Measures Survey (CHMS)

Detailed information for March 2025 to April 2027 (Cycle 8)

The Canadian Health Measures Survey (CHMS) collects important health information through a household interview and direct physical measures at a temporary examination centre (TEC), sometimes referred to as a mobile clinic.

• Questionnaire(s) and reporting guide(s)
• Description
• Data sources and methodology

Description

The Canadian Health Measures Survey (CHMS), launched in 2007, is collecting key information relevant to the health of Canadians by means of direct physical measurements such as blood pressure, height, weight and physical fitness. In addition, the survey involves the collection of blood and urine samples to test for chronic and infectious diseases, nutrition and environmental markers. The blood and urine samples are then stored at the Statistics Canada biobank for future health research projects.

Through household interviews, the CHMS is gathering information related to nutrition, smoking habits, alcohol use, medical history, current health status, lifestyle and physical activity, the environment and housing characteristics, as well as demographic and socioeconomic variables.

All of this valuable information will create national baseline data on major health concerns such as obesity, hypertension, cardiovascular disease, exposure to infectious diseases, and exposure to environmental contaminants. In addition, the survey will provide markers to identify the presence of illness and the extent to which many diseases may be undiagnosed among Canadians. The survey data will allow us to determine relationships between disease risk factors and health status, and to explore emerging public health issues.

CHMS data is representative of the population whether they are healthy or not and provide a better picture of the actual health of Canadians.

The following are some of the measures that the CHMS includes:

Physical measures

- Anthropometry (standing height, sitting height, weight, waist circumference)
- Cardiovascular health and fitness (resting heart rate and blood pressure)
- Physical activity (accelerometry)

Blood measures

- Nutritional status (e.g., Vitamin B12, Vitamin D, ferritin)
- Diabetes (e.g., glucose, glycated hemoglobin A1c)
- Cardiovascular health (e.g., apolipoprotein A1 and B, lipid profile)
- Environmental exposure (e.g., flame retardants, per- and polyfluoroalkyl substances, metals and trace elements)

Urine measures

- Environmental exposure (e.g., environmental phenols, flame retardants, pesticides, metals and trace elements)
- Nutritional status (e.g., sodium, potassium)

Tap water measures

- Environmental exposure (e.g., Per- and polyfluoroalkyl substances)

The CHMS team works closely with the Health Canada and Public Health Agency of Canada Research Ethics Board and the Office of the Privacy Commissioner of Canada in order to address privacy issues and to implement proper laboratory procedures.

Reference period: Varies according to the question (for example: "over the last 12 months," "over the last 6 months," "during the last week")

Collection period: March 2025 - April 2027

Subjects

• Diseases and health conditions
• Environmental factors
• Health
• Lifestyle and social conditions

Data sources and methodology

Target population

The target population for CHMS consists of persons 1 to 79 years of age living in the ten provinces.

The observed population excludes: persons living in the three territories; persons living on reserves and other Aboriginal settlements in the provinces; the institutionalized population and residents of certain remote regions. Altogether these exclusions represent approximately 3% of the target population.

Instrument design

Two questionnaires are used for cycle 8 of the Canadian Health Measures Survey:

1) Household questionnaire:

The household questionnaire content was developed with input from stakeholders (Health Canada and the Public Health Agency of Canada) and from external experts who participated as members of various advisory committees. Much of the cycle 8 household questionnaire was the same as the cycle 7 questionnaire, with questions added or removed to reflect the content changes of cycle 8.

Prior to finalizing the questions, one-on-one qualitative test interviews were conducted to look at specific questionnaire content, particularly the content new to cycle 8. As a result of this testing, improvements were made to questionnaire wording and instructions and to the flow of questions.

2) Clinic questionnaire:

Development of the clinic questionnaire proceeded in much the same way as that of the household questionnaire. Content was determined through a comprehensive consultation process and multiple iterations of the collection application were generated. Each iteration was assessed on flow within the temporary examination centre (TEC) for both the respondent and staff. Quantity and quality of data collected was also assessed.

The clinic questionnaire includes a set of self-reported health questions similar to the type of questions asked within the household questionnaire. The questions include at the TEC are related to medication use and fish and shellfish consumption. In addition, the clinic questionnaire includes introductory text/instructions and screening and administrative questions related to the physical measures tests conducted at the TEC.

Sampling

This is a sample survey with a cross-sectional design.

The Canadian Health Measures Survey uses a stratified three-stage sample made up of one or two selected respondents from each dwelling selected in a sampled collection site.

SAMPLING UNIT
The sampling unit at the first stage is a collection site. A collection site is a geographical unit limited to a radius of about 50 km in urban areas, 20 km for Toronto, Montreal and Vancouver CMA, and up to 95 km for rural areas. The sampling unit at the second stage is the dwelling and at the third stage, the sampling unit is the person.

STRATIFICATION METHOD
Strata are defined at every stage. At the first stage, collection sites are stratified in the 5 Canadian regions (Atlantic, Quebec, Ontario, Prairies, and British Columbia).

At the second stage, dwellings are stratified in 8 hierarchical groups defined according to the presence or not of age groups and derived using the household composition obtained from recent auxiliary information:

1) dwellings with 1 to 2 year-olds, else
2) dwellings with 3 to 5 year-olds, else
3) dwellings with 6 to 11 year-olds, else
4) dwellings with 12 to 19 year-olds, else
5) dwellings with 60 to 79 year-olds, else
6) dwellings with 20 to 39 year-olds, else
7) dwellings with 40 to 59 year-olds, else
8) other dwellings without household composition or with all ages outside the ones above.

Finally, at the third stage, the persons in the household at the time of interview are stratified in three clusters prior to selection:
1) 1 to 2 year-olds, 6 to 11 year-olds, and 60-79 year-olds.
2) 3 to 5 year-olds and 12 to 79 year-olds
3) 20 to 59 year-olds.

If all three clusters are populated, then two clusters are selected at random using PPS sampling, otherwise one or two clusters populated are automatically selected. One person is then randomly chosen from each of the selected clusters. Between one and two people are selected from each in-scope household.

SAMPLING AND SUB-SAMPLING
The Canadian Health Measures Survey consists of a full sample and several subsamples.

For the full sample, at the first stage, a sample of 16 collection sites was required. The sites are allocated by region: Atlantic (2), Quebec (3), Ontario (6), Prairies (3) and British Columbia (2). Within each region, sites are sorted according to the size of their population and whether or not they belonged to a census metropolitan area. Within the Prairies and Atlantic regions, they were first sorted by province. Sites are then randomly selected using a systematic sampling method with probability proportional to the size of each site's population.

The target sample size for cycle 8 is 6,400 respondents for the clinic component of the survey, which works out to on average 400 respondents per collection site. To achieve this, 850 dwellings will be sampled in each collection site.

For each site, a model is used to combine the historical CHMS data and the current cycle sample design to predict actual and effective sample sizes for each age-sex group of interest. The sample design features, such as the dwelling allocation across the strata and the person selection weights used to drive the PPS selection within the clusters are altered in an iterative fashion until the final sampling parameters are settled upon.

The sample is allocated amongst the 7 age group strata (1-2, 3-5, 6-11, 12-19, 20-39, 40-59 and 60-79), with a small portion of the sample going to an "other" stratum. A maximum number of 35 dwellings per site is selected in this stratum. This stratum size helped to prevent extreme dwelling sampling weights.
The survey aims at producing good quality estimates at the national level for each of the 5 age groups (6-11, 12-19, 20-39, 40-59, and 60-79) by sex and for 1-2 and 3-5 year olds for both sexes combined.
The allocation of the dwelling sample to each of the age group strata is done to allow for the best chance of meeting the age and sex clinic respondent targets for cycle 8 without going too far over. Where possible, the sample is allocated in a way that emphasized the strata where more sample was required to meet the targets.

Once the sample of dwellings is in the field, when the household interviewer makes contact with a sampled dwelling, the goal is to create a roster for the household. A roster is a list of all persons residing in the household and includes pertinent information such as age and sex. With this information, the computer application randomly selects one or two persons to take part in the remaining part of the survey, including the questionnaire and the clinic visit.

Among the full sample respondents, several subsamples will be selected.

Data sources

Data collection for this reference period: 2025-03-18 to 2027-04-30

Responding to this survey is voluntary.

Data are collected directly from survey respondents.

Collection includes a combination of a personal interview using a computer-assisted interviewing method and, for the physical measures, a visit to a temporary examination centre (TEC) specifically designed for the survey.

The CHMS will collect data in 16 sites across the country. The collection sites are located in seven provinces: Nova Scotia, Newfoundland and Labrador, Quebec, Ontario, Saskatchewan, Alberta and British Columbia. Collection is scheduled so that each region is distributed within the two-year collection period, distributed between seasons and in a way that tries to minimize the movement of staff and equipment between sites. The CHMS TEC stays in each site for five to seven weeks, collecting direct measures from approximately 400 respondents per site.

First step: personal interview at the household

The first contact with respondents is a letter sent through the mail. The letter informs people living at the sampled address that an interviewer will visit their home to collect some information about the household.

At the home, the application randomly selects one or two respondents, and the interviewer conducts a separate health interview with each of them. The interview takes 60 to 75 minutes per respondent. The interviewer then assists the respondent in setting an appointment for the physical measures at the TEC.

Second step: visit to the CHMS TEC

Statistics Canada uses TECs to conduct the physical measures portion of the survey. Similar TECs have been used successfully for years by the National Health and Nutrition Examination Survey (NHANES) in the United States.

The TEC consists of three trailers (side by side), linked by enclosed pedestrian walkways. One trailer serves as a reception and administration area, the second trailer contains a laboratory and physical measure rooms, while the third trailer contains additional physical measure rooms.

For each respondent, the complete visit to the TEC lasts about an hour and a half. This is an approximate time, given that each respondent is assessed for their suitability for each measure and tested accordingly.

For children under 15 years of age, a parent or legal guardian has to be present with the child at the TEC and has to provide written consent for the child to participate in the tests.

At the end of their visit to the TEC, respondents are provided with a waterproof activity monitor. This small device is worn for a week at all times - even when swimming or bathing. It records information about normal physical activity patterns and sleep without the respondents having to do anything special.

View the Questionnaire(s) and reporting guide(s).