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Children and YouthCommunity ProfilesHealth Indicators for Children & Youth in the South East Region

2010

Acknowledgements

This report is the result of collaborative efforts and input from

the Children’s Services Planning Tables in the South East Region,

the United Way serving KFL&A and the project lead team (listed below).

Emily Cassell,

Data Analysis Coordinator, Lanark

John Cunningham,

Epidemiologist, PHRED Program, LL&G Public Health

Laurie Dixon,

Data Analysis Coordinator, Kingston and the Islands

Megan Hughes,

Data Analysis Coordinator, Hastings, Frontenac and Lennox & Addington

Phil Jones,

Data Analysis Coordinator, Prince Edward and Hastings

Suzanne Sinclair,

Epidemiologist, PHRED Program, KFL&A Public Health

Mary Slade,

Data Analysis Coordinator, United Counties of Leeds and Grenville

Bhavana Varma,

President and CEO, United Way serving KFL&A

Kim Hockey,

Director, Community Investment, United Way serving KFL&A

BmDodo Strategic Design,

Graphic Design

EDI and EQAO information includes

the following school boards:

Algonquin and Lakeshore Catholic District School Board

Catholic District School Board of Eastern Ontario

Conseil des écoles publiques de l’Est de l’Ontario

Conseil des écoles catholiques de langue française du Centre-Est

Hastings & Prince Edward District School Board

Limestone District School Board

Upper Canada District School Board

Chairs or co-chairs of our various Planning Tables:

Hastings-Prince Edward Children’s Services Group:

Joanne TenWolde: 613-476-6038

Terry Swift: 613-966-3100

KFL&A Children’s Services Steering Committee:

JoAnne Maltby: 613-546-8535

Daren Dougall: 613-548-4535

Every Kid in Our Community – United Counties of Leeds & Grenville:

Keith McPhee: 613-342-2917

Lanark County Planning Council for Children, Youth and Families:

Suzanne Geoffrion: 613-264-9991

Nicki Collins: 613-257-8260

The document is available at www.unitedwaykfl a.ca.

This project is an ongoing process of community collaboration and

continues to evolve over time as our data collection capacity is further

developed. Every attempt has been made to ensure accuracy in this

publication, however errors may occur.

2

2 Acknowledgements

3 Table of Contents

4 Health Indicator Defi nitions/Descriptions

8 Body Mass Index

9 Physical Activity

10 Sedentary Activities

11 Fruit and Vegetable Intake

12 Asthma

12 Injuries

13 Learning Disabilities

13 Smoking

14 Drinking

15 Live Births

17 Low Birth Weight

18 Pre-term Births

19 Therapeutic Abortion

20 Teen Pregnancy

21 Smoking During Pregnancy

22 Intention to Breastfeed

23 Child Welfare

23 Violence Against Women

24 Mental Health

25 Ontario Early Years

26 Glossary of Terms

26 References

Table of Contents

3

Health Indicator Definitions/Descriptions

Pregnancy and Smoking:

Maternal smoking during pregnancy can cause numerous

health effects for babies including lower birth weight,

on average 150 g less at term, compared with other infants.8

A relationship has also been demonstrated between the number

of cigarettes smoked by the pregnant mother and the slowing

of fetal development.9 Newborns whose mothers smoke during

pregnancy are also fi ve times as likely to die from Sudden

Infant Death Syndrome (SIDS) than newborns whose mothers

did not smoke. 10

Teen pregnancy has been linked to numerous health

consequences for mothers including pregnancy induced

hypertension and poor weight gain.11 There are also numerous

potential health consequences for the babies including low

birth weight, pre-term birth, and increased risk of a congenital

anomaly.12, 13, 14

Dental Health:

Caries Immune indicates the percentage of children who have

no decayed (visual decay only), fi lled or lost teeth due to dental

caries. The def/DMFT is a measurement of the average number

of teeth affected by dental caries, past and present and it

includes fi lled teeth. CINOT Eligible is the percent of children

who meet the clinical criteria for the Children in Need of

Treatment Program. They require ‘essential’ treatment, which

is defi ned as a large open carious lesion visible to the naked eye.

Physical Activity:

Canada’s Physical Activity Guide to Healthy Active Living

recommends that inactive children (ages 6-9) and youth (ages

10-14) increase the amount of time they currently spend being

physically active by at least 30 minutes more per day and

decrease the time they spend on watching television, playing

computer games and surfi ng the Internet by at least 30 minutes

less per day. The increase in physical activity should include a

combination of moderate activity (such as brisk walking, skating

and bike riding) with vigorous activity (such as running and

playing soccer).15

The guidelines recommend that inactive children and youth

accumulate this increase in daily physical activity in periods

of at least 5 to 10 minutes each. Over several months, children

and youth should try to accumulate at least 90 minutes more

physical activity per day and decrease by at least 90 minutes per

day the amount of time spent on non-active activities such as

watching videos and sitting at a computer.15

Physical Activity Variable for Ages 6-11:

This physical activity variable indicates the total number of hours

per week that children aged 6-11 usually participate in physical

activities. These activities can be at school or outside of school.

Live Birth:

A live birth is a birth where there is evidence of life immediately

following extraction from the mother, regardless of the duration

of the pregnancy or whether or not the newborn is expected

to survive immediately following the birth.1

Low Birth Weight:

The World Health Organization defi nes low birth weight as the

weight of an infant being less than 2500g at the time of delivery,

based on evidence that showed babies who are born under

2500g are 20 times more likely to die compared to heavier

babies.1 Low birth weight at birth is the result of: pre-term birth

(before 37 weeks gestation), small size for gestational age, or

both. Low birth weight is associated with a number of health

risks including an increased risk of neonatal mortality and

morbidity, slow growth, impaired cognitive development,

and other chronic conditions later in life. A mother’s dietary

habits, her body composition at the time of conception, her

socio-economic status, infections and any physically demanding

work during pregnancy can all affect her infant’s health.2

Pre-term Birth:

A pre-term birth is defi ned as a fetus or infant delivered before

37 completed weeks (259 days) gestation (premature infant).1

Pre-term birth is one of the most important perinatal health

problems in industrialized nations and accounts for 75-85%

of all perinatal mortality in Canada.3 As well, pre-term infants

may experience a variety of health problems throughout their

lives including organ-specifi c (lung, heart, and brain) problems,

increased number of infections, and many intellectual, emotional

or physical disabilities.4 For about 50% of women, there are

no identifi able risk factors.4 A woman may be at higher risk

if she has a lifestyle risk factor (such as smoking or poor diet),

lives in poverty, is a teen or over age 35, has had a previous

pre-term birth or is pregnant with more than one fetus.

Breastfeeding:

Health Canada promotes breastfeeding as the best method

of feeding infants as it provides optimal nutritional, immunological

and emotional benefi ts for the growth and development of

infants.5 Exclusive breastfeeding is recommended for the fi rst

six months of life for healthy term infants, as breast milk is the

best food for optimal growth. Infants should be introduced to

nutrient-rich, solid foods with particular attention to iron at six

months with continued breastfeeding for up to two years and

beyond.6 Exclusive breastfeeding is defi ned by the World Health

Organization as the practice of feeding only breast milk (including

expressed breast milk) and allows the baby to receive vitamins,

minerals or medicine.7 Water, breast milk substitutes,

other liquids and solid foods are excluded.

4

Physical Activity Index for Ages 12-17:

Physical Activity Index categorizes respondents as being

Active (EE 3.0 or greater), Moderate (EE between 1.5 and 3.0),

or Inactive (EE 1.5 or less) based on their total daily Energy

Expenditure (kcal/kg/day).

Energy Expenditure is calculated from the frequency and

duration of sessions of physical activity as well as the MET

value of the each activity. The MET is a value of metabolic

energy cost expressed as a multiple of the resting metabolic

rate. For example an activity of 4 METS requires four times

as much energy as the body at rest.

MET values tend to be expressed in three intensity levels

(i.e. low, medium, high). The Canadian Community Health

Survey (CCHS) questions did not ask respondents to specify

the intensity level of their activities. Therefore the MET values

adopted correspond to the low intensity value of each activity.

This approach is adopted by the Canadian Fitness and Lifestyle

Research Institute because individuals tend to overestimate the

intensity, frequency and duration of their activities.16

Sedentary Activity:

Ages 6-11

This sedentary activity variable estimates the total number

of hours per day children ages 6-11 spent in sedentary activities.

Sedentary activities include watching television or videos, playing

video games and spending time on a computer playing games,

e-mailing, chatting and surfi ng the Internet.

Ages 12-19

This sedentary activity variable estimates the total number of

hours per week youth ages 12-17 spent in sedentary activities

(excluding reading). Sedentary activities include playing

computer games, using the internet, playing video games

and watching television or videos. Time spent at school

or work is excluded.

Canadian Community Health

Survey (CCHS) Description

The Canadian Community Health Survey (CCHS) is a relatively

new survey, conducted every two years by Statistics Canada.

This survey has replaced the National Population Health Survey

as a means to provide regular and timely access to health

determinants, health status and health system utilization

for health regions across the country.

The survey design is cross sectional and comprised of two

distinct surveys. Each two year cycle consists of a health

region-level survey in the fi rst year with a total sample of

130,000 and a provincial-level survey in the second year with

a total sample of 30,000. Data may be viewed and/or analyzed

at a sub-provincial level (health region or combination

of health regions).

The target population of the fi rst year of the CCHS includes

household residents ages 12 and over in all provinces and

territories, excluding of populations on Indian Reserves, Canadian

Forces Bases, and some remote areas. The CCHS covers about

98% of the Canadian population. The interview, given in person

with computer-assisted interviewing (CAI), is approximately

45 minutes in length and consists of two components:

• 30 minutes of core questions asked across the country to

meet basic health data needs and a smaller optional content

as determined by each health region.

• Each cycle is number 1, 2, 3 etc. Within in each two

year-cycle the numeral after the decimal (.1 or .2) indicates

the year. Thus 2.1 is the fi rst year of the second cycle and

2.2 is the second year of the second cycle. The second year

of the survey is a provincial-level survey, approximately 60

minutes in length, and consists of some common content

and one focus content topic per cycle. Thus far, two of these

surveys have been completed, Cycle 1.2 Mental Health

and Well-Being and Cycle 2.2 Nutrition.

NIDAY Database

The Eastern and Southeastern Ontario Perinatal Database

was implemented in January, 1997 with the collaboration

of all hospitals in Eastern and Southeastern Ontario,

the Ottawa-Carleton Regional Health Department

(now called Ottawa Public Health), and the Kingston,

Frontenac and Lennox & Addington Health Department

(now called Kingston, Frontenac, and Lennox & Addington

Public Health). Beginning January 1, 2001, the database was

enhanced from a stand-alone computer program installed

in each hospital to the web- based Criticall Ontario system.

The database collects information on almost 95% of births

in Ontario and includes information on place of birth, the health

status of newborns, the use of obstetrical interventions

and maternal characteristics.

Canada’s Physical Activity Guide to Healthy Active Living recommends that inactive children and youth increase the amount of time they currently spend being physically active by at least 30 minutes more per day

5

Table A. Sampling Variability Guidelines

Type of Estimate C.V. (in %) Guidelines

1. Unqualifi ed 0.0 – 16.5 Estimates can be considered for general unrestricted release.

Requires no special notation.

2. Marginal 16.6 – 33.3 Estimates can be considered for general unrestricted release

but should be accompanied by a warning cautioning

subsequent users of the high sampling variability associated

with the estimates. Such estimates should be identifi ed

by the letter M (or in some other similar fashion).

3. Unacceptable Greater than 33.3 The Ministry of Health and Long-Term Care recommends

not releasing estimates of unacceptable quality. Conclusions

based on these data will be unreliable and most likely invalid.

These data and any consequent fi ndings should not be

published. In statistical tables, such estimates should

be deleted and replaced by dashes (-).

Dental Indices Survey

The Ontario Dental Indices Survey (DIS) collects data on the

dental health of children for use at the public health unit level.

Some of the objectives include providing a means of measuring

dental health status of Ontario school entrants, identifying

“at risk” segments of the school aged child population who

would most benefi t from targeted oral health education and

preventive programs, and determining the prevalence of dental

disease and needs for prevention and treatment.17

The Mandatory Health Programs and Services Guidelines require

that Boards of Health conduct the DIS in accordance with the

Dental Indices Survey (DIS) Protocol. The Protocol for January 1,

1998 specifi es that the DIS be done for all school entrants (Junior

Kindergarten and Senior Kindergarten) in every school annually.

The DIS collects demographic data and dental indices, including

fl uorosis index, periodontal indices, malocclusion (optional),

deft/DMFT, CINOT eligible (dental), non-urgent treatment

required, scaling required, prophylaxis required, sealant required,

fl uoride required, and preventive instruction required for each

child in the survey.18

Co-effi cient of Variation

The co-effi cient of variation (C.V.) is a standardized measure

of the dispersion (or amount of variability) of data points around

a mean (or average). It is used to compare the amount

of variation around different means, even if the means are

far apart from one another.

In this report, the C.V. is used as another indicator (in addition

to the confi dence interval) of the reliability or precision of an

estimate. If the estimate has too much variability (a high C.V.,

which would also mean a wide confi dence interval), the estimate

is thought to be too unstable to report. The following table,

adopted from Statistics Canada, provides guidelines on how

to interpret the C.V.

* Due to large sampling variability, estimate should be used with caution (C.V16.6-33.3)

SE Ontario comprises 6 public health units: Renfrew County & District Health Unit, Ottawa Public Health, Eastern Ontario Health Unit, Leeds,

Grenville, and Lanark District Health Unit, Kingston, Frontenac and Lennox & Addington Public Health, and Hastings & Prince Edward Counties Health

Unit Source: Canadian Community Health Survey, CCHS cycle 2.2 (2004), Statistics Canada, Ontario Sharing Files, MOHLTC (9)

Children of Eastern Ontario are not statistically signifi cantly different from Ontario children with respect to any of the variables examined in this table.

Health Indicators by Geographic Zone

Table A. Various Health Indicators for Children by Geographic Zone, 2004

Indicators Children SE Ontario Ontario

Body Mass Index 19.8*% 27.0%

% Overweight or obese, Ages 2-11 (10.8-28.8) (23.5-30.5)

Physical Activity

% of children who are NOT active at least 10.5 hours per week 32.2*% 35.2%

(average of 90 mins per day), Ages 6-11 (20.2-44.2) (31.7-38.7)

Sedentary Activity 35.5% 36.4%

% of children who are sedentary at least 2 hours per day, Ages 6-11 (26.4-44.6) (32.7-40.1)

Fruit and Vegetable Consumption 45.6% 58.5%

% eating fruits and vegetables less than 5 times per day. (34.4-56.8) (54.6-62.5)

(Quantity per time unknown), Ages 6 months-11

6

Table B. Various Health Indicators for Youth by Geographic Zone, 2005-2007

Indicators SE Ontario SE Ontario Ontario Ontario

2005 2007 2005 2007

Body Mass Index 18.7% 21.7% 21.3% 20.3%

% Overweight or obese (13.9-23.5) (16.5-27.0) (19.6-22.9) (18.7-21.9)

Ages 12-17

Physical Activity Index 19.6% 23.7% 28.1% 30.8%

% Inactive (14.1-25.0) (18.9-28.4) (26.4-29.8) (28.8-32.7)

Ages 12-17

Sedentary Activity N/A 37.4% N/A 34.6%

% youth aged 12-19 having 30 or more (31.0-43.7) (32.6-36.7)

hours of sedentary activity per week

Fruit and Vegetable Consumption — 72.9% — 77.0%

% eating less than recommended number (67.0-78.8) (75.0-79.1)

of fruit and vegetable servings per day

(as per 2007 Canada’s Food Guide) Ages 14-18

Fruit and Vegetable Consumption 47.0% 45.4% 53.1% 53.3%

% eating less than 5 fruits and vegetables servings (38.8-55.2) (38.4-52.5) (49.6-56.5) (50.7-56.0)

per day as per 1992 Canada’s Food Guide.

Ages 14-18

Asthma

% with asthma 14.2*% 15.4% 11.1% 11.5%

(diagnosed by a health professional) (9.8-18.9) (10.8-20.0) (10.0-12.2) (10.2-12.8)

Ages 12-19

Injuries

% with injuries (broken bone, bad cut etc) 25.9% N/A 24.4% N/A

in the last 12 months serious enough to limit (20.0-31.8) (22.9-25.9)

normal previous activities

Learning Disabilities

% with learning disabilities 12.5*% N/A 7.9% N/A

(diagnosed by a health professional) (8.1-16.9) (6.9-8.9)

Ages 12-19

Smoking

% Daily or Occasional Smoker 9.8% 10.4% 10.6% 9.0%

Ages 12-19 (5.8-13.8) (6.8-14.0) (9.5-11.7) (7.9-10.2)

Drinking

% of youth who have had 5 or more drinks 31.1% 19.9% 19.7% 18.0%

on one occasion 2 or more times per month (21.4-40.8) (12.3-27.6) (17.5-21.9) (15.9-21.9)

Ages 12-19

* Due to large sampling variability, estimate should be used with caution (C.V16.6-33.3)

SE Ontario comprises 6 public health units: Renfrew County & District Health Unit, Ottawa Public Health, Eastern Ontario Health Unit, Leeds, Grenville,

and Lanark District Health Unit, Kingston, Frontenac and Lennox & Addington Public Health, and Hastings & Prince Edward Counties Health Unit

Sources: Canadian Community Health Survey, CCHS cycle 3.1 (2005) and cycle 4.1 (2007), Statistics Canada, Ontario Sharing Files, MOHLTC (9)

Children of Eastern Ontario are not statistically signifi cantly different from Ontario children with respect to any of the variables examined in this table.

7

Body Mass IndexKey Findings:

• The percentage of youth self-reporting

being overweight has increased between

2005/06 and 2007/08 but not in a

statistically signifi cant manner (Figure X1).

• Almost 80% of youth aged 12-19 years

from Southeastern Ontario self-reported

being of normal weight in 2007/08

(Figure X1).

• Similar patterns of body mass index for

youth aged 12-19 years were evident

between Southeastern Ontario and

Ontario as a whole (Figures X1 and X2).

• There are no statistically signifi cant

differences in percentages of youth aged

12-19 years in Southeastern Ontario who

are neither overweight nor obese between

jurisdictions within and between CCHS

cycles (Figure X3).

• The percentage of youth aged 12-19

years in Southeastern Ontario who

reported being overweight or obese

increased between 2005 and 2007

overall and for both males and females.

However, the increase was not statistically

signifi cant (Figure X4).

* Due to large sampling variability, estimate should be used with caution

Normal Overview Obese

100%

80%

60%

40%

20%

0%

Figure X2: Body mass index of youth

aged 12-19 in Ontario, 2005 and 2007.

78.7 79.7

15.8 15.6

5.5 4.7

84.078.0

Figure X3: Body mass index of youth aged 12-19 who are neither

overweight nor obese in Southeastern Ontario, 2005 and 2007.

KFL&A HPECHU LGLDHU Leeds/Grenville Lanark

100%

80%

60%

40%

20%

0%

79.983.0

76.4 77.2 78.283.3

74.9

88.4

Total Males Females

35%

30%

25%

20%

15%

10%

5%

0%

21.7 18.7

24.6

21.0*18.5

16.0*

Figure X4: Youth aged 12-19 who are overweight

or obese in Southeastern Ontario, 2005 and 2007.

Figure X1: Body mass index of youth aged

12-19 in Southeastern Ontario, 2005 and 2007.

Normal Overview Obese

100%

80%

60%

40%

20%

0%

78.3 81.3

18.5 13.5

3.2 5.2

CCHS Cycle 4.1, 2007/08

CCHS Cycle 3.1, 2005/06

8

Key Findings:

• Youth aged 12-19 years in Southeastern

Ontario reported signifi cantly lower levels

of physical inactivity when compared

to Ontario as a whole for both 2005

and 2007 (Figure X5).

• Males reported signifi cantly higher levels

of physical activity in both Southeastern

Ontario and Ontario as a whole when

compared to females in both 2007

and 2005 (Figures X6 and X7).


Physical Activity Figure X5: Physical Activity Index for youth aged

12-19 in Southeastern Ontario and Ontario, 2007

SE Ontario, 2007 Ontario, 2007 Ontario, 2005SE Ontario, 2005

70%

60%

50%

40%

30%

20%

10%

0%

53.0

57.0

47.3 49.9

23.3 23.5 22.0 22.1 23.7

30.8

19.6

28.1

SE Ontario Male SE Ontario Female Ontario FemaleOntario Male

80%

70%

60%

50%

40%

30%

20%

10%

0%

60.1

56.5

44.6

37.8

21.9 19.724.7 24.2

17.1

30.7

23.7

38.0

Figure X6: Physical Activity Index for youth aged

12-19 by sex in Southeastern Ontario and Ontario, 2007

80%

70%

60%

50%

40%

30%

20%

10%

0%

66.1

56.5

47.342.7

19.4 19.7

27.8

24.1

14.6

24.923.7

33.1

Figure X7: Physical Activity Index for youth aged

12-19 by sex in Southeastern Ontario and Ontario, 2005

Active Moderately Active Inactive



9

Key Findings:

• Just over 34% of youth aged 12-19 years in Southeastern

Ontario and 39.0% of youth from Ontario as a whole

reported spending 11 or more hours per week

on a computer in 2007 (Figure X8).

• Almost half of youth aged 12-19 years in both Southeastern

Ontario and Ontario as a whole reported not spending any

time each week playing video games in 2007(Figure X9).

• Just over 36% of youth aged 12-19 years in Southeastern

Ontario and 34.6% of youth from Ontario as a whole

reported spending 11 or more hours per week watching

television in 2007 (Figure X10).

• Almost equal percentages of youth aged 12-19 years in

both Southeastern Ontario and Ontario as a whole reported

reading between 1 and 5 hours per week 2007. Just under

14% in Southeastern Ontario reported not reading

at all (Figure X11).

• Almost 38% of youth aged 12-19 years reported 30 or

more hours of sedentary activity each week in Southeastern

Ontario. Similar results were observed for Ontario

as a whole (Figure X12).

Sedentary Activities

Figure X9: Number of hours playing video

games per week for youth aged 12-19 in

Southeastern Ontario and Ontario, 2007

60%

50%

40%

30%

20%

10%

0%

46.4 45.7

32.8 35.0

20.8 19.3

Figure X11: Number of hours reading per week for youth

aged 12-19 in Southeastern Ontario and Ontario, 2007

None 1-5 hour 6-10 hours 11 or more hours

70%

60%

50%

40%

30%

20%

10%

0%

13.8

17.8

53.0 53.2

19.4 18.0

13.811.1

Figure X12: Total number of sedentary hours per week for

youth aged 12-19 in Southeastern Ontario and Ontario, 2007

14 hours or less 15-19 hours 20-29 hours 30 or more hours

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

20.9 21.6

17.1

12.5

24.6

31.3

37.434.6

Figure X10: Number of hours watching

television per week for youth aged 12-19

in Southeastern Ontario and Ontario, 2007

5 or less hours 6-10 hours 11 or more hours

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

35.537.9

28.1

27.4

36.434.6

Figure X8: Number of hours spent on a computer

per week (excluding school) for youth aged 12-19

in Southeastern Ontario and Ontario, 2007

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

6.23.8

36.634.0

22.823.3

34.4

39.0

SE Ontario Ontario

None 1-5 hour 6-10 hours 11 or more hours

None 1-5 hour 6 or more hours

10

Key Findings:

• Similar percentages of youth aged 14-18

years in Southeastern Ontario and Ontario

as a whole reported eating less than eight

servings of fruit and vegetable servings

per day.(Figure X13).

• Males reported eating signifi cantly less fruit

and vegetable servings when compared

to females in both Southeastern Ontario

and Ontario as a whole (Figure X13).

• When reduced to fi ve servings of fruit and

vegetables per day, about equal percentages

of males and females report not eating

the recommended daily intake in both

Southeastern Ontario and Ontario as

a whole. Although percentages in

Southeastern Ontario are lower they

are not statistically signifi cant (Figure X14).

* In the 2007 Canada’s Food Guide, it is recommended that males ages 14-18 eat a minimum of 8, and females eat a minimum of 7, fruit and vegetable servings per day.

* In the previous edition of Canada’s Food Guide (1992), it was recommended that males and females ages 14-18 eat a minimum of fi ve fruit and vegetable servings per day.

Figure X13: Proportion of youth aged 14-18 eating

less fruits and vegetables than recommended*

in Southeastern Ontario and Ontario, 2007.

SE Ontario Ontario

100%

80%

60%

40%

20%

0%

72.9 77.081.8 80.6

64.4

73.4

Fruit and Vegetable Intake

Figure X14: Proportion of youth aged 14-18 eating

less than 5 servings of fruits and vegetables per day

in Southeastern Ontario and Ontario, 2005 and 2007*.

SE Ontario, 2007 Ontario, 2007

Ontario, 2005SE Ontario, 2005

70%

60%

50%

40%

30%

20%

10%

0%

45.4

51.4 49.4

55.556.5

42.8

51.2

41.7

49.647.053.4 53.1

Total Male Female

Total Male Female

11

Figure X15: Percentage of youth aged 12-19 with asthma

in Southeastern Ontario and Ontario, 2005 and 2007.



30%

25%

20%

15%

10%

5%

0%

14.2

12.0

15.5

11.3 11.5

19.0

11.612.8

10.7

15.4

11.5 11.1

AsthmaKey Findings:

• More youth aged 12-19 years in

Southeastern Ontario in both 2005

and 2007 reported having asthma

than in Ontario as a whole. However,

the difference was not signifi cant

(Figure X15).

• Similar percentages of males and

females report having asthma in both

Southeastern Ontario and Ontario

as a whole (Figure X15).

InjuriesKey Findings:

• Youth aged 12-19 years in LGLDHU

reported the highest percentages

of injury that limited normal activity

in 2007 and HPECHU reported the

lowest. However, the differences were

not statistically signifi cant (Figure X16).

• Males reported a higher percentage

of injury that limited normal activity

than females in 2007 in Southeastern

Ontario. However, the differences were

not statistically signifi cant (Figure X17).


KFL&A HPEHU LGLHU SE Ontario

40%

35%

30%

25%

20%

15%

10%

5%

0%

19.2

27.6*

30.6

25.9

Figure X16: Percentage of injuries in youth aged

12-19 that limited normal activity in the past

12 months in Southeastern Ontario, 2007

Figure X17: Percentage of injuries in youth aged

12-19 by sex that limited normal activity in the

past 12 months in Southeastern Ontario, 2007

Total Male Female

35%

30%

25%

20%

15%

10%

5%

0%

29.2

22.4

25.9 OUCH!

Total Male Female

12

Figure X18: Percentage of youth aged 12-19 with learning

disabilities in Southeastern Ontario and Ontario, 2005

SE Ontario

Ontario

16%

14%

12%

10%

8%

6%

4%

2%

0%

7.9

11.5

5.8

12.5

13.5

9.9

Learning DisabilitiesKey Findings:

• A higher percentage of youth aged

12-19 years in Southeastern Ontario

were reported to have a learning disability

in 2005 than for Ontario as a whole.

However, the difference was not

statistically signifi cant (Figure X18).

• Similar percentages of both males and

females were reported to have a learning

disability in Southeastern Ontario.


SmokingFigure X19: Youth aged 12-19 who currently smoke, either daily

or occasional in Southeastern Ontario and Ontario, 2005 and 2007.

Total Male Female

14%

12%

10%

8%

6%

4%

2%

0%

9.8

8.2

9.9 9.5

10.9

12.8

8.5

9.810.310.4

9.0

10.6



Key Findings:

• Overall percentages of youth aged 12-19

years who report smoking in both 2005 and

2007 were similar for both Southeastern

Ontario and Ontario as a whole (Figure X19).

• A higher percentage of females in

Southeastern Ontario report smoking in

2007 than in 2005. This is counter to what

is observed for Ontario as a whole. None

of the differences observed were

statistically signifi cant.

Total Male Female

13

DrinkingKey Findings:

• Overall percentages of youth aged

12-19 years who report drinking for both

Southeastern Ontario and Ontario as a

whole have remained fairly constant over

the past 7-years (5-years for Ontario).

The same trend can be seen when

stratifying by sex (Figure X20).

• The percentage of youth aged 12-19

years who report drinking 2 or more times

per month in Southeastern Ontario have

remained constant over the past 7-years.

However, a signifi cantly higher percentage

of males in Southeastern Ontario reported

drinking than females in both 2003 and

2005 (Figure X21).

• The percentage of youth aged 12-19 years

who report binge drinking 2 or more times

per month in Southeastern Ontario have

remained constant over the past 7-years

(Figure X22).


60%

50%

40%

30%

20%

10%

0%

50.146.7

45.3

53.3 52.446.146.3

43.1

47.647.8 45.646.746.4 49.3

44.7

Figure X20: Percentage of youth aged 12-19 who have had a drink in

the past 12 months in Southeastern Ontario and Ontario, 2005 and 2007

70%

60%

50%

40%

30%

20%

10%

0%

50.1

42.9

49.8

63.7 62.9

23.1*

45.6

38.1

32.6

46.6

38.9

35.8*

41.1

47.7

42.1

Figure X21: Youth aged 12-19 (who have had a drink in the past 12

months) who drink 2 or more times per month in Southeastern Ontario

and Ontario, 2005 and 2007

Total

35%

30%

25%

20%

15%

10%

5%

0%

31.1

19.719.9* 19.7* 18.0

Figure X22: Youth aged 12-19 (who have had a drink in the

past 12 months) who binge drink 2 or more times per month

in Southeastern Ontario and Ontario, 2005 and 2007Ontario, 2005

Ontario, 2007

SE Ontario, 2005

SE Ontario, 2003

SE Ontario, 2007

Total Male Female

Total Male Female

14

Figure X23: Number of live births in Southeastern Ontario, 1986 - 2006

2,500

2,000

1,500

1,000

500

0

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

2082 2014 2030 2081 2250 2289 2373 2172 2179 2077 1926 1669 1758 1765 1653 1695 1678 1621 1646 1682 1708

1808 1860 1878 1931 2003 1875 2043 1956 1796 1864 1683 1568 1566 1477 1510 1401 1450 1411 1525 1481 1453

1900 1839 1826 1938 2050 2008 2086 1934 1898 1790 1691 1622 1626 1545 1560 1498 1447 1504 1434 1439 1392

1127 1138 1073 1185 1276 1202 1283 1218 1158 1086 1039 991 968 949 912 882 895 859 856 874 828

773 701 753 753 774 806 803 716 740 704 652 631 658 599 648 616 552 645 578 565 564

KFL&A

HPECHU

LGLHU

Leeds &

Grenville

Lanark

Figure X24: Proportion of births by age groups of mothers in Southeastern Ontario, 1986-2006

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44

Age Group (vertical lines represent years from 1986 – 2006)

Figure X25: Proportion of births by age groups of mothers in LGLDHU, 1986-2006

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44


Live Births

15

Key Findings:

• The overall trend in live births in all

jurisdictions was slightly downward

between 1986 and 2006 (Figure X23).

• Figure X24 breaks down percentages

of live births by age group and year from

1986 to 2006 for Southeastern Ontario.

Percentages of live births for teens have

remained fairly consistent. Percentages

of live births for the 20-24 and 25-29

year age groups have decreased, while

percentages of live births in the 30-34,

35-39 and 40-44 year age groups have

increased over time. These statistics

suggest that women have delayed

becoming pregnant until later in their

reproductive lives over time.

• The trends observed in Southeastern

Ontario are similar for all other

jurisdictions (Figures X25-X27)

Figure X26: Proportion of births by age groups of mothers in KFL&A, 1986-2006

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44


45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

Figure X27: Proportion of births by age groups of mothers in HPECHU, 1986-2006

15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44


16

Figure X28: Proportion of low birth weight births

of all live births in Southeastern Ontario, 1987-2006

Low Birth Weight7%

6.5%

6%

5.5%

5%

4.5%

4%

3.5%

3%

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006

KFL&A

HPECHU

LGLHU

Key Findings:

• The overall trend for low birth weight

births as a proportion of all live births

remained fairly fl at over time in KFLA,

HPECHU and LGLDHU between 1986

and 2006 (Figure X28).

• The 15-19 year age group consistently

had the highest proportion of low birth

weight births over time, followed by

the 40-44 year age group. However,

this age group shows more variability

over time due to fewer births.

There was little variation in all other

age groups over time (Figure X29).

10%

9%

8%

7%

6%

5%

4%

1987–1991 1992–1996 1997–2001 2002–2006

15-19

20-24

25-29

30-34

35-39

40-44

Figure X29: Proportion of low birth weight for all live births

in Southeastern Ontario by age group, 1987-2006

17

Pre-term Births

16%

14%

12%

10%

8%

6%

4%

2%

0%

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006

Figure X30: Percentage of singleton pre-term births in Southeastern

Ontario, age groups 15-19, 35-39, and 40-44, 1986-2006

Key Findings:

• The overall trend for the percentage of pre-term singleton births as a

proportion of all live births for the 15-19, 35-39 and 40-44 year age

groups has been variable over time in Southeastern Ontario between

1986 and 2006 (Figure X30).

• The overall trend for the percentage of pre-term singleton births as

a proportion of all live births for the 20-24, 25-29 and 30-34 year age

groups has remained constant over time in Southeastern Ontario

between 1986 and 2006 (Figure X31).

• The overall trend for the percentage of per-term singleton births as

a proportion of all live births for Southeastern Ontario for all women

of reproductive age (age 10-50) between 1986 and 2009 has been

upward over time (Figure X32).

16%

14%

12%

10%

8%

6%

4%

2%

0%

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006


Ontario, age groups 20-24, 25-29, and 30-34, 1986-2006

9%

8%

7%

6%

5%

4%

3%

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006


Ontario, women aged 10-50, 1986-2006

15–19

35–39

40–44

20–24

25–29

30–34

KFL&A

HPECHU

SE

LGLHU

Linear (SE)

18

Therapeutic Abortion

14

13

12

11

10

9

8

2001 2002 2003 2004 2005 2006 2007

LGLHU

HPEHU

KFL&A

Rate

per

1000 p

op

ula

tio

n

Figure X33: Rate of therapeutic abortions per 1000 female

population aged 15-44 in Southeastern Ontario, 2001-2007

Key Findings:

• The overall trend for the rate of therapeutic

abortions for KFLA, HPECHU and LGLDHU

between 2001 and 2007 was fairly constant

with some year-over-year variability. KFLA

had the highest rates while HPECHU and

LGLDHU had lower and similar rates

(Figure X33).

• Therapeutic abortion rates for KFLA

remained fairly consistent over time when

broken down by age group. The 20-24 age

group had the highest rates and the 35-39

and 40-44 year age groups had the lowest.

Teens (15-19 years) were close to the

15/1000 population range over the 2001

to 2007 time period (Figure X34).

• Therapeutic abortion rates for HPECHU

demonstrated similar patterns as to those of

KFLA. The 20-24 age group had the highest

rates that were slightly increasing over time.

Teens (15-19 years) were consistently in the

15/1000 population range over the 2001

to 2007 time period (Figure X35).

• Therapeutic abortion rates for LGLDHU

demonstrated similar patterns to those of

KFLA. However, the 20-24 age group had

the highest rates but these rates deceased

over time. Teen (15-19 years) rates showed

a slight decrease over time (Figure X36).

Figure X34: Rate of therapeutic abortions per 1000

female population aged 15-44 for KFL&A, 2001-2007

15-19

20-24

25-29

30-34

35-39

40-44

35

30

25

20

15

10

5

0

2001 2002 2003 2004 2005 2006 2007

Rate

per

1000 p

op

ula

tio

n

15-19

20-24

25-29

30-34

35-39

40-44


female population aged15-44 for HPECHU, 2001-2007

35

30

25

20

15

10

5

0

2001 2002 2003 2004 2005 2006 2007

Rate

per

1000 p

op

ula

tio

n

15-19

20-24

25-29

30-34

35-39

40-44


female population aged15-44 for LGLDHU, 2001-2006

35

30

25

20

15

10

5

0

2001 2002 2003 2004 2005 2006 2007

Rate

per

1000 p

op

ula

tio

n

19

Teen Pregnancy40

35

30

25

20

15

102001 2002 2003 2004 2005

Rate

per

1000 p

op

ula

tio

n

Figure X37: Rate of teen pregnancies per 1000 female

population aged 15-19 in Southeastern Ontario, 1986-2006

KFL&A

HPEHU

LGLHU

Key Findings:

• The overall trend for the rate of teen

pregnancy for KFLA, HPECHU and

LGLDHU between 2001 and 2005 was

slightly downward with some year-over-

year variability. HPECHU had the highest

rates while KFLA and LGLDHU had lower

and similar rates (Figure X37).

Age of First Time MothersFigure X38: Average age of fi rst time mothers in Southeastern Ontario, 1986-2006

28.0

27.5

27.0

26.5

26.0

25.5

25.0

24.5

24.0

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006

KFL&A HPECHU LGLHU

Key Findings:

• The trend for the average age of fi rst

time mothers increased steadily in all

jurisdictions in Southeastern Ontario

between 1986 and 2006. KFL&A and

LGLDHU had similar increases in average

age while HPECHU had increases that

were less pronounced (Figure X38).

20

Smoking During PregnancyKey Findings:

• The percentages of mothers who

reported not smoking during pregnancy

remained consistent between 2005

and 2008 for all jurisdictions. However,

percentages in HPECHU were lower

than both KFLA and LGLDHU

(Figures X39-X41).

No Smoking Smoked during Pregnancy

KFL&A, 2005

KFL&A, 2007

KFL&A, 2008

KFL&A, 2006

80%

70%

60%

50%

40%

30%

20%

10%

0%

77.8

20.3 22.2 23.3 20.6

79.7 76.7 79.4

Figure X40: Mother’s Smoking Status

during Pregnancy for KFL&A, 2005-2008


HPEHU, 2005

HPEHU, 2007

HPEHU, 2008

HPEHU, 2006

80%

70%

60%

50%

40%

30%

20%

10%

0%

76.8

21.223.2 22.0 22.1

78.8 78.0 77.9


during Pregnancy for LGLHU, 2005-2008


during Pregnancy for HPECHU, 2005-2008

80%

70%

60%

50%

40%

30%

20%

10%

0%

68.3

28.1 31.7 31.1 29.8

71.9 69.0 70.2

HPEHU, 2007

HPEHU, 2005

HPEHU, 2006

HPEHU, 2008

Smoking during pregnancy and nursing can have many ill effects in a baby’s health . In addition, when pregnant women are exposed to second-hand smoke, harmful chemicals are passed on to the baby. Breast milk will also contain chemicals when nursing mothers breathe in tobacco smoke.


21

Intention to Breastfeed

Key Findings:

• The percentages of mothers who reported

the intention to breastfeed were fairly

consistent from 2005 and 2008 for all

jurisdictions. However, percentages in

HPECHU were lower than both KFLA

and LGLDHU (Figures X42).

• When broken down by age group,

similar patterns exist between jurisdictions.

Women aged 24 years and under were less

likely to have an intention to breastfeed than

women in age groups above the age

of 24 years (Figures X43).

• There was an inverse relationship between

the proportion of mothers reporting the

intention to breastfeed and the number

of children they had given birth to.

This pattern was similar across all

jurisdictions (Figures X44).

X42: Proportion of Mother’s who Intend to Breastfeed, 2005-2008

HPECHU KFL&A LGLDHU

2005 2007 20082006

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

77.884.4 83.6

81.6 81.583.7

87.2

84.877.2 78.3 78.5

85.6

X43: Proportion of Mother’s who Intend to Breastfeed by Age Group, 2005-2008

HPECHU KFL&A LGLDHU

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

72.968.1

78.681.0 78.5 76.6

86.4 85.086.187.4

86.287.2

91.786.0

69.973.0

83.879.8

15-19

20-24

25-29

30-34

35-39

40-44

X44: Proportion of mother’s who intend

to breastfeed by number of Babies, 2005-2008

HPECHU KFL&A LGLDHU

First Baby

Third Baby

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

75.5

82.079.4

76.2

89.1

81.883.0

71.1

87.8

Second Baby

22

Child Welfare

Lennox & Addington Interval House

Kingston Interval House – Family Violence

Three Oaks Foundation – Violence Against Women

South East Region Total

Leeds & Grenville Interval House – Family Violence

Lanark County Interval House – Violence Against Women

South East Region Average

Child Welfare Total Children Served (Children in Care)


Leeds & Grenville

Lanark


Lennox & Addington

Frontenac

Hastings

Prince Edward

2,500

2,000

1,500

1,000

500

0

2004 – 2005 2005 – 2006 2006 – 2007 2007 – 2008 2008 – 2009

25,000

20,000

15,000

10,000

5,000

0

2004 – 2005 2005 – 2006 2006 – 2007 2007 – 2008 2008 – 2009

Interval House Days of Residential CareViolence Against Women

23

2004 – 2005 2005 – 2006 2006 – 2007 2007 – 2008 2008 – 2009

Number of Individuals served by

Children’s Mental Health Agencies by County

Leeds & Grenville

LanarkFrontenac, Lennox & Addington

Hastings & Prince Edward

3,000

2,500

2,000

1,500

1,000

500

0

2004 – 2005 2005 – 2006 2006 – 2007 2007 – 2008 2008 – 2009

Number of Children Receiving Intensive Behavioral Intervention

90

80

70

60

50

40

30

20

10

0

Frontenac, Lennox & Addington

Hastings & Prince Edward

Leeds & Grenville

Lanark



2004 – 2005 2005 – 2006 2006 – 2007 2007 – 2008 2008 – 2009

Children Served by the Autism Intervention

Program in the South East Region

7,500

7,000

6,500

6,000

5,500

5,000

4,500

4,000

3,500

3,000

2,500

2,000

1,500

1,000

500

0

Mental Health

24

Ontario Early Years Centres

Children’s Resouces on Wheels Inc. OEYC, Lanark

United Counties of Leeds and Grenville OEYC, L&G

Northern Frontenac Community Services Corporation, OEYC/ The Child Centre, Frontenac

Lennox & Addington Resouces for Children OEYC, L&A

North Hastings Children’s Services, North Hastings

Family Space Quinte, Hastings, Prince Edward

Limestone Advisory for Child Care Programs, Kingston and the Islands


Number of Children Served by Fiscal Year

2004 2005 2006 2007 2008

12,000

11,500

11,000

10,500

10,000

9,500

9,000

8,500

8,000

7,500

7,000

6,500

6,000

5,500

5,000

4,500

4,000

3,500

3,000

2,500

2,000

1,500

1,000

500

0

Number of Parents/Caregivers

Served by Fiscal Year

2004 2005 2006 2007 2008

12,000

11,500

11,000

10,500

10,000

9,500

9,000

8,500

8,000

7,500

7,000

6,500

6,000

5,500

5,000

4,500

4,000

3,500

3,000

2,500

2,000

1,500

1,000

500

0

25

Carlow

Mayo

Tudor

&

Cashel

Faraday

Bancroft

North Frontenac

Lanark Highlands

Central Frontenac

Stone Mills

Loyalist

Kingston

South Frontenac

Madoc

Tweed

Quinte West

Prince Edward

Mississippi

Mills

North Grenville

Merrickville

Wolford

Athens

Front of

Yonge

Tyendinaga

Belleville

Montague

Marmora

Augusta

Beckwith

Drummond/

North Elmsley

Tay Valley

Rideau Lakes

Leeds & the

Thousand Islands

Elizabethtown

Edwarsburgh

/Cardinal

Brockville

Greater

Napanee

Frontenac Islands

Wolleston

Central

HastingsStirling

Rawdon

Limerick

Hastings

Highlands

Addington

Highlands

South East Regional Map

26

Glossary of TermsCMH Children’s Mental Health

DS Developmental Services

CW Child Welfare

HU Health Units

PSL/IH Preschool Speech and Language / Infant Hearing

Best Start Best Start

SB School Boards

CMSM Consolidated Municipal Service Managers

VAW Violence Against Women

CC Child Care

OEYC Ontario Early Years Centres

CDC Child Development Centres

SRI Social Risk Index

EDI Early Development Instrument

MCI Multiple Challenges Index

EQAO Education Quality and Accountability Offi ce

IBI Intensive Behavioural Intervention

EDI Early Development Instrument

SRL School Readiness to Learn

H-PE Hastings-Prince Edward

L&G Leeds & Grenville

KFL&A Kingston, Frontenac and Lennox & Addington

References1 Provincial Health Indicators Work group.

“Core Indicators for Public Health in Ontario.”

Retrieved March 16, 2007. www.apheo.ca March 2, 2007.

2 World Health Organization and UNICEF. “Low Birthweight:

Country, Regional and Global Estimates.” 2004. Retrieved

March 16, 2007. http://www.who. int/reproductive-health/

publications/low_birthweight/low_birthweight_estimates.pdf.

3 Public Health Agency of Canada. 1999. “Measuring Up: A

Health Surveillance Update on Canadian Children and Youth.”

4 Best Start. “2002 Pre-term Birth: Making a Difference.”

Retrieved March 16, 2007.

http://www.beststart.org/resources/rep_health/index.html.

5 Health Canada. “Nutrition for a Healthy Pregnancy:

National Guidelines for the Childbearing Years.” 1999.

Ottawa: Minister of Public Works and Government Services.

6 Health Canada. “Exclusive Breastfeeding Duration - 2004

Health Canada Recommendation,” 2004. Retrieved March

16, 2007. http://www.hc-sc.gc.ca/fn- an/nutrition/child-

enfant/infant-nourisson/excl_bf_dur-dur_am_excl_e.html.

7 World Health Organization. “Global Strategy for Infant and

Young Child Feeding, The Optimal Duration of Exclusive

Breastfeeding.” 2001. Geneva. Retrieved March 16, 2007.

http://www.who.int/gb/ebwha/pdf_fi les/WHA54/ea54id4.pdf.

8 U.S. Department of Health and Human Services. “The Health

Consequences of Smoking: Nicotine Addition.” A Report

of the Surgeon General. 1988. Rockville, Maryland: U.S.

Department of Health and Human Services, Public Health

Service, Centers for Disease Control, Center for Health

Promotion and Education, Offi ce on Smoking and Health.

9 U.S Department of Health and Human Services. “Reducing

the Health Consequences of Smoking: 25 years of progress.”

A Report of the Sturgeon General. 1989. Rockville, Maryland:

U.S Department of Health and Human Services, Public Health

Service, Centers for Disease Control, Center for Chronic

Disease and Prevention and Health Promotion, Offi ce on

Smoking and Health.

10 Raloft, J. “Prenatal nicotine: A role in SIDS?” Science News

2003;163:270.

11 Stevens-Simon C, White M.M. “Adolescent pregnancy.”

Pediatr.Ann. 1991;20:322-31.

12 Reichman, N.E., Pagnini, D.L. “Maternal age and birth

outcomes: data from New Jersey.” Fam.Plann.Perspect.

1997;29:268-72, 295.

13 Fraser A.M., Brockert JE, Ward RH. “Association of young

maternal age with adverse reproductive outcomes.”

N.Engl..J.Med. 1995; 332:1113-7.

14 Jacono J.J. et al. “Teenage pregnancy: a reconsideration.”

Can.J.Public Health 1992;83:196-9.

15 Public Health Agency of Canada. Canada’s Physical Active

Guide to Health Active Living. February, 2007. Retrieved

March 16, 2007.

http://www.phac- aspc.gc.ca.pau-uap/paguide/.

16 Canadian Fitness and Lifestyle Research Institute.

Retrieved March 16, 2007. www.cfri.ca.

17 Ontario Ministry of Health. Dental Indices Software Program

Manual. December 9, 1997. Retrieved March 16, 2007.

18 Ministry of Health, Dental Indices Survey (DIS) Protocol,

Child Health Program. January 1, 1998. Retrieved March 16,

2007. Available at: http://www.phb.ca/Documents/Protocols/

Dental%20Indices%20Survey%20Protocol.doc.

27

417 Bagot Street, Kingston, ON K7K 3C1

Tel: (613) 542-2674

www.unitedwaykfl a.ca

Call 211 for free, confi dential

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