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of public health epidemiology in Ontario

Food Insecurity Core Indicator

Household food insecurity prevalence measures the proportion of households that were food insecure in the past 12 months due to lack of money. 

  • This indicator reflects the characteristics of food insecurity measured by the Household Food Security Survey Module (HFSSM) of the Canadian Community Health Survey (CCHS), which is the uncertainty of having, or inability to acquire, enough food to meet the needs of all household members due to insufficient money for food. (1) 
  • The APHEO-derived household food insecurity indicator is divided into three ordinal categories (‘Marginal’, ‘Moderate’, ‘Severe’). As supported by current research, it is recommended that the category of ‘Marginal Food Insecurity’ (along with ‘Moderate Food Insecurity’ and ‘Severe Food Insecurity’) be included in the definition of ‘Household Food Insecurity’. As the 2017/2018 CCHS-derived ‘Food Security’ indicator does not include ‘Marginal Food Insecurity’, syntax is provided that enables the user to define a revised ‘Household Food Insecurity’ variable. 
Report an IssueAppendices

Related OPHS Topics

Healthy Eating


Method of Calculation

Household Food Insecurity
Weighted number of marginal, moderate, or severe food insecure households*
100
Weighted total number of households

*defined using the APHEO-derived variable ‘Household Food Insecurity’, as described in the Analysis Checklist below
100

Recommended Subset Analysis Categories

Geographic areas
  • Public health unit

Data Sources

Numerator & Denominator Alternative Data Sources
The Canadian Community Health Survey (CCHS)

Original Source:

Statistics Canada

Distributed by:

1. Ontario Ministry of Health and Long Term Care (MOHLTC)

2. Statistics Canada

Suggested Citation:

1. Canadian Community Health Survey [year], Statistics Canada, Share File, Ontario MOHLTC

2. Canadian Community Health Survey [year], Statistics Canada, Public Use Microdata File, Statistics Canada
None
Numerator Survey Questions

Household Food Security Status - Modified version

  • Food secure
  • Moderately food insecure
  • Severely food insecure
  • Not stated

CCHS Module: Food security

2005

2007/08 FSCDHFS2

2009/10 FSCDHFS2

 

Analysis Checklist  

CCHS
  • The syntax file called "Food Insecurity Status CCHS 2005 (cycle 3.1)" provides syntax for deriving food insecurity status for CCHS 2005 based on the CCHS 2007 Household Food Security Status (HC) derived variable.
  • The categories for ‘Moderately Food Insecure' and ‘Severely Food Insecure' should be grouped together as ‘Food Insecure Households'.  Public health units with sufficient sample size may be able to report these two categories separately. 
  • Beginning in 2007, the entire 24-month sample may be needed by some health units to allow for reporting with ‘Acceptable' CVs, considered for general unrestricted release.  If the sample size still is not sufficient, food secure households could be reported instead of food insecure households.
  • 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 Microdata 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.  
  • 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.
  • Since Household Food Security Status is a derived variable, respondents who did not answer any one required question were "not stated".  In CCHS 2007, 3.2% of Ontario respondents were "not stated".
  • Estimates must be appropriately weighted using the household weight (i.e. WTS_SHH) 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.
Health Region Level Analysis with Household Weights in CCHS
  • Statistics Canada creates household weights for analysis at the provincial level. Therefore, when conducting analyses at the health region level using these weights, only proportions, not counts, should be reported (see Indicator Comments).
      • As noted in the CCHS_Household_Weights.pdf, the last step in creating the CCHS household weight is calibration. Calibration is done using provincial household size counts.  Calibration is done to ensure that the sum of the final weights corresponds to the household estimates defined at the provincial level by household size groups. These groups of interest are defined by the sizes: 1-person household, 2-person household and at least 3-person household. At the same time, the weights are seasonally adjusted to ensure that the each collection period (two-month period) is equally represented within the sample. In terms of geography, all calibration is at the provincial level only.
      • The Statistics Canada demographic division provides population estimates by household size only at the provincial level and not at the health region level. Therefore household weights can only be calibrated at the provincial level and not at the health region level.
      • Since (household) estimates calculated using household weights calibrated at the provincial level are only representative of the population of the province, these estimates may result in increased variability in the estimates and over- or under-representation of households in the health regions. It is therefore recommended that when conducting analyses at the health region level using provincial level household weights only proportions, not counts, should be reported.

  • Because calibration is only done at the provincial level, when we use variables pertaining to households at the health region level, there is a potential problem:
      • If the variable of interest is related to household size – e.g. the more people in a household, the greater likelihood that there is food insecurity – there is a difference between the estimate that comes from a calibrated household weight and the estimate that comes from a non-calibrated weight.  As calibration only occurs at the provincial level and not at the PHU level, the proportions of households estimated at the health region level may not be accurate.
      • If the variable of interest does not relate to household size, it is appropriate to do analysis of proportions at PHU level.
      • E.g. Among the three household size groups (one, two, three or more), the proportion of households which were food insecure was significantly higher in household size = 1 (see 95% confidence intervals highlighted in yellow).  The proportion of households with a size of one was significantly lower than the provincial average in a few health regions.
      • Based on these two observations, the effect of confounding may mask the underlying relationship between household size and food insecurity, and hinder comparison across health regions or over time. 

Indicator Comments

General Comments
  • Income-related household food insecurity is an important public health problem in Canada and is a key social determinant of health. Without consistent economic access to sufficient nutritious food, healthy eating cannot be achieved, increasing the risk of poor health. From a population health perspective, understanding the patterns of food insecurity in Canada over time is critical in developing and evaluating policies and programs. (13)
  • The ‘Household Food Insecurity’ indicator recommended for use here is the same indicator that has been used in Health Canada reports on food insecurity, with the exception of the additional category of ‘Marginal Food Insecurity’ (13). Although there are other indicators available in the CCHS and Rapid Risk Factor Surveillance System (RRFSS) (see table in Survey Questions), the APHEO-derived variable for ‘Household Food Insecurity’ was selected as the Core Indicator as it is considered to be a better measure of food insecurity by leading experts in the field.
  • The household food insecurity questions included in the CCHS since 2005, and the methods used to determine household food insecurity status, were adapted from the 18-item U.S. model of food security status levels published by USDA in 2000. (14,15)
  • The household food insecurity module focuses on self-reports of uncertain, insufficient or inadequate food access, availability and utilization due to limited financial resources, and the compromised eating patterns and food consumption that may result. The module is not designed to capture other possible reasons for compromised food consumption, for example, voluntary dieting or fasting.  (13)
  • This measure of food insecurity is a household measure, so it does not determine the food security status of each individual member residing in the household. It cannot be assumed that all members of a household share the same food security status. (13)
  • As certain populations at high risk of income-related household food insecurity are not included in the survey - for example, the homeless, Aboriginal people living on-reserve and those living in remote and isolated communities - the prevalence of income-related household food insecurity may be underestimated. (13) 

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Definitions

 

 
Food Security - The Food and Agriculture Organization (FAO) defines food security as "...when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.5"

 

References

Cited References
  1. Statistics Canada. Household food insecurity, 2007-2008. Canadian Community Health Survey. Health Fact Sheet (Catalogue 82-625-X). Available online at: http://www.statcan.gc.ca/pub/82-625-x/2010001/article/11162-eng.htm. Accessed 2011 Jun 27.
  2. Health Canada.  Office of Nutrition Policy and Promotion, Health Products and Food Branch. Canadian Community Health Survey, Cycle 2.2, Nutrition (2004) - Income-Related Household Food Security in Canada. (Catalogue No. H164-42 / 2007E). Ottawa, Ontario: Health Canada, 2007.
  3. Statistics Canada. Canadian Community Health Survey (CCHS) Cycle 2.2 (2004) Nutrition: General Health File. Master and Share Files Derived Variables Documentation, April 2008.
  1. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to Measuring Household Food Security, Revised 2000.  Alexandria VA: U.S. Department of Agriculture, Food and Nutrition Service, 2000.  Available online at: http://www.fns.usda.gov/fsec/files/fsguide.pdf.
  2. FAO. Rome Declaration on World Food Security and World Food Summit Plan of Action. (Catalogue No. W3613/E). 1998. Available online at:  http://www.fao.org/docrep/003/w3613e/w3613e00.htm.
Other References
  • Vogt J, Tarasuk V. Analysis of Ontario sample in Cycle 2.2 of the Canadian Community Health Survey (2004).  Toronto: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, 2007.  Available online at: http://www.phred-redsp.on.ca/CCHSReport.htm.

Acknowledgements

Lead Authors

Suzanne Fegan, KFL&A Public Health

Kim Loupos, Middlesex-London Health Unit and Ontario Dietitians in Public Health

Contributing Authors

Mary Ellen Prange, City of Hamilton and Ontario Dietitians in Public Health

Sarah Ahmed, Toronto Public Health

Monika Goetz, Haliburton Kawartha Pine Ridge District Health Unit

Janet Heng, Toronto Public Health

Melanie Hood, Public Health Sudbury & Districts

Hadia Hussain, Southwestern Public Health

Jordan Robson, Algoma Public Health

Dr. Rachel Prowse, Public Health Ontario

Dr. Valerie Tarasuk, University of Toronto

Core Indicator Reviewers

[Name], [Organization at time of contribution]

External Reviewers

[Name], [Organization at time of contribution]


 

Revision History

 This Core Indicator Product webpage is maintained by the Healthy Eating and Active Living Subgroup.
Date Review Type Author Changes PDF
April 17, 2009 Formal Review Healthy Eating and Active Living subgroup
  • The indicator for food insecurity was created, replacing an out-dated indicator which used an older module in the CCHS that is no longer used.
January 4, 2011 Formal Review Healthy Eating and Active Living subgroup
  • Indicator was revised to reflect recommendations from Statistics Canada regarding health region level analysis of variables pertaining to households.
February 2019 
Formal Review
& Website Update 
Healthy Eating and Active Living subgroup
    Changes to Indicator Definition and Documentation:
  • The indicator was revised to create an APHEO-derived indicator for household food insecurity that includes ‘Marginal Food Insecurity’ (defined as 1 affirmed response), along with ‘Moderate Food Insecurity’, and ‘Severe Food Insecurity’.
  • Syntax is provided to create this indicator using CCHS data.
  • Household food insecurity status descriptions were updated. Based on communication with Statistics Canada, users can estimate counts and proportions for this indicator.
  • Analysis checklist, indicator comments, definitions, OPHS section, and references all updated based on the most recent available data.
    • Migrated to new website structure and format, including:
  • Reorganized content to provide high-level information at a glance, and move in-depth analytic information into dedicated sections for users to access when needed.
  • Renamed "Basic Categories" to "Recommended Subset Analysis Categories"; "Definitions" renamed to "Glossary".
  • Replaced both "Cross-References to Other Indicators" and "OPHS" sections with "Related OPHS Topics" to crosslink with relevant Core Indicators webpages including OPHS program standard(s) and associated indicator(s).
  • Removed "Corresponding Health Indicator(s) from Statistics Canada and CIHI" and "from Other Sources" sections.
  • Updated Revision History table, and added PDF copy of previous version for reference.
  

 

APHEO's Core Indicators Project has been developed through collaboration across the field of public health in Ontario, 
to provide standardized methodology for population health assessment, to measure complex concepts of individual and community health.
Please contact core.indicators@apheo.ca for further information.  
   
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