Measuring Our Success Progress Report - 1 · 2 ActNowBC | Measuring Our Success Evaluating progress involves not only examining the impacts or eﬀects that ActNow BC is having on

Measuring Our SuccessProgress Report - I

Technical ReportJanuary, 2008

Albert Schweitzer once said, “Success is not the key to happiness. Happiness is the key to success. If you love what you are doing, you will be successful.”

ActNow BC is a fantastic example of what the government can accomplish when our goals and our enthusiasm align.

Through joint partnerships, community involvement and government initiative, we have created a comprehensive model that has gained international recognition from leading health experts including the World Health Organization. We are at the forefront of a revolutionary health movement that is gaining momentum. We hope the founda-

tion that we are laying, and the innovative work that we are doing, will provide other provinces with a strong basis for creating healthy living programs of their own.

Sincerely,

Honourable Gordon Hogg Minister of State for ActNow BC

Message from the Minister

ActNowBC | Measuring Our Success I

Many of the chronic diseases British Columbians face can be prevented when they become supported to be more active, make healthier eating choices, and eliminate tobacco use. Since the initial baseline document was produced, we have taken into account the research done on health risk factors and lifestyle behaviours throughout the province. As well, we have focused on initiatives like creating the BC School Fruit and Vegetable Snack Program in B.C. public schools, supporting the BC Healthy Living Alliance, encouraging older adults to remain active and getting junk food out of office vending machines and all school environments.

The goal of ActNow BC is to showcase British Columbia as the healthiest jurisdiction ever to host an Olympic and Paralympic Winter Games. We won’t stop there though; we want to make the promotion of active living and health a permanent part of the B.C. experience.

ActNowBC | Measuring Our Success III

Table of Contents

Introduction 1

Section 1 | Lifestyle Behaviours of British Columbians 3

a. Where do people in British Columbia live? 4

b. Does the birth rate differ in differing parts of the province? 4

c. Do the rates of obesity and/or overweight among adults (aged 18+) differ in the province? 5 How do we compare with other provinces?

d. Does the percent of British Columbians who consume the daily recommended number of fruits 13 and vegetables differ in the province? How do we compare with other provinces?

e. Does the percent of British Columbians who engage in physical activity differ in the province? 19 How do we compare with other provinces?

f. Do the rates of tobacco use differ in province? How do we compare with other provinces? 26

Section 2 | Information On Outputs and Outcome Measures 31

a. Physical Activity 31 Active Communities 31 Action Schools!BC 32 Physical Activity Social Marketing Campaign 34

b. Healthy Eating 34 Action Schools! BC – Healthy Eating 34 Dial-A-Dietitian 35 Food and Beverage Sales in BC Schools 35 BC School Fruit and Vegetable Snack Program 36 Shapedown BC 36 Health Check 37 Community Food Action Initiative (CFAI) 37

c. Tobacco Control 38 QuitNow 38 Municipal Smoking Bylaw 40 Second Hand Smoke 41 Tobacco Free Sports Program 42 Honour Your Health 42

d. Healthy Choices in Pregnancy 43 Health Authority FASD Prevention Plans 43 Service Provider Awareness and Education 43 Knowledge of Risks Associated with Alcohol Consumption In Pregnancy 44

Section 3 | Achieving the 2010 Targets 45

a. Tobacco Use - Actual, Projected and Target Rates - 2003 - 2010, 45 National, Provincial and Health Authority Level

b. Fruit and Vegetable Consumption - Actual, Projected and Target Rates - 2003 - 2010, 47 National, Provincial and Health Authority Level.

c. Physically Activity - Actual, Projected and Target Rates - 2003 - 2010, 48 National, Provincial and Health Authority Level.

d. Overweight/Obesity - Actual, Projected and Target Rates - 2003 - 2010, 50 National, Provincial and Health Authority Level.

Section 4 | Conclusion 52

IV ActNowBC | Measuring Our Success

ActNowBC | Measuring Our Success 1

On March 19, 2005, Premier Gordon Campbell launched ActNow BC - its purpose is to make British Columbia the healthiest jurisdiction to host the Olympic and Paralympic Games. ActNow BC is a government-wide initiative that addresses complex interrelationships between the physical, economic, environmental, social and cultural components of society to influence the health and well-being of British Columbians. As such, it provides a corporate framework for ministries to support Government’s Goal Two: Lead the way in North America in healthy living and physical fitness and for the private sector and community agencies to align their efforts with those of government and work synergistically together toward improving the health of British Columbians.

The challenge of implementing ActNow BC lies in its massive scope and potential engagement of every government ministry, municipality, citizen, public and private sector employer in British Columbia, as well as the multiple interest groups and health professionals who have the positive health of British Columbians at the core of their individual mandate and purpose. From a scientific perspective, experience in other jurisdictions including Finland, the United Kingdom, the United States and Latin America, informs us that success does not lie in simply addressing a single dimen-sion of the overall problem. Rather, a holistic approach, with a broader focus on overall health and fitness show greater promise. The science of population health tells us that successful programs of national and international scope are long term, are well conceptualized from a measurement/progress monitoring perspective; are grounded in valid and reliable evidence, and employ reliable benchmark data to establish realistic expectations and monitor progress1.

The ActNow BC Targets for the BC population by 2010 (from 2003 baseline) are:

• 10% reduction in tobacco use

• 20% increase in fruit and vegetable consumption

• 20% increase in physical activity

• 20% reduction in overweight and obesity, and

• 50% increase in women counseled re: alcohol use in pregnancy and by Sept. 2006, all Health Authorities have focused strategies for FASD prevention

The purpose of this document is to provide a progress report on these targets since the Measuring Our Success Baseline Document2 was produced in November 2006. The present document illustrates government’s commitment to report annually on the progress we are making toward achieving the 2010 targets. Section 1 of the report explores, in significant depth, the variations in key health-related behaviours that exist throughout the province - among Health Authorities and Health Service Delivery Areas (HSDA) - as well as presents how British Columbia compares with other provinces in terms of these targeted behaviours. Sources for data in this section come from well established surveys (i.e. Canadian Community Health Survey, Canadian Tobacco Use Monitoring Survey and BC Stats).

1 Dickson, G, & White, F. (2006) Linking Leadership to Healthy Living, Policy Implementation Strategies for the ActNow BC Initiative. Internal Document commissioned by the Ministry for Tourism, Sport and the Arts.

Introduction

Initially the Ministry of Health had lead responsibility for the stewardship of ActNow BC. OnAugust 15, 2006 the Honourable Gordon Hogg was appointed the Minister of State for ActNow BC. The Minister of State and the ActNow BC business functions have been assigned to the Ministry of Tourism, Sport and the Arts. This helped create an integrated, co-ordinated, partnership-based platform to support progress in achieving the 2010 targets for a healthier British Columbia.

2 ActNowBC | Measuring Our Success

Evaluating progress involves not only examining the impacts or effects that ActNow BC is having on the health-related behaviours of British Columbians but also requires an examination of how well and to what extent individual activities are being implemented and who is being reached or participating in which initiative. Section 2 provides information on the outputs for a sampling of ActNow initiatives.

Section 3 examines the current and projected target rates for physical activity, healthy eating, tobacco use and obesity/overweight starting in 2003 (baseline) to 2010 for British Columbia and Canada. Projected target rates indicate where the BC population should be in order to reach the 2010 target rates. They also provide a means by which course corrections can be justified ifdeemed necessary.

Last, Section 4 provides a summary and conclusion and emphasizes the importance of continued inter-sectoral collaboration and sustainability.

2 https://www.healthservices.gov.bc.ca/cpa/publications/ActNowBC_Baseline.pdf


Section 1 | Lifestyle Behaviours of British Columbians

This section provides general demographic information as it relates to population distribution, birth rates, low birth weight and number of teenage births in British Columbia. This is followed by a detailed description of the prevalence of overweight/obesity, daily fruit and vegetable consumption (5+), physical activity, and tobacco use among British Columbians at the provincial, health authority (HA) and health service delivery area (HSDA) levels. Many of the tables and figures contained in this section were developed based on data that was collected through the Canadian Community Health Survey (CCHS). The CCHS utilizes rigorous data collection protocols which allow for the results to be generalized back to respective BC populations within designated margins oferror.Wheneverpossible,95%confidenceintervalsarepresentedandsignificantdifferences(p<.05) from provincial rates or among HSDAs are pointed out.

A word of caution is warranted in the interpretation of this data as it pertains to the determination of greatest need. While certain parts of the province (e.g. the North) may exhibit high prevalence rates of a particular phenomenon (e.g. overweight/obesity), this geographic region may consist of fewer people than are located in a different, but more populated part of the province where the rates of obesity/overweight may be lower. In other words the actual number of people who are overweight or obese may be higher in the latter location. Therefore, when determining greatest need, and how to maximize program impacts, program planners may wish to consider not only the rate (or percent) of a particular health status indicator but also the actual number of persons this percentage represents.

Health Authority/ Health Service Delivery Area All genders Males Females

0 British Columbia 4,254,522 2,109,082 2,145,44011 East Kootenay 82,738 41,846 40,892

12 Kootenay Boundary 80,466 40,349 40,117

13 Okanagan 331,447 161,490 169,957

14 Thompson Cariboo 222,361 111,482 110,879

1 Interior 717,012 355,167 361,845

21 Fraser East (Fraser Valley) 264,277 132,241 132,036

22 Fraser North (Simon Fraser 562,447 279,288 283,159

23 Fraser South 639,604 317,663 321,941

2 Fraser 1,466,328 729,192 737,136

31 Richmond 173,430 84,493 88,937

32 Vancouver 593,273 293,868 299,405

33 North Shore/Coast Garibaldi 273,911 134,651 139,260

3 Vancouver Coastal 1,040,614 513,012 527,602

41 South Vancouver Island 351,023 168,816 182,207

42 Central Vancouver Island 252,968 124,717 128,251

43 North Vancouver Island 119,011 59,754 59,257

4 Vancouver Island 723,002 353,287 369,715

51 Northwest 84,392 43,756 40,636

52 Northern Interior 153,929 78,837 75,092

53 Northeast 69,245 35,831 33,414

5 Northern 307,566 158,424 149,142

Table 1 British Columbia’s Population by Health Authority and Health Service Delivery Area - 2005

Source: Population estimates (1986-2005) and projections (2005-2031) by BC STATS, Service BC, BC Ministry of Labour and Citizens’ Services. Release Date March 2006


A. Where do people in British Columbia live?Table 1 presents the total population of British Columbia as well as the population of each Health Authority and Health Service Delivery Areas (HSDA). The largest segment of the BC population resides in the Fraser and Vancouver Coastal Health Authorities, followed by Vancouver Island, the Interior and finally the Northern Health Authority.

B. Does the birth rate differ in differing parts of the province?Table 2 presents the crude birth rate (births per 1000 population), the rate of low birthweight births and the rate of teen births for British Columbia as well as the rates for each Health Region and HSDA. Highest birth rates occur in the Northeast, Fraser East and Fraser South HSDAs, while lowest rates occur in the Kootenay-Boundary, Okanagan and North Vancouver Island HSDAs. Fraser South, Central Vancouver Island and Vancouver HSDAs exhibit the highest rates of low birthweight births while the Northwest and North Vancouver Island HSDAs have the highest rates of teen births.

Region/HSDA # of birthsBirths/ 1,000 pop

# of low birthweight births

Rate of low birthweight births

# of teen births

Rate of teen births

British Columbia 40,661 9.56 2,280 56.07 1,330 32.71East Kootenay 668 8.07 30 44.91 28 41.92

Kootenay-Boundary 607 7.54 34 56.01 17 28.01

Okanagan 2,625 7.92 141 53.71 115 43.81

Thompson/Cariboo 1,855 8.34 95 51.21 101 54.45

Interior 5,755 8.03 300 52.13 261 45.35

Fraser East 3,118 11.80 164 52.60 129 41.37

Fraser North 5,529 9.83 319 57.70 87 15.74

Fraser South 7,164 11.20 458 63.93 144 20.10

Fraser 15,811 10.78 941 59.52 360 22.77

Richmond 1,570 9.05 93 59.24 13 8.28

Vancouver 5,908 9.96 352 59.58 81 13.71

North Shore/Coast Garibaldi 2,270 8.29 109 48.02 63 27.75

Vancouver Coastal 9748 9.37 554 56.83 157 16.11

South Vancouver Island 2,909 8.29 160 55.00 94 32.31

Central Vancouver Island 2,063 8.16 123 59.62 130 63.02

North Vancouver Island 958 8.05 38 39.67 75 78.29

Vancouver Island 5,930 8.20 321 54.13 299 50.42

Northwest 890 10.55 44 49.44 79 88.76

Northern Interior 1,622 10.54 85 52.40 109 67.20

Northeast 904 13.06 35 38.72 65 71.90

Northern 3,416 11.11 164 48.01 253 74.06

TABle 2 Crude Birth Rate, and Rate of Low Birthweight Births and Teen Births in BC by HSDA (2005)

Source: Data are submitted by British Columbia Vital Statistics Agency, BC Ministry of Health. Population data are based on the information provided by BC STATS, Service BC, Ministry of Labour and Citizens’ Services.Crude Birth Rate: Total number of births per 1000 total populationLow Birth Weight Births: Any live born infant weighing less than 2500 gramsTeen Births: Any mother who was 19 years of age or younger at time of delivery of a live born infantRates (other than live birth rates) are calculated by using total live births as the denominator


Region/ HSDATotal Population (18+ years)

Overweight/ Obese

Per Cent Overweight/ Obese

British Columbia 3,240,549 1,464,109 45.2

East Kootenay 63,039 31,858 50.5

Kootenay-Boundary 64167 28,520 44.4

Okanagan 250910 124,317 49.5

Thompson/Cariboo 167,299 94,128 56.3

Interior 545,415 278,823 51.1

Fraser East (Fraser Valley) 188,941 104,365 52.2

Fraser North (Simon Fraser) 434,862 176,859 40.7

Fraser South 475,841 221,250 46.5

Fraser 1,099,644 502,474 45.7

Richmond 139,125 49,837 35.8

Vancouver 480,168 159,347 33.2

North Shore/Coast Garibaldi 209,290 82,227 39.3

Vancouver/Coastal 828,583 291,411 35.2

South Vancouver Island 273,587 127,692 46.7

Central Vancouver Island 194,455 103,072 53.0

North Vancouver Island 87,655 41,725 47.6

Vancouver Island 555,697 272,489 49.0

Northwest 52,399 29,591 56.5

Northern Interior 111,201 60,190 54.1

Northeast 47,609 29,131 61.2

Northern 211,209 118,912 56.3

TABLE 3 Overweight and Obesity Combined by Health Region and Health Service Delivery Area for Population (Aged 18+), 2005 (Based on self-reported height and weight)

BMI: Weight (Kg)/Height 2(meters)Question: How tall are you without shoes? Select the exact height.Question: How much do you weigh? Was that in pounds or kilograms?Survey covers: Population aged 18+, excluding pregnant women and person less than 3 feet (0.914 metres) tall or greater than 6 feet 11 inches (2.108 metres)Index: less than 18.5 (underweight) 18-24.9 (normal weight), 25.0-29.9 (overweight); more than 30.0 (obese)

3 Source: CCHS CANSIM Tables, 2005 (Cycle 3.1) - The CANSIM table 1050409 is an update of CANSIM table 1050209. Note: Percentages that appear in the CANSIM tables may differ slightly from those obtained from the Share file since the latter include only participants in the survey who agreed to sharing their PHN (Personal Health Number).

C. Do the rates of overweight and obesity among adults (aged 18+) differ in the province?

The next few tables and figures present the prevalence of overweight and obesity among BC adults and the differences that exist among Health Regions and by HSDA.

Table 3 presents the rates of overweight and obesity combined in the general population age 18 and older. Approximately 45.2% of the BC population is either overweight or obese with the percentages ranging from 35.2% in the Vancouver Coastal Health Region to 56.3% in the Northern Health Region3.


Table 4 presents in descending order the percent of overweight/obese adults by HSDA. Sampling introduces the possibility of random error and therefore the table includes 95% Intervals for each HSDA’s estimated rate of overweight/obesity. Vancouver, Richmond, North Shore/Coast Garibaldi and Fraser North exhibited significantly lower (p<.05) levels of overweight and obesity than the province while Kootenay Boundary, Fraser South, South Vancouver Island, North Vancouver Island and East Kootenay did not differ from the provincial average. All other HSDAs in the province exhibited significantly higher (p < .05) overweight/obesity levels than the provincial average.

Health Service Delivery Area Percentage 95% Confidence Interval

Northeast 60.20 55.44 64.97

Thompson Cariboo 57.30 52.55 62.06

Fraser East 55.69 52.30 59.08

Northwest 55.60 49.90 61.31

Northern Interior 53.57 48.66 58.49

Central Vancouver Island 53.12 48.70 57.54

Okanagan 49.73 46.17 53.28

East Kootenay 49.65 44.87 54.43

North Vancouver Island 48.12 42.13 54.11

South Vancouver Island 46.82 43.55 50.10

Fraser South 46.53 42.82 50.23

British Columbia 45.07 44.01 46.13

Kootenay Boundary 44.45 38.89 50.01

Fraser North 39.89 36.700 43.09

North Shore/Coast Garibaldi 38.20 34.74 41.66

Richmond 36.00 30.91 41.10

Vancouver 33.02 30.18 35.87

TABLE 4 Prevalence of Overweight and Obesity by Health Service Delivery Area (95% Confidence Interval) for Population Aged 18+ (2005)

Source: CCHS CANSIM Tables, 2005 (Cycle 3.1)

Note: Percentages that appear in the CANSIM tables may differ slightly from those obtained from the Share file since the latter include only participants in the survey who agreed to sharing their PHN (Personal Health Number).


Source: CCHS 2005 Share File (Cycle 3.1)

Note: Percentages that appear in the CANSIM tables may diff er slightly from those obtained from the Share fi le since the latter include only participants in the survey who agreed to sharing their PHN (Personal Health Number).

Figure 2, on the following page, presents where these signifi cant diff erences exist on a map of the province. Brown areas signify those parts of the province with signifi cantly higher (p<.05) overweight/obesity levels than the provincial average. The fi gure also takes into consideration the population diff erences that exist across the province. The size of the circle in the legend denotes a population of 340,000 persons, while the yellow or green illustrate the proportion who are overweight/obese or neither, respectively. Most overweight/obese people (as denoted by the area of the yellow shading in the circles) are located in the lower mainland and on Vancouver Island.

FIGURE 1

Overweight and Obese by Health Service Delivery Area (95% Confi dence Interval) for Population(Aged 18+) - 2005

33.0

36.038.239.9

44.545.1

46.546.848.149.749.7

60.257.3 55.7 55.6 53.6 53.1

0

10

20

30

40

50

60

70

Perc

enta

ge 36.036.0

Northeast

Northwest

North

Okanagan

British Columbia

Richmond

Vancouve

r

Figure 1 presents information on the prevalence of overweight/obesity with corresponding 95% confi dence intervals for each HSDA in comparison to the provincial average (noted as a red dotted line). Green bars illustrate HSDAs that were signifi cantly below the provincial average, blue connotes those not signifi cantly diff erent from the provincial average, while red identifi es those with overweight/obesity rates that are signifi cantly higher than the provincial average.


FIGURE 2

Percentage of Overweight or Obesity by HSDA,Population Aged 18+, B.C., 2005


The next few tables and figures present the prevalence of overweight and obesity among BC adult males and females and the differences that exist among Health Regions and by HSDA.

MalesTable 5 presents in descending order the percent of overweight and obese males aged 18 and older. Approximately 53.7% of adult BC males are either overweight or obese with the percentages ranging from 41.4% in the Vancouver to 63.9% in the Thompson Cariboo Health Service Delivery Areas.

TABLE 5. Prevalence of Overweight and Obesity by Health Service Delivery Area (95% Confidence Interval) for Males Aged 18+ (2005)



Fraser East 63.52 58.22 68.83

Northeast 63.23 54.35 72.12


Okanagan 60.32 53.82 66.82


Fraser South 59.38 54.43 64.33

Northwest 58.46 51.10 65.82


East Kootenay 55.49 48.00 62.98

British Columbia 53.66 52.03 55.29South Vancouver Island 51.60 47.50 55.70


Fraser North 47.97 43.57 52.38

Richmond 47.08 39.06 55.10


Vancouver 41.42 37.27 45.57

Source: CCHS Share File, 2005 (Cycle 3.1)

Figure 3 presents information on the prevalence of obesity and overweight with corresponding 95% intervals among males for each HSDA in comparison to the provincial average(noted as a red dotted line). Green bars illustrate HSDAs that were significantly below the provincial average, blue connotes those not significantly different from the provincial average, while red identifies those with overweight/obesity rates that are significantly higher than the provincial average. Vancouver Health Service Delivery Area exhibited significant lower (p < .05) and Thompson Cariboo and Fraser East Health Service Delivery Areas exhibited significantly higher (p < .05) levels of overweight/obesity than the provincial average.


FemalesTable 6 presents in descending order the percent of overweight or obese adult females age 18 or older. Vancouver, Richmond, and North Shore/Coast Garibaldi exhibited significantly lower (p<.05) levels of overweight and obesity than the province while East Kootenay, Okanagan, Kootenay Boundary, North Vancouver Island, Fraser South, and Fraser North did not differ from the provincial average. All other HSDAs in the province exhibited significantly higher (p < .05) overweight/obesity levels among females that the provincial average


63.9 63.5 63.2 61.6 60.3 59.6 59.4 58.5 58.4 55.5 53.7 51.6 51.6 48.0 47.1 46.4

41.1

0

10

20

30

40

50

60

70

Northeast

Okanagan

Northwest

British Columbia

Richmond

Vancouve

r

FIGURE 3

Overweight and Obese by Health Service Delivery Area (95% Convidence Interval) for Males (Aged 18+), 2005


TABLE 6.

Prevalence of Overweight and Obesity by Health Service Delivery Area (95% Confidence Interval) for Females Aged 18+ (2005)

Health Service Delivery Area Ratio 95% Confidence IntervalNortheast 56.86 49.06 64.66Northwest 52.17 45.10 59.24Thompson Cariboo 50.70 43.87 57.54Fraser East 48.02 42.15 53.88Northern Interior 47.26 40.92 53.60Central Vancouver Island 44.95 39.57 50.32East Kootenay 43.56 37.33 49.79South Vancouver Island 42.52 38.18 46.86Okanagan 39.79 35.33 44.25North Vancouver Island 37.83 30.15 45.51Kootenay Boundary 37.42 30.06 44.78British Columbia 36.63 35.54 37.71Fraser South 33.73 28.87 38.60Fraser North 31.89 27.54 36.24North Shore/Coast Garibaldi 30.44 26.72 34.17Richmond 25.58 18.98 32.18Vancouver 24.59 20.73 28.44


These data are illustrated in Figure 4 where the prevalence of overweight or obesity with cor-responding 95% intervals among females are presented for each HSDA in comparison to the provincial average (noted as a red dotted line). Green bars illustrate HSDAs that were significantly below the provincial average, blue connotes those not significantly different from the provincial average, while red identifies those with overweight/obesity rates that are significantly higher than the provincial average.

Northeast

T

Cariboo

FrNorthwest

Norther

Interior

Central V

anco

uv Okanag

antenay

NorthVan

couv

SouthVan

couv

FrSouth

British

Columbia

KootenaBoundary

Fr

rth

Nor

re/C

Garibald

i

Richmond

Vanco

uver

0

20

40

60

80

Perc

enta

ge

24.625.630.431.933.736.637.437.839.842.543.6

56.952.2 50.7 48.0 47.3 45.0

FIGURE 4

Overweight and Obesity by Health Service Delivery Area (95% Confidence Interval) for Females 18+) - 2005


How does British Columbia compare with other provinces?

Figure 5 presents the percent of the adult population who are overweight/obese in Canada and by province with accompanying 95% intervals. British Columbia exhibits the lowest level of overweight/obesity in Canada at 45.1%. Not only is our rate lower (p < .05) than the national average at 49.0% but it is also lower (p < .05) than any other province.

0

20

40

60

80

Perc

enta

ge O

verw

eigh

t Or O

bese

Canada

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

New Brunswick

Nova Scotia

Prince Edward Isl

and

Newfoundland and Labrador

Yukon Territory

Northwest T

erritorie

s

Nunavut

56.158.8 56.656.4

48.4

61.356.559.4

46.748.753.4

49.0 45.1 50.7

FIGURE 5

Overweight/Obese By Province - (95% Confidence Interval) for Population (Aged 18+), 2005



d. Does the percent of British Columbians who consume five or more fruits and vegetables per day differ in the province?

Table 7 presents the prevalence of British Columbians (aged 12+) by health region and HSDA who consume five or more fruits or vegetables per day. Only slightly less than four in ten British Columbians consume five or more fruits and vegetables daily.

TABLE 7.

Percent of British Columbians Who Consume 5+ Servings of Fruits and Vegetables per day by Health Region and Health Service Delivery Area for Population (Aged 12+), 2005

Region

Total Population (12+ years)

Pop. Estimate (5+ times) Per Cent


East Kootenay 71,420 34,549 48.4

Kootenay-Boundary 70,609 29,583 41.9

Okanagan 277,186 97,794 35.3


Interior 604,819 234,339 38.7

Fraser East 214,579 78,227 36.5

Fraser North 481,662 202,979 42.1

Fraser South 537,314 201,469 37.5

Fraser 1,233,555 482,675 39.1

Richmond 151,182 54,218 35.9

Vancouver 520,658 197,548 37.9







Northwest 61,178 23,394 38.2


Northeast 55,483 20,644 37.2

Northern 243,669 86,625 35.6

Source: CCHS CANSIM Tables, 2005 (Cycle 3.1) - The CANSIM table 1050449 is an update of CANSIM table 1050249.


Table 8 presents in descending order the percent of the population (aged 12+) who consumed 5+ fruits and vegetables per day by HSDA. Sampling introduces the possibility of random error and therefore the table includes 95% intervals for each HSDAs estimated rate of 5+/dailiy fruit and vegetable consumption. The Northern Interior HSDA exhibited significantly lower (p<.05) levels of fruit and vegetable consumption (5+/day) than the province while the East Kootenay, South Vancouver Island and Central Vancouver Island HSDAs exhibited significantly higher (p< .05) fruit and vegetable intake (5+/day) than the provincial average. All other HSDAs in the province did not differ significantly in terms of their mean rates of 5+/day fruit and vegetable consumption levels from the provincial average.

TABLE 8

Fruit and Vegetable Consumption (5 or More Servings per Day) by Health Service Delivery Area (95% Confidence Interval) for Population (Aged 12+) - 2005

Region Percentage 95% Confidence Interval

East Kootenay 49.33 44.52 54.14

South Vancouver Island 45.77 42.55 49.00



Fraser North 42.21 39.01 45.42


Kootenay-Boundary 42.12 36.33 47.91


Thompson/Cariboo 38.8 34.93 42.67

Northwest 38.44 32.4 44.48

Vancouver 38.38 35.52 41.25

Fraser South 38.19 35.05 41.33

Northeast 37.27 31.49 43.06

Fraser East 37.08 32.89 41.27

Richmond 36.39 31.77 41.02

Okanagan 35.38 30.97 39.80




Figure 6 presents information on the prevalence of 5+/day fruit and vegetable consumption with corresponding 95% intervals for each HSDA in comparison to the provincial average (noted as a red line). Green bars illustrate HSDAs that were significantly above the provincial average, blue connotes those not significantly different from the provincial average, while red identifies those with fruit and vegetable rates that are significantly lower than the provincial average.

Northeast

T

Cariboo

FrNorthwest

Norther

Interior

Central Vanco

uv Okanagan

tenay

NorthVanco

uv

SouthVanco

uvFr

South

British

Columbia

KootenaBoundary

Fr

rth

Nor

re/C

Garibaldi

Richmond

Vancouve

r0

20

40

60

Perc

enta

ge

49.3

33.935.436.437.137.338.238.438.438.840.0

42.142.242.244.545.145.8

FIGURE 6

Fruit and Vegetable Consumption (5 or More Times per Day) By Health Service Delivery Area (95% Confidence Interval) for Population (Aged 12+) - 2005


Figure 7, on the following page, presents where these significant differences exist on a map of the province. Blue areas signify those parts of the province with significantly higher (p<.05) daily recommended fruit and vegetable intake levels than the provincial average. The figure also takes into consideration the population differences that exist across the province. The size of the circle in the legend denotes a population of 360,000 persons, while the yellow or green illustrate the proportion who consume 5+ fruits or vegetable daily or do not, respectively. Most people who consume less than 5 fruits or vegetable daily (as denoted by the area of the yellow shading in the circles) are located in the lower mainland and on Vancouver Island.


FIGURE 7

Percentage of Population Having Fruit and Vegetables at Least 5 Times a Day,by HDSA, Population Aged 12+, B.C., 2005

FIGURE 8

Fruit and Vegetable Consumption (5 or More Times per Day) By Health Service Delivery Area (95% Confidence Interval) for Males (Aged 12+) - 2005

Source: CCHS Share File, 2005 (Cycle 3.1)ActNowBC | Measuring Our Success 17

MalesTable 9 presents in descending order the percent of males by HSDA who consumed 5+ fruits and vegetables per day. East Kootenay HSDA at approximately 48% exhibited a higher (p<.05) percentage of males who consumed 5+ fruits and vegetables than the provincial average. All other HSDA did not differ significantly (p <.05) from the provincial average.

Region Percentage 95% Confidence IntervalEast Kootenay 48.02 39.73 56.31Central Vancouver Island 38.06 31.91 44.22Fraser North 37.44 33.77 41.12North Shore/Coast Garibaldi 37.21 30.25 44.18South Vancouver Island 36.80 32.88 40.72North Vancouver Island 36.32 29.49 43.14Northeast 36.15 26.71 45.60British Columbia 33.74 32.09 35.39Northwest 33.60 25.19 42.01Vancouver 32.75 28.42 37.08Fraser South 31.41 27.21 35.61Kootenay-Boundary 31.10 21.27 40.93Fraser East 30.91 24.30 37.51Okanagan 30.09 23.58 36.60Thompson/Cariboo 29.19 23.09 35.28Richmond 28.85 21.74 35.97Northern Interior 28.47 21.08 35.86

TABLE 9

Fruit and Vegetable Consumption (5 or More Servings per Day) by Health Service Delivery Area (95% Confidence Interval) for Males (Aged 12+ ) - 2005


Figure 8 presents in graph form the information on the prevalence of 5+/day fruit and vegetable consumption among males with corresponding 95% intervals for each HSDA in comparison to the provincial average (noted as a red line).

Northeast

T

Cariboo

FrNorthwest

Norther

Interior

Central Van

couv Oka

nagan

tenay

NorthVan

couv

SouthVan

couv

FrSouth

British

Columbia

KootenaBoundary

Fr

rth

Nor

re/C

Garibald

i

Richmond

Vanco

uver

0

20

40

60

Perc

enta

ge

48.0

28.528.929.230.130.931.131.432.8

33.633.7

36.236.336.837.237.438.1


FemalesTable 10 presents in descending order the percent of females by HSDA who consumed 5+ fruits and vegetables per day. South Vancouver Island HSDA at approximately 54% exhibited a significantly higher (p<.05) percentage of females who consumed 5+ fruits and vegetables than the provincial average. All other HSDA did not differ significantly (p <.05) from the provincial average.

Region Percentage 95% Confidence IntervalSouth Vancouver Island 53.88 49.50 58.26Kootenay-Boundary 53.20 42.29 64.11North Vancouver Island 52.55 42.67 62.44Central Vancouver Island 51.82 46.42 57.23East Kootenay 50.67 44.60 56.75Thompson/Cariboo 48.35 41.99 54.71North Shore/Coast Garibaldi 46.95 41.13 52.78Fraser North 46.87 41.43 52.31British Columbia 46.17 44.77 47.57Fraser South 44.84 40.52 49.15Vancouver 43.87 39.61 48.14Northwest 43.67 34.83 52.51Richmond 43.44 37.48 49.41Fraser East 43.11 37.28 48.93Okanagan 40.38 35.67 45.08Northern Interior 39.57 33.24 45.89Northeast 38.48 29.22 47.73

TABLE 10

Fruit and Vegetable Consumption (5 or More Servings per Day) by Health Service Delivery Area (95% Confidence Interval) for Females (Aged 12+ ) - 2005

Figure 9 presents in graph form the information on the prevalence of 5+/day fruit and vegetable consumption among females with corresponding 95% intervals for each HSDA in comparison to the provincial average (noted as a red line).

0

20

40

60

80

Perc

enta

ge

Northeast

T

Cariboo

FrNorthwest

Norther

Interior

Central Vanco

uv Okanagantenay

NorthVanco

uv

SouthVanco

uvFr

South

British

Columbia

KootenaBoundary

Fr

rth

Nor

re/C

Garibaldi

Richmond

Vancouve

r

53.9

38.539.640.443.143.443.7

43.944.846.246.947.048.450.751.8

52.653.2

FIGURE 9

Fruit and Vegetable Consumption (5 or More Times per Day) By Health Service Delivery Area (95% Confidence Interval) for Females (Aged 12+) - 2005



How does British Columbia compare to other provinces?

Figure 10 presents the percent of the adult population who consume 5+ fruits or vegetables daily in Canada and by province with accompanying 95% intervals. British Columbia at 39.7% does not (p < .05) from the Canadian average at 41.2%. Provinces suchas Quebec exhibit significantly higher (p<.05) levels of 5+ daily fruit and vegetable consumption than British Columbia.

0

20

40

60

Perc

enta

ge 5

+se

rvin

gs/D

ay

34.326.127.8

42.9

23.0

33.535.3

49.9

41.031.9

41.2 39.7 36.432.0

Canada

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

New Brunswick

Nova Scotia

Prince Edward Isl

and


Yukon Territory

Northwest T

erritorie

s

Nunavut

FIGURE 10

Fruit And Vegetable Consumption by Province (95% Confidence Interval) for Population (Aged 12+), 2005

Source: CCHS CANSIM Tables, 2005 (Cycle 3.1) - CANSIM table 1050449 is an update of CANSIM table 1050249

e. Does the percent of British Columbians who engage in physical activity differ in the province?While many definitions of physical activity exist, regardless of which definition is utilized it is clear that many British Columbians are not sufficiently active. Table 11 presents the prevalence of British Columbians (aged 12+) by health region and HSDA who were classified as active or moderately active in their leisure-time physical activity. Approximately 58% of British Columbians (aged 12+) were classified as active or moderately active with the highest percentage of active British Columbians residing in the South Vancouver Island, Kootenay Boundary, East Kootenay, and North Vancouver Island HSDAs.


TABLE 11

Physically Active or Moderately Active by Health Region and Health Service Delivery Area for Population (Aged 12+), 2005

Region or HSDATot. Population (12+ years)

Count Actv/Mod Actv Percentage


East Kootenay 71,420 46,274 64.8

Kootenay Boundary 70,609 46,268 65.5

Okanagan 277,186 156,450 56.4


Interior 533,399 354,996 66.6

Fraser East 214,579 114,175 53.2

Fraser North 481,662 272,823 56.6

Fraser South 537,314 288,178 53.6

Fraser 1,233,555 675,176 54.7

Richmond Health 151,182 80,735 53.4

Vancouver 520,658 286,325 55.0







Northwest 61,178 36,458 59.6


Northeast 55,483 27,456 49.5

Northern 243,669 134,373 55.1

Source: CCHS CANSIM Tables, 2005 (Cycle 3.1) - The CANSIM table 105-0433 is an update of CANSIM table 105-0233

1. Population aged 12 and over reporting level of physical activity, based on their responses to questions about the frequency, duration and intensity of their participation in leisure-time physical activity.

2. Respondents are classified as active, moderately active or inactive based on an index of average daily physical activity over the past 3 months. For each leisure time physical activity engaged in by the respondent, an average daily energy expenditure is calculated by multiplying the number of times the activity was performed by the average duration of the activity by the energy cost (kilocalories per kilogram of body weight per hour) of the activity. The index is calculated as the sum of the average daily energy expenditures of all activities. Respondents are classified as follows: 3.0 kcal/kg/day or more = physically active; 1.5 - 2.9 kcal/kg/day = moderately active; less than 1.5 kcal per day = inactive.


Table 12 presents in descending order the percent of the population (aged 12+) who were classified as physically active or moderately active by HSDA (based on their responses to questions about the frequency, duration and intensity of their participation in leisure-time physical activity). Sampling introduces the possibility of random error and therefore the table includes 95% confidence intervals for each HSDAs estimated rate of being physically active or moderately active. This data are presented in graph form in Figure 11. Green bars illustrate HSDAs that were significantly above the provincial average, blue connotes those not significantly different from the provincial average. Only South Vancouver Island, East Kootenay and North Shore/Coast Garabaldi areas exhibited significantly higher (p<.05) levels of physically active or moderately active residents than the province while the Northeast HSDA exhibited significantly lower (p<.05) levels of physical activity as compared to all other areas of the province

TABLE 12

Prevalence of Physically or Moderately Active by Health Service Delivery Area (95% Confidence Interval) for Population (Aged 12+), 2005


S. Vancouver Island 66.63 63.37 69.88

East Kootenay 65.84 61.65 70.03


N. Shore/Coast Garibaldi 63.91 59.87 67.94



Northwest 59.64 55.07 64.21



Fraser North 57.32 54.32 60.31

Okanagan 56.24 51.66 60.82


Vancouver 55.39 52.21 58.57

Fraser South 54.25 50.70 57.81

Richmond 53.99 49.33 58.65

Fraser East 53.02 49.24 56.79

Northeast 49.66 45.00 54.33

Source: Statistics Canada, Canadian Community Health Survey. Share File, 2005 (Cycle 3.1)

0

20

40

60

80

Perc

enta

ge58.0 57.3

65.2 63.9

54.3 54.0 53.0 49.757.3

63.656.2 55.9 55.4

59.662.165.866.6

Northeast

Northwest

Okanagan

British

Columbia

Richmond

Vancouve

r


FIGURE 11

Physically Active/Moderately Active By Health Service Delivery Area (95% Confidence Interval) for Population (Aged 12+) 2005


Figure 12 presents where these significant differences exist on a map of the province. Blue areas signify those parts of the province with significantly higher (p<.05) rates of physically active or moderately active residents than the provincial average. The figure also takes into consideration the population differences that exist across the province. The size of the circle in the legend denotes a population of 390,000 persons, while the green or yellow illustrate the proportion who are active (physically active or moderately active) or inactive (neither physically active or moderately active), respectively. Most people, in terms of absolute numbers, who are physically inactive (as denoted by the area of the yellow shading in the circles) are located in the lower mainland and on Vancouver Island.


FIGURE 12

Percentage of Population Physically Active by HDSA,Population Aged 12+, B.C., 2005


MalesTable 13 presents in descending order the percent of males by HSDA who were classified as active or moderately active. East Kootenay and South Vancouver Island HSDAs each at almost 70% exhibited a significantly higher (p<.05) percentage of males who were active or moderately active than the provincial average. Males in the Northeast HSDA exhibited significantly lower levels of activity than the province while all other HSDA did not differ significantly (p <.05) from the provincial average.

TABLE 13

Prevalence of Physically or Moderately Active by Health Service Delivery Area (95% Confidence Interval) for Males (Aged 12+), 2005

Health Service Delivery Area Percentage 95% Confidence Interval East Kootenay 69.55 63.26 75.84S. Vancouver Island 67.79 62.86 72.72N. Shore/Coast Garibaldi 64.66 58.41 70.91Kootenay Boundary 63.49 54.69 72.29Northwest 62.15 55.97 68.34Central Vancouver Island 61.87 55.69 68.05Okanagan 60.19 52.84 67.55Fraser North 59.65 55.65 63.65British Columbia 58.88 57.21 60.56Northern Interior 57.69 51.36 64.02Vancouver 57.58 52.96 62.21North Vancouver Island 57.20 49.39 65.01Thompson Cariboo 56.64 50.43 62.86Fraser South 54.43 49.93 58.93Richmond 53.94 44.79 63.08Fraser East 53.02 47.53 58.52Northeast 45.64 37.95 53.33


FIGURE 13

0

20

40

60

80

Perc

enta

ge

59.7 57.7

64.7 63.554.4 53.9 53.0

45.6

58.962.2

57.6 57.2 56.660.261.9

67.869.6

Northeast

ThompsoCarib

oo

Fras

East

Northwest

Norther

nterior

CentrVanco

uvIsla

nd

Okanagan

EasKootenay

NortVanco

uvIsla

nd

SoutVanco

uvIsla

nd

Fras

South

British Columbia

KootenaBoundary

Fras

North

NortShore/Coas

Garibaldi

Richmond

Vancouver

Source: Statistics Canada, Canadian Community Health Survey, Share File (Cycle 3.1) 2005

Figure 13 presents in graph form the information on the prevalence of males who were physically active or moderately active with corresponding 95% confidence intervals for each HSDA in comparison to the provincial average (noted as a red line).

Physically Active/Moderately Active By Health Service Delivery Area for Males (Aged 12+), 2005.


FemalesTable 14 presents in descending order the percent of females by HSDA who were classified as active or moderately active. North Vancouver Island, Kootenay Boundary and South Vancouver Island HSDAs exhibited significantly higher (p<.05) percentages of females who were active or moderately active as compared to the provincial average. All other HSDA did not differ significantly (p <.05) from the provincial average.

TABLE 14

Prevalence of Physically and Moderately Active by Health Service Delivery Area (95% Confidence Interval) for Females (Aged 12+), 2005

Health Service Delivery Area Percentage 95% Confidence IntervalNorth Vancouver Island 70.01 61.83 78.19Kootenay Boundary 66.81 58.89 74.73S. Vancouver Island 65.58 61.68 69.48N. Shore/Coast Garibaldi 63.20 57.56 68.83Central Vancouver Island 62.39 57.43 67.36East Kootenay 62.04 55.82 68.26Thompson Cariboo 58.02 53.00 63.03British Columbia 57.07 55.53 58.61Northwest 56.92 49.76 64.08Fraser North 55.04 50.30 59.79Fraser South 54.08 48.93 59.23Richmond 54.04 47.88 60.21Northern Interior 53.98 47.01 60.94Northeast 53.98 46.23 61.72Vancouver 53.26 49.52 57.00Fraser East 53.01 47.32 58.71Okanagan 52.51 46.94 58.09


FIGURE 14

0

20

40

60

80

Perc

enta

ge

55.057.1

70.066.8

62.058.0 54.054.054.1

62.4 56.952.553.053.354.0

63.265.6

Northeast

ThompsoCarib

oo

FrasEast

Northwest

Norther

nterior

CentrVanco

uvIsla

nd

Okanagan

EasKootenay

NortVanco

uvIsla

nd

SoutVanco

uvIsla

nd

FrasSouth

British Columbia

KootenaBoundary

FrasNorth

NortShore/Coas

Garibaldi

Richmond

Vancouver


Figure 14 presents in graph form the information on the prevalence of females who were physically active or moderately active with corresponding 95% confidence intervals for each HSDA in comparison to the provincial average (noted as a red line).

Physically Active/Moderately Active By Health Service Delivery Area for Females (12+ years), 2005


How does British Columbia compare to other provinces?

Figure 15 presents the percent of the adult population who are active or moderately active in Canada and by province with accompanying 95% intervals. British Columbia at 57.7% is (p < .05) higher than the Canadian average at 51.0% and is higher than all other provinces/territories except for the Yukon Territory (p > .05).

FIGURE 15

Physically Active/Moderately Active By Province (95% Confidence Interval) for Population (Age 12+), 2005

0

20

40

60

80

Perc

enta

ge P

hysic

ally

Act

ive

49.243.3

47.250.5

57.6

44.648.045.647.851.347.351.0

57.7 53.5

Canada

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

New Brunswick

Nova Scotia

Prince Edward Isl

and


Yukon Territory

Northwest T

erritorie

s

Nunavut

Source: CCHS CANSIM Tables, 2005 (Cycle 3.1) - CANSIM table 105-0433 is an update of CANSIM table 105-0233.

f . Do the rates of tobacco use differ in the province?The proportion of British Columbians classified as smokers varies slightly depending on the survey used. Variations may be due to differences in the wording of questions, response categories and survey methodologies. For example, according to the Canadian Tobacco Use Survey (CTUMS)4, in 2006 16.4% (95%CI = 14.2%-18.5%) of the BC population (17.6% of males and 15.1% of females) above the age of 15 are smokers while the Canadian Community Health Survey, in 2005, reports that 17.8% (19.6% of males and 16.0% of females) of British Columbians, aged 12 and over, are current daily or occasional smokers5. BC Stats utilizes a 12- month rolling average to determine smoking rates. According to BC Stats the twelve month average, surveyed monthly from April ‘06 – March ‘07, is 17% (18% men and 16% women6). Table 15 presents in descending order the estimated percentage of smokers (with corresponding 95% intervals), by HSDA for those persons 15 years of age and older.

4 Canadian Tobacco Use Monitoring Survey (CTUMS), Annual Results 2006, http://www.hc-sc.gc.ca/hl-vs/tobac-tabac/research-recherche/stat/ctums-esutc/2006/ann-table2_e.html5 Statistics Canada, Canadian Community Health Survey (CCHS 3.1), 2005 (CANSIM table 105-0427)., see http://www.statcan.ca/english/freepub/82-221-XIE/2006001/tables/t014a.htm6 BC Stats. Summary of Smoking Rates for BC, March 2007, p. 3-4.


TABLE 15

Prevalence of Smokers by Health Service Delivery Area (95% Confidence Interval) for Population (Age 15+), 2005

HSDA%Current Smokers 95% Confidence Interval

Northeast Health 30.86 23.01 38.72Northern Interior 25.55 21.21 29.90Thompson/Cariboo 23.14 18.93 27.35East Boundary 21.99 16.96 27.01Northwest Health 21.96 17.42 26.50Kootenay-Boundary 21.82 15.93 27.70North Vancouver Island 21.11 15.69 26.53Okanagan 19.55 16.49 22.62Fraser East 19.26 15.67 22.85Central Vancouver Island 18.85 15.85 21.84All BC 18.38 17.43 19.33Vancouver 18.38 15.64 21.11Fraser South 17.79 15.34 20.25North Shore/Coast Garibaldi 16.58 13.29 19.87South Vancouver Island 16.48 13.69 19.27Fraser North 14.56 12.04 17.09Richmond 12.68 9.67 15.70


The data presented in Table 15 is illustrated in graph form in Figure 16. Green bars depict HSDAs that exhibited significantly (p. < .05) lower rates of smokers than the provincial average, while blue connotes HSDA that did not differ from the provincial average. Northeast Health, Northern Interior and Thompson/Cariboo exhibited significantly (p. < .05) higher percentages of smokers as compared to the provincial average.

FIGURE 16

Current Smokers (Daily or Occasional) By Health Service Delivery Area (95% Confidence Interval) for Population (Aged 15+) 2005

0

10

20

30

40

Northeast

ThompsoCarib

oo

Fras

East

Northwest

Norther

nterior

CentrVanco

uvIsla

nd

Okanagan

EasKootenay

NortVanco

uvIsla

nd

SoutVanco

uvIsla

nd

Fras

South

British

Columbia

KootenaBoundary

Fras

North

NortShore/Coas

Garibaldi

Richmond

Vancouve

r

12.714.616.516.617.818.418.418.919.319.6

21.121.822.022.023.125.6

30.9


Percentage of Dialy or Occasional Smokers,By HDSA, Population Aged 15+, B.C., 2005

FIGURE 17


Regardless of the method used, overall smoking rates in Canada have been declining gradually since 19857. Figure 18 presents the trends in smoking rates (occasional and daily) for the province as well as for each of the Health Regions between December 2004 to March 2007. At the regional level, the proportion of smokers has generally been declining.

FIGURE 18

Percent of BC Population (Age 15+) Who Are Current (Daily and Occassional) Smokers Stats, C.H.E.S.S.

0%

5%

10%

15%

20%

25%

30%

35%

NHA VIHA

VCHA FHA

BC

2004 2005 2006

Nov-

04

Dec-

04

Jan-

05

Feb-

05

Mar

-05

Apr-0

5

May

-05

Jun-

05

Jul-0

5

Aug-

05

Sep-

05

Oct-0

5

Nov-

05

Dec-

05

Jan-

06

Feb-

06

Mar

-06

Apr-0

6

May

-06

Jun-

06

Jul-0

6

Aug-

06

Sep-

06

Oct-0

6

Nov-

06

Dec-

06

Jan-

07

Feb-

07

Mar

-07

Source: Summary of Smoking Rates for BC – March 2007. BC Stats, p.6.

Prevalence rates are calculated by BC Stats from the Community Health Education and Social Services (CHESS) Survey. CHESS survey data are collected monthly by BC Stats. Daily and occasional smokers are grouped together in the survey results as “current smokers”. Despite the name of the indicator, “tobacco use” only refers to cigarette smoking and ignores cigar smoking, chewing tobacco and pinch and snuff use.

Survey data are weighted to accurately reflect age and gender distribution within each health authority based on BC STATS population estimates.

7 CTUMS. (2006) http://www.hc-sc.gc.ca/hl-vs/tobac-tabac/research-recherche/stat/ctums-esutc/2006/index_e.html

Figure 17 presents where these significant differences exist on a map of the province. Blue areas signify those parts of the province with significantly lower (p<.05) rates of tobacco use than the provincial average, while brown signifies area of the province with significantly higher (p.<.05) rates of tobacco use. The figure also takes into consideration the population differences that exist across the province. The size of the circle in the legend denotes a population of 88,000 persons, while the green or yellow illustrate the proportion who are non-smokers and smokers, respectively. Most people, in terms of absolute numbers, who are smokers (as denoted by the area of the yellow shading in the circles) are located in the lower mainland and on Vancouver Island.


How does British Columbia compare to other provinces?Figure 19 presents the percent of smokers in Canada, and by province, with accompanying 95% confidence intervals. Rates of tobacco use in British Columbia are significantly lower (p.<.05) than any other province.

FIGURE 19

Current Smokers By Province (95% Confidence Interval) for Population (Age 15+), 2005

0

20

40

60

Perc

enta

ge C

urre

nt S

mok

ers

25.4 23.1

55.6

37.931.5

24.223.523.625.421.721.222.6

18.424.0

Canada

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

New Brunswick

Nova Scotia

Prince Edward Isl

and


Yukon Territory

Northwest T

erritorie

s

Nunavut



Section 2 | Information on Output Measures

An important aspect to evaluating ActNow BC involves assessing whether and to what extent initiatives have been implemented as planned and who is being reached or participating in which initiative. While numerous activities are being planned and are at differing stages of being operationalized, this section highlights a sample of initiatives from each of the targeted areas and describes the progress that is being made in achieving program implementation objectives.

a. Physical Activity

Active Communities

The Active Communities Initiative mobilizes and supports local governments and partner organiza-tions in promoting healthy lifestyles, increasing physical activity levels amongst British Columbians, and developing supportive community environments. The BC Recreation and Parks Association is implementing the initiative with funding from ActNow BC and in partnership with 2010 Legacies Now.

Progress of the Active Communities initiative is monitored by collecting information on the number of registered communities. A community is not defined by geographical location – for example, a community can be a municipality, an aboriginal community, or a wellness coalition. Linkages and partnerships within geographical communities are encouraged, however, there may be more than one Active Community within a geographical boundary.

Figure 20 presents the number of registered Active Communities from the inception of the initiative in late September 2005 to June 2007. As of June 30, 2007, there are 137 registered Active Communities, 54 Active Communities grants have been allocated, 581 Active Communities Tool Kits have been distributed and 398 Active Workplace Workbooks have been downloaded from the website. As well, 12 Active Communities Community workshops and one provincial forum have been held.

Using the tagline “Every Step Counts”, Little Shuswap Indian Band launched a Band walking program on May 10th, Move for Health Day. Community members from both reserves (Tappen and Skwlax) and staff walked from the Band Office to the Quaaout Resort. Participants signed up for the program and received a pedometer, walking log and general walking information. The challenge included keeping track of one’s steps/kilometres for six weeks ending on June 21st, Aboriginal Day. The challenge between three teams; Tappen residents, Skwlax residents and staff drew 48 people, an impressive number given the community has a total population of 200.

Little Shuswap Indian Band – “Every Step Counts”

0

20

40

60

80

100

120

140

160

Oct. 2005

Dec. 2005

Feb. 2006

Apr. 2006

June.2006

Aug.2006

Oct.2006

Dec.2006

Feb.2007

April.2007

June.2007

Num

ber

FIGURE 20

Number of Registered Active Communities


Action Schools! BC

Action Schools! BC promotes the creation of inclusive and diverse physical activity opportunities throughout the school day. Students, school staff, families and community practitioners can contribute to and benefit from whole school based action plans that provide opportunities for children to be more physically active more often. There are four steps to becoming an Action School: registering, which provides the school with access to resources and the assistance of the Action Schools! BC Support Team; bringing together an Action Team; developing a School Action Plan; and, recording how the plan unfolds.

The following three figures present data between January 2004 and May 2007 on the increase in the number of schools that registered with Action Schools! BC, the number of students in those schools and the numbers of teachers, principals and other school personnel involved in Action Schools! BC initiatives. As of May 31, 2007, there were 1,308 registered Action Schools, 6,617 classroom action bins distributed, 1,196 workshops delivered, 60 regional trainers in place and 100% of school districts that had at least one Action Schools! BC school in their districts.8

“Getting students fit, getting them doing things – it has helped with their learning, it has helped with their self

esteem, it has helped with the whole climate in the school.”

– Educator

8 Monthly Status Reports provided by Action Schools! BC Support Team. Information on current month located at: http://www.actionschoolsbc.ca/Content/Quick%20Links/ASBC%20Stats.asp

0

200

400

600

800

1000

1200

1400

Jan. 04Mar. 0

4May. 04

July. 04Sept. 0

4Nov. 04

Jan. 05Mar. 0

5May. 05

July. 05Sept. 0

5

Nov. 05Jan. 06

Mar. 06May. 06

July.06Sept.06

Nov.06Jan. 07

Mar. 07May. 07

Num

ber

FIGURE 21

Number of Registered Action Schools! BC (January 2004 to May 2007)

Source: Monthly Status Reports provided by Action Schools! BC Support Team. Information on current month located at: http://www.actionschoolsbc.ca/Content/Quick%20Links/ASBC%20Stats.asp


“Action Schools! has helped me a lot because before I wasn’t that active and now I am like the activist kid in the whole family.”

– Student

0

50000

100000

150000

200000

250000

300000

350000

Jan. 04

April. 04

July. 04

Oct. 04

Jan. 05

April. 05

July. 05

Oct. 05

Jan. 06

April.06

July.06

Oct.06

Jan. 07Apr. 0

7

Num

ber o

f Stu

dent

s

Figure 22

Number of Students In Schools Registered in Action Schools! BC (January 2004 to May 2007)


Figure 23

Number of Teachers, Principals and Other School Personnel Involved in Action Schools! BC (January 2004 to May)

0

2000

4000

6000

8000

10000

12000

14000

Jan.

04

Mar

. 04

May

. 04

July.

04

Sept

. 04

Nov.

04

Jan.

05

Mar

. 05

May

. 05

July.

05

Sept

. 05

Nov.

05

Jan.

06

Mar

. 06

May

. 06

July.

06

Sept

.06

Nov.0

6

Jan.

07

Mar

. 07

May

. 07

Num

ber o

f Sch

ool P

erso

nnel



Physical Activity Social Marketing Campaign

The ActNow BC provincial advertising campaign began in March 2007 and will consist of a number of phases. The first phase of the campaign focused on promoting physical activity for children and occurred in March and April, 2007. The campaign entitled Every Move is a Good Move involved providing tips to children and their families on becoming more active and included newspaper advertising, a 30 second television advertisement, a brochure and transit advertising as well as information on the ActNow BC website.

To assess the effectiveness of the campaign and gather baseline information, 800 adults were randomly selected and interviewed by telephone before the onset of the program (March 2007). A follow-up survey of 800 randomly selected adults was conducted following the physical activity campaign (May 2007). 9

Of the respondents who were aware of the campaign, 42%, 21% and 14% recalled “getting active”, ”directed at children/kids”, and “more exercise” respectively as components they remembered. Moreover, 12% of these persons stated they became more active as a result of being prompted by the ads. 10

b. Healthy eating

Action Schools! BC – Healthy Eating

The development, implementation and evaluation of the healthy eating component of Action Schools! BC began in January 2006. There were 5 intervention schools and 5 usual practice schools. The healthy eating pilot was divided into 2 Phases. Phase I (January 2006-June 2006) measured the effects of the intervention on students in grades 4 and 5, and Phase II (September 2006-June 2007) will measure the effects of the intervention on those same students, now in grades 5 and 6. Action Schools! BC – Healthy Eating utilizes the Action Schools! BC whole-school framework to affect eating behaviors, and specifically the intake of vegetables and fruit, of BC elementary school students.

Key findings from Phase I of the evaluation indicate that students in intervention schools:

• Consumed more servings of fruit per day

• Consumed more total servings of vegetables and fruit per day

• Consumed a greater variety of vegetables and fruit

• Tried more vegetables and fruit from a list

In September 2007 all elementary schools in BC will be eligible to register for the Action Schools! BC – Healthy Eating component.

9 Ipsos-Reid Reports. BC Reid Express March and May 2007 10 Ipsos-Reid Reports. BC Reid Express March and May 2007

“This has totally changed my daughter’s idea of food. She

will actually eat a banana after school instead of cookies

which are both available.”

– Parent

During the pre-test period, approximately 60% (481) respondents were able to recall seeing or hearing any form of advertising that promoted physical activity (in the past three months). This rose to 74% (594) at the post-test period. When asked if they were aware of the provincial government’s physical activity campaign approximately 40% (317) responded although only 18% correctly identified ActNow BC or the Provincial Government as the sponsor of the campaign.


Dial-A-Dietitian

Dial-A-Dietitian provides free nutrition information to British Columbians. Registered dietitians answer questions from the public, health educators and the media through a toll free number (1-800-667-3438) or provide nutrition information through a website at www.dialadietitian.org. By tallying the number of calls answered by Dial-A-Dietitian staff and the number of website pages

.denimreted eb nac noitamrofni noitirtun rof dnamed s’cilbup eht fo noitacidni na ,detisiv ro deweivFrom April 2005 to March 2006, approximately 20,000 calls were answered by Dial-A-Dietitian

Similar to last year, half (51% or 10,158) of the issues concerning Dial-A-Dietitian callers were about nutrition and eating for maintaining or enhancing health. Calls about allergies and food intolerances increased 26% (283 calls) over last year. The other half (49% or 9,653) of callers asked for nutrition guidelines to avoid, delay or treat a disease. Figure 24 presents the nutrition topics callers to Dial-A-Dietitian posed. 11

“Excellent service - I am giving the phone number to my 4 children.”

– Caller

“Your help was greatly appreciated. It is wonderful to have a service like this. Your dietitians are very knowledgeable.”

– Caller

11 Dial-a-Dietitian Annual Report, April 2005 to March 2006. http://www.dialadietitian.org/programs/2005-6%20Exec%20SummaryAnnualReport.pdf p. 311 http://www.bced.gov.bc.ca/health/sales_report.pdf

Child Feeding, Preganacy16%

Digestive12%

Food/Water Safety/Storage6%

Food Nutrients/Labelling/Preparation/Access/ Cost

7%

Nutrient Issues, Exercise/Sports,Vegetarian, Hypoglycemia

15%

Other10%

Diabetes, Cardiovascular16%

Arthritis, Gout, Allergy/Intolerances,Cancer, AIDS/HIV9%

Bone Health4%

Weight5%

FIGURE 24

Dial-A-Dietitian Nutrition Topics (19,841)April 2005-March 2006

Food and Beverage Sales in BC Schools

In November 2005 several resources were released and posted on the Ministry of Education website for Healthy Schools including:

• The School food Sales and Policies Provincial Report12 , which examines the status of food sales in BC schools the extent to which ‘more healthy’ or ‘less healthy’ choices are offered; and the degree to which nutrition policies have been, or are being, implemented;

• The Guidelines for Food and Beverage Sales in BC Schools which are designed to maximize student’s access to healthier options. The province’s goal is to eliminate the sale of unhealthy foods and beverages in BC schools by 2009;

• Fact sheets and reference tools to support the implementation of the guidelines.

A follow-up survey on school food sales and policies was conducted in Spring 2007. Results of this survey will be posted on the Ministry of Education website.


BC School Fruit and Vegetable Snack Program (SFVSP)

This initiative is a partnership with the Ministries of Health, Education and Agriculture and Lands and is delivered through the BC Agriculture in the Classroom Foundation. School children in ten pilot elementary schools began in September 2005 receiving twice per week a free BC grown fruit or vegetable. As well, teachers, students and their families receive information on BC grown fruits and vegetables. These ten pilot schools represent 3300 elementary school children who receive approximately 6600 fruits and vegetables per week.

An evaluation of this initiative was completed in November 2006. Following are key findings of the evaluation:

• SFVSP children ate at least 5 fruit and vegetable servings/day; meeting the guidelines outlined in Canada’s Food Guide to Healthy Eating.

• SFVSP children ate, on average, one fruit and vegetable serving more than the comparison group children.

• Children who were at risk (eating less than fruit and vegetables per day at baseline) increased their consumption by 2 fruit and vegetable servings.

• Children and parents also reported many positive personal and school level changes as a result of participating in the program. For example, 65% of children reported that they made positive changes including: eating more fruits and vegetables; feeling healthier; trying new fruits and vegetables; washing their hands more often; asking their parents to buy fruit and vegetables, and; knowing more about fruit and vegetables.

• 100% of the teachers, administrators, and in-school coordinators who were interviewed were in favour of continuing with the program.

In September 2007, a total of 162 schools (elementary, middle and senior schools) throughout British Columbia will participate in the SFVSP. This will include 9 of the original pilot schools, and 52 from the 2006/2007 school year 13.

Shapedown BC

The Centre for Healthy Weights: Shapedown BC is a prototype primary care clinic in Vancouver at BC Children’s Hospital that provides assessment, referral and treatment services for children in British Columbia dealing with excess weight. Shapedown also: acts as a provincial resource to support Regional Health Authorities to establish similar initiatives throughout the province; provides information and consultation to various health care providers/agencies on child obesity, initiatives, strategies and best practices; and, provides resources to families seeking information on healthy weights, active lifestyles and family dynamics.

Shapedown is family-focused and targets the underlying factors that often promote poor food choices and physical inactivity in families. The core components to the program include:

• A team made up of a dietitian, mental health counselor, physician and physical activity consultant

• A standardized assessment that includes medical psychological and social components

“The kids will eat fruits and vegetables when they are

accessible to them. If it is there, they will eat it. It is almost the norm now, or

maybe even peer pressure to eat it because the other

kids are eating them. It is important for the kids for

their long term health. I feel pride that our school is involved in a program that

is ground breaking and very promising.”

– Teacher

13 Ann Britton, Provincial Coordinator, BC School Fruit and Vegetable Snack Program, BC Agriculture in the Classroom Foundation. Complete list of schools can be found at: http://www.aitc.ca/bc/snacks/infoparticipatingschools.aspx


• Treatmentcomprisedofa10weekgroupprogram,one-on-onecounseling,andsupportfrom secondary and tertiary care specialists according to established clinical standards and guidelines.

A comprehensive evaluation plan has been developed that includes process, outcome and client/provider satisfaction indicators. Preliminary results are expected in late 2007. At present there are approximately 100 children receiving services at the clinic, including 71 new clients since October 2006.

Health Check™ BC Dining Pilot Program

Health Check™ is an initiative intended to help British Columbians make healthy food choices in family dining establishments by incorporating BC foods on healthy menu items. This initiative occurs in partnership with the Canadian Heart and Stoke Foundation, the BC Ministry of Agriculture and Land and the BC Ministry of health and is being pilot-tested in selected White Spot Restaurants in British Columbia.

A baseline survey of 450 patrons was conducted in five White Spot Restaurants in early 2007. The purpose of the baseline survey was to assess consumer knowledge of Health Check™ and overall healthy eating views, as well as demographic information for a typical family-style, sit-down restaurant.

Following are the key results of the survey:

• 81%ofparticipantslookforhealthyfoodchoiceswhenorderingitemsinrestaurants.

• 59%ofparticipantsindicatedhavingseentheHealthCheck™logoonfoodpackaging.

• 61%ofparticipantssaidtheywouldbemorelikelytoorderanitemiftheHealthCheck™logowas beside the item on the menu.

• 85%ofparticipantsindicatedthatWhiteSpot’suseoftheHealthCheck™logowouldprovideadded value for them as a customer of the restaurant.

• 47%ofparticipantssaidthattheywouldusetheavailabilityoftheHealthCheck™programtohelp determine what restaurant they choose to visit next time they plan on eating out.

A follow-up survey and focus groups will be conducted approximately five months after the restaurant launch.

Community Food Action Initiative (CFAI)

The Community Food Action Initiative is a health promotion initiative aimed at increasing food security for all British Columbians, particularly those living with limited incomes. CFAI is a collaborative effort of BC’s six health authorities and the Ministry of Health. The initiative focuses on increasing:

• Awarenessoffoodsecurity

• Accesstolocalhealthyfood

• Foodknowledgeandskills

• Communitycapacitytoaddresslocalfoodsecurity

• Developmentanduseofpolicytosupportcommunityfoodsecurity

“It was great to begin to look at the possibilities that could come out of these discussions and we moved from looking at Good Food Boxes to cooking classes to developing a cookbook to having a Chef Dinner at local farms to having an annual cookbook calendar to raise funds. Great group, great ideas, looking forward to the next steps.”

– Participant


This occurs through facilitating networking, sharing knowledge, sharing betting practices, support-ing policy, evaluating initiatives and collaborating across sectors.

Over the past year CFAI helped improve food security for people in more than 100 communities throughout British Columbia including 73 community-based projects and 54 food security networks liking a cross-section of food system stakeholders.

c. Tobacco Control

QuitNow

QuitNow Services are a set of smoking cessation services available to assist individuals quit smoking. They are available around the clock and are managed by the BC Lung Association. QuitNow Services are funded by the Ministry of Health and freely available to all British Columbians.

QuitNow.ca is an internet-based cessation program. From January to December 2006, 5,364 persons who smoke registered with QuitNow.ca – a monthly average of 447. This is up from a year earlier when 3,498 persons who smoke registered with QuitNow.ca – a monthly average of 291.5.

QuitNow by phone - A toll-free 24/7 intervention and counseling service available in 130 languages and with Telecommunications Device for the Deaf. The purpose of the service is to encourage and assist tobacco users to quit or reduce their use of tobacco products. In 2006, 1,066 persons called QuitNow by phone, while 1,504 outbound calls were made by QuitNow by phone.

“I haven’t felt this good in 27 years. I consider

my lungs to be my new ‘accessory’! The support I found at QuitNow got

me through many a terrible craving.”

– Ex-smoker

Table 16

Registrations and Inbound Calls by Health Authority, January to December 2006

Sum of Health

Authorities

Interior Health

Authority

Fraser Health

Authority

Vancouver Coastal Health

Authority

Vancouver Island Health

Authority

Northern Health

Authority

QuitNow registrations 5,364 951 1,770 1,194 1,087 362

QuitNow by phone 1,066 203 237 245 120 81

Source: QuitNow Annual Report, http://www.quitnow.ca


Table 17 presents the percent of current smokers, age 15+, who stated either “QuitNow.ca” or “QuitNow by phone” when asked to provide three examples of resources or support that might helpthemtoquitsmoking.Percentagesrangedfrom0to6%fortheformerand1to7%forthelatter over the survey period.

Table 17

Top-of-mind Cessation Resources, Current Smokers, Age 15+

Cessation Resource

June06

July06

Aug06

Sept06

Oct06

Nov06

Dec06

Jan07

Feb07

Mar07

QuitNow registrations 3% 2% 2% 2% 4% 3% 4% 3% 3% 2%

QuitNow by phone 1% 1% 0% - 1% 1% 4% 4% 4% 1%

Source: Summary of Smoking Rates for BC - March 2007. p. 7 BC Stats, CHESS 3 month average

Question: When you think of resources or support that you might use to help you quit smoking, what is the first type of resource or support that comes to mind? And what comes to mind next? Third?

Approximatelyoneinfour(24%)BritishColumbiasmokersreportedthattheywereawareofQuitNow.ca,whileapproximately13%wereawareofQuitNowbyphone.14

14 Summary of Smoking Rates for BC - March 2007. BC Stats, p. 37. Twelve month average, surveyed monthly April ’06 - March ’07.

Table 18

Percent of smokers who are aware of QuitNow.ca or QuitNow by Phone by Province and Health Authority - 2006 (Note: Percentages in brackets are for previous year - 2005)

British Columbia

Interior Health

Authority

Fraser Health

Authority

Vancouver Coastal Health

Authority

Vancouver Island Health

Authority

Northern Health

Authority

QuitNow.ca 24%(20%)

26%(24%)

23%(20%)

20%(16%)

26%(19%)

28%(24%)

QuitNow by phone 13%(12%)

16%(16%)

13%(11%)

10%(9%)

13%(12%)

18% (18%)

Source: Summary of Smoking Rates for BC - March 2006. p. 38. BC Stats, CHESS 12 month average, survey monthly April ’05 - Mar ’06 and April ’06 - Mar ‘07.

Question: I am going to read you a list of resources used by smokers to quit. Could you please tell us which of the following resources you are aware of?


Municipal Smoking Bylaws

Most British Columbians agree or strongly agree that smoking in public places should not be tolerated (see Figure 25).

0%

10%

20%

30%

40%

50%

60%

70%

80%

AgreeNeutralDisagree

FIGURE 25

Attitudes towards smoking in public places, Age 15+% Agree, Neutral, Disagree - Smoking in public should not be tolerated

Source: Summary of Smoking Rates for BC, March 2007. p 35 BC Stats, CHESS, Three month rolling average, smokers and non-smokers. http://www.bcstats.gov.bc.ca/data/ssa/reports/tobacco/smokingstats_20062007.pdf

Currently, there are varying bylaws in BC that provide different levels of protection for residents depending on where they live. Since municipal and regional governments in BC have the authority to ban or restrict smoking in public places within their geographic limits, many of the smaller and rural municipalities in the North and Interior regions chose not to adopt smoke-free bylaws - relying instead on the WCB Regulations and the upcoming provincial legislation. In the Lower Mainland and the Capital Regional District (which includes 15 municipalities) however, most municipalities implemented public places bylaws that either met or exceeded the WCB Regulations.

Bylaws across BC vary and may restrict smoking on patios, in transit shelters, on beaches and completely eliminate indoor smoking areas.

The government recently announced province-wide smoke-free legislation in all indoor public places, with no allowances for Designated Smoking Rooms (DSRs) in restaurants and bars in 2008. BC will have consistent legislation that applies equally across the province to protect all workers and the public from hazards cause by exposure to second-hand smoke.


Second Hand Smoke

Almosthalf(47%)ofallBCsmokersaged15+agreedorstronglyagreedwiththestatementthattheirsmokingbotheredotherpeopleagreatdeal,while66%agreedorstronglyagreedthatsecond hand smoke is dangerous to those around them.15

Figure 26 presents the percent of non-smokers, aged 15+ years and older, who report being exposed to second hand smoke in different contexts. Approximately one in five British Columbians in this sample reported being exposed to second hand smoke in either an indoor public place such as a bar, restaurant or shopping mall, or in an outdoor public place, such as an outdoor stadium, field or event. Rates of exposure appear to be decreasing in places of employment.

15 BC Stats (2007) 12 month average April ’06 - Mar ‘07. Summary of Smoking Rates for BC. March 2007, page 24. http://www.bcstats.gov.bc.ca/data/ssa/reports/tobacco/smokingstats_20062007.pdf

0%

5%

10%

15%

20%

25%

Jun-

05

Jul-0

5

Aug-

05

Sep-

05

Oct

-05

Nov

-05

Dec

-05

Jan-

06

Feb-

06

Mar

-06

Apr-

06

May

-06

Jun-

06

Jul-0

6

Aug-

06

Sep-

06

Oct

-06

Nov

-06

Dec

-06

Jan-

07

Feb-

07

Mar

-07

% E

xpos

ed to

SSH

In your householdIn a car or another private vehicleIn a public place In outdoor public placeIn your place of work

Figure 26

Non-Smoking Population who are Exposed to Second Hand, Non-Smokers Age >=15

Source: BC STATS, CHESS Three (3) Month Rolling Average. Summary of Smoking Rates for BC March 2007. p. 32.

Question “In the past month, were you exposed to second-hand smoke in [location], every day, almost every day, or not at all? Note: the in your workplace question applies to those people 15+ who work outside the home for pay. http://www.bcstats.gov.bc.ca/data/ssa/reports/tobacco/smokingstats_20062007.pdf


Tobacco Free Sports Program

The purpose of the Tobacco Free Sports Program is to support the requirement for a tobacco-free Olympics and create a “smoke free” sports legacy for BC. Activities include encouraging the creation of tobacco-free venues, playing fields and other recreational spaces; and identifying and promoting British Columbians who are involved in sports and choosing to live tobacco free, including those athletes in training for the 2010 Olympic Games. Materials include coaches’ tool kit, and posters of high performance athletes endorsing tobacco-free lifestyles. Figure 27 presents the percent of British Columbians above 15 years of age who are aware of this initiative.

Jul-0

5

Aug-

05

Sep-

05

Oct

-05

Nov

-05

Dec

-05

Jan-

06

Feb-

06

Mar

-06

Apr-

06

May

-06

Jun-

06

Jul-0

6

Aug-

06

Sep-

06

Oct

-06

Nov

-06

Dec

-06

Jan-

07

Feb-

07

Mar

-07

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%BCIHAFHAVCHAVIHANHA

Figure 27

Awareness BC’s Tobacco Free Sports Program All Respondents (Age 15+)

Source: BC STATS, CHESS, Three (3) Month rolling average. Summary of Smoking Rates for BC, March 2007. p. 47

Question “There is a program in BC that provides anti-smoking resources and materials to sporting events. Have you seen, read or heard anything about BC’s tobacco free sports program?” http://www.bcstats.gov.bc.ca/data/ssa/reports/tobacco/smokingstats_20062007.pdf

Honour Your Health

Honour Your Health Challenge is a community-based program developed through the BC Aboriginal Tobacco Strategy that brings together best practices in health and the best Aboriginal traditions to promote the health and well-being of Aboriginal people, and to prevent and stop tobacco misuse. The program provides train-the-trainer education and grants to help build capacity in Aboriginal communities to raise awareness of health and tobacco misuse through community level health promotion events.

The October 2006 training event supported 214 front-line workers plus an additional 30 non-Aboriginal provincial/NGO representatives and 40 resource people to network and participate in a variety of skill-building activities. From January 2007 to March 2007, a total of 160 communities (151 grant recipients) participated in Honour Your Health activities. The activities were diverse (e.g. noon walk groups, traditional dance programs, self-care support circles, school-based health promotion challenges/presentations, etc), with organizations and schools engaging all age groups


and focusing on one or more of the ActNow areas of focus. The Network and Celebration Event supported 240 community members to come together and share personal testimonies to lifestyle change (stories of quitting drinking alcohol, smoking or other substance abuse; stories of weight loss and control of blood pressure/blood sugar levels through regular exercise, etc.) and the commitment to maintaining these changes beyond the Honour Your Challenge initiative.

In 2006/2007, the Aboriginal Health Branch, through the Honour Your Health Challenge, supported a new initiative in partnership with the Sport Medicine Council of BC. Two pilot clinics were sponsored to lead and participate in a 13-week walk/run in-training program in preparation for the 2007 Vancouver Sun Run. The clinics engaged 41 participants and 10 volunteer leads and 2 clinic coordinators to be more active. Also sponsored was participation in the on-line 13-week training program, with over 300 community members registering and 173 participants crossing the Sun Run finish line on April 15 in Vancouver.

d. Healthy Choices in Pregnancy

Health Authority FASD Prevention Plans

By September 2006, all health authorities were expected to have focused plans for FASD preven-tion. Health authorities utilized varying planning process to accomplish this goal including holding community round table forums, to active, stakeholder committees through to draft logic models and draft program plans. An integral part of developing these plans involved incorporating relevant community partners into their planning processes.

FASD Prevention Plans were developed by the five regional HAs and submitted to the Ministry of Health in 2006. Feedback letters with suggestions to strengthen the FASD prevention plans were forwarded to each HA’s. Plans were strengthened by incorporating relevant community partners during their development. These partners will be instrumental in the successful implementation of the Health Authority FASD prevention plans.

Health authorities reported that 06/07 HCIP funds were used for enhancing both internally delivered perinatal programs as well as contracted pregnancy outreach programs (POPS). Enhancements included: increased staffing for perinatal programs which served pregnant women from immigrant, refuge and Aboriginal communities, coordination of health authority HCIP activities as well as increased community nutritionist services and food voucher funding to support vulnerable pregnant women.

Service Provider Awareness and Education

The Provincial Health Services Authority has engaged in partnerships with the health authorities, Ministry of Children and Family Development, Public Health Agency of Canada, BC Association of Pregnancy Outreach Programs, and the BC Centre of Excellence for Women’s Health in the development a Provincial education plan addressing best practices for counseling women on the use of alcohol in pregnancy. Tobacco use in pregnancy is included in the education sessions. The education delivery plan targets perinatal service providers including: physicians, midwives, addiction workers, public health nurses, and pregnancy outreach program staff.

As of April 2007, 1600 service providers including physicians, midwives, public health nurses, Pregnancy Outreach Program (POPS) staff and mental health and addictions staff have received training. The Ministry of Children and Family Development, John Howard Society, Aboriginal services, tobacco reduction and youth serving agencies have also attended sessions.

“I really appreciated the chance to remind myself that everyone struggles with the issues that came up around pregnancy and using. Just the opportunity to meet other professionals dealing with these issues is great”

– Family Support Worker, Richmond BC

“I feel confident to use these skills with clients. Previously I felt unskilled and lacked confidence in discussing alcohol and substance use with child-bearing women. Thank you!”

– Midwifery Student, Vancouver BC

“This training has re-energized me and helped me to re-focus some of my skills when working with clients.”

– Public Health Nurse, Victoria, BC


Knowledge of the Risks Associated With the Use of Alcohol in Pregnancy.

Healthy Choices In Pregnancy (HCIP) targets were set broadly because prior to their establishment, no clear data was available regarding the number of women counseled about alcohol use in pregnancy, the quality of these discussions and the knowledge of service providers about such counseling (using a women-centered framework). Therefore, a baseline had to be established to measure and guide the progress of HCIP.

Initially, BC Stats was contracted to measure and track general public awareness of the impact of drinking alcohol during pregnancy on the health of children. Between April 2006, and December 2006, 4,572 surveys were completed. Consuming one or two drinks during the whole pregnancy was identified by 60 percent of participants as unsafe16. Analyses indicated significant differences between health authorities’ concept about the safety of various quantities of alcohol in pregnancy. The Ministry is refining future survey questions to more accurately reflect knowledge and behaviours about alcohol use in pregnancy.

The British Columbia Reproductive Care Program (BCRCP) undertook an antenatal chart review to determine how frequently physicians engaged pregnant women in discussions about alcohol and pregnancy. From a random sample of 2065 antenatal discharge records in 2004/05, 2041 complete antenatal charts were reviewed. Discussion or comment about alcohol use in pregnancy was documented in 1480 (72.5%) of the charts. The BCRCP will undertake a second antenatal chart review for fiscal 07/08, aiming to identify changes in the number and quality of those discussions.

Healthy Babies, Final Report. April 3, 2007


The ActNow BC Targets by 2010 for the BC population are clearly articulated:

> Physical Activity – To increase by 20% the proportion of the B.C. population (aged 12+) who are physically active or moderately active during their leisure time from the current level (2003) of 58.0%17 to 69.6% of the B.C. population by 2010

> Healthy Eating - To increase by 20% the proportion of the B.C. population (aged 12+) who eat the daily recommended level of fruits and vegetables from the current level (2003) of 40.1%18 to 48.1% of the population by 2010.

> Tobacco Use – To reduce by 10% the proportion of the BC population (aged 15+) that use tobacco from the current prevalence rate (2003) of 16.0%19 to 14.4% of the BC population by 2010.

> Overweight/Obesity -To reduce by 20% the proportion of the B.C. population (aged 18+) currently as overweight or obese from the current prevalence rate (2003) of 42.3%20 % to 33.8% of the B.C. population by 2010.

> Healthy Choices in Pregnancy –

• To increase by 50.0% the number of women counseled regarding alcohol use during pregnancy

• By September 2006, for all health authority areas to have focused strategies for FASD prevention

a. Tobacco Use - Actual, Projected and Target Rates - 2003 – 2010, National, Provincial and Health Authority Level

Figure 28 presents the rates for tobacco use in British Columbia (ages 15+) for 2003 and 2005 and projections for 2006 to 2010 (based on the 2010 target), with 95% intervals (i.e. the range in which the actual value lies, 19 times out of 20). The “on-target” zone is depicted in grey and is the area under the upper bound of the 95% intervals for the BC Projection to Target numbers. Actual tobacco rates in 2005 at the provincial level are clearly within the “on-target” zone.

The graph also presents the dispersion in the rates of tobacco use among the Health Authorities.

Section 3 | Achieving the 2010 Targets

17 Statistics Canada, Canadian Community Health Survey, Table 105-0233 , 200318 Statistics Canada, Canadian Community Health Survey, Table 105-0249, 200319 Canadian Tobacco Use Monitoring Survey (CTUMS), Annual Results 1999-2004, http://www.hc-sc.gc.ca/hl-vs/tobac-tabac/research-recherche/stat/ctums-esutc/prevalence/prevalence_e.html20 Statistics Canada, Canadian Community Health Survey, Table 105-0209, 2003

Lead the way in North America in healthy living and physical fitness

Goal #2 of the Five Great Goals for BC

Monitoring progress toward achieving these targets provides a means by which planners and decision-makers can fine-tune initiatives and re-allocate resources if necessary. The following figures present the actual, projected and target rates for tobacco use, 5+/day fruit and vegetable consumption, physical activity and obesity/overweight for 2003 to 2010. The percentages that appear for 2004 are estimated from the average of those obtained from the 2003 and 2005 data. Data from 2003 and 2005 was collected before many ActNow BC initiatives were in place or were still in a pilot or prototype phase. Therefore it may be premature to draw conclusions as to trends and it may be more appropriate to consider these two data points as baseline informa-tion rather than an indication of program effect or lack thereof.


FIGURE 28

Current Smoking Rates; Actual, Projected, and Target Rates;Ages 15+ Years; 2003 to 2010, by Health Authority and B.C.

14

16

18

20

22

24

26

28

Year

Perc

ent

* CCHS 2003 and 2005 (with estimate of 2004).** Percent of weighted population aged 15+ years, with 95% Confidence Intervals (actual and estimated) for B.C. rates.*** The latest data expected before the 2010 Olympics will be for 2008, available in the summer of 2009.**** Target for 2010 (17.5) is 10% below 2003 (19.5).

Source: CCHS Share File, 2003 (Cycle 2.1), - CAMSIM Table 105-0233, CCHS Share File, 2005 (Cycle 3.1).

2010Target****

2009200820072006200520042003Baseline

"On-Target" Zone

BC Actual Results*BC Projection to TargetNorthern HA Actual ResultsVancouver Island HA Actual ResultsVancouver Coastal HA Actual ResultsFraser HA Actual ResultsInterior HA Actual Results

As in the previous figure, Figure 29 presents the rates for tobacco use in British Columbia (ages 15+) for 2003 and 2005 and projections for 2006 to 2010 (based on the 2010 target), with 95% confidence intervals. This figure, however, compares the rates within British Columbia with the tobacco rates at a national level (i.e. Canadian average) and also the ranges in the tobacco rates for other provinces (i.e. highest/lowest other province). British Columbia continues to demonstrate lower levels of tobacco use than the national average and is also exhibits the lowest percentage of smokers as compared to all other provinces.

FIGURE 29

Current Smoking Rates; Ages 15+ Years; 2003 to 2010; National Comparisons and B.C.

14

16

18

20

22

24

26

28

30

2003Baseline

2004 2005 2006 2007 2008*** 2009

Year

Perc

ent*

*

* CCHS 2003 and 2005 (with estimate of 2004).** Percent of weighted population aged 15+ years, with 95% Confidence Intervals (actual and estimated) for B.C. rates.*** The latest data expected before the 2010 Olympics will be for 2008, available in the summer of 2009.**** Target for 2010 (17.6) is 10% below 2003 (19.5).Source: CCHS Share File, 2003 (Cycle 2.1) - CANSIM table 105-0233, CCHS Share File, 2005 (Cycle 3.1).

2010Target****

Actual Results*

Projection to Target

Canadian Average

Highest/Lowest Other Province


b. Fruit and Vegetable Consumption - Actual, Projected and Target Rates - 2003 – 2010. National, Provincial and Health Authority Level.

Figure 30 presents the rates for daily consumption of 5+ fruits and vegetables in British Columbia (ages 12+) for 2003 and 2005 and projections for 2006 to 2010 (based on the 2010 target), with 95% intervals (i.e. the range in which the actual value lies, 19 times out of 20). The “on-target” zone is depicted in grey and is the area above the lower bound of the 95% intervals for the BC Projection to Target numbers. Actual rates for daily 5+ fruit and vegetable consumption in 2005 at the provincial level are not within the “on-target” zone.

The graph also presents the dispersion in the daily consumption rates of 5+ fruits and vegetables among the Health Authorities. Only Vancouver Island Health Authority is within the “on-target” zone.

FIGURE 30

Consumption of 5+ Servings of Fruits and Vegetables; Actual, Projected, and Target Rates; Ages 12+ Years; 2003 to 2010,by Health Authority and B.C.

34

36

38

40

42

44

46

48

50

2010Target****

2009200820072006200520042003Baseline

"On-Target" Zone


As in the previous figure, Figure 31 presents the rates for 5+ daily fruit and vegetable consumption in British Columbia (ages 12+) for 2003 and 2005 and projections for 2006 to 2010 (based on the 2010 target), with 95% intervals. This however, compares the rates within British Columbia with the 5+ daily fruit and vegetable consumption rates at a national level (i.e. Canadian average) and also the ranges in consumption rates for other provinces (i.e. highest/lowest other province). British Columbian rates are similar to the national average, however some provinces (e.g. Quebec) exhibit higher rates of 5+ daily fruit and vegetable consumption than in our province.

* CCHS 2003 and 2005 (with estimate of 2004).** Percent of weighted population aged 12+ years, with 95% Confidence Intervals (actual and estimated) for B.C. rates.*** The latest data expected before the 2010 Olympics will be for 2008, available in the summer of 2009.**** Target for 2010 (48.5) is 20% above 2003 (40.4).Source: CCHS Share File, 2003 (Cycle 2.1), - CAMSIM Table 105-0233, CCHS Share File, 2005 (Cycle 3.1).

Source: CCHS Share File, 2003 (Cycle 2.1), - CAMSIM Table 105-0233, CCHS Share File, 2005 (Cycle 3.1).

Perc

ent*

*


FIGURE 31

Consumption of 5+ Servings of Fruits and Vegetables; Actual, Projected, and Target Rates;Ages 12+ Years; 2003 to 2010, B.C.

0

10

20

30

40

50

60

2003Baseline

2004 2005 2006 2007 2008*** 2009

Year

Perc

ent*

*

* CCHS 2003 and 2005 (with estimate of 2004).** Percent of weighted population aged 12+ years, with 95% Confidence Intervals (actual and estimated) for B.C. rates.*** The latest data expected before the 2010 Olympics will be for 2008, available in the summer of 2009.**** Target for 2010 (48.5) is 20% above 2003 (40.4).

Source: CCHS CANSIM Tables, 2003 (Cycle 2.1) - CANSIM table 1050249; CCHS CANSIM Tables, 2005 (Cycle 3.1) - CANSIM table 1050449 is an update of CANSIM table 1050249.

2010Target****

Actual Results*Projection to TargetCanadian AverageHighest/Lowest Other Province

c. Physically Activity - Actual, Projected and Target Rates 2003 – 2010. National, Provincial and Health Authority Level.

Figure 32 presents the rates for being physically active or moderately active in British Columbia (ages 12+) for 2003 and 2005 and projections for 2006 to 2010 (based on the 2010 target), with 95% intervals (i.e. the range in which the actual value lies, 19 times out of 20). The “on-target” zone is depicted in grey and is the area above the lower bound of the 95% intervals for the BC Projection to Target numbers. Actual rates for being physically active or moderately active in 2005 at the provincial level are not within the “on-target” zone.

The graph also presents the dispersion in the rates for being physically active or moderately among the Health Authorities. Only Vancouver Island Health Authority is within the “on-target” zone.


FIGURE 32

Physically Active or Moderately Active; Actual, Projected, andTarget Rates; Ages 12+ Years; 2003 to 2010, by Health Authority and B.C.

50

55

60

65

70

75

Year

Perc

ent*

*

* CCHS 2003 and 2005 (with estimate of 2004).

** Percent of weighted population aged 12+ years , with 95% Confidence Intervals (actual and estimated) for B.C. rates .*** The latest data expected before the 2010 Olympics will be for 2008, available in the summer of 2009.**** Target for 2010 (70.3) is 20% above 2003 (58.6).

Source: CCHS CANSIM Tables , 2003 (Cycle 2.1) - CANSIM table 105-0233, CCHS CANSIM Tables , 2005 (Cycle 3.1) - CANSIM table 105-0433 is an update of CANSIM table 105-0233.

20102009200820072006200520042003Baseline

"On-Target" Zone

Actual Results*Projection to TargetNorthern HA Actual ResultsVancouver Island HA Actual ResultsVancouver Coastal Actual ResultsFraser HA Actual ResultsInterior HA Actual Results

As in the previous figure, Figure 33 presents the rates for being physically active or moderately active in British Columbia (ages 12+) for 2003 and 2005 and projections for 2006 to 2010 (based on the 2010 target), with 95% intervals. This however, compares the rates within British Columbia with the rates for being physically active or moderately active at a national level (i.e. Canadian average) and also the ranges in rates for other provinces (i.e. highest/lowest other province). British Columbian rates for being physically active or moderately active are higher than the national average and also higher than any other province in Canada.

FIGURE 33

Physically Active or Moderately Active; Actual, Projected,and Target Rates; Ages 12+ Years; 2003 to 2010, B.C.

40

45

50

55

60

65

70

75

2003Baseline

2004 2005 2006 2007 2008*** 2009

Year

Perc

ent*

*

* CCHS 2003 and 2005 (with estimate of 2004).** Percent of weighted population aged 12+ years, with 95% Confidence Intervals (actual and estimated) for B.C. rates.*** The latest data expected before the 2010 Olympics will be for 2008, available in the summer of 2009.**** Target for 2010 (70.3) is 20% above 2003 (58.6).

2010Target****



d. Overweight/Obesity - Actual, Projected and Target Rates 2003 – 2010, National, Provincial and Health Authority Level

Figure 34 presents the rates for overweight/obesity in British Columbia (ages 18+) for 2003 and 2005 and projections for 2006 to 2010 (based on the 2010 target), with 95% intervals (i.e. the range in which the actual value lies, 19 times out of 20). The “on-target” zone is depicted in grey and is the area under the upper bound of the 95% intervals for the BC Projection to Target numbers. Actual rates for overweight/obesity in 2005 at the provincial level are not within the “on-target” zone.

The graph also presents the dispersion in the overweight/obesity rates among the Health Authorities. Only Vancouver Coastal Health Authority is within the “on-target” zone.

FIGURE 34

Overweight and Obesity; Actual, Projected, and Target Rates;Ages 18+ Years; 2003 to 2010, by Health Authority and B.C.

30

35

40

45

50

55

60

Year

Perc

ent*

*


Source: CCHS Share File, 2003 (Cycle 2.1), CCHS Share File, 2005 (Cycle 3.1).

2010Target****

2009200820072006200520042003Baseline

"On-Target" Zone


As in the previous figure, Figure 35 presents the rates for overweight/obesity in British Columbia (ages 18+) for 2003 and 2005 and projections for 2006 to 2010 (based on the 2010 target), with 95% intervals. This however, compares the rates within British Columbia with the rates for being overweight/obese at a national level (i.e. Canadian average) and also the ranges in rates for other provinces (i.e. highest/lowest other province). British Columbian rates for overweight/obesity are lower than the national average and also lower than any other province in Canada.


FIGURE 35

Overweight and Obesity; Ages 18+ Years; 2003 to 2010; National Comparisons and B.C.

30

35

40

45

50

55

60

65

2003Baseline

2004 2005 2006 2007 2008*** 2009

Year

Perc

ent*

*


2010Target****



Section 4 | Conclusion

Given the numerous preventive strategies that have occurred over the past 20 to 30 years, the multiple target groups and issues that have been addressed, and the differing evaluation methods that have been used, one is left with the question - what are the core ingredients to success?

What emerges from the research is a clear message - effective, population-based prevention occurs when a combination of individual and environmental components are targeted. Individual components consist of effective prevention programs/ services and social marketing techniques, while environmental components consist of health promoting policies and economic and social policies. Clear evidence now exists that the core elements to effective prevention initiatives, based on health promotion principles, are21 :

> Comprehensiveness - they utilize combinations of preventive strategies

> Multi-sectorality - they involve multiple partners in multiple settings such as health care facilities, workplaces, schools, local communities, municipalities and cities

> Participatory - to sustain efforts, people have to be at the center of decisions and action

> Awareness raising - access to education and information is essential to achieving effective participation and the empowerment of people and communities

Designing prevention initiatives to serve communities and targeted populations, and not just single individuals, needs to be at the heart of any prevention strategy. The collective well- being of communities can be fostered by creating structures and policies that support healthy lifestyles – the often quoted slogan “making healthy choices the easy choices” concisely illustrates this important concept.

The evidence from published studies on nutrition, physical activity and healthy weight initiatives indicates that the most effective interventions share common elements. These include22 :

• Useoftheory-basedstrategies,forexampleStagesofChange

• Strongemphasisonformativeresearchandsystematicneedsassessment

• Useofvalidatedplanningmodels

• Buildingopportunitiesforsocialsupport

• Buildingpartnershipsandalliancesacrossprofessionalandlayboundariesandacrosssectors

ActNow BC embraces these key components in many ways:

• Ithasclearlydefinedgoalsofbecoming“thehealthiestjurisdictiontohosttheOlympicandParalympic Games”, and “Leading the way in North America in healthy living and physical fitness”.

• Itwaslaunchedfromthemostseniorlevelsofgovernmentandhasatit’shelmaMinisterofState for ActNow BC who champions the goals of ActNow BC.

• Itembracesastewardshipmodelthatfostersinter-sectoralcollaborationacrossgovernmentand among government, non-governmental organizations and the private sector.

21 Jakarta Declaration on Health Promotion in the 21st Century (2001). World Health Organization. At: http://www.who.int/hpr/backgroundhp/jakarta/jakartadeclaration.htm 22 An Evidence-Based Planning Framework for Nutrition, Physical Activity and Healthy Weight - Public Health Division of Human Resources Melbourne Australia 1998


• Itinvolvesabroadframeofreferencethatincludesschools,worksites,andcommunitiesandis aimed at providing environmental supports as well as enhancing individuals’ capacities to improve health.

• Ithasaperformancemonitoringandevaluationprocessthatprovidesameansbywhichinformation on can be used to direct action.

ActNow BC provides a coordinated platform for facilitating multi-sectoral involvement in preven-tion and health promotion by taking integrated action. Clearly no one organization or intervention can address all of the required components to affect change - rather it requires the need to bring together a range of individuals and organizations with a variety of skills and interests in efforts to promote or improve health. By recognizing the importance of individual, community, business, government and non-governmental organization involvement, ActNow BC provides a viable paradigm or way of approaching our lives and interacting with one another that can bring about meaningful change.

While the current report highlights the progress of a number of ActNow BC initiatives, many other aspects to the ActNow BC platform exist. These include the activities of: the British Columbia Healthy Living Alliance (BCHLA), a provincial coalition of organizations working together to improve the health of British Columbians through collaborative action; the Union of BC Municipalities (UBCM), who through the Community Health Promotion Fund has provided grants to support health promotion programs and activities in communities focusing on healthy living and chronic disease prevention in support of ActNow BC; 2010 Legacies Now, which is committed to developing sustainable legacies in sport and recreation by introducing communities to the benefits and enjoyment of lifelong physical activity; and, the BC Recreation and Parks Association, which is dedicated to building and sustaining active healthy lifestyles and communities in British Columbia. Each of these organizations also has evaluation plans in place to measure their progress and demonstrate their contribution toward achieving the 2010 goals.

An obvious question that emerges from this report is: are we making progress toward the 2010 targets? Clearly there are a tremendous number of ActNow BC related activities that are occurring in schools, worksites and communities across British Columbia. The number of schools registered as ActionSchools! BC increases monthly, healthy public polices are being put in place in communi-ties to affect tobacco use, and educational programs are being offered to health care providers to teach them ways to interact with their patients on ways to prevent alcohol use during pregnancy. Many of these initiatives while still at pilot or prototype stages are now beginning to gather momentum as more people become aware of ActNow BC and begin to understand its significance. Therefore at this early stage in the implementation of ActNow BC uptake of programs and services appears to be very positive.

Interpretation of the charts on behavioural outcomes that appear in section 3 of this report should therefore be interpreted with caution. As stated previously, data from 2003 and 2005 was collected before many ActNow BC initiatives were in place or were still in a pilot or prototype phase. Therefore it may be premature to draw conclusions as to trends and it may be more appropriate to consider these two data points as baseline information rather than an indication of program effect or lack thereof.

What emerges from the research is a clear message - effective, population-based prevention occurs when a combination of individual and environmental components are targeted.

We are all part of the solution.


Moreover, changing human behaviour is complex and the societal forces in existence that aim to maintain or even exacerbate the status quo are profound. To bring about changes in these behavioural indicators and therefore a “bend in the trend” will require the application of evidence-based actions that are sustained over a number of years. The success that now occurs in reducing tobacco rates to all time lows is a product of this long-term commitment. Lessons learned from successes achieved in reducing tobacco use can now be applied to other areas and at the same time innovative strategies need to be continued in further reducing the use of tobacco in our province.

In conclusion, the vision behind ActNow BC is commendable and the initiatives expected to flow from this vision are necessary and worthwhile if BC is to achieve a healthier population prepared for the social, demographic, economic and environmental dynamics of the 21st century.

Accepting the Olympic analogy,

this is a marathon, not a sprint.

– White, 2007

Client: PUBLIC AFFAIRS - Bus Super KingFull Size: 222" x 36" trim – 4CFile built at 1/4 size: 55.5" x 9"

PAB-COR-L71799TBWA\VANCOUVER

87629_ActNow_BusSuperKing

CYAN MAG YEL BLACK

AD: ________ CD: ________ COPYW: __________

PROD: ________ AE: ________ CLIENT: ________

Thurs, Mar 22, 2007 8:45 AM

PROOF #2 RUN AT 100%

SPELLCHECK___________________CB

Every move is a good move.

www.gov.bc.ca

Documents

Measuring Our Success Progress Report - 1 · 2 ActNowBC | Measuring Our Success Evaluating progress involves not only examining the impacts or eﬀects that ActNow BC is having on