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Sample design
Sample recruitment and response rate
A detailed presentation of the CPENS method by Michaud et al.1. Briefly, general population probability-based random sampling (GPRS) from all provinces was used to recruit respondents by telephone for the online survey. For this study, the sample was created using two approaches. A random digit dialing approach (ie, GPRS) across the country, with the sample drawn randomly on a state-by-state basis and to stratify those specific groups in First Nations postcodes and remote areas. Respondents who did not complete the survey were sent a reminder message between 3 and 6 days after initial recruitment. Of 22,892 potentially eligible participants, 11,492 were recruited into the study, for a recruitment rate of 50.6%. Of the 11,492 participants recruited, 6647 completed the online survey, representing 29.0% of eligible respondents for the overall response rate. To obtain a representative sample of rural, urban and suburban areas, survey data were weighted against data from the most recent Statistics Canada census. This is also adjusted for groups sampled in specific geographic locations. There was no evidence of overestimation in the weight data, indicating sampling bias. The margin of error of the study was ±1.2%, at the 95% confidence level (ie, 19 out of 20 times).
Determining geographic sample regions
A sampling frame was constructed to target respondents from remote/rural, suburban, and urban areas using Future Identification Area (FSA) postal code data in all ten Canadian provinces.22. Respondents indicated the geographic region that best suited their area of residence based on population size. Because some zip codes can be both rural and urban, geographic region in statistical analysis is based on self-reported geographic region.
Questionnaire development, pre-testing and quality control
The questionnaire included content to assess noise perception, annoyance and expectations of quiet, health-related and socio-demographic variables. The average length of time to complete the online questionnaire was less than 10 minutes. The questionnaire was developed by Health Canada and was pretested in both English and French. 299 people were recruited by telephone (212 in English and 87 in French) for simulation. This resulted in 72 completed online studies (61 English and 11 French). Minor changes made to the survey after the pre-test did not affect the pre-test data, allowing the results collected during the pre-test to be included in the final analysis. English and French versions of the survey are available through Libraries and Archives Canada.23.
Definitions
In the CPENS, participants were asked to indicate how they were personally affected by the Covid-19 pandemic in terms of physical health, mental health, annoyance at environmental noise, annoyance at household noise, stress in their lives, and overall well-being. Response categories for these six outcome variables were: much worse, somewhat worse, unchanged, somewhat improved, and much improved. For modeling, responses were grouped as “somewhat/much worse” and “unchanged/somewhat/much improved”. When reporting prevalence, responses were divided into three categories: “somewhat/much worse,” “unchanged,” and “somewhat/much improved.” Several other variables hypothesized to be associated with the six assessed outcomes were collected in the CPENS. These include demographic variables such as age, gender, education, income and Indigenous status. The age in years is divided into three groups (18-34, 35-54, 55+). The following gender categories are defined (female, male, other/prefer not to say). Education Level: Up to high school diploma or equivalent, certificate or diploma, bachelor’s degree or graduate degree. A certificate or diploma with registered work experience, or another trade, may be a college, CEGEP (ie, Quebec College) or university below the bachelor’s level, if not another university. Canadian dollar gross household income was categorized as follows: under $40 K, $40 K to under $80 K, $80 K to under $150 K, $150 K and over. Indigenous status was grouped as: self-identify as First Nation/Métis/Inuk, or do not self-identify. State of residence and geographic region are also considered potential variables, as response to outbreaks varies by state and geographic region. Due to small sample sizes, Prairie provinces (ie, Manitoba and Saskatchewan), as well as Atlantic provinces (ie, New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador) were grouped together. The remaining provinces (British Columbia, Alberta, Ontario and Quebec) are divided separately. Self-reported geographic region was defined as rural/remote (ie, <1000 to 10,000 inhabitants), suburban (ie, mixed-use or residential area, as part of an urban or urban area, or as a separate residential community). within commuting distance of a city) and urban (ie, 10,000+ residents).
The respondent’s current employment or education status was also taken into account. Respondents identified themselves as: working outside the home or attending school; working at home or attending school; He retired; unemployed And a portion of those that indicate “other” may be classified as paid leave (ie, sick, maternity, and disability). More than one option can be selected; Therefore, each condition was scored separately as a “yes/no” response.
Other variables were added, sleep disturbance (at home for any reason within the past 12 months), severely sleep disturbed (rated 8 to 10) and not severely sleep disturbed (rated 0 to 7). Similarly, sensitivity to noise is defined as very sensitive to noise (8 to 10) and very sensitive to noise (0 to 7). Participants were asked to rate their overall physical health and overall mental health relative to a person their age (no reference to age). The responses to both of these questions included: weak; fair nice; so good; And very good. These are like: poor/fair and good/very good/excellent. Heart disease, including high blood pressure, anxiety or depression, sleep disorders, and hearing loss, as diagnosed by a health care professional, not diagnosed but suffering from this condition or not applicable. Confirmation of the diagnosis is assumed to show that the condition is current and not historically present.
Statistical method
Weighted regressions and cross-tabulations were used to explore the demographic distribution and characteristics of the population by indigenous status and geographic region. Health-related outcomes and noise annoyance variables are presented in relation to state of origin and geographic region. Chi-square tests of independence compared Indigenous status with non-Indigenous respondents and geographic regions.
The first univariate logistic regression models were used to examine the relationship between each of the health-related outcomes, noise annoyance variables and other variables of interest, as mentioned above. Unadjusted odds ratios (ORs) are reported in each supplement (see table). S1). Finally, a multivariate logistic regression model was performed using stepwise regression techniques using a chi-square significance level with an effect equal to 20% and chi-square significance was retained in the model. Adjusted ORs are reported for the final models for each assessed outcome greater than 5% affected by the epidemic. Confidence intervals (CI) of ORs including a value of 1 indicate insufficient evidence to observe an association between the assessed outcome and the variable under investigation.
Statistical analysis was performed using SAS Enterprise Guide 7.15 (SAS Institute Inc., Cary, NC). A statistical significance level of 0.05 was applied in all unless otherwise stated. In addition, Bonferroni corrections were performed to ensure that the general type I (false positive) error rate was less than 0.05 considering all pairwise comparisons. Values of variation (CV) between 16.6 and 33.3% were labeled “E” and should be interpreted with caution due to the high sample variance associated with it. A CV estimate of more than 33.3% was labeled “F”, indicating data of questionable accuracy could not be released. No results were recorded for cell frequencies below 10.
This study was approved by the ethics board of the Health Canada and Public Health Agency of Canada (protocol number REB 2020-038H). Informed consent is a voluntary response to the survey questionnaire. This survey was conducted in accordance with all Canadian government guidelines and guidelines for conducting online surveys.
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